Blunt and non-blunt cannabis use associated with cigarette, e-cigarette, and cigar initiation: Findings from the population assessment of tobacco and health (PATH) study.

Introduction:
This text provides an analysis of the relationship between blunt smoking and the initiation of other tobacco products, such as cigarettes, e-cigarettes, and cigars. The study uses data from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study of non-institutionalized adults and youth in the US. The text presents the results of discrete-time survival analyses that estimate the hazard of initiating different tobacco products associated with past-year blunt and non-blunt cannabis use.

Key Points:

* Blunt smoking is the practice of replacing tobacco in a cigar or cigarillo with marijuana.
* The PATH Study defines blunts as "Sometimes people take tobacco out of a cigar, cigarillo or filtered cigar and replace it with marijuana. This is sometimes called a ’blunt ’".
* The study found that people who smoked blunts in the past year were at an increased risk of starting cigarettes, e-cigarettes, and any cigar compared to those who used neither blunts nor cannabis.
* The odds of initiating e-cigarettes and any cigar differed between blunts versus non-blunt cannabis.
* The study estimated that 2.6 million people in the US aged 12 years and older started smoking cigarettes over the study period, with 13% (335,946) of these new initiates might be explained by past-year blunt smoking and 9.4% (242,878) by non-blunt cannabis.
* The study also found that past-year blunt smoking may be significantly related to starting to smoke cigarillos.
* The study controlled for possible confounders, such as sociodemographics, current use of other tobacco, alcohol, and drugs, living with a tobacco user, and internalizing and externalizing problems.

Main Message:
The study highlights the relationship between blunt smoking and the initiation of other tobacco products, such as cigarettes, e-cigarettes, and cigars. The results suggest that people who smoke blunts are at an increased risk of starting to use these tobacco products, with the association being strongest for cigarillos. The study's findings have implications for the co-marketing of tobacco products and cannabis within an environment of liberalized cannabis laws and highlight the need for further study to determine if the added risk is due to the co-administration of tobacco and cannabis from blunts or other social factors.

Fairman BJ, Kimmel HL, Blanco C, Compton WM. Blunt and non-blunt cannabis use associated with cigarette, e-cigarette, and cigar initiation: Findings from the population assessment of tobacco and health (PATH) study. Drug and alcohol dependence. 2023;246:109837. doi:10.1016/j.drugalcdep.2023.109837