Historique
Article de Périodique
The gateway effect of cigarette, e-cigarette, cigar, and alcohol use vs. cannabis use (2025)
Auteur(s) :
WANG, Y. ;
CAVAZOS-REHG, P. A. ;
CUI, Y. ;
SPEER, M. ;
LOPARCO, C. R. ;
MCCREADY, D. M. ;
YANG, Y. T. ;
BERG, C. J.
Année
2025
Page(s) :
art. 108451
Langue(s) :
Anglais
Domaine :
Alcool / Alcohol ; Drogues illicites / Illicit drugs ; Tabac / Tobacco / e-cigarette
Discipline :
EPI (Epidémiologie / Epidemiology)
Thésaurus géographique
ETATS-UNIS
Thésaurus mots-clés
ALCOOL
;
TABAC
;
E-CIGARETTE
;
CIGARE
;
CANNABIS
;
JEUNE ADULTE
;
FACTEUR DE RISQUE
;
THEORIE DE L'ESCALADE
;
INITIATION
;
POLYCONSOMMATION
;
ETUDE LONGITUDINALE
;
AGE
Résumé :
Background: While the gateway hypothesis suggests that using tobacco and alcohol increases likelihood of initiating cannabis, cannabis use may precede and increase other substance use. We examined gateway effects of cigarettes, e-cigarettes, cigars, and alcohol on cannabis use, and reverse associations.
Methods: We analyzed 2023 survey data from 4,031 US young adults (Mage = 26.29, 60% female, 19% Hispanic, 14% Black, 14% Asian). Discrete-time survival analysis assessed hazards of initiating cannabis based on self-reported age of initiating other substances, and vice versa. Time(age)-lagged predictors indicated whether participants had initiated the other substances by one year younger, accounting for sociodemographics; state non-medical cannabis laws; lifetime depression, anxiety, or attention deficit disorder [ADD]) diagnoses; and personality characteristics.
Results: Lifetime use was: 68% for cannabis, 45% cigarettes, 49% e-cigarettes, 31% cigars, and 85% alcohol. Past-year cigarette, e-cigarette, cigar, and alcohol initiation increased hazards of initiating cannabis (adjusted Hazard Ratio, aHR = 3.78, 95%CI = 3.39-4.22; aHR = 2.17, 95%CI = 1.86-2.53; aHR = 2.90, 95%CI = 2.45-3.43; aHR = 3.41, 95%CI = 3.11-3.75, respectively). Past-year cannabis initiation increased hazards of other substance initiation (cigarettes: aHR = 3.51, 95%CI = 3.11-3.96; e-cigarettes: aHR = 3.73, 95%CI = 3.34-4.17; cigars: aHR = 3.66, 95%CI = 3.20-4.18; alcohol: aHR = 3.07, 95%CI = 2.73-3.45). Associations were generally stronger when initiation occurred at ages 5-18 vs. > 18. Depression predicted cannabis initiation; anxiety and ADD predicted e-cigarette initiation. Certain personality characteristics were protective against initiation (agreeableness and conscientiousness for each, openness for cigarettes and cigars, emotional stability for cannabis, cigarettes, and cigars); extraversion increased hazards of initiating cannabis and e-cigarettes.
Conclusions: Interventions should target underlying mechanisms influencing the use of various substances, such as mental health and personality characteristics, especially among adolescents. [Author's abstract]
Highlights:
Prior tobacco/alcohol initiation increased hazard of cannabis initiation.
Prior cannabis initiation increased hazard of tobacco/alcohol initiation.
Relative strength between the two directions varied by the specific substance.
Most of these effects were stronger for initiation during childhood/adolescence vs. young adulthood.
Interventions should target polysubstance use initiation, especially in adolescence.
Methods: We analyzed 2023 survey data from 4,031 US young adults (Mage = 26.29, 60% female, 19% Hispanic, 14% Black, 14% Asian). Discrete-time survival analysis assessed hazards of initiating cannabis based on self-reported age of initiating other substances, and vice versa. Time(age)-lagged predictors indicated whether participants had initiated the other substances by one year younger, accounting for sociodemographics; state non-medical cannabis laws; lifetime depression, anxiety, or attention deficit disorder [ADD]) diagnoses; and personality characteristics.
Results: Lifetime use was: 68% for cannabis, 45% cigarettes, 49% e-cigarettes, 31% cigars, and 85% alcohol. Past-year cigarette, e-cigarette, cigar, and alcohol initiation increased hazards of initiating cannabis (adjusted Hazard Ratio, aHR = 3.78, 95%CI = 3.39-4.22; aHR = 2.17, 95%CI = 1.86-2.53; aHR = 2.90, 95%CI = 2.45-3.43; aHR = 3.41, 95%CI = 3.11-3.75, respectively). Past-year cannabis initiation increased hazards of other substance initiation (cigarettes: aHR = 3.51, 95%CI = 3.11-3.96; e-cigarettes: aHR = 3.73, 95%CI = 3.34-4.17; cigars: aHR = 3.66, 95%CI = 3.20-4.18; alcohol: aHR = 3.07, 95%CI = 2.73-3.45). Associations were generally stronger when initiation occurred at ages 5-18 vs. > 18. Depression predicted cannabis initiation; anxiety and ADD predicted e-cigarette initiation. Certain personality characteristics were protective against initiation (agreeableness and conscientiousness for each, openness for cigarettes and cigars, emotional stability for cannabis, cigarettes, and cigars); extraversion increased hazards of initiating cannabis and e-cigarettes.
Conclusions: Interventions should target underlying mechanisms influencing the use of various substances, such as mental health and personality characteristics, especially among adolescents. [Author's abstract]
Highlights:
Prior tobacco/alcohol initiation increased hazard of cannabis initiation.
Prior cannabis initiation increased hazard of tobacco/alcohol initiation.
Relative strength between the two directions varied by the specific substance.
Most of these effects were stronger for initiation during childhood/adolescence vs. young adulthood.
Interventions should target polysubstance use initiation, especially in adolescence.
Affiliation :
Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA