title: Characterizing substance use and mental health profiles of cigar, blunt, and non-blunt marijuana users from the National Survey of Drug Use and Health.
abstract: BACKGROUND
  Smoking marijuana in a cigar (blunt use) is gaining popularity in the U.S. Research suggests that blunt users differ from exclusive cigar or marijuana users on a variety of demographic and substance use factors. Misreporting of blunts and cigars is also common, particularly among young people, and may lead to inaccurate prevalence estimates. To determine subtype differences, this study investigated the prevalence and demographic, mental health, and substance use correlates of four mutually-exclusive groups of blunt, cigar, and marijuana past 30-day users (cigar-only, blunt-only, non-blunt marijuana, or dual cigar-blunt).
  
  
  METHODS
  Data were analyzed from the 2013 National Survey of Drug Use and Health.
  
  
  RESULTS
  In weighted multinomial logistic regression models, respondents who were younger, Black, and who had used tobacco, alcohol, or other drugs in the past 30-days had the highest odds of reporting blunt-only or dual cigar-blunt use. Those reporting blunt-only and dual cigar-blunt use also endorsed a greater number of marijuana and alcohol use disorder symptoms compared to those reporting cigar-only and non-blunt marijuana use. Lower marijuana risk perceptions were associated with increased odds of marijuana use with or without blunts. Major depressive episode was uniquely associated with non-blunt marijuana use. With respect to misclassifiers, respondents who reported past 30-day blunt use but not past 30-day marijuana use were younger, Black, female, and had lower education and income.
  
  
  CONCLUSIONS
  Those who report blunt-only and dual cigar-blunt use showed the most severe risk profiles. Communicating health consequences and risks of blunt use should be directed toward specific subgroups.
authors.affiliation: Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA; Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, USA. Electronic address: acohn@truthinitiative.org.
authors.forename: Amy
authors.initials: A
authors.lastname: Cohn
authors.affiliation: Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Johnson
authors.affiliation: Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ehlke
authors.affiliation: Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Villanti
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D044383:Black People; D002648:Child; D003865:Major Depressive Disorder / Q000523:psychology; D005260:Female; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology / Q000523:psychology*; D008385:Marijuana Smoking / Q000453:epidemiology / Q000523:psychology*; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D008875:Middle Aged; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D019966:Substance-Related Disorders / Q000523:psychology; D011795:Surveys and Questionnaires; D062789:Tobacco Products; D014481:United States / Q000453:epidemiology; D055815:Young Adult; D001741:Black or African American
keywords: Alcohol; Blunts; Cigars; Harm perceptions; Marijuana; Tobacco