Prospective associations of e-cigarette use with cigarette, alcohol, marijuana, and nonmedical prescription drug use among US adolescents

Day-level correlates of nicotine and cannabis vaping among young adults in the United States

Over the past two decades, vaping has increased in popularity among young adults. Yet, little is known about the daily activities or contexts associated with vaping behavior. The current study examined whether nicotine vaping, cannabis vaping, and dual-substance vaping (i.e., vaping both nicotine and cannabis) fluctuated in tandem with alcohol use and activities on a given day. Data came from the Monitoring the Future Vaping Supplement, a national sample of U.S. young adults. A subsample of people who vaped (N = 330 people) completed up to 14 daily surveys (N = 3686 days). Multilevel logistic regressions separated within- and between-person characteristics and controlled for combustible nicotine and cannabis use, day of the week, and demographic characteristics. Weights accounted for the complex survey design and attrition. Results demonstrated that nicotine vaping was more common on days when participants drank moderately or binge drank (compared to not drinking), used cigarettes, and spent more time at bars and parties than usual. Cannabis vaping on a given day was more likely on days when young adults drank moderately and spent more time at bars/parties. Likewise, moderate drinking, spending more time at bars/parties than usual, and spending less time on schoolwork than usual was associated with a higher likelihood of dual-substance vaping on a given day. Our findings highlight when young adults vape nicotine and cannabis, while also identifying proximal correlates of these behaviors to inform intervention and cessation efforts.

Longitudinal associations of e-cigarette use with cigarette, marijuana, and other drug use initiation among US adolescents and young adults: Findings from the population assessment of tobacco and health study (Waves 1-6)

INTRODUCTION

Research examining prospective links of e-cigarette use with cigarette, marijuana, and other substance use has been limited largely to 1-2-year follow-up periods and focused on younger adolescents. This study examined longitudinal associations of e-cigarette use with cigarette, marijuana, and other substance use initiation among U.S. adolescents and young adults (AYAs) across an eight-year period.

METHODS

Adolescent (ages 12-17) and young adult (ages 18-25) data from waves 1-6 of the nationally representative Population Assessment of Tobacco and Health study (2013-2021) were used. Discrete time survival models with time-varying weights were employed to examine the risk of cigarette, marijuana, and other drug use initiation over an eight-year follow-up period among AYAs with no lifetime use of e-cigarettes/other tobacco, lifetime but no past 30-day use of e-cigarettes/other tobacco, past 30-day e-cigarettes only, other tobacco use only, or past 30-day e-cigarette/other tobacco use. We compare our time-varying weighting approach to a traditional time-invariant/complete case weighting approach.

RESULTS

Across six follow-up waves, all three past 30-day nicotine/tobacco use groups, including e-cigarettes only, had greater risk for cigarette, marijuana, and other drug use initiation relative to those not using nicotine/tobacco. The three past 30-day nicotine/tobacco use groups did not differ from each other in risk for marijuana use initiation. Associations were smaller in magnitude for young adults compared to adolescents, but significant for both age groups.

CONCLUSIONS

Substance use initiation risks persist beyond 1-2 years for U.S. AYAs using e-cigarettes. Prevention strategies to reduce AYA e-cigarette use are needed to reduce cancer-related risk.

The relationship between cannabis and nicotine use: A systematic review and meta-analysis

BACKGROUND AND AIMS

Cannabis and nicotine (tobacco or e-cigarettes) use commonly co-occurs and understanding their relationship can help to inform public health strategies to prevent their harms. We conducted a systematic review and meta-analysis to estimate the association of cannabis use given prior nicotine use and vice versa.

METHODS

PubMed, Embase, PsycINFO, Google Scholar and a hand-search were conducted in 2023 for longitudinal studies of the general population with no restrictions in settings (locations). Random-effects meta-analysis was conducted to estimate odds ratios between cannabis and nicotine use in both directions. The impact of unmeasured confounding was assessed using E-values.

