E-Cigarettes Associated With Increased Marijuana Use in Adolescents

Hooligan smoking cigarette, dangerous teenager, bad behavior, life difficulties
Investigators noted a significant increase in the odds of concurrent and subsequent marijuana use in adolescents and young adults who used e-cigarettes.

The use of electronic cigarettes (e-cigarettes) was associated with increased rates of marijuana use in adolescents and young adults, according to study results published in JAMA Pediatrics.

In this systematic review and meta-analysis, researchers searched major databases for cross-sectional or longitudinal studies that analyzed rates of marijuana use in teens and young adults with and without a history of e-cigarette use. After applying the search criteria, the investigators identified 21 studies that included 128,227 patients. A random-effects analysis was used for extraction and pooling of data in the meta-analysis. The primary outcome measured was the adjusted odds ratio (aOR) of self-reported marijuana use by patients with vs without e-cigarette use.

Related Articles

After statistical analysis, the odds of marijuana use were 3.5 times greater in adolescents and young adults who had a history of e-cigarette use compared with individuals who denied use (aOR, 3.47; 95% CI, 2.63-4.59). The significant increase was observed in both cross-sectional (aOR, 3.70) and longitudinal studies (aOR, 2.43).

Studies completed in adolescents (aged 12 to 17 years; aOR, 4.29) exhibited a stronger association between e-cigarette and marijuana use than those conducted in young adults (aged 18 to 24 years; aOR, 2.30).

One key study limitation was the observational nature of the included studies.

“These findings suggest that clinical and regulatory approaches to managing e-cigarette use among youth amid the current trend of marijuana legalization should consider the significant association between e-cigarette and marijuana use,” the researchers wrote.


Chadi N, Schroeder R, Jensen JW, Levy S. Association between electronic cigarette use and marijuana use among adolescents and young adults: a systematic review and meta-analysis [published online August 12, 2019]. JAMA Pediatr. doi:10.1001/jamapediatrics.2019.2574