Proportion of young people who tried cigarettes as their first drug fell over the same period, US study says

The proportion of young people using marijuana as their first drug doubled in the 10 years from 2004, a US-based study has found.

The government study reveals that among people aged between 12 and 21, the proportion of those who tried cigarettes as their first drug fell from about 21% to just under 9% between 2004 and 2014. However, the proportion who turned first to marijuana almost doubled from 4.4% to 8%.

While some studies have suggested that, overall, use and abuse of marijuana has fallen among teenagers in the US, the latest research sought to look at trends in which drug, if any, young people turned to first.



“We have, particularly in the US, done prevention programmes that are really focused on alcohol and tobacco – and they are relatively easy arguments to make to young people,” said Dr Renee Johnson, a co-author of the study from Johns Hopkins Bloomberg School of Public Health.

But she said the “fear factor” is less likely to work for marijuana, noting that public programmes need instead to educate young people so they can make good decisions around drugs, and offer support to help them cope with difficulties in life and think about their life plans. “Once we teach young people about that, that will address the unhealthy marijuana use,” she said.

The study, published in the journal Prevention Science, is based on an analysis of data from more than 275,000 participants aged between 12 and 21 collected as part of the US national survey on drug use and health – an annual study that involves participants across all 50 states who are interviewed in person.



Among the findings, the team found that between 2004 and 2014, reported age at first use of each of the substances rose. What’s more, the proportion of young people reporting no drug use increased from 35.5% to just over 46%, while the proportion reporting cigarettes as their first substance fell. The proportion reporting alcohol as the first drug remained fairly constant at about 30%.

Males were more likely than females to report using marijuana first. Ethnicity was also a factor, with almost 12% of American Indian and Alaskan native participants and over 9% of black participants reporting marijuana as their first drug – compared to under 5% of white participants and 2.5% of Asian participants.

Once age, sex and ethnicity were taken into account, the team found that those who smoked marijuana first were more likely to be current heavy marijuana users and have cannabis use disorder than those who used other substances first.

They were also as likely as those who used cigarettes first to have a nicotine dependancy if a smoker. “One concern about marijuana and tobacco use is [if] it increases tobacco use later in life,” said Johnson.

In addition, those who reported marijuana or alcohol as their first substance were more likely to report use of other drugs, such as heroin, than those who first used cigarettes or other tobacco products.

Prof Terrie Moffitt, a clinical psychologist at King’s College London who was not involved in the study, said the data was robust.

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“The finding might arise because in the past decade, there have been major public campaigns warning of the dangers of tobacco and alcohol, whereas in contrast the media coverage of American states legalising cannabis creates the public impression that cannabis has no risks or dangers,” she said.

Sir Robin Murray, professor of psychiatric research at King’s College London, agreed, saying the findings are highly predictable. “It’s a pity that so many young people appear to be swopping one set of health risks with another,” he said.

The impact of cannabis on the brains of young people, mental health and life prospects has received much scrutiny. Moffitt noted the latest study shows it is young people who are already living in socially disadvantaged circumstances who tend to turn to marijuana as their first drug.

“If indeed it is not safe for teens, then cannabis use could compound the life challenges they already have to surmount to make their way in the world as adults,” she said.