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Characterizing tobacco and marijuana use among youth combustible tobacco users experiencing homelessness – considering product type, brand, flavor, frequency, and higher-risk use patterns and predictors



Cigarette smoking is three times more prevalent among youth experiencing homelessness compared with the general population. Co-use of tobacco and marijuana is also common. The aim of this study is to characterize tobacco and marijuana use among youth experiencing homelessness who use combustible tobacco in a Midwestern city to inform smoking cessation intervention.


This study included 96 youth (ages 14–24 years; 52% male, 39% female, 5% transgender/non-binary) attending a homeless drop-in center who had used at least one combustible tobacco product in the past week. We assessed past-month use of tobacco products and marijuana, other product use characteristics (e.g., frequency, brand and flavor), and psychosocial predictors of more frequent (i.e., daily) use of combustible tobacco and marijuana.


Most youth experiencing homelessness with past-week combustible tobacco use had used cigarettes (n = 85, 88.5%), cigars (n = 89, 92.7%), and marijuana (n = 82, 85.4%) in the past month. One-third (n = 34) used electronic vapor products (EVPs), 19.8% (n = 19) smoked hookah, and 11.5% (n = 11) used smokeless tobacco (ST). Most marijuana users co-administered with tobacco (n = 67, 69.8%). Daily combustible tobacco smoking was associated with having a child and smoking out of boredom/habit. Daily marijuana use was associated with using substances to cope with one’s housing situation. Newport (n = 66, 72.5%) and Black & Mild (n = 48, 51.1%) were the most popular brands of cigarettes and cigars among ever users. Most non-combustible tobacco ever users reported not having a usual brand (EVPs: n = 51, 73.9%; ST: n = 16, 57.1%). Cigar smokers reported the most varied selection of flavors.


Young combustible tobacco users experiencing homelessness engage in high-risk use patterns, including poly-tobacco use, co-use of tobacco with marijuana, and frequent combustible product use. Interventions that consider the full context of tobacco and marijuana use are needed to support smoking cessation in this population.

Peer Review reports


As combustible tobacco smoking has declined nationally in the United States (US) following decades of tobacco control policies and treatments, vulnerable populations have been left behind [1]. Members of these populations continue to smoke at alarming rates and experience resulting health disparities. It is therefore critical to determine how to help these marginalized groups engage in smoking cessation, including increasing motivation to quit, quit attempts using evidence-based methods, and sustained abstinence [2, 3]. For youth experiencing homelessness (YEH), one of the US’s most vulnerable populations, awareness of characteristics of tobacco use and the psychosocial context of smoking behavior can identify opportunities to target intervention strategies and thereby enhance population-specific cessation effectiveness [4, 5].

Cigarette smoking is about three times more prevalent among YEH (ages 14 to 25 years) compared with the general population of youth and young adults [6,7,8]. Overall, combustible tobacco use, including cigarette and cigar smoking, constitutes the primary tobacco products used in this population [9]. Additionally, electronic vapor products (EVPs) are used among young adults experiencing homelessness at nearly twice the rate and smokeless tobacco about five times the rate of use in the general population of young adults [10,11,12]. Although YEH are primarily traditional combustible tobacco users or co-use cigarettes and cigars, poly-tobacco use is also prevalent, particularly among those with substance use disorder and among those who have spent more nights outdoors [9].

Substance use overall is extremely high among YEH [13], with estimates up to 96% [14]. In particular, co-administration of tobacco and marijuana (combining the two products, such as in a blunt, where one removes tobacco contents from a cigar and replaces or mixes it with marijuana) is common among YEH. A study of youth and young adults experiencing homelessness in Los Angeles (LA) County, California found that about 90% of tobacco users consumed tobacco and marijuana together [15]. These users were heavier users of tobacco and marijuana compared to those who used tobacco alone or co-used (used both simultaneously or within the same time-period), but not co-administered; they also tended to experience more severe homelessness and other risk factors like depression. Little cigars and cigarillos are commonly viewed among young adults experiencing homelessness as a discreet way to smoke marijuana [16]. About three-quarters of cigar smoking high school youth in Cuyahoga County, Ohio in 2013 reported concurrent past 30-day marijuana use, about half reported “freaking” their cigar (removing the filter paper from the cigar and repacking), and two-thirds reported using blunts [17]. In addition to elucidating patterns of tobacco use among YEH, co-use of marijuana with tobacco needs to be understood as it relates to smoking cessation and its potential need to be addressed when supporting quitting among YEH.

Marijuana and tobacco are often used to cope with stress and traumatic events, which are common among YEH [18, 19]. A study of smokers experiencing homelessness found that a large proportion had experienced trauma and reported posttraumatic stress symptoms; these individuals endorsed smoking to reduce negative affect and for the positive social effects [20]. Tobacco use is socially acceptable and rather ubiquitous in homeless drop-in facilities and shelters, facilitating continued smoking among those in attendance [19]. These factors unique to the homeless experience create a physical and social environment where tobacco use is normal and even expected, creating barriers to smoking cessation [21]. Despite the high prevalence of tobacco use in this population, many YEH are willing to quit smoking. One-fifth to one-third of tobacco product users among youth and young adults experiencing homelessness in LA County were willing to quit their product in 2018 [22]. A previous analysis of qualitative data from the current study showed that while willingness to quit is high, many YEH are not successful at quitting and have limited access to support [23]. It is critical that we develop strategies to get YEH access to evidence-based cessation support and, for those not yet motivated to quit smoking, intervene to move them into a pre-cessation phase where they may begin to utilize cessation support [3]. Research on smoking cessation interventions for this target population is nascent, although some work has shown that providers at shelters and drop-in centers are willing to provide cessation services [24], and engaging smokers outside of a service setting (e.g., via mobile phone) may also be feasible for intervention [25, 26].

