Abstract
This study (a) examined changes in marijuana and cigarette initiation sequencing and (b) considered implications of such changes for prevention efforts by examining associations between initiation sequencing and current adolescent substance use. Analyses used 2000–2019 cross-sectional data from the national Monitoring the Future (MTF) study (78,252 U.S. 12th grade students). Models examined trends in six distinct patterns of initiation order, and multivariable associations between order of initiation and 30-day cigarette and marijuana use prevalence, cigarette and marijuana use frequency among users, and nicotine and marijuana vaping prevalence. While the percentage of students initiating neither cigarettes nor marijuana increased, increases also were observed in marijuana-only initiation (the fastest-growing pattern) and initiation of marijuana before cigarettes; these increases were accompanied by a significant decrease in cigarette-only initiation. Cigarette use prevalence and frequency were highest among students initiating cigarettes before marijuana; marijuana use prevalence and frequency were highest among students initiating marijuana before cigarettes. Cigarette and marijuana prevalence, as well as marijuana frequency, were lowest among students initiating only a single substance. Nicotine vaping was less prevalent among students initiating a single substance versus both substances, but no significant differences were observed in nicotine vaping prevalence between those initiating only cigarettes versus only marijuana. Implications of these findings for prevention efforts are discussed in the frameworks of both the common liability model and route of administration model.
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Notes
From 2017 to 2018, the items were worded as “On how many occasions…”, while in 2019, the wording was changed to “On how many DAYS…”.
References
Agrawal, A., Budney, A. J., & Lynskey, M. T. (2012). The co-occurring use and misuse of cannabis and tobacco: A review. Addiction, 107, 1221–1233. https://doi.org/10.1111/j.1360-0443.2012.03837.x.
Agrawal, A., & Lynskey, M. T. (2009). Tobacco and cannabis co-occurrence: Does route of administration matter? Drug and Alcohol Dependence, 99, 240–247. https://doi.org/10.1016/j.drugalcdep.2008.08.007.
Agrawal, A., Madden, P. A. F., Bucholz, K. K., Heath, A. C., & Lynskey, M. T. (2008). Transitions to regular smoking and to nicotine dependence in women using cannabis. Drug and Alcohol Dependence, 95, 107–114. https://doi.org/10.1016/j.drugalcdep.2007.12.017.
American College of Pediatricians. (2018). Marijuana use: detrimental to youth. https://www.acpeds.org/the-college-speaks/position-statements/effect-of-marijuana-legalization-on-risky-behavior/marijuana-use-detrimental-to-youth. Accessed 8 May 2020.
Bachman, J. G., Johnston, L. D., O’Malley, P. M., Schulenberg, J. E., & Miech, R. A. (2015). The Monitoring the Future project after four decades: design and procedures (Monitoring the Future Occasional Paper No. 82). Ann Arbor, MI: Institute for Social Research, University of Michigan.
Baumeister, S. E., & Tossmann, P. (2005). Association between early onset of cigarette, alcohol and cannabis use and later drug use patterns: An analysis of a survey in European metropolises. European Addiction Research, 11, 92–98.
Brener, N. D., Billy, J. O. G., & Grady, W. R. (2003). Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: Evidence from the scientific literature. Journal of Adolescent Health, 33, –P436, 457. https://doi.org/10.1016/S1054-139X(03)00052-1.
Bretteville-Jensen, A. L., & Williams, J. (2011). Decriminalization and initiation into cannabis use (Research Paper No. 1130). Parkville, VIC: Department of Economics, University of Melbourne.
Budney, A. J., Sargent, J. D., & Lee, D. C. (2015). Vaping cannabis (marijuana): Parallel concerns to e-cigs? Addiction, 110, 1699–1704. https://doi.org/10.1111/add.13036.
Cantrell, J., Bennett, M., Mowery, P., Xiao, H., Rath, J., Hair, E., et al. (2018). Patterns in first and daily cigarette initiation among youth and young adults from 2002 to 2015. PLoS One, 13, e0200827. https://doi.org/10.1371/journal.pone.0200827.
