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The great decline in adolescent cigarette smoking since 2000: consequences for drug use among US adolescents
  1. Richard Miech1,
  2. Katherine M Keyes2,3,
  3. Patrick M O'Malley1,
  4. Lloyd D Johnston1
  1. 1 Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
  2. 2 Columbia University, New York City, New York, USA
  3. 3 Department of Epidemiology, Colulmbia University, New York, New York, United States
  1. Correspondence to Dr Richard Miech, Institute for Social Research, University of Michigan, Ann Arbor, MI 48109, USA; ramiech{at}


Objective Adolescent cigarette smoking declined steadily and substantially from 2000 to 2018. This paper considers the potential consequences of this ‘great decline’ for the prevalence of other drug use among adolescents.

Methods Data are annual, cross-sectional, nationally representative Monitoring the Future surveys of more than 1.2 million US students in 12th, 10th and 8th grades from 2000 to 2018. Analyses include trends in the past 12 months’ non-medical amphetamine, tranquillisers and opioid use overall, among ever and never cigarette smokers, and projected if adolescent cigarette smoking levels had remained at 2000 levels.

Results Within groups of ever and never cigarette smokers, the prevalence for each of the three substances has either changed little or overall increased in 2018 as compared with 2000. When the two groups were combined into one pool, the overall prevalence for each of the drugs declined by about half. The decline resulted from the growing group of never smokers, whose levels of non-medical drug use over the study period were at least four times lower than the levels of ever smokers.

Conclusions The results support the ‘gateway’ prediction that declines in cigarette smoking among adolescents pull downward their non-medical use of amphetamines, tranquillisers and opioids. Continuing to reduce adolescent smoking through policy and programmatic prevention efforts should have further positive spillover effects on adolescent drug use.

  • harm reduction
  • priority/special populations
  • public policy
  • surveillance and monitoring

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  • Contributors RM conceived the original idea, performed all analyses and wrote the first draft of the manuscript. KMK, PMO and LDJ contributed to the intellectual development of the study through discussion and revisions of the manuscript. PMO and LDJ also played a central role in data collection.

  • Funding This work was supported by the National Institute on Drug Abuse, National Institutes of Health (R01-DA-001411 to RM, PI).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The project has been approved by the University of Michigan Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.