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. Author manuscript; available in PMC: 2021 Apr 7.
Published in final edited form as: Subst Use Misuse. 2020 Apr 7;55(8):1335–1342. doi: 10.1080/10826084.2020.1741633

Gender Differences in the Association between Marijuana and Menthol Cigarette Use among African American Adult Cigarette Smokers

LaTrice Montgomery a, Monica Webb Hooper b
PMCID: PMC7281863  NIHMSID: NIHMS1593835  PMID: 32253967

Abstract

Introduction:

Despite the strong relationship between marijuana and tobacco use, especially among African American individuals and males, very few studies have examined the association between marijuana and menthol cigarette use. This study was designed to identify the prevalence of past month, past year and lifetime marijuana use and marijuana dependence among menthol and non-menthol cigarette smokers, as well as the association between marijuana and menthol cigarette use among African American female and male cigarette smokers.

Methods:

Data were drawn from 1,173 African American adult cigarette smokers in the 2017 National Survey on Drug Use and Health.

Results:

Overall, 8.8%, 13.9% and 44.7% of African American menthol and non-menthol cigarette smokers reported past month, past year and lifetime marijuana use, respectively. Weighted multivariable logistic regression models revealed a significant interaction between gender and past month marijuana use on menthol cigarette use (AOR = 1.49, 95% CI: 1.21–2.42, p < .05). Past month marijuana use was associated with an increased odds of past month menthol cigarette use (relative to non-menthol cigarette use) among females, but a decreased odds of past of past month menthol cigarette use among males.

Conclusions:

When stratified by gender, marijuana use is differentially related to menthol cigarette use among African American adults. Given the prevalence of menthol cigarette use among this population, it is important to examine factors such as marijuana use that could be targeted in prevention and treatment interventions for African Americans, especially females, who are at risk for smoking or are currently smoking menthol cigarettes.

Implications:

This study found that marijuana use was associated with an increased odds of menthol cigarette use among African American females, while marijuana use was associated with a decreased odds of menthol cigarette use among their male counterparts. The impact of marijuana use on menthol cigarette smoking differs among females and males, highlighting the need for gender-tailored interventions that target marijuana use among African American individuals, especially females, who are at risk for smoking or are currently smoking menthol cigarettes.

Keywords: Marijuana, menthol, cigarettes, sex, African American

Introduction

Tobacco smoking is positively associated with marijuana use in the United States (Strong et al., 2018). Longitudinal evidence indicates a bi-directional relationship between recent marijuana use and tobacco use frequency and quantity, such that use of one substance positively predicts the frequency of the other (Doran et al., 2019). Consequences of tobacco and marijuana co-use include the potential for comorbid dependence (Degenhardt et al., 2010; Timberlake et al., 2007), greater toxicant exposure (Meier & Hatsukami, 2016) and increased morbidity risk (Stewart & Wild, 2014; Strong et al., 2018; Volkow et al., 2014). In addition, marijuana and tobacco co-use is inversely associated with tobacco quit attempts (Strong et al., 2018) and cessation - even among treatment-seekers (Rabin & George, 2015; Vogel et al., 2018).

Menthol cigarettes are associated with lower odds of cessation compared to non-menthol brands (Foulds et al., 2010), and marijuana and menthol cigarette co-use has also increased over time (Schauer et al., 2018). To date, most studies on the concurrent use of marijuana and menthol cigarettes have focused on youth and young adults. There is a significant need, however, to investigate this topic across adult populations (Montgomery et al., 2017), as this has implications for racial/ethnic health disparities. Compared to other racial/ethnic groups, the likelihood of co-use is greater among African Americans (Ramo et al., 2012), even when blunt users are excluded (Schauer et al., 2015). Approximately 28% of African American past month marijuana or tobacco uses report co-use of these substances (Montgomery, 2015). The present study focused on the association between marijuana and menthol cigarette use at the intersection of race and gender.

Few studies have focused on the relationship between marijuana and menthol cigarette co-use. The extant evidence suggests racial and age differences in this association, with greater co-use among African Americans relative to white non-Hispanics, and among whites aged 12–25 years compared to their African American counterparts (Schauer et al., 2018). Menthol cigarette smoking is positively associated with marijuana use relative to non-menthol smokers in various subpopulations, including adolescents (Azagba & Sharaf, 2014; Kong et al., 2013) and smokers in substance use disorder treatment (Gubner et al., 2018). The co-use of marijuana and menthol cigarette smoking has implications for African American smokers in particular, of whom at least three-quarters are menthol cigarette users (Curtin et al., 2014; Munro et al., 2016).

