A Columbia University Mailman School of Public Health study of more than 50,000 U.S. adolescents indicates that vaping nicotine is strongly linked with an increased likelihood of high levels of binge drinking and cannabis usage. The findings add to growing public health concerns about the increased popularity of electronic cigarette –or ‘vaping’ — use among young people. The results are published in the peer-reviewed journal Substance Use and Misuse.(link is external and opens in a new window)

“While the overall health risks of vaping are lower than smoking, electronic cigarettes are still harmful to adolescents and warrant ongoing surveillance – especially as the long-term impacts remain unknown,” says lead author, Noah Kreski in the Department of Epidemiology at Columbia Mailman School. “Our results indicate that vaping is not an isolated behavior, but rather strongly tied to other substance use that can harm adolescents and make quitting nicotine more difficult. Recognizing the strong overlap between various forms of substance use, effective intervention efforts should work to simultaneously address vaping, drinking and cannabis use to encourage the health and well-being of young people.”

The researchers used the Monitoring the Future survey – conducted by the National Institute on Drug Abuse (NIDA) – to track trends in the use of cigarettes, alcohol, cannabis, vaping of both nicotine and cannabis, and other substances for children in school grades 8 (13-14 years old), 10 (15-16 years old) and 12 (17–18 years old).

The team examined data from 51,872 adolescents who took part in the survey between 2017 and 2019. They assessed the links between past 30-day nicotine use (non, smoking-only, vaping-only, and any smoking plus vaping) with past 30-day cannabis use – making adjustments to account for certain demographic factors, such as age, sex, race, parental education and urbanicity of the participants.

Looking at nicotine use and cannabis use — in any form, including vaping — they found that, compared to those who did not use nicotine at all, adolescents who:

• smoked were 8.03 times more likely to use cannabis.

• vaped were 20.31 times more likely to use cannabis.

• both smoked and vaped were 40.1 times more likely to use cannabis.

The researchers also found a link between past 30-day nicotine use and two-week binge drinking, even after adjustment. The association between smoking and vaping and binge drinking increased in magnitude at greater levels of binge drinking. For instance, compared to those who did not use nicotine at all, adolescents who both smoked and vaped were:

• 5.6 times more likely to have participated in binge drinking on one occasion.

• 21.60 times more likely to participated in binge drinking on three to five occasions.

• 36.53 times more likely to have participated in binge drinking on ten occasions or more.

“The links between vaping-only, or both smoking and vaping, and cannabis use and binge drinking outcomes in adolescents are particularly striking – especially at the highest levels of binge drinking. While the causal direction of these associations is unclear, the size of the effect is concerning given the harms these substances pose to adolescents,” adds Kreski, who is a data analyst at Columbia.

“Given the strong links between nicotine use and both cannabis use and binge drinking, there is a need for sustained interventions, advertising and promotion restrictions, and national public education efforts to reduce vaping in adolescents – efforts that acknowledge co-occurring substance use.”

Co-authors include Hadley Ankrume, Yale School of Public Health; Magdalena Cerdá, New York University School of Medicine; Qixuan Chenc, Deborah Hasin, Silvia Martins, Mark Olfson, and Katherine Keyes, Columbia Mailman School of Public Health.

The study was supported by National Institute on Drug Abuse, grants R01DA048853, R01DA037866, and R01DA048860.

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By Columbia Mailman School of Public Health

Substance abuse among U.S. adolescents is diminishing, except for an uptick in cannabis and vaping use, according to a new study by researchers at Columbia University Mailman School of Public Health. High levels of free social time, especially with low engagement in structured activities or low supervision, was linked to substance use. The results are published online in the journal Substance Use and Misuse.

Examining data from 536,291 adolescents between 1991 and 2019, a team of researchers suggests that while the reasons for this phenomenon are not entirely clear, they appear to correlate to several social factors. These include increased parental monitoring and decreased partying and dating notable among them.

According to lead author, Noah Kreski, MPH, in the Department of Epidemiology at Columbia Mailman School, several demographic factors seem to correlate to increased substance abuse even today.

“Substance use prevalence decreases across decades were largest for the groups defined by significant paid employment or high levels of social time, either with low engagement in other activities or lower levels of supervision, though these groups had the highest initial prevalence of each variety of substance use,” says Kreski.

