Marijuana Vaping Research Articles

Shared Households in the U.S.: A New Perspective on Family Structure and Adolescent Substance Use

Research on the family structure–adolescent substance use association has largely neglected shared households—those in which non-parent adult figures live in the home—even though the number of these households has increased substantially in the U.S. Using data from the state of Florida, we assessed the association between several shared household structures and adolescent substance use, along with whether their associations were mediated by parent-child relationship quality or parental monitoring/discipline. Adolescents in shared family households, especially when a parent did not reside in the home, manifested a higher odds of marijuana use and vaping than those in two-parent households. Monitoring/discipline partly mediated the household structure effects, suggesting that engaging in high levels of monitoring can lower the risk of substance use even in families without two parents.

Initiation of high-intensity drinking and subsequent substance use in young adulthood

High-intensity drinking (HID; 10+ drinks/occasion) is associated with acute and long-term risks, including use of other substances. Earlier HID initiation is associated with high-risk alcohol use in young adulthood. Less is known about when HID initiation occurs relative to other substances and how it is associated with subsequent substance use. This study examined survey data from 468 respondents (35.5% female, 65.5% non-Hispanic white) who reported initiating HID by age 20. Weighted descriptive statistics of year of initiation for HID, marijuana, and nicotine were obtained. Weighted linear and logistic regressions examined associations between year and order of HID initiation and age 20 substance use (i.e., nicotine vaping, cigarette use, other tobacco use, marijuana use, marijuana vaping, simultaneous alcohol and marijuana use, and other illicit drug use) and alcohol use disorder (AUD) symptoms. Over half of participants initiated HID after marijuana (54.6%) and nicotine (54.4%). Later HID initiation was associated with fewer AUD symptoms and lower odds of all outcomes except marijuana and other illicit drug use. Initiating HID before marijuana was associated with lower odds of marijuana use outcomes and other illicit drug use at age 20. Initiating HID before nicotine was associated with lower odds of all substance use outcomes at age 20. Earlier HID initiation was associated with risk for subsequent substance use, but initiating HID earlier than other substances was not. Given its association with both alcohol-related outcomes and other substance use in young adulthood, earlier HID initiation is an important target for screening and intervention.

Nicotine or marijuana vaping exposure during pregnancy and altered immune responses in offspring.

Electronic nicotine delivery systems (ENDS) - which include electronic cigarettes or e-cigarettes, or simply e-cigs, and marijuana vaping have become increasingly popular. ENDS devices have been established as one of the tobacco quit methods and promoted to be safer compared to traditional tobacco cigarettes. Emerging evidence demonstrates that e-cigarette and marijuana vape use can be harmful, with potential associations with cancer. Herein, we summarize the level of evidence to date for altered immune response, with a focus on cancer risks in the offspring after maternal use of, or aerosol exposures from, ENDS or marijuana vape during pregnancy. From 27 published articles retrieved from PubMed, we sought to find out identified carcinogens in ENDS aerosols and marijuana vapor, which cross the placental barrier and can increase cancer risk in the offspring. Carcinogens in vaping aerosols include aldehydes, metals, tobacco-specific nitrosamines, tobacco alkaloids, polycyclic aromatic hydrocarbons, and volatile organic compounds. Additionally, there was only one passive vaping exposure case study on a human fetus, which noted that glycerol, aluminum, chromium, nickel, copper, zinc, selenium, and lead crossed from the mother to the offspring's cord blood. The carcinogens (metals) in that study were at lower concentrations compared to the mother's biological matrices. Lastly, we observed that in utero exposures to ENDS-associated chemicals can occur in vital organs such as the lungs, kidneys, brain, bladder, and heart. Any resulting DNA damage increases the risk of tumorigenesis. Future epidemiological studies are needed to examine the effects of passive aerosol exposures from existing and emerging electronic nicotine and marijuana products on developing offspring to cancer.

