Multi-Modal Cannabis Use and Binge Drinking Outcomes Among 12^th Grade Students in the United States, A Cross-Sectional Analysis from 2018-2021

Background: Although those under 21 years of age cannot legally purchase cannabis products, recent data has suggested that adolescents use cannabis in a variety of ways. However, little is known on if different modes of cannabis administration are associated with other risky substance use behaviors. This study assessed different modes of cannabis administration on binge drinking outcomes among adolescents in the United States. Methods: Data were analyzed from the Monitoring the Future 12th grade student surveys from the years 2018–2021 (n = 6859). Modes of cannabis administration (smoking, vaping, dabbing, eating, drinking, and other), multi-modal cannabis use (the use of 2 or more cannabis products), and any past two-week binge drinking occurrence were included in these analyses. Multiple regression models tested associations between 6 distinct modalities of cannabis use and multi-modal cannabis use with any past-two-week binge drinking occurrence. All models controlled for sex, race, age, socioeconomic status (mothers’ education level), and geographic location. Results: Among survey participants, 30.8% had used cannabis within the past 12 months. Smoking (87%) was the most reported mode of administration, followed by edible consumption (49%), and vaping (45%). Smoking (AOR: 1.9, 95% CI:1.2–3.1), vaping (AOR: 1.5, 95% CI:1.1–2.1), dabbing (AOR: 1.5, 95% CI:1.0–2.1), and other (AOR: 2.4, 95% CI:1.3–4.5) modes of cannabis were significantly associated with any past two-week binge drinking occurrence. Similarly, multi-modal cannabis use was associated with any past two-week binge drinking occurrence (AOR: 1.4, 95% CI:1.2–1.6). Conclusion: Different modes of cannabis administration may increase risky drinking behaviors among adolescents, reinforcing the need to understand cannabis use patterns among this population.