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In summary, we found that the prognosis of BC is closely related to immune regulation in the TME. Although adolescents often co-use alcohol, cigarettes, and cannabis, little is known about sex and racial/ethnic differences in the co-use of these substances. Therefore, this investigation examined sex and racial/ethnic differences in alcohol, cigarette, and cannabis co-use in a large and ethnically diverse group. Participants were drawn from a large, multi-site study of adolescents from three regions in the United States ( = 4,129; M =1