{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T10:49:02Z","timestamp":1786358942978,"version":"build-2736575974"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T00:00:00Z","timestamp":1694563200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005188","name":"California Tobacco-Related Disease Research Program","doi-asserted-by":"crossref","award":["T31FT1564 and T32KT5071"],"award-info":[{"award-number":["T31FT1564 and T32KT5071"]}],"id":[{"id":"10.13039\/100005188","id-type":"DOI","asserted-by":"crossref"}]},{"name":"UCSF Clinical and Translational Science Institute","award":["UL1 TR001872-06"],"award-info":[{"award-number":["UL1 TR001872-06"]}]},{"name":"NIH","award":["5U2CEB021881"],"award-info":[{"award-number":["5U2CEB021881"]}]},{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["COVID-2020C2-10761"],"award-info":[{"award-number":["COVID-2020C2-10761"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-017206"],"award-info":[{"award-number":["INV-017206"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIH\/NCI","award":["75N91020C00039"],"award-info":[{"award-number":["75N91020C00039"]}]},{"name":"NIH\/NIBIB","award":["3U2CEB021881-05S1"],"award-info":[{"award-number":["3U2CEB021881-05S1"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We analyzed data from the COVID-19 Citizen Science Study, a digital cohort study, collected via online surveys during 2020\u20132022 from a convenience sample of 53,843 US adults (\u2265 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>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 (<jats:italic>Anxiety<\/jats:italic>: <jats:italic>OR = 1<\/jats:italic>.<jats:italic>89<\/jats:italic>, <jats:italic>95%CI = 1<\/jats:italic>.<jats:italic>64\u20132<\/jats:italic>.<jats:italic>18; Depression<\/jats:italic>: <jats:italic>OR = 1<\/jats:italic>.<jats:italic>77<\/jats:italic>, <jats:italic>95%CI = 1<\/jats:italic>.<jats:italic>46\u20132<\/jats:italic>.<jats:italic>16<\/jats:italic>), followed by cannabis-only use, and tobacco-only use. Compared to tobacco-only use, co-use <jats:italic>(OR = 1<\/jats:italic>.<jats:italic>35<\/jats:italic>, <jats:italic>95%CI = 1<\/jats:italic>.<jats:italic>08\u20131<\/jats:italic>.<jats:italic>69)<\/jats:italic> and cannabis-only use <jats:italic>(OR = 1<\/jats:italic>.<jats:italic>17<\/jats:italic>, <jats:italic>95%CI = 1<\/jats:italic>.<jats:italic>00\u20131<\/jats:italic>.<jats:italic>37<\/jats:italic>) 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0289058","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T17:25:15Z","timestamp":1694625915000},"page":"e0289058","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":34,"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"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8661-9597","authenticated-orcid":true,"given":"Nhung","family":"Nguyen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4529-8325","authenticated-orcid":true,"given":"Noah D.","family":"Peyser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey E.","family":"Olgin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6966-1312","authenticated-orcid":true,"given":"Mark J.","family":"Pletcher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis L.","family":"Beatty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madelaine F.","family":"Modrow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W.","family":"Carton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasha","family":"Khatib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3378-0691","authenticated-orcid":true,"given":"Djeneba Audrey","family":"Djibo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela M.","family":"Ling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory M.","family":"Marcus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,9,13]]},"reference":[{"key":"pone.0289058.ref001","unstructured":"SAMHSA C for BHS and Q. 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