Youth Initiation of Cannabis Vaping is Associated With State Cannabis Policy and E-Cigarette Use

Abstract

Purpose: Cannabis vaping has emerged as a growing problem, particularly among youth. It is essential to understand how state policies on medical and recreational cannabis as well as vaping bans may influence initiation into cannabis vaping during adolescence. We aimed to determine whether changes in state-level cannabis policies, indoor vaping bans, and youths' nicotine use were associated with cannabis vaping initiation in adolescence.

Methods: We used prospective nationally representative cohort data from the Population Assessment of Tobacco and Health study (19,009 youth across 38,163 observations, ages 13-22). We conducted event history analysis of the role of state-level medical and legal recreational cannabis policies and comprehensive indoor vaping bans on cannabis vaping initiation, net of youth nicotine use and sociodemographics.

Results: Relative to states with illicit cannabis, residing in states where cannabis was legal for recreational use or medical use was associated with 1.449 (95% confidence interval [CI]: 1.285-1.635) and 1.198 (95% CI: 1.006-1.427) higher odds of cannabis vaping initiation, respectively. Though comprehensive indoor vaping bans were not related to cannabis vaping initiation, the associated odds of cannabis vaping initiation were 8.07 times higher (95% CI: 7.170-9.072) for youth reporting e-cigarette use during the past month.

Discussion: Within states that legalized adult use of cannabis, efforts are needed to prevent diversion of novel products, such as vaping devices, from legal marketplaces to adolescents. Prevention efforts for cannabis vaping should focus on youth who already use e-cigarettes.

Keywords: Adolescent; Cannabis; E-cigarettes; Indoor vaping bans; Legalization; Policy; Vaping; Youth.