Rich Jacob James, Back Sudie E, Bui Thanh C, Bernstein Eden Y, Le Phuc
Center for Value-Based Care Research, Primary Care Institute, Cleveland Clinic, Cleveland, OH, United States; Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States.
Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
Drug Alcohol Depend. 2024 Aug 1;261:111355. doi: 10.1016/j.drugalcdep.2024.111355. Epub 2024 Jun 6.
Polysubstance use is associated with adverse health outcomes, yet little research has measured changes in polysubstance use. We aimed to 1) estimate trends in marijuana and heavy alcohol use by cigarette smoking and demographic subgroups, and 2) examine patient factors associated with concurrent use among adults who were smoking.
We conducted a repeated cross-sectional analysis of 687,225 non-institutionalized US adults ≥18 years from the 2002-2019 National Survey on Drug Use and Health. Participants were stratified into current, former, and never smoking groups. Main outcomes were prevalence of heavy alcohol use, marijuana use, and concurrent use of both substances.
From 2002-2019, heavy alcohol use declined from 7.8 % to 6.4 %, marijuana use rose from 6.0 % to 11.8 %, and concurrent use of alcohol and marijuana remained stable. Among adults who were smoking from 2005 to 2019, higher education was associated with higher odds of heavy alcohol use, while older ages, female gender, non-White race/ethnicity, and government-provided health insurance were associated with lower odds. The odds of marijuana use decreased in females, older ages, and higher incomes while increasing in people with poorer health status, higher education, government-provided or no health insurance, and serious mental illness. Compared to White adults who were smoking, Black counterparts had higher odds of marijuana use (OR=1.23; 95 %CI: 1.15-1.29), while Hispanic (OR=0.68; 95 %CI: 0.63-0.72) and other racial/ethnic identities (OR=0.83; 95 %CI: 0.77-0.90) had lower odds.
Our study suggests marijuana use might not be sensitive to changes in the use of tobacco and alcohol.
多种物质使用与不良健康后果相关，但很少有研究测量多种物质使用的变化情况。我们旨在：1）按吸烟情况和人口统计学亚组估计大麻和重度饮酒的使用趋势；2）研究吸烟成年人中与同时使用这两种物质相关的患者因素。
我们对2002 - 2019年美国全国药物使用和健康调查中687,225名年龄≥18岁的非机构化美国成年人进行了重复横断面分析。参与者被分为当前吸烟者、既往吸烟者和从不吸烟者组。主要结局是重度饮酒、大麻使用以及两种物质同时使用的患病率。
2002 - 2019年期间，重度饮酒率从7.8%降至6.4%，大麻使用率从6.0%升至11.8%，酒精和大麻同时使用的情况保持稳定。在2005 - 2019年吸烟的成年人中，高等教育与重度饮酒的较高几率相关，而年龄较大、女性、非白人种族/族裔以及政府提供的医疗保险与较低几率相关。大麻使用几率在女性、年龄较大者和高收入者中降低，而在健康状况较差、高等教育、有政府提供或无医疗保险以及患有严重精神疾病的人群中增加。与吸烟的白人成年人相比，黑人使用大麻的几率更高（OR = 1.23；95%CI：1.15 - 1.29），而西班牙裔（OR = 0.68；95%CI：0.63 - 0.72）和其他种族/族裔身份者（OR = 0.83；95%CI：0.77 - 0.90）的几率较低。
我们的研究表明，大麻使用可能对烟草和酒精使用的变化不敏感。
