Tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, product use behaviors among adults after the onset of the 2019 outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI)

Tetrahydrocannabinol (THC)-containing e-cigarette, or vaping,

product use behaviors among adults after the onset of the 2019

outbreak of E-cigarette, or Vaping, Product Use-Associated Lung

Injury (EVALI)

Katrina F. Trivers

, Christina V. Watson

, Linda J. Neff

, Christopher M. Jones

, Karen

Hacker

Office on Smoking and Health, National Center for Chronic Disease Prevention and Health

Promotion, CDC

National Center for Injury Prevention and Control, CDC

National Center for Chronic Disease Prevention and Health Promotion, CDC

Abstract

Introduction—During the E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI)

outbreak, patient data on tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, product

(EVP) use was collected, but data on non-affected adult product use after the onset of the EVALI

outbreak is limited. This study describes adult THC-EVP use after EVALI began.

Methods—THC-EVP use data came from an 18-state web-based panel survey of adult THC- and

nicotine-containing EVP users conducted February 2020. Unweighted descriptive statistics were

calculated; logistic regression assessed correlates of use.

Results: Among 3,980 THC-EVP users, 23.5% used THC-EVPs daily. Common brands of

THC-EVPs used were Dank Vapes (47.7%) and Golden Gorilla (38.7%). Reported substances

used included THC oils (69.6%), marijuana herb (63.6%) and THC concentrate (46.4%). Access

sources included: recreational dispensaries (41.1%), friend/family member (38.6%) and illicit

dealers (15.1%). Respondents aged 45–64 years had lower odds for daily use compared with those

aged 25–34 years (aOR = 0.73; 95% CI = 0.60, 0.90). Compared with White respondents, Asian

respondents had lower odds (aOR = 0.55; 95% CI = 0.36, 0.84) and Black respondents higher odds

(aOR = 1.48; 95% CI = 1.17, 1.86) of daily use. Respondents odds of daily use and accessing

THC-EVPs through commercial sources were higher among states with legalized nonmedical

adult marijuana use compared to states without.

Corresponding author: Katrina F. Trivers, PhD, MSPH Office on Smoking and Health, National Center for Chronic Disease

Prevention and Health Promotion, CDC, 4770 Buford Highway, MS S107-7, Atlanta, GA 30341, [email protected], 404-498-6861.

Publisher's Disclaimer: Disclaimer:

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the

Centers for Disease Control and Prevention. Use of trade names and commercial sources is for identification only and does not imply

endorsement by the U.S. Department of Health and Human Services.

Disclosure: The authors have nothing to disclose.

HHS Public Access

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Addict Behav

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Published in final edited form as:

Addict Behav

. 2021 October ; 121: 106990. doi:10.1016/j.addbeh.2021.106990.

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Conclusions—Almost half of respondents reported daily or weekly THC-EVP use, and

accessed products through both informal and formal sources, even after EVALI began. Given

the potential for future EVALI-like conditions to occur, it is important to monitor the use of

THC-EVPs and ensure effective education activities about associated risk.

Keywords

electronic cigarettes; e-cigarettes; marijuana; vaping; EVALI

1. Introduction

Beginning August 2019, the Centers for Disease Control and Prevention (CDC), the U.S.

Food and Drug Administration (FDA), state and local health departments, and other public

health stakeholders investigated a national outbreak of e-cigarette, or vaping, product use–

associated lung injury (EVALI).(Krishnasamy et al., 2020) As of February 18, 2020, over

2,807 hospitalized EVALI patients and nearly 70 deaths were reported to CDC. Among

EVALI patients with substance use information (as of January 14, 2020), 82% reported

using tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, products (EVPs) in

the 3 months before symptom onset (Krishnasamy et al., 2020). In addition, most EVALI

patients (as of January 7, 2020) who used THC-containing EVPs (74%) reported daily use,

and 78% reported obtaining their THC-containing products from informal sources such as

friends, family, and in-person or online dealers (Ellington et al., 2020). Further, among

EVALI patients who reported information on the specific brands of THC-containing EVPs

they used, Dank Vapes, a class of largely counterfeit THC-containing products (counterfeit

in this case means of unknown origins, with common packaging that is easily available

online and no clear centralized production or distribution) were the most commonly reported

products used.(Ghinai et al., 2019; Lozier et al., 2019) Vitamin E acetate, an additive in

some THC-containing EVPs, was strongly linked to the EVALI outbreak (Blount et al.,

2020).

