Different Lengths of Gestational Exposure to Secondhand Smoke or e-Cigarette Vapor Induce the Development of Placental Disease Symptoms.

Exposure to cigarette smoke is known to induce disease during pregnancy. Recent evidence showed that exposure to secondhand smoke (SHS) negatively impacts fetal and placental weights, leading to the development of intrauterine growth restriction (IUGR). Electronic cigarettes (eCigs) represent a phenomenon that has recently emerged, and their use is also steadily rising. Even so, the effects of SHS or eCigs during gestation remain limited. In the present study, we wanted to characterize the effects of SHS or eCig exposure at two different important gestational points during mouse pregnancy. C57/Bl6 mice were exposed to SHS or eCigs via a nose-only delivery system for 4 days (from 14.5 to 17.5 gestational days (dGA) or for 6 days (from 12.5 dGA to 17.5 dGA)). At the time of necropsy (18.5 dGA), placental and fetal weights were recorded, maternal blood pressure was determined, and a dipstick test to measure proteinuria was performed. Placental tissues were collected, and inflammatory molecules in the placenta were identified. Treatment with SHS showed the following: (1) a significant decrease in placental and fetal weights following four days of exposure, (2) higher systolic and diastolic blood pressure following six days of exposure, and (3) increased proteinuria after six days of exposure. Treatment with eCigs showed the following: (1) a significant decrease in placental weight and fetal weight following four or six days of exposure, (2) higher systolic and diastolic blood pressure following six days of exposure, and (3) increased proteinuria after six days of exposure. We also observed different inflammatory markers associated with the development of IUGR or PE. We conclude that the detrimental effects of SHS or eCig treatment coincide with the length of maternal exposure. These results could be beneficial in understanding the long-term effects of SHS or eCig exposure in the development of placental diseases.

A Randomized Clinical Trial of a Quitline Vaping Cessation Intervention: Baseline Characteristics of Young Adult Exclusive E-Cigarette Users Seeking Treatment.

Despite interest in quitting vaping among young adults (YAs), little is known about characteristics of e-cigarette (EC) users seeking treatment. In this study, YAs aged 18-24 living in the United States interested in vaping cessation treatment were recruited to complete an online survey regarding demographics and EC use. Primary eligibility criteria were EC use on at least 20 days per month (no other tobacco use), and interest in quitting in the next month. We report descriptive statistics for those who did and did not complete a mandatory coaching call (n = 981). In this sample, most EC users reported high nicotine dependence, a history of unsuccessful quit attempts (including 29.4% with previous NRT use), along with stress, anxiety, and depression. There were few meaningful differences in demographics, EC use behaviors, or behavioral health factors between those who engaged with a phone coaching call (fully enrolled in study; n = 508), and those who did not (n = 473). YAs demonstrated interest in vaping cessation support, but there were no clear characteristics for the half who did not complete a coaching call. Vaping cessation program designers should consider tailoring for the self-reported behavioral health concerns present in this population.

Depression screening outcomes among adolescents, young adults, and adults reporting past 30-day tobacco and cannabis use.

BACKGROUND: Few studies examine the relationship between depression and use of specific tobacco and/or cannabis products among adolescents, young adults, and adults. We determined whether the odds of depression are greater among those who used specific tobacco and/or cannabis products and among co-users of tobacco and cannabis. METHOD: Cross-sectional online survey of a national convenience sample of 13-40-year-olds (N = 6,038). The survey included depression screening and past 30-day use of specific tobacco and cannabis products (cigarettes; e-cigarettes, vaped cannabis, little cigars, cigarillos, cigars, hookah, chewing tobacco, smoked cannabis, edible cannabis, blunts). Analyses correspond to the total sample, and 13-17-, 18-24-, and 25-40-year-olds. RESULTS: Among 5,281 individuals who responded to the depression screener and nine product use questions, 1,803 (34.1 %) reported co-use of at least one tobacco product and one cannabis product in the past 30 days. Past 30-day co-use was associated with higher likelihood of screening positive for depression compared to past 30-day use of tobacco-only (aOR = 1.32, 1.06-1.65; 0.006) or cannabis-only (aOR = 1.94, 1.28-2.94; <0.001). Screening positive for depression was more likely among those who reported past 30-day use of e-cigarettes (aOR = 1.56; 1.35-1.80; <0.001), cigarettes (aOR = 1.24, 1.04-1.48; 0.016), chewed tobacco (aOR = 1.91, 1.51-2.42; <0.001), and blunts (aOR = 1.22, 1.00-1.48; 0.053) compared to those who did not report past 30-day use of these products. Among the 2,223 individuals who screened positive for depression, the most used two-product combination was nicotine e-cigarettes and smoked cannabis (614 individuals, 27.6 %). CONCLUSIONS: Screening positive for depression was more likely among past 30-day co-users versus past 30-day users of tobacco-only or cannabis-only. Findings suggest that prevention programs for depression and substance use address tobacco and cannabis co-use.

