Temporal Trends in Alcohol, Cannabis, and Simultaneous Use Among 12th-grade U.S. Adolescents from 2000 to 2020: Differences by Sex, Parental Education, and Race and Ethnicity

Overview

Journal Alcohol Clin Exp Res

Specialty Psychiatry

Date 2022 Sep 20

PMID 36125706

Authors

Katherine M Keyes

Navdep Kaur

Noah T Kreski

Qixuan Chen

Silvia S Martins

Deborah Hasin

Mark Olfson

Pia M Mauro

Affiliations

Soon will be listed here.

Abstract

Background: Simultaneous use of alcohol and cannabis to enhance each other's effect can cause potential harm. Time trends are diverging in adolescent use of alcohol, which is declining, and cannabis, which is increasing among certain subgroups. However, little is known about trends in their simultaneous and non-simultaneous use. Racial and socioeconomic disparities are emerging in cannabis use, which may portend consequences to public health.

Methods: The 2000 to 2020 Monitoring the Future surveys included approximately 38,000 U.S. 12th-grade students with information on simultaneous use and pertinent demographic factors. A 5-level alcohol/cannabis measure included past-year simultaneous use (i.e., alcohol and cannabis use at the same time), non-simultaneous alcohol and cannabis use, alcohol-use-only, cannabis-use-only, and no use. Multinomial logistic regressions estimated associations (adjusted relative risk ratios; aRRR) with time period (2000 to 2004, 2005 to 2009, 2010 to 2014, 2015 to 2020). Models were adjusted and included interactions with sex, race/ethnicity, and parental education.

Results: Between 2000 and 2020, simultaneous alcohol/cannabis use among 12th graders decreased from 24.4% to 18.7%. From 2015 to 2020 compared to 2000 to 2004, the odds of simultaneous use (adjusted relative risk ratio (aRRR) vs. no use = 0.57, 95% CI [0.50, 0.66]) and alcohol-use-only (aRRR = 0.55, 95% CI [0.49, 0.61]) decreased, while cannabis-use-only odds increased (aRRR = 2.59, 95% CI [1.87, 3.59]). Notably, the prevalence of cannabis-use-only more than doubled from 2011 to 2019. The odds of simultaneous use, alcohol-use-only, and non-simultaneous use of alcohol and cannabis declined more rapidly among males than females, whereas the odds for cannabis-use-only increased faster for females than males. Increases in cannabis-use-only were faster for non-white adolescents.

Conclusion: Simultaneous use of alcohol and cannabis is declining among U.S. adolescents, but the decline is slower among females than males. Declines in simultaneous use are largely concomitant with historical declines in alcohol use, indicating that a continued focus on reducing alcohol use among adolescents and young adults has extended benefits to other adolescent substance use. However, cannabis use without any reported past-year alcohol use more than doubled in the last decade, a concerning trend.

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References

Patrick M, Terry-McElrath Y, Lee C, Schulenberg J . Simultaneous alcohol and marijuana use among underage young adults in the United States. Addict Behav. 2018; 88:77-81. PMC: 6447064. DOI: 10.1016/j.addbeh.2018.08.015. View

Hartman R, Brown T, Milavetz G, Spurgin A, Pierce R, Gorelick D . Cannabis effects on driving lateral control with and without alcohol. Drug Alcohol Depend. 2015; 154:25-37. PMC: 4536116. DOI: 10.1016/j.drugalcdep.2015.06.015. View

Medina K, Schweinsburg A, Cohen-Zion M, Nagel B, Tapert S . Effects of alcohol and combined marijuana and alcohol use during adolescence on hippocampal volume and asymmetry. Neurotoxicol Teratol. 2006; 29(1):141-52. PMC: 1821342. DOI: 10.1016/j.ntt.2006.10.010. View

Jager J, Keyes K, Son D, Patrick M, Platt J, Schulenberg J . Age 18-30 trajectories of binge drinking frequency and prevalence across the past 30 years for men and women: Delineating when and why historical trends reversed across age. Dev Psychopathol. 2022; 35(3):1308-1322. PMC: 9308836. DOI: 10.1017/S0954579421001218. View

Kuhn C . Emergence of sex differences in the development of substance use and abuse during adolescence. Pharmacol Ther. 2015; 153:55-78. PMC: 4527891. DOI: 10.1016/j.pharmthera.2015.06.003. View

Viveros M, Marco E, File S . Nicotine and cannabinoids: parallels, contrasts and interactions. Neurosci Biobehav Rev. 2006; 30(8):1161-81. DOI: 10.1016/j.neubiorev.2006.08.002. View

