Assessing Tobacco Dependence Among Cannabis Users Smoking Cigarettes

Introduction: This study examines the relationship between nicotine exposure and tobacco addiction among young smokers consuming either only tobacco or only tobacco and cannabis. Methods: Data on tobacco and cannabis use were collected by a questionnaire among 313 adolescents and young adults in Western Switzerland between 2009 and 2010. In addition, a urine sample was used to determine urinary cotinine level. Nicotine addiction was measured using the Fagerstrom Test for Nicotine Dependence (FTND). In this study, we focused on a sample of 142 participants (mean age 19.54) that reported either smoking only tobacco cigarettes (CIG group, n = 70) or smoking both tobacco cigarettes and cannabis (CCS group, n = 72). Results: The FTND did not differ significantly between CIG (1.96 +/- 0.26) and CCS (2.66 +/- 0.26) groups (p = 0.07). However, participants in the CCS group smoked more cigarettes (8.30 +/- 0.79 vs. 5.78 +/- 0.8, p = 0.03) and had a higher mean cotinine value (671.18 +/- 67.6 vs. 404.32 +/- 68.63, p = 0.008) than the CIG group. Further, the association between cotinine and FTND was much stronger among the CIG than among the CCS group (regression coefficient of 0.0031 vs. 0.00099, p < 0.0001). Conclusion: Adolescents smoking tobacco and cannabis cigarettes featured higher levels of cotinine than youth smoking only tobacco; however, there was no significant difference in the addiction score. The FTND score is intended to measure nicotine dependence from smoked tobacco cigarettes. Hence, to accurately determine nicotine exposure and the associated dependence among young smokers, it seems necessary to inquire about cannabis consumption.