Sensitivity of Mouse Lung Nuclear Receptors to Electronic Cigarette Aerosols and Influence of Sex Differences: A Pilot Study.

The emerging concern about chemicals in electronic cigarettes, even those without nicotine, demands the development of advanced criteria for their exposure and risk assessment. This study aims to highlight the sensitivity of lung nuclear receptors (NRs) to electronic cigarette e-liquids, independent of nicotine presence, and the influence of the sex variable on these effects. Adult male and female C57BL/6J mice were exposed to electronic cigarettes with 0%, 3%, and 6% nicotine daily (70 mL, 3.3 s, 1 puff per min/30 min) for 14 days, using the inExpose full body chamber (SCIREQ). Following exposure, lung tissues were harvested, and RNA extracted. The expression of 84 NRs was determined using the RT2 profiler mRNA array (Qiagen). Results exhibit a high sensitivity to e-liquid exposure irrespective of the presence of nicotine, with differential expression of NRs, including one (females) and twenty-four (males) in 0% nicotine groups compared to non-exposed control mice. However, nicotine-dependent results were also significant with seven NRs (females), fifty-three NRs (males) in 3% and twenty-three NRs (female) twenty-nine NRs (male) in 6% nicotine groups, compared to 0% nicotine mice. Sex-specific changes were significant, but sex-related differences were not observed. The study provides a strong rationale for further investigation.

Exploring Native Hawaiian and Pacific Islander Youths' E-Cigarette Resistance Strategies: Implications for Tobacco Product Use Prevention.

This study examined the e-cigarette and vaping resistance strategies used by Native Hawaiian and Pacific Islander (NHPI) youths in rural Hawai'i. Focus groups (N = 17) were conducted in eight geographically dispersed elementary, middle/intermediate, and multilevel schools in low-income communities on Hawai'i Island. Sixty-nine youths (67% NHPI, Mage = 12.5 years) participated in this study. The resistance strategies discussed across the greatest number of groups were "refuse" (saying no), "explain" (providing reasons for vaping refusal), "avoid" (avoiding people or places where e-cigarettes were used), and "leave" (walking away from a situation where e-cigarettes were being used). Participants described the challenges in using these strategies within contexts characterized by widespread peer and family vaping and strong social demands to use e-cigarettes. The findings suggest the need for multi-level interventions based on youths' resistance strategies to meaningfully reduce youth vaping use in rural and/or NHPI communities.

Electronic Cigarette Use and Anxiety Among College Students: "Trapped in That Cycle".

INTRODUCTION: Electronic cigarette use is the most prevalent form of tobacco among young college adults between 18 and 25 years old. In addition, during the young adult years, mental health issues surface, such as anxiety. As a result of these factors, it is imperative to describe the experience of electronic cigarettes among college students to better understand the cycle of addiction among electronic cigarette users. OBJECTIVE: This study aims to explore and describe the experience of electronic cigarette use among college students who report feelings of anxiety. METHODS: A qualitative descriptive study design with the Roy Adaptation Model as the theoretical framework was used to describe the experience. The setting was at one medium-sized private university on the east coast of the United States. Twenty participants met the study inclusion criteria of traditional undergraduate students aged 18-25 years. Data were collected using a demographic questionnaire, a smoking status questionnaire, a self-report feelings of anxiety questionnaire, and a semistructured interview guide. RESULTS: Data analysis synthesized three themes: the perfect storm, the power of ripping the nic, and trapped in that cycle. It was found through interviews that feelings of anxiety and the vape culture, along with the college experience, led to the powerful draw to electronic cigarette use among this population. CONCLUSION: This study reflects findings that the college life experience, the vape culture, and the feelings of anxiety contribute to electronic cigarette use and, finally, lead to intense addiction.