Much remains to be understood about tobacco and marijuana use among YEH. A more detailed characterization of tobacco use among homeless youth is needed, including understanding frequency of use, use of flavored tobacco, and what brands these youth are using. Researchers have emphasized the importance of conducting research with YEH that addresses both the basic science of smoking and the factors that influence and maintain smoking behavior [27]. Along these lines, it is critical to better understand the psychosocial context relevant to smokers [28], particularly frequent users of combustible tobacco and marijuana [29], to account for relevant factors when developing combustible tobacco cessation intervention for the highest risk smokers. It is also important to determine how patterns of use compare across samples of YEH assessed in varying geographic settings where prevalence of tobacco use and regulatory contexts differ. For example, most studies based in the US on tobacco use among YEH were conducted in larger cities primarily on the west coast [9, 15, 22].

The overall aim of this study is to quantitatively explore findings from a previous qualitative study that sought to establish a theoretical framework for cessation among YEH, incorporating factors impacting motivation to engage in cessation [23, 30]. Specifically, we aim to characterize tobacco use among YEH who use combustible tobacco in a Midwestern city, including frequency of product use, brand and flavor preferences, co-use with marijuana, and predictors of frequent combustible tobacco and marijuana use. This information will help us to develop targeted smoking cessation interventions, particularly in a drop-in center setting.



Participants were YEH [31] (ages 14–24 years) in a Midwestern city attending a drop-in center that was established to facilitate health intervention research and provides a safe place for youth to rest, eat, wash clothes, shower, and receive case management and requested treatment services. A total of 139 participants were recruited for this study by being approached for eligibility at the drop-in center by research staff. Participants were eligible if they had used at least one combustible tobacco product in the past week, were not currently making an attempt to quit smoking, were attending a drop-in center, and had not participated in an earlier phase of this study. Thirty-one participants were ineligible, ten participants refused, and two participants partially completed the survey and were excluded due to unreliable responses. The final sample consisted of 96 YEH who consented/assented to participate (a waiver of parental consent was obtained to enroll youth 14–17 years of age) and completed the survey.


The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Ohio State University (#2017C0148). Data were collected through an approximately 90-min interviewer-administered survey from December 2019 through March 2020. Trained research staff read questions to the participants while showing response option cards when appropriate. Responses were recorded directly into Qualtrics by the interviewer; however, more sensitive questions were administered via audio-CASI (computer-assisted self-interviewing), for which the participants entered their own responses. Each participant received a $25 grocery gift card incentive.


Demographic characteristics

We measured participants’ age, gender (male, female, genderqueer, intersex, transgender female, transgender male, transgender, other), sexual orientation (heterosexual/straight, gay, lesbian, bisexual, queer/questioning, asexual, other), race (American Indian or Alaska Native, Asian, Black or African American, Native American, Native Hawaiian or another Pacific Islander, White, bi- or multi-racial, other), Hispanic ethnicity, education (less than high school, high school diploma, general educational development (GED), more than high school), number of children, pregnancy status for youth assigned female at birth, hours worked per week, and location slept most nights.

Ever and past 30-day tobacco product and marijuana use

We measured ever use and past 30-day frequency of use (0 days, 1–2 days, 3–5 days, 6–9 days, 10–19 days, 20–29 days, all 30 days) of the following products: cigarettes, cigars, hookah, EVPs, smokeless tobacco, and marijuana.

Usual brand and flavor

We asked participants if they have a usual brand for each product (excluding marijuana) (yes/no; asked of participants who had ever used that product), what that brand is, and whether that brand is usually flavored. Flavor categories were menthol or mint, clove or spice, fruit, chocolate, an alcoholic drink (such as wine, cognac, margarita, piña colada, peach schnapps, or other cocktails), candy or sweets, tobacco, coffee, vanilla, cola, or other [32].

Marijuana administration and lifetime use frequency

Among past 30-day marijuana users (at least once in the past 30 days), we measured the usual method of administration (blunt [cigar hallowed out and filled with marijuana]; joint, bong, pipe; spliff [combination of tobacco and marijuana]; food; drink; vaporized; some other way). We also asked participants how many times they have used marijuana in their lifetime (0, 1–2, 3–9, 10–19, 20–39, 40–99, and 100+ times).

Other tobacco and psychosocial variables

We assessed a number of tobacco-related and psychosocial factors that may be related to tobacco use and to homeless experiences; these measures were selected based on behavior change theory [33] and on findings from qualitative interviews conducted in an earlier phase of this study [23, 30]. The details of these measures are provided in Supplemental Table 1. Briefly, we assessed tobacco dependence using the Hooked on Nicotine Checklist (HONC; 10-item instrument to identify signals of loss of autonomy among adolescents) [34], first use of tobacco (product, age), and motivations, temptations, and rewards from smoking [35, 36], and alcohol use. In addition, other scales assessed interoceptive awareness (e.g., attention and emotion regulation), strategies to cope with one’s housing situation, and anger/worry management [37,38,39,40].

Data analyses

Categorical variables are summarized with frequencies and percentages while continuous and ordinal variables are summarized with means and standard deviations or medians and interquartile ranges (IQR), as is appropriate based on the distribution of the variable. Fisher exact tests, t tests, and Wilcoxon rank-sum tests were conducted to examine group differences between: 1) daily combustible tobacco users vs. non-daily combustible users, and 2) daily marijuana users vs. non-daily marijuana users. Multivariable logistic regression models were fit to determine independent predictors (demographic, tobacco use, and psychosocial measures described above) of daily combustible use and separately, among the subset of current marijuana users, daily marijuana use. Due to the exploratory nature of these analyses, stepwise selection was used to determine the terms included in the final models. All analyses were conducted in SAS 9.4 (SAS Institute Inc., Cary, NC), and p-values < 0.05 were significant.


Sample characteristics

Participants were mostly aged 18–24 years (n = 93, 97%), identified as male (n = 53, 55%), heterosexual (n = 71, 74%), Black (n = 51, 53%) or multi-racial (n = 27, 28%), non-Hispanic (n = 88, 92%), and had earned a high school diploma (n = 46, 48%) or less than high school (n = 31, 32%) (Table 1). Slightly more than one-third had children, and about half were unemployed. Participants were relatively evenly split between sleeping at a friend’s house or own home (n = 31, 32%), at the shelter or drop-in center (n = 27, 28%), or outside on most nights (n = 25, 26%). Participants were, on average, moderately dependent on nicotine (median = 6, IQR = 3.5–8).

