Number of cannabis administration modes as a behavioral indicator of cannabis use frequency among U.S. youth and young adults

Abstract

Cannabis use is a public health concern for youth and young adults because higher-frequency use is associated with adverse physical and mental health outcomes and elevated risk for cannabis use disorder. Multimodal cannabis use, reflected as the number of cannabis administration modes used, has emerged as an important pattern of interest that may co-occur with greater overall involvement in cannabis use. The primary aim of this study was to estimate the cross-sectional association between number of cannabis administration modes and past 12-month cannabis use frequency in a nationally representative sample of U.S. youth and young adults. Data were drawn from the 2023 National Survey on Drug Use and Health public use files and included 6522 respondents ages 12–25 who reported cannabis use in the past 12 months. Truncated negative binomial regression was used to model past 12-month cannabis use days as a function of administration-mode count and covariates. Estimated cannabis use frequency increased across administration-mode categories, from approximately 70 days for single-mode users to 257 days for those reporting five or more modes (IRR = 3.689, p < .001), representing a 269% difference between these groups. A greater number of cannabis administration modes was associated with higher cannabis use frequency in the past 12 months. Because the analyses were cross-sectional, the findings do not establish temporal ordering or causality. These results suggest that multimodal cannabis use may represent a behavioral indicator of greater overall involvement in cannabis use among youth and young adults.