Prevalence, Patterns, and Correlates of Cannabis–Cigarette Co-Use: Findings From a Multi-State Rapid-Response Survey in the U.S., 2023–2024

INTRODUCTION: Cannabis use prevalence is significantly higher among people who smoke cigarettes, and there may be additive health risks associated with cannabis and cigarette co-use. Little is known about co-use, especially in states with already elevated cigarette smoking rates (high-tobacco-burden states). METHODS: Data were from an online rapid-response survey of a probability sample of 9,100 adults (aged 18-65 years) in 13 high-tobacco-burden states collected in 2023 and 2024 and analyzed in 2025. The weighted prevalence of co-use was calculated, and weighted logistic regressions examined sociodemographic correlates and patterns of cannabis and cigarette use. RESULTS: The prevalence of co-use was 8.7% in high-tobacco-burden states, with 45.0% of individuals who currently smoked cigarettes reporting concurrent cannabis use versus 24.5% and 12.3% of individuals who formerly and never smoked, respectively. Individuals who co-used reported smoking 12.8 cigarettes per day on average and using cannabis 18.9 days on average in the past 30 days, similar to cigarettes per day among individuals who exclusively smoked (13.2 cigarettes per day) or to cannabis use among individuals who exclusively used cannabis (18.2 days). Individuals who currently smoked cigarettes were more likely to co-use if they identified as male, were younger (aged 18-24 years), were non-Hispanic Black, were single, or reported a mental or physical disability. CONCLUSIONS: Cannabis use was significantly higher among adults who currently smoked cigarettes than among those who never smoked. Increased monitoring of cannabis and cigarette co-use will be an important component of tobacco control efforts in high-tobacco-burden states, especially among at-risk population subgroups.