Adults who both vape and smoke cannabis had the most behavioral health problems
Among 7,178 adult cannabis users, those who both vaped and smoked (dual-use, 20%) had nearly twice the odds of severe externalizing symptoms compared to smoking-only users, while vaping-only users were more likely to be White and higher income.
Quick Facts
What This Study Found
Dual-use (20% of users) associated with severe externalizing symptoms (OR 1.89); vaping-only (9.1%) associated with White race (OR 3.90) and higher income (OR 2.56) vs smoking-only; over 56% smoked only.
Key Numbers
7,178 cannabis users; 56% smoke only; 9.1% vape only; 20% dual-use; dual-use severe externalizing OR=1.89; vape-only: White OR=3.90, higher income OR=2.56.
How They Did This
Cross-sectional analysis of PATH Study Wave 6; 7,178 adult current cannabis users classified by method (smoking only, vaping only, dual-use, other); multinomial logistic regression for sociodemographic and mental health correlates.
Why This Research Matters
Cannabis consumption methods are shifting, and the finding that dual-use carries the highest behavioral health burden suggests this group needs targeted clinical attention.
The Bigger Picture
The demographic and mental health profiles differ substantially by cannabis consumption method, challenging one-size-fits-all approaches to cannabis-related clinical care.
What This Study Doesn't Tell Us
Cross-sectional PATH data; self-reported methods and mental health; cannot determine direction of association; "other methods" category is heterogeneous.
Questions This Raises
- ?Do externalizing symptoms drive dual-use or vice versa?
- ?Why is vaping-only associated with higher socioeconomic status?
- ?Does dual-use involve higher total THC exposure?
Trust & Context
- Key Stat:
- Dual cannabis vaping/smoking users had 1.89x higher odds of severe externalizing symptoms
- Evidence Grade:
- Nationally representative PATH data with clear method-specific profiles, but cross-sectional design prevents causal interpretation.
- Study Age:
- Published 2025
- Original Title:
- Examining the Relationship of Cannabis use Patterns, Mental Health, and Sociodemographic Factors: A Focus on Cannabis Vaping, Smoking and Dual-Use.
- Published In:
- Addictive behaviors, 163, 108263 (2025)
- Authors:
- Chung, Jack Y C, Lim, Carmen C W(5), Connor, Jason P(8), Hall, Wayne, Stjepanović, Daniel, Chan, Gary C K
- Database ID:
- RTHC-06229
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Does how you use cannabis matter for mental health?
Yes. Adults who both vaped and smoked cannabis had nearly twice the odds of severe externalizing symptoms (aggression, attention problems) compared to those who only smoked.
Who vapes cannabis?
Vaping-only cannabis users were nearly 4x more likely to be White and 2.5x more likely to have higher incomes compared to smoking-only users.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-06229APA
Chung, Jack Y C; Lim, Carmen C W; Connor, Jason P; Hall, Wayne; Stjepanović, Daniel; Chan, Gary C K. (2025). Examining the Relationship of Cannabis use Patterns, Mental Health, and Sociodemographic Factors: A Focus on Cannabis Vaping, Smoking and Dual-Use.. Addictive behaviors, 163, 108263. https://doi.org/10.1016/j.addbeh.2025.108263
MLA
Chung, Jack Y C, et al. "Examining the Relationship of Cannabis use Patterns, Mental Health, and Sociodemographic Factors: A Focus on Cannabis Vaping, Smoking and Dual-Use.." Addictive behaviors, 2025. https://doi.org/10.1016/j.addbeh.2025.108263
RethinkTHC
RethinkTHC Research Database. "Examining the Relationship of Cannabis use Patterns, Mental ..." RTHC-06229. Retrieved from https://rethinkthc.com/research/chung-2025-examining-the-relationship-of
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.