A preliminary investigation of physical and mental health features of cannabis & nicotine co-use among adolescents and young adults by sex

Introduction: Cannabis and nicotine/tobacco products (NTP) are commonly co -used in adolescence and young adulthood; however, limited research has been done on predictive health behaviors to co -use. The current study is a preliminary investigation into the relationships of modifiable health behaviors on cannabis and NTP co -use in adolescents and young adults. Method: 221 participants (ages 16-22) were characterized into cannabis use only (N = 55), NTP use only (N = 20), cannabis and NTP co -use (used cannabis and NTP; N = 96) and control (no use; N = 50) groups based on past 30 -day use. Self -report measures for physical activity, sleep quality, mental health, and reward responsivity were utilized. Participants were given a comprehensive neurocognitive battery. Logistic regressions of self -report measures and fluid intelligence composite scores on substance use group status were run stratified by sex. Results: Higher approach reward sensitivity traits were associated with increased likelihood of cannabis use only (Odds Ratio (OR) = 1.15, p = .036) in female participants. Increased aerobic activity was associated with decreased likelihood of cannabis use only (OR = 0.91, p = .047) and cannabis and NTP co -use (OR = 0.88, p = .007) in female participants. Higher anxiety was associated with increased likelihood of cannabis NTP co -use (OR = 1.51, p = 0.025) in male participants. Discussion: Several health behaviors were linked with cannabis use and cannabis and NTP co -use in both females and male adolescents and young adults. Health markers differed by sex suggesting differing mechanisms of substance co -use. This study informs targetable health behaviors for prevention and intervention efforts.