ArticleAddictive behaviors2025
The gateway effect of cigarette, e-cigarette, cigar, and alcohol use vs. Cannabis use.
Article in Addictive behaviors, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Might cannabis Legalization Have Affected Public Health-Relevant Alcohol- and Tobacco-use Outcomes in Canada?Nordisk alkohol- & narkotikatidskrift : NAT · 2026Article
- Substance use patterns from late childhood to mid-adolescence: Updates on the Adolescent Brain Cognitive Development Study.Drug and alcohol dependence reports · 2026Article
- Association between cannabis use and major depressive disorder: a population-based cross-sectional study.Journal of cannabis research · 2026Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
backgroundWhile the gateway hypothesis suggests that using tobacco and alcohol increases likelihood of initiating cannabis, cannabis use may precede and increase other substance use. We examined gateway effects of cigarettes, e-cigarettes, cigars, and alcohol on cannabis use, and reverse associations.
methodsWe analyzed 2023 survey data from 4,031 US young adults (M
resultsLifetime use was: 68 % for cannabis, 45 % cigarettes, 49 % e-cigarettes, 31 % cigars, and 85 % alcohol. Past-year cigarette, e-cigarette, cigar, and alcohol initiation increased hazards of initiating cannabis (adjusted Hazard Ratio, aHR = 3.78, 95 %CI = 3.39-4.22; aHR = 2.17, 95 %CI = 1.86-2.53; aHR = 2.90, 95 %CI = 2.45-3.43; aHR = 3.41, 95 %CI = 3.11-3.75, respectively). Past-year cannabis initiation increased hazards of other substance initiation (cigarettes: aHR = 3.51, 95 %CI = 3.11-3.96; e-cigarettes: aHR = 3.73, 95 %CI = 3.34-4.17; cigars: aHR = 3.66, 95 %CI = 3.20-4.18; alcohol: aHR = 3.07, 95 %CI = 2.73-3.45). Associations were generally stronger when initiation occurred at ages 5-18 vs. > 18. Depression predicted cannabis initiation; anxiety and ADD predicted e-cigarette initiation. Certain personality characteristics were protective against initiation (agreeableness and conscientiousness for each, openness for cigarettes and cigars, emotional stability for cannabis, cigarettes, and cigars); extraversion increased hazards of initiating cannabis and e-cigarettes.
conclusionsInterventions should target underlying mechanisms influencing the use of various substances, such as mental health and personality characteristics, especially among adolescents.
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