The inverse association of state cannabis vaping prevalence with the e-cigarette or vaping product-use associated lung injury

PLoS One. 2022 Oct 17;17(10):e0276187. doi: 10.1371/journal.pone.0276187. eCollection 2022.

Abstract

The e-cigarette or vaping product-use-associated lung injury (EVALI) epidemic was primarily associated with the use of e-cigarettes containing tetrahydrocannabinol (THC)- the principal psychoactive substance in cannabis, and vitamin-E-acetate- an additive sometimes used in informally sourced THC-containing e-liquids. EVALI case burden varied across states, but it is unclear whether this was associated with state-level cannabis vaping prevalence. We, therefore, used linear regression models to assess the cross-sectional association between state-level cannabis vaping prevalence (obtained from the 2019 behavioral Risk Factor Surveillance System) and EVALI case burden (obtained from the Centers for Disease Control and Prevention) adjusted for state cannabis policies. Cannabis vaping prevalence ranged from 1.14%(95%CI, 0.61%-2.12%) in Wyoming to 3.11%(95%CI, 2.16%-4.44%) in New Hampshire. EVALI cases per million population ranged from 1.90(0.38-3.42) in Oklahoma to 59.10(19.70-96.53) in North Dakota. There was no significant positive association but an inverse association between state cannabis vaping prevalence and EVALI case burden (Coefficient, -18.6; 95%CI, -37.5-0.4; p-value, 0.05). Thus, state-level cannabis vaping prevalence was not positively associated with EVALI prevalence, suggesting that there may not be a simple direct link between state cannabis vaping prevalence and EVALI cases, but rather the relationship is likely more nuanced and possibly reflective of access to informal sources of THC-containing e-cigarettes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetates
  • Analgesics
  • Cannabinoid Receptor Agonists
  • Cannabis*
  • Cross-Sectional Studies
  • Dronabinol / adverse effects
  • Electronic Nicotine Delivery Systems*
  • Hallucinogens*
  • Humans
  • Lung Injury* / epidemiology
  • Lung Injury* / etiology
  • Vaping* / adverse effects
  • Vaping* / epidemiology
  • Vitamins

Substances

  • Acetates
  • Analgesics
  • Cannabinoid Receptor Agonists
  • Hallucinogens
  • Vitamins
  • Dronabinol

Grants and funding

Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number U54HL120163 (https://govtribe.com/award/federal-grant-award/cooperative-agreement-u54hl120163) granted to the American Heart Association Tobacco Regulation and Addiction Center. However, the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.