The gateway effect of cigarette, e-cigarette, cigar, and alcohol use vs. Cannabis use

IF 3.6 2区医学 Q1 PSYCHOLOGY, CLINICAL

Addictive behaviors Pub Date : 2025-08-06 DOI:10.1016/j.addbeh.2025.108451

Yan Wang , Patricia A. Cavazos-Rehg , Yuxian Cui , Morgan Speer , Cassidy R. LoParco , Darcey M. McCready , Y. Tony Yang , Carla J. Berg

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引用次数: 0

Abstract

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 (M_age = 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.

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香烟、电子烟、雪茄和酒精使用与大麻使用的门户效应

虽然门户假说表明，使用烟草和酒精增加了开始使用大麻的可能性，但大麻的使用可能先于其他物质的使用并增加了它们的使用。我们研究了香烟、电子烟、雪茄和酒精对大麻使用的入口效应，以及反向关联。方法我们分析了来自4031名美国年轻人的2023份调查数据（年龄为26.29岁，60%为女性，19%为西班牙裔，14%为黑人，14%为亚洲人）。离散时间生存分析评估了基于自我报告的开始使用其他物质的年龄的大麻的危害，反之亦然。时间（年龄）滞后的预测指标表明，考虑到社会人口统计学因素，参与者是否在年轻一岁时开始使用其他物质；国家非医用大麻法；终生抑郁、焦虑或注意力缺陷障碍（ADD）诊断；还有人格特征。结果大麻占68%，香烟占45%，电子烟占49%，雪茄占31%，酒精占85%。过去一年开始吸食香烟、电子烟、雪茄和酒精增加了开始吸食大麻的危险(调整风险比，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)。过去一年吸食大麻增加了吸食其他物质的危险(香烟：aHR = 3.51, 95% CI = 3.11-3.96；电子烟：aHR = 3.73, 95% CI = 3.34-4.17；雪茄：aHR = 3.66, 95% CI = 3.20-4.18；酒精：aHR = 3.07, 95% CI = 2.73-3.45)。与5-18岁相比，5-18岁时的关联通常更强。18. 抑郁预测大麻成瘾；焦虑和注意力缺陷多动症预示着电子烟的开始。某些人格特征对启蒙具有保护作用（每一种性格特征都具有亲和性和严谨性，香烟和雪茄具有开放性，大麻、香烟和雪茄具有情绪稳定性）；外向性增加了吸食大麻和电子烟的危险。结论干预措施应针对影响各种物质使用的潜在机制，如心理健康和人格特征，特别是青少年。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addictive behaviors 医学-药物滥用

CiteScore

8.40

自引率

4.50%

发文量

283

审稿时长

46 days

期刊介绍： Addictive Behaviors is an international peer-reviewed journal publishing high quality human research on addictive behaviors and disorders since 1975. The journal accepts submissions of full-length papers and short communications on substance-related addictions such as the abuse of alcohol, drugs and nicotine, and behavioral addictions involving gambling and technology. We primarily publish behavioral and psychosocial research but our articles span the fields of psychology, sociology, psychiatry, epidemiology, social policy, medicine, pharmacology and neuroscience. While theoretical orientations are diverse, the emphasis of the journal is primarily empirical. That is, sound experimental design combined with valid, reliable assessment and evaluation procedures are a requisite for acceptance. However, innovative and empirically oriented case studies that might encourage new lines of inquiry are accepted as well. Studies that clearly contribute to current knowledge of etiology, prevention, social policy or treatment are given priority. Scholarly commentaries on topical issues, systematic reviews, and mini reviews are encouraged. We especially welcome multimedia papers that incorporate video or audio components to better display methodology or findings. Studies can also be submitted to Addictive Behaviors? companion title, the open access journal Addictive Behaviors Reports, which has a particular interest in ''non-traditional'', innovative and empirically-oriented research such as negative/null data papers, replication studies, case reports on novel treatments, and cross-cultural research.