Almost 15% of middle and high school students reported ever using marijuana in an

e-cigarette in 2018 (Dai, 2020), and approximately 4%, 13%, and 14% of 8

, 10

, and 12

graders, respectively, reported vaping marijuana during the past 30-days (Miech, Patrick,

O’Malley, Johnston, & Bachman, 2020). Data are available on use of THC-containing

EVPs among youth (Dai, 2020; Miech et al., 2020; Trivers, Phillips, Gentzke, Tynan,

& Neff, 2018), but data on the use of THC-containing EVPs among adults are limited

(Baldassarri, Camenga, Fiellin, & Friedman, 2020; Morean, Lipshie, Josephson, & Foster,

2017; Schauer, King, Bunnell, Promoff, & McAfee, 2016; Trivers et al., 2019). Particularly

lacking is detailed information about adult behaviors and usage patterns (e.g. brands and

device types used, frequency of use, access source), correlates of THC-containing EVP use,

and whether there are differences by state-level marijuana legalization status. One study

found that, in 2017, approximately 18% of current (past-30 day) adult EVP users reported

past-year marijuana use in their EVP (Trivers et al., 2019), and another study observed that

among adults who self-reported any marijuana use in 2017 and 2018, almost 11% reported

vaping as their main mode of use (Baldassarri et al., 2020). Unlike EVALI, where patient

data on THC-containing EVP use and use behaviors was collected and reported, data on

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non-affected adult product use and behaviors after the onset of the EVALI outbreak is

limited

As of the first quarter of 2020 when the survey was fielded, non-medical marijuana use was

legal in 11 states and the District of Columbia for adults aged 21 years or older (NORML),

representing over a quarter of the population of the United States, and 33 states and the

District of Columbia had legalized marijuana use for medical purposes (NORML). As

additional states consider legalizing the sale of marijuana, shifts in acceptability, availability,

and use of marijuana continues to occur.

There is some evidence to support that cannabis or cannabinoids are effective in the

treatment of chronic pain among adults, as antiemetics in the treatment of chemotherapy-

induced nausea and vomiting, and for improving patient-reported spasticity symptoms from

multiple sclerosis (National Academies of Sciences Engineering and Medicine, 2017).

Harmful health consequences associated with marijuana use include: increased risk of

respiratory problems; declines in memory, attention, and learning; increased occurrence of

schizophrenia and other psychoses; increased dependence on cannabis and other substances;

and increased risk of low birth weight among babies exposed

in utero

(National Academies

of Sciences Engineering and Medicine, 2017). The marijuana product landscape includes

a variety of modes of use (e.g. smoked, aerosolized, edibles) and products which vary in

THC potency. For example, aerosolized marijuana often uses concentrates that can contain

substantially higher THC levels than levels found in dried marijuana plant material (Al-

Zouabi, Stogner, Miller, & Lane, 2018; Aston, Farris, Metrik, & Rosen, 2019; Murray,

Quigley, Quattrone, Englund, & Di Forti, 2016). Given the ongoing scientific debate

about the risks and potential benefits of marijuana use (National Academies of Sciences

Engineering and Medicine, 2017), the rapid emergence of the EVALI outbreak in 2019, and

the continuously evolving marijuana product landscape (Al-Zouabi et al., 2018; Aston et al.,

2019; Murray et al., 2016), there is a need for timely surveillance of THC-containing EVP

use behaviors. This study describes THC-containing EVP use behaviors among adults after

the onset of the 2019 – 2020 outbreak of EVALI.

2. Methods

2.1. Data Source

Data on self-reported THC-containing EVP use behaviors among adults (aged ≥18 years)

are from a web-based panel survey conducted from February 25, 2020 and February 29,

2020. Respondents (n = 3,980) were selected from the US YouGov panel, a proprietary

opt-in internet panel survey of 1.8 million U.S. residents. U.S. YouGov panel members

are recruited through several methods to help ensure diversity in the panel composition,

including web advertising campaigns, partner sponsored solicitations, telephone to web

recruitment, mail to web recruitment, and traffic to the YouGov website for polling content.

