{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:01:22Z","timestamp":1791396082407,"version":"4.3.3"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"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>Economic instability may shape substance use (i.e., cigarette use and cannabis use) among the adult population. However, their relationship remains poorly understood. This study estimated the prevalence of economic instability indicators (i.e., employment instability, received food stamps, food insecurity, housing insecurity, and threatened utility shutoffs), exclusive cigarette use (TU), exclusive cannabis use (CU), and cigarette-cannabis co-use (TCU), and investigated the associations between economic instability indicators and these distinct substance use patterns among adults aged \u226518 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study used cross-sectional population-based data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS) Marijuana Use and Social Determinants and Health Equity modules, administered in 10 US states. The 2023 BRFSS achieved a response rate of 44.7%. The sample included (unweighted n\u2009=\u200950,481; weighted N\u2009=\u200924,896,969) adults \u226518 years. The outcome variables were TU, CU, and TCU. Indicators of economic instability included employment instability, receipt of food stamps, food insecurity, housing insecurity, and threats of utility shutoffs. Weighted descriptive statistics and multivariable multinomial logistic regression analyses were conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 48.6% of the participants were aged \u226450 years, 52.6% were women, and 64.4% self-identified as non-Hispanic White. The prevalences of TU, CU, and TCU were 8.1%, 11.1%, and 3.6%, respectively. Participants experiencing employment instability, housing insecurity, or threats of utility shutoffs were more likely to engage in CU compared to TU or TCU (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009\u2264\u20090.01). All economic instability indicators were significantly associated with TCU, with the strongest association observed for those who received food stamps (aRRR\u2009=\u20092.27, 95% CI: 1.75\u20132.94), which was also significantly associated with TU (aRRR\u2009=\u20091.55, 95% CI: 1.24\u20131.93). Threats of utility shutoffs (aRRR\u2009=\u20091.37, 95% CI: 1.10\u20131.70) and housing insecurity (aRRR\u2009=\u20091.27, 95% CI: 1.04\u20131.55) were significantly associated with CU.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Economic instability indicators are significantly associated with cigarette and cannabis use, as well as their co-use patterns among US adults residing in the 10 participating states. Effective, targeted public health interventions to mitigate substance use risk in economically precarious populations are needed. Healthcare providers should routinely screen for economic instability to identify individuals at high risk for substance use and provide them with social services and behavioral health interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360066","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:36:52Z","timestamp":1791394612000},"page":"e0360066","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Economic instability and substance use among adults in 10 US states: Evidence from a population-based study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1197-4537","authenticated-orcid":true,"given":"Peiyuan","family":"Liu","sequence":"first","affiliation":[{"name":"Yale University","place":["Orange, Connecticut, United States of America"],"department":["School of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3312-4121","authenticated-orcid":true,"given":"Tania de Jes\u00fas","family":"Espinosa","sequence":"additional","affiliation":[{"name":"Yale University","place":["Orange, Connecticut, United States of America"],"department":["School of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elham","family":"Samami","sequence":"additional","affiliation":[{"name":"Yale University","place":["Orange, Connecticut, United States of America"],"department":["School of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3432-0350","authenticated-orcid":true,"given":"Bernard","family":"Mensah","sequence":"additional","affiliation":[{"name":"Yale University","place":["Orange, Connecticut, United States of America"],"department":["School of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermine","family":"Poghosyan","sequence":"additional","affiliation":[{"name":"Yale University","place":["Orange, Connecticut, United States of America"],"department":["School of Nursing"]},{"name":"Yale School of Medicine","place":["New Haven, Connecticut, United States of America"],"department":["COPPER Center"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"pone.0360066.ref001","author":"Lung Association A","year":"2024"},{"key":"pone.0360066.ref002","author":"National Cancer Institute","year":"2024"},{"key":"pone.0360066.ref003","author":"CF Prevention","year":"2025"},{"issue":"5","key":"pone.0360066.ref004","doi-asserted-by":"crossref","first-page":"108221","DOI":"10.1016\/j.amepre.2025.108221","article-title":"The impact of recreational cannabis legalization on Cannabis Use in U.S. adults from 2016 to 2023: A quasi-experimental study","volume":"70","author":"SS Hawkins","year":"2026","journal-title":"Am J Prev Med"},{"key":"pone.0360066.ref005","doi-asserted-by":"crossref","first-page":"104618","DOI":"10.1016\/j.drugpo.2024.104618","article-title":"Cannabis legalization and changes in cannabis and tobacco\/nicotine use and co-use in a national cohort of U.S. adults during 2017-2021","volume":"134","author":"V Pravosud","year":"2024","journal-title":"Int J Drug Policy"},{"key":"pone.0360066.ref006","unstructured":"Administration SA a MHS. 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