Research Group on Adolescent Health, Institute for Social and Preventive Medicine, Rte de la Corniche 2, Bâtiment Biopôle 1, Epalinges, Switzerland.
Nicotine Tob Res. 2011 Aug;13(8):746-50. doi: 10.1093/ntr/ntr043. Epub 2011 Mar 31.
Young cannabis users are at increased risk of later cigarette initiation and progression to nicotine addiction. The present study addresses the frequency at which mulling (adding tobacco to cannabis smoked as joints) is performed and in which way this practice varies according to cigarette smoking status.
Data were issued from the Swiss 2007 European School Survey Project on Alcohol and other Drugs (ESPAD). A total of 881 past month cannabis users (mean age 15 years, boys 60.1%) were inquired on mulling using an anonymous self-administered questionnaire. Participants were further grouped according to their cigarette smoking status (daily, occasional, former, and never-smokers).
Four of every 5 cannabis users depicted mulling as frequently performed. The highest occurrence was found among daily cigarette smokers (DSC; 90.3%), while former cigarette smokers reported the lowest (58.9%). The multinomial logistic regression showed DSC more likely reporting mulling as frequent compared with never-smokers (risk ratio = 3.56 [95% CI 1.55-8.21]).
Mulling appears to be a very common process among young cannabis users, especially among concomitant cigarette smokers. Nevertheless, the majority of cigarette abstainers also reported frequently adding tobacco to the cannabis they smoke. Because it may represent a significant exposition to nicotine, mulling should be taken into account when assessing substance use among adolescents and in supporting their quitting attempts.
年轻的大麻使用者有更高的风险在以后开始吸烟并发展成尼古丁成瘾。本研究探讨了吸食大麻时添加烟草（将烟草混入大麻烟卷中吸食）的频率，以及这种做法根据吸烟状况的变化。
数据来自于瑞士 2007 年欧洲酒精和其他药物调查项目（ESPAD）。共有 881 名过去一个月吸食大麻的使用者（平均年龄 15 岁，男生占 60.1%）使用匿名自填问卷被询问吸食大麻时添加烟草的情况。参与者根据其吸烟状况（每日、偶尔、曾经、从不吸烟者）进一步分组。
每 5 个大麻使用者中有 4 个表示经常吸食大麻时添加烟草。每日吸烟的大麻使用者（DSC）的吸食频率最高（90.3%），而曾经吸烟的大麻使用者报告的频率最低（58.9%）。多项逻辑回归显示，DSC 比从不吸烟者更有可能报告经常吸食大麻时添加烟草（风险比=3.56[95%CI 1.55-8.21]）。
吸食大麻时添加烟草似乎是年轻大麻使用者中非常普遍的做法，特别是在同时吸烟的人群中。然而，大多数不吸烟的大麻使用者也报告经常在吸食的大麻中添加烟草。因为这可能代表着对尼古丁的大量暴露，所以在评估青少年的物质使用情况和支持他们戒烟尝试时，应该考虑吸食大麻时添加烟草的情况。
