Is it “Loud” Enough?: A Qualitative Investigation of Blunt Use among African American Young Adults

Abstract

Heavy blunt use is common among young adult cannabis users, especially African Americans. This exploratory qualitative study aimed to examine how African American young adults understand, talk about and experience their blunt use. Semi-structured interviews were conducted with adults reporting daily or almost daily blunt use in the past month (N = 20; 75% male). Thematic analysis of the audio-recorded interviews revealed aspects of how blunts are described, made and used among heavy blunt users. The three emergent themes have implications for the assessment of cannabis use and intervention development for heavy blunt users.

INTRODUCTION

The concurrent use of cannabis and tobacco has become increasingly prevalent among young adults in the United States (Lemyre, Poliakova, & Belanger, 2019; Ramo, Liu & Prochaska, 2012), partly due to the use of co-administered products such as blunts (Schauer, Rosenberry, & Peters, 2017). Blunts are partially or entirely hollowed out cigars that are filled with cannabis (Fairman, 2015; Schauer et al., 2017). Blunt smokers have an increased risk of developing nicotine and cannabis dependence relative to non-blunt cannabis smokers (Timberlake, 2009; 2013). Blunt smoking is also associated with an increased odds of tobacco product initiation (Mayer, Kong, Barrington-Trimis et al., 2019) and current cigar use (Audrain-McGovern, Rodriguez, Alexander et al., 2019). Although research is limited, blunt smoking has also been linked to an increase in carbon monoxide levels, which are strongly connected to cardiovascular and pulmonary diseases (Cooper & Haney, 2009).

Research suggests that blunt use may be more prevalent among African Americans. In a nationally representative sample of 12–25 year olds (Delnevo et al., 2011) and in individuals aged 12 and older (Cohn, Johnson, Ehlke et al., 2016), the prevalence of past month blunt use was found to be approximately 5%. Among African Americans, the prevalence of past month blunt use ranged from 8.3% in a nationally representative sample of adults (Montgomery & Mantey, 2017) to 14.1% among a community sample of adults who reside in California (Corral, Landrine, Simms et al., 2013). Moreover, 73.2% of African American past month cannabis users reported smoking blunts in the past month (Montgomery & Bagot, 2016). Several reasons have been cited for an increased use of blunts among African Americans, such as aggressive marketing of little cigars and cigarillos (LCCs) in minority communities and a higher likelihood of having a friend who smokes blunts relative to other racial/ethnic groups (Kong, Queen, Golden et al., 2020; Sinclair, Foushee, Pevear et al., 2012; Ribisl, D’Angelo, Feld et al., 2017).

Given the high prevalence of blunt use among African Americans, it is important to better understand its use in this population. Although the literature on blunt use is limited (Schauer et al., 2017), a small number of available studies have explored racial/ethnic differences in outcomes or have focused exclusively on African Americans (e.g., Cohn et al., 2016; Montgomery & Mantey, 2018; Sinclair et al., 2012). These studies have revealed the prevalence and correlates (e.g., younger age, cigarette and illicit drug use; Montgomery & Mantey, 2018) of blunt use behaviors among African Americans, but only one qualitative study highlights the nuances associated with blunt use in this population. In qualitative interviews with young African American men who were current or former users of LCCs, participants revealed that they often use cigarillos to make blunts and that the use of blunts was perceived to be less harmful and addictive than cigarettes because the loose tobacco is removed (Koopman-Gonzalez, Cofie, & Trapl. 2017). In other qualitative studies that were not restricted to African Americans but had a fairly large proportion of African Americans in the sample (80%; Antognoli, Cavallo, Trapl et al., 2018; 60%; Sterling, Fryer, & Fagan, 2016), participants also reported commonly using LCCs, especially flavored products, to make blunts.

Existing research has provided insights into blunt use, but important gaps in the literature remain. First, many of the interviews and focus groups were conducted with adult LCC users. Therefore, some of the participants in these samples may have never smoked blunts or may not identify themselves as a blunt smoker even if they have a history of smoking blunts (Delnevo, Bover-Manderski, & Hrywna, 2011). Second, qualitative studies on blunt use have primarily captured the experiences of non-African American populations (e.g., Dickinson et al., 2016; Kelly, 2005; Sifaneck et al., 2005). It is unclear how African American young adults who are disproportionately represented among blunt users talk about their blunt use. Third, no qualitative or quantitative studies focus exclusively on heavy blunt use, especially among African American young adults. The lack of focus on heavy blunt use is problematic, as African American young adults report more days of past month blunt smoking (23.2 days) and more blunts smoked in the past month (27.2 blunts) relative to their Hispanic (19.7 days, 15.4 blunts) and White (15.8 days, 22.2 blunts) counterparts (Montgomery, Heidelburg, & Robinson, 2017). Given the positive association between frequent cannabis use and cannabis use disorders (Dierker, Mendoza, Goodwin et al., 2017), additional qualitative work is needed to fully understand how heavy blunt users characterize their blunt use in an effort to inform prevention and treatment strategies. The current exploratory qualitative study addresses these gaps by assessing how African American adults who report current heavy blunt use understand, talk about and experience their blunt use.

