All gates lead to smoking: The ‘gateway theory’, e-cigarettes and the remaking of nicotine

doi:10.1016/j.socscimed.2014.08.016

Social Science & Medicine

Volume 119, October 2014, Pages 45-52

https://doi.org/10.1016/j.socscimed.2014.08.016 Get rights and content

Highlights

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The gateway theory is a product of academic, media and popular accounts of drug use.
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Its influence continues to be felt in recent debates about electronic cigarettes.
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The ‘gateway’ has been transformed from a descriptive to a predictive model.
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Via the theory, nicotine is constituted as simultaneously ‘soft’ and ‘hard’.

Abstract

The idea that drug use in ‘softer’ forms leads to ‘harder’ drug use lies at the heart of the gateway theory, one of the most influential models of drug use of the twentieth century. Although hotly contested, the notion of the ‘gateway drug’ continues to rear its head in discussions of drug use—most recently in the context of electronic cigarettes. Based on a critical reading of a range of texts, including scholarly literature and media reports, we explore the history and gestation of the gateway theory, highlighting the ways in which intersections between academic, media and popular accounts actively produced the concept. Arguing that the theory has been critical in maintaining the distinction between ‘soft’ and ‘hard’ drugs, we turn to its distinctive iteration in the context of debates about e-cigarettes. We show that the notion of the ‘gateway’ has been transformed from a descriptive to a predictive model, one in which nicotine is constituted as simultaneously ‘soft’ and ‘hard’—as both relatively innocuous and incontrovertibly harmful.

Introduction

The idea that drug use in ostensibly harmless forms engenders more harmful drug use took hold in the twentieth century in tandem with increasing efforts to regulate and restrict drugs, reaching its epitome in the ‘gateway theory’ (also known as the ‘gateway hypothesis’). As its name suggests, the assumption at the heart of this concept is that certain drugs act as a ‘gateway’ to the usage of other drugs. This notion is readily invoked in discussions of a variety of substances, from cigarettes and alcohol, to cannabis and solvents. It has also featured prominently in debates about newer products such as electronic cigarettes (or ‘e-cigarettes’). However, although a seemingly straightforward theory, it is one with a complicated gestation and history.

In this paper we explore the history of this concept, highlighting the intersections between academic, media and popular accounts. We focus on the role of the gateway theory in not just describing relationships between forms of drug use but in categorizing different drugs and constituting them as harmful in particular ways. Our interest in the gateway theory and its effects on public discourse about drugs has been provoked by the debates about e-cigarettes and their relationship to smoking. As we aim to show in the second half of the paper, while the argument that e-cigarette use could lead to young people taking up smoking explicitly deploys the gateway theory, it is also quite different from earlier claims about ‘soft’ drugs as a stepping stone to ‘hard’ drugs.

Our exploration of the gateway theory and its re-emergence in debates about e-cigarettes is based on a critical reading of a range of texts, including scholarly literature and media accounts. Academic and policy literature on the gateway theory was found through searches of Google Scholar and media accounts were found through a search of LexisNexis. We also conducted Google Scholar searches to explore the literature discussing e-cigarettes in the context of gateway usage, along with broader Google searches to examine the ways the term ‘gateway’ is currently being employed in the media—both in accounts of e-cigarettes and beyond them.

The analysis that follows is not intended to represent a comprehensive review of the literature on this topic, although we have tried to conduct our search of the relevant bodies of literature in a reasonably organized and logical fashion (further detail is provided in the relevant sections below). Importantly, our goal is not to prove or disprove the veracity of the gateway theory; instead, our approach to this subject matter is influenced by material-semiotic approaches which take account of the role of both signs and things in the production of reality (e.g. Latour, 2007, Fraser and Valentine, 2008, Law, 2009). As Law (2009, p. 142) observes, “If all the world is relational, then so too are texts. They come from somewhere and tell particular stories about particular relations”. It is these stories we aim to explicate in the paper, focusing particularly on the ways that the concept has been continuously dismantled, reassembled and reappropriated, and its critical role in producing the notion of drug harms.