Vaping Behaviors and Criminal Activity among a Nationally Representative Sample of U.S. Adults

Background: Prior research has discovered an association between vaping activities and increased delinquent behaviors. However, this relationship has been exclusively studied among adolescents and has not been examined among an adult sample. Methods: The current study uses a nationally representative sample of approximately 45,000 adults from the 2021 National Survey on Drug Use and Health. Logistic regression and negative binomial regression are employed to assess the association between three types of vaping (marijuana, nicotine, flavor) and five crime measures (arrest, sold drugs, stole >$50, attack, crime index), net of covariates. A vaping index is also examined to determine whether the number of substances vaped is related to criminal outcomes. Results: Results indicate that past year and past month marijuana and nicotine vaping are associated with higher odds of almost all crime measures, but flavor vaping was not significantly associated with the crime outcomes. Additionally, the vaping index suggests that the number of substances vaped is associated with the likelihood of engaging in certain crimes. Conclusions: The findings of the current study indicate the need for more awareness of the negative social consequences associated with vaping, particularly marijuana vaping. Additionally, the crime patterns among adults in this study are different from previous studies using adolescent samples. Specifically, flavor vaping is not associated with criminal behavior among the adult only sample. Thus, vaping studies that use adolescent samples may not generalize to adults.

Abstract P124: Mental Health Differences by Vaping Behavior Observed Among Youth and Young Adults

Introduction: Previous studies have identified associations between nicotine and marijuana vaping among youth. Studies also have identified associations between vaping and both anxiety and depression among young adults. Hypothesis: We hypothesized that mental health differences would be evident across current nicotine-only vapers, current vapers of both nicotine and THC, and never vapers. Methods: A national online survey was conducted among 2,505 youth and young adults aged 13-24 during June and July 2022. The participants were recruited via an online panel and received an incentive to complete the survey. Parent consent was obtained for minors and informed consent was obtained from participants. Quotas were established for vaping and THC use. This analysis focuses on current vapers and never vapers (n=1,762). Current use was defined as having vaped in the past 30 days. Of the participants, 1,200 were current nicotine vapers (370 nicotine-only vapers and 830 dual vapers of nicotine and THC); 562 have never vaped nicotine or THC. Results: Dual vapers were significantly more likely than nicotine-only vapers to indicate addiction to nicotine, as defined as waking up at night to vape (55% vs. 45%, p<0.05). Both vaping groups were significantly more likely than never vapers to report mental health concerns. Anxiety was more prevalent among dual vapers (60%) and nicotine-only vapers (58%) than never vapers (43%) (p<0.05). Depression was more prevalent among dual vapers (52%) and nicotine-only vapers (53%) than never vapers (25%) (p<0.05). And having suicidal thoughts was more prevalent among dual vapers (51%) and nicotine-only vapers (53%) than never vapers (33%) (p<0.05). About one in four dual vapers (24%) and nicotine-only vapers (28%) started vaping nicotine to calm down/feel less stressed or anxious; one in three dual vapers (30%) and nicotine-only vapers (35%) currently vaped nicotine for this reason. One in five vapers (19% of dual vapers and nicotine-only vapers) started vaping to help feel less depressed, and currently vaped for this reason (20% of dual vapers and 21% of nicotine-only vapers). Dual vapers were significantly more likely than nicotine-only vapers to say they were less depressed after starting vaping (46% vs. 31%, p<0.05); nicotine-only vapers were more likely to say vaping had no impact on their depression (38% vs. 27%, p<0.05). Conclusions: In conclusion, our analysis shows an association between mental health symptoms with vaping nicotine and THC. Dual use may either compound the addictive nature of vaping or attract those more prone to addiction, as well as have an impact on depression. Anxiety and depression symptoms were notable among both groups, compared with never vapers, and were cited as reasons for nicotine vaping. These findings suggest the importance of addressing the use of THC and the need for building resilience skills in vaping prevention efforts.