RESULTS

From 5387 identified records, we included 20 studies. Among cannabis-naïve youths, baseline use of any nicotine products was positively associated with initiation of any cannabis use at follow-up [odds ratio (OR) = 5.39, 95% confidence interval (CI) = 3.19, 9.11; adjusted OR (aOR) = 2.59, 95% CI = 2.01, 3.32]. In nicotine-naïve participants (youths + adults), baseline cannabis use was positively associated with the initiation of any nicotine use at follow-up (OR = 4.08, 95% CI = 2.05, 8.11; aOR = 2.94, 95% CI =1.54, 5.61). There were no significant associations between baseline cannabis use and subsequent initiation of any nicotine (aOR = 3.29, 95% CI = 0.85, 12.76) or daily nicotine use (aOR = 2.63, 95% CI = 0.41, 16.95) among youths. The median E-values were 5.5 for nicotine exposure and cannabis use initiation and 4.1 for cannabis exposure and nicotine use initiation, indicating that substantial unmeasured confounding would need to have a strong association with both outcomes to fully explain away the cannabis and nicotine relationship.

CONCLUSION

Although the evidence for associations between cannabis use and tobacco use is mixed, a majority of studies to date have found that cannabis use is associated with prior nicotine use and vice versa.

A systematic review and meta-analysis of the association between e-cigarette use among non-tobacco users and initiating smoking of combustible cigarettes

INTRODUCTION

The rapid increase in e-cigarette use over the past decade has triggered an important public health question on the potential association between e-cigarette use and combustible cigarette smoking. Following AMSTAR 2 and PRISMA guidelines, this evidence synthesis sought to identify and characterize any associations between e-cigarette use among individuals not smoking cigarettes and initiation of cigarette smoking.

METHODS

The protocol was registered on September 24, 2018 (PROSPERO 2018 CRD42018108540). Three databases were queried from January 01, 2007 to April 26, 2023. Search results were screened using the PICOS review method.

RESULTS

Among 55 included studies (40 "good" and 15 "fair"; evidence grade: "high") that adjusted for gender, age, and race/ethnicity between groups, generally, there was a significant association between non-regular e-cigarette use and initiation of cigarette smoking, further supported by the meta-analytic results (AOR 3.71; 95% CI 2.86-4.81). However, smoking initiation was most often measured as ever/current cigarette smoking. Two studies (quality: 2 "good") evaluated progression to regular cigarette smoking among individuals with regular use of e-cigarettes, and generally found no significant associations. One study ("good") evaluated smoking initiation among individuals with regular use of e-cigarettes, finding an increasing probability of ever smoking cigarettes with increased e-cigarette use. Twelve studies (10 "good" and two "fair") examining progression to regular smoking among individuals with non-regular use of e-cigarettes reported inconsistent findings.

CONCLUSIONS

Numerous methodological flaws in the body of literature limit the generalizability of these results to all individuals who are not smoking cigarettes with few studies measuring established/regular use/smoking of e-cigarettes and cigarettes. Further, studies did not control adequately for specific confounding variables representing common liabilities between e-cigarette use and cigarette smoking, nor did they account for sufficient follow-up durations. Collectively, these flaws limit the generalizability of findings to the question of an association between e-cigarette use and cigarette smoking initiation.

Cigarette and e-cigarette use trajectories and prospective prescription psychotherapeutic drug misuse among adolescents and young adults

OBJECTIVE

This study aimed to determine the potential longitudinal impact of different cigarette and e-cigarette use trajectories among people aged 10-24 on prescription drug misuse of psychotherapeutic drugs.

METHODS

Data came from waves 1-5 of the Population Assessment of Tobacco and Health (PATH) Study (2013-2019; n = 14,454). Group-based trajectory modeling identified groups of adolescents and young adults based on cigarette and e-cigarette use across the five waves. Weighted logistic regression models were fit to examine the association of group membership with two outcomes at all waves: 1) misuse of opioids, sedatives, and/or tranquilizers, and 2) misuse of Ritalin and/or Adderall, adjusting for background characteristics.

