Trends in Cannabis and Tobacco Use by Racial and Ethnic Groups Among US Youth: 1991-2021

ObjectivesTo examine the temporal trends of current cannabis use only, tobacco use only, and co-use of these two substances by racial and ethnic adolescent groups.MethodsData were drawn from the 1991-2021 Youth Risk Behavior Surveys (YRBS) (n = 234,572) to examine changes in cannabis and tobacco use among American Indian or Alaskan Native (AI/AN), Asian, Black, Hispanic/Latino (H/L), Native Hawaiian or other Pacific Islander only (NH/PI), White, and multi-racial high school students. Multivariable logistic regressions were performed to examine racial and ethnic disparities in current cannabis and tobacco use across four equal interval periods (i.e., 1991-1997, 1999-2005, 2007-2013, 2015-2021).ResultsDuring 2015-2021, Black (12.6% (95% CI11.3-13.9%)), H/L (9.0% (7.9-10.1%)), and multi-racial (8.8% (7.3-10.3%)) adolescent reported higher prevalences of cannabis-only use than whites (4.9% (4.4-5.5%)), while AI/AN (20.1% (15.1-25.2%)) reported higher prevalence of tobacco and cannabis co-use than whites (13.4% (12.2-14.5%)). The prevalence of cannabis-only use was highest among Black adolescents and increased from 10.8% (9.3-12.2%) in 1991-1997 to 12.6% (11.3-13.9%) in 2015-2021 (linear trend, p = .004), while AI/AN adolescents maintained the highest prevalences of cannabis and tobacco co-use across last three decades (p = .17) with 23.0% (16.6-29.4%) in 1991-1997 to 20.1% (15.1-25.2%) in 2015-2021. As compared to their White counterparts, Black and H/L adolescents consistently exhibited higher prevalences of reporting cannabis-only use, but lower tobacco-only use; AI/AN adolescents had higher cannabis-tobacco co-use and Asian adolescents reported lower cannabis and tobacco use.ConclusionsThese disparities highlight the importance of public health programs addressing diverse substance use behaviors across racial and ethnic groups. There is a need for early prevention and tailored interventions to reduce cannabis-only use among Black adolescents and tobacco-cannabis co-use among American Indian/Alaskan Native adolescents.