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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

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

  1. 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…”.

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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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Correspondence to Yvonne M. Terry-McElrath.

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The authors declare that they have no conflicts of interest.

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The study procedures were approved by the University of Michigan’s Health Sciences and Behavioral Sciences Institutional Review Board, and were performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Appropriate consent procedures were used in accordance with federal, state, and school policies.

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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

Keywords

  • Cigarette
  • Vaping
  • Nicotine
  • Marijuana
  • Adolescent
  • Substance use initiation