Abstract
This cross-sectional study examines the prevalence and frequency of cannabis vaping, which is distinct from nicotine vaping, among young people aged 12 to 24 years.
E-cigarette use, or vaping, has gained much public attention because of its rapidly increasing popularity among adolescents.1 Besides its use for vaping nicotine, vaping devices, such as e-cigarettes and vape pens, can be used to vape cannabis by heating a liquid or oil containing delta-9-tetrahydrocannabinol (THC). However, little is known about cannabis vaping,2 and many people may mistakenly interpret vaping as just nicotine vaping. For example, EVALI (e-cigarette or vaping use–associated lung injury) was initially assumed by most investigators to be associated with nicotine vaping but was later found to be associated with vaping THC with vitamin E acetate as an additive.3 However, after this finding was widely disseminated, most adults associated the EVALI deaths with the use of nicotine-containing e-cigarettes.4 Thus, distinguishing nicotine from cannabis vaping is important. We used data from the Population Assessment of Tobacco and Health (PATH) Study5 to identify the proportion of current e-cigarette users who vaped cannabis and their frequency of cannabis vaping, characterized by age and other sociodemographic variables.
Methods
The PATH Study5 is a national longitudinal study of tobacco use among US adults and youth. A total of 11 356 young adults aged 18 to 24 years and 11 976 adolescents aged 12 to 17 years participated in the wave 5 survey, which was conducted from December 2018 to November 2019. The weighted response rates for the wave 4 cohort were 88.0% for adult and 83.5% for youth participants. We incorporated cross-sectional survey weights to calculate nationally representative prevalence. Race and ethnicity data were self-reported. The University of Alabama at Birmingham Institutional Review Board exempted the present cross-sectional study from review and waived the requirement for patient informed consent because it used deidentified data. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
We assessed the frequency of cannabis vaping according to the categorical responses to the PATH Study survey question, “When you have used an electronic product, how often were you using it to smoke marijuana, marijuana concentrates, marijuana waxes, THC, or hash oils?” We also constructed a binary variable of cannabis vaping based on the answer “never” vs all other responses. We included only participants who reported past 30-day use (current use) of electronic nicotine products.
Pearson χ2 test of independence was performed to assess the association between cannabis vaping and the sociodemographic variable. A P = .05 was used as the threshold for statistical significance. This complete case analysis used Stata, version 17 (StataCorp LLC), with the svy command to incorporate survey weights.
Results
This study analyzed 164 participants aged 12 to 14 years, 919 participants aged 15 to 17 years, and 3038 participants aged 18 to 24 years. Of these participants, 1824 (44%) were female and 2297 (56%) were male individuals, and 1009 (24%) self-identified as Hispanic, 341 (8%) as non-Hispanic Black, 2378 (58%) as non-Hispanic White, or 393 (10%) other race and ethnicity (including American Indian or Alaska Native, Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian, Native Hawaiian, Guamanian or Chamorro, Samoan, and Other Pacific Islander). The weighted proportion of current e-cigarette use was 3.0% (95% CI, 2.6%-3.4%) in youths aged 12 to 14 years, 14.4% (95% CI, 13.5%-15.3%) in youths aged 15 to 17 years, and 26.2% (95% CI, 25.3%-27.1%) in young adults aged 18 to 24 years.
As seen in Table 1, the prevalence of cannabis vaping among young people who reported current use of e-cigarettes was 35.0% (95% CI, 29.3%-41.2%) in participants aged 12 to 14 years, 51.3% (95% CI, 47.7%-54.9%) in those aged 15 to 17 years, and 54.6% (95% CI, 52.5%-56.7%) in young adults. Table 1 also presents prevalence estimates for each age group by sociodemographic characteristics.
Table 1. Prevalence of Cannabis Vaping Among US Youth and Young Adults Who Currently Use e-Cigarettes .