RESULTS

Five trajectory groups emerged: (1) non-use (77.7 %); (2) early-onset cigarette use with reducing use (4.6 %); (3) ever-increasing e-cigarette use (6.1 %); (4) stable dual use of cigarettes and e-cigarettes (3.2 %); and (5) accelerating dual use of cigarettes and e-cigarettes (8.4 %). In comparison to the non-use group, all other groups had significantly higher odds of misuse of opioids, tranquilizers, and/or sedatives and all but the early-onset cigarette use with reducing use group had significantly higher odds of misuse of Ritalin and/or Adderall by the end of wave 5.

DISCUSSION

Patterns of cigarette and e-cigarette use in adolescent and young adult populations may serve as important indicators for concurrent and prospective prescription psychotherapeutic drug misuse. Findings highlight the need for cigarette and e-cigarette use prevention, harm reduction, and/or cessation efforts among adolescents and young adults.

Associations for subgroups of E-cigarette, cigarette, and cannabis use with asthma in a population sample of California adolescents

Knowledge about the respiratory health consequences of adolescents' use of tobacco products with cannabis remains limited. We studied whether e-cigarettes, combustible cigarettes, and cannabis were independently associated with asthma in a population-based sample of 150,634 public high school students (10th and 12th graders), drawn in a two-stage design to be representative of the state of California in 2019-2020. Measures were obtained for use of e-cigarettes, combustible cigarettes, and cannabis; motives for use (three substances); method of use (for cannabis); ever being diagnosed with asthma; and having an asthma attack in past 12 months. Cross-classification indicated Nonuse for 64% of the sample; 15% Dual E-cigarette/Cannabis Use; 10% Exclusive Cannabis Use; 5% Exclusive E-cigarette Use; and 5% Triple Use. Multinomial logistic regression with a three-level criterion variable, controlling for age, sex, parental education, race/ethnicity, and three types of household use showed that compared with Nonuse, odds of Lifetime Asthma (vs. Never Had) was elevated for Triple Use (AOR = 1.14, CI 1.06-1.24), Dual E-cigarette/Cannabis Use (1.17, 1.12-1.23), Exclusive Cannabis Use (1.17, 1.11-1.23), and Exclusive E-cigarette Use (1.10, 1.02-1.18). Similar results were noted for Recent Asthma. Among persons who had used cannabis, 88% of the Triple group and 74% of the Dual E-cigarette/Cannabis group reported both smoking and vaping cannabis. Thus, co-occurrence of e-cigarette and cannabis use was a common pattern among adolescents in this study, and subgroups of cannabis and e-cigarette use showed similar associations with asthma. Preventive approaches should highlight the health implications of exclusive or combined e-cigarette and cannabis use.

Latin America and the Caribbean Code Against Cancer 1st edition: Tobacco and nicotine-related products, secondhand smoke, and alcohol and cancer

Tobacco, secondhand smoke (SHS), and alcohol, all carcinogens, are leading preventable cancer risk factors in Latin America and the Caribbean (LAC). Since 2000, smoking and SHS exposure have significantly decreased in the region. Yet alcohol consumption remains high. The entry of nicotine-related products such as electronic cigarettes (e-cigs) threatens achievements made in tobacco control and chronic diseases prevention, including cancer. E-cigs use is likely associated with smoking initiation among adolescents who had never smoked and dual use with combustible tobacco products. Therefore, the LAC Code Against Cancer recommends to the public actions they can take to reduce their risk of cancer: 1. Don't smoke or use any type of tobacco. If you do, quitting is possible, with professional help if needed. Don't use e-cigarettes either, as they lead to tobacco use. 2. Make your home a smoke-free place. Respect and promote laws that ensure smoke-free spaces to protect our health. and 3. Avoid drinking alcoholic beverages. This helps prevent several types of cancer. The Code recommends to policymakers a package of cost-effective policies based on the MPOWER and SAFER to prevent cancer at the population level. It also recommends that primary care health professionals: 1. Ask all their patients and their families whether they smoke or vape, inform them about the harms of smoking and vaping, and promote tobacco and nicotine related products cessation strategies among users. 2. Inform about the harms of exposure to SHS, especially among children, and promote smoke-free environments, and 3. Prevent alcohol use by their patients and their families, use tools to assess use, intensity, and frequency, and apply brief counseling intervention to support alcohol abstinence in primary care.

