{"doi":"10.1371/journal.pone.0289058","title":"Associations between tobacco and cannabis use and anxiety and depression among adults in the United States: Findings from the COVID-19 citizen science study","abstract":"BACKGROUND: Little is known about whether people who use both tobacco and cannabis (co-use) are more or less likely to have mental health disorders than single substance users or non-users. We aimed to examine associations between use of tobacco and/or cannabis with anxiety and depression. METHODS: We analyzed data from the COVID-19 Citizen Science Study, a digital cohort study, collected via online surveys during 2020-2022 from a convenience sample of 53,843 US adults (≥ 18 years old) nationwide. Past 30-day use of tobacco and cannabis was self-reported at baseline and categorized into four exclusive patterns: tobacco-only use, cannabis-only use, co-use of both substances, and non-use. Anxiety and depression were repeatedly measured in monthly surveys. To account for multiple assessments of mental health outcomes within a participant, we used Generalized Estimating Equations to examine associations between the patterns of tobacco and cannabis use with each outcome. RESULTS: In the total sample (mean age 51.0 years old, 67.9% female), 4.9% reported tobacco-only use, 6.9% cannabis-only use, 1.6% co-use, and 86.6% non-use. Proportions of reporting anxiety and depression were highest for the co-use group (26.5% and 28.3%, respectively) and lowest for the non-use group (10.6% and 11.2%, respectively). Compared to non-use, the adjusted odds of mental health disorders were highest for co-use (Anxiety: OR = 1.89, 95%CI = 1.64-2.18; Depression: OR = 1.77, 95%CI = 1.46-2.16), followed by cannabis-only use, and tobacco-only use. Compared to tobacco-only use, co-use (OR = 1.35, 95%CI = 1.08-1.69) and cannabis-only use (OR = 1.17, 95%CI = 1.00-1.37) were associated with higher adjusted odds for anxiety, but not for depression. Daily use (vs. non-daily use) of cigarettes, e-cigarettes, and cannabis were associated with higher adjusted odds for anxiety and depression. CONCLUSIONS: Use of tobacco and/or cannabis, particularly co-use of both substances, were associated with poor mental health. Integrating mental health support with tobacco and cannabis cessation may address this co-morbidity.","journal":"PLoS ONE","year":2023,"id":323753,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":36,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.6991,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":576124,"name":"Noah D. Peyser","orcid":"0000-0003-4529-8325","position":1,"is_corresponding":false},{"id":901,"name":"Jeffrey E. Olgin","orcid":"0000-0003-1684-9327","position":2,"is_corresponding":false},{"id":232378,"name":"Mark J. Pletcher","orcid":"0000-0002-6966-1312","position":3,"is_corresponding":false},{"id":651483,"name":"Alexis L. Beatty","orcid":"0000-0001-8405-7386","position":4,"is_corresponding":false},{"id":1039052,"name":"Madelaine Faulkner Modrow","orcid":"0000-0001-7153-2731","position":5,"is_corresponding":false},{"id":784991,"name":"Thomas W. Carton","orcid":"0000-0003-0059-1990","position":6,"is_corresponding":false},{"id":1020260,"name":"Rasha Khatib","orcid":"0000-0001-7480-3840","position":7,"is_corresponding":false},{"id":1039053,"name":"Djeneba Audrey Djibo","orcid":"0000-0003-3378-0691","position":8,"is_corresponding":false},{"id":367323,"name":"Pamela M. Ling","orcid":"0000-0001-6166-9347","position":9,"is_corresponding":false},{"id":266842,"name":"Gregory M. Marcus","orcid":"0000-0001-5197-7696","position":10,"is_corresponding":false},{"id":715252,"name":"Nhung Nguyen","orcid":"0000-0002-8661-9597","position":0,"is_corresponding":true}],"reference_count":50,"raw_metadata":null,"created_at":"2026-07-19T01:08:06.496579Z","pmid":"37703257","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}