Cannabis liberalization is only associated with increased blunt use if states lack strong tobacco control

Background: Co-use of tobacco and cannabis has long been an issue for prevention and intervention efforts targeting these substances. Blunt use—cannabis inside a cigar wrapper—has been a consistent mode of cannabis consumption in the U.S. for several decades. During these same decades, both tobacco control and cannabis policies have changed rapidly across U.S. states. This paper examines the influence of these policy changes on blunt use among young people.

Methods: Combining U.S. state-level tobacco control and cannabis policy data with the restricted-access youth cohort of the Population Assessment of Tobacco and Health (PATH) Study, we use multilevel logistic regression models to examine the impact of these policies on past-year blunt use. 

Results: While regression results show a main effect whereby legal cannabis in the form of both medical and recreational policy is associated with higher odds of blunt use among youth, interaction effects demonstrate that this association only emerges in states lacking a comprehensive tobacco smoking ban. In states with smoking bans, there were no significant associations between cannabis policy and odds of blunt use.

Conclusions: Denormalization through smoking bans may mitigate the effects of cannabis policy liberalization on blunt use. Smoking bans represent a possible cost-effective mechanism to curb known health effects of the co-use of tobacco and cannabis. Places with liberalized cannabis policies may benefit from greater prevention efforts for young people specifically focused on co-use of tobacco and cannabis, especially in locales that do not have strong tobacco control.