Menthol cigarettes represent 35% of the tobacco market share, a rate which has increased over time (Federal Trade Commission, 2017). Menthol cigarette smoking is associated with greater odds of poor mental health days (Hooper et al., 2011), depression and anxiety (Cohn et al., 2016). Although the evidence is mixed (Sulsky et al., 2014), menthol cigarettes smoking have been associated with lower odds of cessation compared to non-menthol smoking (Delnevo et al., 2011; Foulds et al., 2010), potentially increasing exposure and susceptibility to health problems. The disproportionate use of menthol cigarette use among African Americans has implications for tobacco-related health disparities, as this population faces an undue burden of cancer, cardiovascular disease, cerebrovascular disease, and others (Fagan et al., 2007). Marijuana use may serve as a gateway (i.e. antecedent) to tobacco use, particularly among African Americans (Kennedy et al., 2016). Enhancing our understanding of the menthol cigarette and marijuana use relationship among African Americans is important. This population has greater difficulty quitting smoking, yet are more likely to use mentholated cigarettes and marijuana - both of which are associated with reduced cessation. Menthol facilitates smoking uptake, in part, by masking the harshness of cigarettes making it easier to smoke (Giovino et al., 2004). Moreover, menthol compared to non-menthol smokers in treatment for substance use disorders were more likely to report marijuana use as their primary drug (Gubner et al., 2018), possibly due to the heightened sensory effects of following (or chasing) a marijuana blunt with a cigarette (Ream et al., 2008).

The emerging science of sex and gender based medicine highlights the need to understand biological and behavioral differences between groups. Both marijuana use (Calakos et al., 2017) and tobacco smoking (Allen et al., 2014) studies have identified biological and psychosocial differences between males and females, including variations in routes of administration, sensory effects, and withdrawal symptoms. Moreover, the use of these substances pose dual risks to females, including the potential harms of marijuana and tobacco exposure to the developing fetus (Dong et al., 2019) and infant (Straub et al., 2019; Stroud et al., 2019) among pregnant females and females of childbearing age. Research has also identified gender differences in the prevalence of menthol cigarette and marijuana use. Multiple studies have found that females are more likely to smoke menthol cigarettes than males (Curtin et al., 2014; D’Silva et al., 2012; Gubner et al., 2018). In contrast, marijuana use is more prevalent among males (Carliner et al., 2017). Understanding such differences may help guide targeted treatments, which may be more effective than one-size-fits-all approaches, and equitable guideline-concordant care (Regitz-Zagrosek & Seeland, 2012).

Largely unexamined are gender differences in the association between marijuana and menthol cigarette use among African American adults, despite gender differences found in both marijuana and menthol cigarette use in this population. A scoping review of marijuana and tobacco use treatments indicated an underrepresentation of African American women in the existing literature (Montgomery et al., 2017). This study sought to (1) identify the prevalence of past month, past year and lifetime marijuana use and marijuana dependence among menthol and non-menthol cigarette smokers and (2) assess the association between past month and past year marijuana use and past month menthol cigarette use. Findings will be presented for the overall sample and stratified by gender. Focusing on gender differences in menthol cigarettes and marijuana co-use has the potential to inform intervention and policy.

Methods

Study sample and population

This study uses data collected from the 2017 National Survey on Drug Use and Health (NSDUH). The NSDUH is an annual repeated cross-sectional survey that is designed to provide quarterly and annual estimates of substance use and health status of civilian noninstitutionalized individuals ages 12 years and older in the United States. NSDUH uses a multistage probability sampling design in which larger geographic areas are broke down into sequentially smaller areas before specific households are selected for survey participation. Data were collected from computer-assisted personal interviews and computer-assisted self-interviews in order to increase validity. After the interview, participants were compensated $30 in cash. Details of the multistage sampling strategy and data collection methods are described in the 2017 NSDUH report (Center for Behavioral Health Statistics & Quality, 2018). For the current institutional review board approved study, we used NSDUH data from the 1,173 males (n = 646) and females (n = 527) who (a) self-identified as African American or Black, (b) were 18 years of age or older and (b) reported past month menthol or non-menthol cigarette use.