Social, educational, and psychological health correlates of e-cigarette and combustible cigarette use among adolescents in the US from 2015 to 2021

BACKGROUND

The prevalence of e-cigarette and vaping products has increased in the past decade, especially among adolescents. To provide data that will inform identification of youth at high risk, the goals of this study are to determine the social, educational, and psychological health outcomes associated with e-cigarette use distinct from combustible cigarettes.

METHODS

Annual samples of adolescents in grade 12 (years: 2015-2021, N = 24,015) were analyzed from Monitoring the Future cross-sectional data. Students were categorized based on vaping and smoking patterns (no use, vape only, combustible cigarette smoking only, or both). Survey-weighted prevalence and logistic regression were used to assess associations.

RESULTS

Between 2015 and 2021, 78.7% of students used neither e-cigarettes nor combustible cigarettes, 13.2% used e-cigarettes only (vape-only), 3.7% used combustible cigarettes only (smoke-only), and 4.4% used both. Students who vaped-only (OR:1.49, CI:1.28-1.74), smoked-only (OR:2.50, CI:1.98-3.16), or both (OR:3.03, CI:2.43-3.76) had worse academic performance than non-smoking, non-vaping peers after demographic adjustment. There was no significant difference in self-esteem between the "neither" group and the other groups, though the "vaping-only", "smoking-only" and "both" groups were more likely to report unhappiness. Inconsistent differences emerged regarding personal & family beliefs.

CONCLUSIONS

Generally, adolescents who reported e-cigarette-only use had better outcomes than their peers who smoked cigarettes. However, students who vape-only reported poorer academic performance compared to those who did not vape or smoke. Vaping and smoking were not significantly related to self-esteem, but were linked to unhappiness. Still, vaping does not follow the same patterns as smoking, despite frequent comparisons in the literature.

Adolescent simultaneous use of alcohol and marijuana by trends in cigarette and nicotine vaping from 2000 to 2020

BACKGROUND

Simultaneous alcohol and marijuana (SAM) use is associated with adverse consequences for youth. While SAM use is overall declining among youth, prior studies indicate increasing marijuana use among US adolescents who ever used cigarettes, suggesting possible moderation of the alcohol-marijuana relationship by cigarette use.

METHODS

We included 43,845 12-th grade students participating in Monitoring the Future data (2000-2020). A 5-level alcohol/marijuana measure was used, including past-year SAM, alcohol-only, marijuana-only, non-simultaneous alcohol and marijuana, or no use. Multinomial logistic regressions estimated associations between time periods (categorized based on sample size: 2000-2005, 2006-2009, 2010-2014, 2015-2020) and the 5-level alcohol/marijuana measure. Models adjusted for sex, race, parental education and survey mode and included interactions of time periods and lifetime cigarette or vaped nicotine use.

RESULTS

While overall SAM among 12th graders decreased from 23.65% to 18.31% between 2000 and 2020, SAM increased among students who never used cigarettes or vaped nicotine (from 5.42% to 7.03%). Among students who ever used cigarettes or vaped nicotine, SAM increased from 39.2% in 2000-2005-44.1% in 2010-2014 then declined to 37.8% in 2015-2020. Adjusted models controlling for demographics indicated that among students with no lifetime cigarette or vaped nicotine use, students in 2015-2020 had 1.40 (95% C.I. 1.15-1.71) times the odds of SAM, and 5.43 (95% C.I. 3.63-8.12) times the odds of marijuana-only (i.e., no alcohol use) compared to students who used neither in 2000-2005. Alcohol-only declined over time in both students who ever and never used cigarettes or nicotine vape products.

