Among 6,131 co-users, about 71% tried tobacco first, with nicotine e-cigarettes the most common gateway product, especially among younger users.
Substance use prevention professionals, school health educators, and policymakers.
71% of co-users tried tobacco first; ~60% started with nicotine e-cigarettes
What the researchers found
38.4% of participants co-used tobacco and cannabis. Among co-users, 70.9% tried tobacco first, with e-cigarettes being the first tobacco product for ~60% of those who started with tobacco.
Why it matters
Understanding the sequence from e-cigarettes to cannabis can help design prevention programs targeting the most common entry point.
The numbers in context
6,131 participants. 38.4% co-used. 70.9% tried tobacco first. ~60% started with e-cigarettes.
How the study worked
Cross-sectional national survey of 6,131 participants aged 13-40 reporting use of 17 tobacco and cannabis products.
What this study cannot tell us
Cross-sectional with retrospective recall. Does not establish causation.
How to read the evidence
Large national survey with detailed product data, but cross-sectional design limits causal inference.
When this study was published
Published in 2024.
The bigger picture
For today's generation, nicotine e-cigarettes may serve as initial substance exposure preceding cannabis, a different sequence from previous generations.
Questions still open
- Would reducing e-cigarette access decrease cannabis initiation?
- Is the sequence causal or reflecting shared risk factors?
Common questions
Do people start with tobacco or cannabis first?
Are e-cigarettes a gateway to cannabis?
Read the original research
Products and patterns through which adolescents, young adults, and adults initiate co-use of tobacco and cannabis.
Addictive behaviors, 158, 108105
Citation
McCauley, Devin M; Liu, Jessica; Gaiha, Shivani Mathur; Halpern-Felsher, Bonnie. (2024). Products and patterns through which adolescents, young adults, and adults initiate co-use of tobacco and cannabis.. Addictive behaviors, 158, 108105. https://doi.org/10.1016/j.addbeh.2024.108105
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