Cannabis, Vaping, and Respiratory Symptoms in a Probability Sample of U.S. Youth

Published:March 03, 2021DOI:



The purpose of this study was to explore the association between respiratory symptoms among U.S. adolescents who were current (past 30-day) users of cigarettes, e-cigarettes, and/or cannabis, as well as lifetime users of cannabis with electronic nicotine delivery systems (ENDS).


Wave 4 from a national probability sample (N = 14,798) of adolescents (12–17 years) using Population Assessment of Tobacco and Health Study data was used for this study. Retention rate was 88.4%.


The odds of indicating “wheezing or whistling” in the chest were roughly two times higher among those who had used cannabis in ENDS (adjusted odds ratio 1.81, 95% confidence interval 1.47–2.22); neither e-cigarettes nor cigarettes had a significant association with all five respiratory symptoms in the fully adjusted models.


This study provides preliminary evidence that adolescents’ cannabis use with ENDS may have negative health consequences. Lifetime cannabis use with ENDS was substantially associated with higher odds of respiratory symptoms.

Update: Product, Substance-Use, and Demographic Characteristics of Hospitalized Patients in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States, August 2019–January 2020

Weekly / January 17, 2020 / 69(2);44–49

On January 14, 2020, this report was posted online as an MMWR Early Release.

Although most EVALI cases have been associated with use of informally sourced THC-containing products, 16% of patients reporting use of THC-containing products reported acquiring them only from commercial sources. Even in states where marijuana has been legalized for recreational use by adults, it might be difficult to determine whether a source is licensed through the state. For example, in California, the Bureau of Cannabis Control seized nearly 10,000 illegal vape pens from unlicensed retailers during December 10–12, 2019.** The high prevalence of informally sourced THC-containing products among EVALI patients reinforces current recommendations to not use THC-containing e-cigarette, or vaping, products, particularly those acquired from informal sources.