Cannabis vaping among adults in the United States: Prevalence, trends, and association with high-risk behaviors and adverse respiratory conditions

Ellen Boakye; Olufunmilayo H Obisesan; S M Iftekhar Uddin; Omar El-Shahawy; Omar Dzaye; Albert D Osei; Emelia J Benjamin; Andrew C Stokes; Rose Marie Robertson; Aruni Bhatnagar; Michael J Blaha

doi:10.1016/j.ypmed.2021.106800

Cannabis vaping among adults in the United States: Prevalence, trends, and association with high-risk behaviors and adverse respiratory conditions

Prev Med. 2021 Dec:153:106800. doi: 10.1016/j.ypmed.2021.106800. Epub 2021 Sep 11.

Authors

Affiliations

¹ Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA. Electronic address: eboakye2@jhmi.edu.
² Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA. Electronic address: oabiru1@jhu.edu.
³ Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA. Electronic address: iuddin@jhu.edu.
⁴ The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA. Electronic address: Omar.ElShahawy@nyulangone.org.
⁵ Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA. Electronic address: odzaye@jhmi.edu.
⁶ Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA. Electronic address: albert.d.osei@medstar.net.
⁷ The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Cardiovascular Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA. Electronic address: emelia@bu.edu.
⁸ The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA. Electronic address: acstokes@bu.edu.
⁹ The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: rosemarie.robertson@heart.org.
¹⁰ The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA; University of Louisville School of Medicine, Louisville, KY, USA. Electronic address: aruni.bhatnagar@louisville.edu.
¹¹ Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; The American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA. Electronic address: mblaha1@jhmi.edu.

Abstract

The e-cigarette or vaping product-use-associated lung injury outbreak in the United States has raised concerns about the potential health effects of cannabis vaping, a method of cannabis use that is becoming increasingly popular. We used 2017-2019 Behavioral Risk Factor Surveillance System data to estimate yearly prevalence and trends of past-30-day cannabis use and vaping among US adults. We used multivariable logistic regression to evaluate the associations of cannabis vaping with high-risk behaviors, asthma, and other respiratory symptoms. Our sample size was 160,209 (53,945-2017; 55,475-2018; and 50,789-2019). Past-30-day cannabis use prevalence increased from 10.0% (95% CI, 9.4%-10.7%) in 2017 to 13.4% (12.8%-12.0%) in 2019. Similarly, past-30-day cannabis vaping prevalence increased from 1.0% (0.8%-1.2%) to 2.0% (1.7%-2.2%) over the same period, with the greatest increase, 1.2% to 3.9%, observed among young adults (18-24 years). Individuals who vaped cannabis were more likely to concurrently vape nicotine. Cannabis vaping was associated with increased odds of heavy alcohol use (aOR, 1.95; 95% CI, 1.45-2.63), binge drinking (aOR, 2.82; 95% CI, 2.25-3.54), and other high-risk behaviors (aOR, 2.47; 95% CI, 1.89-3.24). In analyses adjusting for sociodemographic characteristics and body mass index, cannabis vaping was not associated with asthma (aOR, 1.03; 95% CI, 0.64-1.64) or other respiratory symptoms (aOR, 1.08; 95% CI, 0.44-2.63). Adjusting for nicotine vaping did not substantively alter these associations. The prevalence of past-30-day cannabis vaping has increased, particularly among young adults, and was associated with high-risk behaviors. Although there was no association between cannabis vaping and asthma or other respiratory symptoms, the increasing trends of cannabis vaping, particularly among young adults, raise concern and underscore the need for continued surveillance.

Keywords: Asthma; Cannabis; High-risk behaviors; Respiratory symptoms; Trends; Vaping.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Cannabis* / adverse effects
Electronic Nicotine Delivery Systems*
Humans
Prevalence
Risk-Taking
United States / epidemiology
Vaping* / adverse effects
Vaping* / epidemiology
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding