Skip to main content
SpringerLink
Log in

Racial and Ethnic Disparities in Mental Health Problems and Tobacco and Cannabis Use Among US Emerging Adults

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Introduction

Mental health problems in emerging adulthood are linked to tobacco and cannabis use, but whether race and ethnicity modifies these associations is unclear.

Methods

We used data from wave 4 of the Population Assessment of Tobacco and Health Study (youth n = 6898, young adult n = 10,304) to conduct latent class analysis (LCA) of six past 30-day tobacco and cannabis use indicators (i.e., cigarettes, electronic nicotine delivery systems (ENDS), cigars, blunts, cannabis vaping, other cannabis). We estimated associations between past 30-day internalizing and externalizing (i.e., low (referent), moderate, high) problems and latent classes of tobacco/cannabis use (vs. never/former use) using adjusted multinomial logistic regression. We explored whether associations varied by race and ethnicity through stratification.

Results

We identified four exclusive use latent classes and two dual/poly use latent classes for both youth and young adult samples. Race/ethnicity-stratified models identified associations between internalizing/externalizing problems and most use classes for Hispanic and non-Hispanic White youth/young adults, with mixed results for non-Hispanic Black youth/young adults. For example, Hispanic (OR: 2.50, 95% CI: 1.09–5.74) and non-Hispanic White (OR: 1.90, 95% CI: 1.18–3.06) youth with high internalizing problems had higher odds of ENDS + cannabis vaping. Externalizing problems were not associated with use among non-Hispanic Black youth while internalizing problems were not associated with use among non-Hispanic Black young adults.

Conclusion

We observed racial/ethnic variation in mental health problems and tobacco and cannabis use. Understanding mental health problem and tobacco product and cannabis use comorbidity may better inform culturally relevant interventions aimed to prevent and reduce use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Palmer RH, Young SE, Hopfer CJ, Corley RP, Stallings MC, Crowley TJ, et al. Developmental epidemiology of drug use and abuse in adolescence and young adulthood: evidence of generalized risk. Drug Alcohol Depend. 2009;102(1-3):78–87.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Schulte MT, Hser YI. Substance use and associated health conditions throughout the lifespan. Public Health Rev. 2014;35(2)

  3. Johnston LD, Miech RA, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME. Monitoring the Future national survey results on drug use 1975–2020: overview, key findings on adolescent drug use: Institute for Social Research. Ann Arbor, MI: University of Michigan; 2021.

    Google Scholar 

  4. Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Rockville: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2021. https://www.samhsa.gov/data/

    Google Scholar 

  5. Lipperman-Kreda S, Islam S, Wharton K, Finan LJ, Kowitt SD. Youth tobacco and cannabis use and co-use: associations with daily exposure to tobacco marketing within activity spaces and by travel patterns. Addict Behav. 2022;126:107202.

    Article  PubMed  Google Scholar 

  6. Smith DM, Kozlowski L, O'Connor RJ, Hyland A, Collins RL. Reasons for individual and concurrent use of vaped nicotine and cannabis: their similarities, differences, and association with product use. J Cannabis Res. 2021;3(1):39.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Saran SK, Salinas KZ, Foulds J, Kaynak O, Hoglen B, Houser KR, et al. A comparison of vaping behavior, perceptions, and dependence among individuals who vape nicotine, cannabis, or both. Int J Environ Res Public Health. 2022;19(16):10392.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Schauer GL, Rosenberry ZR, Peters EN. Marijuana and tobacco co-administration in blunts, spliffs, and mulled cigarettes: a systematic literature review. Addict Behav. 2017;64:200–11.

    Article  PubMed  Google Scholar 

  9. Chu A, Chaiton M, Kaufman P, Goodwin RD, Lin J, Hindocha C, et al. Co-use, simultaneous use, and mixing of cannabis and tobacco: a cross-national comparison of Canada and the US by Cannabis Administration type. Int J of Environ Res Public Health. 2023;20(5):4206.

    Article  Google Scholar 

  10. Mattingly DT, Patel A, Hirschtick JL, Fleischer NL. Sociodemographic differences in patterns of nicotine and cannabis vaping among US adults. Prev Med Rep. 2022;26:101715.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sun R, Mendez D, Warner KE. Evaluation of self-reported cannabis vaping among US youth and young adults who use e-cigarettes. JAMA Pediatr. 2022;176(4):417–9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dai H, Siahpush M. Use of e-cigarettes for nicotine, marijuana, and just flavoring among U.S. youth. Am J Prev Med. 2020;58(2):244–9.

    Article  PubMed  Google Scholar 

  13. Gentzke AS, Wang TW, Cornelius M, Park-Lee E, Ren C, Sawdey MD, et al. Tobacco product use and associated factors among middle and high school students - National Youth Tobacco Survey, United States, 2021. MMWR Surveill Summ. 2022;71(5):1–29.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM. Tobacco product use among adults - United States, 2020. MMWR Morb Mortal Wkly Rep. 2022;71(11):397–405.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Halladay J, Woock R, El-Khechen H, Munn C, MacKillop J, Amlung M, et al. Patterns of substance use among adolescents: a systematic review. Drug Alcohol Depend. 2020;216:108222.

