More Than 2 Million High School Students Have Used Marijuana in an E-Cigarette Interview with:

Katrina Trivers, PhD, MSP Lead author and lead epidemiologist Office on Smoking and Health CDC

Dr. Trivers

Katrina Trivers, PhD, MSP
Lead author and lead epidemiologist
Office on Smoking and Health
CDC What is the background for this study?

Response: Although we’ve seen considerable declines in the use of regular cigarettes among U.S. youth over the past several decades, the tobacco product landscape is evolving, and the use of other tobacco products have become increasingly popular. For example, as of 2014, e-cigarettes have become the most commonly used tobacco product among US youth. During 2011-2015, e-cigarette use increased 900% among U.S. high school students before declining in 2016. No change was observed in 2017, with about 2 million youth, including 12% of high school students and 3% of middle school students, reporting they had used e-cigarettes in the past 30 days.

This is a public health concern because the use of any form of tobacco product is unsafe among youth, irrespective of whether it’s smoked, smokeless, or electronic. The U.S. Surgeon General has concluded that the aerosol emitted from e-cigarettes is not harmless. It can contain harmful ingredients, including nicotine, carbonyl compounds, and volatile organic compounds known to have adverse health effects. The nicotine in these products is of particular concern given that nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain.

In recent years, many youth have also been using other psychoactive substances in e-cigarettes, including cannabinoids and other illicit drugs. This could have been fueled, in part, by shifts in the social acceptability and access to cannabis as several states have or are considering legalized cannabis sales for adults. A previous CDC study found that in 2015, almost 1 in 3 students reported using e-cigarettes with non-nicotine substances. However, it wasn’t possible to identify what exactly those substances were based on the question. Given the high concurrent use of tobacco and other substances, including cannabis, a more detailed question was added to a future survey to assess the use of cannabis in e-cigarettes among U.S. youth. This study presents the findings from that question. What are the main findings?

Response: Nearly 1 in 11 US middle and high school students, including one-third of those who ever used e-cigarettes, used cannabis in an e-cigarette in 2016. That equates to more than 2 million youth who have ever used cannabis in an e-cigarette, including nearly 1 in 3 high school e-cigarette users and nearly 1 in 4 middle school e-cigarette users.

The use of cannabis in e-cigarettes was significantly higher among males than females and high school students than middle school students. Use was also higher among those who had used e-cigarettes more recently and more frequently, those who used other tobacco products and those who lived with someone who used tobacco products. A product that is often used by the younger generation is a dab pen. like an e-cigarette, it uses wax pen batteries to heat up liquids producing vapours. These devices are normally used with cannabis concentrates which can be a problem depending on which country you are living in!

These findings reinforce the importance of strategies to reduce all forms of e-cigarette use, including with cannabis, to protect our nation’s young people from this preventable health risk. E-cigarette use among youth is unsafe. The use of cannabis in e-cigarettes is of particular public health concern given that the National Academies of Science has found cannabis use among youth can adversely affect learning and memory and may impair later academic achievement and education. What should readers take away from your report?

Response: The bad news is that more than 2 million of our nation’s youth, including one-third of high school student e-cigarette users, have ever used cannabis in an e-cigarette. This is a public health concern because e-cigarette use among young people is unsafe. The use of marijuana in these products is of particular concern because cannabis use among youth can adversely affect learning and memory and may impair later academic achievement and education.

But the good news is that we know what works to effective reduce all forms of tobacco product use among youth, including e-cigarettes, and irrespective of whether those products contain cannabis. For example, we can continue to modernize our proven, evidence-based interventions to reduce e-cigarette use among youth. Actions could include incorporating e-cigarettes in smoke-free policies, and preventing access to e-cigarettes by youth.

Everyone can play a role in helping youth to recognize and avoid the dangers of e-cigarette use. Parents in particular can set a positive example by being tobacco-free, and ensuring that their kids aren’t exposed to the secondhand emissions from any tobacco products, including e-cigarettes. We know e-cigarettes are now the most commonly used tobacco product among youth and that many youth aren’t aware of the dangers of these products, including the negative impacts of nicotine exposure on the developing adolescent brain, as well as the negative impacts of marijuana on learning, memory, and later academic achievement. Therefore, ensuring that youth are aware of the risks of using all forms of tobacco products, including e-cigarettes, is critical. What recommendations do you have for future research as a result of this work?

Response: Given the continued popularity of e-cigarettes among youth and the variety of substances that can be used in e-cigarettes, it’s important to continue to monitor not only the use of e-cigarettes among U.S. youth, but also the diversity of substances they’re using in e-cigarettes. Further detail on why youth use these products, where youth access these products, and how frequently they use these products would also be beneficial, in addition to studying the extent to which the use of these products could lead to subsequent use of other substances. This type of research could help inform public health policy, planning, and practice aimed at addressing youth use of e-cigarettes, including the use of e-cigarettes with cannabis.


Ellerbeck EF, Nollen N, Hutcheson TD, et al. Effect of Long-term Nicotine Replacement Therapy vs Standard Smoking Cessation for Smokers With Chronic Lung DiseaseA Randomized Clinical Trial. JAMA Network Open.2018;1(5):e181843. doi:10.1001/jamanetworkopen.2018.1843

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Last Updated on September 17, 2018 by Marie Benz MD FAAD