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)

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