Table 1 Demographic and Tobacco Use Characteristics of Youth Experiencing Homelessness

Ever and past 30-day (current) product use

Combustible tobacco

Among the full sample, the most common product used was cigars, with 92.7% (n = 89) smoking cigars currently, only 5.2% (n = 5) having tried them but not currently using them, and 2.1% (n = 2) having never smoked them (Fig. 1). Closely following cigars, 88.5% (n = 85) smoked cigarettes currently, and equal proportions of the sample had ever smoked cigarettes (but did not currently smoke cigarettes) and had never smoked cigarettes (n = 5, 5.2%). Most of the youth in our sample did not report currently smoking hookah (ever tried, but not currently smoking: 37.5% (n = 36), never tried hookah: 42.7% (n = 41)), although about one-fifth of the sample did report currently smoking hookah (n = 19, 19.8%).

Fig. 1
figure 1

Never, Ever, and Past 30-Day Use of Tobacco Products and Marijuanaa. a A blunt is a cigar hallowed out and filled with marijuana; a spliff is a combination of tobacco and marijuana. EVP: electronic vapor product; P30D: past 30-day use

Non-combustible tobacco

Seventy-two percent (n = 69) of youth in our sample ever used an EVP, while less than one-third (n = 28, 29.2%) had ever used a smokeless tobacco product. Current use was lower where just over one-third (n = 34) of the youth in this study used EVPs and 11.5% (n = 11) used smokeless tobacco in the past month (Fig. 1).


Most youth in the sample were currently using marijuana (85.4% (n = 82) marijuana overall; 85.4% blunts (n = 82); Fig. 1). Thirty-four percent (n = 33) of the sample were currently using spliffs. Almost three-quarters (n = 69, 71.9%) of the youth in this study reported having used marijuana more than 100 times in their lives, followed by 12.5% (n = 12) reporting 40–99 times and 5.2% (n = 5) 20–39 times. Most marijuana users usually co-administered with tobacco, with 67.7% (n = 65) of our sample usually smoking blunts and 2.1% (n = 2) usually smoking spliffs. An additional 11.5% (n = 11) reported usually smoking marijuana in a joint, bong or pipe, and 2.1% (n = 2) reported usually smoking marijuana in a bowl.

Poly-product use

The primary use patterns (Table 1) in the past month among YEH in this sample was poly-combustible use (n = 48, 51%) or combustible plus EVP use (n = 26, 27%). Only 8% (n = 8) used all tobacco product types we assessed, and about 11% (n = 10) used just one combustible product. Few (n = 3, 3%) used smokeless tobacco without EVPs.

Similar to strictly tobacco use patterns, about half of the sample reported concurrent use of combustible tobacco and marijuana (n = 48), and about one quarter (n = 24) reported concurrent use of combustible tobacco, marijuana, and EVPs (Table 1). Fifteen percent (n = 14) used only tobacco with no marijuana, and 7% (n = 7) used all product types assessed.

Frequency of product use in the past 30 days

Combustible products (except hookah) were more frequently used than non-combustible products in this study. The most frequently used product in the past month among youth in our sample was cigarettes, with 40.6% (n = 39) reporting daily use (Fig. 2), followed by marijuana (n = 26, 27.1%), cigars (n = 18, 18.8%), and EVPs and smokeless tobacco (n = 2, 2.1% each). No one reported daily hookah smoking. Infrequent use (1–2 days) was most common among cigar smokers (n = 18, 18.8%), followed by EVPs (n = 15, 15.6%), hookah (n = 13, 13.5%), marijuana (n = 8, 8.3%), smokeless tobacco (n = 6, 6.3%), and cigarettes (n = 4, 4.2%).

Fig. 2
figure 2

Past 30-Day Marijuana and Tobacco Product Use Frequency. EVP: electronic vapor product

Daily vs. non-daily combustible use

We examined differences between daily and non-daily combustible tobacco users (Supplemental Table 2). Compared to non-daily combustible tobacco use, daily combustible tobacco use was associated with having at least one child (55.6% vs. 31.4%, p = 0.017), higher mean nicotine dependence as measured by the HONC (6.5 vs. 5.2, p = 0.039), past 30-day cigarette smoking (97.8% vs. 82.0%, p = 0.039), poly-combustible use (60.0% vs. 42.0%, p = 0.006), and younger mean age when first tried tobacco (13 years vs. 15 years, p = 0.028). In addition, daily combustible tobacco users were more likely than non-daily users to endorse smoking for boredom relief (p < 0.001), stress relief (p = 0.025), or because it’s comforting (p = 0.002), and smoking related to negative affect (p = 0.024) or habit (p = 0.001). More daily combustible tobacco users also reported binge drinking in the past month (p = 0.043).

In multivariable analyses (Table 2), significant predictors of daily combustible tobacco use were having at least one child (odds ratio (OR) = 3.52, 95% confidence interval (CI) = 1.25, 9.92), smoking related to habit (OR = 4.00, 95% CI = 1.08, 14.83), smoking for boredom relief (OR = 1.40, 95% CI = 1.14, 1.71), and higher scores on the non-distracting scale of the Science of Behavior Change (SOBC) Multidimensional Assessment of Interoceptive Awareness (MAIA) measure (OR = 1.67, 95% CI = 1.10, 2.54), indicating that those who tend not to ignore or distract oneself from sensations of pain or discomfort had higher odds of being a daily smoker.

