Correspondence| Volume 60, ISSUE 10, P1166, November 15, 2006


      We appreciate Dr. Gold’s interest in our recently published article examining the gateway effect of nicotine in an attention-deficit/hyperactivity disorder (ADHD) sample. Dr. Gold raises an interesting question about the temporal ordering of tobacco use and marijuana use in youth, citing his own research that shows marijuana to be a gateway substance to tobacco use in college students. He regrets that we did not also consider marijuana as a gateway substance to tobacco use in our analysis, in cases where marijuana use begins either before or concurrently with tobacco use. However, in disagreement with Dr. Gold’s premise and as stated in the methods of our paper, the temporal sequence of use, essential to an assessment of the gateway hypothesis, cannot be determined in subjects who report the initiation of smoking and substance use at the same age, and these subjects should not be considered in an analysis of the gateway hypothesis. In our data, only two and four ADHD and control subjects, respectively, began to use tobacco and marijuana at the same age, and these subjects were excluded from our analysis. We do not think that investigators can make assumptions about the direction of the gateway effect in these temporally ambiguous subjects.
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