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

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.

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.

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.

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.