Vaping Cannabis, Nicotine, or Both: All Three Linked to Respiratory Symptoms in Young Adults | Research

The takeaway

Among 8,033 U.S. young adults, cannabis vaping was associated with wheezing and dry cough at similar rates to nicotine vaping — and dual vaping (both cannabis and nicotine) was associated with the widest range of respiratory symptoms.

Read this if you vape cannabis and assume it's harmless for your lungs — this nationally representative data shows otherwise, especially if you also vape nicotine.

What the researchers found

Vaping is often positioned as a safer alternative to smoking, but this large national survey reveals that vaping — whether nicotine, cannabis, or both — is associated with respiratory symptoms in young adults.

Among 8,033 Americans aged 18-24 surveyed in 2021, the breakdown was: 75.4% didn't vape, 15% vaped nicotine only, 4.7% vaped cannabis only, and 4.9% vaped both. All three vaping groups had more respiratory symptoms than non-vapers.

Cannabis-only vaping was associated with sounding wheezy (82% higher prevalence) and dry cough at night (61% higher). Nicotine-only vaping showed similar patterns: 75% higher prevalence of wheezing and 43% higher dry cough. The two were comparable in magnitude.

Dual vaping — both cannabis and nicotine — was the worst. It was associated with wheezing, dry cough, AND additional symptoms including wheezing/whistling and high overall respiratory symptom levels. The combined effect appeared to be more than additive, suggesting that dual vaping has a synergistic negative impact on respiratory health.

This is one of the first large studies to compare cannabis vaping, nicotine vaping, and dual vaping head-to-head for respiratory outcomes. The finding that cannabis vaping produces respiratory symptoms comparable to nicotine vaping challenges the assumption that cannabis vaping is benign for the lungs.

Why it matters

Cannabis vaping has exploded among young adults, partly because it's perceived as a harmless way to consume cannabis. This study directly challenges that perception with nationally representative data. The comparable respiratory symptom rates between cannabis and nicotine vaping, and the amplified symptoms from dual use, are findings that both public health messaging and individual decision-making need to incorporate.

The numbers in context

8,033 young adults (18-24). Cannabis-only vaping: 82% higher prevalence of wheezing (aPR=1.82), 61% higher dry cough (aPR=1.61). Nicotine-only vaping: 75% higher wheezing (aPR=1.75), 43% higher dry cough (aPR=1.43). Dual vaping: 124% higher wheezing (aPR=2.24), 50% higher dry cough (aPR=1.50), plus additional symptoms including wheezing/whistling (aPR=1.93).

How the study worked

Cross-sectional analysis of 8,033 U.S. young adults (ages 18-24) from a nationally representative survey conducted in 2021. Vaping categorized as: none, nicotine-only, cannabis-only, or dual. Multivariable logistic regressions assessed associations between vaping behavior and past 12-month respiratory outcomes, controlling for confounders.

Who was studied

N=8,033 young adults aged 18-24, 54% female, national survey in the US.

What this study cannot tell us

Cross-sectional design — respiratory symptoms and vaping are measured at the same time, so causation can't be established. Self-reported vaping and symptoms are subject to recall and reporting biases. No objective lung function testing (spirometry) — only subjective symptom reports. The survey can't distinguish between different vaping products, temperatures, or additives, which vary enormously. The 2021 survey period means EVALI awareness may have influenced both behavior and symptom reporting.

How to read the evidence

Large, nationally representative cross-sectional survey with appropriate multivariable adjustment. Strong for describing associations at the population level but cannot establish causation. Self-reported symptoms rather than objective lung function measures.

When this study was published

Published in 2024 with 2021 survey data. Cannabis vaping continues to grow among young adults.

The bigger picture

This study complicates the vaping harm reduction narrative from RTHC-00110 (marijuana and lung health, which suggested vaping reduces some smoking-related harms) and RTHC-00122 (route-specific cardiovascular/respiratory review). While vaping may produce fewer combustion byproducts than smoking, it's not symptom-free — especially for young adults whose lungs are still developing. The dual vaping finding adds a new dimension since many young cannabis users also vape nicotine.

Replication

Not stated in abstract.

Funding

Not reported in abstract.

Conflicts of interest

Not reported in abstract.

Questions still open

Do cannabis vaping respiratory symptoms progress to measurable lung function decline with long-term use? What specific components of cannabis vape aerosol are driving the symptoms — THC, carrier oils, additives, or something else? Would switching from dual vaping to cannabis-only or nicotine-only reduce the amplified symptom burden? Are the respiratory effects of cannabis vaping reversible with cessation?

Read the original research

Association of vaping with respiratory symptoms in U.S. young adults: Nicotine, cannabis, and dual vaping.

Preventive medicine, 189, 108175

Preventive Medicine is a reputable journal focusing on health promotion and disease prevention research.

View on PubMed ↗Publisher’s paper ↗

Citation

Sun, Ruoyan; Oates, Gabriela R. (2024). Association of vaping with respiratory symptoms in U.S. young adults: Nicotine, cannabis, and dual vaping.. Preventive medicine, 189, 108175. https://doi.org/10.1016/j.ypmed.2024.108175