Trends in Cannabis and Tobacco Use by Racial and Ethnic Groups Among U.S. Youth: 1991-2021.

OBJECTIVES

To examine the temporal trends of current cannabis use only, tobacco use only, and co-use of these two substances by racial and ethnic adolescent groups.

METHODS

Data were drawn from the 1991-2021 Youth Risk Behavior Surveys (YRBS) (n = 234,572) to examine changes in cannabis and tobacco use among American Indian or Alaskan Native (AI/AN), Asian, Black, Hispanic/Latino (H/L), Native Hawaiian or other Pacific Islander only (NH/PI), White, and multi-racial high school students. Multivariable logistic regressions were performed to examine racial and ethnic disparities in current cannabis and tobacco use across four equal interval periods (i.e., 1991-1997, 1999-2005, 2007-2013, 2015-2021).

RESULTS

During 2015-2021, Black (12.6% (95% CI11.3-13.9%)), H/L (9.0% (7.9-10.1%)), and multi-racial (8.8% (7.3-10.3%)) adolescent reported higher prevalences of cannabis-only use than whites (4.9% (4.4-5.5%)), while AI/AN (20.1% (15.1-25.2%)) reported higher prevalence of tobacco and cannabis co-use than whites (13.4% (12.2-14.5%)). The prevalence of cannabis-only use was highest among Black adolescents and increased from 10.8% (9.3-12.2%) in 1991-1997 to 12.6% (11.3-13.9%) in 2015-2021 (linear trend, p = .004), while AI/AN adolescents maintained the highest prevalences of cannabis and tobacco co-use across last three decades (p = .17) with 23.0% (16.6-29.4%) in 1991-1997 to 20.1% (15.1-25.2%) in 2015-2021. As compared to their White counterparts, Black and H/L adolescents consistently exhibited higher prevalences of reporting cannabis-only use, but lower tobacco-only use; AI/AN adolescents had higher cannabis-tobacco co-use and Asian adolescents reported lower cannabis and tobacco use.

CONCLUSIONS

These disparities highlight the importance of public health programs addressing diverse substance use behaviors across racial and ethnic groups. There is a need for early prevention and tailored interventions to reduce cannabis-only use among Black adolescents and tobacco-cannabis co-use among American Indian/Alaskan Native adolescents.