CONCLUSION

Paradoxically, while SAM declined in the overall adolescent US population, the prevalence of SAM increased among students who have never smoked cigarettes or vaped nicotine. This effect arises because of a substantial decline in the prevalence of cigarette smoking; smoking is a risk factor for SAM, and fewer students smoke. Increases in vaping are offsetting these changes, however. Preventing adolescent use of cigarettes and nicotine vaped products could have extended benefits for other substance use, including SAM.

The Association Between Cannabis Use and Subsequent Nicotine Electronic Cigarette Use Among US Adolescents

PURPOSE

The current study assessed the association between cannabis use among youth never e-cigarette users and subsequent e-cigarette use.

METHODS

The Population Assessment of Tobacco and Health Study is a nationally representative cohort study. Participants aged 12 years and older were selected using a 4-stage, stratified probability sample design from the US civilian, noninstitutionalized population. We included adolescents who participated in both wave 4.5 (2017-2018) and wave 5 (2018-2019) of Population Assessment of Tobacco and Health, and were never e-cigarette users at baseline (N = 9,925). Through multivariable logistic regressions, we examined the prospective association between cannabis use and subsequent e-cigarette use.

RESULTS

E-cigarette use at wave five was significantly more common among youth cannabis users at wave 4.5. The adjusted relative risks between ever cannabis use and subsequent past 12-month, past 30-day, and frequent e-cigarette use (≥20 days per month) were 1.53 (95% CI, 1.26-1.81), 1.70 (95% CI, 1.25-2.15), and 2.10 (95% CI, 1.17-3.03), respectively. The adjusted relative risks between past 30-day cannabis use and subsequent past 12-month, past 30-day, and frequent e-cigarette use were 1.54 (95% CI, 1.04-2.28), 2.01 (95% CI, 1.23-3.29), and 2.87 (95% CI, 1.44-5.71), respectively. We also found significant associations between ever cannabis vaping with subsequent e-cigarette use.

DISCUSSION

While previous research associates e-cigarette use with subsequent onset of cannabis use, we identify a reverse directional effect, where adolescent cannabis use is associated with increased likelihood of future e-cigarette use.

Nicotine Vaping and Co-occurring Substance Use Among Adolescents in the United States from 2017-2019

Background: The use of electronic cigarettes (or "vaping") among adolescents remains a public health concern given exposure to harmful substances, plus potential association with cannabis and alcohol. Understanding vaping as it intersects with combustible cigarette use and other substance use can inform nicotine prevention efforts. Methods: Data were drawn from 51,872 US adolescents (grades 8, 10, 12, years: 2017-2019) from Monitoring the Future. Multinomial logistic regression analyses assessed links of past 30-day nicotine use (none, smoking-only, vaping-only, and any smoking plus vaping) with both past 30-day cannabis use and past two-week binge drinking. Results: Nicotine use patterns were strongly associated with greater likelihood of cannabis use and binge drinking, particularly for the highest levels of each. For instance, those who smoked and vaped nicotine had 36.53 [95% CI:16.16, 82.60] times higher odds of having 10+ past 2-week binge drinking instances compared to non-users of nicotine. Discussion: Given the strong associations between nicotine use and both cannabis use and binge drinking, there is a need for sustained interventions, advertising and promotion restrictions, and national public education efforts to reduce adolescent nicotine vaping, efforts that acknowledge co-occurring use.

Early-onset prescription drug misuse in Indiana youth

BACKGROUND

Based on 2018 national estimates, approximately 5-10% of youth between the ages of 12-17 report past year prescription drug misuse (PDM) in the United States. PDM among adolescents is associated with negative health outcomes and risk behaviors. The current study examined both the prevalence of PDM among diverse groups of adolescents and the association of alcohol and cigarette use with early PDM.

METHODS

Data came from the cross-sectional state-based 2018 Indiana Youth Survey of students from grades 6-12, ranging in age from 10 to 17 years (n = 80,926). Lifetime PDM, alcohol, and cigarettes were assessed by self-report, including ages at first use. A series of analyses were conducted separately for non-Hispanic Black, non-Hispanic White, and Hispanic students. We estimated the prevalence of PDM. Likelihood of PDM was estimated using the Kaplan-Meier survivor function. Cox proportional hazards regression models estimated age at first PDM from ages at first use of alcohol and cigarettes.