Christiani, D. C. (2020). Vaping-induced acute lung injury. New England Journal of Medicine, 382, 960–962. https://doi.org/10.1056/NEJMe1912032.
Degenhardt, L., Chiu, W.-T., Sampson, N., Kessler, R. C., Anthony, J. C., Angermeyer, M., et al. (2008). Toward a global view of alcohol, tobacco, cannabis, and cocaine use: Findings from the WHO World Mental Health Surveys. PLoS Medicine, 5, e141. https://doi.org/10.1371/journal.pmed.0050141.
Degenhardt, L., Dierker, L., Chiu, W. T., Medina-Mora, M. E., Neumark, Y., Sampson, N., et al. (2010). Evaluating the drug use “gateway” theory using cross-national data: Consistency and associations of the order of initiation of drug use among participants in the WHO World Mental Health Surveys. Drug and Alcohol Dependence, 108, 87–97. https://doi.org/10.1016/j.drugalcdep.2009.12.001.
DuPont, R. L., Han, B., Shea, C. L., & Madras, B. K. (2018). Drug use among youth: National survey data support a common liability of all drug use. Preventive Medicine, 113, 68–73. https://doi.org/10.1016/j.ypmed.2018.05.015.
Evans-Polce, R. J., Veliz, P., Boyd, C. J., & McCabe, S. E. (2020). Initiation patterns and trends of e-cigarette and cigarette use among U.S. adolescents. Journal of Adolescent Health, 66, 27–33. https://doi.org/10.1016/j.jadohealth.2019.07.002.
Fairman, B. J. (2015). Cannabis problem experiences among users of the tobacco-cannabis combination known as blunts. Drug and Alcohol Dependence, 150, 77–84https://doi.org/10.1016/j.drugalcdep.2015.02.014.
Fairman, B. J., Furr-Holden, C. D., & Johnson, R. M. (2019). When marijuana is used before cigarettes or alcohol: Demographic predictors and associations with heavy use, cannabis use disorder, and other drug-related outcomes. Prevention Science, 20, 225–233. https://doi.org/10.1007/s11121-018-0908-3.
Green, K. M., Johnson, R. M., Milam, A. J., Furr-Holden, D., Ialongo, N. S., & Beboussin, B. A. (2016). Racial differences and the role of neighborhood in the sequencing of marijuana and tobacco initiation among urban youth. Substance Abuse, 37, 507–510. https://doi.org/10.1080/08897077.2016.1178680.
Henry, K. L., & Thornberry, T. P. (2010). Truancy and escalation of substance use during adolescence. Journal of Studies on Alcohol and Drugs, 71, 115–124. https://doi.org/10.15288/jsad.2010.71.115.
Hindocha, C., Shaban, N. D. C., Freeman, T. P., Das, R. K., Gale, G., Schafer, G., et al. (2015). Associations between cigarette smoking and cannabis dependence: A longitudinal study of young cannabis users in the United Kingdom. Drug and Alcohol Dependence, 148, 165–171. https://doi.org/10.1016/j.drugalcdep.2015.01.004.
Humfleet, G. L., & Hass, A. I. (2004). Is marijuana use becoming a ‘gateway’ to nicotine dependence? Addiction, 99, 5–6.
Johnston, L. D., & O’Malley, P. M. (1985). Issues of validity and population coverage in student surveys of drug use. In B. A. Rouse, N. J. Kozel, & L. G. Richards (Eds.), Self-report methods of estimating drug use: Meeting current challenges to validity (NIDA Research Monograph 57). National Institute on Drug Abuse: Washington, D.C.
Kandel, D., & Kandel, E. (2015). The gateway hypothesis of substance abuse: Developmental, biological and societal perspectives. Acta Pediatrica, 104, 130–137. https://doi.org/10.1111/apa.12851.