An ecological momentary assessment study to examine covariates and effects of concurrent and simultaneous use of electronic cigarettes and marijuana among college students

IntroductionThe prevalence of concurrent and simultaneous use of e-cigarette and marijuana among college students is high. Yet, the literature was mainly based on cross-sectional surveys with emphasis on the smoking route. This is the first ecological momentary assessment (EMA) study that examined the vaping route of nicotine-marijuana co-use and the associated short-term psychological effects. MethodsThis study recruited 686 college student e-cigarette users to participate in an on-line survey and 7-day EMA. Frequent marijuana users (247) – using marijuana weekly or daily – were compared with infrequent/non-users (439) on academic performance, e-cigarette use patterns, and dependence and respiratory symptoms. EMA data from the frequent users were used to study the association between marijuana vaping and e-cigarette consumption and the short-term psychological effects of e-cigarette and marijuana use. ResultsThe results show that e-cigarette users who frequently used marijuana tended to have lower academic performance, be involved in higher-risk use patterns, and have higher levels of e-cigarette dependence, marijuana problems, and respiratory symptoms, compared to infrequent/non-users. Marijuana vaping was associated with a higher level of e-cigarette consumption. E-cigarette use and marijuana use were both associated with higher levels of positive affect, physiological sensation, and craving for e-cigarettes. While marijuana use was linked to a lower level of negative affect, e-cigarette use did not have a significant effect. Further, none of the interaction effects between e-cigarette and marijuana use on psychological states were significant. ConclusionsThe results showed additive effects of e-cigarette and marijuana use although the hypothesized synergistic effects were not supported.

The association between concussions and vaping among a nationally representative sample of U.S. adolescents

Background Concussions represent an important health threat that is crucial to study. Prior research has established a relationship between concussions and substance use. Specifically, studies find higher rates of drugs use, such as alcohol, marijuana, non-medical prescription pills, and illegal drugs among individuals who have suffered a concussion compared to those who have not. Unfortunately, research has yet to determine whether this link extends to a newer and increasingly popular form of adolescent drug use, vaping. Methods The current study investigates the association between concussions and various vaping activities (flavor vaping, nicotine vaping, marijuana vaping, variety score) on a nationally representative sample of U.S. 8th and 10th grade adolescents from the 2019 Monitoring the Future Survey. Results Results indicate that adolescents who were diagnosed with a concussion in their lifetime have higher odds of engaging in all types of vaping compared to adolescents who have never been diagnosed with a concussion. Conclusions The findings of this study support any policy or program aimed at increasing awareness about the connection between concussions and drug use and considering early interventions to potentially reduce substance use among adolescents who suffer concussions.

Within-person associations of escalated electronic nicotine delivery systems use with cigarette, alcohol, marijuana and drug use behaviors among US young adults.

Most extant evidence has addressed between-person differences, short-term or cross-sectional associations of electronic nicotine delivery systems (ENDS) use with other substance use, the majority focusing on current rather than escalated use. The present study aimed to examine within-person changes in escalated ENDS use and their associations with individual and combined substance use over a 6-year period. This study used a longitudinal cohort design with US young adults. A generalized linear mixed-model approach was employed to fit a series of weighted logistic regression models. Data were drawn from waves 1-5 of the Population Assessment of Tobacco and Health (PATH) study in the United States. Of the 9110 young adults at baseline, aged 18-24 years, a total of 5042 individuals had matched data across all five waves of assessments. Escalated ENDS use was computed by subtracting the number of days of ENDS use within the past 30 days at wave from that at wave and coded as 1 = escalated, if the value was greater than zero (otherwise, coded as 0 = not escalated). Escalated ENDS use gradually decreased over time, with the lowest prevalence at wave 4 (4.0%) but sharply increasing at wave 5 (8.4%). Escalated ENDS use was associated with increased odds of using each substance (binge drinking, marijuana use, marijuana vaping, prescription and illicit drugs) and different combinations of polysubstance use between cigarette smoking, binge drinking and marijuana use (Ps < 0.05). In addition, sweet/fruit flavor use (versus menthol/mint) was associated with increased likelihood of reporting co-use of cigarettes and marijuana. In the United States, the prevalence of young adults using electronic nicotine delivery systems appears to have increased steadily between 2013 and 2019, although the rate of increase may have started to accelerate in recent years. Escalated electronic nicotine delivery systems use and time-lagged established electronic nicotine delivery systems use appear to be prospectively associated with individual and combined substance use, particularly between cigarettes, alcohol and marijuana. Among established electronic nicotine delivery systems users, sweet/fruit flavor appears to be associated with increased risk of co-using cigarettes and marijuana.