MATERIALS AND METHODS

Participants

Participants were recruited via purposive sampling in a Midwestern city between June and August 2018. Individuals were eligible to participate in the qualitative interviews if they (1) were an African American/Black man or woman, (2) were between the ages of 18–29, (3) self-reported heavy blunt use in the past month (i.e., daily or almost daily), (4) read English, (5) were willing to participate in an audiotaped interview and (6) were an active social media user (i.e., used at least one social media platform in the past month). The interviews were conducted as the first phase of a larger project designed to develop and pilot test a social media intervention for cannabis users. The primary mode of recruitment was led by a certified marketing consulting firm that specializes in research, engagement and outreach to the African American community. Given the focus on illegal behaviors and anticipated hesitation among young adults to participate, the marketing firm was utilized to recruit and assist with data collection and improve the perceived credibility and trustworthiness of the study in the community. The firm primarily recruited participants from community events, social media announcements and a company email listserv consisting of individuals who previously expressed interest in participating in research studies. Other recruitment methods included study flyers in predominately African American communities (e.g., health centers), word of mouth, and online ads on Craigslist (i.e., a free online classified advertisement service).

Procedures

Interested individuals were asked to call the firm to speak with a member of the research team for a brief phone screening to determine if they met study eligibility criteria. After providing verbal consent over the phone, eligible individuals were invited to schedule a date and time for a one-hour individual interview with research staff at the marketing firm office located in a predominately African American community. Upon arrival to the research appointment, participants provided written consent to participate in the study and also received a copy of the consent form for their records. Participants received $35 for their time and travel. The research staff conducting individual interviews received training in qualitative data collection from the first author. The individual interviews were based on a semi-structured interview guide and interviewers routinely met to discuss the progress of the interviews to ensure fidelity. The study protocol was approved by the University of Cincinnati Institutional Review Board.

Participants were initially asked to provide responses to close-ended questions regarding demographic characteristics (e.g., gender) and blunt use history (e.g., average number of blunts smoked per day). Then open-ended questions elicited information on (1) the social context of blunt use, (2) reasons for blunt use, (3) treatment needs, attitudes and preferences towards internet-based social media interventions for blunt use reduction and (4) quit experiences. All interviews were audio-recorded and lasted an average of 43.2 (SD = 2.1) minutes.

Data Analysis

Thematic analysis (Braun & Clarke, 2006) was used to identify themes that provide insight how young African American adults understand, talk about and experience their blunt use. The interviews were transcribed and reviewed for accuracy. After reviewing the first five interviews and noting thoughts and ideas, initial codes were created and refined throughout the analysis led by the first author. The codes, along with brief descriptions and illustrative quotations, were written and organized in a codebook. Two researchers independently coded data from the entire dataset into relevant topics and categories (e.g., quality of rolling papers, group activities while smoking). After discussing and reaching consensus on the codes, dominant and repeated codes were categorized into themes. The team met on a biweekly basis during the analysis period to discuss ideas and patterns in the data until consensus on the codes and themes and definitions of the themes was reached. A third researcher settled discrepancies in cases of disagreement on codes and themes.

Given the exploratory nature of the interviews and our overall goal of exploring opinions and diversity of views, every piece of discovered data was unique and never considered truly saturated (Wray et al., 2007). The goal was not to generalize or quantify findings, but rather gain a deeper understanding of blunt use among African American young adults. Several strategies were employed to ensure the credibility of study findings, such as taking detailed notes about interpretations of the data, including rich and verbatim descriptions from participants to support study findings, and engaging a team of researchers in the interpretation of the data to reduce bias (Noble & Smith, 2015). MAXQDA (VERBI Software, 2017), a qualitative data management software, was used to assist with organizing, coding and analyzing the data.