Kennedy, S. M., Patel, R. P., Cheh, P., Hsia, J., & Rolle, I. V. (2016). Tobacco and marijuana initiation among African American and white young adults. Nicotine and Tobacco Research, 18, S57–S64. https://doi.org/10.1093/ntr/ntv194.
Keyes, K. M., Rutherford, C., & Miech, R. (2019). Historical trends in the grade of onset and sequence of cigarette, alcohol, and marijuana use among adolescents from 1976-2016: Implications for “gateway” patterns in adolescence. Drug and Alcohol Dependence, 194, 51–58. https://doi.org/10.1016/j.drugalcdep.2018.09.015.
Ksinan, A. J., Spindle, T. R., Thomas, N. S., Eissenberg, T., Spit for Science Working Group, & Dick, D. M. (2020). E-cigarette use is prospectively associated with initiation of cannabis among college students. Addictive Behaviors, 106, 106312. https://doi.org/10.1016/j.addbeh.2020.106312.
LaBouvie, E., Bates, M. E., & Pandina, R. J. (1997). Age of first use: Its reliability and predictive utility. Journal of Studies on Alcohol, 58, 638–643.
Leatherdale, S. T., Hammond, D., & Ahmed, R. (2008). Alcohol, marijuana, and tobacco use patterns among youth in Canada. Cancer Causes and Control, 19, 361–369https://www.jstor.org/stable/40271873.
Livingston, M., Holmes, J., Oldham, M., Vashishtha, R., & Pennay, A. (2020). Trends in the sequence of fist alcohol, cannabis and cigarette use in Australia, 2001-2016. Drug and Alcohol Dependence, 207, 107821. https://doi.org/10.1016/j.drugalcdep.2019.107821.
Majmundar, A., Kirkpatrick, M., Cruz, T. B., Unger, J. B., & Allem, J. P. (2019). Characterising KandyPens-related posts to Instagram: Implications for nicotine and cannabis use. Tobacco Control.https://doi.org/10.1136/tobaccocontrol-2019-055006.
McBride, D. C., Terry-McElrath, Y. M., & VanderWaal, C. J. (2016). Illicit drug policy. In A. Eyler, J. Chriqui, S. M. Russell, & R. Brownson (Eds.), Prevention, policy, and public health (pp. 263–287). New York: Oxford University Press.
Miech, R. A., Johnston, L. D., O'Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2020). Monitoring the future national survey results on drug use, 1975–2019: Volume I, secondary school students. Ann Arbor, MI: Institute for Social Research, The University of Michigan.
Muthén, L. K., & Muthén, B. O. (1998-2017). Mplus user’s guide (Eighth ed.). Los Angeles, CA: Muthén and Muthén.
National Institute on Drug Abuse. (2019). Screening tools for adolescent substance use. https://www.drugabuse.gov/nidamed-medical-health-professionals/screening-tools-resources/screening-tools-for-adolescent-substance-use. Accessed 8 May 2020.
Nguyen, T. Q., Ebnesajjad, C., Stuart, E. A., Kennedy, R. D., & Johnson, R. M. (2018). Does marijuana use at ages 16–18 predict initiation of daily cigarette smoking in late adolescence and early adulthood? A propensity score analysis of Add Health Data. Prevention Science. https://doi.org/10.1007/s11121-018-0874-9.
O’Malley, P. M., Bachman, J. G., & Johnston, L. D. (1983). Reliability and consistency of self-reports of drug use. International Journal of the Addictions, 18, 805–824.
Panlilio, L. V., Zanettini, C., Barnes, C., Solinas, M., & Goldberg, S. R. (2013). Prior exposure to THC increases the addictive effects of nicotine in rats. Neuropsychopharmacology, 38, 1198–1208. https://doi.org/10.1038/npp.2013.16.
Peters, E. N., Budney, A. J., & Carroll, K. M. (2012). Clinical correlates of co-occurring cannabis and tobacco use: A systematic review. Addiction, 107, 1404–1417. https://doi.org/10.1111/j.1360-0443.2012.03843.x.