Section snippets

The origins of the gateway theory

Any consideration of the origins of the gateway theory must attend to its predecessor, the ‘stepping stone theory’, which formed the backdrop against which the notion of the ‘gateway drug’ emerged. The origins of the ‘stepping stone’ view of drugs are obscure, and sources attribute its roots differently. According to Sifanek and Kaplan (1995), the notion was initially articulated in a pamphlet printed by the U.S. Bureau of Narcotics in 1965 and asserted that drug users who begin with cannabis

Academic and policy literature on the gateway theory

Interest in the idea of the ‘gateway theory’ or ‘gateway drugs’ has flourished over the past three decades amongst researchers, clinicians and policy makers. Although it is beyond the scope of this paper to attempt a detailed analysis of the concept in the academic and policy literature, in an attempt to identify broad trends, we conducted Google Scholar searches of both terms in May 2014, limiting ourselves to documents published between 1975 and 2000, which arguably represents the concept's

The gateway theory and conceptions of ‘hard’ and ‘soft’ drugs

Questions of causality aside, there is empirical support for a patterned sequence in drug use in western countries, although this pattern is certainly not universal (see Degenhardt et al., 2010, Vanyukov et al., 2012). However, what does this actually tell us about drug use beyond the fact that some users tend to experiment with different types of drugs? In many respects, the gateway theory is a kind of epidemiological “black box” (Peretti-Watel, 2011). As Vanyukov et al. (2012, p. S5) observe,

The seductiveness of the ‘gateway’ trope: the media's uptake of the concept

As the preceding account makes clear, the notion of the ‘gateway drug’ was never a purely academic concept, but rather a hybrid of political, popular and academic accounts. The media has therefore had an important role to play in disseminating and popularizing the term. A LexisNexis search of media references to “gateway AND drug” in October 2013 placed the first reference to the concept in a Washington Post article in 1985 discussing DuPont's book (Weber, 1985). “Gateway drugs” were also

The resurrection of the gateway theory in e-cigarettes

Electronic cigarettes are a product launched in 2006 by a Chinese electronics company. While some models resemble cigarettes, they do not involve combustion but are battery-powered devices that deliver nicotine via an inhaled mist. Opinion on e-cigarettes has quickly polarized. While some tobacco harm reduction advocates have embraced e-cigarettes as a safer alternative to smoking cigarettes, for many working in the field of tobacco control they are merely the latest incarnation of the tobacco

Nicotine and reconceptualizations of ‘hardness’

Another notable difference in invocations of the ‘gateway’ in the context of e-cigarettes is the general absence of any reference to the concept's initial orientation towards illicit drugs, where gateway drugs induce a continuous movement towards ‘harder’ drugs (however that be defined). Only rarely is the specter of escalating drug abuse invoked—and such speculation is limited to media reports. For example, a recent NBC news article on e-cigarettes discusses a “life-long marijuana user” who

Conclusion

Although the concept of the gateway theory is often treated as a straightforward scientific theory, its emergence is rather more complicated. In effect, it is a hybrid of popular, academic and media accounts—a construct retroactively assembled rather than one initially articulated as a coherent theory. We have argued that what the gateway theory is and what it means is neither fixed nor stable. However, rather than detracting from its utility, this instability has been central to the continued

Acknowledgments

This article was inspired in part by conversations with Michael Mair about current deployments of the gateway theory in relation to e-cigarettes, Miley Cyrus, etc. We are extremely grateful to the two anonymous Social Science and Medicine reviewers, both of whom provided invaluable feedback that influenced the direction of the arguments presented in the paper.

References (84)

J.C. Anthony
Steppingstone and gateway ideas: a discussion of origins, research challenges, and promising lines of research for the future
Drug Alcohol Dependence
(2012)
K. Bell et al.
Nicotine control: e-cigarettes, smoking and addiction
Int. J. Drug Policy
(2012)
L. Degenhardt et al.
Evaluating the drug use ‘gateway’ theory using cross-national data: consistence and associations of the order of initiation of drug use among participants in the WHO World Mental Health Surveys
Drug Alcohol Dependence
(2010)
A. Golub et al.
The misuse of the ‘Gateway Theory’ in US policy on drug abuse control: a secondary analysis of the muddled deduction
Int. J. Drug Policy
(2002)
C.K. Haddock et al.
Evidence that smokeless tobacco use is a gateway for smoking initiation in young adult males
Prev. Med.
(2001)
H. Keane
Making smokers different with nicotine: NRT and quitting
Int. J. Drug Policy
(2013)
J.K. Pepper et al.
Adolescent males' awareness of and willingness to try electronic cigarettes
J. Adolesc. Health
(2013)
L.W. Reid et al.
Ecstasy and gateway drugs: initiating the use of ecstasy and other drugs
Ann. Epidemiol.
(2007)
S. Shiffman et al.
Ten years after the Rx-to-OTC switch of nicotine replacement therapy: what have we learned about the benefits and risks of non-prescription availability
Health Policy
(2008)
M.M. Vanyukov et al.
Common liability to addiction and ‘gateway hypothesis’: theoretical, empirical and evolutionary perspective
Drug Alcohol Dependence
(2012)

M.-P. Viveros et al.

