Racial differences were also apparent in the association of tobacco and cannabis use with alcohol related outcomes. Tobacco use and cannabis use both increased the risk of alcohol initiation in EA and AA women; however, the relationship was clearly associated with early initiation in EA compared to AA women. In AA women, tobacco and cannabis use conferred a consistent, significant risk for alcohol initiation, whereas the association between tobacco and cannabis use and alcohol initiation in EA women varied by risk period. Cannabis use continued to be a significant predictor of transitions to an AUD symptom and to AUD in both EA and AA women, while tobacco use conferred statistically significant risk for problem alcohol involvement in EA women only, with only a trend in AA women.