RESULTS

Participant Characteristics

As noted in Table 1, 20 African American young adults participated in the individual interviews. The average age of participants was 24.7 years (SD = 3.3). Most participants were male (75%) and 60% had completed some level of college. Participants reported smoking blunts nearly every day in the month prior to the interview (M = 26.3 days, SD = 5.5), with an average of 4.7 (SD = 3.3) blunts smoked per smoking day. Most participants reported smoking joints as another method of cannabis administration in the past month (80%) and using tobacco via hookah in the past month (50%).

Table 1.

Demographic Characteristics of Young Adult African American Heavy Blunt Smokers Participating in a Semi-Structured Interview (N = 20)

Male, n (%)	15 (75.0)
Age (years), mean (SD)	24.7 (3.3)
Education, n (%)
Some high school	1 (5.0)
High school graduate	7 (35.0)
Some college	12 (60.0)
Number of blunts smoked in the past month, mean (SD)	26.3 (5.5)
Number of blunts smoked per day, mean (SD)	4.7 (3.3)
Other cannabis administration methods in the past month, n (%)
Joints	16 (80.0)
Pipes/Bowls	11 (55.0)
Bongs	10 (50.0)
Ingestion	4 (20.0)
Vaporizers	5 (25.0)
Other	2 (10.0)
Tobacco use in the past month, n (%)
Cigarettes	5 (25.0)
Electronic cigarettes	2 (10.0)
Cigars	2 (10.0)
Little cigars and cigarillos	8 (40.0)
Hookah	10 (50.0)
Other	2 (10.0)

Qualitative Themes

Three themes emerged during discussions that highlight how blunts are described, made and used from the perspective of African American young adults who reported heavy blunt use: (1) participants preferred to refer to blunts as joints, (2) participants described how the quality of cannabis impacts how blunts are made and smoked, and (3) participants discussed norms regarding when and how blunts are smoked in groups. In an effort to protect the confidentiality of study participants, we do not report demographic characteristics with the example quotes. There were no notable age or gender differences in the experiences of young adults as described by the sample.

Blunts were referred to as “joints.”

Participants had their own local convention for how to talk about blunts. Although the definition of a “blunt” was provided by the research staff during the study, many young adults preferred to refer to blunts as “joints.” To clarify, research staff asked participants to describe their definition of a joint. All 13 of the participants who referred to blunts as “joints” described joints using descriptors consistent with that commonly used to define a blunt. For example, one participant described “the best joints” as: “For me, I use Swishers [Swisher Sweets] and take all of the tobacco and nicotine and stuff out, or maybe leave a little bit in and then put all of my weed in it.” Another young adult used similar language when describing the choice of “what kind of joint” to smoke: “I use Phillies or Swisher Sweets to make my joints, or I might just get a regular blunt wrap if I don’t feel like fooling with the tobacco.”

Young adult blunt smokers acknowledged knowing the difference between a joint and blunt as described by others in popular culture, but noted that they still referred to blunts as joints in their own context. One participant explained, “well I have heard of joints and blunts but they are the same thing to me.….like where we live now, people call them joints, but in other cities people call them blunts.” Most participants described “blunts” as a technical term to describe hollowed-out cigars filled with cannabis, as seen by the participant who indicated that “blunts is a fancy science term…around here we call it joints because that’s what’s popular for smoking weed, it’s our own regular version of what other people call blunts…” A few participants noted that they also smoke what is traditionally known as joints (i.e., cannabis rolled into rolling papers that do not contain tobacco), but their use of joints as defined this way was limited to certain occasions. For instance, one young adult explained that “joints are not my go to way of smoking, but I will smoke one if I don’t have any rellos [cigarillos] on me and I can’t get to the store.”

The quality of cannabis impacts how blunts are made and smoked.

The specifics of how a blunt is rolled, smoked, etc. varies from user to user. However, many young adults (n = 16) expressed that the quality of cannabis impacts how a blunt is made. For instance, one participant stated that “…it’s stupid to put a small amount of regular weed in a blunt …it defeats the purpose, you won’t feel anything…you won’t get that good high you are looking for.” Another participant used specific terminology to clearly describe the differences between the quality of cannabis and how it impacts how blunts are made. The participant noted that “If you have regular you’re going to put more inside of the blunt than you will if you have kush or loud because loud is stronger than regular.” When young adults who specifically mentioned “regular” or “kush/loud” (n = 12) were asked to define these terms, all of their definitions consisted of describing “regular” (also referred to as “Reggie” by 7 participants) as lower quality cannabis and “kush/loud” as premium cannabis. For example, one participant described regular as “…that weed you get when you broke for the week and don’t have money to get something better…but you need some type of high, even if it ain’t that strong” and another participant described kush/loud as “…the best thing to smoke out of a rello [cigarillo] because loud will give you the best and longest type of high ever… but my cherry rello helps to balance me out a little bit so I can relax without completely zoning out…and helps with covering up the smell [of loud] that most people don’t like.”

