Patterns and Correlates of Cannabis, Electronic Cigarettes, and Tobacco Use Among Illinois Adolescents

Patterns and Correlates of Cannabis, Electronic Cigarettes, and Tobacco Use Among Illinois Adolescents | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patterns and Correlates of Cannabis, Electronic Cigarettes, and Tobacco Use Among Illinois Adolescents Kai-Wen Cheng, Frank Czuba This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8360260/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Objectives Our study aims to identify social and behavioral factors associated with the sole-, dual-, and poly-substance use of cannabis, electronic cigarettes (ECs), and combustible tobacco among Illinoisan adolescents during the period when medical and recreational marijuana use have both been legalized. Methods Data came from the 2022 Illinois Youth Survey (IYS, administered to 8th-, 10th-, and 12th-grade adolescents). Multinomial regression models were used to estimate the associations between social, environmental, and behavioral characteristics and substance use patterns of sole-, dual-, and poly-substance use. Results After adjusting for demographics, self-reported depression, being bullied at school, self-perceived campus being unsafe, having peer pressure, and alcohol use were significantly associated with higher odds of sole-, dual-, and poly-substance use, respectively, compared with no substance use at all. Participating in structured sports, having family rules on substance use, living in rural areas, and living in more economically affluent areas significantly reduced the odds of sole-, dual-, and poly-substance use, respectively. Conclusions Our study identified several social, environmental, and behavioral factors associated with adolescent substance use. Findings can help inform program designs, prevention strategies, and clinical screening to tackle adolescent substance use. Adolescent substance use Electronic Cigarette Cannabis Vaping Poly Substance Use INTRODUCTION The prevalence of electronic cigarette (EC) use in the US has increased over the past few years, with the most substantial increase observed among youth and young adults. [ 1 , 2 ] In 2023, 22.2% of US middle and high school students reported having used any tobacco products, with 10% of students reporting current use of any tobacco products. ECs were the most commonly reported currently used tobacco products among all students (7.7%), followed by cigarettes (1.6%) and cigars (1.6%). [ 3 ] Cannabis is another substance commonly used among adolescents in the US and can lead to adverse neurobiological health effects. [ 4 , 5 ] As EC use is emerging as an increasingly popular cannabis delivery mode, adolescents who use ECs tend to use combinations of substances, including nicotine and cannabis vape products as well as the combustible forms of cannabis and tobacco. Cannabis vaping by school-aged youth doubled between 2013 and 2020, with reported use within the last 30 days rising sevenfold during the same period. [ 6 ] The prevalence of past 30-day cannabis vaping among 12th graders in the US increased significantly from 4.9% in 2017 to 14.8% in 2022. [ 7 ] Understanding multiple substance use among youth is critical, as several studies reported that the onset of nicotine and cannabis smoking and vaping might progress and extend into young adulthood and longer-term usage. [ 8 – 10 ] Illinois legalized marijuana for medical purposes through a physician’s recommendation in 2013. The state legalized adult recreational marijuana use as of 2020; Illinois residents 21 years and older now can buy cannabis from licensed sellers with or without a medical marijuana card. The expansion of a legal adult recreational cannabis market, its increased accessibility, possibly lower prices, lower health risk perceptions, and higher social acceptability may promote increased adolescent use of cannabis. [ 11 – 14 ] While previous studies of the effects of adolescent marijuana use provide some guidance for current policy and public health recommendations, it is unknown how adolescent consumption patterns may change if marijuana is widely available and marketed in different forms within the context of a legal adult environment. Given the increased accessibility and social acceptance of cannabis due to widespread recreational legalization, innovative tobacco and cannabis marketing strategies, youth-friendly designs of vaping devices, and the low perceived risks of cannabis and nicotine use, our paper aims to focus on middle and high school adolescents in Illinois where adult cannabis has been legalized and provide a thorough characterization of their demographic, social, environmental, and behavioral factors associated with sole-, dual-, and poly-substance use of ECs, combustible tobacco, and cannabis. METHODS Data Our study used data from the 2022 Illinois Youth Survey (IYS) funded by the Illinois Department of Human Services. IYS is a self-reported biennial survey administered to adolescents in 8th-, 10th-, and 12th-grade school settings. All Illinois public schools with students enrolled in the 8th, 10th, or 12th grades were included in the statewide sampling frame. Schools with fewer than 16 students in 8th, 10th, and 12th grades, schools with no grade configuration, and other special types of schools (e.g., vocational schools, special education schools, department of corrections, or other state-funded public schools) were excluded from the sampling frame. Our study used the IYS data including every unit of the sampling frame. IYS asks various health and social questions, including youth demographics, household socioeconomic status, health behaviors, drug use, academic performance, and experiences at home and school. Household income by zip code is derived from American Community Survey – US Census Bureau 2010–2014 data and merged to the IYS based on self-reported zip code. We excluded those who reported being in 9th and 11th grades, those who did not answer their current status of cigarette, cigarillo, EC, or cannabis use, or those who did not provide their residential zip code information. The final sample included 108,534 respondents from 8th grade (39%; N = 41,988), 10th grade (36%; N = 38,765), and 12th grade (25%; N = 27,601) in Illinois statewide. Measurements Combustible tobacco use, EC use, and cannabis use Combustible tobacco use was measured by combining the results from combustible cigarettes and cigars/cigarillos/little cigars. Combusted cigarette use was measured with the question: “How frequently have you smoked cigarettes during the past 30 days?” and participants who reported “less than one cigarette per day,” “ 1 to 5 cigarettes per day,” “About one-half pack per day,” “About one pack per day,” or “More than 1 pack per day” were categorized as having any past 30-day use of combusted cigarettes. Use of combusted cigars/ cigarillos/little cigars was measured with the question: “How frequently have you smoked tobacco products other than cigarettes such as cigars, cigarillos, or little cigars during the past 30 days?” and participants who reported at least “Once or twice” were categorized as having any past 30-day use of combusted cigars/cigarillos/little cigars. Individuals who reported any past 30-day use of combustible cigarettes or cigars/cigarillos/little cigars were treated as past 30-day users of combustible tobacco. Cannabis use was measured with the question: “On how many occasions have you used marijuana during the past 30 days?” and participants who reported at least “1 to 2 occasions” use were categorized as having any past 30-day use of cannabis. EC use was measured with the question: “How frequently have you used electronic cigarettes during the past 30 days?” and participants who reported at least “Once or twice” were categorized as having any past 30-day use of ECs. Sole-use, dual-use, and poly-use of combustible tobacco, ECs, and cannabis Sole-use was defined as any past 30-day use of only one substance of combustible tobacco, ECs, or cannabis. Dual-use was defined as any past 30-day use of two of the three substances. Poly-use was defined as any past 30-day self-reported use of all three substances. The outcome categories of sole-, dual-, and poly-use are mutually exclusive. Socio-demographic characteristics of individuals, households, and schools Socio-demographic characteristics used to predict substance use include gender (male, female), grade (8th, 10th, 12th), race/ethnicity (Non-Hispanic White, Non-Hispanic Black, Hispanic, Asian, Others), sexual orientation (heterosexual, sexual minority), self-reported depression (“During the past 12 months did you ever feel so sad or hopeless almost every day?”), bullied at school (“During the past 12 months, has another student at school bullied you by calling you names OR threatened to hurt you OR hitting, punching, kicking, or pushing you OR bullied, harassed, or spread rumors about you on the Internet, social media, or through text messages?”), participation in school or other organized sports, home rule (“My family has clear rules about alcohol and drug use”), peer pressure (“What are the chances you would be seen as cool if you used ECs OR smoked cigarettes