PRIMARY SPONTANEOUS PNEUMOTHORAX WITH AN APICAL BLEB: CONTROVERSIES IN WORKUP AND MANAGEMENT

A 16-year-old boy presented to the pediatric emergency department (ED) for evaluation of chest pain. Two days prior to arrival to the ED, he woke up with chest pain, cough, and shortness of breath. He attributed it to allergies and asthma, and used his albuterol inhaler. He described pain localized in his left chest that worsened with deep inspiration. He also felt lightheaded when taking a deep breath. He reported infrequent marijuana use and vaping. On presentation, the patient had stable vital signs with heart rate of 64 beats/min, respiratory rate of 18 breaths/min, and pulse oximetry of 100% on room air.

The Bully-Victim Overlap and Vaping Activity Among Adolescents

Previous research links substance use with bullying perpetration and bullying victimization. Limited research, however, has explored how vaping, is related to bullying activities. What limited research has been conducted links vaping with bullying victimization in some samples. However, the relationship between vaping and the victim-offender overlap is extremely limited. This study addresses this gap in the literature by exploring the associations between nicotine and marijuana vaping and bullying perpetration and victimization both in-person and online. In addition, we explore the relationship between vaping and holding bully-victim status. Our results suggest that marijuana vaping is associated with in-person bullying and nicotine vaping is associated with many facets of both in-person and cyber bullying experiences.

Bullying victimization and nicotine and marijuana vaping among Florida adolescents

PurposePrevious research links bullying victimization with the use of illicit substances in adolescence. In addition, recent research has linked bullying victimization with vaping. Very limited research, however, has explored how different forms of bullying may be linked with nicotine and marijuana vaping specifically. ProceduresThis study addresses this gap in the literature by utilizing logistic regression to examine the relationships between verbal, physical, and cyber bullying victimization and nicotine and marijuana vaping in a sample of Florida adolescents. FindingsOur findings reveal that all three forms of bullying victimization are linked with recent nicotine vaping, and these associations differ somewhat by youth gender. In addition, our findings indicate that cyber bullying victimization is linked with marijuana vaping. ConclusionsIn conclusion, our findings suggest that bullying victimization is linked with greater odds of vaping activity in adolescents. The implications of these findings for future research and policy are discussed.

Daily fluctuations in drinking intensity: Links with vaping and combustible use of nicotine and marijuana

BackgroundWhether alcohol use intensity on a given day is linked with nicotine or marijuana use that same day is not well known, nor are links of drinking intensity with different modes of nicotine and marijuana use. This study examined these within-person links across 14 days in a national sample of young adults (YAs). MethodsPast 30-day drinkers participating in the U.S. nationally representative Monitoring the Future study of 12th graders in 2018, who also reported alcohol use during a 14-day data collection one year later in the Young Adult Daily Life Study in 2019, were included (N = 487). Weighted multilevel modeling estimated within- and between-person associations of drinking intensity with cigarette smoking, nicotine vaping, marijuana smoking, and marijuana vaping. ResultsWithin-person fluctuations in drinking intensity on a given day were associated with cigarette smoking, nicotine vaping, and marijuana smoking, but not marijuana vaping. There were significant between-person associations of means of drinking intensity and each outcome, except for cigarette smoking. ConclusionDrinking intensity on a given day was associated with multiple modes of nicotine use and marijuana smoking that day. Nicotine and marijuana use remain critical areas of concern for public health, and future research and interventions should consider the comorbidity of drinking intensity and multiple modes of nicotine and marijuana use. Focusing on the same-day use of alcohol may provide a tailored avenue for preventing and reducing nicotine and marijuana emerging trends among YAs.

Identifying risk profiles for marijuana vaping among U.S. young adults by recreational marijuana legalization status: A machine learning approach

