News Release

High rates of depression and anxiety in people who use both tobacco and cannabis

Among more than 50,000 COVID-19 Citizen Science Study participants, around a quarter of users of both tobacco and cannabis experienced anxiety or depression – almost twice the rate of non-users

Peer-Reviewed Publication


Associations between tobacco and cannabis use and anxiety and depression among adults in the United States: Findings from the COVID-19 citizen science study

image: Use of both tobacco and cannabis is linked to poor mental health. view more 

Credit: geralt, Pixabay, CC0 (

People who use both tobacco and cannabis are more likely to report anxiety and depression than those who used tobacco only or those who used neither substance, according to a new study published this week in the open-access journal PLOS ONE by Nhung Nguyen of the University of California, San Francisco, USA, and colleagues.

Tobacco and cannabis are among the most commonly used substances worldwide, and their co-use has been on the rise amid the expanding legalization of cannabis. In the new study, the researchers analyzed data on the substance use and mental health of 53,843 US adults who participated in online surveys as part of the COVID-19 Citizens Health Study, which collected data from 2020 to 2022.

Overall, 4.9% of participants reported tobacco-only use, 6.9% reported cannabis-only use, and 1.6% reported co-use. Among people in the co-use group, 26.5% reported anxiety and 28.3% reported depression, while among people who used neither tobacco or cannabis, percentages of anxiety and depression were 10.6% and 11.2%. The likelihood of having these mental health disorders were about 1.8 times greater for co-users than non-users, the study found. Co-use and use of cannabis only were also associated with higher likelihood of having anxiety compared to use of tobacco only.

This study cannot determine causation. However, the authors conclude that the co-use of tobacco and cannabis is associated with poor mental health and suggest that integrating mental health support with tobacco and cannabis cessation programs may help address this link.

The authors add: “Engaging in both tobacco and cannabis is linked to diminished mental well-being.”


In your coverage please use this URL to provide access to the freely available article in PLOS ONE:

Citation: Nguyen N, Peyser ND, Olgin JE, Pletcher MJ, Beatty AL, Modrow MF, et al. (2023) Associations between tobacco and cannabis use and anxiety and depression among adults in the United States: Findings from the COVID-19 citizen science study. PLoS ONE 18(9): e0289058.

Author Countries: USA

Funding: NN is supported by the California Tobacco-Related Disease Research Program (grants T31FT1564 and T32KT5071) and the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF Clinical and Translational Science Institute (grant UL1 TR001872-06). The Eureka Research Platform was supported by grant 5U2CEB021881 from NIH to GM, JO, and MP. The COVID-19 Citizen Science Study is supported by Patient-Centered Outcomes Research Institute contract COVID-2020C2-10761 to GM, JO, and MP; the Bill and Melinda Gates Foundation contract INV-017206 to GM, JO, and MP, and grants 75N91020C00039 from NIH/NCI and 3U2CEB021881-05S1 from NIH/NIBIB to GM, JO, and MP. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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