OR drank alcohol OR smoked pot”), academic grades (“mostly A’s/B’s, mostly C’s or worse”), past 30-day alcohol use (“On how many occasions have you had beer, wine, or hard liquor during the past 30 days”), and living in urban or rural areas. Median household income by respondent’s residential location was categorized into household income (less than 30k, 30k-58k, 58k-94k, 94k-150k, and 150k and above). Statistical Analysis A multinomial regression model was used to estimate the associations between substance use outcomes and socio-demographic characteristics. Substance use outcomes included non-use, sole-use, dual-use, and poly-use. An adjusted multinomial regression model included all the covariates of interest for all adolescent samples, including 8th graders, 10th graders, and 12th graders combined. Standard errors were clustered by county to account for potential correlations among individuals in the same county. RESULTS Table 1 indicates the socio-demographic profiles of the sample’s Illinoisan 8th, 10th, and 12th graders. Among the sample individuals, 48% are Male, 48% Female, and 4% preferred not to answer. There were 88% who declared heterosexual and 12% who declared sexual minority (Gay, Lesbian, Bisexual, Asexual, and others). There are 61% Caucasian, 10% African American, 20% Latino, and 9% Asian and others. A proportion of 37% reported having depression in the past 12 months and 63% otherwise; 28% of the sample reported having experienced being bullied at school in the past 12 months; and 12% of the sample reported being absent from school due to safety concerns in the past 30 days. There were 60% of the sample who participated in structured sports; 30% of the sample received grades mostly ‘C’ or below in their classes; 24% of the sample perceived being seen as cool if they used cigarettes, vapes, alcohol, or cannabis; 18% of the sample reported past 30-day alcohol use; and 82% of the sample declared their family has clear rules about alcohol and drug use. There are 2% of individuals living in the area with less than 30k household income, 34% with household income between 30k-58k, 43% with household income between 58k-94k, 14% with household income between 94k-150k, and 7% with household income above 150k. Table 1 Socio-demographics of the sample, Illinoisan 8th, 10th, and 12th graders from the 2022 Illinois Youth Survey N % Gender Male 51,461 47% Female 52,269 48% Other 4,624 4% Self-identified Sexuality Orientation Heterosexual 95,308 88% Sexual minority 13,046 12% Grade 8th grade 41,988 39% 10th grade 38,765 36% 12th grade 27,601 25% Race/ethnicity White 66,173 61% African American 10,484 10% Latino 22,019 20% Asian and others 9,678 9% Self-reported depression in past 12 months Yes 40,586 37% No 67,768 63% Past 12 months being bullied at school Yes 30,681 28% No 77,673 72% Past 30 days being absent from school due to safety concern Yes 13,240 12% No 95,114 88% Participating in structured sports Yes 64,747 60% No 43,607 40% Academic performance Grades mostly As and Bs 75,867 70% Grades mostly Cs or below 32,487 30% Perceived being seen as cool if use cigarettes, vaping, alcohol, or cannabis Yes 25,604 24% No 82,750 76% Past 30 days alcohol use Yes 19,343 18% No 89,011 82% Family has clear rules about alcohol and drug use Yes 88,672 82% No 19,682 18% Median household income of the residential location Less than 30k 1,646 2% 30k-58k 37,260 34% 58k-94k, 46,115 43% 94k-150k, 15,330 14% 150k and above 8,003 7% Total Observations 108,354 Table 2 indicates any past 30-day use of combustible tobacco, ECs, and cannabis. Among the sample, 14% indicated any use of combustible tobacco, ECs, or cannabis in the past 30 days. Among those reporting ever use in the past 30 days, 64% reported current use of cannabis, 71% ECs, and 17% combustible tobacco. Further, 56% reported sole use, 35% dual use, and 9% poly use of cannabis, ECs, and combustible tobacco. Among the dual users, 84% used cannabis and ECs, 11% used ECs and combustible tobacco, and 5% used combustible tobacco and cannabis. Among the sole users, 52% used ECs only, 43% cannabis only, and 5% combustible tobacco only. Table 2 Any past-30 days use of combustible tobacco, ECs, and Cannabis Substance Use Status N % No Use 93,152 86% Any use of Combustible, ECs or Cannabis 15,202 14% Total Number of Individuals 108,354 100% Any use of Combustible, ECs or Cannabis 15,202 100% Current Use of Cannabis 9,739 64% Current Use of ECs 10,824 71% Current Use of Combustible Tobacco 2,638 17% Any use of Combustible, ECs or Cannabis 15,202 100% Poly Use 1,314 9% Dual Use 5,371 35% Sole Use 8,517 56% Dual Use 5,371 100% ECs & Combustible 579 11% ECs & Cannabis 4503 84% Combustible & Cannabis 289 5% Sole Use 8,517 100% Combustible 456 5% ECs 4428 56% Cannabis 3633 43% Table 3 indicates that belonging to a sexual minority subgroup (RR:1.36, 95% CI: 1.29–1.48), Caucasian (RR: 1.19, 95% CI: 1.11–1.27 ), African American (RR: 1.74, 95% CI: 1.59–1.90), self-reported depression (RR:1.88, 95% CI: 1.78–1.98), being bullied (RR: 1.34, 95% CI:1.27–1.42 ), self-perceived campus unsafe (RR:1.20, 95% CI: 1.12–1.28), peer pressure (RR:1.67, 95% CI:1.59,1.76), participating in structured sports (RR:1.07, 95% CI: 1.02–1.13), and alcohol use (RR:6.99, 95% CI: 6.65–7.36) were significantly associated with higher odds of sole-use compared with no substance use. Being in 10th grade (RR:1.93, 95% CI: 1.81–2.06) or 12th grade (RR: 3.26, 95% CI: 3.05–3.48) was associated with higher odds of sole-use compared to no substance use. Living in a family with a clear rule about substance use (RR:0.76, 95% CI: 0.72–0.81), having better academic performance (RR: 0.59, 95% CI: 0.56, 0.62), and living in an area with a higher median household income and/or urban areas (RR: 0.79; 95% CI: 0.74, 0.85) were significantly associated with lower odds of sole-use compared with no substance use. Table 3 Multinomial Regressions of Risk Factors of Sole Use, Dual Use, and Poly Use, using None Use as the base Sole Use Dual Use Poly Use Gender Male Female 1.04 [0.99, 1.10] 0.98 [0.92, 1.05] 0.487 [0.43, 0.55] Other 1.01 [0.90, 1.13] 0.77 [0.66, 0.89] 0.801 [0.64, 1.02] Sex Minority Yes 1.39 [1.29. 1.48] 1.63 [1.51, 1.77] 1.81 [1.56, 2.10] No Race/Ethnicity White 1.19 [1.11, 1.27] 1.27 [1.16, 1.39] 1.14 [0.96, 1.35] African American 1.74 [1.59, 1.90] 1.59 [1.41, 1.78] 1.40 [1.11, 1.76] Hispanics 1.05 [0.97, 1.13] 0.91 [0.83, 1.01] 0.81 [0.67, 0.98] Depression Yes 1.88[1.784, 1.98] 2.33 [2.18, 2.50] 2.25 [1.98, 2.56] No Bully Yes 1.34 [1.27, 1.42] 1.53 [1.43, 1.64] 1.50 [1.31, 1.70] No Campus Unsafe Yes 1.20 [1.12, 1.28] 1.39 [1.29, 1.51] 1.89 [1.64, 2.18] No Peer Pressure Yes 1.68 [1.59, 1.76] 1.69 [1.59, 1.80] 1.79 [1.59, 2.01] No Play in Structured Sports Yes 1.07 [1.02, 1.13] 0.93 [0.88, 0.10] 0.87 [0.77, 0.98] No Alcohol Use Yes 6.99 [6.65, 7.36] 13.11 [12.28, 13.99] 34.25 [29.42, 39.86] No Family Rule Yes 0.76 [0.72, 0.81] 0.67 [0.62, 0.71] 0.58 [0.51, 0.65] No Grade 8th 10th 1.93 [1.81, 2.06] 2.71 [2.48, 2.96] 2.29 [1.93, 2.72] 12th 3.26 [3.05, 3.48] 4.37 [4.00, 4.79] 4.38 [3.70, 5.18] Household Income Less than 30k 30k – 58k 0.70 [0.59, 0.82] 1.01 [0.79, 1.28] 0.84 [0.54, 1.31] 58k – 94k 0.55 [0.46, 0.64] 0.78 [0.61, 1.00] 0.65 [0.41, 1.02] 94k – 150k 0.54 [0.45, 0.64] 0.78 [0.60, 1.01] 0.66 [0.41, 1.06] 150k and above 0.44 [0.37, 0.54] 0.69 [0.52, 0.90] 0.59 [0.36, 0.97] Urban 0.79 [0.74, 0.86] 0.77 [0.71, 0.84] 0.57 [0.49, 0.67] Pseudo R-squared 0.23 Number of Observations 108,354 Exponentiated coefficients; 95% confidence intervals in brackets Belonging to a sexual minority subgroup (RR:1.63, 95% CI: 1.29–1.48), being Caucasian (RR: 1.27, 95% CI: 1.16–1.39), African American (RR: 1.59, 95% CI: 1.41–1.78), self-reported depression (RR: 2.33, 95% CI:2.18–2.50), being bullied (RR:1.53, 95% CI: 1.43–1.64), self-perceived campus unsafe (RR: 1.39, 95% CI: 1.29–1.51), peer pressure (RR:1.69, 95% CI: 1.59–1.80), being in 10th grade (RR:2.71, 95% CI:2.48–2.96) or 12th grade (RR: 4.37, 95% CI: 4.00-4.79), and alcohol use (RR:13.11, 95% CI: 12.28–13.99) were significantly associated with higher odds of dual-use compared with no substance use. Participating in structured sports (RR: 0.93, 95% CI: 0.88–0.99), having better academic performance (RR: 0.43, 95% CI: 0.40, 0.47), living in a family with a clear rule about substance use (RR:0.70, 95% CI:0.62–0.72), living in an area with median household income between 58k-94k (RR: 0.78, 95% CI: 0.61, 0.99) and 150k and above (RR: 0.69, 95% CI: 0.52, 0.90), and living in urban areas (RR: 0.77, 95% CI:0.66, 0.89) were significantly associated with lower odds of dual-use compared with no substance use at all. Belonging to a sexual minority subgroup (RR:1.81, 95% CI:1.56–2.11), being African American (RR: 1.40, 95% CI:1.11–1.76), self-reported depression (RR:2.25, 95% CI:1.98–2.56), being bullied (RR:1.50, 95% CI:1.31–1.70), self-perceived campus unsafe (RR:1.89, 95% CI:1.64–2.18), peer pressure (RR:1.79, 95% CI:1.59–2.01), and alcohol use (RR:34.25, 95% CI:29.42–39.86) were significantly associated with higher odds of poly-use compared with no substance use. Being in 10th grade (RR: 2.19, 95% CI: 1.86–2.57) or 12th grade (RR: 4.14, 95% CI: 3.64–4.95) were