An observational study found that cannabis use is on the rise among adolescents living in the United States and that use is significantly associated with binge drinking and nicotine use. These findings were published in Addition.

Data for this study were sourced from the Monitoring the Future (MTF) study collected between 2017 and 2019 among adolescents in grades 8, 10, and 12. Adolescents (N=51,052) attending nationally represented schools received questionnaires about cannabis, nicotine, and alcohol use.

The student cohort comprised 51.4% girls, 49.3% were White, 35.2% were in 8th grade, 35.9% were in 10th grade, and 28.9% were in 12th grade.


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Most students (85.8%) said that they had not used nicotine in the past 30 days. The students who did use nicotine said they used a vape only (10.1%) and few students endorsed smoking (1.8%) or smoking and vaping (2.3%).

Similarly, most students (91.3%) did not binge drink in the past 2 weeks. Few students endorsed drinking once (4.3%), twice (2.4%), 3 to 5 (1.5%), 6 to 9 (0.3%), or 10 or more (0.3%) times in the past 2 weeks.

Over time, cannabis use without vaping was declining, however, any cannabis use increased from 13.9% in 2017 to 15.4% in 2019.

Stratified by gender, boys who reported frequent cannabis vaping increased from 2.9% in 2017 to 6.2% in 2019 and from 1.3% to 4.7% among girls in the same time period, respectively.

In general, using nicotine associated with using cannabis, in which students who smoked and vaped nicotine associated with increased odds of vaping cannabis (adjusted odds ratio [aOR], 42.28; 95% CI, 33.14-53.93) and students who vaped nicotine were more likely to vape cannabis (aOR, 19.76; 95% CI, 17.29-22.57). Any nicotine use was strongly associated with any cannabis use (aOR range, 4.16-42.28).

Similarly, students who endorsed drinking 10 or more days in the past 2 weeks were more likely to vape cannabis (aOR, 10.09; 95% CI, 4.51-22.53). Any binge drinking was strongly associated with any cannabis use (aOR range, 3.89-10.09).

This study may have been limited by not evaluating the potency of cannabis.

“In summary, an increasing national trend of frequent cannabis use with vaping among adolescents may signal future increases in harms associated with cannabis. These risks arise from the greater efficiency of vaping as a tetrahydrocannabinol delivery device, high association of its use with other products that are known to be harmful to health and observations that heavy and prolonged periods of cannabis use increase the risk of cannabis use disorder as well as other adverse health outcomes. As cannabis legalization continues across US states, and as products, delivery systems, potency and marketing proliferate within a for-profit industry, increased attention to youth trends, including investment in sustained and evidence-based prevention and intervention, is increasingly necessary,” stated the study authors.

Reference

Keyes KM, Kreski NT, Ankrum H, et al. Frequency of adolescent cannabis smoking and vaping in the United States: Trends, disparities and concurrent substance use, 2017–19. Addiction. Published online May 19, 2022. doi:10.1111/add.15912