*New research from UC San Diego suggests young people who use cannabis may be more likely to become regular tobacco users.
Published in Tobacco Control, the study estimates that cannabis use could account for roughly 13 percent of new regular tobacco use cases among American youth. “This study challenges long-held assumptions about the pathways between cannabis and tobacco use among youth,” said lead author Dr. Karen Messer of UC San Diego’s Herbert Wertheim School of Public Health.
The analysis drew from a 2017 national dataset of more than 13,800 respondents between the ages of 12 and 24, all of whom had no prior history of regular tobacco use. Among participants, fifteen percent reported recent cannabis use within the previous year. When researchers followed up four years later, those who had used cannabis were significantly more likely to have taken up regular tobacco use than those who had not.
The link was particularly pronounced among adolescents. Among 12-to-17-year-olds, nearly 33 percent of cannabis users had become regular tobacco users by 2021. Among 18-to-24-year-olds, about 14 percent of cannabis users transitioned to regular tobacco use.
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Using national projections, researchers estimate over 500,000 young Americans might have avoided regular tobacco use without prior cannabis exposure. However, the observational study cannot prove direct causation. Messer emphasized, “These findings underscore the importance of investigating not only the direct effects of cannabis, but also its broader influence on patterns of tobacco initiation and dependence.”
The authors acknowledge limitations, noting unmeasured factors like socioeconomic status, peer influences, and general substance use vulnerability may contribute to the pattern. The findings point to what researchers call a potential “reverse gateway” effect, where cannabis precedes tobacco rather than the traditional assumption.
Despite these limitations, the study’s authors recommend treating youth cannabis use as a meaningful risk factor for future tobacco addiction.
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