Does Marijuana Use Serve as a Gateway to Nicotine Dependence for African-American Youth?

Purpose: As a result of the relatively widespread acceptance of the gateway hypothesis, most efforts to prevent adolescent substance use focus on preventing young people from going through the “gateways” (e.g., using tobacco) so that they will not progress to the use of illicit drugs. Implicit in this prevention strategy is the assumption that all young people, irrespective of their socio-demographic characteristics (e.g., race/ethnicity), proceed sequentially through the same pattern of substance use. If this assumption is correct, existing prevention approaches might be equally effective for all young people. Unfortunately, the findings of recent research suggest that this assumption may not be true. Although substance use among African American youth is lower than other racial and ethnic groups, they more likely to have used the illicit drug, marijuana, than they are to have used cigarettes (Johnston et al., 2007). In light of these well documented and substantial racial differences in adverse substance-related health and social consequences (e.g., cancer mortality, incarceration), investigating the extent to which there are racial differences in the sequence in which young people initiate the use of illicit drugs may suggest the need for race-specific approaches to substance use prevention. Accordingly, this investigation tested whether the gateway hypothesis of drug initiation sequencing applies equally well to African American and Caucasian youth.

Methods: The study sample (N= 723, mean age = 15.5, SD = 1.2) represented the population of residents in the Missouri Division of Youth Services (DYS) residential rehabilitation system. The analytic sample was comprised of youth (N = 618) who had initiated marijuana and nicotine use. Chi-square proportional tests, logistic regression, and multinomial simulation test were conducted to assess marijuana and cigarette use sequences among racial and ethnic groups.

Results: Findings revealed that African American youth were significantly more likely to initiate marijuana use before cigarette use. Over one-third of African Americans reported initiating marijuana before cigarettes (37.9%), compared to less than one-quarter of youth in the other ethnic groups (Caucasian = 17.3%, Latino/Latina = 21.7%, Biracial / other = 20.8%). Further, multinomial simulation and logistic regression models revealed that African-American youth were significantly more likely than other ethnic groups to initiate marijuana before cigarettes (Adjusted OR = 3.53, CI = 1.92 – 6.46).

Implications for policy and practice: Despite the influence of the gateway hypothesis as the conceptual foundation for many current prevention approaches, the data presented here suggest that the gateway theory may not be equally applicable to African American young people. Findings of this study support notions that marijuana can serve as a gateway drug for nicotine dependence. Moreover, there is no developmental reason to believe that the gateway sequence is invariant. The practical implication is that universal prevention strategies predicated on specified gateway sequences might need to be amended for African-American youth. For example, a greater focus on preventing marijuana initiation as a means for interrupting future nicotine dependence may be of great utility.