When Marijuana Is Used before Cigarettes or Alcohol: Demographic Predictors and Associations with Heavy Use, Cannabis Use Disorder, and Other Drug-related Outcomes
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Recent loosening of state and federal policy restrictions on marijuana, along with changes in social norms regarding marijuana use and decreases in prevalence of other types of substance use, may lead to increases in youth initiating marijuana before other types of substances such as alcohol and tobacco. We investigated predictors and potential consequences of initiating marijuana before other drugs for youth aged 12–21-years in the USA. Nationally representative, cross-sectional survey data from the US National Survey on Drug Use and Health supplied self-reported age of first marijuana, cigarettes, alcohol, other tobacco, and other illegal drug use among 12–21-year-old samples from 2004 to 2014 (n = 275,559). We first examined the degree to which initiating marijuana use first was associated with sex, age, race/ethnicity, and survey year. Then, we examined whether using marijuana first predicted heavy marijuana use, cannabis use disorder (CUD), alcohol use disorder (AUD), nicotine dependence (ND), or lifetime use of other illegal drugs. Among all survey youth (substance users and non-users), the proportion using marijuana first increased from 4.8 to 8.8% from 2004 to 2014. Those using marijuana first (vs. alcohol or cigarettes first) were more likely to be male and older and Black, American Indian/Alaskan Native, multiracial, or Hispanic than White or Asian. Among substance users and adjusting for age of onset and the number of substances used, using marijuana first was associated higher odds of heavy current marijuana use and CUD. In recent years, youth have been increasingly likely to use marijuana as their first drug and sequence of initiation is associated with race/ethnicity, gender, and age. Using marijuana first might increase the chance of heavy use and CUD.
KeywordsMarijuana Cigarettes Alcohol Dependence Gateway
Dr. Fairman’s contribution to this work was supported by a grant from the National Institute on Drug Abuse (T32DA007292) and the Intramural Research Program of the Eunice Kennedy Shriver National Institute for Child Health and Human Development. Dr. Johnson is supported by a K01DA031738 NIDA grant, and Dr. Furr-Holden is supported by a R01CE002682 grant from the CDC National Center for Injury Prevention and Control.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
The original study procedures were approved by RTI’s Institution Review Board (IRB) for the protection of human subjects. Authors had only access to the publicly available, de-identified data, and thus this research was deemed “not human subjects research” by the Johns Hopkins Bloomberg School of Public Health IRB.
All survey participants were provided informed consent.
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