Racial Differences and the Role of Neighborhood in the Ordering of Onset of Marijuana and Tobacco Use Among Urban Youth

Background: While previous work has shown that youth tend to initiate tobacco products before they initiate the use of marijuana consistent with the gateway hypothesis, there is preliminary evidence suggesting that African American youth may be more likely than their White counterparts to initiate marijuana either before tobacco or at the same time as tobacco.  Understanding the process by which minority youth initiate marijuana and tobacco is critical considering the evidence of long-term negative consequences of adolescent marijuana and tobacco use, particularly for disadvantaged youth. 

Method: In this study, we add to the growing literature base about the order of onset of tobacco and marijuana by utilizing prospectively gathered data from the Baltimore Prevention Intervention Research Center.  The study began in 1993 with 678 boys and girls who were entering first grade in one of nine Baltimore city public elementary schools.  Data was collected mostly annually through age 25.  We focus on the following research questions using the childhood, middle school, and high school data.  First, are African American urban youth more likely than White urban youth to initiate marijuana before they initiate tobacco use?  Second, do neighborhood factors, including neighborhood disadvantage, neighborhood drug trafficking, and community violence exposure, predict onset ordering?  Specifically, we investigate the role of neighborhood disadvantage and neighborhood drug trafficking measured by the Neighborhood Environment Scale, as well witnessing and experiencing violence as measured by the Child Report of Violence Exposure.

Results: Regression analyses show that African Americans are more than twice as likely as Whites (OR = 2.724, p=0.017) to initiate marijuana before tobacco compared to initiating tobacco before marijuana.  While neighborhood disadvantage and drug trafficking did not differentiate those who initiated marijuana first from those who initiated tobacco first, community violence exposure, particularly experiencing greater violent victimization, predicted ordering onset (OR=2.656, p=0.014).    

Conclusion:  This study offers evidence that the process by which African American youth initiate marijuana and tobacco may differ from conventional drug progression pathways.  Further, the alternative pathway by which marijuana is initiated before tobacco use may be rooted in a history of violent victimization, which is more common among urban youth.  Future research is necessary to understand the interrelationship of tobacco and marijuana use among urban youth, and in particular study the role of blunts (hollowed-out cigars or leaf tobacco filled with marijuana), which is particularly common among urban African Americans.  This information is critical to reduce the burden of adverse health consequences associated with tobacco and marijuana.