This study underscores the importance of studying in-home cannabis smoking, which occurs at a higher rate than in-home tobacco smoking; however, more research is needed. Cannabis users comprise a sizeable population, both in absolute and relative terms, and with cannabis laws becoming more liberal, the number of users is rising. A major public health goal for future studies is to identify how often in-home cannabis smoking occurs in the general public and in high-use populations. Knowing the rates in the overall population will reveal the full scope of the behavior while understanding rates in high-use groups will quantify the behavior among those who have the most to gain from intervention. Obtaining these prevalence data will inform interventions to eliminate in-home smoking and will encourage further research, including the identification of public health messages designed to prevent in-home smoking and research on the health consequences of first hand, secondhand, and third hand cannabis grow tray smoke exposure.
As with all studies, results of the present analysis should be viewed considering the strengths and limitations of the methods used. While we included data from 107,274 men and women from 17 countries, the data were collected using anonymized web-based surveys specifically targeted toward those who use drugs through advertisements on social media and drug-scene-related media outlets. While non-probability-based sampling and self-selection bias prevent generalizable estimates of prevalence , the inferences that were presented comparing in-home tobacco and cannabis smoking by use-status are expected to have significantly less bias since it is unlikely that the primary prerequisite for selection bias was present. In the Introduction, we referenced online information on tobacco and cannabis control policies that highlight significant variance in the type and implementation of policies across countries.
To our knowledge, no study has attempted to quantify the impact of such regulatory differences on the in-home use of cannabis and tobacco, an investigation that was beyond the scope of the present study. However, the presence and diversity of public policies toward both substances should be considered when interpreting our findings. To reduce bias related to confounding by participant-level characteristics and by country-level characteristics such as regulatory policies, our models statistically controlled for several potential confounders,vertical grow system for sale and included country as a fixed and random effect. Future investigations of how tobacco and cannabis control policies impact in-home smoking are warranted, especially studies that explore how legalized cannabis use, with and without legalized outdoor use, impacts in-home use and subsequent SHS and THS exposure. The self-report origin of our cannabis and tobacco use status and in-home smoking status is also a limitation, although the GDS is a well-respected entity among the drug-using community and is known for preserving anonymity, making it more likely to elicit accurate responses.
We were unable to study usual in-home smoking patterns including the frequency of in-home smoking or household composition because we did not collect usable data on these important factors—future studies should capture more detailed data. As a result, our estimates likely overestimate problematic in-home smoking, although this is not expected to greatly bias results since the overestimation is likely non-differential—i.e., similar for both in-home cannabis and in-home tobacco smoking. Transmission of severe acute respiratory syndrome coronavirus 2 , the virus responsible for causing coronavirus disease 2019 , has led to unprecedented morbidity and mortality across the U.S. . Risk factors for COVID-19-related severe illness resulting in possible hospitalization include: active or former smoking status and/or having pre-existing comorbidities or an immunocompromised status . Combustible and non-combustible tobacco users are vulnerable to clinical morbidities, including impaired pulmonary function and respiratory illnesses.Additionally, vaping nicotine, flavorings, and/or tetrahydrocannabinol products may place individuals at increased risk for COVID-19- related symptomatology and illness due to impairment of normal pulmonary defenses to inhaled viral pathogens . Smoking, and possibly e-cigarette use, can upregulate the angiotensin-converting enzyme-2 receptor, which is the receptor for SARS-CoV-2 .