Concurrent e-cigarette and cannabis use was associated with higher odds of depression, suicidal ideation, and suicide attempts in US high school students, especially females.
School counselors, adolescent health providers, and suicide prevention specialists.
16.4% concurrent usersof high school students used both e-cigarettes and cannabis, with higher odds of depression and suicidal behavior
What the researchers found
Exclusive e-cigarette users, exclusive cannabis users, and concurrent users all had increased odds of depression and suicidal behavior compared to non-users, with female students showing particularly elevated risks.
Why it matters
With 16.4% of high school students using both e-cigarettes and cannabis, understanding the mental health implications of this combined use pattern is critical for prevention.
The numbers in context
12,401 high school students. 15.7% exclusive e-cigarette, 4.5% exclusive cannabis, 16.4% concurrent users. All groups had elevated odds of depression, suicidal ideation, suicide plans, attempts, and attempt-related injuries vs. non-users.
How the study worked
Cross-sectional analysis of 2019 National Youth Risk Behavior Survey data using multivariable logistic regression, stratified by sex.
Who was studied
12,401 US high school students in grades 9-12 from the 2019 National Youth Risk Behavior Survey.
What this study cannot tell us
Cross-sectional design cannot determine if substance use causes mental health problems or vice versa. Self-reported data. Past 30-day substance use may not reflect chronic patterns.
How to read the evidence
Large nationally representative cross-sectional survey; strong associations but cannot establish causation.
When this study was published
2019 YRBSS data, reflecting pre-pandemic adolescent substance use and mental health.
The bigger picture
This study reveals that a substantial proportion of US teens use both e-cigarettes and cannabis, and this dual use pattern is associated with the most concerning mental health outcomes.
Replication
Nationally representative data; longitudinal studies needed to establish directionality.
Funding
Not specified in abstract
Conflicts of interest
Not specified in abstract
Questions still open
- Does concurrent use carry risks beyond what each substance does individually?
- Should school-based prevention programs address e-cigarette and cannabis use together?
Read the original research
E-Cigarette and Cannabis Use Patterns, Depression, and Suicide Behaviors Among US Youth: Analysis of 2019 Youth Risk Behavior Survey Data.
American journal of health promotion : AJHP, 37(1), 77-83
Citation
Jacobs, Wura; Orozco, Georgina; Villanueva, Guadalupe; Merianos, Ashley L. (2023). E-Cigarette and Cannabis Use Patterns, Depression, and Suicide Behaviors Among US Youth: Analysis of 2019 Youth Risk Behavior Survey Data.. American journal of health promotion : AJHP, 37(1), 77-83. https://doi.org/10.1177/08901171221112927