Use and co-use of tobacco and cannabis before, during, and after pregnancy: A longitudinal analysis of waves 1-5 of the Population Assessment of Tobacco and Health (PATH) study.

OBJECTIVE: Co-use of tobacco and cannabis may be prevalent in pregnancy, potentially leading to additional adverse health outcomes. Utilizing a national sample of women followed prospectively before, during, and after pregnancy, this study tested whether prepregnancy co-use of tobacco and cannabis (vs. tobacco-only use and cannabis-only use) was associated with greater likelihood of continuing to use tobacco and/or cannabis during pregnancy and postpartum. METHOD: Data were drawn from Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health (PATH) Study. Prepregnancy, pregnancy, and postpartum data were captured and stacked over three intervals (Waves 1-3, 2-4, and 3-5). Participants were N = 686 U.S. women (72% White, 46% age 25-34) who were currently pregnant during the middle wave of an interval. Rates of tobacco-only use, cannabis-only use, and tobacco and cannabis co-use at all three time points were examined. RESULTS: Generalized estimating equation models demonstrated that pregnant women who reported prepregnancy tobacco and cannabis co-use (vs. tobacco-only or cannabis-only use) were more likely to continue to use tobacco and/or cannabis during pregnancy and relapse in postpartum (p < .05). Among women who endorsed prepregnancy co-use and continued to use tobacco and/or cannabis in pregnancy, about half transitioned to tobacco-only use (45.16%). CONCLUSIONS: Findings underscore the need for further clinical and empirical focus on dynamic patterns of use/co-use of tobacco and cannabis across the perinatal period, including cessation interventions to reduce tobacco and cannabis use in pregnancy and protect against relapse in postpartum. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pain is associated with exclusive use and co-use of tobacco and cannabis: Findings from Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study.

INTRODUCTION: Rates of tobacco and cannabis use are disproportionately high among individuals with pain, and evidence suggests that pain may engender greater likelihood of substance co-use, yielding additive risk. This study examined national associations of pain with past-month tobacco use, cannabis use, and co-use of tobacco and cannabis. METHODS: Data came from a nationally representative US sample of adults in Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health study (N = 32,014). The sample included civilian, non-institutionalized people who use tobacco and people who do not use tobacco. Past-week pain intensity (0-10) was dichotomized (0-4 no/low pain; 5-10 moderate/severe pain). Multinomial models adjusted for demographics examined substance use category membership (no tobacco or cannabis use, exclusive cannabis use, exclusive tobacco use, co-use) as a function of pain status. RESULTS: Moderate/severe pain was associated with increased relative risk of exclusive tobacco use (RRR [CI] 2.26 [2.05, 2.49], p <.001), exclusive cannabis use (1.49 [1.22, 1.82], p <.001), and co-use of tobacco and cannabis (2.79 [2.51, 3.10], p <.001), in comparison to no tobacco or cannabis use. Additionally, moderate/severe pain was associated with increased risk of co-use compared to exclusive tobacco use (1.23 [1.11, 1.37], p <.001) and exclusive cannabis use (1.88 [1.54, 2.29], p <.001). DISCUSSION: Findings suggest that not only is pain independently associated with greater risk of exclusively using tobacco or cannabis, but pain is also associated with heightened risk of co-using both products. Future work should examine the dynamic and potentially bidirectional relationships between pain and use of cannabis and tobacco.

Pain and Menthol Use Are Related to Greater Nicotine Dependence Among Black Adults Who Smoke Cigarettes at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health (PATH) Study.

Burdens related to pain, smoking/nicotine dependence, and pain-smoking comorbidity disproportionately impact Black Americans, and menthol cigarette use is overrepresented among Black adults who smoke cigarettes. Menthol may increase nicotine exposure, potentially conferring enhanced acute analgesia and driving greater dependence. Therefore, the goal of the current study was to examine associations between pain, menthol cigarette use, and nicotine dependence. Data was drawn from Black adults who were current cigarette smokers (n = 1370) at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study. Nicotine dependence was assessed using the Wisconsin Inventory of Smoking Dependence Motives. ANCOVA revealed that moderate/severe pain (vs. no/low pain) was associated with greater overall nicotine dependence (p < .001) and greater negative reinforcement, cognitive enhancement, and affiliative attachment smoking motives (ps < .001). Menthol smokers with moderate/severe pain also endorsed greater cigarette craving and tolerance, compared to non-menthol smokers with no/low pain (ps < .05). Findings support the notion that among Black individuals who smoke cigarettes, the presence of moderate/severe pain (vs. no/low pain) and menthol use may engender greater physical indices of nicotine dependence relative to non-menthol use. Compared to no/low pain, moderate/severe pain was associated with greater emotional attachment to smoking and greater proclivity to smoke for reducing negative affect and enhancing cognitive function. Clinical implications include the need to address the role of pain and menthol cigarette use in the assessment and treatment of nicotine dependence, particularly among Black adults. These data may help to inform evolving tobacco control policies aimed at regulating or banning menthol tobacco additives.

Longitudinal Associations Between Pain and Use of Cigarettes and E-cigarettes in the Population Assessment of Tobacco and Health (PATH) Study.

INTRODUCTION: Pain has been implicated in the onset and maintenance of nicotine addiction, and there is initial cross-sectional evidence of covariation between pain and the use of cigarettes and e-cigarettes. The goals of the current study were to: (1)test pain severity as a predictor of initiating co-use of cigarettes and e-cigarettes, (2)examine longitudinal associations between pain and use/co-use of cigarettes and e-cigarettes, (3)generate the first prevalence rate data regarding cigarette and e-cigarette use as a function of pain, and (4)examine gender as a moderator of these associations. AIMS AND METHODS: Data were drawn from Waves 1-4 of the Population Assessment of Tobacco and Health Study (2013-2018). RESULTS: Among exclusive cigarette smokers at Wave 1 (n = 7719), pain severity was associated with a greater likelihood of and faster trajectory to initiating co-use of cigarettes and e-cigarettes (ps < .05). A significant pain × gender interaction (p < .05) revealed this prospective relationship was stronger among women. Among adult respondents who provided at least three waves of data (n = 24 255), greater Wave 1 pain severity was positively associated with e-cigarette use, cigarette smoking, and co-use of cigarettes and e-cigarettes at Waves 2, 3, and 4 (ps < .001). At Wave 4 (n = 33 822), adults with moderate or severe pain endorsed rates of e-cigarette and cigarette use almost two times greater versus no or low pain (ps < .001). CONCLUSIONS: Collectively, these findings provide evidence that pain likely serves as an important candidate risk factor for the initiation and maintenance of cigarette and e-cigarette use. IMPLICATIONS: This is the first prospective study to show that pain serves as an important risk factor for initiation and maintenance of cigarette and e-cigarette use over time. Weighted prevalence estimates further demonstrated that individuals with moderate or severe pain endorsed rates of cigarette and e-cigarette use and co-use approximately two times greater compared to those with no or low pain. These findings highlight a subpopulation of nicotine users more susceptible to greater healthcare burden, nicotine dependence, and physical impairment. Nicotine users with comorbid pain may benefit from integrated interventions that address pain in the context of cessation.