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TOPLINE:

In young adults, dual cannabis use (vaping and smoking) was associated with increased odds of respiratory symptom onset compared with no use.

METHODOLOGY:

• Researchers examined the longitudinal relationship between cannabis use and the development of respiratory symptoms in young adults in the US using data from two survey waves of the PATH Study.
• A total of 5211 young adults aged 18-24 years (49.7% female; 51.7% non-Hispanic White) who had no prior respiratory or pulmonary conditions in the March 2021-November 2021 survey wave and completed the January 2022-April 2023 survey wave were included.
• Participants were categorized on the basis of their self-reported cannabis use in the past 30 days: those who did not use (neither vaping nor smoking), those who only vaped, those who only smoked, and those who engaged in both vaping and smoking.
• The outcome measured was a change in the respiratory symptoms index score (range, 0-9), modified for adult use and validated, during the second survey wave (2022-2023), with a cutoff of at least 3 for functionally important respiratory symptoms.

TAKEAWAY:

• At baseline, 18.8% of young adults reported cannabis vaping or smoking in the past 30 days: 2.1% only vaped, 11.3% only smoked, and 5.3% both vaped and smoked.
• Compared with no cannabis vaping or smoking, cannabis smoking only was associated with increased odds of respiratory symptoms (adjusted odds ratio [aOR], 3.04; 95% CI, 1.64-5.64), whereas cannabis vaping only showed no significant association.
• Dual cannabis use (vaping and smoking) vs no use was associated with higher odds of respiratory symptoms (aOR, 4.36; 95% CI, 2.12-8.96).
• Among young adults who did not use combustible tobacco products or e-cigarettes at baseline, dual cannabis use (vaping and smoking) remained linked to increased odds of respiratory symptoms (aOR, 4.20; 95% CI, 2.03-8.70).

IN PRACTICE:

“Compared with no cannabis vaping or smoking, cannabis smoking only and cannabis vaping and smoking are associated with higher odds of developing functionally important respiratory symptoms, while cannabis vaping only is not. However, given the limitations noted, these findings must be considered preliminary,” the authors of the study wrote.

SOURCE:

The study was led by Ruoyan Sun, PhD, Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham. It was published online on May 15, 2026, in the American Journal of Preventive Medicine.

LIMITATIONS:

Cannabis use frequency was measured only for overall use and did not reflect use frequency by specific administration routes. The study relied on self-reported data, which may be subject to recall and reporting biases. The follow-up period between the survey waves was 1 year, and the longitudinal association might differ with a longer follow-up period.

DISCLOSURES:

No specific funding was received for the study. One author disclosed serving as a consultant for various companies and has been a paid expert in litigation against tobacco companies. Another author disclosed serving as a paid expert witness on behalf of public health authorities in response to legal challenges from the cannabis, tobacco, and vaping industries.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.