Nicotine and cannabinoids: parallels, contrasts and interactions

Neurosci. Behav. Rev.

(2006)

W.P. Adelman

Nicotine replacement therapy for teenagers: about time or a waste of time?

JAMA Pediatr.

(2004)

R. Borland

Electronic cigarettes as a method of tobacco control

Br. Med. J.

(2011)

J. Braham

Drug firm fights drugs; Marion Labs teaches students how to say no

Ind. Week

(August 4 1986)

J.D. Brighton

Politics of pot

Newsweek

(Feburary 24 1997)

CDC

E-cigarette Use More than Doubles Among U.S. Middle and High School Students from 2011–2012

(2013)

K. Choi et al.

Young adults' favorable perceptions of snus, dissolvable tobacco products, and electronic cigarettes: findings from a focus group study

Am. J. Public Health

(2012)

CNN

E-cigarettes: Healthy Tool or Gateway Device?

(2013)

C. Corey et al.

Notes from the field: electronic cigarette use among middle and high school students — United States, 2011–2012

Morb. Mortal. Wkly. Rep.

(2013)

G. Davey Smith et al.

Confounding in epidemiological studies: why ‘independent’ effects may not be all they seem

Br. Med. J.

(1992)

L. Dayton

Pot leads to harder drugs, say researchers

Syd. Morning Her.

(June 28 1997)

J.R. DiFranza et al.

Measuring the loss of autonomy over nicotine use in adolescents: the Development and Assessment of Nicotine Dependence in Youths (DANDY) Study

Archiv. Pediatr. Adolesc. Med.

(2002)

R.L. DuPont

Getting Tough on Gateway Drugs: a Guide for the Family

(1984)

R.L. DuPont et al.

NIDA's role in applied research

J.-F. Etter et al.

Electronic cigarettes: users' profile, utilization, satisfaction and perceived efficacy

Addiction

(2011)

J.-F. Etter et al.

Electronic nicotine delivery systems: a research agenda

Tob. Control

(2011)

D. Fagan

Tobacco industry suffers new blow Clinton expected to tighten rules

Globe Mail

(August 22 1996)

L. Fleck

Genesis and Development of a Scientific Fact

(1979)

S. Fraser et al.

Needle fictions: medical constructions of needle fixation and the injecting drug user

Addict. Res. Theory

(2004)

S. Fraser et al.

Substance & Substitution: Methadone Subjects in Liberal Societies

(2008)

A. Givens et al.

I-Team: e-cigarettes, used to smoke marijuana, spark new concerns

(2013)

E.R. Gritz

Gender and the teenage smoker

M.L. Goniewicz et al.

Patterns of electronic cigarette use and user beliefs about their safety and benefits: an internet survey

Drug Alcohol Rev.

(2013)

W.D. Hall et al.

Is cannabis a gateway drug? Testing hypotheses about the relationship between cannabis use and the use of other illicit drugs

Drug Alcohol Rev.

(2005)

E. Hartney

What Is the Difference between Soft Drugs and Hard Drugs?

(2012)

J.E. Henningfield et al.

Electronic nicotine delivery systems: emerging science foundation for policy

Tob. Control

(2010)

G.L. Humfleet et al.

Is marijuana use becoming a ‘gateway’ to nicotine dependence?

Addiction

(2004)

A. Hyland et al.

Drug counselor report of adolescents abuse of nicotine replacement therapy

J. Addict. Dis.

(2006)

D. Kandel

Stages in adolescent involvement in drug use

Science

(1975)

D.B. Kandel

Issues of sequencing of adolescent drug use and other problem behaviors

Drugs Soc.

