Association Between Psychological Distress and Cannabis Vaping Among U.S. Adults: A Cross-Sectional Analysis of the 2023 National Survey on Drug Use and Health (NSDUH)
A Nationally Representative Study
DOI:
https://doi.org/10.54103/2282-0930/31277Keywords:
cannabis vaping, psychological distress, NSDUH, substance use, mental health, United StatesAbstract
Background: Cannabis vaping has emerged as a rapidly expanding mode of marijuana consumption in the United States. Although cannabis use has been linked to adverse mental health outcomes, nationally representative evidence examining the association between psychological distress and cannabis vaping among adults remains limited.
Methods: This cross-sectional study analyzed data from 45,133 U.S. adults participating in the 2023 National Survey on Drug Use and Health, representing approximately 257.5 million adults nationally after applying survey weights. Past-month cannabis vaping and past-month psychological distress were assessed using standardized NSDUH measures. Survey-weighted prevalence estimates were calculated, and Rao–Scott chi-square tests were used to compare groups. Survey-weighted logistic regression models estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs), controlling for sociodemographic characteristics, medical marijuana law status, past-month alcohol use, past-month tobacco use, and past-year mental health support group participation.
Results: The weighted prevalence of past-month cannabis vaping was 4.9% (95% CI, 4.6–5.2) among adults without psychological distress and 16.5% (95% CI, 14.9–18.0) among those with distress (p < 0.001). After adjustment, psychological distress was associated with significantly higher odds of cannabis vaping (AOR = 1.85; 95% CI, 1.55–2.21; p < 0.001).
Conclusions: Psychological distress was strongly associated with cannabis vaping among U.S. adults. Integrating mental health considerations into cannabis-related prevention and screening efforts may be important as vaping products continue to evolve and expand.
Keywords: Cannabis vaping; Psychological distress; NSDUH; Substance use; Mental health; United States
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Hasin DS, Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, Jung J, Pickering RP, Grant BF. Epidemiology of marijuana use and cannabis use disorders. JAMA Psychiatry. 2015;72(12):1235–1242. doi:10.1001/jamapsychiatry.2015.1360
Ul Haq Z, Hasan MR. Alcohol-related disruptions in PrEP continuity and associated HIV vulnerabilities. Eur J Health Sci. 2025;11(2):61–95. doi:10.47672/ejhs.2805
Volkow ND, Baler RD, Compton WM, Weiss SRB. Adverse health effects of marijuana use. N Engl J Med. 2014;370(23):2219–2227. doi:10.1056/NEJMra1402309
Lev-Ran S, Roerecke M, Le Foll B, George TP, McKenzie K, Rehm J. Cannabis use and depression: A systematic review and meta-analysis. Psychol Med. 2014;44(4):797–810. doi:10.1017/S0033291713001627
Sarvet AL, Wall MM, Keyes KM, et al. Rapid increase in marijuana use among U.S. adults. Am J Public Health. 2018;108(9):1228–1234. doi:10.2105/AJPH.2018.304585
Ul Haq Z, Hasan MR. A multilevel perspective on PrEP adherence in HIV prevention. Br J Nurs Sci. 2025;5(3):2. doi:10.32996/BJNS.2025.5.3.2
Gobbi G, Atkin T, Zytynski T, et al. Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality. JAMA Psychiatry. 2019;76(4):426–434. doi:10.1001/jamapsychiatry.2018.4500
Ul Haq Z, Hasan MR. Exploring the association between psychological distress and cannabis edible use among U.S. adults. Int J Pharm Biol Sci. 2025;16(4). doi:10.22376/ijpbs.v16i4.111
Danielsson AK, Lundin A, Yaregal A, Östberg V, Allebeck P, Agardh E. Cannabis use and risk of anxiety and depression. BMC Psychiatry. 2016;16:136. doi:10.1186/s12888-016-0835-8