associated with higher odds of poly-use compared to no substance use. Being female (RR: 0.49, 95% CI: 0.43, 0.56), Hispanic/Latino (RR: 0.81, 95% CI: 0.67, 0.98), participating in structured sports (RR: 0.87, 95% CI: 0.77–0.98), having better academic performance (RR: 0.32, 95% CI: 0.28, 0.36), living in a family with a clear rule about substance use (RR: 0.58, 95% CI: 0.51–0.65), living in an area with median household income 150k and above (RR: 0.59, 95% CI: 0.36, 0.97), and living in urban areas (RR: 0.57, 95 CI%: 0.49, 0.67) were significantly associated with lower odds of poly-use compared with no substance use. DISCUSSION As ECs have become the most commonly used nicotine-containing product among US middle school and high school students since 2014, [ 1 – 3 ] tetrahydrocannabinol (THC, the principal psychoactive constituent of marijuana) can also be vaped and become another substance used among adolescents. Our study documented a high prevalence of EC and cannabis use among adolescents in Illinois. Among those who had ever used in the past 30 days, 64% reported current use of cannabis, 71% ECs, and 17% combustible tobacco, with more than 40% reporting multiple substance use. Among those reporting using multiple substances, over 80% used cannabis and ECs. Vaping devices can be used to vape nicotine and cannabis, making concurrent use of multiple substances easy. Our study echoes previous findings showing that cannabis vaping was especially common among teens who already frequently use ECs. [ 15 , 16 ] The popularity of EC use, to vape either nicotine or cannabis, raises concern that such use may serve as a gateway through which youth progress to other forms of nicotine and cannabis co-use [ 8 , 10 ] and long-term cannabis use through other use forms, such as eating or smoking cannabis. [ 17 – 19 ] Furthermore, the expansion of medical and recreational cannabis legalization has raised concerns regarding whether cannabis legalization would increase cannabis uptake among the younger population by making cannabis more readily accessible and socially acceptable and misperception of the products’ risk. Since California legalized medical use of cannabis in 1996, 37 other states, including the District of Columbia, have done so. Twenty-four states, including the District of Columbia, have legalized the retail sale of cannabis to adults over the age of 21 since 2012. Illinois legalized marijuana for medical purposes in 2013 and recreational marijuana use among adults over the age of 21 as of 2020. Our study found that sole-, dual- and poly-use correlates were generally similar, but several different correlates were identified. There were no significant gender differences in use patterns, except females were less likely to be poly-users compared to no substance use at all. Adolescents in the sexual minority subgroup, Caucasian, African American, and higher grade levels had higher odds of being sole-, dual-, or poly-users. Hispanics, Asians, and other race adolescents had lower odds of being sole-, dual-, or poly-users. Such demographic differences in use patterns are consistent with findings from previous studies. [ 20 – 22 ] Our study found that adolescents living in areas with higher household incomes have significantly lower odds of sole substance use. Further, adolescents living in the highest household income areas have significantly lower odds of dual-use and poly-use. As previous studies found, socioeconomic disparities exist in the prevalence of substance use, abuse, and dependence across a wide range of substances. [ 23 – 27 ] Our findings provide evidence that socioeconomic disadvantage is a key predictor of adolescent substance use. Possible explanations include that socioeconomically disadvantaged areas may have less access to healthy activities due to financial difficulties, neighborhood deprivation, or other constraints. [ 28 – 30 ] Indeed, our study found that while participating in structured sports significantly reduced the odds of dual-use and poly-use – possibly related to the time demands and focus on physical performance – such participation in structured sports may create certain peer pressure and significantly increase the odds of sole-use compared to the never-use counterparts. Our study found that several mental health predictors, such as self-reported depression, being bullied at school, self-perceived campus being unsafe, and experiencing peer pressure were significantly associated with higher odds of sole-use, dual-use, and poly-use, consistent with prior research findings. [ 21 , 31 – 33 ] Having clear family rules around substance use significantly reduces the odds of adolescents’ sole-, dual-, and poly-substance use, possibly related to parents’ or older siblings’ use of or views on substances, structured families, or opportunities to engage in substance use. [ 34 , 35 ] Our study also highlights that living in rural areas is a strong risk factor predicting sole-, dual-, and poly-substance use, consistent with what Coughlin et al. 2019 [ 36 ] found in the substance use patterns between urban and rural areas. Our study has some limitations. Our results were derived from cross-sectional data designs, which do not address causal inferences between socio-demographic and behavioral risk factors and adolescent substance use. For example, the associations between adolescent academic performance and school experiences do not necessarily lead to improvement or deterioration of adolescent substance use. Their relationships may be bi-directional. In addition, students’ level of comprehension and willingness to answer social behavioral and psychological questions raise concerns regarding response bias and measurement error. For example, suppose there are systematic differences in adolescents’ willingness to report their social and health behaviors and experiences or fear of reporting mental health issues due to stigma. In that case, the results may be biased. However, there is evidence supporting the reliability of self-administered surveys targeting risky adolescent health behaviors using similar questionnaires. [ 37 – 39 ] CONCLUSION The increasing density of cannabis dispensaries, followed by recreational cannabis legalization and increased access to cannabis, may promote dual- and poly-substance use among adolescents. Our study identified several individual and family social and behavioral factors associated with adolescent substance use. Our findings may inform public health, medical, and scientific experts to consider efforts needed for policymaking, program and preventive strategy designs, and clinical screening to tackle adolescent substance use. Declarations Funding: None. Conflicts of interest/Competing interests: Authors report no conflicts of interest. Ethics approval: The Governors State University Institutional Review Board has granted exempt approval under Exemption Category 4 for secondary research for which consent is not required. Author Contribution Kai-Wen Cheng: Conceptualization; Formal analysis; Investigation; Methodology; Supervision; WritingFrank Czuba: Conceptualization; Investigation; Writing ACKNOWLEDGEMENT Data for this study were provided by the Center for Prevention Research and Development (CPRD, a unit within the School of Social Work at the University of Illinois at Urbana-Champaign). The opinions in this article, however, reflect those of the authors and do not reflect official positions of CPRD or the funding source. Data Availability Data for this study were provided by the Center for Prevention Research and Development (CPRD, a unit within the School of Social Work at the University of Illinois at Urbana-Champaign). Data availability is subject to controlled access. The dataset is not publicly available. Access requests should be directed to CPRD and are subject to a Data Use Agreement. References Centers for Disease Control and Prevention. About electronic cigarettes (e-cigarettes). 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Barbeau EM, Krieger N, Soobader MJ. Working class matters: socioeconomic disadvantage, race/ethnicity, gender, and smoking in NHIS 2000. Am J Public Health. 2004;94(2):269–78. Chuang YC, Cubbin C, Ahn D, Winkleby MA. Effects of neighbourhood socioeconomic status and convenience store concentration on individual level smoking. J Epidemiol Commun Health. 2005;59(7):568–73. Pampel FC, Krueger PM, Denney JT. Socioeconomic Disparities in Health Behaviors. Ann Rev Sociol. 2010;36:349–70. van Lenthe FJ, Martikainen P, Mackenbach JP. Neighbourhood inequalities in health and health-related behaviour: results of selective migration? Health Place. 2007;13(1):123–37. Williams DR, Mohammed SA, Leavell J, Collins C. Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Ann N Y Acad Sci. 2010;1186:69–101. Hanson MD, Chen E. Socioeconomic status and health behaviors in adolescence: a review of the literature. J Behav Med. 2007;30(3):263–85. Moore LV, Diez Roux AV, Evenson KR, McGinn AP, Brines SJ. Availability of recreational resources in minority and low socioeconomic status areas. Am J Prev Med. 2008;34(1):16–22. Powell LM, Slater S, Chaloupka FJ, Harper D. Availability of physical activity-related facilities and neighborhood demographic and socioeconomic characteristics: a national study. Am J Public Health. 