YouGov survey respondents are not paid to join the panel but they receive incentives through

a points-based loyalty program for taking individual surveys (Ashley Grosse, YouGov,

personal communication, September 24, 2020).

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The inclusion criteria for the THC-containing EVP survey were: (1) aged ≥18 years; (2)

used nicotine-containing and marijuana or THC-containing EVP, or reported dabbing, (i.e.,

using a highly concentrated form of THC) in the past 3 months; (3) no diagnosis of

probable or confirmed EVALI in the past year; and (4) resident of 1 of 18 selected states

(California, Colorado, Florida, Illinois, Michigan, Minnesota, New Jersey, New York, North

Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Tennessee, Texas, Utah, Washington,

and Wisconsin). States were selected to capture geographic diversity, burden of EVALI

patients (CDC) and status of THC/marijuana legalization (National Conference of State

Legislators) (medical only use legalized, medical and non-medical use legalized, and not

legalized).

To protect the privacy of respondents’ and to ensure non-disclosure of reported information,

the THC-containing EVP survey and the associated data were protected by an Assurance of

Confidentiality stating that the information obtained will be held in strict confidence, will be

used only for the purposes stated, and will not otherwise be disclosed or released without the

individual’s consent. This work was determined to be public health practice by CDC during

human subjects review.

2.2. Measures

Survey questions primarily focused on the use of THC-containing EVPs in the 3 months

before the survey; most response options were ‘select all that apply’, therefore, percentages

could add up to more than 100%. Questions included “Which THC substance(s) did you use

in an e-cigarette, vaping device, vaporizer, or dab rig in the past 3 months? (Answer choices

were: Marijuana herb (flower or leaves),THC oils, Butane hash oil, THC concentrate (e.g.,

wax, badder/budder, crumble, shatter, pull and snap), THC powder form (e.g., dry sift), or

Other); “What type of device(s) did you use to vape or dab THC-containing products in

the past 3 months?” (Answer choices were: Disposable e-cigarette or vape, E-cigarette or

vape with prefilled cartridges, E-cigarette or vape with a tank that you refill with liquids

(including sub-ohm, mod or modifiable systems), E-cigarette or vape with prefilled or

refillable “pods” or pod cartridges (e.g. JUUL, Suorin), Dab rig, Vaporizer (for dry herbs,

etc.), Other); and “What brand of THC-containing cartridge(s) were used with device(s)”?

(Answer choices were: Rove, Dank Vapes, Golden Gorilla, Smart Cart, other).

Sources for THC-containing EVPs were assessed by the following question “Where did

you obtain these THC-containing products? (Answer choices were: Medical dispensary,

Recreational dispensary (retail cannabis/marijuana shop), Vape or smoke shop, Pop-up shop,

Grocery store/Drug store/Convenience store, Family or friend, Illicit dealer, Online, Other).

“Informal” sources include accessing from a family member or friend, illicit dealer, or

online. All others were categorized as ‘commercial’ sources.

Frequency of THC EVP use was determined by the following question: “Approximately

how frequently did you vape THC-containing products in the past 3 months?” (Answer

choices were: Monthly or less, a few days per month, a few days per week, daily) and length

of time using THC-containing EVPs was assessed with the following question :“How long

have you been vaping or dabbing THC-containing products?” (Answer choices were:< 3

months, 3–6 months, 7–12 months, >1 year).

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Basic demographic characteristics were also assessed on the survey including sex (male or

female), age (subsequently grouped into 18–24, 25–34, 35–44, 45–64, and 65–86 years), and

race or ethnicity (“What racial or ethnic group best describes you”; answer choices were:

White, Black, Hispanic, Asian, Native American, Mixed, Other or Middle Eastern). Racial/

ethnic categories were mutually exclusive and were collapsed into the following groups

(White, Black, Hispanic, Asian, and ‘other’ which included all other categories).

2.3. Statistical Analysis

Descriptive statistics of the sample were calculated. Prevalence was calculated, along with

95% confidence intervals (CIs) for the THC-containing EVP use behaviors assessed in the

survey. A dichotomous “daily THC-containing product use” variable was created by using

responses to the THC-containing EVP frequency of use question. Respondents who selected

“a few days per week,” “a few days per month,” and “monthly or less” were classified as

non-daily users.