Measures

Demographics/other substance use

Participants were asked about their demographic (i.e. race, gender, age, family income, education) and past month substance use (i.e. cigar [defined as big cigars, cigarillos and even little cigars that look like cigarettes], alcohol and other illicit drug use [cocaine, heroin, hallucinogens, inhalants, methamphetamine, and prescription pain relievers, sedatives, stimulants or tranquilizers], menthol cigarette use, marijuana use, blunt use, marijuana dependence and nicotine dependence) characteristics.

Marijuana use

Participants were asked “How long has it been since you last used marijuana or hashish?” with the following response options: within the past 30 days, more than 30 days ago but within the past 12 months, more than 12 months ago but within the past 3 years, and never used marijuana. Participants were also asked “How long has it been since you last smoked part or all of a cigar with marijuana in it?”, with the same response options as the aforementioned question. Past month marijuana use was defined as any use of marijuana or hashish in the past 30 days (including the use of blunts). Participants who reported any marijuana or hashish use or blunt use in the past 12 months, but not in the past 30 days, were defined as past year marijuana users. Participants who reported using marijuana or hashish or blunts more than 12 months ago were considered lifetime marijuana users.

Marijuana dependence

Individuals who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) (American Psychiatric Association, 2000) criteria for marijuana dependence were categorized as having past year marijuana dependence.

Menthol cigarette use

Participants were asked, “During the past 30 days, have you smoked part or all of a cigarette?” with the following response options: within the past 30 days, more than 30 days ago but within the past 12 months, more than 12 months ago but within the past 3 years, more than 3 years ago and never used cigarettes. Adults who endorsed cigarette use within the past 30 days were included in the study. Past month cigarette users were also asked “Were the cigarettes you smoked during the past 30 days menthol?” (yes/no). To create the menthol cigarette dependent variable for Aim 2, individuals who reported smoking menthol cigarettes in the past 30 days were defined as past month menthol smokers, while those who endorsed “no” were defined as past month non-menthol smokers.

Nicotine dependence

Participants who met DSM-IV-TR criteria for nicotine dependence, either on the Nicotine Dependence Syndrome Scale (Shiffman & Sayette, 2005) or the Fagerstrom Test of Nicotine Dependence (Degenhardt et al., 2010) Strong et al., (2018) were categorized as having past month nicotine dependence.

Data analysis plan

Survey-weighted descriptive statistics were conducted to assess demographic characteristics of study participants, stratified by gender. To identify the prevalence of marijuana use and dependence among menthol and non-menthol cigarette smokers (Aim 1), chi-square analyses were conducted among males and females. For Aim 2, weighted multivariable logistic regression models were conducted in stages. First, the main effects of sociodemographic variables (e.g. age, education, family income, past month cigar use, past month other illicit drug use, past month alcohol use, nicotine dependence and marijuana dependence), gender, past month and past year marijuana use on menthol cigarette use were tested for females (Model 1a) and males (Model 1 b). In subsequent models, a two-way interaction term for gender and marijuana use was used to examine whether the impact of past month marijuana use (Model 2) and past year marijuana use (Model 3) on menthol cigarette use varied by gender. Significant demographic variables from Models 1a and 1 b were also included as covariates in Models 2 and 3. Weighted data were used to be representative of the U.S. population. Analyses were performed via SPSS Statistics for Windows Complex Samples Module (Version 24).

Results

Demographic characteristics

Table 1 presents the demographic characteristics by gender (N = 1,173; 527 females, 646 males). The majority of participants were between the ages of 18–25 (29.5%) or 26–34(27.1%). Most participants were high school graduates (37.2%) or completed some college (29.8%). Approximately 49% of the sample reported a total family income of less than $20,000 or between $20,000–$49,000 (34.6%). Some participants reported using cigars (5.0%), alcohol (54%), and illicit drug use other than marijuana (2.8%) in the past month. Approximately 1% and 12.9% of the sample reported marijuana dependence and nicotine dependence, respectively.

Table 1.

Demographic characteristics of African American adult cigarette smokers, stratified by gender.