2006;96(9):1676–80. Becker TD, Arnold MK, Ro V, Martin L, Rice TR. Systematic Review of Electronic Cigarette Use (Vaping) and Mental Health Comorbidity Among Adolescents and Young Adults. Nicotine Tob Res. 2021;23(3):415–25. Bernat D, Gasquet N, Wilson KO, Porter L, Choi K. Electronic Cigarette Harm and Benefit Perceptions and Use Among Youth. Am J Prev Med. 2018;55(3):361–7. Nawi AM, Ismail R, Ibrahim F, et al. Risk and protective factors of drug abuse among adolescents: a systematic review. BMC Public Health. 2021;21(1):2088. Cavazos-Rehg PA, Krauss MJ, Sowles SJ, et al. 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Cheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYBACCQYeEGUD4zMTrSUNRDA2kKLlMAlaJNvPHnxc8Ou8Xb9E+vMHDBXWiQ2EtEjz5CUbz+y7nTxzRo5hA8OZdMJa5CR4zKR5e24nG5w5w9jA2HaYKC3mv3l7zgG1HH/YwPiPCC3SQFuYeX4csDM43mDYwNhAhBbJnhxjad6G5ATJ9h7DGQnH0o0JapE4fsbwM88fO3t+ZvYHHz7UWMsS1AIGjG0MEPckEKUcDP4w2BOveBSMglEwCkYcAABiej3ShFB06gAAAABJRU5ErkJggg==","orcid":"","institution":"Governors State University","correspondingAuthor":true,"prefix":"","firstName":"Kai-Wen","middleName":"","lastName":"Cheng","suffix":""},{"id":572803219,"identity":"5f9f020a-d36b-4fe4-9557-34541d61daa9","order_by":1,"name":"Frank Czuba","email":"","orcid":"","institution":"Governors State University","correspondingAuthor":false,"prefix":"","firstName":"Frank","middleName":"","lastName":"Czuba","suffix":""}],"badges":[],"createdAt":"2025-12-14 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12:02:38","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":115491,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8360260/v1/653a4550536977ad9396d6de.html"},{"id":100381362,"identity":"345ab271-5cdc-4427-942f-8e3a89372dce","added_by":"auto","created_at":"2026-01-16 10:38:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":935584,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8360260/v1/2c667b68-427c-4636-8871-8f190c463883.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Patterns and Correlates of Cannabis, Electronic Cigarettes, and Tobacco Use Among Illinois Adolescents","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe prevalence of electronic cigarette (EC) use in the US has increased over the past few years, with the most substantial increase observed among youth and young adults.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e In 2023, 22.2% of US middle and high school students reported having used any tobacco products, with 10% of students reporting current use of any tobacco products. ECs were the most commonly reported currently used tobacco products among all students (7.7%), followed by cigarettes (1.6%) and cigars (1.6%). \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCannabis is another substance commonly used among adolescents in the US and can lead to adverse neurobiological health effects.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e As EC use is emerging as an increasingly popular cannabis delivery mode, adolescents who use ECs tend to use combinations of substances, including nicotine and cannabis vape products as well as the combustible forms of cannabis and tobacco. Cannabis vaping by school-aged youth doubled between 2013 and 2020, with reported use within the last 30 days rising sevenfold during the same period.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e The prevalence of past 30-day cannabis vaping among 12th graders in the US increased significantly from 4.9% in 2017 to 14.8% in 2022.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e Understanding multiple substance use among youth is critical, as several studies reported that the onset of nicotine and cannabis smoking and vaping might progress and extend into young adulthood and longer-term usage. \u003csup\u003e[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIllinois legalized marijuana for medical purposes through a physician\u0026rsquo;s recommendation in 2013. The state legalized adult recreational marijuana use as of 2020; Illinois residents 21 years and older now can buy cannabis from licensed sellers with or without a medical marijuana card. The expansion of a legal adult recreational cannabis market, its increased accessibility, possibly lower prices, lower health risk perceptions, and higher social acceptability may promote increased adolescent use of cannabis.\u003csup\u003e[\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e While previous studies of the effects of adolescent marijuana use provide some guidance for current policy and public health recommendations, it is unknown how adolescent consumption patterns may change if marijuana is widely available and marketed in different forms within the context of a legal adult environment.\u003c/p\u003e \u003cp\u003eGiven the increased accessibility and social acceptance of cannabis due to widespread recreational legalization, innovative tobacco and cannabis marketing strategies, youth-friendly designs of vaping devices, and the low perceived risks of cannabis and nicotine use, our paper aims to focus on middle and high school adolescents in Illinois where adult cannabis has been legalized and provide a thorough characterization of their demographic, social, environmental, and behavioral factors associated with sole-, dual-, and poly-substance use of ECs, combustible tobacco, and cannabis.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData\u003c/h2\u003e \u003cp\u003eOur study used data from the 2022 Illinois Youth Survey (IYS) funded by the Illinois Department of Human Services. IYS is a self-reported biennial survey administered to adolescents in 8th-, 10th-, and 12th-grade school settings. All Illinois public schools with students enrolled in the 8th, 10th, or 12th grades were included in the statewide sampling frame. Schools with fewer than 16 students in 8th, 10th, and 12th grades, schools with no grade configuration, and other special types of schools (e.g., vocational schools, special education schools, department of corrections, or other state-funded public schools) were excluded from the sampling frame. Our study used the IYS data including every unit of the sampling frame. IYS asks various health and social questions, including youth demographics, household socioeconomic status, health behaviors, drug use, academic performance, and experiences at home and school. Household income by zip code is derived from American Community Survey \u0026ndash; US Census Bureau 2010\u0026ndash;2014 data and merged to the IYS based on self-reported zip code.\u003c/p\u003e \u003cp\u003eWe excluded those who reported being in 9th and 11th grades, those who did not answer their current status of cigarette, cigarillo, EC, or cannabis use, or those who did not provide their residential zip code information. The final sample included 108,534 respondents from 8th grade (39%; N\u0026thinsp;=\u0026thinsp;41,988), 10th grade (36%; N\u0026thinsp;=\u0026thinsp;38,765), and 12th grade (25%; N\u0026thinsp;=\u0026thinsp;27,601) in Illinois statewide.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasurements\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eCombustible tobacco use, EC use, and cannabis use\u003c/h2\u003e \u003cp\u003eCombustible tobacco use was measured by combining the results from combustible cigarettes and cigars/cigarillos/little cigars. Combusted cigarette use was measured with the question: \u0026ldquo;How frequently have you smoked cigarettes during the past 30 days?\u0026rdquo; and participants who reported \u0026ldquo;less than one cigarette per day,\u0026rdquo; \u0026ldquo; 1 to 5 cigarettes per day,\u0026rdquo; \u0026ldquo;About one-half pack per day,\u0026rdquo; \u0026ldquo;About one pack per day,\u0026rdquo; or \u0026ldquo;More than 1 pack per day\u0026rdquo; were categorized as having any past 30-day use of combusted cigarettes. Use of combusted cigars/ cigarillos/little cigars was measured with the question: \u0026ldquo;How frequently have you smoked tobacco products other than cigarettes such as cigars, cigarillos, or little cigars during the past 30 days?\u0026rdquo; and participants who reported at least \u0026ldquo;Once or twice\u0026rdquo; were categorized as having any past 30-day use of combusted cigars/cigarillos/little cigars. Individuals who reported any past 30-day use of combustible cigarettes or cigars/cigarillos/little cigars were treated as past 30-day users of combustible tobacco. Cannabis use was measured with the question: \u0026ldquo;On how many occasions have you used marijuana during the past 30 days?\u0026rdquo; and participants who reported at least \u0026ldquo;1 to 2 occasions\u0026rdquo; use were categorized as having any past 30-day use of cannabis. EC use was measured with the question: \u0026ldquo;How frequently have you used electronic cigarettes during the past 30 days?\u0026rdquo; and participants who reported at least \u0026ldquo;Once or twice\u0026rdquo; were categorized as having any past 30-day use of ECs.