Multivariable logistic regression was used to examine the association between demographic

characteristics and daily versus non-daily THC-containing EVP use. Multivariable logistic

regression, adjusting for age, race or ethnicity, and sex, was used to examine the association

between specifics of THC-containing EVP use behaviors and living in a state with

legalized adult nonmedical marijuana use (i.e., state-wide law allows for personal possession

and consumption of marijuana for all adults; California, Colorado, Illinois, Michigan,

Oregon, Washington) versus living in a state without legalized adult nonmedical marijuana

use (Florida, Minnesota, New Jersey, New York, North Carolina, North Dakota, Ohio,

Pennsylvania, Tennessee, Texas, Utah, Wisconsin). Because the response options were

select all that apply, separate multivariable logistic regression models were run for each

response option comparing yes to no responses (e.g., respondents reporting yes to the use

of disposable EVPs versus those who did not report such use). Results for the multivariable

logistic regression models are presented as adjusted odds ratios (aOR) and associated 95%

CIs. Unweighted data are analyzed and reported because the sampling frame only included

selected states and is not representative of state or national populations. Analyses were

conducted using SAS 9.4 (Cary, NC).

3. Results

3.1. Descriptive Findings

Among the 3,980 adult respondents, 53.5% were female and the median age was 36 years

(range 19 – 86 years). Of respondents, 71% identified as White, 11.0% Hispanic, 10.0%

Black, 4.4% Asian, and 3.7% all other groups (Table 1).

Among respondents (Table 2), 53.1% used prefilled cartridge-based THC-containing EVPs,

37.9% used a tank system, 33.2% used disposable EVPs, and 32.7% used prefilled or

refillable pods or pod cartridges in the past 3 months (Table 2). Less than 25% of

respondents reported using dab rigs or vaporizers. The most common brand of THC-

containing cartridge used was Dank Vapes (47.7%), followed by Golden Gorilla (38.7%),

Smart Cart (21.8%), and Rove (20.1%). Nineteen percent of respondents reported using

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other brands. The most reported type of THC-based substance used in THC-containing

EVPs was THC oils (69.6%), followed by marijuana herb (63.6%), THC concentrate

(46.4%), butane hash oils (14.2%), and THC powder (11.6%).

Respondents reported obtaining their THC-containing EVPs from a variety of sources

including, a recreational dispensary (41.1%), a friend or family member (38.6%), vape/

smoke shop (38.4%), medical dispensary (25.5%), an illicit dealer (15.1%), grocery, drug or

convenience store (9.0%), and online (7.4%).

Almost one-fourth (23.5%) of respondents used THC-containing EVPs daily, 23.0% weekly,

18.6% a few days per month, and 34.7% monthly or less. Most users (67.7%) reported using

THC-containing EVPs 0–5 times per day, 13.7% reported 6–10 times per day, and 18.6%

used over 10 times per day on the days they used THC-containing EVPs. Approximately

41% of respondents reported using THC-containing EVPs for more than a year, 19.2% for

7–12 months, 24.6% for 3–6 months, and 15.5% had been using for less than 3 months.

3.2. Multivariable Findings

After adjustment for gender, race or ethnicity, and state nonmedical marijuana legalization

status, respondents aged 45–86 years had lower adjusted odds of reporting daily use

compared to those aged 25–34 years (aOR = 0.74; 95% CI = 0.61, 0.90) (Table 3).

Compared to White respondents, Asian respondents had lower adjusted (for age, gender,

state nonmedical marijuana legalization status) odds [aOR =0.55; 95% CI = 0.36, 0.84) of

reporting daily THC-containing EVP use. Black or other respondents had higher adjusted

odds of reporting THC-containing EVP use daily (Black respondents aOR = 1.48; 95% CI

= 1.17, 1.86; other respondents, aOR = 1.51; 95% CI= 1.05, 2.17). Those living in legalized

nonmedical marijuana states had higher adjusted (for age, gender, race/ethnicity) odds of

using THC-containing EVPs daily than those living in non-legalized marijuana states (aOR

= 1.18; 95% CI = 1.01, 1.37). No other significant differences were observed among the

assessed groups.