The "Gateway" hypothesis: evaluation of evidence and alternative explanations.

BACKGROUND: Electronic nicotine delivery systems (ENDS) offer a substantial harm reduction opportunity for adults who smoke and are unlikely to quit. However, a major concern about ENDS is their use by non-smoking youth, and particularly whether ENDS are acting as a "gateway" that leads youth to later start smoking cigarettes. However, evidence for the gateway hypothesis can be interpreted in alternative ways, e.g. that youth who have certain characteristics were already predisposed to use both ENDS and cigarettes ("common liability" explanation). AIMS: This commentary provides an evaluation of the gateway hypothesis that is accessible by a lay audience. This paper first reviews and evaluates the evidence interpreted as supporting the gateway hypothesis. Important alternative explanations (i.e., common liability) are discussed, as are different types of evidence (i.e., population-level trends) that can help differentiate between these competing explanations. OVERVIEW: Evidence for the gateway hypothesis is based on the finding that youth who use ENDS are more likely to also smoke cigarettes. However, this evidence suffers from an important flaw: these studies fail to fully account for some youths' pre-existing tendency to use products containing nicotine, and inappropriately interpret the results as ENDS use causing some youth to smoke. Common liability studies suggest that ENDS use does not, in and of itself, directly cause youth to later smoke cigarettes, beyond their pre-existing tendency to use products containing nicotine. Population-level trends show that youth cigarette smoking declined faster after ENDS use became common, which contradicts the central prediction of the gateway hypothesis (i.e. that youth smoking would be more common following ENDS uptake, than otherwise be expected). CONCLUSION: Evidence offered in support of the gateway hypothesis does not establish that ENDS use causes youth to also smoke cigarettes. Instead, this evidence is better interpreted as resulting from a common liability to use both ENDS and cigarettes. Population-level trends are inconsistent with the gateway hypothesis, and instead are consistent with (but do not prove) ENDS displacing cigarettes. Policies based on misinterpreting a causal gateway effect may be ineffective at best, and risk the negative unintended consequence of increased cigarette smoking.

Unveiling the Impact of Smokers' Self-Construals on the Effectiveness of Smoking Cessation Campaigns: A Comparative Analysis of E-Cigarettes and Combustible Cigarettes.

Objective: This research conducted two studies in South Korea to explore the relationship between smokers' self-construals and the types of cigarettes they use, emphasizing their combined effects on cessation campaign effectiveness. Methods: Study 1 explored how smokers' self-construals influenced their intentions to quit smoking or vaping, considering their primary cigarette usage. Study 2 further investigated this relationship within cessation campaigns, employing messages framed by both self-construal (independent vs. interdependent) and cigarette type (combustible vs. electronic). Results: The results of Study 1 showed that individuals with a strong interdependent self-construal were more likely to express intentions to quit smoking or vaping when using e-cigarettes compared to combustible cigarettes. Similarly, Study 2 demonstrated that cessation messages for e-cigarettes were more effective in eliciting intentions to quit when presented with an interdependent self-construal frame, while messages for combustible cigarettes showed greater effectiveness with an independent self-construal frame. Conclusion: Campaigns solely focused on independent self-construals might not effectively persuade e-cigarette users to quit, as they may prioritize communal wellbeing over individual benefits. Adapting anti-e-cigarette campaigns to align with the values of interdependent self-construals could yield better outcomes in promoting cessation among e-cigarette users.

[Tobacco cessation - the underused potential in clinical routine]. / Tabakentwöhnung ­ die bisher wenig genutzte Chance im ärztlichen Alltag.

Tobacco control, psychosocial and medical assistance regarding tobacco cessation is still a hidden potential within the German health care system. So far doctors rarely talk to their patients about their smoking status and physical and psychological benefits of quitting.This paper focusses on recommended current diagnostic and treatment standards, as well as evidence-based methods to address the topic on how to stop smoking and its association with certain diseases such as COPD, lung cancer and COVID-19 infection. The role of e-cigarettes as a cessation tool and its health related risks are critically examined. Consequences and advice how to implement smoking cessation procedures into daily practice are presented.

Knowledge of Tunisian physicians about electronic cigarettes.

