Why We Think it’s Important
This article is important because it highlights the mental health risks associated with concurrent tobacco and cannabis use among youths, emphasizing the need for targeted public health strategies and integrated treatment approaches to address both substance use and mental health concerns.
Introduction
A recent study investigated whether the simultaneous use of tobacco and cannabis among youths is associated with higher levels of mental health problems than using either substance alone. The study involved a national sample of 5,585 youths aged 14 to 17 years and found that those who used both substances had a significantly higher risk of externalizing problems, such as impulsivity or conduct issues, compared to those who used only tobacco or cannabis. In the context of psychology and mental health, internalizing and externalizing problems describe two different categories of behavioral and emotional issues, particularly in children and adolescents.
- Internalizing Problems refer to inward-directed behaviors and emotional struggles. These include issues like anxiety, depression, withdrawal, and somatic complaints (e.g., unexplained physical symptoms). Internalizing problems are typically less visible because they involve internal emotional distress rather than outward behaviors.
- Externalizing Problems involve outward-directed behaviors that may be disruptive to others or violate social norms. These include issues such as aggression, impulsivity, rule-breaking, and hyperactivity. Externalizing behaviors are often more noticeable and can lead to conflicts with peers, family, and authority figures.
Key Findings
The study categorized substance use into four groups: concurrent use of tobacco and cannabis, tobacco-only use, cannabis-only use, and no use of either substance. The researchers found that youths who used both tobacco and cannabis in the past month reported the highest levels of mental health issues. Youths who used both tobacco and cannabis in the past month were nearly twice as likely to experience externalizing problems compared to those who used only one of the substances. However, there was no significant difference in internalizing problems (such as anxiety or depression) between the concurrent use group and those who used only one substance.
Study Design and Methods
The data for this cross-sectional study came from the Population Assessment of Tobacco and Health (PATH) Study, which surveyed US youths aged 14 to 17 years between March and November 2021. The study used self-reported data from participants about their substance use and mental health. Mental health problems were measured based on self-reports of internalizing and externalizing symptoms, categorized into low, moderate, and high levels.
Results
- The prevalence of concurrent use (3.4%) was slightly lower than tobacco-only use (3.9%) but higher than cannabis-only use (2.5%).
- Youths who used both tobacco and cannabis reported the highest levels of mental health issues. Among the concurrent use group, 47.4% experienced high levels of internalizing problems, and 61.6% reported high levels of externalizing problems.
- After controlling for various factors, the odds of reporting higher levels of externalizing problems were significantly higher among youths who used both substances, compared to those who used only tobacco or cannabis.
Implications
These findings suggest that the combination of tobacco and cannabis use may have an additive effect on mental health problems, particularly externalizing issues. Given the increasing use of these substances among youths, the study highlights the need for integrated mental health support and substance use treatment. This could help address both the mental health problems and the substance use in youths simultaneously.
Conclusion
This research sheds light on the potential risks of concurrent tobacco and cannabis use in youths, particularly regarding externalizing mental health problems. It calls for targeted interventions that address both mental health and substance use to better support young people’s well-being. By focusing on both aspects, healthcare providers can offer more effective treatment and prevention strategies for youths at risk.
“Concurrent Use of Tobacco and Cannabis and Internalizing and Externalizing Problems in US Youths.” (V. V. Do, et al., JAMA Netw Open, 2024)
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820706
