title: Patterns of marijuana and tobacco use associated with suboptimal self-rated health among US adult ever users of marijuana.
abstract: The purpose of this study was to examine the patterns of marijuana and tobacco use and their associations with suboptimal self-rated health (SRH) among US adults who reported "ever, even once, using marijuana or hashish." Data came from the 2009-2012 National Health and Nutrition Examination Survey, restricting to respondents aged 20 years and older who reported using marijuana at least once in their lifetime (n = 3,210). We assessed the age-adjusted prevalence of mutually exclusive groups of regular (at least once a month for more than one year) and non-regular marijuana smoking by current (serum cotinine ≥ 3.08 ng/mL) and not current use of tobacco. Suboptimal SRH status was defined as "fair" or "poor" in response to the question "Would you say that in general your health is excellent, very good, good, fair, or poor?" We produced prevalence ratios with multivariable log-linear regression models. Among ever users of marijuana, the age-adjusted prevalence of regular marijuana smoking with current tobacco use, non-regular marijuana smoking with current tobacco use, and regular marijuana smoking without current tobacco use was 24.7%, 15.2%, and 21.1%, respectively. When compared to non-regular marijuana smokers without current tobacco use, the adjusted prevalence ratio for reporting suboptimal SRH was 1.98 (95% CI: 1.50-2.61), 1.82 (95% CI: 1.40-2.37), and 1.34 (95% CI: 1.05-1.69), respectively. In conclusion, among adult ever users of marijuana, current tobacco use is high and strongly associated with suboptimal SRH; regular marijuana smoking with or without current tobacco use is significantly associated with suboptimal SRH.
authors.affiliation: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Tsai
authors.affiliation: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Italia V
authors.initials: IV
authors.lastname: Rolle
authors.affiliation: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education, and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Tushar
authors.initials: T
authors.lastname: Singh
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Sheree L
authors.initials: SL
authors.lastname: Boulet
authors.affiliation: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: McAfee
authors.affiliation: Office of Non-communicable Disease, Injury, and Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Althea M
authors.initials: AM
authors.lastname: Grant
keywords: Cannabis; Cotinine; Hashish; Marijuana; Self-rated health; Tobacco