Graduate Research Assistant Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, South Carolina
Background & Introduction: Tobacco use and stimulant use has been found to frequently co-occur among U.S. adults. The biochemical property of nicotine and stimulants are similar and therefore has been linked to increased vulnerability to stimulant misuse. However, whether this association has changed in recent years amid evolving substance use patterns remains unclear. This study looked at national trends in tobacco use, stimulant use, and their co-use from 2021–2023 using a nationally representative data, and tests the extent to which tobacco use predicts stimulant use over time.
Methods: We analyzed combined 2021–2023 data from the National Survey on Drug Use and Health (NSDUH), a nationally representative survey of the U.S. civilian population. Adults (aged ≥18) were included (N = 173,808). Past-year stimulant use included cocaine, methamphetamine, MDMA, or nonmedical use of prescription stimulants. Past-year tobacco use included any cigarettes, cigars, smokeless tobacco, or nicotine vaping. Co-use was defined as any individual reporting both stimulant and tobacco use in the past year. We calculated weighted prevalence estimates and confidence intervals for each substance and co-use, stratified by year. To test the association between stimulant and tobacco use, we used survey-weighted logistic regression. Temporal trends (including stimulant-by-year interaction), adjusting for sex, age, race/ethnicity, and education was also tested.
Results: Between 2021 to 2023, stimulant use prevalence remained relatively stable (2021: 2.9%; 2022: 3.0%; 2023: 2.8%), while tobacco use declined modestly (2021: 24.7%; 2023: 22.3%). Co-use prevalence was steady (2021: 2.2%; 2023: 2.0%), with no significant linear trend (p > 0.05). Stimulant use was strongly associated with tobacco use (adjusted OR = 8.31; 95% CI: 6.56–10.52; p < 0.001). The stimulant-by-year interaction was not significant (p = 0.26), indicating the strength of this association did not change over time. Predicted probabilities showed parallel tobacco use trends among stimulant users and non-users.
Conclusion & Discussion: While overall tobacco use declined slightly between 2021 and 2023, stimulant use and stimulant-tobacco co-use rates remained stable and the strong association between stimulant use and tobacco use persisted across all three years. These findings suggest that stimulant users have not benefited equally from recent tobacco control progress and remain at high risk for dual substance use. Given the persistent co-use and its link to poorer addiction outcomes, tobacco cessation should be systematically integrated into stimulant use disorder treatment. Simultaneously, tobacco control strategies should include targeted outreach to populations with high stimulant use. Addressing both addictions concurrently could enhance recovery outcomes and reduce broader health risks.
References: 1. Barbosa-Méndez, S. and Salazar-Juárez, A., 2018. Cocaine+ nicotine mixture enhances induction and expression of behavioral sensitization in rats. Journal of Psychiatric Research, 100, pp.88-98. 2.Wang, Z., Bao, Y., Yan, S., Lian, Z., Jia, Z. and Liu, Z., 2014. An Investigation of cigarettes smoking behavior and nicotine dependence among Chinese methamphetamine users in two Provinces. BioMed research international, 2014(1), p.175205. 3.Weinberger AH, Sofuoglu M. The impact of cigarette smoking on stimulant addiction. Am J Drug Alcohol Abuse. 2009;35(1):12-17. doi:10.1080/00952990802326280 4. John, W.S. and Wu, L.T., 2017. Trends and correlates of cocaine use and cocaine use disorder in the United States from 2011 to 2015. Drug and alcohol dependence, 180, pp.376-384.
Disclosure(s):
Gazi Sakir Mohammad Pritom, MBBS, MPH: No financial relationships to disclose
Learning Objectives:
Upon completion, participants will be able to describe the national trends in past-year stimulant use, tobacco use, and their co-use among U.S. adults from 2021 to 2023 using data from the National Survey on Drug Use and Health (NSDUH).
Upon completion, participants will be able to conduct and interpret survey-weighted data analyses to assess associations and temporal trends between stimulant and tobacco use within a nationally representative dataset.
Upon completion, participants will be able to evaluate how demographic and behavioral covariates influence stimulant–tobacco co-use patterns and interpret adjusted odds ratios derived from complex survey analyses.