| Variable | Weighted prevalence (95% CI), %a | ||
|---|---|---|---|
| Youths | Young adults | ||
| Aged 12-14 y (n = 164) | Aged 15-17 y (n = 919) | Aged 18-24 y (n = 3038) | |
| Overall | 35.0 (29.3-41.2) | 51.3 (47.7-54.9) | 54.6 (52.5-56.7) |
| Sex | |||
| Male | 31.5 (25.0-38.8) | 51.9 (46.4-57.3) | 53.1 (50.4-55.7) |
| Female | 37.8 (28.6-48.0) | 51.0 (45.9-56.0) | 56.9 (53.2-60.4) |
| P valueb | .30 | .81 | .11 |
| Race and ethnicityc | |||
| Hispanic | 46.2 (37.7-54.9) | 61.9 (54.4-68.9) | 58.7 (54.9-62.5) |
| Non-Hispanic Black | 28.6 (8.4-63.8) | 53.5 (39.0-67.4) | 46.7 (40.3-53.3) |
| Non-Hispanic White | 32.1 (25.8-39.2) | 46.2 (41.3-51.3) | 54.9 (52.4-57.3) |
| Otherd | 23.8 (10.4-45.6) | 59.5 (50.0-68.3) | 53.4 (46.4-60.4) |
| P valueb | .11 | .002 | .02 |
| Annual household income, $ | |||
| <50 000 | 46.9 (36.7-57.4) | 51.5 (45.6-57.4) | 53.6 (50.6-56.6) |
| 50 000-100 000 | 26.3 (16.2-39.6) | 43.0 (36.3-50.1) | 54.8 (50.2-59.3) |
| >100 000 | 24.4 (16.4-34.7) | 58.5 (52.0-64.7) | 57.9 (53.7-62.1) |
| P valueb | .004 | .007 | .26 |
| Educational levele | |||
| ≤High school diploma/GED certificate | 40.8 (27.8-55.3) | 47.9 (40.6-55.3) | 51.9 (48.8-55.0) |
| Some college | 40.0 (31.0-49.8) | 45.9 (40.0-51.8) | 55.6 (52.3-58.8) |
| ≥College degree | 17.5 (9.8-29.4) | 58.7 (49.0-67.8) | 63.5 (55.3-71.0) |
| P valueb | .02 | .06 | .02 |
| School gradesf | |||
| ≥Mostly B | 25.9 (20.8-31.9) | 50.2 (45.6-54.7) | NA |
| <Mostly B | 44.4 (33.8-55.6) | 52.1 (46.7-57.4) | NA |
| P valueb | .005 | .57 | NA |
Abbreviations: GED, General Educational Development; NA, not applicable.
Weighted estimates and 95% CIs were reported by taking the complex survey design into account using the Fay variant of balanced repeated replication for variance estimation.
Pearson χ2 test of independence was performed to assess the association between cannabis vaping and the sociodemographic variable.
Race and ethnicity data were self-reported.
Other category included American Indian or Alaska Native, Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, other Asian, Native Hawaiian, Guamanian or Chamorro, Samoan, and other Pacific Islander.
Educational level was the highest educational attainment for parents of youth.
School grades were not available for young adults.
The frequency of cannabis vaping is shown in Table 2. The prevalence of those who reported vaping cannabis every time they vaped was 3.1% (95% CI, 1.3%-6.9%) of youths aged 12 to 14 years, 6.7% (95% CI, 5.3%-8.6%) of youths aged 15 to 17 years, and 10.3% (95% CI, 9.0%-11.6%) of young adults.
Table 2. Frequency of Cannabis Vaping Among US Youth and Young Adults Who Currently Use e-Cigarettes.
| Reported frequency | Weighted prevalence (95% CI), %a | ||
|---|---|---|---|
| Youth | Young adult | ||
| Aged 12-14 y (n = 164) | Aged 15-17 y (n = 919) | Aged 18-24 y (n = 3038) | |
| Never | 65.0 (57.3-72.0) | 48.7 (45.3-52.1) | 45.4 (43.3-47.5) |
| Rarely | 16.2 (11.2-22.8) | 22.2 (19.7-24.8) | 17.1 (15.5-18.8) |
| Sometimes | 9.2 (5.6-14.6) | 14.0 (11.7-16.8) | 16.4 (14.8-18.2) |
| Most of the time | 6.6 (3.6-11.9) | 8.3 (6.5-10.7) | 10.8 (9.5-12.3) |
| Every time | 3.1 (1.3-6.9) | 6.7 (5.3-8.6) | 10.3 (9.0-11.6) |
Weighted estimates and 95% CIs were reported by taking the complex survey design into account using the Fay variant of balanced repeated replication for variance estimation.
Discussion
Previous researchers may have modestly overestimated the prevalence of nicotine vaping given that this study found that a proportion of current e-cigarette users reported cannabis vaping every time they vaped. These current e-cigarette users may be vaping cannabis exclusively. However, if some current users vaped nicotine and cannabis simultaneously, then overestimation of nicotine vaping would be smaller. Similarly, the frequency of nicotine vaping may have been overestimated to the extent that cannabis vaping sometimes, most of the time, or every time occurred completely in the absence of nicotine vaping.
Future surveys may pose detailed questions on nicotine and cannabis vaping, including the substance being vaped (nicotine, cannabis, or both) and the frequency and intensity of use. In addition, future surveys may examine whether and how much other substances are being vaped, such as opium and cocaine. Study limitations included the biases of self-reported data and the generally lower estimates of youth risky behaviors in the PATH Study.6
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Citations
- National Institutes of Health, National Institute on Drug Abuse, US Department of Health and Human Services; Food and Drug Administration, Center for Tobacco Products. Population Assessment of Tobacco and Health (PATH) Study [United States] Public-Use Files. October 21, 2020. Accessed October 1, 2021. doi: 10.3886/ICPSR36498.v11 [DOI]