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSole-use, dual-use, and poly-use of combustible tobacco, ECs, and cannabis\u003c/h3\u003e\n\u003cp\u003eSole-use was defined as any past 30-day use of only one substance of combustible tobacco, ECs, or cannabis. Dual-use was defined as any past 30-day use of two of the three substances. Poly-use was defined as any past 30-day self-reported use of all three substances. The outcome categories of sole-, dual-, and poly-use are mutually exclusive.\u003c/p\u003e\n\u003ch3\u003eSocio-demographic characteristics of individuals, households, and schools\u003c/h3\u003e\n\u003cp\u003eSocio-demographic characteristics used to predict substance use include gender (male, female), grade (8th, 10th, 12th), race/ethnicity (Non-Hispanic White, Non-Hispanic Black, Hispanic, Asian, Others), sexual orientation (heterosexual, sexual minority), self-reported depression (\u0026ldquo;During the past 12 months did you ever feel so sad or hopeless almost every day?\u0026rdquo;), bullied at school (\u0026ldquo;During the past 12 months, has another student at school bullied you by calling you names OR threatened to hurt you OR hitting, punching, kicking, or pushing you OR bullied, harassed, or spread rumors about you on the Internet, social media, or through text messages?\u0026rdquo;), participation in school or other organized sports, home rule (\u0026ldquo;My family has clear rules about alcohol and drug use\u0026rdquo;), peer pressure (\u0026ldquo;What are the chances you would be seen as cool if you used ECs OR smoked cigarettes OR drank alcohol OR smoked pot\u0026rdquo;), academic grades (\u0026ldquo;mostly A\u0026rsquo;s/B\u0026rsquo;s, mostly C\u0026rsquo;s or worse\u0026rdquo;), past 30-day alcohol use (\u0026ldquo;On how many occasions have you had beer, wine, or hard liquor during the past 30 days\u0026rdquo;), and living in urban or rural areas. Median household income by respondent\u0026rsquo;s residential location was categorized into household income (less than 30k, 30k-58k, 58k-94k, 94k-150k, and 150k and above).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eA multinomial regression model was used to estimate the associations between substance use outcomes and socio-demographic characteristics. Substance use outcomes included non-use, sole-use, dual-use, and poly-use. An adjusted multinomial regression model included all the covariates of interest for all adolescent samples, including 8th graders, 10th graders, and 12th graders combined. Standard errors were clustered by county to account for potential correlations among individuals in the same county.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e indicates the socio-demographic profiles of the sample\u0026rsquo;s Illinoisan 8th, 10th, and 12th graders. Among the sample individuals, 48% are Male, 48% Female, and 4% preferred not to answer. There were 88% who declared heterosexual and 12% who declared sexual minority (Gay, Lesbian, Bisexual, Asexual, and others). There are 61% Caucasian, 10% African American, 20% Latino, and 9% Asian and others. A proportion of 37% reported having depression in the past 12 months and 63% otherwise; 28% of the sample reported having experienced being bullied at school in the past 12 months; and 12% of the sample reported being absent from school due to safety concerns in the past 30 days. There were 60% of the sample who participated in structured sports; 30% of the sample received grades mostly \u0026lsquo;C\u0026rsquo; or below in their classes; 24% of the sample perceived being seen as cool if they used cigarettes, vapes, alcohol, or cannabis; 18% of the sample reported past 30-day alcohol use; and 82% of the sample declared their family has clear rules about alcohol and drug use. There are 2% of individuals living in the area with less than 30k household income, 34% with household income between 30k-58k, 43% with household income between 58k-94k, 14% with household income between 94k-150k, and 7% with household income above 150k.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographics of the sample, Illinoisan 8th, 10th, and 12th graders from the 2022 Illinois Youth Survey\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51,461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52,269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-identified Sexuality Orientation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeterosexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95,308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual minority\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13,046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8th grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41,988\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10th grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38,765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12th grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27,601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace/ethnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66,173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfrican American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10,484\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLatino\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22,019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian and others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9,678\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-reported depression in past 12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40,586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67,768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePast 12 months being bullied at school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30,681\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77,673\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePast 30 days being absent from school due to safety concern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13,240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e95,114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipating in structured sports\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64,747\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43,607\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrades mostly As and Bs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75,867\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrades mostly Cs or below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32,487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerceived being seen as cool if use cigarettes, vaping, alcohol, or cannabis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25,604\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82,750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePast 30 days alcohol use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19,343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89,011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily has clear rules about alcohol and drug use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88,672\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19,682\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian household income of the residential location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 30k\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,646\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30k-58k\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37,260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e58k-94k,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46,115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e94k-150k,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15,330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e150k and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8,003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Observations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108,354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e indicates any past 30-day use of combustible tobacco, ECs, and cannabis. Among the sample, 14% indicated any use of combustible tobacco, ECs, or cannabis in the past 30 days. Among those reporting ever use in the past 30 days, 64% reported current use of cannabis, 71% ECs, and 17% combustible tobacco. Further, 56% reported sole use, 35% dual use, and 9% poly use of cannabis, ECs, and combustible tobacco. Among the dual users, 84% used cannabis and ECs, 11% used ECs and combustible tobacco, and 5% used combustible tobacco and cannabis. Among the sole users, 52% used ECs only, 43% cannabis only, and 5% combustible tobacco only.