Table 2 Multivariable logistic regression models assessing relationship between tobacco/psychosocial factors and daily combustible/marijuana use

Daily vs. non-daily marijuana use

There were also differences between daily and non-daily marijuana users (n = 82). In univariable analyses (Supplemental Table 3), compared to non-daily marijuana users, daily marijuana users had lower mean nicotine dependence (4.7 vs. 6.4, p = 0.017) and were less likely to report that a combustible tobacco product was their first tobacco product tried (84.6% vs. 98.2%, p = 0.048). Daily marijuana use was associated with reporting smoking (combustible tobacco) related to the positive social aspects (p = 0.045), but less so when experiencing negative affect (p = 0.015) and because it is calming (p = 0.045). Daily marijuana use was associated with lower scores on the dysregulation scale of the SOBC Children’s Emotion Management Scale (CEMS): Worry measure, indicating that daily marijuana users may self-regulate worry better than non-daily users (p = 0.045).

In multivariable analyses (Table 2), those who reported that they smoke combustible tobacco related to experiencing negative affect had lower odds (OR = 0.03, 95% CI = 0.004, 0.21) of daily marijuana use. The odds of being a daily marijuana user decreased by 75% for every five-year increase in age of first trial of tobacco (p = 0.004). Those who reported using substances to feel better about or get through one’s housing situation had 72% higher odds of being a daily marijuana user (p = 0.004).

Usual brand and flavor

Most (n = 81, 89.0%) cigarette smokers reported a usual brand (Supplemental Fig. 1). Almost three-quarters (n = 66, 72.5%) of cigarette smokers reported that their usual brand was Newport, followed by Marlboro (n = 5, 5.5%). The remainder of the brands reported made up 2% or less of cigarette smokers. Eighty-one percent (n = 76) of cigar smokers reported a usual brand. About half (n = 48, 51.1%) of cigar smokers reported that their usual brand was Black & Mild, followed by Swisher Sweets (n = 15, 16.0%). The remainder of the brands reported made up 2% or less of cigar smokers. Most EVP users did not report a usual brand (n = 49, 72%), 8.7% (n = 6) reported usually using JUUL, and 7.2% (n = 5) did not know what brand they usually used. Almost 60% (n = 12) of smokeless tobacco users did not report a usual brand. Twenty-five percent (n = 7) of smokeless tobacco users reported usually using Grizzly, 10.7% (n = 3) Copenhagen, and 7.1% (n = 2) other brands.

Among cigarette smokers who reported a usual brand (n = 81), 72.8% (n = 59) usually smoked a menthol or mint flavored brand (Supplemental Table 4). Cigar smokers reported the most varied selection of flavored products. About half (n = 37) of cigar smokers who report a usual brand (n = 76) use flavored products, ranging from 1.3% (n = 1) vanilla and coffee to 15.8% (n = 12) fruit. Almost all EVP users who reported a usual brand (n = 18) reported using flavored products; over half (n = 10) usually used fruit flavored EVPs. Most (n = 9, 75%) of the smokeless tobacco users who had a usual brand (n = 12) used a menthol or mint flavor, while 25.0% (n = 3) used fruit flavors.


The aim of this study was to characterize tobacco use, including co-use with marijuana, poly-tobacco, flavor, and brand use, frequency of product use, and predictors of frequent use, among YEH who use combustible tobacco in a Midwest city to inform combustible tobacco cessation intervention.

Findings indicate that most (85%) combustible tobacco users in our study currently used marijuana, used marijuana on ≥100 occasions in their lives (72%), and co-administered marijuana with tobacco (e.g., blunt, spliff; 70%). These findings are consistent with another larger study of YEH in LA County that found 90% of any tobacco users were also using marijuana and 65% were co-administering tobacco and marijuana [15]. Nationally in the US, among high school-aged youth, 53.6% of single tobacco product (cigarettes, cigars, smokeless tobacco) users and 64.5% of users of at least two tobacco products also used marijuana in the past month [41]. Together, these studies suggest that co-use of marijuana may be more common among YEH than the general population of young people.

In addition to concurrent use of tobacco and cannabis, poly-tobacco use was common in our study, with 89% reporting the use of a combustible product and at least one other product. Poly-tobacco use in the general population of youth and young adults is lower than what was observed in our study. In 2013, 57.1% of youth and 65.2% of young adults who used cigarettes also used at least one other product in the past month [42], and over 70% of past-month cigar smokers used at least one other tobacco product [43]. The most prevalent combination of products used in our study was two or more combustible products. Combustible products (except hookah) were more frequently used than non-combustible products. Perhaps relatedly, brand preferences were more common for cigarettes and cigars than for smokeless tobacco and EVPs. Newport and Black & Mild were the most popular cigarette and cigar brands, respectively. Consistent with the popularity of Newport cigarettes, most (three-quarters) cigarette smokers usually smoked menthol cigarettes. About half of cigar smokers usually use a flavored product, with fruit being the most popular, followed by alcoholic drink, and candy flavors, which is consistent with these flavors’ share of the market nationally [44]. It should be noted that our inclusion criteria included having used a combustible tobacco product in the past week, so the primary pattern of poly-combustible use and the difference in frequency of use of these products could be explained in part by this requirement.

Our findings suggest that YEH are engaging in numerous high-risk tobacco-related behaviors: co-use with marijuana and multiple tobacco products, frequent combustible tobacco use, and use of menthol cigarettes and flavored cigars. Co-using tobacco and cannabis has been linked to a potential increase in exposure to toxic constituents (compared to only using one type of product) [45], more frequent product use, and increased nicotine/marijuana dependence [46,47,48]. Similarly, poly-tobacco use, frequent combustible product use, and use of flavored products (particularly menthol) are associated with increased nicotine dependence [49,50,51,52]. These high-risk behaviors can escalate use, make it difficult to quit, and lead to disproportionate disease burden for people experiencing homelessness.

