Cannabis Vaping, Smoking, and Dual Use and the Onset of Respiratory Symptoms Among U.S. Young Adults.

Abstract

Many young adults vape and smoke cannabis, but it remains unclear whether dual use increases the risk of respiratory problems. This study analyzed the national longitudinal Population Assessment of Tobacco and Health Study. The sample included 5,211 young adults (aged 18-24 years) without prior respiratory or pulmonary conditions at Wave 6 who completed Wave 7. Multivariable logistic regressions examined longitudinal associations between baseline cannabis vaping and smoking and functionally important respiratory symptoms at follow-up, controlling for sociodemographics, other substance use, health conditions, obesity, and cannabis use frequency. Data were collected between 2021 and 2023 and analyzed in 2025. At baseline, 18.8% of young adults reported past 30-day cannabis vaping or smoking: 2.1% vaped only, 11.3% smoked only, and 5.3% both vaped and smoked. Overall, 2.3% reported the onset of respiratory symptoms at follow-up. Compared with no cannabis vaping or smoking, cannabis vaping only was not associated with respiratory symptoms (AOR=0.93, 95% CI=0.20, 4.43), whereas cannabis smoking only (AOR=3.04, 95% CI=1.64, 5.64) and dual vaping and smoking (AOR=4.36, 95% CI=2.12, 8.96) were associated with increased odds. Excluding young adults who used tobacco products at baseline, only dual vaping and smoking were associated with increased odds (AOR=4.20, 95% CI=2.03, 8.70). Young adults who smoke cannabis, particularly those who smoke and vape, have higher odds of developing functionally important respiratory symptoms. However, these findings must be considered preliminary. More detailed data on cannabis use patterns, products, and co-use with tobacco are needed to better understand these associations.