Meier MH, Docherty M, Leischow SJ, et al. Cannabis vaping and mental health outcomes. Drug Alcohol Depend. 2020;214:108147. doi:10.1016/j.drugalcdep.2020.108147
Ul Haq Z, Hasan MR. Patterns of marijuana use, psychological distress, and suicide risk among U.S. adolescents. Am J Public Health Res. 2025;13(6):263–274. doi:10.12691/ajphr-13-6-2
Ramo DE, Liu H, Prochaska JJ. Tobacco and marijuana co-use patterns. Addict Behav. 2012;37(9):1064–1070. doi:10.1016/j.addbeh.2012.04.014
Ul Haq Z, Hasan MR. The hidden continuum of risk: behavioral and mental health pathways from tobacco consumption to illicit drug use. East Afr Sch J Med Sci. 2025;8(11). doi:10.36349/easms.2025.v08i11.002
Weinberger AH, Zhu J, Lee J, et al. Cannabis use and cigarette smoking initiation. Drug Alcohol Depend. 2018;191:116–123. doi:10.1016/j.drugalcdep.2018.06.021
Compton WM, Han B, Blanco C, Johnson K, Jones CM. Marijuana use and use disorders in adults. JAMA Psychiatry. 2016;73(3):300–307. doi:10.1001/jamapsychiatry.2015.2737
Barry RA, Glantz SA. Cannabis legalization and cannabis use disorder. Lancet Psychiatry. 2018;5(8):683–691. doi:10.1016/S2215-0366(18)30200-4
Ul Haq Z, Hasan MR. Lifestyle behaviors and psychosocial determinants of adult obesity in the United States. ICRRD Qual Index Res J. 2026;7(1):1. doi:10.53272/icrrd.v7i1.1
Wilkinson ST, Radhakrishnan R, D’Souza DC. Cannabis and first-episode psychosis. Am J Psychiatry. 2016;173(7):727–735. doi:10.1176/appi.ajp.2016.15101341
Meier MH, Caspi A, Ambler A, et al. Persistent cannabis users show neuropsychological decline. PNAS. 2012;109(40):E2657–E2664. doi:10.1073/pnas.1206820109
Hasin DS. US epidemiology of cannabis use and disorders. Curr Addict Rep. 2018;5(4):406–414. doi:10.1007/s40429-018-0213-z
Compton WM, Jones CM, Baldwin GT. Cannabis use and mental health disorders. JAMA. 2019;322(7):638–639. doi:10.1001/jama.2019.11417
Mattingly DT, Agbonlahor O, Hart JL, McLeish AC, Walker KL. Psychological distress and cannabis vaping among U.S. adolescents. Am J Prev Med. 2024;66(3):534–539. doi:10.1016/j.amepre.2023.10.013
Ramo DE, Delucchi KL, Hall SM, et al. Marijuana and tobacco co-use in young adults. J Stud Alcohol Drugs. 2013;74(2):301–310. doi:10.15288/jsad.2013.74.301
Weinberger AH, Delnevo CD, Wyka K, et al. Cannabis use and cigarette smoking behaviors. Nicotine Tob Res. 2020;22(8):1404–1408. doi:10.1093/ntr/ntz085
Lemyre A, Poliakova N, Bélanger RE. Cannabis and anxiety: A systematic review. Front Psychiatry. 2019;10:510. doi:10.3389/fpsyt.2019.00510
Peters EN, Budney AJ, Carroll KM. Co-occurring cannabis and tobacco use. Drug Alcohol Depend. 2012;123(1–3):83–88. doi:10.1016/j.drugalcdep.2011.10.019
Schauer GL, Berg CJ, Kegler MC, Donovan DM, Windle M. Differences in tobacco product use among marijuana users. Addict Behav. 2016;57:49–53. doi:10.1016/j.addbeh.2016.02.012
Hall W, Degenhardt L. Adverse health effects of cannabis. Lancet. 2009;374(9698):1383–1391. doi:10.1016/S0140-6736(09)61037-0
Cerdá M, Mauro C, Hamilton A, et al. Association between recreational marijuana laws and cannabis use among adults in the United States. JAMA Netw Open. 2020;3(10):e2014598. doi:10.1001/jamanetworkopen.2020.14598
Weinberger AH, Zhu J, Lee J, Xu S, Goodwin RD. Cannabis use and onset of cigarette and e-cigarette use. Nicotine Tob Res. 2021;23(3):609–613. doi:10.1093/ntr/ntaa158
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Copyright (c) 2026 Zeeshan Ul Haq, Md Rakibul Hasan, Usman Mustafa, Fahad Bin Halim, M. Tayyeb Ayyoubi
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Accepted 2026-05-12
Published 2026-06-15
