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

Authors

Yan Wang, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA; George Washington Cancer Center, George Washington University, Washington, DC, USA. Electronic address: yanwang20@gwu.edu.
Patricia A. Cavazos-Rehg, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
Yuxian Cui, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Morgan Speer, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Cassidy R. LoParco, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Darcey M. McCready, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Y Tony Yang, George Washington Cancer Center, George Washington University, Washington, DC, USA; Center for Health Policy and Media Engagement, School of Nursing, George Washington University, Washington, DC, USA.
Carla J. Berg, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA; George Washington Cancer Center, George Washington University, Washington, DC, USA.

Document Type

Journal Article

Publication Date

11-1-2025

Journal

Addictive behaviors

Volume

170

DOI

10.1016/j.addbeh.2025.108451

Keywords

Polysubstance use; Risk factors; Substance use; Substance use initiation; Young adults

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 = 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.

APA Citation

Wang, Yan; Cavazos-Rehg, Patricia A.; Cui, Yuxian; Speer, Morgan; LoParco, Cassidy R.; McCready, Darcey M.; Yang, Y Tony; and Berg, Carla J., "The gateway effect of cigarette, e-cigarette, cigar, and alcohol use vs. Cannabis use" (2025). GW Authored Works. Paper 7691.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7691

Department

Prevention and Community Health