Estimates from Wave 4 are nationally representative of the US civilian, noninstitutionalized population. Additional information on the PATH Study sampling design, participant documentation, and data access can be found elsewhere . Respondents with missing data on nicotine and cannabis vaping indicators and covariates were excluded, resulting in a final analytic sample of 3795. This research is considered not regulated by the University of Michigan Institutional Review Board due to the use of de-identified, publicly available data. Our study found that more than half of adults who used EVPs indicated that they vaped nicotine only, while about a quarter vaped nicotine and cannabis, 14.6% vaped non-nicotine/non-cannabis e-liquid, and 7.4% vaped cannabis only. Results from our regression model indicated that nicotine and cannabis vaping patterns differed by age, race/ethnicity, sexual orientation, and educational attainment. Notably, young adults , Hispanic and NH Black adults, and LGB+ adults had higher odds of vaping either cannabis only, cannabis grow tent nicotine and cannabis, or non-nicotine/non-cannabis e-liquid compared to vaping nicotine only.
These findings collectively call for further investigation on the intersection of nicotine and cannabis vaping to better understand the population prevalence of use among adults. Most prior research on nicotine and cannabis vaping focuses on younger populations, with limited investigations of adult samples . One study found that the prevalence of cannabis vaping was more common among young adults aged 18–34 years compared to adults aged 50 years or older . In our study, young adults had greater odds of vaping cannabis only, vaping nicotine and cannabis together, and vaping non-nicotine/ non-cannabis e-liquid, compared to vaping nicotine only. In addition, adults aged 25–34 had greater odds of vaping nicotine and cannabis, compared to vaping nicotine only. These findings emphasize the importance of addressing not only nicotine vaping among younger adult populations, but also vaping other substances such as cannabis and perhaps additives that do not include nicotine or cannabis such as flavorings . Regarding differences by race/ethnicity, we found that Hispanic adults had greater odds of vaping cannabis only, nicotine and cannabis, and non-nicotine/non-cannabis e-liquid versus nicotine only vaping, while NH Black adults had greater odds of vaping cannabis only and non-nicotine/non-cannabis e-liquid versus nicotine only vaping, compared to their NH White counterparts.
These results suggest that Hispanic adults are not using EVPs to consume nicotine only, and an important subset of both Hispanic and NH Black adults may be using EVPs to consume cannabis alone. A recent study found that Hispanic and NH Black youth had the highest prevalence of cannabis use with EVPs compared to other racial/ethnic groups . Factors influencing cannabis vaping may include perceptions of harms or benefits relative to other modes of cannabis delivery, curiosity, grow lights for cannabis or patterns of nicotine use and cannabis smoking unique to certain racial/ ethnic groups. Furthermore, cannabis vaping may bypass the social consequences of cannabis smoking , which might contribute to the differences we observed in cannabis-only vaping by race/ethnicity. Research has found that potential health consequences of smoking/ vaping cannabis only may be unique from vaping nicotine and could therefore disproportionately impact these populations . However, further work that aims to clarify the health effects of vaping cannabis and smoking cannabis, separately, is needed, as studies have revealed that many people who vape cannabis also smoke cannabis . In addition, the finding that Hispanic and NH Black adults may be vaping non-nicotine/non-cannabis e-liquid more than their NH White counterparts suggests that these consumers may be seeking out vaping flavorings with low to no nicotine or THC content .
The possibility also exists that some adults who currently use EVPs are unaware of the substance contents in their EVPs , and the non-nicotine/non-cannabis e-liquid use group may be consuming nicotine and/or THC without realizing it. LGB+ adults had higher odds of vaping nicotine and cannabis relative to vaping nicotine only, compared to heterosexual adults. This finding is somewhat consistent with a previous study indicating that bisexual adults had higher odds of nicotine and cannabis consumption , compared to heterosexual adults . Our results, in conjunction with other studies, emphasize a need to address nicotine and cannabis vaping among LGB+ adults to prevent the potential joint health consequences of nicotine and cannabis intake and promote health equity within the LGBTQ community. While associations involving educational attainment and annual household income were limited, one study among a sample of young adults found that the prevalence of cannabis vaping was more common among respondents with high SES compared to respondents with low SES .