Progression from E-Cigarette to Cannabis Use Possible, Not Likely

Teen-e-cigarette
girl tries e-cigarette under the influence of her friend.
Although previous studies have examined the association between e-cigarettes and cannabis use among teenagers, the researchers wanted more recent data given the growing popularity of vaping.

Teenagers who use e-cigarettes are more likely than nonvaping adolescents to try cannabis 1 year later according to a study published in JAMA Network. There’s a caveat: “despite the strong association at the individual level, e-cigarette use seems to have had a minimal association with the prevalence of youth cannabis use at the population level,” the researchers stated.

Although previous studies have examined the association between e-cigarettes and cannabis use among teenagers, the researchers wanted more recent data given the growing popularity of vaping.

To do so, they analyzed longitudinal data from the 2 most recent waves of the Population Assessment of Tobacco and Health (PATH) Study: wave 4.5 (2017-2018) and wave 5 (2018-2019). They also compared teenagers who had used e-cigarettes at any time, had used in the past 12-months, and had used in the past 30 days to cannabis use over the past 12 months and the past 30 days. The study used data from 9828 adolescents.

Teenagers who had used e-cigarettes at some point had a 13.93% higher risk for using cannabis 1 year later than those who never used e-cigarettes. Those who used e-cigarettes in the past year had a 14.89% higher risk. Past-30-day e-cigarette users had an 11.86% higher risk for using cannabis.

The researchers assume e-cigarette users are more likely to engage in risk-taking behaviors or they may have friends who use cannabis. The fact that vaping is a way to use cannabis may also be a reason.

Cannabis use at the population level, however, has remained relatively stable between 1995 and 2020, the researchers report. The current study’s small sample size may be to blame: only 7.8% of the cannabis-naïve teenagers surveyed had ever used e-cigarettes. Based on the data, “the estimated change in cannabis use at the population level due to e-cigarette use is less than 1 percentage point,” the researchers stated.

Of the limitations, the study did not control for state-level cannabis legalization. The self-reported data may also have skewed study results.

In conclusion, “e-cigarette use seems to have had a minimal association with the overall prevalence of youth cannabis use,” the researchers stated. “At the population level, adolescent use of cannabis has remained relatively stable for the past quarter century.”

Reference

Sun R, Mendez D, Warner KE. Use of electronic cigarettes among cannabis-naive adolescents and its association with future cannabis use. JAMA Netw Open. 2022;5(7):e2223277. doi:10.1001/jamanetworkopen.2022.23277