RESULTS

Three percent of non-Hispanic Black, 4% of non-Hispanic White, and 5% of Hispanic students reported PDM. Onset of smoking was associated with first PDM across adolescence for all groups. Onset of drinking was associated with first PDM among Hispanic students across adolescence. For Non-Hispanic Black and Non-Hispanic White students, likelihood of PDM was most pronounced during very early adolescence.

CONCLUSIONS

Onset of alcohol and cigarette use were associated with of PDM among Indiana youth, suggesting that interventions aimed at preventing early smoking and drinking may also reduce PDM among youth.

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

AIMS

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.

DESIGN, SETTING AND PARTICIPANTS

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.

MEASUREMENTS

Escalated ENDS use was computed by subtracting the number of days of ENDS use within the past 30 days at wave w - 1 from that at wave w and coded as 1 = escalated, if the value was greater than zero (otherwise, coded as 0 = not escalated).

FINDINGS

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.

CONCLUSIONS

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.

Associations between muscle-building exercise and concurrent e-cigarette, cigarette, and cannabis use among U.S. adolescents

Physical activity and team sports may be protective of substance use among adolescents, although there is mixed evidence on whether muscle-building exercise is associated with patterns of e-cigarette use (i.e., vaping), cigarette use, and cannabis use. Therefore, this study aimed to determine the association between muscle-building exercise and patterns of concurrent substance use among U.S. adolescents. Cross-sectional data from the 2019 Youth Risk Behavior Survey (N = 8,474) were analyzed in 2022. Muscle-building exercise was assessed by number of days of the behavior in the past week and categorized based on level of engagement (none, low, medium, and high). Concurrent vaping, cigarette use, and cannabis use within the past 30 days were assessed using a combined, four-category variable (no use, any single use, any dual use, and triple use). Multinomial logistic regressions, with coefficients transformed to relative risk ratios (RRR), were conducted to estimate the associations between muscle-building exercise and concurrent substance use among the overall sample, and by sex, while adjusting for relevant sociodemographic variables. Among the overall sample, high engagement (6-7 days) in muscle-building exercise was associated with greater relative risk of any single use (RRR 1.36, 95% confidence interval [CI] 1.06-1.72), any dual use (RRR 1.46, 95% CI 1.10-2.94), and triple use (RRR 1.81, 95% CI 1.05-3.12). While muscle-building exercise was associated with greater relative risk of concurrent patterns of vaping, cigarette use, and cannabis use among adolescent males, there were no significant relationships found among adolescent females. Healthcare professionals should consider this association when treating adolescent males, particularly given the high prevalence of muscle-building exercise and substance use among this group. More research is needed to understand the experiences of adolescent males who report high engagement in muscle-building exercise and substance use to uncover mechanisms of association.

Use of Electronic Cigarettes Among Cannabis-Naive Adolescents and Its Association With Future Cannabis Use

IMPORTANCE

Electronic cigarette (e-cigarette) use has been reported to increase the likelihood of future cigarette smoking among adolescents. The prospective association between e-cigarette use and cannabis use has been less clear, especially in recent years.

OBJECTIVE

To examine the association between e-cigarette use among cannabis-naive adolescents and cannabis use 1 year later.

DESIGN, SETTING, AND PARTICIPANTS

The Population Assessment of Tobacco and Health (PATH) Study, a nationally representative cohort study, uses a 4-stage, stratified probability sample design to select participants aged 12 years or older from the US civilian, noninstitutionalized population. This study sample included 9828 cannabis-naive adolescents at the baseline survey who participated in both wave 4.5 (2017-2018) and wave 5 (2018-2019) of PATH.

EXPOSURES

e-Cigarette use, assessed by ever use, past 12-month use, and past 30-day use.

MAIN OUTCOMES AND MEASURES

Cannabis use in wave 5, assessed by past 12-month and past 30-day use. Multivariable logistic regressions assessed the association between e-cigarette use and cannabis use 1 year later. Results were weighted to produce nationally representative findings.

