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Association between secondhand marijuana smoke and respiratory infections in children



Little is known about the effects of secondhand marijuana smoke on children. We aimed to determine caregiver marijuana use prevalence and evaluate any association between secondhand marijuana smoke, childhood emergency department (ED) or urgent care (UC) visitation, and several tobacco-related illnesses: otitis media, viral respiratory infections (VRIs), and asthma exacerbations.


This study was a cross-sectional, convenience sample survey of 1500 subjects presenting to a pediatric ED. The inclusion criteria were as follows: caregivers aged 21–85 years, English- or Spanish-speaking. The exclusion criteria were as follows: children who were critically ill, medically complex, over 11 years old, or using medical marijuana.


Of 1500 caregivers, 158 (10.5%) reported smoking marijuana and 294 (19.6%) reported smoking tobacco. Using negative-binomial regression, we estimated rates of reported ED/UC visits and specific illnesses among children with marijuana exposure and those with tobacco exposure, compared to unexposed children. Caregivers who used marijuana reported an increased rate of VRIs in their children (1.31 episodes/year) compared to caregivers with no marijuana use (1.04 episodes/year) (p = 0.02).


Our cohort did not report any difference with ED/UC visits, otitis media episodes, or asthma exacerbations, regardless of smoke exposure. However, caregivers of children with secondhand marijuana smoke exposure reported increased VRIs compared to children with no smoke exposure.


  • Approximately 10% of caregivers in our study were regular users of marijuana.

  • Prior studies have shown that secondhand tobacco smoke exposure is associated with negative health outcomes in children, including increased ED utilization and respiratory illnesses.

  • Prior studies have shown primary marijuana use is linked to negative health outcomes in adults and adolescents, including increased ED utilization and respiratory illnesses.

  • Our study reveals an association between secondhand marijuana smoke exposure and increased VRIs in children.

  • Our study did not find an association between secondhand marijuana smoke exposure and increased ED or UC visitation in children.

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Author information

Authors and Affiliations



A.B.J conceived the study, performed subject recruitment, and drafted the manuscripts. R.D.M., G.S.W., and K.W. helped design the study and performed regular review/modifications of the paper during the review process. R.D.M. oversaw the research design/methods. S.S. and V.R. served as the primary recruiters of subjects, supervised data collection, organized REDCap data, and performed the literature review. D.M.C. performed the initial statistical analysis of the data and made revisions to the study. T.E.C. performed the final statistical analysis and helped with the editing of the manuscript. A.B.J. takes responsibility for the paper as a whole.

Corresponding author

Correspondence to Adam B. Johnson.

Ethics declarations

Competing interests

G.S.W. receives royalties from Uptodate for authorship contributions on related subjects. G.S.W. is now a co-investigator for an NIH NIDA funded grant. The other authors declare no competing interests.

Consent statement

Informed consent was obtained from all caregivers by trained research assistants prior to the filling out of the survey. Assent was obtained from children aged >7 years.

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Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix 1 Survey Questions

Appendix 1 Survey Questions

- How many times in the last 12 months has your child been seen in the EMERGENCY ROOM or URGENT CARE Center (including the visit today)?

-How many times in the last 12 months has a healthcare provider (example: doctor, nurse practitioner, physician assistant) diagnosed your child with an EAR INFECTION?

- How many times in the last 12 months has a healthcare provider diagnosed your child with an ASTHMA ATTACK (any wheezing episode that required treatment in the Emergency Room or Urgent Care Center)?

- How many times in the last 12 months has a healthcare provider diagnosed your child with a COLD or RESPIRATORY VIRUS (an episode of runny nose, cough, and low grade fever)?

- Has your child been diagnosed with any of the following medical conditions? (Asthma, allergies, eczema)

- Is there a history of ASTHMA in either of the child’s biological parents?

-Does anyone who lives in your home, or who primarily cares for your child, use smoked TOBACCO PRODUCTS (such as CIGARETTES, CIGARS, PIPES)?

-Does anyone who lives in your home, or who primarily cares for your child, use MARIJUANA (in any form)?

-Has your child been prescribed MEDICAL MARIJUANA for an illness (example: seizures, muscle spasms, pain)?

-In which locations are SMOKED or VAPORIZED MARIJUANA products typically used?

-Has your child’s Pediatrician ever asked or counseled you about MARIJUANA?

-How many adults in your home regularly use MARIJUANA?

-Please indicate the Form and Frequency of MARIJUANA that is used? (Smoked, vaporized, edibles, highly concentrated products, topical, other)

-How old is your child?

-Gender (Sex) of your child?

-Race of your child?

-Caregiver age?

-What is your annual household income?

-What type of health insurance does your child have?

-What is your highest level of education?

-What best describes the type of residence or home in which you and your child currently live?

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Johnson, A.B., Wang, G.S., Wilson, K. et al. Association between secondhand marijuana smoke and respiratory infections in children. Pediatr Res 91, 1769–1774 (2022).

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