IntroductionThis study attempted to identify risk profiles of marijuana vaping by state-level recreational marijuana legalization (RML) status among U.S. young adults (YA). MethodsData were drawn from the most recent two waves of restricted use files of the Population Assessment of Tobacco and Health Study with state identifiers. We analyzed 6155 young adult (18–24 years) respondents who were naïve to marijuana vaping at Wave 4 and had matched data at Wave 5. We employed a two-stage machine learning approach to predict marijuana vaping initiation at Wave 5 with predictors measured at Wave 4. ResultsAmong YA who had never vaped marijuana at Wave 4, 19% of those who lived in the states with RML and 15% of those who lived in the states without RML reported marijuana vaping at Wave 5. Substance-use-related predictors were rarely found as leading predictors in the states with RML. In the states without RML, substance use behaviors, including electronic nicotine delivery systems and smokeless tobacco use, and the presence of externalizing symptoms emerged as predictors for marijuana vaping. Results also revealed that nonlinear interactions between the predictors of marijuana vaping. ConclusionsOur results highlight the importance of accounting for the RML status in developing risk profiles of marijuana vaping. Externalizing symptoms may be a behavioral endophenotype of marijuana vaping in the states without RML. Machine learning appears to be a promising analytical approach to identify complex interactions between factors in predicting an emerging risk behavior such as marijuana vaping.

Changes in marijuana and nicotine vaping perceptions and use behaviors among young adults since the COVID-19 pandemic: A qualitative study

BackgroundResearch is lacking on the impact of the COVID-19 pandemic on marijuana vaping behaviors; a notable limitation as marijuana vaping has been previously associated with respiratory issues among young people. This qualitative study explored how the COVID-19 pandemic influenced vaping perceptions and behaviors among young adults (18 to 25-year-olds). MethodsQualitative interviews were conducted with 50 regular marijuana vapers. Individuals were eligible if they vaped marijuana at least 3 days per week (exclusively or dual use with nicotine). Interview transcripts were analyzed using deductive coding processes to identify themes. Differences in themes by gender and user status (regular marijuana versus regular dual vapers) were explored. ResultsWhile many participants indicated that the pandemic negatively impacted their attitudes about vaping, participants also noted that their negative attitudes did not translate into reductions in use. Overall, 54% of participants reported increasing vaping during COVID-19. For both regular dual vapers and marijuana vapers, boredom was a prominent theme for increases in vaping. Lack of accessibility of marijuana was cited as a reason for decreasing marijuana among regular marijuana vapers but not for regular dual vapers. Males reported more unchanged attitudes about vaping and more males than females reported still sharing their devices. ConclusionsMore than half of participants reported increasing their vaping behaviors since the COVID-19 pandemic despite concerns about the potential for vaping to adversely impact lung and immune health. As the U.S. adapts to the COVID-19 pandemic, interventions should address factors that may contribute to increases in use behaviors.

Protective Factors for Nicotine and Marijuana Vaping Among U.S. Adolescents

Nicotine and marijuana vaping among U.S. adolescents are public health priorities. Research has assessed the demographic and risk factors related to vaping, but there is a dearth of research on protective factors for vaping. On the basis of the healthy youth development perspective, the developmental assets framework is used to assess cumulative protective factors and vaping in a national sample of adolescents. Data came from the nationally representative Monitoring the Future study, consisting of 12th graders (n=6,982) from the 48 contiguous U.S. states (2017-2019). Past 30-day nicotine and marijuana vaping and developmental assets (low, medium, or high) were examined. Covariates included demographics and other substance use. Weighted descriptive statistics, logistic regression, postestimation analyses, and multiple imputation were used. Students with higher assets were less likely to vape nicotine and marijuana, even after adjusting for covariates. The odds of nicotine vaping were lower for students with medium assets (AOR=0.65, 95% CI=0.54, 0.78) and high assets (AOR=0.22, 95% CI=0.16, 0.29) than for students with low assets. Similarly, the odds of marijuana vaping were lower for youth with medium assets (AOR=0.54, 95% CI=0.42, 0.69) and high assets (AOR=0.09, 95% CI=0.05, 0.18) than for those with low assets. Social competence and positive peer norms were strongly protective against both forms of vaping. The healthy youth development perspective applies to the critical issues of nicotine and marijuana vaping among adolescents. Promoting cumulative assets may help to prevent vaping among U.S. adolescents, and increasing the specific assets of social competence and positive peer norms could be particularly fruitful.