Using data from the National Institute on Drug Abuse (NIDA)’s Monitoring the Future survey, the researchers tracked trends in use of cigarettes, alcohol, cannabis, vaping of both nicotine and cannabis, and other substances for school-age students in grades 8 (13-14 years old), 10 (15-16 years old) and 12 (17–18 years old), and cross-referenced these habits against demographic factors such as level of social engagement, participation in structured activities, level of adult supervision, and employment. They further analyzed these patterns across race, sex, parental education, along with other demographics.

Conversely, substance abuse was higher overall in the highly social and highly engaged groups with less supervision. Time at a paid job was also a significant factor in increasing the chances of trying illicit substances.

Cannabis use increased among all groups, but especially among adolescent workers. Nicotine vaping increased the most among the highly social and engaged group that was less supervised, and cannabis vaping increased most among social but disengaged teens.

“Social settings where adolescents interact with peers, at parties, for example, provide opportunities for substance use, especially in the absence of adult supervision,” Kreski says. “These social settings may produce peer pressure for adolescents to engage in substance use in order to fit in.”

This may be particularly true of employed adolescents, who regularly interact with older teens and adults. Employed adolescents often come from lower income brackets and are thus propelled into an early “pseudo-adulthood,” leading them to adopt the habits more typical of people older than they are. Further, cannabis users, in particular, appear to seek out other cannabis users, leading to social circles in which the drug plays a significant role. Vaping was similarly correlated to social influence.

Analyzing the data further, results show:
    • 15 percent of respondents reported any past two-week binge drinking
    • 27 percent drank alcohol in the past month
    • 15 percent of adolescents smoked cigarettes in the past month
    • 13 percent reported any past-month cannabis use
    •  9 percent reported past-month use of other substances
    • 12 percent reported nicotine vaping
    •  6 percent reported cannabis vaping from 2017 onward

In summary, Kreski noted: “Uncovering these links between complex patterns of time use and substance use outcomes could reveal new opportunities for intervention and education of adolescents surrounding substances, helping to promote declines in use. Taken together, while the prevalence of substance use varied drastically between the groups, the trends in substance use tended to be relatively consistent across groups. Further research is now needed to investigate the factors driving these universal trends in adolescent substance use.”

The authors suggest that a variety of peer-led and community-based programs may be effective in diminishing use across a broad spectrum of adolescent demographics. They urge further examination of mental health conditions that may lead to substance abuse.

Co-authors are Magdalena Cerdá, NYU Grossman School of Medicine; Qixuan Chen, Deborah Hasin, Silvia Martins, Pia Mauro, Mark Olfson, and Katherine Keyes, Columbia Mailman School of Public Health.

The study was supported by the National Institute on Drug Abuse (grant DA048853).

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LARGEST INCREASES FOUND AMONG HIGH-SCHOOL SENIORS, TRIPLING IN 2 YEARS FROM 5 TO 14 PERCENT

Cannabis vaping is increasing as the most popular method of cannabis delivery among all adolescents in the U.S., as is the frequency of cannabis vaping, according to research at Columbia University Mailman School of Public Health. The study found that the frequency of vaping cannabis among adolescents from all demographic groups is reported at six or more times per month, and rising faster than occasional use. Those who vape and smoke nicotine are more than 40 times more likely to also vape and smoke cannabis.

Until now time trends in vaping use had largely been unexamined including trends in use frequency, emerging disparities, and co-occurring use of other substances, which are all critical for surveillance and public health programmatic efforts. The findings are published in the journal Addiction.

“Heavy and frequent use of cannabis is increasing among U.S. adolescents, and vaped systems for products for both cannabis and nicotine are growing in number so understanding the prevalence and patterns of frequent cannabis vaping is important public health information for prevention,” said Katherine Keyes, PhD, professor of epidemiology at Columbia Mailman School. “Given rising concerns about cannabis vaping in terms of safety, and potential for transition to cannabis use disorder especially at frequent levels of use, these results indicate a necessity for public health intervention and increased regulation.”
 
The findings are based on the U.S.-based representative annual survey, Monitoring the Future, a population of 51,052 school-attending adolescents. Schools were randomly selected and invited to participate for two years.
 
