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Cannabis use with vaping devices increased among teenagers while non-vaped cannabis use fell, survey data showed.

Both past 30-day frequent cannabis vaping and occasional cannabis vaping increased from 2017 to 2019, while frequent and occasional cannabis use without vaping fell during the same period, reported Noah Kreski, MPH, of Columbia University Mailman School of Public Health in New York City, and co-authors.

Overall, any level of cannabis use increased from 13.9% to 15.4% during the study period, according to the findings in .

"Cannabis vaping is now the most popular method of cannabis delivery among adolescents in the U.S., and we're seeing especially strong increases in cannabis vaping for frequent use," co-author Katherine Keyes, PhD, MPH, also of Columbia University, said in an interview with 番茄社区.

What's "particularly alluring" to adolescents is that cannabis vaping devices are hard to detect and easy to conceal from parents and teachers, she added.

The rise in cannabis vaping is concerning because vaping devices can deliver very high concentrations of tetrahydrocannabinol (THC), which may affect levels of intoxication, degree of physiological impacts, and the potential to develop cannabis use disorder, Keyes said. Vaping has also been tied to lung diseases, including e-cigarette or vaping use-associated lung injury (EVALI).

The findings were based on 51,052 responses in the (MTF) study, a nationally representative annual survey of adolescents in schools. Overall, 49.3% were white, 27.8% were Hispanic or Latino, and 11.8% were non-Hispanic Black students. Most participants had at least one parent with a college degree (58.2%) and lived in a metropolitan statistical area (80.2%).

From 2017 to 2019, the 30-day prevalence of cannabis vaping rose across all grades but nearly tripled among high school seniors, increasing from 5% to 14%. "The 1-year increase in this grade from 2018 to 2019 (7.5-14%) is the second largest 1-year increase in any type of substance use ever tracked by MTF," the authors wrote.

Frequent cannabis use involving vaping -- defined as more than six times a month -- saw the largest increase, from 2.1% in 2017 to 5.4% in 2019. However, frequent cannabis use without vaping fell from 3.8% to 2.1% and occasional cannabis use dropped from 6.9% to 4.4% in the same period.

Cannabis was highly associated with other substance use. The strongest link was between nicotine use and cannabis vaping (adjusted OR 42.28, 95% CI 33.14-53.93).

"Kids who vape cannabis ... especially those who vape cannabis frequently, are much more likely to also smoke cannabis, but also engage in nicotine vaping and cigarette smoking, as well as binge drinking," Keyes said. "Certainly, the more products you use, the more likely it is for that transition to a substance use disorder or addiction."

Adolescents who use cannabis in vaping devices are 10 times as likely to binge drink, and do so frequently, compared with those who don't use cannabis at all, she noted.

Among boys, frequent cannabis vaping jumped from 2.9% in 2017 to 6.2% in 2019; among girls, it rose from 1.3% to 4.7%. Adolescents who did not have a parent with a college degree were more likely to have frequently vaped cannabis than those who did (6.8% vs 4.5%). Patterns across years were "relatively similar between levels of urbanicity," the authors noted.

Frequent cannabis vaping was prevalent across all ethnic and racial groups except non-Hispanic Black adolescents for whom cannabis use without vaping was most common. The authors also observed "notable increases" in frequent cannabis use among Hispanic/Latino teens and adolescents of lower socioeconomic status.

The study's limitations include a lack of information about THC content and the survey's cross-sectional design.

"So we don't have that prospective design to really look in-depth at product use over time ... to see how that progresses," Keyes said. "I think that would be an important future study."

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