Deepa Camenga is an instructor in pediatrics at the Yale School of Medicine and the first author of “Marijuana, Alcohol Use and Attempted Cigarette Cessation in Adolescent Boys and Girls,” a Yale study recently published in the journal Substance Abuse. The study focuses on the ways in which alcohol and marijuana use affect the frequency of attempts to quit smoking in teenagers. The research, which involved over 800 teen smokers at 10 Connecticut high schools, found that increased alcohol and tobacco use leads to a decrease in quit attempts, though generally men were less likely than women to attempt to quit smoking if they frequently smoke marijuana, and women were less likely to quit smoking if they engaged in heavy binge drinking. The News talked with Camenga about teen education practices, drug “substitution,” and the changes in today’s drug climate.
Q. How do you see your research being applied in the field?
A. This study looks at the association between making a cigarette quit attempt — trying to quit smoking — and other very common substances that are used by adolescents, that is, alcohol and marijuana. And those three drugs travel together. People tend to use combinations of those, and it shows that if you smoke marijuana more often or binge drink more often, you’re less likely to quit smoking. It’s important for people who are working in smoking cessation to really understand the whole breadth of substances that people are using. The study doesn’t really answer the question as to why — it wasn’t designed that way — but it does suggest that specialized treatment strategies are needed for people who are using multiple substances because they might be less motivated to quit smoking.
Q. What was your most interesting finding?
A. This data was collected in 2006, but it’s interesting because of the increased access [to] marijuana. We’re expecting to see more marijuana use in teenagers because it is more available [now], and how does that relate to their smoking behaviors? We’ve spent a lot of time as a country preventing smoking in children and in teenagers, and there’s definitely an interrelationship between marijuana and tobacco cigarette use. People will convert to marijuana use only because it’s more available now than cigarettes — with tobacco we have a lot of taxation and so it’s difficult to get and it’s expensive. Marijuana seems to be less expensive and easier to get. So it will be interesting, public health-wise. Now this data was collected eight years ago so it wasn’t an issue, but now it will be interesting to see what happens with patterns of use now as this country moves more towards decriminalization and legalization for adults, which we presume will lead to an increase in access for kids — but we don’t know yet.
Q. Did any part of the findings surprise you?
A. One interesting thing is that we have a gender related finding in males, that males but not females have decreased likelihood of trying to quit if they smoke higher amounts of marijuana. There are some hypotheses but we don’t know why. There may be something known as a substitution phenomenon. It’s well known that there’s a relaxing effect from both smoking cigarettes and marijuana [since] both of the substances helped [the user] in relaxation. Teens are able to smoke marijuana, but they’re not able to do it out on the street, so they would switch to cigarettes, for when they were in places where they couldn’t smoke [marijuana].
Q. What’s the next step for research based on your findings?
A. There’s a lot of follow up questions, and then of course there’s testing interventions, actual treatment strategies for teens who are using multiple substances to see what works best. It would be targeted treatment studies for kids who are engaging in high use of marijuana, alcohol and cigarettes. There are people across the country who are demonstrating that those kids, because a lot of people are treating their marijuana and alcohol use, and there’s definitely a health implication to that, but they are trying to see what’s the best way to also help them quit smoking. People think that that’s the least of what the issues are, but there’s long-term unhealthy effects of tobacco use and the kids deserve a chance to get treatment for that as well. So testing treatments for these kids.