Past 30-day frequent cannabis use with vaping increased (2.1 percent to 5.4 percent), while occasional use with vaping rose from 1.2 to 3.5 percent from 2017 to 2019.  Past 30-day frequent (3.8 to 2.1 percent) and occasional (6.9 to 4.4 percent) cannabis use without vaping declined. Certain groups, such as Hispanic/Latino or lower socioeconomic status adolescents, experienced particularly notable increases in frequent cannabis use with vaping (e.g., prevalence among Hispanic/Latino adolescents in 2017: 2.2 percent, 2019: 6.7 percent).
 
According to Keyes, tobacco use and e-cigarettes, as well as binge drinking, are strongly linked to frequent cannabis use –both vaping and non-vaping. The evidence indicates that young adults who use nicotine, especially through vaporizers, are more likely to subsequently use vaped cannabis.
 
In fact, adolescents who reported smoking and vaping nicotine on more than 10 occasions of binge drinking, were 42 times and 10 times more likely to report past 30-day cannabis use with vaping, respectively, compared to no use.
 
“Given that it is easier for adolescents to conceal vaping than cannabis smoking, this mode of cannabis use may facilitate more frequent use,” comments Keyes.
 
Prevalence increased across grades, with the largest burden among high school seniors for whom past-30-day prevalence almost tripled from 5 percent (2017) to 14 percent (2019). The one-year increase in this grade from 2018 to 2019 (7.5 percent to 14 percent) is the second largest one-year increase in any type of substance use prevalence ever tracked by Monitoring the Future.
 
“This persisting prevalence of daily cannabis use, which in 2020 use was higher than any year since 1981, is of further alarm for several reasons, observes Keyes. “Heavy levels of cannabis use are associated with adverse cognitive and social outcomes for youth, as well as long-term trajectories of drug use that may have adverse health and other consequences.”
 
Also concerning is that high levels of tetrahydrocannabinol (THC) can be delivered through vaping devices, which may lead to dangerous consequences for youth users with lower tolerance.
 
“In addition, of note, is the evidence that the increases we are seeing in vaping as compared with smoking are concentrated among non-Hispanic white and higher socioeconomic status adolescents, the latter possibly reflecting the higher price point for vaping devices compared with other administration methods, “noted Keyes.
 
“As cannabis legalization continues across U.S. states, and as products, delivery systems, potency and marketing proliferate within a for-profit industry, increased attention to youth trends, including investment in sustained and evidence-based prevention and intervention, is increasingly urgent.”

Co-authors are Noah Kreski, Hadley Ankrum, Deborah Hasin, Silvia Martins, Mark Olfson, and Qixuan Chen, Columbia Mailman School; Magdalena Cerdá, New York University Grossman School of Medicine; and Richard Miech, University of Michigan.

The study was supported by National Center for Injury Prevention and Control, grant R49-CE003094; National Institute on Drug Abuse, grants R01DA001411, R01DA016575, R01DA037866, R01DA048853, R01DA048860.

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Ending a tobacco addiction can be tough. While many smokers may think that e-cigarettes are a quit-smoking product, the American Lung Association is reminding people that e-cigarettes are a tobacco product and that switching to vaping is not the same as quitting.

The Food and Drug Administration (FDA) has not found any e-cigarette to be safe and effective in helping smokers quit. In one study, only 10.1 percent of the smokers who used e-cigarettes quit smoking after six months, while 26.6 percent of smokers who did not use e-cigarettes quit. Another study found 80 percent of the smokers given e-cigarettes did not quit, but switched, and instead became addicted to e-cigarettes, which produce a number of dangerous chemicals including acetaldehyde, acrolein, and formaldehyde, causing irreversible lung damage, lung diseases — and even death.

Advocates say that it’s critically important that the FDA crack down on these false claims, but in the meantime, those seeking to quit smoking should talk to their healthcare providers about developing a quit plan. To learn more about the American Lung Association’s Freedom From Smoking Plus program, visit lung.org/stop-smoking.

Deciding you want to quit smoking is the first step toward a healthier future. For the best possible chance of success in breaking your addiction for good, seek out methods with proven results.

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