Susceptibility to and Use of E-cigarettes and Marijuana Is Common Among Adolescents With Congenital Heart Disease

Susceptibility to and Use of E-cigarettes and Marijuana Is Common Among Adolescents With Congenital Heart Disease 1024 575 Lauren Dembeck

Adolescents with congenital heart disease (CHD) are subject to disease-related stressors, such as attending medical appointments and undergoing medical procedures. They have elevated risk for cardiovascular and cognitive complications, which may be exacerbated by the use of e-cigarettes and marijuana. To inform prevention strategies for their long-term wellbeing, it is critical to understand patterns of e-cigarette and marijuana use in these at-risk patients.

Kristen Fox, PhD

“The existing literature on susceptibility to and use of these substances by this vulnerable population is limited and outdated, certainly from before the explosion of e-cigarette use among teens and prior to evolving perceptions about marijuana that have come with the legalization of recreational use in some states,” explains Kristen Fox, PhD, a post-doctoral scientist in clinical health psychology in the Center for Biobehavioral Health at Nationwide Children’s Hospital.

“Given the unique stressors and higher rate of mental health difficulties among teens with CHD compared with their healthy peers, we thought that it was important to look at the relationship between stress and their risk for using e-cigarettes or marijuana in the future,” says Dr. Fox.

To fill this knowledge gap, Dr. Fox and colleagues surveyed 98 adolescents with CHD, 12 to 18 years of age, about their susceptibility to future use and history of ever using e-cigarettes and marijuana. The researchers also assessed patients’ perceived global and disease-related stress and explored associations between susceptibility to and use of e-cigarettes and marijuana and stress. The findings were recently published in the Journal of Pediatric Psychology.

The study showed that susceptibility to both e-cigarettes and marijuana was common among adolescents with CHD, with 31.3% and 40.2% reporting susceptibility to e-cigarettes and marijuana, respectively. It also revealed that 15.3% and 14.3% the group reported having used e-cigarettes and marijuana, respectively.

“These findings are striking and suggest that there is a significant portion of teens with CHD that are vulnerable to using e-cigarettes and marijuana despite the potential health risks,” says Jamie Jackson, PhD, senior author on the study and principal investigator in the Center for Biobehavioral Health.

Jamie Jackson, PhD

The researchers found that global stress was associated with both susceptibility to and lifetime use of e-cigarettes and marijuana, but that disease-related stress was associated with only susceptibility to marijuana.

“Because susceptibility to and use of e-cigarettes and marijuana is common in this group, it is important that these teens are assessed for risk when they come to their medical and clinical encounters,” says Dr. Fox. “If we don’t ask teens about these substances, we are missing opportunities to provide education and to intervene.”

Drs. Fox and Jackson believe that future research should focus on developing and testing prevention interventions, with an emphasis on stress reduction, to reduce e-cigarette and marijuana susceptibility and use in this at-risk population. They are now aiming to develop a mobile health vaping prevention intervention that will help teens manage stress and learn more about living with congenital heart disease.

“As evidence of potential health harms of using e-cigarettes and marijuana grows, we need to understand the extent and nature of these behaviors so we can identify ways to help reduce cardiovascular risk for teens with congenital heart disease,” adds Dr. Fox.



Fox KR, Ferketich AK, Groner JA, Rausch JR, Garg V, Grant VR, Neville SP, Cua CL, Jackson JL. The Association of Global and Disease-Related Stress With Susceptibility to and Use of E-Cigarettes and Marijuana Among Adolescents With Congenital Heart Disease. Journal of Pediatric Psychology. 2023 Feb 22:jsad005. doi: 10.1093/jpepsy/jsad005. Epub ahead of print. PMID: 36810676.

About the author

Lauren Dembeck, PhD, is a freelance science and medical writer based in New York City. She completed her BS in biology and BA in foreign languages at West Virginia University. Dr. Dembeck studied the genetic basis of natural variation in complex traits for her doctorate in genetics at North Carolina State University. She then conducted postdoctoral research on the formation and regulation of neuronal circuits at the Okinawa Institute of Science and Technology in Japan.