Nicotine-only, THC-only, and dual vaping are not exchangeable: how exposure composition determines the pooled "vaping"-anxiety association (2024 NSDUH)
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Introduction. A single "vaping" exposure combines nicotine-only, tetrahydrocannabinol (THC)-only, and dual use. We tested whether their adjusted associations with anxiety symptoms are equal and what a pooled association represents. Methods. Cross-sectional analysis of 47,299 adults in the 2024 National Survey on Drug Use and Health, the first wave carrying the adult 7-item Generalized Anxiety Disorder scale (GAD-7). Survey-weighted logistic regression estimated adjusted odds ratios (aOR) for moderate-to-severe anxiety symptoms (GAD-7 >=10) across four mutually exclusive past-month groups. Pairwise contrasts, a binary any-vaping model, and composition re-weighting were post hoc; serious psychological distress (Kessler-6) provided an internal cross-instrument check. Results. aORs were 1.65 (95% CI 1.39-1.95) for nicotine-only, 2.45 (1.90-3.15) for THC-only, and 2.23 (1.82-2.73) for dual use; after marijuana and depression adjustment, 1.50, 1.51, and 1.21. The nicotine-only/THC-only ratio was 0.67 (0.50-0.90; p = 0.009), significant at a Bonferroni threshold of 0.017; nicotine-only/dual was 0.74 (0.57-0.96; p = 0.025) and THC-only/dual 1.10 (0.80-1.50; p = 0.54). Any vaping had an aOR of 1.94 (1.69-2.24) - by construction a mixture of the three group-specific associations, weighted by their composition, whose interval overlapped every group-specific interval. Re-weighting to three published compositions yielded 1.93-2.12. The nicotine-only/THC-only difference was reproduced for distress (p = 0.006). Conclusions. The three vaping groups are not exchangeable. A pooled "vaping" association is a mixture whose value depends on the sample's nicotine:THC:dual composition and should be reported alongside it. These cross-sectional estimates do not establish causation.
Source: Research Square
Author: KAOFEI SAYION
Institutions: Tzu Chi Foundation, Hualien Tzu Chi Medical Center
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7204247335