Cigarette smoking as a predictor of alcohol and other drug use by children and adolescents: evidence of the "gateway drug effect"

J Sch Health. 1993 Sep;63(7):302-6. doi: 10.1111/j.1746-1561.1993.tb06150.x.


Data from a statewide survey, conducted by the Indiana Prevention Resource Center, of 20,629 Indiana students in grades 5-12 were analyzed to determine the extent to which cigarette smoking predicted use of alcohol and other drugs and acted as a so-called "gateway drug." A three-stage purposive/quota cluster sampling strategy yielded a representative sample of Indiana students, stratified by grade. Cross-tabulated data revealed a strong, dose-dependent relationship between smoking behavior and binge drinking, as well as use of alcohol and illicit drugs. Daily pack-a-day smokers were three times more likely to drink alcohol, seven times more likely to use smokeless tobacco, and 10-30 times more likely to use illicit drugs than nonsmokers. A stepwise multiple regression analyzed the role that the student's perceptions of the risk of using drugs and of peer approval/disapproval of the student's drug use, gender, grade in school, and ethnic background played in predicting alcohol and other drug use.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Alcohol Drinking / epidemiology*
  • Attitude to Health
  • Child
  • Female
  • Health Surveys
  • Humans
  • Indiana / epidemiology
  • Male
  • Peer Group
  • Predictive Value of Tests
  • Prevalence
  • Regression Analysis
  • Risk-Taking
  • Smoking / epidemiology*
  • Substance-Related Disorders / epidemiology*
  • Surveys and Questionnaires