Abstract
ObjectiveTo determine the relationship between lifetime e-cigarette use and current cannabis use among youth. Our analyses accounted for county variability, in addition to student-level covariates.MethodsThis study examined responses from high school students on a state-level population survey, the 2018 Maryland Youth Risk Behavior Survey/Youth Tobacco Survey, a cross-sectional, complex survey sample. Of participating students, final analyses included an unweighted sample of 41,091 9th to 12th grade students who provided complete reports for measured variables. Analyses with survey weights were conducted between August 2019 and May 2020. A multivariable logistic regression was conducted to investigate the association between lifetime e-cigarette use and current (past 30-day) cannabis use, after controlling for county, lifetime cigarette use, current (past 30-day) alcohol use, emotional distress, and demographics.ResultsLifetime e-cigarette use significantly increased the odds of current cannabis use among Maryland high school students (aOR = 6.04; 95% CI 5.27, 6.93). Other significant risk factors for current cannabis use included lifetime cigarette use (aOR 2.23, 95% CI 1.86, 2.68) and current alcohol use (aOR 5.21, 95% CI 4.42, 6.14). Significantly higher odds of current cannabis use were also found among older high school students, males, non-Hispanic Blacks and students identifying as other race, and those reporting emotional distress.ConclusionsLifetime e-cigarette use among Maryland high school students is strongly associated with current cannabis use when including counties as a covariate. Non-significant county differences, however, suggest smaller geographical units may be required to control for variability. Efforts should focus on reducing youth e-cigarette use to decrease cannabis use. Maryland’s recent implementation of Tobacco 21 and a ban on flavored e-cigarettes will be of interest for future evaluations.
Highlights
Since 2014, electronic cigarettes (e-cigarettes) have been the most commonly used tobacco product among youth, when the prevalence of their use surpassed cigarettes (Cullen et al 2018; Gentzke et al 2019)
Recent meta-analyses show that e-cigarette use is associated with a greater than 3.5- to 6- fold increase in the odds of cannabis use; the magnitude of effects was stronger in studies published after 2017 (Chadi et al 2019; Hershberger et al 2020)
We examine whether a history of e-cigarette use is associated with current cannabis use among a statewide sample of Maryland high school students
Summary
Since 2014, electronic cigarettes (e-cigarettes) have been the most commonly used tobacco product among youth, when the prevalence of their use surpassed cigarettes (Cullen et al 2018; Gentzke et al 2019). Recent meta-analyses show that e-cigarette use is associated with a greater than 3.5- to 6- fold increase in the odds of cannabis use; the magnitude of effects was stronger in studies published after 2017 (Chadi et al 2019; Hershberger et al 2020). Both the increasing prevalence of e-cigarette use and the increasing likelihood of transitioning from e-cigarette use to cannabis use among American youth highlight the public health importance of examining e-cigarette use as a potential risk factor for cannabis initiation. Maryland youth lifetime ecigarette prevalence in 2017 (35.3%) was below the national average (42.2%), whereas current cannabis use (18.4%) was similar to the national prevalence of 19.8% (18.1%, 21.6%) in 2017 (CDC 2017)
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