(1989)

D.B. Kandel

Examining the gateway hypothesis: stages and pathways of drug involvement

D. Kandel

Does marijuana use cause the use of other drugs

J. Am. Med. Assoc.

(2003)

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Marijuana and E-cigarette Initiation Among Adolescents: A Survival Analysis
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Prior literature suggests marijuana and e-cigarette initiation among adolescents is surpassing combustible cigarette uptake. Marijuana and nicotine co-use is also a concern as these products grow in popularity. Initiation trajectories for marijuana and e-cigarette products are not well understood, let alone how the use of one product may impact initiation susceptibility for the other.
We used national longitudinal data from the Population Assessment of Tobacco and Health study from 2013 to 2018. Eighth graders in Wave 1 made up the analytic sample (N = 2,270). We employed discrete time survival analyses to determine the likelihood of initiating marijuana and e-cigarettes between Waves 2 and 5. We used survival analyses to estimate the relationships between prior cigarette and marijuana use and subsequent e-cigarette initiation, as well as prior cigarette and e-cigarette use and subsequent marijuana initiation.
Previous marijuana initiation was associated with later e-cigarette initiation (odds ratio = 6.88, 95% confidence interval [4.89, 9.67]). Previous e-cigarette initiation was associated with later marijuana initiation (odds ratio = 9.28, 95% confidence interval [6.86, 12.56]). By wave 5, adolescents were more than 42% likely to initiate marijuana and e-cigarettes.
Susceptibility to marijuana and e-cigarette products starts as early as eighth grade and increases over time. The use of one product is significantly related to later initiation for the other. Rather than addressing marijuana and nicotine as separate concerns, interventions may benefit by recognizing the closely related nature of these products.
From gateways to multilinear connections: A qualitative longitudinal investigation of the relationships between vaping and smoking among adolescent users
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Citation Excerpt :
In turn, this escalation is conceived hierarchically: variously from ‘softer’ to ‘harder’ — from less to more risky, harmful, addictive, potent, or intoxicating substances and/or modes of usage (again, such classifications are employed differentially in the pursuit of varying political and epistemic priorities) (Kandel, 2002; Etter, 2018; Bell & Keane, 2014: 48). Significantly, where tobacco was once conceived as the ‘gateway drug’ common to almost every other form of substance use, this relationship has shifted over the past decade, with nicotine increasingly understood as a dangerously addictive drug in itself, and smoking progressively ‘denormalised’ (Bell et al., 2010); so much so that reverse-gateways (e.g. from cannabis to tobacco smoking and e-cigarettes) have been posited and investigated (Bell & Keane, 2014: 50; Patton et al., 2005; Weinberger et al., 2020; Wong et al., 2020). The motor of such escalation underpinning the gateway effect involves manifold possibilities, for example: 1) drug A activates a neural pathway that leads to the appetite for drug B; 2) tolerance of drug A leads to an escalation of dose met by drug B; 3) use of drug A reduces the inhibition to try drug B; 4) use of drug A engenders the social conditions (e.g. mixing in different circles to obtain supply and/or (re)normalising the use of certain substances) which leads to a greater likelihood of using drug B (see, variously, analyses by Vankuyov et al., 2012; Kandel & Kandel, 2014; Philips, 2015; Etter, 2018; Chapman, Bareham, & Maziak, 2019).
The international growth of e-cigarette use has been accompanied by a corresponding concern that e-cigarettes will act as a ‘gateway’ to smoking and the use of other drugs. Taking these concerns as our point of departure, we explore the relationships between vaping and smoking among a cohort of young people.
Qualitative longitudinal methods with a diverse sample of 36 14–18-year olds from the UK city of Leicester. A total of 66 depth interviews conducted across two phases separated by 6–12 months. The interviews were recorded, transcribed verbatim and thematically analysed.
We highlight a complex ‘tangle’ of connections between substances/risk behaviours recounted to us by our adolescent study participants, including multiple and multilinear relationships between vaping and smoking. These findings problematise some of the core axioms of the notion of gateways as an explanatory model of causality and sequential connection between smoking and vaping. They also throw into question gateway logics more fundamentally. While many of our study participants themselves consciously invoked ideas of ‘gateway effects’, the accounts they produced repeatedly disrupted the logics of connection (between e-cigarettes and smoking; one set of behaviours and another) presupposed in gateway theory and our own early lines of questioning. Accordingly, we explore how cultural understandings of gateway effects are invoked by users in accounting for their vaping and smoking behaviours, noting the potential influence of these ideas upon the very processes they are understood to apprehend.
Our findings suggest there is a case to be made to reinforce the distinctiveness of tobacco and e-cigarettes in the life-worlds of young people to avoid naturalising a ‘gateway’ logic of connection that might ultimately inform the associative logic of young users themselves, and potentially the development of their usage careers.
Risk assessment of inhaled diacetyl from electronic cigarette use among teens and adults
2021, Science of the Total Environment
