Electronic Vapor Products, Marijuana Use, Smoking, and Asthma in US Adolescents

Consumption of e-cigarettes can lead to cigarette smoking and use of other combustible products, but little is known about concurrent use of e-cigarettes, marijuana, and cigarettes in adolescents. Use of e-cigarettes has been associated with symptoms and exacerbations of asthma and the authors hypothesized that e-cigarette use would be associated with asthma in adolescents, and that such association would be stronger when e-cigarette use is combined with marijuana and/or cigarette smoking.

Data from the Youth Risk Behavior Surveillance (YRBS) system from 2015 and 2017, including 21 532 study participants with valid data.

The US Centers for Disease Control and Prevention established the YRBS system to monitor health risk behaviors in US youth. The YRBS is conducted every 2 years and uses a 3-stage cluster sampling design to produce a representative sample of ninth-grade through 12th-grade students. The YRBS contained questions on use of an electronic vapor product (including e-cigarettes, e-cigars, e-pipes, vape pipes, vaping pens, e-hookahs, and hookah pens), cigarette smoking, and marijuana use. Data from the 2015 and 2017 surveys were used for this analysis.

The overall prevalence of asthma was 24.3%. Compared with control subjects, subjects with asthma were more likely to report current cigarette smoking, marijuana use, and use of an electronic vapor product. Of the 4073 participants reporting use of an electronic vapor product, 2587 (63.5%) also reported marijuana use and/or cigarette smoking. Use of any of these products was higher in subjects with asthma than in controls across all racial/ethnic groups. Frequent cigarette smoking, frequent marijuana use, and frequent use of an electronic vapor product were each significantly associated with 55% to 65% increased odds of asthma. Compared with participants who reported no current use of an electronic vapor product or marijuana or cigarette smoking, those currently using an electronic vapor product and marijuana had significantly increased (1.45 times greater) odds of asthma, and those currently using an electronic vapor product, marijuana, and cigarette smoking had significantly increased (1.74 times greater) odds of asthma.

Together with recent reports of serious and sometimes fatal e-cigarette/vaping–related acute lung injury, the authors conclude that these results strongly support both vigorous policies to stop use of e-cigarettes in children and adolescents and continued research on the detrimental effects of these products on respiratory health.

While we all recognize that these activities are common in adolescents and that they must have negative health consequences, to me, these results are absolutely striking in both their prevalence and their effects on asthma.