Predictors of vaping marijuana initiation among US adolescents: Results from the Population Assessment of Tobacco and Health (PATH) study Wave 3 (2015-2016) and Wave 4 (2016-2018)

Introduction: Marijuana vaping among adolescents is a growing public health concern. Marijuana vaping exposes youth to greater levels of tetrahydrocannabinol (THC) and may be related to e-cigarette or vaping product use-associated lung injury (EVALI). This study examined the risk factors for initiating marijuana vaping among US adolescents. Methods: We analyzed Waves 3 (2015-2016) and 4 (2016-2018) of the Population Assessment of Tobacco and Health (PATH) Study. We estimate a multivariable logistic regression to model marijuana vaping initiation at Wave 4 among those who never vaped marijuana at Wave 3 (N = 7,821) as a function of key risk factors associated with youth substance use. Results: Marijuana vaping initiation is associated with current use of electronic nicotine delivery system (ENDS) (aOR = 2.16, 95 % CI = 1.20, 3.89), cigarettes (aOR = 2.65, 95 % CI = 1.10, 6.35), other marijuana products (aOR = 7.78, 95 % CI = 3.74, 6.15), and alcohol (aOR = 1.98, 95 % CI = 1.35, 2.91). Other factors contributing to marijuana vaping initiation include being 15-17 years old (aOR = 1.51, 95 % CI = 1.19, 1.90) and Hispanic (aOR = 1.37, 95 % CI = 1.08, 1.76), as well as having less than college-level parental education (aOR = 1.35, 95 % CI = 1.07, 1.70), vaping peers (aOR = 2.31; 95 % CI = 1.81, 2.96), and a high internalizing (aOR = 1.49, 95 % CI = 1.10, 2.02) and externalizing tendency (aOR = 1.66, 95 % CI = 1.14, 2.41). Conclusions: Multi-level efforts are needed to target the varying risk factors leading to marijuana vaping initiation in adolescents. Knowledge of these risk factors can help policymakers and health program administrators to identify at-risk individuals and design interventions that can prevent marijuana vaping initiation at the indi-vidual, household, school, clinical and public health levels.

Automated summary

This study identified various risk factors associated with initiating marijuana vaping among adolescents, including current use of electronic nicotine delivery system, cigarettes, other marijuana products, and alcohol, as well as age, race, parental education level, influence of peers, and internal/externalizing tendencies.