Diacetyl (C₄H₆O₂) is a toxicant commonly found in electronic cigarettes (e-Cigs) as a flavoring component and an enhancer of e-juices. Lung injury in current and former workers in popcorn manufacturing suggests a possible association with diacetyl inhalation exposure. Although the number of e-Cig users continues to rise steadily among the teens and adults, the potential risk of pulmonary disease has not been characterized. A systematic review of the open literature identified bronchiolitis obliterans—a pathological inflammation resulting in fibrosis of the bronchioles leading to an irreversible limitation to airflow in lungs—as the primary outcome of diacetyl exposures. Following the deterministic United States National Research Council/Environmental Protection Agency's risk assessment framework, that consists of four key steps: hazard identification, dose-response assessment, exposure assessment and risk characterization, we estimated noncarcinogenic (systemic) risks using a Hazard Quotient (HQ) approach upon exposure to diacetyl among teens and adults who use e-Cigs. Based on the NIOSH Benchmark Dose (BMD; 0.0175 mg/kg-day) and modelled Average Daily Doses (ADDs; range 0.11–5.2 mg/kg-day), we estimated 12 different HQ values—a measure of non-carcinogenic risk for diacetyl inhalation exposures—all of which were greater than 1 (range 6.2875–297.1429), suggesting a significantly higher non-carcinogenic risk from diacetyl exposures among the teens and adults who use e-Cigs. These results underscore the need to regulate e-Cigs to protect teens and adults from diacetyl exposures and risk of developing lung injuries, including bronchiolitis obliterans.
Concurrent E-cigarette and marijuana use and health-risk behaviors among U.S. high school students
2021, Preventive Medicine
The use of electronic cigarettes (e-cigarettes) and marijuana remain prevalent problems among adolescents nationwide. We assessed current (past 30-day) exclusive e-cigarette use, exclusive marijuana use, and concurrent use with unintentional injury and violent behaviors, alcohol and other drug use behaviors, and sexual behaviors among U.S. high school students. We analyzed 2017 Youth Risk Behavior Survey data including 12,578 high school students nationwide. Multivariable logistic regression models were performed to compare these health-risk behaviors among exclusive e-cigarette users, exclusive marijuana users, and concurrent users with non-users among the overall sample, and then to compare exclusive e-cigarette users and exclusive marijuana users with concurrent users among current users only. All models adjusted for adolescent sex, grade, and race/ethnicity, and other tobacco product use. Approximately 77% of students were non-users, 5.2% were exclusive e-cigarette users, 9.9% were exclusive marijuana users, and 7.8% were concurrent users. Compared to non-users, exclusive e-cigarette users and exclusive marijuana users were more likely to engage in most negative health-risk behaviors associated with unintentional injuries and violence, alcohol and other drug use, and sexual behaviors. Among current users only, exclusive e-cigarette users and exclusive marijuana users were at reduced odds of engaging in most of these health-risk behaviors when compared to concurrent users of both substances. The relationship between exclusive and concurrent e-cigarette and marijuana use and health-risk behaviors highlights the importance of comprehensive educational efforts during high school. Findings suggest need for more studies on influence of e-cigarette and marijuana use on injury and violence risk among youth.
Is E-cigarette use a gateway to marijuana use? Longitudinal examinations of initiation, reinitiation, and persistence of e-cigarette and marijuana use
2020, Drug and Alcohol Dependence
Citation Excerpt :
Results suggested a bi-directional relationship with e-cigarette-to-marijuana initiation (Model 1) and marijuana-to-e-cigarette initiation (Model 4). According to aforementioned sequencing and escalation assumptions in “Pathways of Drug Involvement” suggested by Kandel and others (Bell and Keane, 2014; Kandel and Kandel, 2015), the current study could not conclude that e-cigarette use served as a gateway to marijuana use because prior use of marijuana was also associated with later e-cigarette use initiation. The current study found that e-cigarette use at baseline was associated with marijuana use reinitiation at follow-up among prior marijuana users who discontinued marijuana use at baseline (Model 2).
Concerns have been raised regarding e-cigarette use as a potential stepping-stone to marijuana use. Based on Kandel’s gateway hypothesis, this study investigated if e-cigarette use could lead to marijuana use by testing two hypotheses with a longitudinal national U.S. adult sample, including (1) primary hypothesis: e-cigarette use is a gateway to marijuana use; and (2) falsification hypothesis: marijuana use is not a gateway to e-cigarette use.
Adults were extracted from the Population Assessment of Tobacco and Health Study Waves 1–3 (2013–2016). For primary hypotheses, based on baseline e-cigarette use statuses, three study groups were defined, and three logistic regressions were conducted to examine associations between baseline e-cigarette use and follow-up marijuana use initiation, reinitiation, and persistence, respectively. Similarly, for falsification hypotheses, three additional study groups were defined, and three logistic regressions were conducted to examine associations between baseline marijuana use and follow-up e-cigarette use behaviors.
Baseline e-cigarette use was associated with marijuana use initiation and reinitiation (ORs = 2.08, 1.37, respectively, both ps < .05) but not persistence at follow-up. Additionally, baseline marijuana use was associated with only e-cigarette use initiation (OR = 2.23, p < .01) but not reinitiation or persistence at follow-up.
Findings partially support the gateway hypothesis that e-cigarette use could be a steppingstone to marijuana use reinitiation among the U.S. adults. The mechanisms and behavioral characteristics, such as etiological and psychosocial factors, that may pertain to the progression from e-cigarette use to reinitiation of other substance use should be further investigated to inform effective behavioral, educational, and policy interventions.
Cannabis use and its psychosocial correlates among school-going adolescents in Sierra Leone
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All gates lead to smoking: The ‘gateway theory’, e-cigarettes and the remaking of nicotine

