Heavy Alcohol Consumption Related With Tobacco Use, Mediated by Marijuana Use

man holding glass of brown liquor, alcohol
The researchers investigated the relationship between heavy alcohol consumption and tobacco to see if their use might be mediated by marijuana use.

The relationship between heavy alcohol consumption and tobacco use may be mediated by marijuana use. These findings were published in Addictive Behaviors.

Data for this study were sourced from the 2020 Behavioral Risk Factor Surveillance System (BRFSS). Adults (N=157,138) residing in the United States were surveyed about substance use. The primary outcome was the past-month interaction between heavy alcohol use and tobacco and marijuana use. Heavy alcohol consumption was defined as >14 or 7 drinks per week for men and women, respectively.

The study population comprised 56.5% women, 57.0% were aged ≥45 years, 61.5% were White, 6.8% used marijuana, and 4.7% had heavy alcohol use. Stratified by type of cigarette use, all demographic characteristics differed (all P <.001).

E-cigarette use in the past month was associated with 18 to 24 years of age (adjusted odds ratio [aOR], 22.38), 25 to 34 years of age (aOR, 5.45), 34 to 44 years of age (aOR, 2.52), past-month marijuana use (aOR, 15.77), heavy alcohol consumption (aOR, 3.91), having 16 to 30 mental distress days (aIR, 3.42), and 1 to 15 mental distress days (aOR, 1.88).

Cigarette use was associated with past-month marijuana use (aOR, 4.89), heavy alcohol consumption (aOR, 3.02), 16 to 30 mental distress days (aOR, 1.73), having 3 or more chronic health conditions (aOR, 1.62), non-Hispanic multiracial ethnicity (aOR, 1.52), current smokeless tobacco use (aOR, 1.47), age 35 to 44 years (aOR, 1.46), and among men (aOR, 1.30).

Co-use of e-cigarettes and cigarettes was more likely among individuals aged 18 to 44 years, men, those who were divorced or separated, gay, with mental distress, 3 or more health conditions, current smokeless tobacco use, past-month marijuana use, and heavy alcohol use. Co-use was less likely among individuals earning ≥$50,000 annually, with education beyond high school, and among Black and Hispanic individuals.

The association between heavy alcohol consumption and tobacco use was modified by past-month marijuana use (all P ≤.011), in which marijuana users who were heavy alcohol consumers were more likely to use e-cigarettes (aOR, 1.88), cigarettes (aOR, 2.07), and both e-cigarettes and cigarettes (aOR, 2.82).

This study may have been limited by not adjusting for other types of tobacco use, such as cigars and hookahs or for types of alcohol.

The study authors concluded, “Our findings extend the literature on heavy alcohol consumption and e-cigarette/cigarette use. US adults who engage in heavy alcohol consumption had higher odds of current e-cigarette, cigarette, and dual use. In addition, the findings indicate that these associations were modified by past-month marijuana use. Longitudinal research could explore and disentangle the temporal associations of heavy alcohol consumption with current e-cigarette, cigarette, and dual use, including the role of marijuana use on these associations and the implications for public health regarding the adverse effects of their co-use on health.”


Osibogun O, Erinoso O, Gautam P, Bursac Z, Osibogun A. Marijuana use modifies the association between heavy alcohol consumption and tobacco use patterns among US adults: findings from behavioral risk factor surveillance system, 2020. Addict Behav. 2022;135:107435. doi:10.1016/j.addbeh.2022.107435