assessing the association Between Electronic Cigarette Use among Cannabis-Naive adolescents and Future Cannabis Use-Overlapping Substances.

Introduction:
This text is a commentary on a study that examines the association between electronic cigarette (e-cigarette) use among cannabis-naive adolescents and future cannabis use. The study uses data from the Population assessment of Tobacco and health (PaTh) Study to analyze the longitudinal association between e-cigarette use and subsequent cannabis initiation. The authors document strong associations between prior e-cigarette use and the onset of cannabis use, even after adjusting for various sociodemographic and behavioral factors. however, they also note that the pathways from e-cigarette use to cannabis use are unlikely to explain a major portion of cannabis use among youths.

Key Points:

* The study uses data from the PaTh Study, a nationally representative household population study of 9828 cannabis-naive youths aged 12 to 17 years.
* The study documents strong associations between prior e-cigarette use and the onset of cannabis use.
* after adjusting for various sociodemographic and behavioral factors, e-cigarette use at baseline was associated with an adjusted relative risk for the onset of cannabis use of 2.19 to 3.41.
* The authors note that the pathways from e-cigarette use to cannabis use are unlikely to explain a major portion of cannabis use among youths.
* The study suggests that an explanation for the paradox of high rates of e-cigarette use in the face of generally stable prevalence of cannabis use in the overall youth population is that only a relatively modest subgroup of youths use e-cigarettes.
* The authors also discuss the potential biological mechanisms by which e-cigarettes could increase subsequent cannabis use.
* The study suggests that social and environmental factors may lead to the initiation and progression to further drug use, which may be successfully targeted by existing evidence-based prevention interventions.

Main Message:
The main message of this text is that there is a strong association between e-cigarette use and subsequent cannabis use among cannabis-naive adolescents. however, the study also notes that the pathways from e-cigarette use to cannabis use are unlikely to explain a major portion of cannabis use among youths. The authors suggest that the gateway properties of any drug are intensely driven by social and environmental factors that may lead to the initiation and progression to further drug use. The text highlights the importance of existing evidence-based prevention interventions in targeting these social and environmental factors to reduce the risk of future drug use among adolescents.

Compton WM, Einstein EB. assessing the association Between Electronic Cigarette Use among Cannabis-Naive adolescents and Future Cannabis Use-Overlapping Substances. JaMa network open. 2022;5(7):1. doi:10.1001/jamanetworkopen.2022.23282