{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T01:54:19Z","timestamp":1791942859054,"version":"4.3.4"},"reference-count":55,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Cannabis use has been shown to modestly increase shortly after legalization of recreational use, but little is known about longer-term changes in cannabis and tobacco use.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the association of cannabis legalization and commercialization with the use of cannabis, cigarettes, and electronic nicotine delivery systems (ENDS) in the 5 years after legalization in the US.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n The Population Assessment of Tobacco and Health (PATH) study, a nationally representative longitudinal cohort study of adults 18 years or older in the US, was used for a retrospective, difference-in-differences analysis of panel data from January 2013 to December 2022. Data were analyzed from May 8, 2024, to April 20, 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n State-level recreational cannabis legalization (RCL) and opening of retail outlets with 5 years of follow-up.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Percentage point changes in 30-day use of cannabis, cigarettes, and ENDS in states with legalization compared with control states, aggregated over 5 years and then broken down into the periods before and after retail outlets opened.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among the 171\u202f257 observations from 55\u202f406 individuals included in the analysis (50.9% female; mean [SD] age, 37.97 [17.69] years), RCL was associated with an increase of cannabis use by 3.28 (95% CI, 2.29-4.27) percentage points and ENDS use by 1.39 (95% CI, 0.44-2.35) percentage points compared with control states. There was no differential change in cigarette use (\u22120.99 [95% CI, \u22122.25 to 0.27] percentage points). For cannabis, this change was greater after retail outlets opened (3.74 [95% CI, 2.65-4.82] percentage points) compared with before (1.17 [95% CI, 0.13-2.20] percentage points). There were no large changes in ENDS or cigarette use associated with the opening of retail outlets.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this longitudinal cohort study, RCL was associated with more cannabis and ENDS use after 5 years and no significant change in cigarette use. Furthermore, cannabis use increased over time, underscoring the importance of studying commercialization policy going forward. Based on the present results, it is unlikely RCL has been associated with a large increase in cigarette use, but increases in use of cannabis and vaped nicotine bear close monitoring as retail cannabis rapidly expands.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.20093","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T15:30:35Z","timestamp":1752247835000},"page":"e2520093","source":"Crossref","is-referenced-by-count":18,"title":["Use of Tobacco and Cannabis Following State-Level Cannabis Legalization"],"prefix":"10.1001","volume":"8","author":[{"given":"Andrew S.","family":"Hyatt","sequence":"first","affiliation":[{"name":"Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts"},{"name":"Department of Psychiatry, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Overhage","sequence":"additional","affiliation":[{"name":"Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts"},{"name":"Department of Psychiatry, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin L\u00ea","family":"Cook","sequence":"additional","affiliation":[{"name":"Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts"},{"name":"Department of Psychiatry, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"issue":"9904","key":"zoi250621r2","doi-asserted-by":"publisher","first-page":"1564","DOI":"10.1016\/S0140-6736(13)61530-5","article-title":"Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010.","volume":"382","author":"Degenhardt","year":"2013","journal-title":"Lancet"},{"issue":"10100","key":"zoi250621r3","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1016\/S0140-6736(17)32366-8","article-title":"Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.","volume":"390","author":"Gakidou","year":"2017","journal-title":"Lancet"},{"key":"zoi250621r4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e536","article-title":"Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis.","volume":"344","author":"Asbridge","year":"2012","journal-title":"BMJ"},{"issue":"8","key":"zoi250621r5","doi-asserted-by":"publisher","first-page":"1348","DOI":"10.1111\/add.13347","article-title":"The effects of cannabis intoxication on motor vehicle collision revisited and revised.","volume":"111","author":"Rogeberg","year":"2016","journal-title":"Addiction"},{"key":"zoi250621r6","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2020.106479","article-title":"What is the prevalence and risk of cannabis use disorders among people who use cannabis? a systematic review and meta-analysis.","volume":"109","author":"Leung","year":"2020","journal-title":"Addict Behav"},{"issue":"8","key":"zoi250621r7","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1001\/jamapsychiatry.2023.1256","article-title":"Cannabis use disorder and subsequent risk of psychotic and nonpsychotic unipolar depression and bipolar disorder.","volume":"80","author":"Jefsen","year":"2023","journal-title":"JAMA Psychiatry"},{"issue":"2","key":"zoi250621r8","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1177\/0706743720952251","article-title":"Cannabis use and prospective long-term association with anxiety: a systematic review and meta-analysis of longitudinal studies. 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