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

Source: 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.

Highlights

• Grade of first use of alcohol/cigarettes increasing, onset of marijuana use stable.

• Majority of adolescent use marijuana in a grade prior to or same as cigarettes.

• Marijuana displaces alcohol/cigarettes as 1 st substance among users of >1 substance.

Abstract

Introduction: In the past decade, marijuana use prevalence among adolescents has remained relatively steady while cigarette and alcohol prevalence has declined. We examined historical trends in: average grade of onset of marijuana, alcohol, and cigarette use by 12th grade; proportion who try alcohol/cigarettes before first marijuana use, among those who use by 12th grade; and conditional probability of marijuana use by 12th grade after trying alcohol/cigarettes.

Methods: Data were drawn from 40 yearly, cross-sectional surveys of 12thgrade US adolescents. A subset of students (N = 246,050) were asked when they first used each substance. We reconstructed cohorts of substance use from grade-of-onset to determine sequence of drug use, as well as probability of marijuana use in the same or later grade.

Results: Average grade of first alcohol and cigarette use by 12th grade increased across time; e.g., first cigarette increased from grade 7.9 in 1986 to 9.0 by 2016 (, SE = 0.001, p < 0.01). The proportion of 12thgrade adolescents who smoke cigarettes before marijuana fell below 50% in 2006. Each one-year increase was associated with 1.11 times increased odds of first cigarette in a grade after first marijuana (95% C.I. 1.11–1.12). Among those who initiate alcohol/cigarettes prior to marijuana by 12thgrade, the probability of subsequent marijuana use is increasing.

Conclusion: Marijuana is increasingly the first substance in the sequence of adolescent drug use. Reducing adolescent smoking has been a remarkable achievement of the past 20 years; those who continue to smoke are at higher risk for progression to marijuana use.