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States With Recreational Cannabis See a Rise in Adolescent Asthma


Secondhand cannabis smoke (SCS) may be contributing to an increase in asthma among children and teens in states where recreational cannabis is legal.

This story was corrected to reflect that prevalence is rising where recreational cannabis is legal.

The prevalence of asthma increased slightly among adolescents aged 12-17 years and among non-Hispanic minoritized race and ethnic groups in states where adult recreational cannabis use is legal, compared with states where recreational cannabis is illegal, according to a new study.

“Cannabis use is increasing among adults with children in the home, particularly in states which have legalized for medical or recreational use,” Renee D. Goodwin, PhD, adjunct professor in the Department of Epidemiology at Columbia Mailman School of Public Health, and professor at The City University of New York, said in a statement. “Exposure to secondhand smoke is a key risk factor for asthma among children. This study offers a critical first step in identifying a key children’s health concern emerging in the context of rapid, ongoing changes in cannabis policy that are unaccompanied by clinical or public health guidelines for parents.”

The results of this ecologic analysis were published in the journal Preventative Medicine.

Asthma affects approximately 5 million children and is the most common chronic condition affecting US youth. Using data from the 2011-2019 National Survey on Children’s Health, the researchers of this study measured the annual prevalence in pediatric asthma by the status of recreational cannabis legislation (RCL) or medical cannabis legalization (MCL) over time.

This sample included a total of 227,451 children living in the United States and between the ages of 0-17. Additionally, 59.6% of children identified as non-Hispanic White, 16.7% identified as Hispanic, 12.3% identified as non-Hispanic Black, and 11.3% of children were additional minorized race/ethnicity groups. Furthermore, 19.7% of children lived in a household with income below 100% federal poverty level, and 7.3% of children were without insurance coverage.

Despite an overall decrease (1.1%) in adolescent asthma between 2011-2012 and 2016-2017 (–0.94; P < .05), which remained stable thereafter (–0.18; P > .05), overall reductions in asthma were generally greater in states with no legislation on recreational cannabis or medical cannabis. However, the rate of decline between RCL and MCL with non-RCL and non-MCL states did not differ.

Relative to states where cannabis was fully illegal, the prevalence of asthma increased slightly among adolescents aged 12-17 years (2018-2019 difference-in-difference [DID] = 2.56; P = .028) and in some minoritized race/ethnicity groups (2016-2017 DID = 3.88; P = .013 and 2018-2019 DID = 4.45, P = .004) in states with RCL.

These findings align with a prior study by Goodwin, in which the highest prevalence of cannabis use was observed in parents with minor children in states with MCL (11.9%), followed by parents in states with RCL (9.5%), and the lowest prevalence seen in parents in states with no cannabis laws (6.1%).

The researchers attribute their findings to an increase in cannabis legalization, commercialization, and adult cannabis use that may be exposing secondhand cannabis smoke (SCS) to young children living in homes where cannabis is smoked. They advocate for further studies to better understand the potential impact of increased adult cannabis use on children, especially among minority populations and among those with asthma.

“While tremendous progress has been made in asthma management in concert with tobacco control over the past several decades, the possibility that increased adult cannabis use may pose new risks, requires more in-depth study and, in particular, to learn whether SCS is associated with increases in asthma morbidity, including symptom frequency, use of rescue medicines, impairment (including missed school days), and emergency medical services,” said Goodwin in the same statement.


Goodwin RD, Wyka K, Luo M, Weinberger AH, Kattan M. Cannabis legalization and childhood asthma in the United States: An ecologic analysis. Preventive Medicine. 2022:107414. doi:10.1016/j.ypmed.2022.107414

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