Adverse childhood experiences and adolescent nicotine and marijuana vaping: Findings from a statewide sample of Florida youth

A wealth of research links exposure to adverse childhood experiences (ACEs) with negative outcomes including nicotine and marijuana use. In addition, an emerging line of research has documented associations between exposure to ACEs and vaping activity in American adults and international samples of adolescents. Very limited research, however, has explored whether a history of ACEs is linked with adolescent nicotine and marijuana vaping activity in an American sample. This study addresses this gap in the literature by employing multinomial logistic regression to examine whether cumulative exposure to ACEs is associated with adolescent nicotine vaping, dual mode use of nicotine, marijuana vaping, and dual mode use of marijuana in a sample of Florida high school students. Our findings reveal that greater cumulative exposure to ACEs (up to 5 ACEs) in adolescents leads to an increase in the likelihood of vaping nicotine and marijuana. In addition, greater cumulative exposure to ACEs (up to 6 ACEs) leads to an increase in the likelihood of using nicotine and marijuana through multiple delivery modes.

43.3 Cannabis Vaping in Adolescents: A Review of Prevalence, Comorbidities, Appraisal of Lung Injury, and Long-Term Complications

As of 2020, there were 2807 hospitalizations for electronic cigarette (e-cigarette)- or vaping-associated lung injury (EVALI) reported to the CDC, of which 15% were adolescents. As per a 2020 NIDA survey, there was a twofold increase in marijuana vaping in adolescents from 2017 to 2019. Recent studies have shown associations between marijuana smoking or vaping with bronchitis, increased risk of respiratory infections, and acute lung injury. Eighty-five percent of patients with vaping-associated lung injury had tetrahydrocannabinol (THC) or its metabolites in alveolar fluid samples. The objective of this study is to review the available literature on cannabis vaping in adolescents and understand the possible risks and pulmonary complications of vaping. We conducted a systematic review of literature using PubMed with keywords “cannabis” OR “marijuana,” “vaping” OR "e-cigarettes," “lung injury” OR “pneumonia,” in all fields. We included RCTs, cross-sectional studies, longitudinal studies, review articles, and case reports published until December 2020. The search resulted in 63 articles. After filtering for children and adolescents, 15 articles (2 cross-sectional surveys, 1 retrospective cohort, 7 case series or reports, 4 review articles, and 1 novel mental health metric) were identified for abstract and full paper review. We are currently conducting retrospective chart reviews of patients admitted to a tertiary care children’s hospital for lung infection or injury. Upon review of the selected 15 articles, there were no relevant longitudinal studies, which focused on the adolescents with e-cigarette- and cannabis-associated lung injuries or pneumonia. Out of the works that included adolescents, many focused on and surveyed only adults. The literature from PubMed about adolescent cannabis vaping was limited to a few case reports and case series. There are no comprehensive studies that have rigorously investigated cannabis vaping in adolescents. There needs to be more investigations into how e-cigarettes containing THC affects the adolescent population. Many complications have been associated with vaping of cannabis, nicotine, and combined products, such as COVID-19 susceptibility, EVALI, and pain and sedative management. More research needs to be done to explore these connections, especially in adolescents.

State marijuana policies and vaping associated lung injuries in the US

BackgroundThe United States’ 2019 outbreak of e-cigarette or vaping-associated lung injuries (EVALI) was linked to an additive most common in informally-sourced vaporizable marijuana concentrates. This study estimates how states’ recreational and medical marijuana policies related to their 2019 EVALI incidence and residents’ likelihood of vaping as their primary mode of marijuana use. MethodsMultivariable negative binomial regressions estimated associations between states’ total 2019 EVALI cases and marijuana policies: recreational legalization, medical legalization only, and whether medical-only policies allowed home cultivation, prohibited combustible use, or had operational dispensaries. Logistic regressions used survey data from the Behavioral Risk Factor Surveillance System’s 2016–2019 marijuana supplements to assess how these policies related to past-30-day marijuana users’ selection of vaping as their primary mode of use. ResultsEVALI incidence was 42% lower in recreational marijuana states (95%CI=0.339,0.993), versus a positive but statistically insignificant association with medical legalization alone. Adjusting for policy attributes revealed heterogeneity: among medical-marijuana-only states, EVALI incidences were > 60% lower where laws allowed home cultivation (aIRR=0.374; 95%CI=0.196, 0.715). Similarly, among past-30-day marijuana users, odds of vaping as one’s primary mode of use were > 40% lower in medical-only states where home cultivation was allowed versus prohibited (aOR=0.588; 95%CI=0.365,0.946). ConclusionsMarijuana policy attributes linked to lower EVALI incidences were also associated with reduced likelihoods of vaping as one’s primary mode of use. As additives in informally-sourced vaping concentrates could drive future EVALI cases, marijuana policy design should account for effects on mode of use in licit and illicit markets, to limit the scope of future outbreaks.