Considerations for tobacco cessation intervention

Factors are at play at multiple levels of the social ecology to explain these high-risk behaviors among YEH and to inform interventions targeted for this population. On the individual level, we found that daily combustible tobacco smokers and marijuana users had somewhat unique psychosocial predictors but with similar implications for intervention. Daily combustible tobacco users (47% of the sample) smoked out of habit or boredom and were more likely to have at least one child and to not ignore feelings of pain or discomfort. Daily marijuana users (about one quarter of the sample) were less likely to smoke combustible tobacco due to negative affect, were younger when they initiated tobacco use, and used substances to cope with their housing situation. A national study of young adults found that those who had at least one child were two times as likely to have ever smoked daily than those with no children [53], likely related to added stressors, especially for those without shelter where childcare could also be seen as a competing priority to smoking cessation [21]. Studies also show that young adults who are novelty-seekers and who have more unorganized leisure time are more likely to be daily smokers [53, 54], which could indicate that providing structured activities while at a homeless drop-in center could reduce frequent smoking. For YEH, facilitating access and connection to evidence-based cessation services, such as Quitlines, in the face of daily stressors will be an important initial step toward cessation. Group or individual behavioral cessation counseling for YEH will need to identify stressors and emphasize development of alternative coping strategies.

Also at the individual level, cessation interventions will need to promote recognition/management of triggers to use marijuana and cannabis in relation to one another. We did not assess interest in quitting smoking marijuana, and there is no evidence on marijuana cessation among YEH. However, studies of adults and housing-secure individuals point to the need to address use of both products in tobacco smoking cessation studies. One study of tobacco Quitline callers found that of smokers who also reported currently using marijuana, 43% were interested in quitting marijuana in addition to tobacco [55]. Another study of dual tobacco and marijuana users found compensation of one product when trying to quit the other, with 50% perceiving an increase in their marijuana smoking during tobacco cessation and 62% perceiving an increase in tobacco use during marijuana cessation [56]. Some studies have found reduced tobacco cessation among marijuana users [57, 58]. To develop cessation interventions for YEH, targeting use of both combustible tobacco and marijuana may be necessary. A meta-analysis of interventions targeting co-users found weak evidence for an effect on marijuana cessation and no clear effect on tobacco cessation [59]. Cessation interventions may need to help YEH understand how they use these two products in relation to one another (e.g., to substitute or complement) to elucidate barriers to successful cessation and to better clarify their cessation goals (quitting only tobacco or both products).

At the community/policy level, more frequent combustible tobacco use may be common among YEH because of ease of access due to reduced price and increased availability of cigars in particular (93% of our sample smoked cigars in the past month), which are more likely to be sold in low-income neighborhoods [60, 61]. Menthol cigarettes have been marketed heavily to disadvantaged groups, including young and Black consumers [62], so exposure to such marketing in our sample is likely. Congruently, a national study of brand preferences among young adults found that while Marlboro was the most preferred brand, Newport was more preferred among Black, non-Hispanic and low-income young adults [63]. In the US, federal regulation banning menthol in cigarettes and flavors (including menthol) in cigars has been proposed [64]. Research suggests that policies banning flavors not only have the intended effect of preventing youth initiation, but are also effective in promoting cessation, especially for the 85% of Black smokers who use a menthol brand [65,66,67]. It remains to be determined what impact a menthol or flavor ban may have on co-use of tobacco and cannabis and use of non-combustible tobacco products. Studies suggest that YEH have misperceptions about the relative risk of non-combustible tobacco compared with cigarettes [16], which could perpetuate the use of combustible products, even if menthol is banned. Correcting for harm misperceptions may be needed through counseling. There is also limited access to evidence-based cessation medication, such as nicotine replacement therapy, for people experiencing homelessness [68]. Given the association of high-risk tobacco use behaviors and increased nicotine dependence [48,49,50, 52], intervention approaches to directly increase NRT access, access to lower risk nicotine products, or policy changes to restrict nicotine levels in combustible tobacco products should be tested to determine if they may reduce harm and support cessation in this high-risk population [69, 70].

Innovation, limitations, and future directions

Data are available on tobacco and marijuana use prevalence among other samples of YEH [15], but our study is one of the first to additionally assess flavor use, brands, frequency of use, and predictors of more frequent product use among a sample of YEH. However, there are several limitations to note. First, as our sample was a small convenience sample of YEH in one drop-in center in one city, our results may not generalize to other geographic areas. We also excluded those actively making a current tobacco quit attempt to be consistent with our target population in a future cessation intervention trial, but this may have led to selection bias. Second, measures relied on self-report, so measurement error is possible. Third, another issue possibly affecting measurement is the difficulty in assessing cigars with only tobacco and blunts, which are often conflated [71]. However, providing definitions in the survey questionnaire likely minimized this problem. Future research should further assess co-use of marijuana and tobacco, including frequency/quantity of use, psychosocial contextual factors around co-use, and cessation of these products among YEH.


Young combustible tobacco users experiencing homelessness engage in high-risk use patterns, including high rates of poly-combustible tobacco use, menthol and other flavored tobacco use, and co-use of tobacco with marijuana. Findings from this study indicate that the highest risk tobacco users are more likely to contend with environmental stressors including having children and also do not ignore or distract themselves from pain, factors that should be considered when targeting cessation support for YEH. Interventions that consider the full context of tobacco and marijuana use are needed to support cessation in this population and to inform policy interventions that promote health equity.

Availability of data and materials

The datasets generated and/or analysed during the current study are available in the GitHub repository,



Children’s Emotion Management Scale


Electronic vapor product


General educational development


Hooked on Nicotine Checklist


Interquartile range


Los Angeles


Science of Behavior Change


Multidimensional Assessment of Interoceptive Awareness


Youth experiencing homelessness


United States


Odds ratio


Confidence interval


  1. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.

    Google Scholar 

  2. Warner KE. Disparities in smoking are complicated and consequential. What to do about them? Am J Health Promot. 2011;25(5 Suppl):S5–7.

    Article  PubMed  Google Scholar 

  3. Baker TB, Mermelstein R, Collins LM, Piper ME, Jorenby DE, Smith SS, et al. New methods for tobacco dependence treatment research. Ann Behav Med. 2011;41(2):192–207.

    Article  PubMed  Google Scholar 

  4. Collins LM, Baker TB, Mermelstein RJ, Piper ME, Jorenby DE, Smith SS, et al. The multiphase optimization strategy for engineering effective tobacco use interventions. Ann Behav Med. 2011;41(2):208–26.