INTRODUCTION: The electronic cigarette is a new-generation smoking product whose mechanism of use could, in theory, minimize adverse health effects. AIM: Determine the knowledge and perceptions of a sample of Tunisian doctors regarding electronic cigarettes. METHODS: We conducted a descriptive cross-sectional study over a two-month period with a sample of Tunisian doctors. We used an online self-questionnaire on physicians' knowledge and perceptions of e-cigarettes. RESULTS: Data were obtained from 216 physicians. Of the participants, 97.2% were familiar with e-cigarettes, 56.5% reported low knowledge, and 83.4% expressed motivation to learn more about e-cigarettes. Overall, 83.8% of doctors felt that electronic cigarettes are harmful to the user's health. Use of this product would increase the risk of cancer according to 73.1% of participants, the risk of cardiovascular disease according to 68.5% of participants, and the risk of chronic lung disease according to 79.2% of participants. The perception of e-cigarettes as harmful to the user's health was associated with the physicians' medical specialty (p=0.032). The recommendation of e-cigarettes as a smoking cessation tool was negatively correlated with addictology training (p=0.027). CONCLUSIONS: Physicians' knowledge of electronic cigarettes is heterogeneous, reflecting the current lack of information and consensus.

Dual Exposure to E-Cigarette Vapour and Cigarette Smoke Results in Poorer Airway Cell, Monocyte, and Macrophage Function Than Single Exposure.

E-cigarette users predominantly also continue to smoke cigarettes. These Dual Users either consume e-cigarettes in locations where smoking is not allowed, but vaping is, or to reduce their consumption of cigarettes, believing it will lead to harm reduction. Whilst it is known that e-cigarette vapour is chemically less complex than cigarette smoke, it has a distinct chemical profile, and very little is known about the health impacts of exposure to both chemical profiles vs. either alone. We simultaneously exposed cells in vitro to non-toxic levels of e-cigarette vapour extract (EVE) and cigarette smoke extract (CSE) to determine their effects on 16HBE14o- airway epithelial cell metabolism and inflammatory response, as well as immune cell (THP-1 cells and monocyte-derived macrophages (MDM) from healthy volunteers) migration, phagocytosis, and inflammatory response. We observed increased toxicity, reduced metabolism (a marker of proliferation) in airway epithelial cells, and reduced monocyte migration, macrophage phagocytosis, and altered chemokine production after exposure to either CSE or EVE. These cellular responses were greater after dual exposure to CSE and EVE. The airway epithelial cells from smokers showed reduced metabolism after EVE (the Switcher model) and dual CSE and EVE exposure. When EVE and CSE were allowed to interact, the chemicals were found to be altered, and new chemicals were also found compared to the CSE and EVE profiles. Dual exposure to e-cigarette vapour and cigarette smoke led to worse functional outcomes in cells compared to either single exposure alone, adding to limited data that dual use may be more dangerous than smoking only.

[Lung injury associated with vaping: A case report]. / Lesión pulmonar asociada al vapeo: informe de un caso.

Vaping is the practice of inhaling an aerosol created by heating a liquid with an electronic cigarette. These aerosols contain toxic, carcinogenic compounds and nicotine, an addictive substance. In Argentina, the commercialization of electronic cigarettes is prohibited. Acute lung injury associated with vaping (EVALI) is an acute respiratory disease that can be life threatening. An 18-year-old male patient, smoker, consulted for shortness of breath and fever. He presented with hypoxemic respiratory failure, and leukocytosis. The patient reported use of electronic cigarettes. Chest computed tomography (CT) showed extensive areas of ground glass opacities with areas of consolidation with air bronchogram. Antibiotic treatment was started and a fibrobronchoscopy was performed, which showed hematic debris, without endoluminal lesions. A diagnosis of EVALI was done and high doses systemic corticosteroids were prescribed. The patient evolved favorably, hewas discharged 48 hours after the end of treatment. In the control ambulatory CT was observed an improvement of the lesions. EVALI is an exclusion diagnosis, so it is necessary to rule out infectious diseases and pulmonary inflammatory processes. There are different scores that describe the probability of EVALI. The Centers for Disease Control and Prevention (CDC), developed in 2019 a definition of confirmed case based on vape exposure, imaging, clinical presentation and history. In 2019 was first reported an EVALI in Argentina. It is important to know the criteria for a confirmed case to initiate accurate and early treatment, considering the exponential increase in electronic cigarette use, mainly in the young population.