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAny past-30 days use of combustible tobacco, ECs, and Cannabis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubstance Use Status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93,152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny use of Combustible, ECs or Cannabis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15,202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Number of Individuals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108,354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny use of Combustible, ECs or Cannabis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15,202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent Use of Cannabis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9,739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent Use of ECs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10,824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent Use of Combustible Tobacco\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,638\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny use of Combustible, ECs or Cannabis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15,202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoly Use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDual Use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,371\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSole Use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8,517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDual Use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,371\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECs \u0026amp; Combustible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECs \u0026amp; Cannabis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4503\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombustible \u0026amp; Cannabis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSole Use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8,517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombustible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e456\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eECs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCannabis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3633\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e indicates that belonging to a sexual minority subgroup (RR:1.36, 95% CI: 1.29\u0026ndash;1.48), Caucasian (RR: 1.19, 95% CI: 1.11\u0026ndash;1.27 ), African American (RR: 1.74, 95% CI: 1.59\u0026ndash;1.90), self-reported depression (RR:1.88, 95% CI: 1.78\u0026ndash;1.98), being bullied (RR: 1.34, 95% CI:1.27\u0026ndash;1.42 ), self-perceived campus unsafe (RR:1.20, 95% CI: 1.12\u0026ndash;1.28), peer pressure (RR:1.67, 95% CI:1.59,1.76), participating in structured sports (RR:1.07, 95% CI: 1.02\u0026ndash;1.13), and alcohol use (RR:6.99, 95% CI: 6.65\u0026ndash;7.36) were significantly associated with higher odds of sole-use compared with no substance use. Being in 10th grade (RR:1.93, 95% CI: 1.81\u0026ndash;2.06) or 12th grade (RR: 3.26, 95% CI: 3.05\u0026ndash;3.48) was associated with higher odds of sole-use compared to no substance use. Living in a family with a clear rule about substance use (RR:0.76, 95% CI: 0.72\u0026ndash;0.81), having better academic performance (RR: 0.59, 95% CI: 0.56, 0.62), and living in an area with a higher median household income and/or urban areas (RR: 0.79; 95% CI: 0.74, 0.85) were significantly associated with lower odds of sole-use compared with no substance use.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultinomial Regressions of Risk Factors of Sole Use, Dual Use, and Poly Use, using None Use as the base\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSole Use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDual Use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePoly Use\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.04 [0.99, 1.10]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.98 [0.92, 1.05]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.487 [0.43, 0.55]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.01 [0.90, 1.13]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.77 [0.66, 0.89]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.801 [0.64, 1.02]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex Minority\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.39 [1.29. 1.48]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.63 [1.51, 1.77]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.81 [1.56, 2.10]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace/Ethnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.19 [1.11, 1.27]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.27 [1.16, 1.39]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.14 [0.96, 1.35]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfrican American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.74 [1.59, 1.90]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.59 [1.41, 1.78]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.40 [1.11, 1.76]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.05 [0.97, 1.13]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.91 [0.83, 1.01]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.81 [0.67, 0.98]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.88[1.784, 1.98]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.33 [2.18, 2.50]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2.25 [1.98, 2.56]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBully\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.34 [1.27, 1.42]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.53 [1.43, 1.64]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.50 [1.31, 1.70]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCampus Unsafe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.20 [1.12, 1.28]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.39 [1.29, 1.51]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.89 [1.64, 2.18]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeer Pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.68 [1.59, 1.76]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.69 [1.59, 1.80]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.79 [1.59, 2.01]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlay in Structured Sports\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.07 [1.02, 1.13]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.93 [0.88, 0.10]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.87 [0.77, 0.98]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol Use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e6.99 [6.65, 7.36]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e13.11 [12.28, 13.99]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e34.25 [29.42, 39.86]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Rule\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.76 [0.72, 0.81]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.67 [0.62, 0.71]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.58 [0.51, 0.65]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.93 [1.81, 2.06]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.71 [2.48, 2.96]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2.29 [1.93, 2.72]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12th\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3.26 [3.05, 3.48]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4.37 [4.00, 4.79]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4.38 [3.70, 5.18]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 30k\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30k \u0026ndash; 58k\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.70 [0.59, 0.82]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.01 [0.79, 1.28]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.84 [0.54, 1.31]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e58k \u0026ndash; 94k\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.55 [0.46, 0.64]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.78 [0.61, 1.00]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.65 [0.41, 1.02]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e94k \u0026ndash; 150k\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.54 [0.45, 0.64]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.78 [0.60, 1.01]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.66 [0.41, 1.06]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e150k and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.44 [0.37, 0.54]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.69 [0.52, 0.90]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.59 [0.36, 0.97]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.79 [0.74, 0.86]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.77 [0.71, 0.84]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.57 [0.49, 0.67]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePseudo R-squared\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Observations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108,354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eExponentiated coefficients; 95% confidence intervals in brackets\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBelonging to a sexual minority subgroup (RR:1.63, 95% CI: 1.29\u0026ndash;1.48), being Caucasian (RR: 1.27, 95% CI: 1.16\u0026ndash;1.39), African American (RR: 1.59, 95% CI: 1.41\u0026ndash;1.78), self-reported depression (RR: 2.33, 95% CI:2.18\u0026ndash;2.50), being bullied (RR:1.53, 95% CI: 1.43\u0026ndash;1.64), self-perceived campus unsafe (RR: 1.39, 95% CI: 1.29\u0026ndash;1.51), peer pressure (RR:1.69, 95% CI: 1.59\u0026ndash;1.80), being in 10th grade (RR:2.71, 95% CI:2.48\u0026ndash;2.96) or 12th grade (RR: 4.37, 95% CI: 4.00-4.79), and alcohol use (RR:13.11, 95% CI: 12.28\u0026ndash;13.99) were significantly associated with higher odds of dual-use compared with no substance use. Participating in structured sports (RR: 0.93, 95% CI: 0.88\u0026ndash;0.99), having better academic performance (RR: 0.43, 95% CI: 0.40, 0.47), living in a family with a clear rule about substance use (RR:0.70, 95% CI:0.62\u0026ndash;0.72), living in an area with median household income between 58k-94k (RR: 0.78, 95% CI: 0.61, 0.99) and 150k and above (RR: 0.69, 95% CI: 0.52, 0.90), and living in urban areas (RR: 0.77, 95% CI:0.66, 0.89) were significantly associated with lower odds of dual-use compared with no substance use at all.