Participants also reported that the quality of cannabis influenced not just how much cannabis goes in a blunt, but how and in what context blunts are used. One participant indicated that the quality of cannabis impacts how smoke is inhaled: “…you don’t really need that much weed when you have loud…I typically only take one puff of loud on the rotation [in a group] but two or three puffs on reg[ular].” Some young adult blunt smokers even indicated that the quality of cannabis smoked in a blunt varied based on who they were smoking with. For instance, one participant stated “When I smoke blunts….I usually smoke Reggie with my girl just to kick back and chill with her…it won’t get you too high…but loud is for when my boys come through and we ready to get blazed [high].”

Norms regarding when and how blunts are smoked in groups.

All participants reported smoking blunts in a group and alone at least once in their lifetime. Many of the young adults (n = 14) reported that they initiated their blunt use in a group setting, but over time they were more likely to smoke alone than in groups. For example, when asked to describe their first time smoking a blunt, one participant stated that “I was in junior high…smoking a couple of blunts with neighborhood friends…laughing and relaxing after school one day.” Later in the interview, that same participant noted that “…smoking blunts with a bunch of people takes too much work now…I’d rather relax, smoke and chill by myself…just watching a movie or something.” Similarly, another young adult described how age impacts the preferred social setting for smoking, noting that“…the older I get, the more I want to smoke by myself to help relieve my stress…if I just happen to link up with people when I’m about to smoke, it’s cool…but I’m not going out looking for a group of people to smoke with.”

Several young adults (n = 14) described smoking cannabis with others in an enclosed area, such as a car. This activity was referred to as “hotboxing.” Hotboxing was commonly described as a fun activity to do in a group, especially when most or all of the members of the group reported being stressed out. For example, one participant stated that “…it’s fun to hotbox with my friends, especially when we got some loud and we can just relieve some stress…and laugh at the first person who starts coughing or leaves the room or van.” Another participant added that hotboxing can also help determine how the body responds to cannabis, as it is “a good way to test your tolerance level to weed if you’re new to it…especially when you just start off with passing some reg around in a rello [cigarillo] and then working your way up to that next level weed.” The participant also added that “if you can sit in a hotbox with loud, even if you don’t hit the blunt at all, and still go to work the next day, you a pro…especially if you can pass a drug test.”

Almost all of the participants (n = 18) noted the importance of not holding the blunt for a long period of time when smoking in a group. This practice was commonly referred to as “babysitting”, with one participant noting that blunt smokers should not“…hold it for too long and babysit it [the blunt], just hit it two, maybe three times at the most, and keep it moving…” Individuals who babysit the blunt will be punished by others in the group, as seen by a participant who explained that “I’ve seen plenty of people argue or even fight cause they messed up the rotation…especially when they don’t buy cigarillos, weed or ain’t bring nothing to the table for everybody there.” Some young adults (n = 10) also described the unsanitary nature of getting saliva on the blunt when smoking and passing it around, with a few even providing specific tips on how to avoid getting saliva on a blunt. For instance, one participant indicated that “…you need to make sure that you only take a couple of hits and that you hold the blunt close to the tip.” Another participant provided a tip regarding interactions with other smokers in the group, emphasizing that blunt smokers should “…keep an eye on whoever is rolling the blunt, especially if you don’t know them…amateurs get too much spit on it…it’s better to just smoke with people you know for real.”

DISCUSSION

Young African American adults are disproportionately represented among heavy blunt smokers. The current study was designed to examine how African American young adult heavy blunt smokers understand, talk about and experience their blunt use. Findings revealed themes centered around the language used to describe blunts, the impact of the quality of cannabis smoked within a blunt and norms regarding smoking blunts in groups. These themes provide additional insights into how blunt use is discussed, initiated and maintained among heavy blunt smokers.

