Initial use of tobacco or marijuana and later use profiles in young adults
Amy J. Park 1
Milkie Vu 2
Carla J. Berg 3, 4  
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Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, United States
Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, United States
Department of Preventive and Community Health, Milken School of Public Health, George Washington University, Washington, United States
George Washington Cancer Center, Washington, Unites States
Carla J. Berg   

Department of Preventive and Community Health, Milken School of Public Health, George Washington University, Washington, DC, Unites States
Publication date: 2020-03-05
Submission date: 2019-10-17
Final revision date: 2019-11-08
Acceptance date: 2020-01-23
Tob. Prev. Cessation 2020;6(March):16
Given the relatively limited literature regarding risk factors for progression of alternative tobacco and marijuana use, this study examined initially-used tobacco or marijuana products and psychosocial risk factors such as adverse childhood events (ACEs), mental health (depression, ADHD), and parental substance use, in relation to young adult lifetime and current (past 30- day) tobacco and marijuana use.

Using cross-sectional data from a 2014–2016 study of 3418 young adult college students in Georgia, we analyzed lifetime and current use of various tobacco products (cigarettes, cigar products, smokeless tobacco, e-cigarettes, hookah) and marijuana among lifetime tobacco or marijuana users (N=1451) in relation to initially-used product as well as sociodemographic characteristics and psychosocial risk factors.

Multivariable analyses indicated that more products ever used correlated with cigarettes being first used (vs cigars, B=-0.66; e-cigarettes, OR=-1.33; hookah, B=-0.99; and marijuana, B=-1.05; p<0.001), as well as being older (B=0.06), male (B=-0.72) and White (vs Black, B=-0.30; or Asian, B=-0.60), more adverse childhood events (ACEs, B=0.07), and parental marijuana use (B=0.47; p<0.05). Currently-used products correlated with cigarettes being first used (vs cigars, B=-0.18; e-cigarettes, B=-0.37; and hookah, B=-0.18; p<0.05), being younger (B=-0.04), male (B=-0.15), more depressive symptoms (B=0.01), and parental marijuana use (B=0.40; p<0.05). Current cigarette, smokeless tobacco, hookah and marijuana use demonstrated specificity to initially-used products.

Initially-used products, specifically cigarettes, with well-documented and communicated risks, correlated with using more products subsequently among young adults, underscoring needed research on such risks and risk communication, and early intervention strategies.

We would like to thank our Campus Advisory Board members across the state of Georgia in developing and assisting in administering this survey. We also thank ICF Macro for their scientific input and technical support in conducting this research.
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
This research was supported the National Cancer Institute (R01 CA179422- 01; PI: Berg). C.J. Berg is also supported by the National Cancer Institute (R01CA215155-01A1; PI: Berg; R01CA239178-01A1; MPIs: Berg, Levine; P30CA138292; PI: Curran), the Fogarty International Center/NIH/NIEHS (1R01TW010664-01; MPIs: Berg, Kegler; D43ES030927-01; MPIs: Berg, Marsit, Sturua). M. Vu is also supported by the National Cancer Institute (F31 CA243220-01; PI: Vu). The funders had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript or the decision to submit it for publication.
AP and CJB co-led the overall conceptualization and writing of the manuscript, as well as data analysis. MV, RH and MW contributed to the overall conceptualization of the parent study and the current manuscript, and contributed to the final preparation of the manuscript. All authors reviewed and approved of the final manuscript.
Not commissioned; externally peer reviewed.
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