Introduction
E-cigarette use may be associated prospectively with subsequent cannabis use among
U.S. adolescents. However, it remains unclear whether this association differs by
individual mental health status. This longitudinal study examines effect modifications
by mental health status.
Methods
The first 4 waves (2013–2017) of the Population Assessment of Tobacco and Health study
were analyzed in 2020. Adolescents (aged 12–17 years) who reported never using cannabis
at baseline waves were included. Waves 1–3 were each considered as baseline for their
12-month follow-up waves. Generalized estimating equations were used to evaluate the
effect modification of internalizing mental health and externalizing mental health
problems on the associations between baseline past 30–day e-cigarette use and past
30–day cannabis use at follow-up, controlling for individual characteristics and state
recreational cannabis laws.
Results
Baseline e-cigarette use was significantly associated with cannabis use at follow-up
(AOR=4.81, 95% CI=2.93, 7.90). Adolescents with high severity of internalizing mental
health/externalizing mental health problems were significantly more likely to initiate
cannabis use. However, current e-cigarette users who reported high severity of internalizing
mental health symptoms were less likely to initiate cannabis use (AOR=2.51, 95% CI=0.92,
6.83) than those who reported low severity of internalizing mental health problems
(AOR=8.84, 95% CI=4.19, 18.65). There were no differences by the severity of externalizing
mental health problems.
Conclusions
Baseline e-cigarette use and endorsement of severe internalizing mental health/externalizing
mental health problems were significantly associated with subsequent cannabis use
among U.S. adolescents. Efforts to reduce youth vaping and improve youth mental health
could help curb cannabis initiation. Tailored interventions may be warranted for e-cigarette‒using
adolescents with internalizing mental health problems.
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Article Info
Publication History
Published online: December 20, 2021
Identification
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© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
