Dual Use of Nicotine and Cannabis Through Vaping Among Adolescents

Abstract

Introduction: This study seeks to identify adolescent nicotine and cannabis vaping patterns and the characteristics of those adolescents who comprised each pattern.

Methods: This prospective longitudinal survey study measured the relationship between nicotine and cannabis vaping among 1,835 adolescents from 4 public high schools outside of Philadelphia, Pennsylvania. Adolescents completed in-classroom surveys, including questions of lifetime and past 30-day nicotine and cannabis vaping, at Wave 1 (fall 2016, ninth grade) and 6-month intervals for the following 36 months (fall 2019, 12th grade). Data were analyzed in 2021.

Results: A sequential processes growth mixture model revealed 4 latent conjoint classes of nicotine and cannabis vaping: early, declining dual use (Class 1: n=259); rapidly increasing dual use (Class 2: n=128); later, slower dual use (Class 3: n=313); and no use (Class 4: n=1,136). Increased odds of belonging to Class 1 and Class 2 versus belonging to Class 4 were significantly associated with cigarette smoking (OR=3.71, OR=2.21), alcohol use (OR=2.55, OR=4.39), peer vaping (OR=1.24, OR=1.20), sensation seeking (OR=1.03, OR=1.11), positive E-cigarette expectations (OR=1.21, OR=1.17), and cigar smoking (OR=2.39 Class 2 only). Increased odds of belonging to Class 3 versus Class 4 were significantly associated with alcohol use (OR=1.66), perceived benefits of E-cigarette use (OR=1.03), positive E-cigarette expectations (OR=1.08), depressive symptoms (OR=1.02), and sensation seeking (OR=1.03).

Conclusions: From middle to late adolescence, vaping of nicotine and cannabis develop in close parallel. Regulatory policy and prevention interventions should consider the interplay between these 2 substances during this period of adolescence.