What topics does this cannabis study cover?

This study covers research on: Mental Health, Addiction.

Where was this research published?

Published in Addictive behaviors on May 4, 2026.

Mental Health Addiction

Cannabis use now surpasses tobacco among U.S. teenagers

Changing Norms, Changing Risks: Adolescent Cannabis Use Surpasses Tobacco in the United States.

Addictive behaviors • May 4, 2026 • Moderately Relevant

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AI Summary

This groundbreaking national study reveals a significant shift in adolescent substance use patterns across the United States. Using data from 2015 to 2023, researchers found that cannabis use among teenagers has now surpassed tobacco use, with cannabis-only use increasing from 3.8% in 2015 to 5.1% in 2023, while tobacco-only use and co-use declined substantially. The most dramatic changes occurred among older adolescents (ages 16-17), who showed consistently higher rates of cannabis use compared to younger teenagers. These shifts coincided with rapid expansion of adult-use cannabis legalization across U.S. states, which appears to have altered how adolescents perceive and experience cannabis—viewing it as less risky than previous generations.

The research highlights concerning parallels to the early tobacco epidemic, when youth uptake surged before the full health consequences were understood. Older adolescents were 10.9-16.0 percentage points more likely to use cannabis-only compared to younger teens, suggesting age-specific vulnerability patterns. Post-pandemic data (2021-2023) also revealed that Medicaid-insured adolescents were significantly more likely than privately insured peers to use cannabis exclusively, pointing to potential socioeconomic disparities in cannabis access and use patterns during policy shifts.

Public health experts emphasize that these findings demand urgent action. As cannabis legalization continues evolving across the country, prevention strategies must be recalibrated to address changing youth perceptions of cannabis risk. Researchers call for enhanced risk communication specifically targeting adolescents, integration of cannabis prevention into existing tobacco control programs, and careful monitoring of long-term health consequences. The study underscores that without proactive public health responses, cannabis could follow tobacco's historical trajectory of widespread youth adoption followed by decades of health consequences.

📄 Original Abstract

Rapid expansion of adult-use cannabis legalization in the U.S. altered adolescents' exposure to and perceptions of cannabis risk. Early initiation of cannabis use may increase dependence vulnerability and long-term health consequences, echoing early tobacco diffusion before its harms were fully recognized. This study examines national trends in tobacco and cannabis use and co-use among U.S. adolescents, identifying demographic groups experiencing most pronounced shifts. Using nationally representative data from 2015 to 2023 National Survey on Drug Use and Health, we assessed past-30-day cannabis-only use, tobacco-only (cigarettes, cigars, pipes, and smokeless tobacco) use, and co-use among adolescents aged 12-17. Trends were examined across pre-pandemic (2015-2019), pandemic onset (2020), and post-pandemic (2021-2023) periods. Multivariable logistic regression models estimated sociodemographic predictors. Cannabis-only use predominated throughout the study period, increasing from 3.8% in 2015 to 5.1% in 2023. Conversely, tobacco-only use and co-use declined. Largest increase in cannabis-only use and sharpest decline in tobacco-only use occurred among older adolescents (16-17), consistently exhibiting higher probabilities of cannabis-only use than younger adolescents (AMEs between 10.9-16.0 percentage-points). Post-pandemic, Medicaid-insured adolescents were significantly more likely than privately insured peers to use cannabis-only (AME = 1.1 percentage-points; 95% CI: 0.1, 2.0). Cannabis use prevalence surpassed tobacco use prevalence as the dominant substance among U.S. adolescents. These patterns resemble tobacco uptake in early stages, underscoring the urgency of recalibrating youth prevention strategies. As cannabis policy continues to evolve, public health responses must prioritize adolescent-focused risk communication, integrate cannabis prevention into existing tobacco control infrastructures, and anticipate long-term population health consequences.

Paper Type

📄 Research

Publication

Journal: Addictive behaviors
Published: May 4, 2026
PMID: 42096868
DOI: 10.1016/j.addbeh.2026.108731

Authors (2)

Joanne Constantin Department of Health Policy and Management, School of Public Health, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY, United States. Electronic address: Joanne.Constantin@downstate.edu.
Jayani Jayawardhana Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY, United States.