COVID-Related Stress Predicted Adolescent Cannabis Vaping Two Years Later Through Increased Susceptibility
Higher COVID-related stress during remote learning predicted increased susceptibility to vaping cannabis one year later, which in turn predicted actual cannabis vaping two years later, in a study of 1,316 LA high school students.
Quick Facts
What This Study Found
COVID-related stress during remote learning (2020-2021) predicted increased susceptibility to cannabis vaping one year later (B=0.04, p=0.02), which predicted actual cannabis vaping another year later (B=1.62, p<0.001). The same mediation pattern held for e-cigarette vaping (susceptibility B=0.04, p=0.02; vaping B=0.98, p=0.003).
Key Numbers
1,316 students; 9 schools; COVID stress to cannabis vaping susceptibility B=0.04 (p=0.02); susceptibility to cannabis vaping B=1.62 (p<0.001).
How They Did This
Prospective cohort of 1,316 9th graders from 9 LA County public high schools. Annual surveys over 3 years. Mediation analysis testing COVID stress (2020-21) to vaping susceptibility (2021-22) to vaping behavior (2022-23).
Why This Research Matters
The pandemic created a generation of stressed adolescents. This study shows that stress translated to actual substance use two years later through a measurable intermediary (susceptibility), identifying a window for intervention.
The Bigger Picture
The mediation through susceptibility (defined as lacking a firm commitment not to use) suggests that building resilience and commitment during stressful periods could prevent later substance use. School-based programs during crises could target this pathway.
What This Study Doesn't Tell Us
LA County sample may not generalize. Self-reported measures. Attrition over 3 years not detailed. COVID stress may be a proxy for other pandemic-related changes. Cannot establish causation from observational mediation.
Questions This Raises
- ?Would stress-reduction programs during the pandemic have prevented later vaping?
- ?Is the susceptibility-to-use pathway specific to pandemic stress or generalizable to other stressors?
Trust & Context
- Key Stat:
- COVID stress predicted cannabis vaping susceptibility (p=0.02)
- Evidence Grade:
- Prospective mediation design with temporal separation provides reasonable evidence for the pathway, though observational design limits causal claims.
- Study Age:
- 2025 study tracking students from remote learning (2020-21) through 2022-23.
- Original Title:
- Prospective associations of COVID-related stress with vaping nicotine and cannabis among high school students: Mediated by vaping susceptibility.
- Published In:
- PloS one, 20(10), e0334159 (2025)
- Authors:
- Lee, Ryan(2), Cho, Junhan(3), Bae, Dayoung(2), Albers, Larisa, Herzig, Shirin Emma, Ramirez, Carla Michelle, Carvajal, Alberto, Soto, Daniel, Unger, Jennifer B
- Database ID:
- RTHC-06911
Evidence Hierarchy
Enrolls participants and follows them forward in time.
What do these levels mean? →Frequently Asked Questions
Did the pandemic increase teen cannabis vaping?
This study found COVID-related stress predicted later cannabis vaping, but through a two-step process: stress first increased susceptibility (openness to trying), which then predicted actual use.
Can school programs prevent stress-related vaping?
The mediation through susceptibility suggests programs that build commitment not to vape during stressful periods could interrupt the pathway from stress to substance use.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-06911APA
Lee, Ryan; Cho, Junhan; Bae, Dayoung; Albers, Larisa; Herzig, Shirin Emma; Ramirez, Carla Michelle; Carvajal, Alberto; Soto, Daniel; Unger, Jennifer B. (2025). Prospective associations of COVID-related stress with vaping nicotine and cannabis among high school students: Mediated by vaping susceptibility.. PloS one, 20(10), e0334159. https://doi.org/10.1371/journal.pone.0334159
MLA
Lee, Ryan, et al. "Prospective associations of COVID-related stress with vaping nicotine and cannabis among high school students: Mediated by vaping susceptibility.." PloS one, 2025. https://doi.org/10.1371/journal.pone.0334159
RethinkTHC
RethinkTHC Research Database. "Prospective associations of COVID-related stress with vaping..." RTHC-06911. Retrieved from https://rethinkthc.com/research/lee-2025-prospective-associations-of-covidrelated
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.