Associations between tobacco and cannabis use and anxiety and depression among adults in the United States: Findings from the COVID-19 citizen science study

Nhung Nguyen, Department of Medicine, Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California, San Francisco, San Francisco, California, United States of America.
Noah D. Peyser, Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America.
Jeffrey E. Olgin, Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America.
Mark J. Pletcher, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America.
Alexis L. Beatty, Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America.Follow
Madelaine F. Modrow, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America.
Thomas W. Carton, Louisiana Public Health Institute, New Orleans, Louisiana, United States of America.Follow
Rasha Khatib, Advocate Aurora HealthFollow
Djeneba Audrey Djibo, CVS Health, Northbrook, Illinois, United States of America.
Pamela M. Ling, Department of Medicine, Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California, San Francisco, San Francisco, California, United States of America.
Gregory M. Marcus, Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, California, United States of America.

Abstract

Background:Little is known about whether people who use both tobacco and cannabis (co-use) are more or less likely to have mental health disorders than single substance users or non-users. We aimed to examine associations between use of tobacco and/or cannabis with anxiety and depression.

Methods:We analyzed data from the COVID-19 Citizen Science Study, a digital cohort study, collected via online surveys during 2020-2022 from a convenience sample of 53,843 US adults (≥ 18 years old) nationwide. Past 30-day use of tobacco and cannabis was self-reported at baseline and categorized into four exclusive patterns: tobacco-only use, cannabis-only use, co-use of both substances, and non-use. Anxiety and depression were repeatedly measured in monthly surveys. To account for multiple assessments of mental health outcomes within a participant, we used Generalized Estimating Equations to examine associations between the patterns of tobacco and cannabis use with each outcome.

Results:In the total sample (mean age 51.0 years old, 67.9% female), 4.9% reported tobacco-only use, 6.9% cannabis-only use, 1.6% co-use, and 86.6% non-use. Proportions of reporting anxiety and depression were highest for the co-use group (26.5% and 28.3%, respectively) and lowest for the non-use group (10.6% and 11.2%, respectively). Compared to non-use, the adjusted odds of mental health disorders were highest for co-use (Anxiety: OR = 1.89, 95%CI = 1.64-2.18; Depression: OR = 1.77, 95%CI = 1.46-2.16), followed by cannabis-only use, and tobacco-only use. Compared to tobacco-only use, co-use (OR = 1.35, 95%CI = 1.08-1.69) and cannabis-only use (OR = 1.17, 95%CI = 1.00-1.37) were associated with higher adjusted odds for anxiety, but not for depression. Daily use (vs. non-daily use) of cigarettes, e-cigarettes, and cannabis were associated with higher adjusted odds for anxiety and depression.

Conclusions:Use of tobacco and/or cannabis, particularly co-use of both substances, were associated with poor mental health. Integrating mental health support with tobacco and cannabis cessation may address this co-morbidity.

Document Type

Article

PubMed ID

37703257

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