Blunt use was most prevalent among adults who may be doubly marginalized.

Blunt use was more prevalent among young adults than older adults.

Disparities in blunt use by race and SES were greater among older adults.

Structural interventions to reduce blunt use could improve health equity.

Blunts (cigars with tobacco replaced or mixed with cannabis) incur health risks from exposure to tobacco and cannabis and are disproportionately used by young adults, people identifying as Black/African American (B/AA), people with lower socioeconomic status (SES), and people with mental health issues. This study described patterns of blunt use among US adults with multiple identities or circumstances increasing risk for blunt use.

We used Wave 6 (2021) (US adults; N = 30,516) of the Population Assessment of Tobacco and Health Study to examine the association between current blunt use and race (B/AA vs. non-B/AA) +  mental health (symptoms of internalizing/externalizing conditions) and socioeconomic status (SES; receipt of government assistance) using weighted multivariable logistic regression models, stratified by age (young adults [YAs] 18–34 vs. adults 35 + years).

In 2021, 8.4 % of YAs and 1.4 % of adults 35 +  currently used blunts. Compared to people with joint advantage (e.g., non-B/AA + high SES), those identifying as B/AA with low SES (aOR=5.10, 95 % CI=4.16–6.26), high internalizing (aOR=4.83, 95 % CI=3.70–6.32), or externalizing conditions (aOR=4.74, 95 % CI=3.47–6.48) had greater odds of using blunts. The magnitude of the association between identifying as B/AA and having low SES (alone and jointly) and blunt use was greater among adults 35 +  years (vs. YAs).

Blunt use was most prevalent among B/AA adults with low SES or those who experienced mental health conditions. The magnitude of some inequities was greater among adults 35 + . Social and structural interventions to reduce blunt use among US adults could improve health equity.

Cannabis

Tobacco

Blunts

Intersectionality

Health equity

© 2025 The Authors. Published by Elsevier B.V.