Marijuana in E-Cigarettes: A Growing Public Health Concern Among US Youth

Among American students in grades 6 to 12, trying marijuana in e-cigarettes is common.¹

According to new findings published in JAMA Pediatrics, the number of students who had used cannabis in e-cigarettes had reached an alarming 1 in 11 in 2016, including one-third of students who had ever tried e-cigarettes.

Moreover, approximately 1 in 3 middle-school students and about 1 in 4 high-school students identifying as e-cigarette users had experimented with cannabis in e-cigarettes at some point in their lives.

These statistics are a cause for concern, as neither cannabis nor e-cigarettes come without health hazards, said lead author Katrina Trivers, PhD, MSPH, from the Office on Smoking and Health at the Centers for Disease Control and Prevention in Atlanta, Georgia.

Dr Trivers recently shared her insights with Consultant360, explaining the effects of these substances on the young brain, factors that may perpetuate the cannabis/e-cigarette trend, and ways for physicians, parents, and policymakers to help address this issue.

Consultant360: Your study found that cannabis use in e-cigarettes is prevalent among middle and high school students. What factors do you think contributed to this finding?

Katrina Trivers: There are likely multiple factors that may be influencing the use of cannabis in e-cigarettes among our nation’s youth. The tobacco product landscape has changed in recent years, and e-cigarettes have become increasingly popular to the point where they have been the most commonly used tobacco product among youth since 2014. In recent years, many youths have also been using other psychoactive substances in e-cigarettes, including cannabinoids and other illicit drugs.

Young people may use cannabis for a variety of reasons, including curiosity, peer pressure, misperceptions that cannabis is harmless, as well as shifts in availability and opportunity as social norms and public policies related to cannabis have changed in recent years. Exposure to marijuana or other substance use through friends or family members may also cause the use of these products to be seen as more normative behavior. For example, our study found that youth who lived with a tobacco user were significantly more likely to use an e-cigarette with cannabis than those who did not live with a tobacco user.

C360: In your experience, what are some of the biggest misconceptions about the health-related effects of cannabis use, especially among youth?

KT: One of the biggest misconceptions is that cannabis use is harmless.

This is a public health concern because the use of any form of tobacco product is unsafe among youth, irrespective of whether it is smoked, smokeless, or electronic. The US Surgeon General has concluded that the aerosol emitted from e-cigarettes is not harmless. It can contain harmful ingredients, including nicotine, carbonyl compounds, and volatile organic compounds known to have adverse health effects.

The use of marijuana in these products is of particular concern because cannabis use among youth can adversely affect learning and memory and may impair later academic achievement and education.

C360: What health consequences can arise from cannabis use among youth? Are youth more vulnerable to the effects of cannabis than adults?

KT: The brain continues to develop until age 25, so youth and young adulthood is a critical window for preventing the use of harmful substances, including e-cigarettes with cannabis. Again, cannabis use among youth can adversely affect learning and memory and may impair later academic achievement and education.

Among marijuana users, youth may be more likely than adults to become addicted to marijuana. This is because the developing brains of children and teenagers are especially susceptible to the addictive effects of marijuana.

C360: In your view, how might the findings from your study inform future research and related endeavors, and what steps can be taken to help reduce cannabis and e-cigarette use among youth?

KT: This is the first time we have assessed the use of cannabis in e-cigarettes, and now that these questions have been added to our surveys to keep pace with the changing landscape, we will be in a position to assess any changes moving forward. It is also important to ensure that our surveys and questions keep pace with the rapidly changing landscape of products that youth are using.

Given the continued popularity of e-cigarettes among youth and the variety of substances that can be used in e-cigarettes, it is important to continue to monitor not only the use of e-cigarettes among US youth, but also the diversity of substances that they are using in these products. For example, further detail on why youth use these products, where youth access these products, and how frequently they use these products would also be beneficial, in addition to studying the extent to which the use of these products could lead to subsequent use of other substances. This type of research could help inform public health policy, planning, and practice aimed at addressing youth use of e-cigarettes, including with cannabis.

These findings ultimately reinforce the importance of strategies to reduce all forms of e-cigarette use, including with cannabis, to protect our nation’s young people from this preventable health risk. Everyone can play a role. Pediatricians, nurses, and other health care providers can ask about youths’ e-cigarette use and counsel them about the dangers of e-cigarette use, including with cannabis. They can also ask all patients whether they use tobacco products, encourage those who do to quit, and provide help with quitting.

Additionally, parents can set a positive example by being tobacco-free, and ensuring that their kids are not exposed to the secondhand emissions from any tobacco products, including e-cigarettes. We know e-cigarettes are now the most commonly used tobacco product among youth and that many youths are not aware of the dangers of these products. Therefore, ensuring that youth are aware of the risks of using all forms of tobacco products, including e-cigarettes, is critical. 

C360: In your view, how might the legalization of cannabis in several US states affect ease of access to cannabis among youth, and what steps should be taken to address this?

KT: Young people may use cannabis for a variety of reasons, including shifts in availability and opportunity as social norms and public policies related to cannabis have changed in recent years. For example, the increased legalization of cannabis could result in it being more accessible either directly or indirectly by youth, as well as its use being seen as a more normal or acceptable behavior.

At the population level, there are several actions that can be taken to address the use of e-cigarettes more broadly, including those with cannabis, among youth. The good news is that we know what works to effectively reduce all forms of tobacco product use among youth, including e-cigarettes, and irrespective of whether those products contain cannabis. For example, we can continue to modernize our proven, evidence-based interventions to reduce e-cigarette use among youth. Actions could include incorporating e-cigarettes in smoke-free policies, and preventing access to e-cigarettes by youth.

Additionally, at the individual level, it is important that youth influencers, including parents and health care professionals, continue to reinforce to youth that using cannabis, including in e-cigarettes, is harmful to their health. In addition to the risks of e-cigarettes among youth, cannabis use among youth can adversely affect learning and memory and may impair later academic achievement and education.

Katrina Trivers, PhD, MSPH, is an epidemiologist at the Office on Smoking and Health in the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention in Atlanta, Georgia.

—Christina Vogt

Reference:

1. Trivers KF, Phillips E, Gentzke AS, et al. Prevalence of cannabis use in electronic cigarettes among US youth [Published online September 17, 2018]. JAMA Pediatr. doi:10.1001/jamapediatrics.2018.1920