As more states legalize cannabis (National Conference of State Legislatures, 2024) and its social acceptance increases (Pew Research Center, 2024), interest has grown in understanding its public health implications (Centers for Disease Control and Prevention, 1982, Murthy, 2017; National Academies of Sciences, 2017). A proliferation of different cannabis products has ensued (Hammond et al., 2022), with the average potency of cannabis products increasing over time (Freeman et al., 2021, Volkow et al., 2014). Cannabis may prove addictive and has been associated with a variety of adverse medical consequences (Volkow et al., 2014).

The methods by which cannabis is used has potential public health and regulatory implications. While smoking has historically been the predominant method of cannabis use (Volkow et al., 2014), alternative modalities of use appear increasingly common. Cannabis vaping has increased, particularly among young adults (Boakye et al., 2021) as has dabbing, or inhaling vaporized cannabis concentrates (Leal & Moscrop-Blake, 2024). Such changes may be driven by legalization (Caulkins et al., 2018, Goodman, S., Wadsworth, E., Leos-Toro, C., Hammond, D., International Cannabis Policy Study, t., 2020, Vachhani et al., 2022), though risk perceptions (West, Romm, & Berg, 2021), targeted marketing efforts (Berg et al., 2024), and belonging to certain demographic groups (Jeffers, Glantz, Byers, & Keyhani, 2021) have all been found to correlate with the likelihood an individual uses a particular cannabis modality. Those who use multiple cannabis modalities may be more likely to engage in other risky behaviors (Krauss, Rajbhandari, Sowles, Spitznagel, & Cavazos-Rehg, 2017), underscoring the importance of studying this group.

Limitations exist regarding prior evidence examining patterns of using different cannabis methods (Geissler, Kaizer, Johnson, Doonan, & Whitehill, 2020). Given evolving norms and perceptions, earlier studies may now reflect outdated historical patterns (Schauer, King, Bunnell, Promoff, & McAfee, 2016; Schauer, Njai, & Grant-Lenzy, 2020). Prior research has examined predictors of particular methods of cannabis use (Lankenau et al., 2017, Leal and Moscrop-Blake, 2024) and using multiple cannabis use methods generally (Azcarate et al., 2020, Krauss et al., 2017, Leal and Moscrop-Blake, 2024, Schauer et al., 2016, Schauer et al., 2020) but limited descriptions exist on specific patterns by which individuals combine various methods of cannabis use. An article previously focused on this noted that sole smoking was most commonly observed, followed by the combined use of smoking, vaping, and edibles (Steigerwald et al., 2018). Prior studies have not consistently accounted for physical health conditions that might confound relationships between demographics and cannabis use, nor have they considered the frequency of use among recent users. In this study, we use representative survey data from the Behavioral Risk Factor Surveillance System (BRFSS) to address these gaps. We assess patterns of use across different methods of cannabis use. In so doing, we examine demographic, health, and substance use correlates of use, and additionally assess the frequency of use among recent cannabis users.