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Original Investigation
October 25, 2021

Prevalence of Adolescent Cannabis Vaping: A Systematic Review and Meta-analysis of US and Canadian Studies

Author Affiliations
  • 1National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
  • 2School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
  • 3National Health and Medical Research Council Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
  • 4Discipline of Psychiatry, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
  • 5Queensland Alliance for Environmental Health Sciences, The University of Queensland, St Lucia, Queensland, Australia
JAMA Pediatr. Published online October 25, 2021. doi:10.1001/jamapediatrics.2021.4102
Key Points

Question  What is the prevalence of adolescent cannabis vaping in the US and Canada?

Findings  This systematic review and meta-analysis reviewed 17 unique studies from the US and Canada, with a total of 198 845 adolescents, and found that the lifetime prevalence of cannabis vaping doubled from 2013 to 2020 (6.1% to 13.6%), past 12-month use doubled from 2017 to 2020 (7.2% to 13.2%), and the 30-day prevalence of cannabis vaping increased 7-fold from 2013 to 2020 (1.6% to 8.4%). Preference for cannabis products may be shifting from dried herb to cannabis oil.

Meaning  The findings of this study suggest that more effective prevention and response measures are required to mitigate the increasing prevalence of cannabis vaping among adolescents.

Abstract

Importance  Vaping products were initially designed to deliver nicotine as a tobacco cigarette substitute (eg, electronic cigarettes) but are now frequently used to deliver psychoactive substances, such as cannabis and its derivatives. Large, nationally representative surveys, such as Monitoring the Future, found that approximately 1 in 3 grade-12 students vaped cannabis in 2018 alone.

Objective  To summarize the findings of epidemiological studies that reported the global prevalence of cannabis vaping in adolescents by survey year and school grades.

Data Sources  PubMed, PsycINFO, Scopus, and Web of Science were searched systematically on August 19, 2020, for studies published globally between January 1, 2003, and August 19, 2020.

Study Selection  Publications that reported the prevalence of cannabis vaping in adolescents in the general population were included.

Data Extraction and Synthesis  Study characteristics and prevalence estimates were extracted from each article. Random-effects meta-analysis based on the DerSimonian and Laird method and meta-regression were performed on lifetime, 12-month, and 30-day prevalence estimates. Meta-regression was also conducted using survey year and school grades as moderators.

Main Outcomes and Measures  Prevalence of cannabis vaping.

Results  Seventeen studies met the eligibility criteria (n = 198 845 adolescents). Although no restrictions were imposed on study location, all 17 studies were from the US and Canada. Across all school grades, the pooled prevalence increased for lifetime use (6.1% in 2013-2016 to 13.6% in 2019-2020), use in the past 12 months (7.2% in 2017-2018 to 13.2% in 2019-2020), and use in the past 30 days (1.6% in 2013-2016 to 8.4% in 2019-2020). Heterogeneity across studies was large. The limited evidence from studies using similar survey and study designs suggested that adolescents’ preference for cannabis products other than dried herbs, which usually contain higher Δ9-tetrahydrocannabinol levels, may have shifted over time.

Conclusions and Relevance  The findings of this study suggest that the prevalence of cannabis vaping has increased among adolescents in the US and Canada and that more effective preventive and response measures are required.

Trial Registration  PROSPERO Identifier: CRD42020219644

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