\u003c/p\u003e \u003cp\u003eBelonging to a sexual minority subgroup (RR:1.81, 95% CI:1.56\u0026ndash;2.11), being African American (RR: 1.40, 95% CI:1.11\u0026ndash;1.76), self-reported depression (RR:2.25, 95% CI:1.98\u0026ndash;2.56), being bullied (RR:1.50, 95% CI:1.31\u0026ndash;1.70), self-perceived campus unsafe (RR:1.89, 95% CI:1.64\u0026ndash;2.18), peer pressure (RR:1.79, 95% CI:1.59\u0026ndash;2.01), and alcohol use (RR:34.25, 95% CI:29.42\u0026ndash;39.86) were significantly associated with higher odds of poly-use compared with no substance use. Being in 10th grade (RR: 2.19, 95% CI: 1.86\u0026ndash;2.57) or 12th grade (RR: 4.14, 95% CI: 3.64\u0026ndash;4.95) were associated with higher odds of poly-use compared to no substance use. Being female (RR: 0.49, 95% CI: 0.43, 0.56), Hispanic/Latino (RR: 0.81, 95% CI: 0.67, 0.98), participating in structured sports (RR: 0.87, 95% CI: 0.77\u0026ndash;0.98), having better academic performance (RR: 0.32, 95% CI: 0.28, 0.36), living in a family with a clear rule about substance use (RR: 0.58, 95% CI: 0.51\u0026ndash;0.65), living in an area with median household income 150k and above (RR: 0.59, 95% CI: 0.36, 0.97), and living in urban areas (RR: 0.57, 95 CI%: 0.49, 0.67) were significantly associated with lower odds of poly-use compared with no substance use.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAs ECs have become the most commonly used nicotine-containing product among US middle school and high school students since 2014,\u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e tetrahydrocannabinol (THC, the principal psychoactive constituent of marijuana) can also be vaped and become another substance used among adolescents. Our study documented a high prevalence of EC and cannabis use among adolescents in Illinois. Among those who had ever used in the past 30 days, 64% reported current use of cannabis, 71% ECs, and 17% combustible tobacco, with more than 40% reporting multiple substance use. Among those reporting using multiple substances, over 80% used cannabis and ECs. Vaping devices can be used to vape nicotine and cannabis, making concurrent use of multiple substances easy. Our study echoes previous findings showing that cannabis vaping was especially common among teens who already frequently use ECs.\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e The popularity of EC use, to vape either nicotine or cannabis, raises concern that such use may serve as a gateway through which youth progress to other forms of nicotine and cannabis co-use \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e and long-term cannabis use through other use forms, such as eating or smoking cannabis.\u003csup\u003e[\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFurthermore, the expansion of medical and recreational cannabis legalization has raised concerns regarding whether cannabis legalization would increase cannabis uptake among the younger population by making cannabis more readily accessible and socially acceptable and misperception of the products\u0026rsquo; risk. Since California legalized medical use of cannabis in 1996, 37 other states, including the District of Columbia, have done so. Twenty-four states, including the District of Columbia, have legalized the retail sale of cannabis to adults over the age of 21 since 2012. Illinois legalized marijuana for medical purposes in 2013 and recreational marijuana use among adults over the age of 21 as of 2020.\u003c/p\u003e \u003cp\u003eOur study found that sole-, dual- and poly-use correlates were generally similar, but several different correlates were identified. There were no significant gender differences in use patterns, except females were less likely to be poly-users compared to no substance use at all. Adolescents in the sexual minority subgroup, Caucasian, African American, and higher grade levels had higher odds of being sole-, dual-, or poly-users. Hispanics, Asians, and other race adolescents had lower odds of being sole-, dual-, or poly-users. Such demographic differences in use patterns are consistent with findings from previous studies.\u003csup\u003e[\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOur study found that adolescents living in areas with higher household incomes have significantly lower odds of sole substance use. Further, adolescents living in the highest household income areas have significantly lower odds of dual-use and poly-use. As previous studies found, socioeconomic disparities exist in the prevalence of substance use, abuse, and dependence across a wide range of substances.\u003csup\u003e[\u003cspan additionalcitationids=\"CR24 CR25 CR26\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e Our findings provide evidence that socioeconomic disadvantage is a key predictor of adolescent substance use. Possible explanations include that socioeconomically disadvantaged areas may have less access to healthy activities due to financial difficulties, neighborhood deprivation, or other constraints. \u003csup\u003e[\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e Indeed, our study found that while participating in structured sports significantly reduced the odds of dual-use and poly-use \u0026ndash; possibly related to the time demands and focus on physical performance \u0026ndash; such participation in structured sports may create certain peer pressure and significantly increase the odds of sole-use compared to the never-use counterparts. Our study found that several mental health predictors, such as self-reported depression, being bullied at school, self-perceived campus being unsafe, and experiencing peer pressure were significantly associated with higher odds of sole-use, dual-use, and poly-use, consistent with prior research findings.\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e Having clear family rules around substance use significantly reduces the odds of adolescents\u0026rsquo; sole-, dual-, and poly-substance use, possibly related to parents\u0026rsquo; or older siblings\u0026rsquo; use of or views on substances, structured families, or opportunities to engage in substance use.\u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e Our study also highlights that living in rural areas is a strong risk factor predicting sole-, dual-, and poly-substance use, consistent with what Coughlin et al. 2019\u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e found in the substance use patterns between urban and rural areas.\u003c/p\u003e \u003cp\u003eOur study has some limitations. Our results were derived from cross-sectional data designs, which do not address causal inferences between socio-demographic and behavioral risk factors and adolescent substance use. For example, the associations between adolescent academic performance and school experiences do not necessarily lead to improvement or deterioration of adolescent substance use. Their relationships may be bi-directional. In addition, students\u0026rsquo; level of comprehension and willingness to answer social behavioral and psychological questions raise concerns regarding response bias and measurement error. For example, suppose there are systematic differences in adolescents\u0026rsquo; willingness to report their social and health behaviors and experiences or fear of reporting mental health issues due to stigma. In that case, the results may be biased. However, there is evidence supporting the reliability of self-administered surveys targeting risky adolescent health behaviors using similar questionnaires. \u003csup\u003e[\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003e The increasing density of cannabis dispensaries, followed by recreational cannabis legalization and increased access to cannabis, may promote dual- and poly-substance use among adolescents. Our study identified several individual and family social and behavioral factors associated with adolescent substance use. Our findings may inform public health, medical, and scientific experts to consider efforts needed for policymaking, program and preventive strategy designs, and clinical screening to tackle adolescent substance use.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNone.\u003c/p\u003e \u003cp\u003eConflicts of interest/Competing interests: Authors report no conflicts of interest.\u003c/p\u003e \u003cp\u003e Ethics approval: The Governors State University Institutional Review Board has granted exempt approval under Exemption Category 4 for secondary research for which consent is not required.