Racial and Ethnic Differences in Marijuana Use in e-Cigarettes Among US Youth in 2017, 2018, and 2020

Marijuana use in e-cigarettes increased among US adolescents during 2017 to 2018.¹ States are increasingly legalizing adult marijuana sales, which could affect ease of access, social acceptance, and youth marijuana use. Marijuana use during adolescence is associated with decline in memory, attention, and learning.² Differences in use by racial and ethnic groups in adults have been reported,³ but little is known about differences among youth. Identifying differences in marijuana use in e-cigarettes by racial and ethnic groups opens avenues for targeted interventions. This study reports the prevalence of ever use of marijuana in e-cigarettes among US youth in 2020 and changes in prevalence from 2017 to 2020 by racial and ethnic groups.

Self-reported data were collected from the 2017, 2018, and 2020 National Youth Tobacco Surveys (NYTS), annual cross-sectional surveys administered to students in grades 6 to 12 attending public and private schools.⁴ NYTS was paper based in 2017 (N = 20 675; response rate = 71.6%) and 2018 (N = 20 189; response rate = 68.2%) and administered electronically in 2020 (N = 14 531; response rate = 43.6%). Marijuana use in e-cigarettes was not queried in 2019. Persons who ever used marijuana in e-cigarettes responded yes to the question, “Have you ever used marijuana, marijuana concentrates, marijuana waxes, THC [tetrahydrocannabinol], or hash oils in an e-cigarette?” (2017 and 2018) or “Have you ever vaped marijuana or cannabis (including concentrates, waxes, or hash oils)?” (2020). NYTS data collection was approved by the US Centers for Disease Control and Prevention institutional review board. Participation in NYTS was voluntary; written parental consent and student assent were required for NYTS participation.

Weighted analyses provided national estimates and accounted for the complex sampling design. Using 2020 data, correlates of use assessed included sex, race and ethnicity, school level, current (past 30-day) e-cigarette use, and frequency of e-cigarette use. Statistical significance (P < .05) of differences in estimates within years and between years (2020 vs 2017) and by covariates were determined using pairwise t tests. There were 365 students excluded owing to missing self-reported race/ethnicity. Analyses were conducted using SAS-Callable SUDAAN version 11.0.3 (SAS Institute).

In 2020, 19.5% (weighted) of students (2485 of 13 719) reported ever using marijuana in an e-cigarette (vs 11.1% [1975 of 16 872] in 2017; P < .001), including 68% (1119 of 1685) of those who currently used e-cigarettes. There were significant differences among racial and ethnic groups (Table), with Hispanic youths having the highest prevalence (921 of 4078 [25.6%]), compared with non-Hispanic Black youths (241 of 1475 [19.4%]) and non-Hispanic White youths (1201 of 6776 [18.2%]). All racial and ethnic groups had statistically significant increases from 2017 to 2020, with Hispanic youths having the highest percent point change (14.1% to 25.6% [11.6%]) (Figure). Non-Hispanic Black youths showed an increase in use from 2018 to 2020.

In 2020, 1 in 5 US middle and high school students (5.1 million), including 7 in 10 who currently used e-cigarettes (2.3 million), reported ever using marijuana in e-cigarettes. Increases in use occurred among all racial and ethnic groups from 2017 to 2020, with Hispanic youths having the highest prevalence and largest percent increase, followed by non-Hispanic Black youths. Further research is needed to assess why differences in marijuana use in e-cigarettes exist (eg, differences in harm perceptions and/or curiosity).

These findings are subject to limitations. Differences in question wording and mode of survey administration between years may limit comparisons. The term electronic cigarette may not have resonated with marijuana users.⁵ Additionally, ever use was queried; estimates could reflect 1-time use or experimentation. Future research could address whether observed differences exist based on current use or by frequency of use. e-Cigarette use among youth and young adults is unsafe, regardless of the substances used in these products, including marijuana.^1,2 Initiating marijuana use at younger ages can lead to higher risks of more problematic use later in life.⁶ Evidence-based strategies to reduce marijuana use in e-cigarettes are important for protecting young people from these health risks.

Corresponding Author: Christina V. Watson, DrPH, MPH, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S107-7, Atlanta, GA 30341 (bsu8@cdc.gov).

Accepted for Publication: February 10, 2021.

Published Online: April 26, 2021. doi:10.1001/jamapediatrics.2021.0305

Author Contributions: Dr Watson had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Watson, Trivers.

Acquisition, analysis, or interpretation of data: Puvanesarajah, Trivers.

Drafting of the manuscript: Watson.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Puvanesarajah.

Administrative, technical, or material support: Watson.

Supervision: Watson, Trivers.

Conflict of Interest Disclosures: None reported.

Funding/Support: The National Youth Tobacco Survey data collection was funded by the US Food and Drug Administration and the US Centers for Disease Control and Prevention.

Role of the Funder/Sponsor: The US Centers for Disease Control and Prevention participated in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript. The study sponsors were involved in the decision to submit the manuscript for publication but did not control the decision regarding to which journal the manuscript was submitted.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.