Adolescent Cannabis Vaping Doubled in 7 Years in US, Canada, Review Finds

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Multiple nationally representative surveys found that approximately 1 in 3 grade 12 students vaped cannabis in 2018 alone.

The prevalence of cannabis vaping has increased among adolescents in the United States and Canada from 2013 to 2020, according to a study published in JAMA Pediatrics.

Vaping products were originally designed as a substitute for tobacco cigarette. However, they are now a popular way to deliver psychoactive substances such as cannabis.

The systematic review and meta-analysis analyzed 17 studies from the United States and Canada published between 2015 and 2021, with survey years as early as 2013. A total of 198,845 adolescents were included, defined as children aged 18 years or younger or in grade school.

The review found that the lifetime prevalence of cannabis vaping doubled from 2013 to 2020 (6.1% to 13.6%). Additionally, 12-month prevalence of cannabis vaping doubled from 2017 to 2020 (7.2% to 13.2%) and 30-day prevalence increased 7-fold from 2013 to 2020 (1.6% to 8.4%).

“A possible explanation for the upward trajectory in the prevalence of cannabis vaping observed in our study timeframe is the increasing uptake of vaping products generally used among youth and young adults, widening access to cannabis vaping products through legalization of cannabis, and the decrease in perceived risk of harm toward cannabis in the last decade,” the authors said.

One study found that 70% of adolescents in grades 9 through 12 in Canada reported 2 or more routes of administration, with a substantial overlap between vaping cannabis and other routes of administration, especially smoking. The Healthy Kids Colorado Survey found that among adolescents who usually vaped, 54.6% also have smoked cannabis.

Multiple nationally representative surveys included in the review found that approximately 1 in 3 grade-12 students vaped cannabis in 2018 alone, showing a higher prevalence in this age group than younger groups. The review also suggested a shift in preference from dried herb to cannabis oil.

The authors cited cannabis potency as a potential factor in this shift, noting that products such as cannabis oil and concentrates typically contain a higher proportion of THC than herbal cannabis.


“The typical THC concentration sold in licensed retail stores for oils is approximately 70.3% compared with the 21.4% concentration in herbal cannabis,” they said. “The ready accessibility of non-age-restricted video tutorials on how to vape cannabis products may also facilitate adolescent experimentation with cannabis.”

The authors of the meta-analysis also suggested that more effective preventive and response measures are required to tackle this issue, noting that cannabis vaping is associated with a range of adverse health outcomes.

One study found the odds of respiratory symptoms such as wheezing and dry cough were nearly 2 times higher in adolescents aged between 12 and 17 who had vaped cannabis compared with those who had never used cannabis vape products (adjusted odds ratio, 1.81; 95% CI, 1.47-2.22). Another study showed that heavy cannabis use is associated with poorer cognitive development in adolescents.

“Because cannabis vaping is a relatively new phenomenon, little is known about its potential long-term harms to adolescents,” the authors said. “However, the regular use of cannabis is associated with a broad range of adverse health outcomes that may be more pronounced in those who initiate use in adolescence.”


Lim CCW, Sun T, Leung J, et al. Prevalence of adolescent cannabis vaping: a systematic review and meta-analysis of US and Canadian studies. JAMA Pediatr. Published online October 25, 2021. doi:10.1001/jamapediatrics.2021.4102