Changes in the Order of Cigarette and Marijuana Initiation and Associations with Cigarette Use, Nicotine Vaping, and Mar
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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 Yvonne M. Terry-McElrath 1
&
Patrick M. O’Malley 1 & Lloyd D. Johnston 1
# Society for Prevention Research 2020
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. Keywords Cigarette . Vaping . Nicotine . Marijuana . Adolescent . Substance use initiation
Adolescent cigarette and marijuana use are associated with a range of negative outcomes (American College of Pediatricians 2018; U.S. Department of Health and Human Services 2012). Several theoretical models have been developed to explain if and how the order in which adolescents initiate substance use may have implications for prevention effort focus and timing, e.g., the gateway, common liability, and route of administration models. The gateway model (Kandel and Kandel 2015) posits that initiation order is important because tobacco use—particularly cigarette use—is Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11121-020-01150-2) contains supplementary material, which is available to authorized users. * Yvonne M. Terry-McElrath [email protected] 1
Institute for Social Research, University of Michigan, PO Box 1248, Ann Arbor, MI 48106-1248, USA
causal of later marijuana use. The gateway model indicates preventio
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