Several participants preferred to refer to blunts as joints, with many suggesting that “blunt” is a technical term that is not commonly used among laypeople. Although African American young adult blunt smokers were aware of the term “blunt” and the distinction that others often make between blunts and joints, most participants suggested that blunts and joints are considered the same thing in their social context. A similar finding emerged from individual interviews with 17 young African American LCC users who noted that “blunting” was not a recognized term in their communities (Koopman Gonzalez et al., 2017). However, the term “blunt” was used by half of the participants in that sample. A small number of those participants also used the term “shell” to describe the outer wrapping of the nontipped cigarillo that is used to make blunts. In another qualitative analysis of 16 focus groups with 123 racially diverse adults who reported past month LCC use, participants also used a diverse array of terms to describe an image of a nontipped cigarillo (Dickinson, Johnson, Coleman et al., 2016). In addition to referring to the image as a “blunt,” young adults used cigar brand names and slang terms, such as “Swisher,” “Dutch,” “Rillo” and “Blunt wrap,” to describe nontipped cigarillos.

Findings from the current study supports and extends this line of qualitative research. The aforementioned qualitative studies (Dickinson et al., 2016; Koopman Gonzalez et al., 2017) were conducted among adult LCC users who happened to mention how they modify their cigars to make blunts, while the findings from the current study are from young adults who self-identified as heavy blunt smokers prior to entering the study. There is a slight, but subtle difference between these two populations. Previous studies suggest that self-identified blunt smokers recognize blunts as a form of cannabis use, but not tobacco use via a cigar (Delevo, Bover-Manderski, & Hrywna, 2011). Conversely, a small number of LCC users acknowledge their tobacco use, but do not label their use of modified cigars as blunt use or as a form of cannabis use (Delevo et al., 2011). Therefore, it is plausible that the previous studies of LCC users did not accurately identify all of the blunt users in the sample. Moreover, the way in which young smokers identify their blunt use might also impact how they describe and label the behavior. This issue might be illustrated in the use of “joints” by young adults in the current sample to describe what are traditionally known as blunts, as heavy blunt smokers may have a stronger identification with the cannabis culture relative to the tobacco culture. The labels used in previous qualitative studies among LCC users were more representative of terms commonly used to describe tobacco paraphernalia, such as “Swishers” and “Dutch.” The current finding emphasizes the importance of gaining a stronger understanding of the experiences of young adults who identify as blunt smokers, as they may conceptualize their use differently than those who may solely identify as LCC users, even if they do modify their cigars to make blunts. Taken together, all of these studies suggest that the language smokers use is extremely varied and should be considered when monitoring, assessing, preventing and treating blunt use to ensure the specificity and accuracy of public health data in this area.

The assessment of cannabis use quantity and frequency is challenging (Prince, Conner & Pearson, 2019) and further complicated by the various methods of administration. This issue was illustrated in the current study among young adult blunt smokers who described how the quality of cannabis impacts how blunts are made and smoked. Although previous studies have shown that blunts hold a larger quantity of cannabis than joints (Mariani, Brooks, Haney et al., 2011) and that blunt smokers may present to treatment with greater amounts of cannabis smoked relative to joint smokers (Montgomery, McClure, Tomko, et al., 2019), the quantity of cannabis included within a blunt might vary based on its quality. Young adult heavy blunt smokers noted that large amounts of lower quality (or potency) cannabis (i.e., regular) is needed to achieve a subjective high from a blunt, whereas a small amount of premium grade cannabis (i.e., kush/loud) can be used to experience a subjective high. Moreover, the inhalation patterns of young adults varied based on the quality of cannabis, with participants suggesting that the lower the potency of cannabis, the more puffs that are needed to achieve a subjective high. This ideology implies that clinicians and researchers can not assume that individuals who consume blunts are exposed to higher levels of cannabis relative to other consumption methods, such as joints. Assessments should focus on both the quantity and quality of cannabis to better inform how individuals make, use and respond to blunts. Some studies have attempted to assess the potency of cannabis by asking participants to estimate the cost of their cannabis use (Mariani, Brooks, Haney et al., 2011; Montgomery et al., 2019). Although there are limitations with this practice (e.g., use of self-report data), future studies should continue to attempt to assess both the quantity and quality of cannabis use among blunt smokers, as it may have implications for the blunt making process and inhalation patterns of users.

Lastly, young adults discussed several norms regarding when and how to smoke blunts in groups. Although all young adults in the study reported smoking blunts in groups, most participants described smoking blunts with a group only during their initial encounter and shortly thereafter. One ethnographic study of 92 young adult blunt and joint smokers from New York City also revealed preferences for smoking in group settings (Dunlap, Johnson, Benoit et al., 2005). However, the current study extends this literature by suggesting that African American young adult heavy smokers may initiate their blunt use in a group, but prefer to smoke alone as they age. Given the differences observed among adults who consume blunts in groups versus alone (e.g., groups promote moderate consumption and decrease the chances of intoxication; Dunlap et al., 2005), future studies are needed to better understand the decision-making process regarding smoking blunts alone versus in a group and the potential impact the decision might have on cannabis use outcomes.

