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.
School health researchers, youth prevention specialists, and policymakers planning crisis-era youth programming.
COVID stress predicted cannabis vaping susceptibility (p=0.02)
What the researchers 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).
Why it 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 numbers in context
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 the study worked
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).
What this study cannot 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.
How to read the evidence
Prospective mediation design with temporal separation provides reasonable evidence for the pathway, though observational design limits causal claims.
When this study was published
2025 study tracking students from remote learning (2020-21) through 2022-23.
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.
Questions still open
- 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?
Common questions
Did the pandemic increase teen cannabis vaping?
Can school programs prevent stress-related vaping?
Read the original research
Prospective associations of COVID-related stress with vaping nicotine and cannabis among high school students: Mediated by vaping susceptibility.
PloS one, 20(10), e0334159
Citation
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
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