Reidpath, D. D., Davey, T. M., Kadirvelu, A., Soyiri, I., & Allotey, P. (2014). Does one cigarette make an adolescent smoker, and is it influenced by age and age of smoking initiation? Evidence of association from the U.S. Youth Risk Behavior Surveillance System (2011). Preventive Medicine, 59, 37–41. https://doi.org/10.1016/j.ypmed.2013.11.011.
Richmond-Rakerd, L. S., Slutske, W. S., & Wood, P. K. (2017). Age of initiation and substance use progression: A multivariate latent growth analysis. Psychology of Addictive Behaviors, 31, 664–675. https://doi.org/10.1037/adb0000304.
Rubinstein, M. L., Rait, M. A., & Prochaska, J. J. (2015). Frequent marijuana use is associated with greater nicotine addiction in adolescent smokers. Drug and Alcohol Dependence, 141, 159–162. https://doi.org/10.1016/j.drugalcdep.2014.05.015.
Swift, W., Coffey, C., Degenhardt, L., Carlin, J. B., Romaniuk, H., & Patton, G. C. (2012). Cannabis and progression to other substance use in young adults: Findings from a 13-year prospective population-based study. Journal of Epidemiology and Community Health, 66, e26. https://doi.org/10.1136/jech.2010.129056.
Tice, P., Lipari, R. N., & Van Horn, S. L. (2017). Substance use among 12thgrade aged youths, by dropout status. CBHSQ Report. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality.
Tullis, L. M., DuPont, R., Frost-Pineda, K., & Gold, M. S. (2003). Marijuana and tobacco. Journal of Addictive Diseases, 22, 51–62. https://doi.org/10.1300/J069v22n03_05.
U.S. Department of Health and Human Services. (2012). Preventing tobacco use among youth and young adults: A report of the surgeon general. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
van Leeuwen, A. P., Verhulst, F. C., Reijneveld, S. A., Vollebergh, W. A. M., Ormel, J., & Huizink, A. C. (2011). Can the gateway hypothesis, the common liability nodel and/or, the route of administration model predict initiation of cannabis use during adolescence? A survival analysis—The TRAILS Study. Journal of Adolescent Health, 48, 73–78. https://doi.org/10.1016/j.jadohealth.2010.05.008.
Vanyukov, M. M., Tarter, R. E., Kirillova, G. P., Kirisci, L., Reynolds, M. D., Kreek, M. J., et al. (2012). Common liability to addiction and “gateway hypothesis”: Theoretical, empirical and evolutionary perspective. Drug and Alcohol Dependence, 123S, S3–S17. https://doi.org/10.1016/j.drugalcdep.2011.12.018.
Weinberger, A. H., Platt, J., Copeland, J., & Goodwin, R. D. (2018). Is cannabis use associated with increased risk of cigarette smoking initiation, persistence, and relapse? Longitudinal data from a representative sample of US adults. Journal of Clinical Psychiatry, 79, e1.
Wen, H., Hockenberry, J., & Druss, B. G. (2019). The effect of medical marijuana laws on marijuana-related attitude and perception among US adolescents and young adults. Prevention Science, 20, 215–223. https://doi.org/10.1007/s11121-018-0903-8.
Funding
This study was supported by the National Institute on Drug Abuse (R01DA001411). The study sponsor had no role in (a) study design; (b) the collection, analysis, and interpretation of data; (c) the writing of the report; or (4) the decision to submit the manuscript for publication. The views expressed in this article are those of the authors and do not necessarily reflect the views of the sponsor.
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Terry-McElrath, Y.M., O’Malley, P.M. & Johnston, L.D. Changes in the Order of Cigarette and Marijuana Initiation and Associations with Cigarette Use, Nicotine Vaping, and Marijuana Use: U.S. 12th Grade Students, 2000–2019. Prev Sci 21, 960–971 (2020). https://doi.org/10.1007/s11121-020-01150-2
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DOI: https://doi.org/10.1007/s11121-020-01150-2