Effects and equity impacts of cannabis policy on tobacco and cannabis co-use in young adults

Rutgers Biomedical And Health Sciences, Newark NJ

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT Blunts – cigars with the tobacco filling replaced or mixed with cannabis – present substantial health risks to their users given exposure to harmful chemicals from combustion and the high addictive potential from nicotine in the cigar wrap and tobacco. Blunts are predominantly used by young adults (YAs) and groups who go on to suffer disproportionately from tobacco-attributable death and disease, chiefly people who identify as Black/African American (B/AA). Therefore, B/AA YAs are at greatest risk for the health effects of blunt use. In the United States, tobacco policies have become increasingly restrictive while cannabis policies have become increasingly permissive. In this rapidly changing context, it is important to understand how blunt use is impacted by both tobacco and cannabis policies. However, no studies have evaluated these impacts. There is a critical need to understand the impact of evolving cannabis and cigar policies on people who use blunts, particularly B/AA YAs, to address public health and promote health equity. Aligned with National Institute on Drug Abuse research priorities (NOSI NOT-DA-22-003), the overall objective of the proposed study is to determine the impact of policies relevant to blunt use on health equity. Informed by a health equity framework to detect, understand, and reduce health disparities, I will build upon analyses of national data and focus group data (K99 phase) to construct a hypothetical choice experiment (R00 phase) to predict potential impacts of intersecting tobacco and cannabis policies on blunt use in B/AA YAs. The first aim is to detect the impact of state cannabis and tobacco policies relevant to blunt use on B/AA and non-B/AA YAs through secondary analyses of Nielsen convenience store data and Population Assessment of Tobacco and Health Study data. The second aim is to understand multi-level determinants of blunt use disparities and policy impacts through focus groups with B/AA YAs. The third aim is to assess the impact of proposed cannabis and tobacco policies to reduce blunt use among B/AA YAs through a discrete choice experiment. This study will provide timely evidence on an understudied pattern of cannabis and tobacco use (blunt use) in a priority population impacted by rapidly-evolving tobacco and cannabis laws. Results are expected to have substantial positive impact by 1) directly informing policy interventions to support public health, 2) identifying determinants of health inequities from blunt use, and 3) introducing unique scientific approaches to a budding field of cannabis regulatory science. A comprehensive training plan is proposed to ensure the implementation of study aims, with objectives focused on: 1) enhancing research methods to engage health equity through all phases of research; 2) expanding data analytic skills for policy evaluation; 3) obtaining experience with experimental methods to inform and evaluate policy attributes; 4) extending knowledge in core substantive areas of cannabis use and policy; and 5) developing leadership and professional skills relevant to tobacco and cannabis regulatory science.