Interviews explore why young adults combine tobacco and cannabis

INTRODUCTION: Commercial tobacco and cannabis use in American Indian populations are disproportionately high compared to non-American Indian groups, and a nuanced understanding of patterns, contexts, and motivations for co-use of these products is needed. METHODS: American Indian young adults (N = 52, ages 21-29) in California currently using commercial tobacco and cannabis participated in a community-engaged study where they completed in-depth interviews about their commercial tobacco and cannabis use between 2023 and 2024. RESULTS: Participants co-used commercial tobacco and cannabis to tailor psychoactive effects (e.g., alertness from nicotine and relaxation from cannabis). Social factors influenced co-use patterns. Some participants reported using certain products like vapes or blunts to facilitate bonding in social settings. Products were commonly shared, and their use often involved taking multiple hits from the same device or product. Co-use routines also depended on participants' responsibilities for the day, including caregiving and working, or considerations for public environments. For some, mixing commercial tobacco and cannabis was a cost-saving strategy. CONCLUSIONS: Co-use is complex and contextual, often influenced by multiple factors, including psychoactive effects, social settings, and day-to-day responsibilities. Future interventions addressing co-use among American Indian individuals should address cravings and environmental and behavioral cues, social contexts, and promote alternative coping strategies.