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Invited Commentary
Health Policy
April 6, 2020

Marijuana Legislation and Electronic Cigarette– or Vaping–Associated Lung Injury: A Historical Perspective

Author Affiliations
  • 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City
JAMA Netw Open. 2020;3(4):e202238. doi:10.1001/jamanetworkopen.2020.2238

In JAMA Network Open, Wing et al1 report an intriguing and insightful analysis of state-level incidences of electronic cigarette (e-cigarette)– or vaping–associated lung injury (EVALI), determined from case rates from the Centers for Disease Control and Prevention and Surveillance, Epidemiology, and End Results estimates of state populations. They found that the incidence of EVALI is lower in states that have legalized recreational marijuana and its active ingredient, tetrahydrocannabinol (THC), compared with states where it remains illegal or available only for medicinal uses. This finding withstood adjustment for variation in vaping rates among states. The cross-sectional nature of the analysis and inherent limitations of the available data mean that the ecological fallacy and other sources of confounding may be at play. In part because of its preliminary nature, interesting questions arise from the analysis, answers to which are likely to ultimately be found at the intersection of sociology, public health, and the law. It is illuminating to examine some of these questions through a wide historical lens.

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