Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Drug Alcohol Depend. 2023 Aug 1;249:109948. doi: 10.1016/j.drugalcdep.2023.109948. Epub 2023 May 27.
Simultaneous alcohol and marijuana (SAM) use is associated with adverse consequences for youth. While SAM use is overall declining among youth, prior studies indicate increasing marijuana use among US adolescents who ever used cigarettes, suggesting possible moderation of the alcohol-marijuana relationship by cigarette use.
We included 43,845 12-th grade students participating in Monitoring the Future data (2000-2020). A 5-level alcohol/marijuana measure was used, including past-year SAM, alcohol-only, marijuana-only, non-simultaneous alcohol and marijuana, or no use. Multinomial logistic regressions estimated associations between time periods (categorized based on sample size: 2000-2005, 2006-2009, 2010-2014, 2015-2020) and the 5-level alcohol/marijuana measure. Models adjusted for sex, race, parental education and survey mode and included interactions of time periods and lifetime cigarette or vaped nicotine use.
While overall SAM among 12th graders decreased from 23.65% to 18.31% between 2000 and 2020, SAM increased among students who never used cigarettes or vaped nicotine (from 5.42% to 7.03%). Among students who ever used cigarettes or vaped nicotine, SAM increased from 39.2% in 2000-2005-44.1% in 2010-2014 then declined to 37.8% in 2015-2020. Adjusted models controlling for demographics indicated that among students with no lifetime cigarette or vaped nicotine use, students in 2015-2020 had 1.40 (95% C.I. 1.15-1.71) times the odds of SAM, and 5.43 (95% C.I. 3.63-8.12) times the odds of marijuana-only (i.e., no alcohol use) compared to students who used neither in 2000-2005. Alcohol-only declined over time in both students who ever and never used cigarettes or nicotine vape products.
Paradoxically, while SAM declined in the overall adolescent US population, the prevalence of SAM increased among students who have never smoked cigarettes or vaped nicotine. This effect arises because of a substantial decline in the prevalence of cigarette smoking; smoking is a risk factor for SAM, and fewer students smoke. Increases in vaping are offsetting these changes, however. Preventing adolescent use of cigarettes and nicotine vaped products could have extended benefits for other substance use, including SAM.
同时饮酒和吸食大麻（SAM）与青少年的不良后果有关。尽管青少年的 SAM 使用总体呈下降趋势，但先前的研究表明，在美国青少年中，曾经使用过香烟的人中吸食大麻的比例有所增加，这表明吸烟可能会调节酒精和大麻之间的关系。
我们纳入了 43845 名参与“监测未来”数据（2000-2020 年）的 12 年级学生。使用了 5 级酒精/大麻测量方法，包括过去一年的 SAM、仅饮酒、仅吸食大麻、非同时饮酒和吸食大麻或未使用。多项逻辑回归估计了时间期间（基于样本量分类：2000-2005 年、2006-2009 年、2010-2014 年、2015-2020 年）与 5 级酒精/大麻测量之间的关联。模型调整了性别、种族、父母教育程度和调查模式，并包括了时间期间和终生吸烟或吸食尼古丁产品的交互作用。
尽管 12 年级学生的总体 SAM 从 2000 年的 23.65%下降到 2020 年的 18.31%，但从未使用过香烟或吸食过尼古丁的学生的 SAM 却有所增加（从 5.42%增加到 7.03%）。在曾经使用过香烟或吸食过尼古丁的学生中，SAM 从 2000-2005 年的 39.2%增加到 2010-2014 年的 44.1%，然后在 2015-2020 年下降到 37.8%。控制人口统计学因素的调整模型表明，在没有终生吸烟或吸食尼古丁的学生中，与 2000-2005 年既不使用也不吸食的学生相比，2015-2020 年的学生 SAM 的可能性增加了 1.40（95%CI 1.15-1.71）倍，而仅吸食大麻（即不饮酒）的可能性增加了 5.43（95%CI 3.63-8.12）倍。在两个曾吸烟或使用尼古丁电子烟的学生群体中，仅饮酒的比例随着时间的推移而下降。
矛盾的是，尽管美国青少年的 SAM 使用总体呈下降趋势，但从未吸烟或吸食过尼古丁的学生的 SAM 发生率却有所增加。这种影响源于吸烟的普遍减少；吸烟是 SAM 的一个风险因素，吸烟的学生人数减少了。然而，电子烟的使用增加抵消了这些变化。防止青少年使用香烟和尼古丁电子烟产品可能会对其他物质使用产生延伸效益，包括 SAM。