    Article  CAS  PubMed  Google Scholar 

  16. Forns M, Abad J, Kirchner T. Internalizing and Externalizing Problems. In: Levesque RJR, editor. Encyclopedia of Adolescence. Cham: Springer International Publishing; 2018. p. 1965–70.

    Chapter  Google Scholar 

  17. Achenbach TM, Ivanova MY, Rescorla LA, Turner LV, Althoff RR. Internalizing/externalizing problems: review and recommendations for clinical and research applications. J Am Acad Child Adolesc Psychiatry. 2016;55(8):647–56.

    Article  PubMed  Google Scholar 

  18. Hindocha C, Brose LS, Walsh H, Cheeseman H. Cannabis use and co-use in tobacco smokers and non-smokers: prevalence and associations with mental health in a cross-sectional, nationally representative sample of adults in Great Britain, 2020. Addiction. 2021;116(8):2209–19.

    Article  PubMed  Google Scholar 

  19. Sumbe A, Wilkinson AV, Clendennen SL, Bataineh BS, Sterling KL, Chen B, et al. Association of tobacco and marijuana use with symptoms of depression and anxiety among adolescents and young adults in Texas. Tob Prev Cessat. 2022;8:03.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Smith CL, Cooper BR, Miguel A, Hill L, Roll J, McPherson S. Predictors of cannabis and tobacco co-use in youth: exploring the mediating role of age at first use in the Population Assessment of Tobacco Health (PATH) study. J Cannabis Res. 2021;3(1)

  21. Duan Z, Wang Y, Spears CA, Self-Brown SR, Weaver SR, Zheng P, et al. Role of mental health in the association between e-cigarettes and cannabis use. Am J Prev Med. 2022;62(3):307–16.

    Article  PubMed  Google Scholar 

  22. Montgomery L, Mantey D. Racial/ethnic differences in prevalence and correlates of blunt smoking among adolescents. J Psychoactive Drugs. 2018;50(3):195–205.

    Article  PubMed  Google Scholar 

  23. Cobb CO, Soule EK, Rudy AK, Sutter ME, Cohn AM. Patterns and correlates of tobacco and cannabis co-use by tobacco product type: findings from the Virginia Youth Survey. Subst Use Misuse. 2018;53(14):2310–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Fataar F, Hammond D. The prevalence of vaping and smoking as modes of delivery for nicotine and cannabis among youth in Canada, England and the United States. Int J of Environ Res Public Health. 2019;16(21):4111.

    Article  Google Scholar 

  25. Wang JB, Ramo DE, Lisha NE, Cataldo JK. Medical marijuana legalization and cigarette and marijuana co-use in adolescents and adults. Drug Alcohol Depend. 2016;166:32–8.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tucker JS, Rodriguez A, Dunbar MS, Pedersen ER, Davis JP, Shih RA, et al. Cannabis and tobacco use and co-use: trajectories and correlates from early adolescence to emerging adulthood. Drug Alcohol Depend. 2019;204:107499.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Bears Augustyn M, Fulco CJ, Agbeke D, Henry KL. The joint development of externalizing and internalizing behaviors in black and Hispanic youth and the link to late adolescent substance use. Dev Psychopathol. 2021;34(3):1144–62.

    Article  PubMed  Google Scholar 

  28. Ryce P, Sirin SR, Rogers-Sirin L, Sin EJ, Palmeri J. The role of internalizing mental health problems in substance use trajectories for minority adolescents. Int J Ment Health Addict. 2021;19(6):2031–44.

    Article  Google Scholar 

  29. United States Department of Health and Human Services, National Institute on Drug Abuse of the National Institutes of Health, Food and Drug Administration, Center for Tobacco Products. Population Assessment of Tobacco and Health (PATH) Study [United States] Public-Use Files. Inter-university Consortium for Political and Social Research [distributor]; 2021.

  30. United States Department of Health and Human Services, National Institute on Drug Abuse of the National Institutes of Health, Food and Drug Administration, Center for Tobacco Products. Population Assessment of Tobacco and Health (PATH) Study [United States] Restricted-Use Files. Inter-university Consortium for Political and Social Research [distributor]; 2022.

  31. Hyland A, Ambrose BK, Conway KP, Borek N, Lambert E, Carusi C, et al. Design and methods of the Population Assessment of Tobacco and Health (PATH) study. Tob Control. 2017;26(4):371–8.

    Article  PubMed  Google Scholar 

  32. Conway KP, Green VR, Kasza KA, Silveira ML, Borek N, Kimmel HL, et al. Co-occurrence of tobacco product use, substance use, and mental health problems among adults: findings from Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study. Drug Alcohol Depend. 2017;177:104–11.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Dennis ML, Chan YF, Funk RR. Development and validation of the GAIN Short Screener (GSS) for internalizing, externalizing and substance use disorders and crime/violence problems among adolescents and adults. Am J Addict. 2006;15(Suppl 1):80–91.