Highlights

Abstract

Introduction

Section snippets

The origins of the gateway theory

Academic and policy literature on the gateway theory

The gateway theory and conceptions of ‘hard’ and ‘soft’ drugs

The seductiveness of the ‘gateway’ trope: the media's uptake of the concept

The resurrection of the gateway theory in e-cigarettes

Nicotine and reconceptualizations of ‘hardness’

Conclusion

Acknowledgments

Drug Alcohol Dependence

Int. J. Drug Policy

Drug Alcohol Dependence

Int. J. Drug Policy

Prev. Med.

Int. J. Drug Policy

J. Adolesc. Health

Ann. Epidemiol.

Health Policy

Drug Alcohol Dependence

Neurosci. Behav. Rev.

Nicotine replacement therapy for teenagers: about time or a waste of time?

JAMA Pediatr.

Electronic cigarettes as a method of tobacco control

Br. Med. J.

Drug firm fights drugs; Marion Labs teaches students how to say no

Ind. Week

Politics of pot

Newsweek

E-cigarette Use More than Doubles Among U.S. Middle and High School Students from 2011–2012

Young adults' favorable perceptions of snus, dissolvable tobacco products, and electronic cigarettes: findings from a focus group study

Am. J. Public Health

E-cigarettes: Healthy Tool or Gateway Device?

Notes from the field: electronic cigarette use among middle and high school students — United States, 2011–2012

Morb. Mortal. Wkly. Rep.

Confounding in epidemiological studies: why ‘independent’ effects may not be all they seem

Br. Med. J.

Pot leads to harder drugs, say researchers

Syd. Morning Her.

Measuring the loss of autonomy over nicotine use in adolescents: the Development and Assessment of Nicotine Dependence in Youths (DANDY) Study

Archiv. Pediatr. Adolesc. Med.

Getting Tough on Gateway Drugs: a Guide for the Family

NIDA's role in applied research

Electronic cigarettes: users' profile, utilization, satisfaction and perceived efficacy

Addiction

Electronic nicotine delivery systems: a research agenda

Tob. Control

Tobacco industry suffers new blow Clinton expected to tighten rules

Globe Mail

Genesis and Development of a Scientific Fact

Needle fictions: medical constructions of needle fixation and the injecting drug user

Addict. Res. Theory

Substance & Substitution: Methadone Subjects in Liberal Societies

I-Team: e-cigarettes, used to smoke marijuana, spark new concerns

Gender and the teenage smoker

Patterns of electronic cigarette use and user beliefs about their safety and benefits: an internet survey

Drug Alcohol Rev.

Is cannabis a gateway drug? Testing hypotheses about the relationship between cannabis use and the use of other illicit drugs

Drug Alcohol Rev.

What Is the Difference between Soft Drugs and Hard Drugs?

Electronic nicotine delivery systems: emerging science foundation for policy

Tob. Control

Is marijuana use becoming a ‘gateway’ to nicotine dependence?

Addiction

Drug counselor report of adolescents abuse of nicotine replacement therapy

J. Addict. Dis.

Stages in adolescent involvement in drug use

Science

Issues of sequencing of adolescent drug use and other problem behaviors

Drugs Soc.

Examining the gateway hypothesis: stages and pathways of drug involvement

Does marijuana use cause the use of other drugs

J. Am. Med. Assoc.