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Cannabis or alcohol first? Differences by ethnicity and in risk for rapid progression to cannabis-related problems in women

Published online by Cambridge University Press:  18 July 2012

C. E. Sartor ,
A. Agrawal ,
M. T. Lynskey ,
A. E. Duncan ,
J. D. Grant ,
E. C. Nelson ,
P. A. F. Madden ,
A. C. Heath  and
K. K. Bucholz
C. E. Sartor*
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
A. Agrawal
Affiliation:
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
M. T. Lynskey
Affiliation:
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
A. E. Duncan
Affiliation:
George Warren Brown School of Social Work, Washington University, St Louis, MO, USA
J. D. Grant
Affiliation:
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
E. C. Nelson
Affiliation:
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
P. A. F. Madden
Affiliation:
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
A. C. Heath
Affiliation:
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
K. K. Bucholz
Affiliation:
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
*
*Address for correspondence: C. E. Sartor, Ph.D., Department of Psychiatry, Yale School of Medicine, VA Connecticut Healthcare System, 950 Campbell Ave. (151D), West Haven, CT 06516, USA. (Email: carolyn.sartor@yale.edu)
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Abstract

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.

Keywords

African-Americansalcoholcannabiswomen
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 4 , April 2013 , pp. 813 - 823
Copyright
Copyright © Cambridge University Press 2012

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