Background

Understanding adolescent drug use mechanisms is critical for drug use prevention. Although some theories such as the gateway theory suggest that drug users gradually transition into using more addictive drugs, there is no consensus about such a hypothesis. One important factor that hinders the advancement of knowledge in this area is the scarcity of longitudinal studies examining the type of drugs adolescents initially use and the different pathways adolescents take to transition into using other drugs as they grow older.

Methods

Using the pooled sample of adolescent dug users (14–17 years old; n = 10,644) from the National Survey on Drug Use and Health (2015–2018), we constructed longitudinal data on adolescents’ illicit drug use history other than the use of tobacco and alcohol based on the age of drug initiation. This allowed us to investigate what drugs were initially used by adolescents, how the use of these drugs may have progressed into a new drug, and whether there were racial/ethnic differences in the initiation and progression. The retrospective longitudinal data analyses applied life table method and Cox regression models.

Results

Two thirds of the adolescent drug users initiated their drug use trajectories with marijuana, one quarter with inhalants, and the remaining with hallucinogens, prescription drugs, and hard drugs. Adolescent drug users who initiated with different drugs showed unique trajectories to the use of a new drug. By year 8, the probability of using a new drug was about 40% and 70% to 80% for adolescents who initiated with inhalants and other drugs, respectively. The probability of using a new drug for adolescents who initiated with marijuana and inhalants accumulated stably over time, and its difference with that of other drug users diminished over time. The multivariate Cox regression models suggest the observed discrepancies generally held after controlling for covariates. There were also racial/ethnic differences in adolescent drug use initiation and progression, with Black/African American adolescents being the least likely to switch to the use of a new drug.

Conclusion

Adolescents’ initial use of marijuana and inhalants may lead to substantial risks of using other drugs over time. It is therefore important to screen adolescent drug use comprehensively and provide early interventions to prevent an escalation to more detrimental drugs. The findings provide new evidence to support aspects of both the gateway and generalized risk drug use theories.

中文翻译：

---

青少年药物使用的开始和过渡到其他药物：跨种族/族裔的回顾性纵向检查

背景

了解青少年用药机制对于预防用药至关重要。尽管诸如网关理论之类的一些理论表明，吸毒者逐渐过渡为使用更具成瘾性的药物，但对于这种假设尚无共识。阻碍该领域知识发展的一个重要因素是缺乏纵向研究来研究青少年最初使用的药物类型，以及随着年龄的增长青少年过渡到使用其他药物的不同途径。

方法

使用《 全国药物滥用与健康调查》（2015-2018）的青少年挖地使用者（14-17岁；n = 10,644）的汇总样本，我们构建了关于青少年非法药物使用历史（而非使用毒品的历史）的纵向数据烟草和酒精取决于药物起始年龄。这使我们能够调查青少年最初使用的药物，这些药物的使用可能如何发展为新药物，以及在开始和发展过程中是否存在种族/种族差异。回顾性纵向数据分析应用寿命表方法和Cox回归模型。

结果

三分之二的青少年吸毒者开始使用大麻吸毒，四分之一吸入剂吸食，其余使用致幻剂，处方药和硬毒品。服用不同药物的青少年吸毒者对新药的使用表现出独特的轨迹。到第8年时，开始使用吸入剂和其他药物的青少年使用新药的可能性分别约为40％和70％至80％。随着大麻和吸入剂的使用，青少年使用新药的可能性随着时间的推移稳定增长，并且与其他吸毒者的差别随着时间的推移而逐渐减少。多元Cox回归模型表明，观察到的差异通常在控制协变量之后仍然存在。

结论

青少年最初使用大麻和吸入剂可能会导致长期使用其他药物的巨大风险。因此，全面筛选青少年用药并提供早期干预措施以防止升级为更多有害药物非常重要。研究结果提供了新的证据来支持门户和广义风险药物使用理论的各个方面。