Females 44.9% Unweighted n = 527 % Males 55.1% Unweighted n = 646 % Total 100.0% Unweighted n= 1,173 x2
Age (years)
 18–25 25.2 33.6 29.5 7.40
 26–34 29.2 25.2 27.1
 35–49 29.0 29.0 29.0
 50+ 16.6 12.2 14.3
Education
 Less than high school 22.5 29.3 26.0 8.90*
 High school graduate 38.8 35.7 37.2
 Some college 34.4 25.3 29.8
 College graduate 4.2 9.7 7.0
Family Income
 <$20,000/year 58.8 38.8 48.6 6.21*
 $20,000–$49,000 29.6 39.3 34.6
 $50,0000–$74,999 6.2 7.8 7.0
 v$75,000 or more 5.4 14.1 9.8
Past Month Cigarette Use
 Menthol 82.9 82.7 82.8
 Non-Menthol 17.1 17.3 17.2 3.60
Past Month Cigar Use
 Yes 4.5 5.5 5.0 0.97
 No 95.5 94.5 95.0
Past Month Marijuana Use
Yes 9.7 7.9 8.8 1.44
No 90.3 92.1 91.2
Past Month Other Illicit Drug Use
 Yes 2.7 2.9 2.8 0.16
 No 97.3 97.1 97.2
Past Month Alcohol Use
 Yes 51.2 56.7 54.0 4.12*
 No 48.8 43.3 46.0
Nicotine Dependence
 Yes 12.8 13.0 12.9 0.18
 No 87.2 87.0 87.1
Marijuana Dependence
 Yes 0.2 1.0 0.6 3.81
 No 99.8 99.0 99.4
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Note.

1

Percentages are weighted, n’s are not.

2*

p < .05,

**

p < .01.

African American males were more likely to be college graduates than their female counterparts, x2 (1, 3) = 8.90, p < .05. Males were also more likely to report higher levels of family income relative to females, x2 (1, 3) = 6.21, p < .05. Past month alcohol use was higher among males compared to females, x2 (1, 1) = 4.12, p < .05.

Prevalence of marijuana use among cigarette smokers, by gender (aim 1)

Among the overall sample of African American past month cigarette smokers, (N = 1,173), 8.8%, 13.9% and 44.7% reported past month, past year and lifetime marijuana use, respectively. Marijuana dependence was reported by 0.6% of the sample. When the overall sample was stratified by gender, 9.7%, 13.8%, and 42.3% of females reported past month, past year and lifetime marijuana use, respectively. Among males, 7.9% 14.0%, and 47.0% reported past month, past year and lifetime marijuana use, respectively. Marijuana dependence was reported by 1.0% of males and 0.2% of females in the overall sample.

Among female past month menthol cigarette smokers,10.1%, 14.4%, and 42.0% reported past month, past year and lifetime marijuana use, respectively. Less than 1% (0.2%) reported marijuana dependence. Among female past month non-menthol cigarette smokers, 7.9%, 10.9% and 44.2% reported past month, past year and lifetime marijuana use, respectively. None of the female non-menthol cigarette smokers reported marijuana dependence.

Among male past month menthol cigarette smokers,7.0%, 12.8% and 46.0% reported past month, past year and lifetime marijuana use, respectively. Approximately 1% (1.2%) reported marijuana dependence. Among male past month non-menthol cigarette smokers, 12.3%, 19.8% and 51.6% reported past month, past year and lifetime marijuana use, respectively. None of the male non-menthol cigarette smokers reported marijuana dependence. There were no significant differences by gender in the prevalence of marijuana use and dependence among menthol and non-menthol cigarette smokers.

Associations between marijuana use and menthol cigarette use (aim 2)

Among African American females (Model 1 b), none of the variables were significantly associated with menthol cigarette use. Among African American males (Model 1 b), younger age (Odds Ratio [OR] = 0.84, 95% CI: 0.72–0.98, p < .05) was associated with an increased odds of menthol cigarette use. As displayed in Table 2, to assess the impact of past month use marijuana use on menthol cigarette use by gender (Model 2), age, gender, past month marijuana use and interaction terms (i.e. gender by age, age by past month marijuana use, gender by past month marijuana use) were included in the model. Older age (AOR = 0.71, 95% CI:0.45–0.93, p < .05) was inversely related to past month menthol cigarette use. The interaction between gender and past month marijuana use was also significant (AOR = 1.49, 95% CI: 1.21–2.42, p < .05). Specifically, past month marijuana use was associated with an increased odds of past month menthol cigarette use (relative to non-menthol cigarette use) among females, but a decreased odds of past of past month menthol cigarette use among males. No other significant differences were found for the main effect of gender or past month marijuana or the interaction between gender and age.

