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Co-use was relatively stable across the different periods. Writing in the journal of Addictive Behaviors, the researchers said that the evolving trends in use of the two substances could be evidence of a substitution effect amid changing harm perceptions, evolving legislation, and shifting norms. The rising cannabis-only use across groups parallels the expanding state-level recreational cannabis legalization, increasing accessibility and normalization, the paper says

The higher usage among females may reflect changing social dynamics, targeted marketing, or different stress factors impacting young women, indicating the need for gender-specific approaches in tobacco prevention and education efforts

A machine rolls the shredded tobacco into the paper and cuts it to the desired length

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