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.
Addiction clinicians, mental health providers, cannabis researchers
Dual cannabis vaping/smoking users had 1.89x higher odds of severe externalizing symptoms
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
What this study cannot tell us
Cross-sectional PATH data; self-reported methods and mental health; cannot determine direction of association; "other methods" category is heterogeneous.
How to read the evidence
Nationally representative PATH data with clear method-specific profiles, but cross-sectional design prevents causal interpretation.
When this study was published
Published 2025
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.
Questions still open
- 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?
Common questions
Does how you use cannabis matter for mental health?
Who vapes cannabis?
Read the original research
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
Citation
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
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