PM2.5 exposure close to marijuana smoking and vaping: A case study in residential indoor and outdoor settings

We conducted 35 experiments for spatial measurement of marijuana aerosols in a current smoker's residential spaces. Fine particulate matter (PM2.5) concentrations were measured every second at 1, 2, and 3 m horizontal distances from the smoker who performed prescribed 5-min smoking and vaping activities. In each experiment, five SidePak monitors measured PM2.5 concentrations at five different angles facing the front of the smoker, representing the worst-case exposures. We studied the effect of distance from the smoker for two marijuana sources – smoking a marijuana cigarette, or joint, and vaping a liquid-cartridge vaping pen. Experiments were conducted in the family room indoors and in the backyard outdoors where the smoker normally consumes marijuana. Indoor marijuana vaping had higher average exposures (5-min PM2.5) at 1 m distance than indoor marijuana smoking, but the levels from indoor vaping decreased more rapidly with distance (e.g., 77% reduction for vaping versus 33% for smoking from 1 to 2 m). Smoking and vaping in the outdoor environment reduce the average exposures down to <5% of the indoor levels at each distance. Cumulative frequency distributions of the 1-s PM2.5 concentrations revealed the frequencies of exceeding any selected transient peak exposure limit at a given distance. The frequency of exceedance decreased more quickly with distance for vaping than for smoking. Smoking and vaping outdoors made the transient peak exposures close to the source much less frequent than smoking and vaping indoors (e.g., <1% exceeded 1000 μg/m3 outdoors versus >20% indoors at 1 m). Plotting the frequency of exceedance versus distance could offer additional guidance for a recommended minimum distance from a marijuana source.

Predictors of vaping marijuana initiation among US adolescents: Results from the Population Assessment of Tobacco and Health (PATH) study Wave 3 (2015–2016) and Wave 4 (2016–2018)

IntroductionMarijuana vaping among adolescents is a growing public health concern. Marijuana vaping exposes youth to greater levels of tetrahydrocannabinol (THC) and may be related to e-cigarette or vaping product use-associated lung injury (EVALI). This study examined the risk factors for initiating marijuana vaping among US adolescents. MethodsWe analyzed Waves 3 (2015–2016) and 4 (2016–2018) of the Population Assessment of Tobacco and Health (PATH) Study. We estimate a multivariable logistic regression to model marijuana vaping initiation at Wave 4 among those who never vaped marijuana at Wave 3 (N = 7,821) as a function of key risk factors associated with youth substance use. ResultsMarijuana vaping initiation is associated with current use of electronic nicotine delivery system (ENDS) (aOR = 2.16, 95 % CI = 1.20, 3.89), cigarettes (aOR = 2.65, 95 % CI = 1.10, 6.35), other marijuana products (aOR = 7.78, 95 % CI = 3.74, 6.15), and alcohol (aOR = 1.98, 95 % CI = 1.35, 2.91). Other factors contributing to marijuana vaping initiation include being 15−17 years old (aOR = 1.51, 95 % CI = 1.19, 1.90) and Hispanic (aOR = 1.37, 95 % CI = 1.08, 1.76), as well as having less than college-level parental education (aOR = 1.35, 95 % CI = 1.07, 1.70), vaping peers (aOR = 2.31; 95 % CI = 1.81, 2.96), and a high internalizing (aOR = 1.49, 95 % CI = 1.10, 2.02) and externalizing tendency (aOR = 1.66, 95 % CI = 1.14, 2.41). ConclusionsMulti-level efforts are needed to target the varying risk factors leading to marijuana vaping initiation in adolescents. Knowledge of these risk factors can help policymakers and health program administrators to identify at-risk individuals and design interventions that can prevent marijuana vaping initiation at the individual, household, school, clinical and public health levels.