    Article  PubMed  Google Scholar 

  5. Sorensen G, Emmons K, Hunt MK, Barbeau E, Goldman R, Peterson K, et al. Model for incorporating social context in health behavior interventions: applications for cancer prevention for working-class, multiethnic populations. Prev Med. 2003;37(3):188–97.

    Article  PubMed  Google Scholar 

  6. Miech RA, Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME. Monitoring the future national survey results on drug use, 1975-2018: volume I, secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan; 2019.

    Google Scholar 

  7. Wenzel SL, Tucker JS, Golinelli D, Green HD Jr, Zhou A. Personal network correlates of alcohol, cigarette, and marijuana use among homeless youth. Drug Alcohol Depend. 2010;112(1–2):140–9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Centers for Disease C, Prevention. Vital signs: current cigarette smoking among adults aged >/=18 years--United States, 2005–2010. MMWR Morb Mortal Wkly Rep. 2011;60(35):1207–12.

    Google Scholar 

  9. Golinelli D, Siconolfi D, Shadel WG, Seelam R, Tucker JS. Patterns of alternative tobacco product use among youth experiencing homelessness. Addict Behav. 2019;99:106088.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mirbolouk M, Charkhchi P, Kianoush S, Uddin SMI, Orimoloye OA, Jaber R, et al. Prevalence and distribution of E-cigarette use among U.S. adults: behavioral risk factor surveillance system, 2016. Ann Intern Med. 2018;169(7):429–38.

    Article  PubMed  Google Scholar 

  11. Tucker JS, Shadel WG, Golinelli D, Ewing B. Alternative tobacco product use and smoking cessation among homeless youth in los Angeles county. Nicotine Tob Res. 2014;16(11):1522–6.

    Article  CAS  PubMed  Google Scholar 

  12. Jones DM, Majeed BA, Weaver SR, Sterling K, Pechacek TF, Eriksen MP. Prevalence and factors associated with smokeless tobacco use, 2014-2016. Am J Health Behav. 2017;41(5):608–17.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Santa Maria D, Padhye N, Yang Y, Gallardo K, Santos GM, Jung J, et al. Drug use patterns and predictors among homeless youth: results of an ecological momentary assessment. Am J Drug Alcohol Abuse. 2018;44(5):551–60.

    Article  PubMed  Google Scholar 

  14. Bousman CA, Blumberg EJ, Shillington AM, Hovell MF, Ji M, Lehman S, et al. Predictors of substance use among homeless youth in San Diego. Addict Behav. 2005;30(6):1100–10.

    Article  PubMed  Google Scholar 

  15. Tucker JS, Shadel WG, Seelam R, Golinelli D, Siconolfi D. Co-use of tobacco and marijuana among young people experiencing homelessness in Los Angeles County. Drug Alcohol Depend. 2020;207:107809.

    Article  CAS  PubMed  Google Scholar 

  16. Shadel WG, Tucker JS, Abbott MM. Knowledge of alternative tobacco products in unaccompanied homeless youth. Tob Regul Sci. 2019;5(1):65–75.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Trapl ES, Koopman Gonzalez SJ, Cofie L, Yoder LD, Frank J, Sterling KL. Cigar product modification among high school youth. Nicotine Tob Res. 2018;20(3):370–6.

    PubMed  Google Scholar 

  18. DiGuiseppi GT, Davis JP, Christie NC, Rice E. Polysubstance use among youth experiencing homelessness: the role of trauma, mental health, and social network composition. Drug Alcohol Depend. 2020;216:108228.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Pratt R, Pernat C, Kerandi L, Kmiecik A, Strobel-Ayres C, Joseph A, et al. "It's a hard thing to manage when you're homeless": the impact of the social environment on smoking cessation for smokers experiencing homelessness. BMC Public Health. 2019;19(1):635.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Baggett TP, Campbell EG, Chang Y, Magid LM, Rigotti NA. Posttraumatic stress symptoms and their association with smoking outcome expectancies among homeless smokers in Boston. Nicotine Tob Res. 2016;18(6):1526–32.

    Article  PubMed  Google Scholar 

  21. Twyman L, Bonevski B, Paul C, Bryant J. Perceived barriers to smoking cessation in selected vulnerable groups: a systematic review of the qualitative and quantitative literature. BMJ Open. 2014;4(12):e006414.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tucker JS, Shadel WG, Golinelli D, Ewing B, Mullins L. Motivation to quit and interest in cessation treatment among homeless youth smokers. Nicotine Tob Res. 2015;17(8):990–5.

    Article  PubMed  Google Scholar 

  23. Glasser AM, Macisco JM, Miller LM, Garbsch EM, Wermert A, Nemeth JM. Smoking cessation methods among homeless youth in a Midwestern city. Addict Behav Rep. 2020;11:100276.

    PubMed  PubMed Central  Google Scholar 

  24. Shadel WG, Tucker JS, Mullins L, Staplefoote L. Providing smoking cessation programs to homeless youth: the perspective of service providers. J Subst Abus Treat. 2014;47(4):251–7.

    Article  Google Scholar 

  25. Tucker JS, Linnemayr S, Pedersen ER, Shadel WG, Zutshi R, DeYoreo M, et al. Pilot randomized clinical trial of a text messaging-based intervention for smoking cessation among young people experiencing homelessness. Nicotine Tob Res. 2021;23(10):1691–8.

    Article  PubMed  Google Scholar 

  26. Linnemayr S, Zutshi R, Shadel W, Pedersen E, DeYoreo M, Tucker J. Text messaging intervention for young smokers experiencing homelessness: Lessons learned from a randomized controlled trial. JMIR Mhealth Uhealth. 2021;9(4):e23989.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Shadel WG, Tucker JS, Golinelli D. Readjusting our priorities: helping homeless youth quit smoking. Am J Prev Med. 2015;49(6):970–3.

    Article  PubMed  Google Scholar 

  28. Pateman K, Ford P, Fizgerald L, Mutch A, Yuke K, Bonevski B, et al. Stuck in the catch 22: attitudes towards smoking cessation among populations vulnerable to social disadvantage. Addiction. 2016;111(6):1048–56.

