Teens in states with legal recreational cannabis were 45% more likely to start vaping it, with e-cigarette use being the strongest predictor
A nationally representative study of over 19,000 youth found that living in states with legal recreational cannabis was associated with 45% higher odds of starting cannabis vaping, while current e-cigarette use was linked to 8 times higher odds.
Quick Facts
What This Study Found
Youth in recreational cannabis states had 1.449 times the odds of initiating cannabis vaping compared to states where cannabis was illicit. Medical-only states showed a smaller but still significant increase (1.198x). The strongest predictor was e-cigarette use, which was associated with 8.07 times higher odds of cannabis vaping initiation. Comprehensive indoor vaping bans showed no significant effect.
Key Numbers
19,009 youth; 38,163 observations; ages 13-22; recreational states: OR 1.449 (95% CI: 1.285-1.635); medical states: OR 1.198 (95% CI: 1.006-1.427); e-cigarette use: OR 8.07 (95% CI: 7.170-9.072); indoor vaping bans: not significant
How They Did This
Prospective nationally representative cohort from the Population Assessment of Tobacco and Health (PATH) study, with 19,009 youth across 38,163 observations (ages 13-22). Event history analysis examined the role of state-level cannabis policies and indoor vaping bans on cannabis vaping initiation.
Why This Research Matters
Cannabis vaping among youth is a growing concern because vaping delivers concentrated forms that may pose unique risks to developing brains. Understanding what drives initiation can help target prevention efforts.
The Bigger Picture
This adds to the debate about legalization effects on youth use. While legalization was associated with increased cannabis vaping initiation, the much stronger link to e-cigarette use suggests that nicotine vaping may serve as a gateway specifically to cannabis vaping.
What This Study Doesn't Tell Us
Observational design cannot prove causation. Self-reported data may undercount use. State policies changed during the study period. Does not distinguish between THC and CBD vaping products.
Questions This Raises
- ?Would stricter age verification for vaping products reduce cannabis vaping initiation?
- ?Does the type of legal cannabis market (commercial vs. home grow) affect youth access differently?
- ?Are there specific features of e-cigarette use that facilitate transition to cannabis vaping?
Trust & Context
- Key Stat:
- E-cigarette use linked to 8x higher odds of starting cannabis vaping in youth
- Evidence Grade:
- Strong: large nationally representative prospective cohort with robust statistical controls and validated measures from the PATH study.
- Study Age:
- 2026 publication using PATH study data (ongoing longitudinal cohort).
- Original Title:
- Youth Initiation of Cannabis Vaping Is Associated With State Cannabis Policy and E-Cigarette Use.
- Published In:
- The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 78(1), 53-60 (2026)
- Authors:
- Vuolo, Mike(2), Orsini, Maria M, Staff, Jeremy, Maggs, Jennifer L, Kelly, Brian C
- Database ID:
- RTHC-08693
Evidence Hierarchy
Follows a group of people over time to track how outcomes develop.
What do these levels mean? →Frequently Asked Questions
Does cannabis legalization increase youth vaping?
This study found that youth in recreational cannabis states had 45% higher odds of initiating cannabis vaping compared to states where cannabis was illegal. Medical-only states also showed a smaller increase.
What is the biggest risk factor for teens starting cannabis vaping?
E-cigarette use was by far the strongest predictor, associated with over 8 times higher odds of cannabis vaping initiation, much stronger than any state policy variable.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-08693APA
Vuolo, Mike; Orsini, Maria M; Staff, Jeremy; Maggs, Jennifer L; Kelly, Brian C. (2026). Youth Initiation of Cannabis Vaping Is Associated With State Cannabis Policy and E-Cigarette Use.. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 78(1), 53-60. https://doi.org/10.1016/j.jadohealth.2025.03.016
MLA
Vuolo, Mike, et al. "Youth Initiation of Cannabis Vaping Is Associated With State Cannabis Policy and E-Cigarette Use.." The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2026. https://doi.org/10.1016/j.jadohealth.2025.03.016
RethinkTHC
RethinkTHC Research Database. "Youth Initiation of Cannabis Vaping Is Associated With State..." RTHC-08693. Retrieved from https://rethinkthc.com/research/vuolo-2026-youth-initiation-of-cannabis
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.