Table 2.

Predictors of past month menthol cigarette use among African American cigarette smokers (N = 1,173).

Variable AOR [95% CI] p
Age 0.71 0.45–0.93 <.05
Gender 1.23 0.91–1.95 0.78
Past Month Marijuana Use 1.31 0.83–2.05 0.34
Age*Gender 2.87 0.56–3.29 0.41
Age*Past Month Marijuana Use 1.34 0.81–2.05 0.54
Gender*Past Month Marijuana Use 1.49 1.21–2.42 <.05
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Note. Age (referent category = 18–25 compared to 26–34, 35–49 and 50+); gender (referent category = males); Past Month Marijuana Use (referent category = no use).

A similar model was conducted for past year marijuana use (Model 3). Similar to Model 2, there was an inverse relationship between age and past month menthol cigarette use (AOR = 1.26, 95% CI: 1.18–2.39, p < .05). No other significant differences were found for the main effect of gender or past year marijuana use or the interaction effects of gender and age and gender and past year marijuana use.

Discussion

Current research suggests that females are more likely than their male counterparts to smoke menthol cigarettes (Smith et al., 2017), while males are more likely than females to use marijuana (Carliner et al., 2017). Given these gender differences and the high prevalence of co-occurring marijuana and tobacco use among African Americans (Schauer et al., 2015), it is important to examine if the relationship between marijuana use and tobacco use, especially menthol cigarettes, varies by gender among African Americans. The current study found that marijuana use was prevalent among African American male and female menthol cigarette smokers, especially those between the ages of 18–34. Moreover, marijuana use was associated with an increased odds of menthol cigarette use among females and decreased odds of menthol cigarette use among males.

Marijuana use is equally prevalent among both African American male and female menthol and non-menthol cigarette smokers. Although only 0.6% of the overall sample reported marijuana dependence, possibly due to state marijuana policies or relaxed attitudes toward marijuana, 1.2% of African American male menthol cigarette smokers were dependent on marijuana (albeit not statistically significant from their female counterparts). Although this represents a very small number of cases in the current sample, the prevalence of marijuana dependence is important to monitor among males given that males are at a higher risk than females of developing Cannabis Use Disorders (CUD) (Ehlers et al., 2010), potentially due to risk factors such as environmental circumstances (e.g. lower socioeconomic status) (White et al., 2015) and genetic vulnerabilities (Xian et al., 2008). The legalization of both medical and recreational marijuana use in many states across the country has been linked to more positive attitudes and willingness toward marijuana use (Clarke et al., 2018). The rates of marijuana use have significantly increased from 4% in 1969 to 45% in 2017 (Swift, 2017), and is likely to continue growing over time. It is important to monitor the prevalence of marijuana use and dependence among tobacco users, as the dual use of marijuana and tobacco is associated with poor outcomes (e.g. psychiatric health problems) relative to the single use of those products (Peters et al., 2014).

Interestingly, marijuana use was associated with an increased odds of menthol cigarette use among African American female cigarette smokers and a decreased odds of menthol cigarette use among African American male cigarette smokers. Although additional research is needed to fully disentangle this gender difference, a few explanations are plausible. First, several preclinical studies have shown that females have greater CB1 agonist receptor availability (Normandin et al., 2015), thereby suggesting that females are more sensitive than males to the therapeutic and adverse effects of CB1 agonists, such as tetrahyrdocannabinol (THC), the primary psychoactive component in marijuana. It is possible that this sensitivity to CB1 in females increases their risk of using other substances, such as menthol cigarettes. In fact, one study posits that the endocannabinoid system, which includes receptors such as CB1, is also involved in modulating the use and misuse of other substances, including nicotine (Scherma et al., 2008). Additional research is needed to assess potential gender differences in other receptors, such as transient receptor potential channel melastatin 8 (TRPM8) (Willis et al., 2011) that have been implicated in menthol cigarette use and might contribute to the link between marijuana use and increased menthol cigarette use among African American females.

Second, females have a stronger preference for flavors than males (Hinds et al., 2018). The subjective cooling and soothing effect of menthol cigarettes might help mask the unpleasant flavor and smell of marijuana, thereby making the dual use of both products more appealing for females. Moreover, African Americans are more likely than other racial/ethnic groups to smoke blunts (Schauer et al., 2018). Flavored cigars, including menthol flavored cigars or cigarillos, are often used to make blunts (Chen-Sankey et al., 2019). It is possible that exposure to flavors in products used to make blunts reinforces the use of other flavored products, such as menthol cigarettes. The use of flavors in cigars and cigarettes might increase the chances of females engaging in blunt chasing. Additional research is needed to support these claims.