    Article  PubMed  Google Scholar 

  29. Inoue-Choi M, Christensen CH, Rostron BL, Cosgrove CM, Reyes-Guzman C, Apelberg B, et al. Dose-response Association of low-Intensity and Nondaily Smoking with Mortality in the United States. JAMA Netw Open. 2020;3(6):e206436.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Patterson JG, Glasser AM, Macisco JM, Hinton A, Wermert A, Nemeth JM. “I smoked that cigarette, and it calmed me down": A qualitative analysis of intrapersonal, social, and environmental factors influencing decisions to smoke among youth experiencing homelessness. Nicotine Tob Res. 2022;24(2):250-6.

  31. Practical Lessons: The 1998 National Symposium on homelessness research (Arlington, Virginia, October 29-30, 1998). National Symposium on homelessness research; 1998; Arlingon, VA: Department of Housing and Urban Development, Washington, DC. Office of Policy Development and Research.; Department of Health and Human Services, Washington, DC.

  32. Centers for Disease Control and Prevention. Youth Risk Behavior Survey Questionnaire 2019. Available from:

    Google Scholar 

  33. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.

    Article  PubMed  PubMed Central  Google Scholar 

  34. DiFranza JR, Savageau JA, Fletcher K, Ockene JK, Rigotti NA, McNeill AD, et al. Measuring the loss of autonomy over nicotine use in adolescents: the DANDY (development and assessment of nicotine dependence in youths) study. Arch Pediatr Adolesc Med. 2002;156(4):397–403.

    Article  PubMed  Google Scholar 

  35. Plummer BA, Velicer WF, Redding CA, Prochaska JO, Rossi JS, Pallonen UE, et al. Stage of change, decisional balance, and temptations for smoking: measurement and validation in a large, school-based population of adolescents. Addict Behav. 2001;26(4):551–71.

    Article  CAS  PubMed  Google Scholar 

  36. Wills TA, Sandy JM, Shinar O. Cloninger's constructs related to substance use level and problems in late adolescence: a mediational model based on self-control and coping motives. Exp Clin Psychopharmacol. 1999;7(2):122–34.

    Article  CAS  PubMed  Google Scholar 

  37. Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol. 1989;56(2):267–83.

    Article  CAS  PubMed  Google Scholar 

  38. Mehling WE, Price C, Daubenmier JJ, Acree M, Bartmess E, Stewart A. The multidimensional assessment of interoceptive awareness (MAIA). PLoS One. 2012;7(11):e48230.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Zeman JL, Cassano M, Suveg C, Shipman K. Initial validation of the children’s worry management scale. J Child Fam Stud. 2010;19(4):381–92.

    Article  Google Scholar 

  40. Zeman JL, Shipman K, Penza-Clyve S. Development and initial validation of the Children's sadness management scale. J Nonverbal Behav. 2001;25(3):187–205.

    Article  Google Scholar 

  41. Creamer MR, Portillo GV, Clendennen SL, Perry CL. Is adolescent poly-tobacco use associated with alcohol and other drug use? Am J Health Behav. 2016;40(1):117–22.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Taylor KA, Sharma E, Edwards KC, Halenar MJ, Kissin W, Kasza KA, et al. Longitudinal pathways of exclusive and polytobacco cigarette use among youth, young adults and adults in the USA: findings from the PATH study waves 1-3 (2013-2016). Tob Control. 2020;29(Suppl 3):s139–s46.

    Article  PubMed  Google Scholar 

  43. Edwards KC, Sharma E, Halenar MJ, Taylor KA, Kasza KA, Day H, et al. Longitudinal pathways of exclusive and polytobacco cigar use among youth, young adults and adults in the USA: findings from the PATH study waves 1-3 (2013-2016). Tob Control. 2020;29(Suppl 3):s163–s9.

    Article  PubMed  Google Scholar 

  44. Delnevo CD, Giovenco DP, Ambrose BK, Corey CG, Conway KP. Preference for flavoured cigar brands among youth, young adults and adults in the USA. Tob Control. 2015;24(4):389–94.

    Article  PubMed  Google Scholar 

  45. Meier E, Hatsukami DK. A review of the additive health risk of cannabis and tobacco co-use. Drug Alcohol Depend. 2016;166:6–12.

    Article  CAS  PubMed  Google Scholar 

  46. National Academy of Sciences, Engineering and Medicine (NASEM). The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington (DC): The National Academies Collection: Reports funded by National Institutes of Health; 2017.

    Google Scholar 

  47. Agrawal A, Budney AJ, Lynskey MT. The co-occurring use and misuse of cannabis and tobacco: a review. Addiction. 2012;107(7):1221–33.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Tucker JS, Pedersen ER, Seelam R, Dunbar MS, Shih RA, D'Amico EJ. Types of cannabis and tobacco/nicotine co-use and associated outcomes in young adulthood. Psychol Addict Behav. 2019;33(4):401–11.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Harrell PT, Naqvi SMH, Plunk AD, Ji M, Martins SS. Patterns of youth tobacco and polytobacco usage: the shift to alternative tobacco products. Am J Drug Alcohol Abuse. 2017;43(6):694–702.

    Article  PubMed  Google Scholar 

  50. Gomez Y, Creamer M, Trivers KF, Anic G, Morse AL, Reissig C, et al. Patterns of tobacco use and nicotine dependence among youth, United States, 2017-2018. Prev Med. 2020;141:106284.

    Article  PubMed  Google Scholar 

  51. Villanti AC, Collins LK, Niaura RS, Gagosian SY, Abrams DB. Menthol cigarettes and the public health standard: a systematic review. BMC Public Health. 2017;17(1):983.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Villanti AC, Johnson AL, Halenar M, Sharma E, Cummings KM, Stanton CA, et al. Menthol and mint cigarettes and cigars: Initiation and progression in youth, young adults and adults in Waves 1–4 of the PATH Study, 2013–2017. Nicotine Tob Res. 2020.