RESULTS

Of the 9828 adolescents included in the analysis, 5361 (57.3%) were aged 12 to 14 years, 5056 (50.7%) were male, and 4481 (53.0%) were non-Hispanic White. After adjustment for sociodemographic characteristics, environmental factors, other substance use, and sensation seeking, e-cigarette use among cannabis-naive adolescents was associated with increased likelihoods of both self-reported past 12-month and past 30-day cannabis use 1 year later. The adjusted relative risks (aRRs) of subsequent past 12-month cannabis use with ever use of e-cigarettes was 2.57 (95% CI, 2.04-3.09), with past 12-month use of e-cigarettes was 2.62 (95% CI, 2.10-3.15), and with past 30-day use of e-cigarettes was 2.18 (95% CI, 1.50-2.85). The aRRs of subsequent past 30-day cannabis use with ever use of e-cigarettes was 3.20 (95% CI, 2.10-4.31), with past 12-month use of e-cigarettes was 3.40 (95% CI, 2.17-4.63), and with past 30-day use of e-cigarettes was 2.96 (95% CI, 1.52-4.40).

CONCLUSIONS AND RELEVANCE

This cohort study's findings suggest a strong association between adolescent e-cigarette use and subsequent cannabis use. However, 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.

Documento de posicionamiento de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) ante las estrategias de reducción del daño del tabaco

In the last decade, the appearance of electronic cigarettes and new tobacco products (heated tobacco or smokeless tobacco) has generated a growing interest in harm reduction methods that are defined as mechanisms that seek to reduce the harmful consequences of tobacco without give up the pleasant effects of it by replacing it with these new electronic devices. However, these products are addictive and not safe as they contain nicotine. Harm reduction is a false solution as it represents a commercial strategy of the tobacco industry to increase its sales, making it difficult to control smoking, since it keeps smokers from consuming tobacco and prevents them from making serious attempts to quit. In addition, these products are a gateway to adolescents in tobacco.

Associations between Concurrent Substance Use and Anabolic-Androgenic Steroid Use among Adolescents

BACKGROUND

Concurrent use of e-cigarettes, cigarettes, and cannabis is common among adolescents, while illicit anabolic-androgenic steroid (AAS) use has recently been on the rise. Today, no known research has investigated the patterns of concurrent substance use and AAS use among adolescents in the United States.

OBJECTIVE

To determine the association between concurrent lifetime use of e-cigarettes, cigarettes, and cannabis and illicit AAS use among adolescents.

METHODS

Cross-sectional data from the 2019 Youth Risk Behavior Survey (N = 13,677) were analyzed in 2021. Four mutually exclusive categories of concurrent substance use (no use, any single use, any dual use, and triple use) were constructed, along with any lifetime AAS use. One logistic regression model was estimated to determine the association between concurrent substance use and lifetime AAS use.

RESULTS

Compared to no use, lifetime triple use (adjusted odds ratio 3.95, 95% confidence interval 1.73-8.95) was associated with lifetime AAS use while adjusting for potential confounders.

CONCLUSIONS

Findings underscore an overlapping pattern of problematic substance use that may be harmful for adolescents. Health care professionals should be aware of these patterns to improve substance use assessment protocols.

Cannabis use and electronic cigarette use: The role of dual use on use frequency and related problems

Despite high rates of use of both cannabis and electronic nicotine delivery systems (ENDS), little is known about the role of cannabis use among ENDS users and of ENDS use among cannabis users. This study tested whether dual use was related to more frequent use, use-related problems, and negative affect. Among cannabis users (n=315), ENDS was associated with more frequent cannabis use, cannabis-related problems, anxiety, and depression. Among ENDS users (n=156), cannabis was associated with more frequent ENDS use, ENDS-related problems, and anxiety. Overall, ENDS use is common among cannabis users and cannabis use is common among ENDS users. Further, use of both of these substances is related to more use, use-related problems, and negative affect, especially anxiety.