Green Kerry M, Johnson Renee M, Milam Adam J, Furr-Holden Debra, Ialongo Nicholas S, Reboussin Beth A
a Department of Behavioral and Community Health , University of Maryland School of Public Health , College Park , Maryland , USA.
b Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.
Subst Abus. 2016 Oct-Dec;37(4):507-510. doi: 10.1080/08897077.2016.1178680. Epub 2016 Apr 19.
With patterns of initiation of tobacco and marijuana changing, there is increasing evidence that marijuana use may serve as an antecedent to tobacco use among adolescents. However, studies have not fully characterized the prevalence of these patterns among vulnerable youth and have rarely examined the factors that predict the sequencing of onset of tobacco and marijuana use.
Utilizing longitudinal data from a sample of urban youth followed from age 6 to age 18, the authors identify the sequencing of initiation of tobacco and marijuana and test whether race and 5 neighborhood factors (i.e., perceived disorder, drug activity, drug access, exposure to violence, and exposure to violent victimization) predict onset sequencing.
Various sequencing patterns were observed, with 12.4% of the sample initiating marijuana use before tobacco use was initiated. In adjusted logistic regression models, black youth were 2.66 times as likely as whites to initiate marijuana before tobacco compared with initiating tobacco before marijuana (P = .032). Youth with greater exposure to violent victimization were 3.89 times as likely to initiate marijuana first than initiate tobacco first (P = .002). Other neighborhood factors were not statistically significantly associated with sequencing.
Black youth and youth with greater exposure to victimization had an increased risk of initiating marijuana before tobacco, which suggests that this pattern may be rooted in specific risk factors. Substance use prevention efforts should consider taking into account that marijuana use may put certain youth at risk of initiating tobacco. Future research needs to monitor sequencing, as well as risk factors for and consequences of the various patterns, particularly since marijuana use and the mixing of tobacco and marijuana use are gaining acceptability in general populations.
随着烟草和大麻使用起始模式的变化，越来越多的证据表明，在青少年中，大麻使用可能是烟草使用的前奏。然而，研究尚未充分描述这些模式在弱势青年中的流行情况，并且很少研究预测烟草和大麻使用起始顺序的因素。
利用对一批城市青年从6岁到18岁进行跟踪调查的纵向数据，作者确定了烟草和大麻使用起始的顺序，并测试种族和5个社区因素（即感知到的混乱、毒品活动、毒品获取、暴力暴露和暴力受害经历）是否能预测起始顺序。
观察到了各种起始顺序模式，12.4%的样本在开始使用烟草之前就开始使用大麻。在调整后的逻辑回归模型中，与先开始使用烟草再开始使用大麻相比，黑人青年先开始使用大麻再开始使用烟草的可能性是白人的2.66倍（P = 0.032）。暴力受害经历更多的青年先开始使用大麻而不是先开始使用烟草的可能性是其3.89倍（P = 0.002）。其他社区因素与起始顺序没有统计学上的显著关联。
黑人青年以及暴力受害经历更多的青年在开始使用烟草之前开始使用大麻的风险增加，这表明这种模式可能源于特定的风险因素。药物使用预防工作应考虑到大麻使用可能使某些青年面临开始使用烟草的风险。未来的研究需要监测起始顺序以及各种模式的风险因素和后果，特别是因为大麻使用以及烟草与大麻混合使用在普通人群中越来越被接受。
