Recent studies reveal gateway interactions between cigarettes, e-cigarettes, and cannabis use

Recent studies demonstrate that the consumption of cigarettes, e-cigarettes, and cannabis are interrelated. In consideration of the developments towards cannabis legalisation in Switzerland, this calls for a well-developed policy environment for cigarettes, e-cigarettes, and cannabis.

• The US National Survey on Drug Use and Health (NSDUH), conducted by the Substance Abuse and Mental Health Services Administration in 2019, demonstrated that although concerns have traditionally centered on tobacco as a gateway to cannabis use, cannabis use also shapes patterns of tobacco consumption, with the dual use of both substances common among young people. The survey showed that amongst the group of cigarette smokers, 46% of those aged 18–25 and 60% of adolescents aged 12–17 used cannabis in the past month.
  
• Weinberger et al. (2021) drew data from the 2002-2019 NSDUH and included US individuals aged 12+ who used cigarettes at least once in the past month (n=231,572). The authors indicated that US individuals who use both cigarettes and cannabis report a higher prevalence of cigarette dependence relative to individuals who only use cigarettes.

Studies reveal that the gateway path is present towards e-cigarettes as well.

• With the study population of 3,929 young adults aged 18-25, drawn from the 2018 California Health Interview Survey (CHIS), Meng et al. (2022) investigated the relationship between the use of cigarettes, e-cigarettes, or cannabis. Meng et al. (2022) found that those young adults who were using one product (e-cigarettes, cigarettes, or cannabis) had significantly increased odds of using any other one of those in the future, compared to those who didn’t consume any of the products.
  
• In their longitudinal study based in Germany, Seidel et al. (2021) demonstrated that e-cigarette use among cannabis non-users was associated with future cannabis use. With a cohort of 3,040 students who had never used cannabis in their lifetime, Seidel et al. (2021) demonstrated that 34.5% of the e-cigarette users used cannabis during the 18-month observation period, whereas only 10.4% of those who had never tried e-cigarettes used cannabis in that same period of time.,. The association remained significant, even after adjusting for social-demographic and personality factors, other substance use, and peer cannabis use.
  
• The study from Sun et al. (2022) used a cohort of youths aged 12-17 years who participated in the nationally representative US PATH study. Their cohort comprised of 9,828 youth who had never used cannabis. They found a significant and robust association between baseline e-cigarette use among non-cannabis-using youth and subsequent cannabis use.
  
• Westling et al. (2022) stated that prospective studies indicate that youth who initiate e-cigarettes are more likely to subsequently initiate conventional cigarettes and may even be more likely to subsequently initiate marijuana use, than those who did not begin e-cigarette use. In their sample of 1,123 eight-grade students followed between 2014 and 2017, youth were more likely to transition from e-cigarettes to cigarettes or marijuana than the reverse; fewer youth reported onset of cigarette or marijuana use prior to use of the other substances.

From a large, US nationally representative sample, Vuolo et al. (2021) collected individual-level data from adolescents ages 12-16 to examine the impact of cannabis policies on cigarette smoking. They showed that with robust tobacco control policies, including significant effects of comprehensive smoking bans, total vending machine restrictions, single cigarette sales restrictions, and advertising restrictions, cannabis liberalisation policies do not directly affect young adult smoking patterns in an adverse way.

Therefore, in light of the explosion of e-cigarettes across Switzerland and the foreseen legalisation of cannabis, it is crucial that we establish a well-regulated environment that ensures youth are not ensnared in this gateway triangle of cigarette, e-cigarette, and cannabis consumption.

Publication bibliography

Meng, Ying-Ying; Yu, Yu; Ponce, Ninez A. (2022): Cigarette, electronic cigarette, and marijuana use among young adults under policy changes in California. In Addictive behaviors reports 16, p. 100459. DOI: 10.1016/j.abrep.2022.100459.

Seidel, Ann-Kathrin; Morgenstern, Matthis; Galimov, Artur; Pedersen, Anya; Isensee, Barbara; Goecke, Michaela; Hanewinkel, Reiner (2021): Use of electronic cigarettes as a predictor of cannabis experimentation: A longitudinal study among German youth. In Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, Article ntab166. DOI: 10.1093/ntr/ntab166.

Substance Abuse and Mental Health Services Administration (2019): Key substance use and mental health indicators in the United States: results from the 2019 National Survey on Drug Use and Health. Available online at https://digitalcommons.fiu.edu/srhreports/health/health/32/.

Sun, Ruoyan; Mendez, David; Warner, Kenneth E. (2022): Use of Electronic Cigarettes Among Cannabis-Naive Adolescents and Its Association With Future Cannabis Use. In JAMA Netw Open 5 (7), e2223277. DOI: 10.1001/jamanetworkopen.2022.23277.

Vuolo, Mike; Lindsay, Sadé L.; Kelly, Brian C. (2021): Further Consideration of the Impact of Tobacco Control Policies on Young Adult Smoking in Light of the Liberalization of Cannabis Policies. In Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, Article ntab149. DOI: 10.1093/ntr/ntab149.

Weinberger, Andrea H.; Dierker, Lisa; Zhu, Jiaqi; Levin, Jacob; Goodwin, Renee D. (2021): Cigarette dependence is more prevalent and increasing among US adolescents and adults who use cannabis, 2002-2019. In Tob Control. DOI: 10.1136/tobaccocontrol-2021-056723.

Westling, Erika; Rusby, Julie C.; Crowley, Ryann; Light, John M. (2022): A Longitudinal Study of E-Cigarette, Cigarette, and Marijuana Use Sequence in Youth. In Tob Use Insights 15, 1179173X221101813. DOI: 10.1177/1179173X221101813.