Assessing the Association Between Respiratory Symptoms and Nicotine and Cannabis Use Through Traditional and E-Product Devices in the U.S.

Introduction: The aim of this study was to assess the association between past 30-day cigarette smoking, nicotine use with an e-product device (e.g., vape), cannabis smoking, cannabis use with an e-product device, and other forms of cannabis use and past-year respiratory symptoms in a nationally representative sample of people aged ≥12 years in the U.S. during 2021. Methods: Data from Wave 6 (2021) of the Population Assessment of Tobacco and Health Study, a national probability sample of adolescents (aged 12-17 years; Results: The odds of a past-year respiratory index score of 2+ was greater among respondents who indicated either past 30-day cigarette or cannabis smoking than among respondents who did not use any nicotine or cannabis during the past 30 days. Past 30-day nicotine and cannabis use with an e-product device was not associated with a respiratory symptom index of 2+. The combination of past 30-day cigarette smoking and cannabis smoking had one of the strongest associations with experiencing a respiratory index score of 2+ among dual users of nicotine and cannabis. Conclusions: Past 30-day cigarette smoking and cannabis smoking were associated with higher odds of functionally important respiratory impairment. In addition, this study provides robust evidence regarding the potential respiratory harms of single or dual nicotine and cannabis smoking as it relates to respiratory health.