El vapeo es la práctica de inhalar un aerosol creado al calentar un líquido con cigarrillo electrónico. Estos aerosoles contienen tóxicos, compuestos cancerígenos y nicotina, sustancia adictiva. En nuestro país está prohibida la comercialización del cigarrillo electrónico. La lesión pulmonar aguda asociada al vapeo (EVALI) es una enfermedad respiratoria aguda potencialmente mortal. Se presenta el caso de un varón de 18 años, tabaquista, que consultó por falta de aire y fiebre. Presentaba insuficiencia respiratoria hipoxémica y leucocitosis, refiriendo reciente inicio de utilización de cigarrillo electrónico. En la tomografía computarizada de tórax (TC) se observaban extensas áreas en "vidrio esmerilado" bilaterales y áreas de consolidación con broncograma aéreo. Se inició tratamiento antibiótico y se realizó una fibrobroncoscopia que mostró restos hemáticos sin lesiones endoluminales. Se interpretó como EVALI y se indicaron corticoides sistémicos. El paciente evolucionó favorablemente y egresó a las 48 h de finalizado el tratamiento. En TC de control se observó mejoría de las lesiones. El diagnóstico de EVALI es de exclusión. Existen diferentes scores que describen la probabilidad de un EVALI. Los Centers for Disease Control and Prevention (CDC), propusieron en 2019 una definición de caso confirmado de EVALI basado en la exposición al vapeo, las imágenes, la presentación clínica y los antecedentes. La primera notificación de un caso de EVALI en la Argentina fue en el año 2019. Es importante conocer los criterios diagnósticos para poder iniciar un tratamiento preciso y precoz, considerando el aumento exponencial del uso de cigarrillo electrónico, principalmente en la población joven.

The efficacy and acceptability of pharmacological monotherapies and e-cigarette on smoking cessation: a systemic review and network meta-analysis.

Background and aims: Several pharmacological interventions, such as nicotine replacement therapy (NRT), varenicline, and bupropion, have been approved for clinical use of smoking cessation. E-cigarettes (EC) are increasingly explored by many RCTs for their potentiality in smoking cessation. In addition, some RCTs are attempting to explore new drugs for smoking cessation, such as cytisine. This network meta-analysis (NMA) aims to investigate how these drugs and e-cigarettes compare regarding their efficacy and acceptability. Materials and methods: This systematic review and NMA searched all clinical studies on smoking cessation using pharmacological monotherapies or e-cigarettes published from January 2011 to May 2022 using MEDLINE, COCHRANE Library, and PsychINFO databases. NRTs were divided into transdermal (TDN) and oronasal nicotine (ONN) by administrative routes, thus 7 network nodes were set up for direct and indirect comparison. Two different indicators measured the efficacy: prevalent and continuous smoking abstinence. The drop-out rates measured the acceptability. Results: The final 40 clinical studies included in this study comprised 77 study cohorts and 25,889 participants. Varenicline is more effective intervention to assist in smoking cessation during 16-32 weeks follow-up, and is very likely to prompt dropout. Cytisine shows more effectiveness in continuous smoking cessation but may also lead to dropout. E-cigarettes and oronasal nicotine are more effective than no treatment in encouraging prevalent abstinence, but least likely to prompt dropout. Finally, transdermal nicotine delivery is more effective than no treatment in continuous abstinence, with neither significant effect on prevalent abstinence nor dropout rate. Conclusion: This review suggested and agreed that Varenicline, Cytisine and transdermal nicotine delivery, as smoking cessation intervention, have advantages and disadvantages. However, we had to have reservations about e-cigarettes as a way to quit smoking in adolescents.

Specialist vape store audit reveals poor compliance with new e-cigarette regulations.

AIM: Regulations announced in mid-2023 aimed to reduce youth vaping by curtailing the availability of cheap high-nicotine e-cigarettes (vapes). This study tested compliance with the new regulations for single-use vapes, which came into force on 21 December 2023. METHODS: A 20-year-old "mystery shopper" visited 96% of specialist vape retailers (SVRs) in Wellington, Porirua, Lower Hutt and Upper Hutt (N=74) in January 2024, and observed i) R18 signage, ii) age verification practices, and ii) prices and brands of the cheapest available vaping products. Low-price vapes were purchased and inspected for compliance with new nicotine limits and safety regulations. RESULTS: All but three stores (96%) displayed an R18 sign; however, signage in 29 stores (39%) was suboptimal. Only one store (1.4%) requested age identification (ID) on entry to the R18 premises. In 50% of stores, ID was requested when a purchase was made; however, a third of those retailers proceeded with the sale despite the buyer not providing ID. Single-use vapes remained available for NZ$10 or less in most stores, and reusable starter kits were also widely available for NZ$10-20. Discounted high-nicotine products were sold for as little as NZ$2.50 each. Most low-price products did not comply with the updated regulations. CONCLUSION: Cheap, high-nicotine vaping products remained widely available following the introduction of stricter regulations in December 2023; products for sale included discounted and non-compliant vapes. The majority of SVRs had poor age verification practices. There is an urgent need to clarify rules, increase enforcement efforts and disallow discounting and giveaways of vapes.

