Are adolescents who vape tobacco more likely to start using cannabis?

Last week, multiple news outlets, including the The Washington Post, reported on recently published research that found a strong individual-level association between adolescent electronic cigarette use and subsequent cannabis use. This flurry of media interest may be due to the fact that electronic cigarettes have eclipsed regular cigarettes in popularity among US middle school and high school students, therefore concerns have been raised that teens with access to devices to vape tobacco would be inclined to use them to try cannabis. The research findings were contained in an article published online in July by authors Sun, Mendez, and Warner in the journal, JAMA Network Open. The authors took advantage of longitudinal data from the ongoing, multi-wave Population Assessment of Tobacco and Health (PATH) Study, which contains a national sample of adult and youth tobacco users and non-users, and is meant for monitoring the US population’s tobacco use behavior, attitudes and beliefs, and tobacco-related health outcomes. The PATH Study is a collaboration between the National Institutes of Health (NIH) and the Food and Drug Administration (FDA), and both its public-use and restricted-use data are distributed by the National Addiction & HIV Data Archive Program (NAHDAP).

Sun, Mendez, and Warner specifically used data collected from a nationally representative cohort of 9,828 youths between 2017 and 2019 in waves 4.5 and 5, available in the study, Population Assessment of Tobacco and Health (PATH) Study [United States] Special Collection Public-Use Files (ICPSR 37786). When comparing teen behavior from one wave to the next, the researchers found that cannabis-naive adolescents who had used electronic cigarettes were significantly more likely to report cannabis use one year later compared with those who had not used electronic cigarettes, after adjusting for sociodemographic characteristics, environmental factors, other substance use, and sensation seeking. On the other hand, the authors cited research based on data from the ongoing study, Monitoring the Future, showing that e-cigarette use has only a minimal link to rates of teen cannabis use, which have remained stable over the last 25 years. And indeed, in their own investigation, the authors found that, “Despite the strong association at the individual level, e-cigarette use seems to have had a minimal association with the prevalence of youth cannabis use at the population level.”