  53. Hu MC, Davies M, Kandel DB. Epidemiology and correlates of daily smoking and nicotine dependence among young adults in the United States. Am J Public Health. 2006;96(2):299–308.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Kvaavik E, von Soest T, Pedersen W. Nondaily smoking: a population-based, longitudinal study of stability and predictors. BMC Public Health. 2014;14:123.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Carpenter KM, Torres AJ, Salmon EE, Carlini BH, Vickerman KA, Schauer GL, et al. Marijuana use and adherence to smoking cessation treatment among callers to tobacco Quitlines. Prev Chronic Dis. 2020;17:E102.

    Article  PubMed  PubMed Central  Google Scholar 

  56. McClure EA, Tomko RL, Salazar CA, Akbar SA, Squeglia LM, Herrmann E, et al. Tobacco and cannabis co-use: drug substitution, quit interest, and cessation preferences. Exp Clin Psychopharmacol. 2019;27(3):265–75.

    Article  PubMed  Google Scholar 

  57. Rogers AH, Shepherd JM, Buckner JD, Garey L, Manning K, Orr MF, et al. Current cannabis use and smoking cessation among treatment seeking combustible smokers. Drug Alcohol Depend. 2020;209:107928.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Voci S, Zawertailo L, Baliunas D, Masood Z, Selby P. Is cannabis use associated with tobacco cessation outcome? An observational cohort study in primary care. Drug Alcohol Depend. 2020;206:107756.

    Article  PubMed  Google Scholar 

  59. Walsh H, McNeill A, Purssell E, Duaso M. A systematic review and Bayesian meta-analysis of interventions which target or assess co-use of tobacco and cannabis in single- or multi-substance interventions. Addiction. 2020;115(10):1800–14.

    Article  PubMed  Google Scholar 

  60. Giovenco DP, Spillane TE, Merizier JM. Neighborhood differences in alternative tobacco product availability and advertising in new York City: implications for health disparities. Nicotine Tob Res. 2019;21(7):896–902.

    Article  PubMed  Google Scholar 

  61. Cantrell J, Kreslake JM, Ganz O, Pearson JL, Vallone D, Anesetti-Rothermel A, et al. Marketing little cigars and cigarillos: advertising, price, and associations with neighborhood demographics. Am J Public Health. 2013;103(10):1902–9.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Richardson A, Ganz O, Pearson J, Celcis N, Vallone D, Villanti AC. How the industry is marketing menthol cigarettes: the audience, the message and the medium. Tob Control. 2015;24(6):594–600.

    Article  PubMed  Google Scholar 

  63. Glasser AM, Johnson AL, Rath JM, Williams VF, Vallone DM, Villanti AC. Tobacco product brand preference among US young adults, 2011-2014. Tob Regul Sci. 2016;2(1):44–55.

    Article  Google Scholar 

  64. U.S. Food & Drug Administration. FDA Commits to Evidence-Based Actions Aimed at Saving Lives and Preventing Future Generations of Smokers 2021 Available from:

    Google Scholar 

  65. Villanti AC, Mowery PD, Delnevo CD, Niaura RS, Abrams DB, Giovino GA. Changes in the prevalence and correlates of menthol cigarette use in the USA, 2004–2014. Tobacco control. 2016;25(Suppl 2):ii14–20.

    Article  PubMed  Google Scholar 

  66. Cook S, Hirschtick JL, Patel A, Brouwer A, Jeon J, Levy DT, et al. A longitudinal study of menthol cigarette use and smoking cessation among adult smokers in the US: assessing the roles of racial disparities and E-cigarette use. Prev Med. 2022;154:106882.

    Article  PubMed  Google Scholar 

  67. Chaiton M, Schwartz R, Cohen JE, Soule E, Zhang B, Eissenberg T. Prior daily menthol smokers more likely to quit 2 years after a menthol ban than non-menthol smokers: a population cohort study. Nicotine Tob Res. 2021;23(9):1584–9.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Vijayaraghavan M, Elser H, Apollonio D. Interventions to reduce tobacco use in people experiencing homelessness. Cochrane Database Syst Rev. 2019;2019(9):CD013413.

    PubMed Central  Google Scholar 

  69. Berman ML, Glasser AM. Nicotine reduction in cigarettes: literature review and gap analysis. Nicotine Tob Res. 2019;21(Suppl 1):S133–S44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Hartmann-Boyce J, McRobbie H, Butler AR, Lindson N, Bullen C, Begh R, et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2021;9:CD010216.

    PubMed  Google Scholar 

  71. Delnevo CD, Bover-Manderski MT, Hrywna M. Cigar, marijuana, and blunt use among US adolescents: are we accurately estimating the prevalence of cigar smoking among youth? Prev Med. 2011;52(6):475–6.

    Article  PubMed  PubMed Central  Google Scholar 

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This work was supported by the National Cancer Institute (NCI) grant 5K07CA216321 (PI: Nemeth J). This research was also supported by The Ohio State University Comprehensive Cancer Center and the National Institutes of Health under grant number P30 CA016058. Funding sources had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

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AG and JN conceived of the study. AH analyzed the data. AG wrote the first draft of the manuscript. All authors (AG, JN, AH, JM, AW) interpreted the data and approved the final manuscript.

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Correspondence to Allison M. Glasser.

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The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Ohio State University (#2017C0148). Participants 18 years of age or older provided informed consent to participate, participants ages 14–17 provided informed assent to participate. A waiver of parental consent was obtained from the Ethics Committee of Ohio State University to enroll youth 14–17 years of age because youth experiencing homelessness are most often not in contact with their family and requiring consent from a legal guardian would preclude participation in the project.

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Glasser, A.M., Hinton, A., Wermert, A. et al. Characterizing tobacco and marijuana use among youth combustible tobacco users experiencing homelessness – considering product type, brand, flavor, frequency, and higher-risk use patterns and predictors. BMC Public Health 22, 820 (2022).

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  • Homelessness
  • Youth
  • Young adults
  • Combustible
  • Marijuana
  • Poly-tobacco