Cannabis or alcohol first? Differences by ethnicity and in risk for rapid progression to cannabis-related problems in women.
BACKGROUND
Initiation of cannabis use typically follows alcohol use, but the reverse order does occur and is more common for African-Americans (AAs) than European-Americans (EAs). The aim of this study was to test for differences in the order of initiation of cannabis and alcohol use between AA and EA women and to determine whether order and ethnicity contribute independently to risk for rapid progression to cannabis-related problems. Method Data were drawn from structured psychiatric interviews of 4102 women (mean age = 21.6 years), 3787 from an all-female twin study and 315 from a high-risk family study; 18.1% self-identified as AA, 81.9% as EA. Ethnicity and order of initiation of cannabis and alcohol use were modeled as predictors of transition time from first use to onset of cannabis use disorder symptom(s) using Cox proportional hazards regression analyses.


RESULTS
AA women were nearly three times as likely as EA women to initiate cannabis use before alcohol use. Using cannabis before alcohol [hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.08-1.93] and AA ethnicity (HR 1.59, 95% CI 1.13-2.24) were both associated with rapid progression from first use to cannabis symptom onset even after accounting for age at initiation and psychiatric risk factors.


CONCLUSIONS
The findings indicate that AA women are at greater risk for rapid development of cannabis-related problems than EA women and that this risk is even higher when cannabis use is initiated before alcohol use. Prevention programs should be tailored to the various patterns of cannabis use and relative contributions of risk factors to the development of cannabis-related problems in different ethnic groups.
Department of Psychiatry, Yale School of Medicine, New Haven, CT 06516, USA. carolyn.sartor@yale.edu
C E
CE
Sartor
A
A
Agrawal
M T
MT
Lynskey
A E
AE
Duncan
J D
JD
Grant
E C
EC
Nelson
P A F
PA
Madden
A C
AC
Heath
K K
KK
Bucholz
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D017668:Age of Onset; D000428:Alcohol Drinking / Q000208:ethnology*; D000437:Alcoholism / Q000208:ethnology*; D018450:Disease Progression; D004200:Diseases in Twins; D005192:Family Health; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D002189:Marijuana Abuse / Q000208:ethnology*; D008385:Marijuana Smoking / Q000208:ethnology*; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult