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To date, no prospective studies have evaluated the degree to which cannabis co\u2010use affects tobacco cessation, nor are there treatment recommendations for those who co\u2010use. The goal of this study was to evaluate and quantify the impact of cannabis co\u2010use on tobacco cessation through a 12\u2010week prospective tobacco cessation trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This was a multi\u2010site, non\u2010randomized trial. Inverse probability weighted modified Poisson regression models were used to assess the probability of tobacco abstinence between tobacco\u2010only and tobacco\u2010cannabis co\u2010use cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Enrollment occurred at three sites across South Carolina, USA: The Medical University of South Carolina (MUSC) Charleston, Behavioral Health Services of Pickens County and MUSC Florence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      Enrolled participants were adults (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009181; ages 18\u201340) who (1) smoked tobacco cigarettes and used cannabis regularly (co\u2010use cohort; oversampled) or (2) smoked tobacco cigarettes daily (tobacco\u2010only cohort). Across 3 sites, 181 adults (110 co\u2010using cannabis; 71 tobacco\u2010only) were enrolled (49% female; 19% Black\/African American; 6% Hispanic\/LatinX).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>All participants received 12\u2009weeks of first\u2010line tobacco treatment (varenicline, incentives for tobacco abstinence, counseling), while cannabis use was not addressed as part of treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>The primary outcome was biochemically confirmed 7\u2010day point prevalence tobacco abstinence (PPA) at end of treatment (EOT; Week 12 post\u2010enrollment).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Average baseline reported cigarettes per day were not different between tobacco\u2010only or cannabis co\u2010use cohorts [14.9, (standard deviation, SD\u2009=\u00a07.2) versus 13.4 (SD\u2009=\u00a07.8);\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.25]. Among the co\u2010use cohort, days of cannabis use in the past month at baseline was 23.7 (SD\u2009=\u00a09.5). In imputed analyses, EOT 7\u2010day PPA tobacco abstinence was achieved in 59% of tobacco\u2010only participants and 33% of the cannabis co\u2010use cohort [Imputed data: relative risk (RR)\u2009=\u00a01.63, 95% confidence interval (CI) = 1.14\u20132.33]. Neither baseline daily cannabis use [adjusted relative risk (RR\n                      <jats:sub>adj<\/jats:sub>\n                      )\u2009=\u00a01.05, 95% CI\u00a0= 0.63\u20131.77] nor within\u2010treatment cannabis use frequency (RR\n                      <jats:sub>adj<\/jats:sub>\n                      \u00a0=\u00a00.51, 95% CI = 0.25, 1.06) was associated with EOT PPA for tobacco in the cannabis co\u2010use cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This is the first prospective study designed to compare tobacco cessation outcomes by cannabis co\u2010use status. Regular cannabis co\u2010use had a negative impact on tobacco abstinence among younger to middle\u2010aged adults. Addressing cannabis use should be incorporated into standard tobacco treatment to improve cessation outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70382","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T08:54:28Z","timestamp":1773305668000},"page":"1876-1887","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Determining the impact of cannabis use on tobacco cessation: Results from a prospective non\u2010randomized tobacco treatment trial"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9744-7818","authenticated-orcid":false,"given":"Erin A.","family":"McClure","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Medical University of South Carolina  Charleston SC USA"},{"name":"Hollings Cancer Center Medical University of South Carolina  Charleston SC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3313-1579","authenticated-orcid":false,"given":"Nathaniel","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Medical University of South Carolina  Charleston SC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6961-4399","authenticated-orcid":false,"given":"Rachel L.","family":"Tomko","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Medical University of South Carolina  Charleston SC USA"},{"name":"Hollings Cancer Center Medical University of South Carolina  Charleston SC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4223-1432","authenticated-orcid":false,"given":"Kyle J.","family":"Walters","sequence":"additional","affiliation":[{"name":"CARF international  Tucson AZ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Chapman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Medical University of South Carolina  Charleston SC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8909-1302","authenticated-orcid":false,"given":"Matthew J.","family":"Carpenter","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Medical University of South Carolina  Charleston SC USA"},{"name":"Hollings Cancer Center Medical University of South Carolina  Charleston SC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin M.","family":"Gray","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Medical University of South Carolina  Charleston SC USA"},{"name":"Hollings Cancer Center Medical University of South Carolina  Charleston SC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7111a1"},{"key":"e_1_2_11_3_1","unstructured":"Substance Abuse and Mental Health Services Administration.Key substance use and mental health indicators in the United States: Results from the 2022 National Survey on drug use and health (HHS publication no. 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