E-Cigarette Use Was Linked to Asthma in Adolescents, Independent of Marijuana and Cigarette Smoking

Cross-sectional survey administered in classrooms across 33 high schools statewide in Hawaii in 2015. Multinomial regression examined the association between e-cigarette use and asthma, controlling for cigarette smoking, marijuana use, and six demographic covariates.

E-cigarettes are frequently marketed as safer alternatives to smoking, including among adolescents. This study adds to growing evidence that e-cigarette aerosol may have significant respiratory health effects. The finding that marijuana was not independently associated with asthma after controlling for e-cigarette use provides context for understanding the relative respiratory risks of different inhalation methods.

This study is notable for what it found about marijuana: after accounting for e-cigarette use, marijuana was not independently associated with asthma in adolescents. This does not mean marijuana is safe for the lungs, but it suggests that in the current landscape of adolescent substance use, e-cigarettes may be a more significant respiratory concern.

Cross-sectional design cannot determine causation: teens with asthma might be more likely to use e-cigarettes (reverse causation) rather than e-cigarettes causing asthma. Self-reported data on both substance use and asthma diagnosis. Hawaii's multiethnic population may not be representative of the broader U.S. The study could not distinguish between nicotine and cannabis vaporizers.