Changes in cannabis, tobacco, and alcohol use among sexually active female adolescents and young adults over a twelve-year period ending in 2019

Kathleen Shyhalla, Danielle M. Smith, Angela Diaz, Anne Nucci-Sack, Mary Guillot, Dominic Hollman, Maciej L. Goniewicz, Richard J. O'Connor, Viswanathan Shankar, Robert D. Burk, Nicolas F. Schlecht

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1 Scopus citations


Background: The United States has experienced an increasing divergence in cannabis, tobacco, and alcohol use among adolescents and young adults (AYA). We assessed the changes in cannabis, tobacco and alcohol use in an inner-city population of predominantly minority AYA females attending a large adolescent-specific health center in New York City. Methods: This was a longitudinal study of AYA women recruited and followed over a twelve-year period between 2007 and 2019. Lifetime and past 30-day use were assessed by self-administered questionnaire every six months. In addition, we assessed associations with race, ethnicity, sexual behaviors, receipt of social services, living situation at home (e.g., with or without parents), and use of other drugs. Results: Participants included 1549 AYA females aged 13–21 at baseline, 95% of whom were youth of color. Use of cannabis increased significantly over the twelve-year period, with frequent cannabis use (≥20 times in 30-days) increasing almost 18% per year (OR = 1.18; 95%CI:1.13–1.23). In contrast, past 30-day tobacco use declined over the same period (OR = 0.86; 95%CI:0.83–0.89). Past 30-day cannabis use was more likely among African Americans (OR = 1.33; 95%CI:1.08–1.63), women who had sex with both men and women compared to with men only (OR = 1.44; 95%CI:1.18–1.75), recent users of tobacco (OR = 2.20; 95%CI:1.92–2.52) and alcohol (OR = 2.84; 95%CI:2.52–3.20), and ever users of other drugs (OR = 1.69; 95%CI:1.44–1.99), independent of age, time and living situation. Conclusions: Increasing rates of cannabis use and the association with concurrent tobacco and alcohol use in AYA females underscore the need to screen for unhealthy cannabis use, in addition to tobacco and alcohol, especially among inner-city AYA.

Original languageEnglish
Article number106994
JournalAddictive Behaviors
StatePublished - Oct 2021


  • Adolescent and young adults, alcohol and drug use
  • Adolescent health
  • African American
  • Cannabis or marijuana
  • Hispanic
  • Minorities
  • Risk behaviors
  • Tobacco smoking


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