After adjusting for age, race or ethnicity, and sex, adults reporting THC-containing EVP

use via a disposable device, a dab rib, or a vaporizer had higher adjusted odds of living

in a legalized nonmedical marijuana state (aOR for disposable device = 1.16; 95% CI =

1.01, 1.32; aOR for dab rig = 1.39; 95% CI = 1.18, 1.62; aOR for vaporizer = 1.21; 95%

CI = 1.04, 1.42) compared to those not using those particular devices (Table 4). Further,

those reporting using marijuana herb, butane hash oil, and THC concentrate had higher

adjusted odds of living in a legalized nonmedical marijuana state (aOR for marijuana herb

= 1.38; 95% CI = 1.20, 1.58; aOR for butane hash oil = 1.59; 95% CI = 1.32, 1.91;

aOR for THC concentrate = 1.27; 95% CI 1.11, 1.43). There was limited variation in

brands of THC products by residence in a legalized nonmedical marijuana state; however,

users of the Golden Gorilla or ‘other’ brand had higher adjusted odds of living in a

legalized nonmedical marijuana state (aOR for Golden Gorilla = 1.18; 95% CI = 1.03, 1.35;

aOR for ‘other’ = 1.21; 95% CI = 1.02, 1.42). THC-containing EVP users who reported

sourcing THC-containing EVPs through commercial means (e.g., recreational or medical

dispensaries) had higher adjusted odds of living in a legalized nonmedical marijuana state

(aOR for recreational dispensaries = 3.96; 95% CI = 3.45, 4.54, aOR for medical dispensary

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= 1.47; 95% CI = 1.27, 1.71; aOR for vape or smoke shop = 1.40; 95% CI = 1.23, 1.61).

Correspondingly, accessing products via informal sources such as friends and family, the

internet, or an illicit dealer was associated with lower adjusted odds of living in a legalized

nonmedical marijuana state (aOR for illicit dealer = 0.47; 95% CI = 0.39, 0.58; aOR for

family or friend = 0.56; 95% CI = 0.49, 0.64; and aOR for online source = 0.70; 95% CI =

0.54, 0.91). Those reporting first using THC–containing EVPs within the last year had lower

odds of living in a legalized nonmedical marijuana state compared to adults who reported

using THC-containing EVPs for more than a year (e.g., OR for < 3 months = 0.69; 95% CI =

0.57, 0.84). No other assessed groups had significant differences.

4. Discussion

Among adults from a geographically diverse sample of 18 states who reported use of THC-

containing EVPs after the onset of the EVALI outbreak, but who did not develop EVALI,

almost half reported daily or weekly use. In addition, nearly 50% of respondents reported

using Dank Vapes, a class of largely counterfeit THC-containing EVPs of unknown origin

that was also commonly reported among EVALI patients (Lozier et al., 2019). In addition,

respondents reported obtaining products through informal sources, with approximately 40%

obtaining EVPs from friends or family, 15% from illicit dealers, and 7% from an online

source. Ultimately, EVALI was strongly linked to THC-containing products from informal

sources. Equally concerning, nearly 1 in 6 respondents started using THC-containing EVPs

within 3 months of the survey, meaning they initiated use during or after the EVALI

outbreak.

In addition, a substantial proportion of respondents reported using highly potent THC

substances (e.g., butane hash oils and concentrates) and those living in legal nonmedical

marijuana states were more likely to report use of these products, which could indicate

easier access to higher potency products in these states (Al-Zouabi et al., 2018; Struble,

Ellis, & Lundahl, 2019). Overall, THC potency in marijuana products has increased during

the past 2 decades (ElSohly et al., 2016) and little is known about the differential health

effects and characteristics of various forms of THC substances.

Our results also demonstrated that living in a state that has legalized nonmedical marijuana

sales was associated with longer-term and more frequent use of THC-containing EVPs.

This is consistent with a prior study, which found that living in a state with medical

marijuana laws was associated with a higher likelihood of ever vaping THC (Borodovsky,

Crosier, Lee, Sargent, & Budney, 2016), however others have observed little impact of

medical marijuana laws on use (Harper, Strumpf, & Kaufman, 2012). Given the limited

and inconsistent data currently available, rapidly changing marijuana policy landscape and

product marketplace in states, more research is needed to better understand the relationship

between marijuana legalization (both medical and nonmedical use) and adult use behaviors

and outcomes. In addition, given the documented health risks associated with marijuana use,

as well as the uncertainty regarding therapeutic benefits for a range of medical conditions

(National Academies of Sciences Engineering and Medicine, 2017), further efforts to

provide evidenced-based information to the public, clinicians, and policymakers could be

beneficial.