Third, the increased use of marijuana and menthol cigarette use might be influenced by psychosocial factors that are uniquely experienced by females. For instance, marijuana and tobacco co-use among pregnant women is prevalent (3.3% between 2005 and 2014) (Coleman-Cowger et al., 2017). Women have reported using marijuana during pregnancy to treat nausea, anxiety and pain (Dickson et al., 2018). Further, pregnant women have described smoking cigarettes as a source of freedom and as a means to cope with stress (Acquavita et al., 2017). Additional studies are needed to assess how expectancies and other psychosocial factors, such as depression and fear of weight gain, may contribute to increased use and risks for marijuana and menthol cigarette use among women.

Although this study has several strengths (e.g. use of a national dataset, focus on gender differences in menthol cigarette use among African Americans), a few limitations should be noted. First, the cross-sectional nature of the NSDUH survey limits the ability to infer causation. Second, the NSDUH does not assess flavored tobacco product use, except for past month menthol cigarette use. Therefore, it is unclear if and to what extent flavored tobacco products were used to make blunts, making it difficult to determine if the use of flavored cigars or cigarillos reinforces the use of menthol cigarettes. Further, additional research is needed on the pattern of marijuana and menthol cigarette use. For example, it is unclear if respondents used marijuana and smoked menthol cigarettes on the same or separate occasions, or if one product was substituted for the other at any point of use. Third, the NSDUH survey does not assess the consumption method of marijuana among participants, except for blunt use. In a qualitative study of adults who reported using a marijuana vaporizer, some participants reported combining tobacco with marijuana when they smoked marijuana (Malouff et al., 2014). Therefore, it is plausible that the consumption method of marijuana might impact if and how adults use tobacco products, such as menthol cigarettes. Future studies should explore this relationship further.

Despite these limitations, findings from this study underscore the public health impact of marijuana and its role in menthol cigarette smoking among African Americans. Although several studies have described potential mechanisms that contribute to marijuana and tobacco co-use (Agrawal et al., 2012; Rabin & George, 2015), more work is needed to focus on factors that might specifically reinforce the use of marijuana and menthol cigarettes, such as flavors, especially among young African American females. This study also highlights the importance of examining gender differences in correlates of menthol cigarette use. Given that marijuana is associated with an increased odds of menthol cigarette use among African American females, tobacco interventionists should consider screening for and addressing marijuana use in the prevention and treatment of menthol cigarette use in this subgroup. Intervention efforts for menthol cigarette use among African American women should focus on improving factors that have been associated with increased use of marijuana specifically among women, such as the perception of harm from marijuana and influence from family members to use marijuana (Oser et al., 2019).

Similarly, factors that are associated with an increased use of marijuana among African American men (e.g. discrimination) (Parker et al., 2017) should be considered in tobacco prevention and treatment interventions. It is plausible that African American men use marijuana to cope with social and contextual issues such as discrimination. African American men may also use cigarettes to cope with stress associated with experiences of discrimination (Parker et al., 2017), but African American males are more likely than African American females to initiate marijuana use before tobacco use. Therefore, males might be more likely to experience stress relief upon using marijuana, especially when consumed in a flavored-wrapped blunt that exposes users to nicotine and flavors, thereby mitigating urges to also smoke menthol cigarettes. On a similar note, it possible that African American males are more likely than women to substitute menthol cigarette use with marijuana use. Additional research is needed to determine how marijuana use decreases the odds of menthol cigarette use among African American males, as it may increase our understanding of how gender influences the relationship between these two products and inform evidence-based treatments and messaging for public health initiatives. As marijuana legalization and positive attitudes toward marijuana use increases across the country, it will be important to continue to identify how marijuana use impacts the use of other substances, such as tobacco. Findings emphasize the need for gender-tailored interventions that target marijuana use among African American individuals, especially females, who are at risk for smoking or are currently smoking menthol cigarettes.

Funding

Effort for this project was supported by the National Institute on Drug Abuse K23DA042130 (PI Montgomery). The ideas and data in this study have not been previously disseminated.

Footnotes

Declaration of interest

The authors report no conflict of interest.

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