The prospective relationship between a-priori intentions for and patterns of e-cigarette use among adults who smoke cigarettes.

BACKGROUND: Electronic (e-)cigarettes may help adult cigarette smokers achieve cigarette cessation, depending on patterns of e-cigarette use. Among cigarette smokers who do not use e-cigarettes, it is unclear if and how a-priori intentions for use are related to uptake patterns. Longitudinal studies have focused on established e-cigarette users or adolescent and young adult populations exclusively. METHODS: Within a nationwide randomized clinical trial (N = 638), adult cigarette smokers not currently using e-cigarettes were randomized (2:1) to receive (or not) one-month sampling of e-cigarettes. An exploratory factor analysis (EFA) was performed on an established 15-item measure assessing a-priori intentions for e-cigarette use to identify latent variables. Among those receiving e-cigarette products, regression models examined relationships between intentions and: 1) uptake (yes/no), 2) frequency (number of days per week), and 3) amount (puffing episodes per day) of e-cigarette use at one-month follow-up. RESULTS: Two factors emerged from the EFA: 1) cigarette-related intentions (e.g., cigarette cessation, no smell) and 2) novel appeal of e-cigarettes (e.g., flavors). Three items remained and were treated as separate intentions: "feels like cigarette smoking", "curiosity", and "affordability". In the final multivariable models, "feel like cigarette smoking" predicted more frequent e-cigarette use (ß = 0.187, SE = 0.086, p = 0.03); however, none of the five factors/intentions were significantly associated with uptake or amount of use. CONCLUSIONS: For adult cigarette smokers not currently using e-cigarettes, a-priori intentions for using e-cigarettes might not be predictive of if or how these products will be used in the future, suggesting that motives may not drive use behavior.

Reasons for multiple tobacco product and cannabis co-use among Texas young adults.

OBJECTIVE: This study examines differences in reasons for e-cigarette, cigarette, and cannabis use across exclusive, dual, co-, and poly co-users. METHODS: Participants were 645 young adults who reported past 30-day (P30D) use of e-cigarettes, cigarettes, or cannabis at wave 14 (Fall, 2021) of the Texas Adolescent Tobacco Marketing and Surveillance System (TATAMS). Exclusive users reported P30D use of one product, dual users reported P30D use of e-cigarettes and cigarettes, co-users reported use of cannabis and one tobacco product, and poly co-users reported P30D use of all three products. Participants were asked if they agreed with a series of reasons for using their respective products. Multinomial logistic regression analyses were conducted to examine associations between reasons for use and pattern of use, controlling for sex, race/ethnicity, and lifetime product use. RESULTS: 26.36 % of P30D users reported cannabis and tobacco use. Poly co-users were more likely to report using e-cigarettes because their friends do than e-cigarette co-users (aRRR = 2.64; 95 %CI = 1.19-5.83) and dual tobacco users (aRRR = 5.11; 95 %CI = 1.73-15.12). Poly co-users were more likely to smoke cigarettes while drinking alcohol (aRRR = 4.68; 95 %CI = 1.06-20.72) or to experience a pleasurable buzz (aRRR = 5.48; 95 %CI = 1.62-18.57) than exclusive cigarette users. Poly co-users more often reported using cannabis for taste (aRRR = 3.13; 95 %CI = 1.51-6.51), because their friends use it (aRRR = 2.19; 95 %CI = 1.08-4.42), and while drinking alcohol (aRRR = 2.13; 95 %CI = 1.03-4.41) than exclusive cannabis users. CONCLUSIONS: Given that reasons for use differ significantly among types of multiple product users and exclusive users, interventions should be tailored to address the specific tobacco and cannabis use practices of young adults.