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Respondents in this investigation were older, on average, than EVALI patients and there

are differences in time frames of data collection and populations assessed. Most EVALI

patients (74%) reported daily use of THC-containing products (Ellington et al., 2020),

whereas only 23.5% of this sample reported daily use. Most EVALI patients (78%) reported

only using THC-containing products from informal sources (Ellington et al., 2020), whereas

respondents in this sample, especially those living in legalized non-medical marijuana states,

more frequently reported using products obtained from formal sources. Similarly, a survey

conducted in Illinois during the midst of the EVALI outbreak which found that EVALI

patients reported more frequent use of THC-containing EVPs and were more likely to obtain

them through informal sources than a comparison group of THC-containing EVP users who

did not develop EVALI (Navon et al., 2019).

The strengths of this investigation are its robust overall sample size, the geographic diversity

of states included in the survey, and the ability to rapidly collect these data in the period

during and after the EVALI outbreak. This manuscript describes in depth THC containing

EVP use behaviors after the onset of the nation-wide EVALI outbreak in the U.S. However,

it is subject to at least three limitations. First, although we prospectively targeted a set

of states that were diverse geographically, with laws regarding medical and nonmedical

marijuana use, and burden of EVALI patients, the sample is not representative of national

or state populations and was limited to those who reported using both THC- and nicotine-

containing EVPs. Therefore, results cannot be generalized to states, the nation or to all

THC EVP users. Second, some groups had small sample sizes (e.g., older age groups, and

non-White race or ethnicity), limiting our analysis among these groups. Finally, the data are

self-reported and subject to recall or measurement bias. Misclassification is likely among the

response options for the access source variable in particular. Most of the comparison states

without legalized adult nonmedical marijuana use included in the survey had some form

of legalization of marijuana for medical use, therefore the ability to access legal medical

marijuana may have partially confounded the observed relationship between legalization for

adult nonmedical marijuana use and use behaviors. Social desirability bias may also have

been present, given the sensitive nature of some of the questions. However, the THC-EVP

survey was covered by an Assurance of Confidentiality, with reminders throughout the

questionnaire that confidentiality would be maintained.

4.1 Conclusion

Almost half of survey respondents reported daily or weekly use of THC-EVP, and many

accessed products through informal sources, even after EVALI began. These findings

underscore that EVALI-like outcomes could occur again and highlight the importance of

continued surveillance of THC-containing EVP use and expanded education and awareness

about the potential risks associated with their use.

This work expands understanding of THC EVP use among adults in the U.S., which is

particularly important in the midst of the evolving landscape of state-level marijuana policies

and in the aftermath of the nation-wide outbreak of serious lung injuries associated with

the use of THC-containing EVPs. Additional in-depth surveillance and research on EVP use

behaviors, contents (including additives), product sources, associations with awareness of

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EVALI, and motivations for use, including the information provided from this report, can

further inform prevention and education efforts and guide future outbreak response efforts.

CDC and FDA recommend that people not use THC-containing e-cigarette, or vaping,

products, particularly from informal sources like friends, family, or in-person or online

dealers. Because Vitamin E acetate is strongly linked to EVALI, it should not be added

to any e-cigarette, or vaping, products. Additionally, people should not add any other

substances not intended by the manufacturer to products, including products purchased

through retail establishments. Evidence is not sufficient to rule out the contribution of other

chemicals in either THC or non-THC products, in some of the reported EVALI patients.

E-cigarette, or vaping, products (nicotine- or THC-containing) should never be used by

youths, young adults, or women who are pregnant. THC use has been associated with a

wide range of health effects, particularly with prolonged frequent use. The best way to avoid

potentially harmful effects is to avoid the use of THC-containing e-cigarette, or vaping,

products.

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Table 1.