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eKai-Wen Cheng: Conceptualization; Formal analysis; Investigation; Methodology; Supervision; WritingFrank Czuba: Conceptualization; Investigation; Writing\u003c/p\u003e\u003ch2\u003eACKNOWLEDGEMENT\u003c/h2\u003e \u003cp\u003eData for this study were provided by the Center for Prevention Research and Development (CPRD, a unit within the School of Social Work at the University of Illinois at Urbana-Champaign). The opinions in this article, however, reflect those of the authors and do not reflect official positions of CPRD or the funding source.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData for this study were provided by the Center for Prevention Research and Development (CPRD, a unit within the School of Social Work at the University of Illinois at Urbana-Champaign). Data availability is subject to controlled access. The dataset is not publicly available. Access requests should be directed to CPRD and are subject to a Data Use Agreement.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCenters for Disease Control and Prevention. About electronic cigarettes (e-cigarettes).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUS Department of Health and Human Services. 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Addiction. 2019;114(10):1763\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu J, Tan ASL, Winickoff JP, Rees VW. Correlates of adolescent sole-, dual- and poly-use of cannabis, vaped nicotine, and combusted tobacco. Addict Behav. 2023;146:107804.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatson CV, Puvanesarajah S, Trivers KF. Racial and Ethnic Differences in Marijuana Use in e-Cigarettes Among US Youth in 2017, 2018, and 2020. JAMA Pediatr. 2021;175(7):746\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarbeau EM, Krieger N, Soobader MJ. Working class matters: socioeconomic disadvantage, race/ethnicity, gender, and smoking in NHIS 2000. Am J Public Health. 2004;94(2):269\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChuang YC, Cubbin C, Ahn D, Winkleby MA. Effects of neighbourhood socioeconomic status and convenience store concentration on individual level smoking. J Epidemiol Commun Health. 2005;59(7):568\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePampel FC, Krueger PM, Denney JT. Socioeconomic Disparities in Health Behaviors. Ann Rev Sociol. 2010;36:349\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Lenthe FJ, Martikainen P, Mackenbach JP. Neighbourhood inequalities in health and health-related behaviour: results of selective migration? Health Place. 2007;13(1):123\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams DR, Mohammed SA, Leavell J, Collins C. Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Ann N Y Acad Sci. 2010;1186:69\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHanson MD, Chen E. Socioeconomic status and health behaviors in adolescence: a review of the literature. J Behav Med. 2007;30(3):263\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoore LV, Diez Roux AV, Evenson KR, McGinn AP, Brines SJ. Availability of recreational resources in minority and low socioeconomic status areas. Am J Prev Med. 2008;34(1):16\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePowell LM, Slater S, Chaloupka FJ, Harper D. Availability of physical activity-related facilities and neighborhood demographic and socioeconomic characteristics: a national study. Am J Public Health. 2006;96(9):1676\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBecker TD, Arnold MK, Ro V, Martin L, Rice TR. Systematic Review of Electronic Cigarette Use (Vaping) and Mental Health Comorbidity Among Adolescents and Young Adults. Nicotine Tob Res. 2021;23(3):415\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernat D, Gasquet N, Wilson KO, Porter L, Choi K. Electronic Cigarette Harm and Benefit Perceptions and Use Among Youth. Am J Prev Med. 2018;55(3):361\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNawi AM, Ismail R, Ibrahim F, et al. Risk and protective factors of drug abuse among adolescents: a systematic review. BMC Public Health. 2021;21(1):2088.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCavazos-Rehg PA, Krauss MJ, Sowles SJ, et al. Multiple Levels of Influence That Impact Youth Tobacco Use. Tob Regul Sci. 2016;2(2):106\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhitesell M, Bachand A, Peel J, Brown M. Familial, social, and individual factors contributing to risk for adolescent substance use. J Addict. 2013;2013:579310.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoughlin LN, Bonar EE, Bohnert KM, et al. Changes in urban and rural cigarette smoking and cannabis use from 2007 to 2017 in adults in the United States. Drug Alcohol Depend. 2019;205:107699.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrener ND, Collins JL, Kann L, Warren CW, Williams BI. Reliability of the Youth Risk Behavior Survey Questionnaire. Am J Epidemiol. 1995;141(6):575\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen-Sankey J, Bover Manderski MT, Young WJ, Delnevo CD. Examining the Survey Setting Effect on Current E-Cigarette Use Estimates among High School Students in the 2021 National Youth Tobacco Survey. Int J Environ Res Public Health. 2022;19(11).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson TP. Sources of Error in Substance Use Prevalence Surveys. Int Sch Res Notices. 2014;2014:923290.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Adolescent substance use, Electronic Cigarette, Cannabis, Vaping, Poly Substance Use","lastPublishedDoi":"10.21203/rs.3.rs-8360260/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8360260/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjectives\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOur study aims to identify social and behavioral factors associated with the sole-, dual-, and poly-substance use of cannabis, electronic cigarettes (ECs), and combustible tobacco among Illinoisan adolescents during the period when medical and recreational marijuana use have both been legalized.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eData came from the 2022 Illinois Youth Survey (IYS, administered to 8th-, 10th-, and 12th-grade adolescents). Multinomial regression models were used to estimate the associations between social, environmental, and behavioral characteristics and substance use patterns of sole-, dual-, and poly-substance use.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAfter adjusting for demographics, self-reported depression, being bullied at school, self-perceived campus being unsafe, having peer pressure, and alcohol use were significantly associated with higher odds of sole-, dual-, and poly-substance use, respectively, compared with no substance use at all. Participating in structured sports, having family rules on substance use, living in rural areas, and living in more economically affluent areas significantly reduced the odds of sole-, dual-, and poly-substance use, respectively.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOur study identified several social, environmental, and behavioral factors associated with adolescent substance use. Findings can help inform program designs, prevention strategies, and clinical screening to tackle adolescent substance use.\u003c/p\u003e","manuscriptTitle":"Patterns and Correlates of Cannabis, Electronic Cigarettes, and Tobacco Use Among Illinois Adolescents","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 12:02:33","doi":"10.21203/rs.3.rs-8360260/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-14T16:52:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-12T20:07:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-10T18:42:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"27114510477738575218173414747184659133","date":"2026-02-08T19:32:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253266138222693762893021633084376130708","date":"2026-02-02T16:37:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"247760378257905814233465596331721152513","date":"2026-01-13T05:51:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-11T16:59:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246026706241468178567331730018007541486","date":"2026-01-11T11:16:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"322295081489353632121588245675831993066","date":"2026-01-08T20:49:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-08T05:32:04+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-18T11:01:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-18T08:37:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-18T08:35:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-12-14T21:01:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fd8dafe3-94b0-4e86-b2e8-457cb7dd529b","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-24T06:23:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 12:02:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8360260","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8360260","identity":"rs-8360260","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}