Background:
Between 2012/2013 and 2014/2015, a significant increase in tobacco and cannabis use occurred among PEI students that did not align with patterns of use in other Canadian provinces. We have not identified why these rates are rising in PEI; however, there are growing concerns about health risks resulting from dual use, given the strong and consistent association between tobacco and cannabis.

Methods:
From 2008/2009 to 2014/2015, the Canadian Student Tobacco Alcohol and Drugs Survey (CSTADS) (formerly the Youth Smoking Survey) collected biennial student substance use data across Canada. In 2014/2015, CSTADS data were collected from 42 094 students in 336 Canadian schools (incl. 2 256 PEI students in 53 schools).

Results:
PEI student tobacco use has risen significantly from 2012/2013 for three indicators (past 30 day use of menthol cigarettes [3.0 to 4.3%]; little cigars or cigarillos [4.3 to 5.4%]; and any tobacco product [13.8 to 16.1%]). In 2014/2015, PEI student tobacco use rates (incl. current smoking, ever tried, and past 30 day use of any tobacco product) were all significantly higher than national rates. In addition, 44.5% of Canadian students (15+) reported ever using cannabis (incl. >90% of current cigarette smokers). Provincially, prevalence of cannabis use (grades 7-12) varied significantly (PEI - 24.8% vs. Canada - 16.5%). Access to cannabis was perceived ´easier´ by students who reported smoking cigarettes.

Conclusions:
This divergent pattern of tobacco and cannabis use in PEI raises alarms. Is there a possible "gateway effect," where use of one substance is increasing the likelihood of another, or, is the change the result of provincial policies/programs being focused on other student risk behaviours? A national call to action on dual use of tobacco and cannabis is needed, which sets clear targets for reducing use, documents the impacts of dual use on health, and creates policies to protect against harm.