Demographic characteristics of adults (18+ years) reporting Tetrahydrocannabinol (THC) vaping or dabbing

and nicotine vaping— Selected States

, United States, February- March 2020

Characteristics

No./Total No. (%

)

Demographics

Sex

Male 1850/3980 (46.5)

Female 2130/3980 (53.5)

Median age, years (range) 36 (19–86)

Age Group (years)

18–24 585/3980 (14.7)

25–34 1145/3980 (28.8)

35–44 987/3980 (24.8)

45–64 1071/3980 (26.9)

65–86 192/3980 (4.8)

Race/Ethnicity

White 2825/3980 (71.0)

Black 399/3980 (10.0)

Hispanic 436/3980 (11.0)

Asian 174/3980 (4.4)

Other 146/3980 (3.7)

Dabbing is the use of concentrated forms of THC

California, Colorado, Florida, Illinois, Michigan, Minnesota, New Jersey, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania,

Tennessee, Texas, Utah, Washington, Wisconsin

Percentages may add up to more than 100% due to rounding.

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Table 2:

Tetrahydrocannabinol (THC)-vaping characteristics of adults (18+ years) reporting THC vaping or dabbing

and nicotine vaping in the past 3 months— Selected States

, United States, February- March 2020

Frequency Percent 95% Confidence Intervals

Type of device(s) used to vape or dab THC-containing products

Disposable e-cigarette or vape 1322 33.2 31.7 34.7

E-cigarette or vape with prefilled cartridges 2115 53.1 51.6 54.7

E-cigarette or vape with a tank that you can refill with liquids 1508 37.9 36.4 39.4

E-cigarette or vape with prefilled or refillable pods or Pod cartridges 1300 32.7 31.2 34.1

Dab Rig 857 21.5 20.2 22.8

Vaporizer 839 21.1 19.8 22.3

Other 86 2.2 1.7 2.6

Brand of THC-containing cartridge(s) used with device(s)

Rove 800 20.1 18.9 21.3

Dank Vapes 1901 47.7 46.2 49.3

Golden gorilla 1539 38.7 37.1 40.2

Smart cart 868 21.8 20.5 23.1

Other 757 19.0 17.8 20.2

THC substance(s) used in THC-containing devices, vaporizer, or dab rig in the

past 3 months?

Marijuana Herb 2533 63.6 62.2 65.1

THC oils 2768 69.6 68.1 71.0

Butane hash oils 563 14.2 13.1 15.2

THC concentrate (wax, badder/budder, crumble, shatter, pull and snap 1846 46.4 44.8 47.9

THC powder form 462 11.61 10.61 12.60

Access source of THC-containing products

Medical Dispensary 1014 25.5 24.1 26.8

Recreational dispensary 1637 41.1 39.6 42.6

Vape or smoke shop 1530 38.4 36.9 39.9

Pop up shop 331 8.3 7.5 9.2

Grocery/Drug store/Convenience store 360 9.0 8.2 9.9

Family/friend 1538 38.6 37.1 40.1

Illicit dealer 601 15.1 14.0 16.2

Online 296 7.4 6.6 8.25

Other 54 1.4 1.0 1.7

Frequency of THC-containing vaping product use

Monthly or less 1382 34.7 33.2 36.2

A few days per month 742 18.6 17.4 19.8

A few days per week 917 23.0 21.7 24.3

Daily 937 23.5 22.2 24.9

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Frequency Percent 95% Confidence Intervals

Average number of times per day THC-containing vaping products used

0–5 times per day 2696 67.7 66.3 69.2

6–10 times per day 544 13.7 12.6 14.7

Over 10 times per day 740 18.6 17.4 19.8

Length of time vaping or dabbing THC-containing products

< 3 months 618 15.5 14.4 16.7

3–6 months 978 24.6 23.2 25.9

7–12 months 763 19.2 18.0 20.4

> 1 year 1621 40.7 39.2 42.3

Dabbing is the use of concentrated forms of THC

California, Colorado, Florida, Illinois, Michigan, Minnesota, New Jersey, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania,

Tennessee, Texas, Utah, Washington, Wisconsin

Response options were not mutually exclusive

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Table 3:

Adjusted odds of daily vs non-daily tetrahydrocannabinol (THC)-vaping or dabbing

and age, race, and

living in a legalized nonmedical marijuana state

among adults (18+ years)— Selected States

, United States,

February- March 2020

Characteristic

Adjusted OR

95% Confidence Intervals

p-value

Gender (Female vs. Male)

