Fewer teenagers in 2019 reported drinking alcohol, smoking cigarettes, and trying hard drugs, but the number of teens who reported vaping marijuana and nicotine rose, according to federal survey data as well as a study based on the data published recently in JAMA.

Resource guide: Medical marijuana in the health system

The findings come as state and federal officials have found both legal and illegal products containing the marijuana compound tetrahydrocannabinol (THC) are linked to a number of cases of a lung illness officials believes is linked to e-cigarette use and vaping, dubbed EVALI. CDC data shows the number of reported hospitalized cases of EVALI reached 2,409 as of Dec. 10. There have been 52 confirmed deaths related to EVALI as of Dec. 10, according to CDC. Cases of the illness have been reported in all 50 states, Washington, D.C., and two U.S. territories, with deaths confirmed in 26 states and the District of Columbia.

Study details

For the study, researchers from the University of Michigan analyzed data from National Institute on Drug Abuse's (NIDA's) Monitoring the Future survey, which measures drug and alcohol use among adolescents in 8th, 10th, and 12th grade.

Findings on vaping

According to the study, the percentage of teens reporting having used marijuana overall remained steady, but an increasing percentage of teens reported vaping marijuana, representing a shift away from smoking the substance.

The researchers found the percentage of adolescents who reported vaping marijuana increased from 2018 to 2019. According to the researchers, 14% of 12th graders—or 8,314—reported marijuana vaping in the 30 days leading up to the survey in 2019, up from 7.5%—or 4,247—who reported vaping marijuana in the 30 days leading up to the survey in 2018.

Similarly, the researchers found the percentage of 8th graders who reported vaping marijuana in the 30 days leading up to the survey increased from 2.6% in 2018 to 3.9% in 2019, and the percentage of 10th graders who reported vaping marijuana in the 30 days leading up to the survey increased from 7% in 2018 to 12.6% in 2019.

The researchers also found that the percentage of teens who reported vaping marijuana at least once during the 12 months leading up to the survey increased from:

• 4.4% in 2018 to 7% in 2019 among 8th graders;
• 12.4% in 2018 to 19.4% in 2019 among 10th graders; and
• 13.1% in 2018 to 20.8% in 2019 among 12th graders.

In addition, the researchers found that the percentage of 8th, 10th, and 12th graders who reported vaping marijuana at some point in their lifetimes increased from 2018 to 2019:

The researchers found that relatively low shares of teens reported vaping marijuana daily. According to the researchers:

• 0.8% of 8th graders reported vaping marijuana daily;
• 3% of 10th graders reported vaping marijuana daily; and
• 3.5% of 12th graders reported vaping marijuana daily.

The researchers found that larger shares of teens reported vaping nicotine than marijuana. Specifically, they noted that:

• 35% of 12th graders reported vaping nicotine in the 12 months leading up to the survey—up 5.6 percentage points from 2018;
• 31% of 10th graders reported vaping nicotine in the 12 months leading up to the survey; and
• 17% of 8th graders reported vaping nicotine in the 12 months leading up to the survey.

When the researchers asked respondents why they vaped:

• About 61% said they vaped to experiment;
• 42% said they enjoyed the flavors of vaping liquids;
• About 38% said they vaped to have a good time with friends; and
• About 37% said they vaped to relieve tension or relax.

Findings on other substances

Although the percentages of 8th, 10th, and 12th graders who reported vaping increased, the researchers found that the percentages of respondents who reported using other substances decreased.

For instance, the researchers found that the share of teens who reported using alcohol declined by 14 percentage points over the past five years, and the percentages of those who reported binge drinking alcohol during the year leading up to the survey fell from:

• 19% in 2014 to 14% in 2019 among 12th graders; and
• 12.6% in 2014 to 8.5% in 2019 among 10th graders.

The researchers also found declines in the shares of 8th, 10th, and 12th graders who reported smoking traditional cigarettes and misusing prescription painkillers. For example, the researchers found the percentage of 12th graders who reported smoking cigarettes daily fell from 3.6% in 2018 to 2.4% in 2019, and the percentage of 12th graders who reported misusing the opioid painkiller Oxycontin during the 30 days leading up to the survey decreased from 4% in 2002 to 1.7% in 2019. The researchers also found declines in reported use of amphetamines and smokeless tobacco.

Discussion

NIDA Director Nora Volkow said the increases in 8th, 10th, and 12th graders who reported vaping marijuana and nicotine in 2019 "is a very, very worrisome trend." Volkow said teens likely are "embracing [vaping] devices … because they are new technology." However, she said, "When you use marijuana regularly, your risk of becoming addicted is close to 50%, particularly if you're a young person."

But Volkow also said new vaping devices could be driving the declines in teens' use of other substances, because more teens are spending time vaping and communicating over social media than coming together to drink or use drugs.

Silvia Martins, an associate professor of epidemiology at the Columbia University Mailman School of Public Health, said the rise in the percentage of teens who reported vaping marijuana could be a result of increasing marijuana legalization, which can lead to more marketing of the substance and suggest the substance provides health benefits. Martins said the spike in marijuana vaping among teens "could be related to the fact it is seen as less harmful and less risky."

Neal Benowitz, a clinical pharmacologist and emeritus professor of medicine at the University of California-San Francisco, said, "Any marijuana use among kids is a bad idea," noting that research has shown marijuana affects memory and learning.

Still, Sion Kim Harris, a pediatrician and director for the Center for Adolescent Substance Abuse Research at Boston Children's Hospital, said the survey data showed some "encouraging trends," including the declines in reported alcohol and cigarette use.

Public health experts have attributed the declines in the percentages of adolescents who smoke cigarettes and use other substances to a number of efforts aimed at discouraging such use, including awareness campaigns, smoking bans, and stricter school penalties (O'Donnell, USA Today, 12/18; Bernstein, Washington Post, 12/18; Richtel, New York Times, 12/18; Owens, "Vitals," Axios, 12/18).