Gase L, Glenn B, Gomez L, Kuo T, Inkelas M, Ponce N . Understanding Racial and Ethnic Disparities in Arrest: The Role of Individual, Home, School, and Community Characteristics. Race Soc Probl. 2017; 8(4):296-312. PMC: 5509345. DOI: 10.1007/s12552-016-9183-8. View

Arterberry B, Goldstick J, Walton M, Cunningham R, Blow F, Bonar E . Alcohol and cannabis motives: Differences in daily motive endorsement on alcohol, cannabis, and alcohol/cannabis co-use days in a cannabis-using sample. Addict Res Theory. 2021; 29(2):111-116. PMC: 8262404. DOI: 10.1080/16066359.2020.1787390. View

Terry-McElrath Y, Patrick M . Simultaneous Alcohol and Marijuana Use Among Young Adult Drinkers: Age-Specific Changes in Prevalence from 1977 to 2016. Alcohol Clin Exp Res. 2018; 42(11):2224-2233. PMC: 6214706. DOI: 10.1111/acer.13879. View

10.

Smith D, Miller C, OConnor R, Kozlowski L, Wadsworth E, Fix B . Modes of delivery in concurrent nicotine and cannabis use ("co-use") among youth: Findings from the International Tobacco Control (ITC) Survey. Subst Abus. 2020; 42(3):339-347. PMC: 7365746. DOI: 10.1080/08897077.2019.1709603. View

11.

Kann L, Brener N, Warren C, Collins J, Giovino G . An assessment of the effect of data collection setting on the prevalence of health risk behaviors among adolescents. J Adolesc Health. 2002; 31(4):327-35. DOI: 10.1016/s1054-139x(02)00343-9. View

12.

Yu B, Chen X, Chen X, Yan H . Marijuana legalization and historical trends in marijuana use among US residents aged 12-25: results from the 1979-2016 National Survey on drug use and health. BMC Public Health. 2020; 20(1):156. PMC: 6998313. DOI: 10.1186/s12889-020-8253-4. View

13.

Hartman R, Huestis M . Cannabis effects on driving skills. Clin Chem. 2012; 59(3):478-92. PMC: 3836260. DOI: 10.1373/clinchem.2012.194381. View

14.

Palamar J . Increases in Frequent Vaping of Cannabis Among High School Seniors in the United States, 2018-2019. J Adolesc Health. 2021; 69(1):153-156. PMC: 8238831. DOI: 10.1016/j.jadohealth.2021.03.034. View

15.

Purcell J, Orihuela C, Elliott M, Tortolero Emery S, Schuster M, Mrug S . Examining Sex and Racial/Ethnic Differences in Co-use of Alcohol, Cannabis, and Cigarettes in a Community Sample of Adolescents. Subst Use Misuse. 2020; 56(1):101-110. PMC: 11619460. DOI: 10.1080/10826084.2020.1843056. View

16.

Miech R, Patrick M, OMalley P, Johnston L, Bachman J . Trends in Reported Marijuana Vaping Among US Adolescents, 2017-2019. JAMA. 2019; 323(5):475-476. PMC: 6990699. DOI: 10.1001/jama.2019.20185. View

17.

D Goncalves P, Gutkind S, Segura L, Castaldelli-Maia J, Martins S, Mauro P . Simultaneous Alcohol/Cannabis Use and Driving Under the Influence in the U.S. Am J Prev Med. 2022; 62(5):661-669. PMC: 9038028. DOI: 10.1016/j.amepre.2021.11.009. View

18.

Banks D, Rowe A, Mpofu P, Zapolski T . Trends in typologies of concurrent alcohol, marijuana, and cigarette use among US adolescents: An ecological examination by sex and race/ethnicity. Drug Alcohol Depend. 2017; 179:71-77. PMC: 5599350. DOI: 10.1016/j.drugalcdep.2017.06.026. View

19.

Keyes K, Hamilton A, Patrick M, Schulenberg J . Diverging Trends in the Relationship Between Binge Drinking and Depressive Symptoms Among Adolescents in the U.S. From 1991 Through 2018. J Adolesc Health. 2019; 66(5):529-535. PMC: 7183904. DOI: 10.1016/j.jadohealth.2019.08.026. View

20.

Cooper Z, Haney M . Comparison of subjective, pharmacokinetic, and physiological effects of marijuana smoked as joints and blunts. Drug Alcohol Depend. 2009; 103(3):107-13. PMC: 2776770. DOI: 10.1016/j.drugalcdep.2009.01.023. View