1.16 1.00 1.34 0.059

Age Group, years (vs. 25–34)

18–24

0.88 0.71 1.10 0.27

35–44

0.88 0.72 1.08 0.22

45–86

0.74 0.61 0.90 0.0027

Race (vs. White respondents)

Asian

0.55 0.36 0.84 0.01

Black

1.48 1.17 1.86 0.00

Hispanic

0.83 0.65 1.06 0.14

Other

1.51 1.05 2.17 0.025

Living in legalized non-medical marijuana state (vs not)

1.18 1.01 1.37 0.033

Dabbing is the use of concentrated forms of THC

California, Colorado, Illinois, Michigan, Oregon, Washington

California, Colorado, Florida, Illinois, Michigan, Minnesota, New Jersey, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania,

Tennessee, Texas, Utah, Washington, Wisconsin

Adjusted for all other variables in the tables

p-value from chi-square test

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Table 4:

Adjusted odds of living in a legalized nonmedical marijuana state

by tetrahydrocannabinol (THC)-vaping or

dabbing

characteristics among adults (18+ years)— Selected States, United States

, February- March 2020

Adjusted OR

95% Confidence Intervals

p-value

Type of device(s) used to vape or dab THC-containing products (yes vs no)

Disposable e-cigarette or vape 1.16 1.01 1.32 0.040

E-cigarette or vape with prefilled cartridges 1.12 0.98 1.27 0.091

E-cigarette or vape with a tank that you can refill with liquids 0.92 0.81 1.05 0.23

E-cigarette or vape with prefilled or refillable pods or Pod cartridges 1.13 0.99 1.30 0.075

Dab Rig 1.39 1.18 1.62 <.0001

Vaporizer 1.21 1.04 1.42 0.016

Other 1.06 0.68 1.64 0.81

Which THC substance(s) did you use in an e-cigarette, vaping device,

vaporizer, or dab rig in the past 3 months? (yes vs no)

Marijuana herb (flower or leaves) 1.38 1.20 1.58 <.0001

THC oils 0.86 0.75 0.99 0.035

Butane Hash Oil 1.59 1.32 1.91 <.0001

THC Concentrate 1.27 1.11 1.45 0.0004

THC Powder 1.17 0.96 1.43 0.12

Other 0.76 0.50 1.14 0.18

Brand of THC-containing cartridge(s) used with device(s)

Rove 1.17 1.00 1.37 0.055

Dank Vapes 0.88 0.78 1.01 0.063

Golden gorilla 1.18 1.03 1.35 0.014

Smart cart 0.86 0.73 1.01 0.061

Other 1.21 1.02 1.42 0.026

Access source of THC-containing products (yes vs no)

Medical Dispensary 1.47 1.27 1.71 <.0001

Recreational dispensary 3.96 3.45 4.54 <.0001

Vape or smoke shop 1.40 1.23 1.61 <.0001

Pop up shop 0.99 0.78 1.25 0.92

Grocery/Drug store/Convenience store 0.92 0.73 1.15 0.44

Family/friend 0.56 0.49 0.64 <.0001

Illicit dealer 0.47 0.39 0.58 <.0001

Online 0.70 0.54 0.91 0.0066

Other 0.70 0.39 1.26 0.23

Average number of times per day THC-containing vaping products used

0–5 times per day 0.97 0.82 1.14 0.70

6–10 times per day 0.98 0.78 1.23 0.85

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Adjusted OR

95% Confidence Intervals

p-value

Type of device(s) used to vape or dab THC-containing products (yes vs no)

Over 10 times per day ref

Length of time vaping or dabbing THC-containing products

< 3 months 0.69 0.57 0.84 0.0002

3–6 months 0.76 0.64 0.89 0.0009

7–12 months 0.81 0.68 0.97 0.0223

<1 year ref

California, Colorado, Illinois, Michigan, Oregon, Washington

Dabbing is the use of concentrated forms of THC

California, Colorado, Florida, Illinois, Michigan, Minnesota, New Jersey, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania,

Tennessee, Texas, Utah, Washington, Wisconsin

Adjusted for age, race/ethnicity, sex

p-value from chi-square test

Addict Behav

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