    PubMed  PubMed Central  Google Scholar 

  34. Dennis ML, White M, Titus JC, Unsicker J. Global appraisal of individual needs: administration guide for the GAIN and related measures (Version 5). Normal, IL: Chestnut Health Systems; 2008.

    Google Scholar 

  35. Nylund-Gibson K, Choi AY. Ten frequently asked questions about latent class analysis. Transl Issues Psychol Sci. 2018;4(4):440–61.

    Article  Google Scholar 

  36. Judkins D. Fay’s method for variance estimation. J Off Stat. 1990;6:223–39.

    Google Scholar 

  37. Mattingly DT, Elliott MR, Fleischer NL. Latent classes of tobacco and cannabis use among youth and young adults in the United States. Subst Use Misuse. 2023;58(10):1235–45.

    Article  PubMed  Google Scholar 

  38. Green VR, Conway KP, Silveira ML, Kasza KA, Cohn A, Cummings KM, et al. Mental health problems and onset of tobacco use among 12- to 24-year-olds in the PATH study. J Am Acad Child Adolesc Psychiatry. 2018;57(12):944–54.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Hussong AM, Ennett ST, Cox MJ, Haroon M. A systematic review of the unique prospective association of negative affect symptoms and adolescent substance use controlling for externalizing symptoms. Psychol Addict Behav. 2017;31(2):137–47.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Audrain-McGovern J, Rodriguez D, Tercyak KP, Neuner G, Moss HB. The impact of self-control indices on peer smoking and adolescent smoking progression. J Pediatr Psychol. 2006;31(2):139–51.

    Article  PubMed  Google Scholar 

  41. Tomczyk S, Isensee B, Hanewinkel R. Latent classes of polysubstance use among adolescents-a systematic review. Drug Alcohol Depend. 2016;160:12–29.

    Article  PubMed  Google Scholar 

  42. Mezuk B, Abdou CM, Hudson D, Kershaw KN, Rafferty JA, Lee H, et al. "White box" epidemiology and the social neuroscience of health behaviors: The Environmental Affordances Model. Soc Ment Health. 2013;3(2):79.

    Article  Google Scholar 

  43. Vanyukov MM, Tarter RE, Kirillova GP, Kirisci L, Reynolds MD, Kreek MJ, et al. Common liability to addiction and “gateway hypothesis”: theoretical, empirical and evolutionary perspective. Drug Alcohol Depend. 2012;123(Suppl 1):S3–17.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Williams DR. Stress and the mental health of populations of color: advancing our understanding of race-related stressors. J Health Soc Behav. 2018;59(4):466–85.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Farahmand P, Arshed A, Bradley MV. Systemic racism and substance use disorders. Psychiatr Ann. 2020;50(11):494–8.

    Article  Google Scholar 

  46. Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453–63.

    Article  PubMed  Google Scholar 

  47. Rhee JU, Vieira VM, Firth CL, Pedersen ER, Dunbar MS, Timberlake DS. Concentration of cannabis and tobacco retailers in Los Angeles County, California: a spatial analysis of potential effects on youth and ethnic minorities. J Stud Alcohol Drugs. 2022;83(4):502–11.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Allem J-P, Soto DW, Baezconde-Garbanati L, Sussman S, Unger JB. Cultural and social influences on adolescent smoking dissipate by emerging adulthood among Hispanics in Southern California. J Immigr Minor Health. 2013;17(1):192–7.

    Article  Google Scholar 

  49. Matsuzaka S, Knapp M. Anti-racism and substance use treatment: addiction does not discriminate, but do we? J Ethn Subst. 2019;19(4):567–93.

    Article  Google Scholar 

Download references

Acknowledgements

The restricted-use data used in this manuscript were obtained from the National Addiction and HIV Data Archive Program (NAHDAP) through the Inter-university Consortium for Political and Social Research at the University of Michigan and supported by the National Institute on Drug Abuse. Further information on how to access the restricted use files can be requested through NAHDAP. doi.org/10.3886/ICPSR36231.v30

Funding

This work was supported by the National Cancer Institute of the National Institutes of Health (grant number U54CA229974 to N. L. F.).

Author information

Authors and Affiliations

  1. Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA

    Delvon T. Mattingly, Briana Mezuk & Nancy L. Fleischer

  2. Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, 40536, USA

    Delvon T. Mattingly

  3. Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY, 40536, USA

    Delvon T. Mattingly

  4. Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA

    Michael R. Elliott

  5. Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, 48104, USA

    Michael R. Elliott

  6. Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA

    Harold W. Neighbors

Authors
  1. Delvon T. Mattingly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Briana Mezuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael R. Elliott
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harold W. Neighbors
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nancy L. Fleischer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation and data analysis were performed by Delvon T. Mattingly. The first draft of the manuscript was written by Delvon T. Mattingly, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript for submission.

Corresponding author

Correspondence to Delvon T. Mattingly.

Ethics declarations

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Competing Interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mattingly, D.T., Mezuk, B., Elliott, M.R. et al. Racial and Ethnic Disparities in Mental Health Problems and Tobacco and Cannabis Use Among US Emerging Adults. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01822-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40615-023-01822-z

Keywords

Search

Navigation