Is E-cigarette use a gateway to marijuana use? Longitudinal examinations of initiation, reinitiation, and persistence of e-cigarette and marijuana use

• Published in: Drug and alcohol dependence 2020-03, Vol.208, p.107868, Article 107868
• Main Authors: Wong, Su-Wei, Lohrmann, David K., Middlestadt, Susan E., Lin, Hsien-Chang
• Format: Article
• Language: English
• Subjects: Addictive behaviors; Adolescent; Adult; Adults; Behavior; Cannabis; Cigarettes; Disease Progression; Drug abuse; E-cigarette; Electronic cigarettes; Electronic Nicotine Delivery Systems - statistics & numerical data; Etiology; Falsification; Female; Gateway hypothesis; Humans; Hypotheses; Initiation; Logistic Models; Longitudinal Studies; Male; Marijuana; Marijuana Abuse - epidemiology; Marijuana Abuse - psychology; Persistence; Psychosocial factors; Reinitiation; Smoking; Substance abuse; Substance use; Tobacco; United States - epidemiology; Vaping; Vaping - epidemiology; Vaping - psychology; Young Adult
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2020.107868

•Findings do not support the gateway from e-cigarette use to marijuana initiation.•Findings support the gateway from e-cigarette use to marijuana reinitiation.•Findings do not support the gateway from e-cig use to persistent marijuana use.•Concept of common liability pertains to substance use may explain the findings. Concerns have been raised regarding e-cigarette use as a potential stepping-stone to marijuana use. Based on Kandel’s gateway hypothesis, this study investigated if e-cigarette use could lead to marijuana use by testing two hypotheses with a longitudinal national U.S. adult sample, including (1) primary hypothesis: e-cigarette use is a gateway to marijuana use; and (2) falsification hypothesis: marijuana use is not a gateway to e-cigarette use. Adults were extracted from the Population Assessment of Tobacco and Health Study Waves 1–3 (2013–2016). For primary hypotheses, based on baseline e-cigarette use statuses, three study groups were defined, and three logistic regressions were conducted to examine associations between baseline e-cigarette use and follow-up marijuana use initiation, reinitiation, and persistence, respectively. Similarly, for falsification hypotheses, three additional study groups were defined, and three logistic regressions were conducted to examine associations between baseline marijuana use and follow-up e-cigarette use behaviors. Baseline e-cigarette use was associated with marijuana use initiation and reinitiation (ORs = 2.08, 1.37, respectively, both ps < .05) but not persistence at follow-up. Additionally, baseline marijuana use was associated with only e-cigarette use initiation (OR = 2.23, p < .01) but not reinitiation or persistence at follow-up. Findings partially support the gateway hypothesis that e-cigarette use could be a steppingstone to marijuana use reinitiation among the U.S. adults. The mechanisms and behavioral characteristics, such as etiological and psychosocial factors, that may pertain to the progression from e-cigarette use to reinitiation of other substance use should be further investigated to inform effective behavioral, educational, and policy interventions.