While describing their experiences smoking in groups, many young adults reported engaging in “hotboxing” and emphasized the importance of not “babysitting” the blunt or getting saliva on the blunt when passing it around to other group members. Due to the repeated inhalation of exhaled cannabis by users and their friends, hotboxing has been linked to the transmission of tuberculosis in Seattle in 2004 (Oeltmann, Oren, Haddad et al., 2006). Moreover, smoking just one cigarette in a vehicle with closed windows can generate over 100 times the Environmental Protection Agency’s 24-hr recommended exposure limit to particles that irritate the respiratory system (Sendzik, Fong, Travers, et al., 2008; Ott, Klepeis, & Switzer, 2008). Future studies should further examine hotboxing toxicities among cannabis users, especially since heavy blunt smokers promoted the practice and described it as a method to relieve stress and a way to test tolerance. The perceived benefits and lack of health education campaigns on hotboxing may cause heavy blunt smokers to overlook the potential harms of the practice. Similarly, other norms in smoking groups (e.g., holding a blunt close to the tip will not transfer saliva among smokers) might provide a false sense of security from harm. Although these norms do not represent new practices in cannabis culture, this is the first time that they have been thoroughly described in research by African American young adult heavy blunt smokers. Future work should continue to focus on the experiences of heavy blunt users, as social and environmental factors are major influences of health.

Although this was the first qualitative study to assess the experience of African American young adult heavy blunt smokers, data collection was limited to participants in a Midwestern region of the United States. Unfortunately, the small number of women in the sample limits the ability to further analyze the findings by gender. Given gender differences observed in the consequences and treatment of cannabis use (Cooper & Craft, 2018; Sherman, Baker, & McRae-Clark, 2016), additional studies are needed to further assess the experiences of young African American women who report heavy blunt use. The study was also limited by our inability to conduct follow-up interviews over time or observe blunt use in group settings. Lastly, non-combustible medical cannabis is legal in the state where the study was conducted and may have therefore impacted attitudes and experiences of young adults in this sample (e.g., Carliner, Brown, Sarvet et al., 2017). Future work should assess if and how medical and recreational cannabis laws impact how young African American adults talk about their blunt use.

Several implications can be drawn from this study. First, given that heavy blunt smokers often refer to blunts as joints, it is imperative that future surveillance studies provide clear definitions and images of both blunts and joints. Clear assessment measures are necessary to enable researchers and other key stakeholders to fully characterize the prevalence, patterns and correlates of blunt use. Second, this study emphasizes the need for more measures that assess both the quantity and quality (potency) of cannabis in studies designed to understand the health and social impact of blunt use. For instance, some researchers have modified the Timeline Followback assessment (i.e., a tool to assess cannabis use frequency and quantity) to inquire about the estimated amount and value of a surrogate substance designed to represent participants’ cannabis use (Mariani et al., 2011; Montgomery et al., 2019). Third, given that African American young adults are more likely to initiate blunt smoking in a group, it is important to target the peer networks of adolescents and young adults to prevent and treat blunt use via interventions and health campaigns. Group activities, such as hotboxing, might impact the amount of exposure to harmful contaminants in cannabis and tobacco via blunts compared to smoking alone in a well ventilated setting. Moreover, future studies should monitor the social settings of blunt users over time, as many young adults have reported a preference for solitary use as they aged. The solitary use of blunts could be an indicator of adverse consequences, such as cannabis dependence and a strong urge to use cannabis to cope with stress (Spinella, Stewart & Barrett, 2019). Additional studies are needed to assess how the norms in both solitary and group settings might impact characteristics of blunt use, such as use patterns, motives for use, and adverse consequences. Fourth, several young adults in the sample reported using other cannabis and tobacco products in the past month, such as joints (80%) and hookah (50%). It is important to assess and address the co-occurrence of blunts with other cannabis and tobacco products, as this trend has also been observed in epidemiological and treatment studies (Montgomery, Mantey, Peters et al., 2020; Montgomery et al., 2019; Schauer et al., 2017). Blunt smoking is a significant public health problem that warrants additional attention from clinicians, researchers, policy makers, and public health officials. Further research is needed to capture the experiences of African American young adults who are inordinately represented among heavy blunt smokers.