Effects of alcohol and cigarette use on the initiation, reinitiation, and persistence of cannabis use from adolescence to emerging adulthood

Objective: Adolescent cannabis use has been associated with several negative outcomes. A previous study on an adult sample found alcohol and cigarette use to be associated with three cannabis use stages: initiation, re initiation, and persistence, which represent distinct periods of use regarding progression and severity. Yet, the risk factors associated with these important stages have never been examined in a longitudinal study spanning adolescence to emerging adulthood. Methods: Using longitudinal data from Add Health Waves 1-3, 1775 nonusers, 200 prior users, and 384 current users of cannabis were identified who were at risk of cannabis use initiation, reinitiation, and persistence, respectively. Three logistic regressions were conducted to examine the effects of prior cigarette and alcohol use on the three cannabis use stages, controlling for sociodemographic factors. Results: Early onset of cigarette use (OR = 2.04, p = 0.006) and higher alcohol use frequency (OR = 1.40, p < 0.001) were associated with cannabis use initiation. Greater cigarette use quantity was associated with a lower likelihood of reinitiation of cannabis use (OR = 0.58, p = 0.02). Increased cannabis use frequency (OR = 1.72, p = 0.006) and higher alcohol use frequency (OR = 1.32, p = 0.048) were associated with persistence of cannabis use. Sociodemographic factors such as household income, sex, and being older adolescents were associated with different cannabis use stages. Conclusions: Prior cigarette and alcohol use affect the risk of initiation, reinitiation, and persistence of cannabis use. The specific risk factors vary across different cannabis use stages. Interventions to prevent adolescent cannabis use should recognize these different risk factors and tailor to the stages of cannabis use.