Alcohol, Tobacco, Illicit Drugs, and Youth

"What do you think is the most important problem facing people your age today?" This question was asked of 480 teenagers aged thirteen to seventeen in the Gallup Youth Survey conducted December 5, 2005, to January 16, 2006. The results show that nearly one-third (31%) of this teenaged population placed the consumption of alcohol, tobacco, and drugs at the top of their list of concerns. The next most important problem cited by only 17% of the teens was peer pressure/fitting in/looks/popularity. Sexual issues, such as teen pregnancy, abortion, and sexually transmitted diseases, shared the number-three spot with education; 14% of the teens thought that those were the top problems faced by people their age.

Gallup pollsters then separated the teens into two response groups: thirteen- to fifteen-year-olds and sixteen- to seventeen-year-olds. In both groups the top problem was the same: the consumption of alcohol, tobacco, and drugs, although the younger teens mentioned this problem more frequently (35%) than did the older teens (26%). When separated by sex, male and female teens responded in near-equal percentages (32% and 31%, respectively) that the consumption of alcohol, tobacco, and drugs was the top problem facing people their age.

PROBLEM BEHAVIORS BEGIN EARLY IN LIFE

The Centers for Disease Control and Prevention (CDC), in its Youth Risk Behavior Survey (YRBS), 2005, asked high school students if they had smoked a whole cigarette, had drunk alcohol, or had tried marijuana before the age of thirteen. The results are shown in Table 5.1.

A higher percentage of younger students than older students reported having initiated cigarette, alcohol, or marijuana use before age thirteen. The most frequently reported behavior was drinking alcohol before the age of thirteen. One-third (33.9%) of ninth graders reported they had done so, as had one-quarter (26.2%) of tenth graders and one-fifth of both eleventh graders (20.5%) and twelfth graders (19.3%). Males throughout all grades (29.2%) were more likely to report having had a drink before age thirteen than females (22%). Hispanics (29.8%) were the most likely ethnic group to report having an alcoholic drink before the age of thirteen, followed by African-Americans (27.9%) and then whites (23.7%).

Table 5.1 shows that the next most frequently reported behavior was smoking an entire cigarette before the age of thirteen. Once again, males throughout all grades (18.3%) were more likely than females (13.6%) to report having smoked a cigarette before age thirteen. Whites (16.4%) were slightly more likely than Hispanics (16%) to report having smoked before their teens. African-Americans (13.8%) reported this behavior less frequently.

The same pattern between males and females emerged with the least frequently reported behavior of trying marijuana before the age of thirteen. However, the ethnic group most likely to report this early behavior were Hispanics (12.5%), followed by African-Americans (9.1%) and then whites (7.7%).

ALCOHOL AND YOUTH

Age of First Use

The data in the previous section clearly show that the use of alcohol, tobacco, and marijuana often begins early in life, especially alcohol use. Elizabeth J. D'Amico and Denis M. McCarthy, in "Escalation and Initiation of Younger Adolescents' Substance Use: The Impact of Perceived Peer Use" (Journal of Adolescent Health, October 2006), note that the middle school years are peak years for the first-time use of alcohol, tobacco, and marijuana.

Although the precise reasons for increasing rates of alcohol and drug use at younger ages have not yet been pinpointed, Drew W. Edwards and Mark S. Gold, in "Facts about Marijuana Use" (February 6, 2001, http://psychcentral.com/library/sa_factsm.htm), speculate that a variety of factors contribute to lower ages of first use. These include media and other cultural influences that minimize the dangers and glamorize the use of illegal drugs; increasing parental expectations and acceptance of a certain amount of experimentation with illegal drugs; and easier access to alcohol, tobacco, and marijuana. Furthermore, in "Middle Childhood and Early Adolescence: Growth and Change" (2004, http://www.childrenssummit.umn.edu/docs/growthandchange.pdf), the 2004 Minnesota Children's Summit: Staying Strong through Challenge and Change cites less face-to-face contact with working parents and limited parental monitoring of behavior; reduced access to after-school programs and safety concerns that limit children's ability for outdoor, unstructured play, which has increased time spent home alone and unsupervised; and greater access to undesirable content via television, music, and the Internet.

The 2004 National Survey on Drug Use and Health (NSDUH; September 2005, http://oas.samhsa.gov/nsduh/2k4nsduh/2k4overview/2k4overview.htm) by the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that in 2004, 4.4 million people used alcohol for the first time. The number of initiates ("first-timers") increased from 3.9 million in 2002 and from 4.1 million in 2003. Most (86.9 percent) of the 4.4 million 2004 alcohol initiates were younger than the age of twenty-one when they took their first drink.

Reasons for Drinking

Findings from a 2003 nationwide survey of thirteen- to seventeen-year-olds by the Roper Youth Report, 2003 (2003, http://www.gfkamerica.com) revealed that 69% of respondents cited parents as the most influential factor in their decision whether to smoke and drink. Best friends were the second-most important factor influencing a young person's decision to smoke or drink, according to the Roper report. The attitudes of one's peer group can hold tremendous sway over a young person's alcohol and tobacco choices. Results of research conducted by Bruce Simons-Morton et al., in "Peer and Parent Influences on Smoking and Drinking among Early Adolescents" (Health Education and Behavior, February 2001), agree with this conclusion, reporting that teens with friends who smoked and drank were nine times more likely to participate in these behaviors than those with friends who did not smoke and drink.

However, D'Amico and McCarthy note that perception of peer use of alcohol is an important factor in the onset of use of this drug. They state, "Specifically, for alcohol, if youth thought that many of their friends used alcohol, they initiated alcohol use during the academic year." D'Amico and McCarthy indicate that students make assumptions about their peers' behaviors and that these assumptions may not be accurate, so risky behaviors often begin based on false assumptions. They also suggest that peer influence may outweigh parental influence in the initiation and escalation of substance use in early adolescence.

Current Use of Alcohol in High School Students

It is illegal for high school students to purchase alcoholic beverages, yet in 2005 slightly more than 43.3% of high school students had consumed alcohol at least once in the thirty days prior to taking the CDC's YRBS. (See Table 5.2.) These students are considered current users. Monitoring the Future National Survey Results on Drug Use, 1975–2005, Volume 1: Secondary School Students (2006, http://www.monitoringthefuture.org/pubs/monographs/vol1_2005.pdf) by the National Institute on Drug Abuse and the University of Michigan Institute for Social Research also provides data on current alcohol use among eighth, tenth, and twelfth graders. Data from the Monitoring the Future survey shown in Table 5.3 and the YRBS overlap in current drinking data for tenth and twelfth graders. Comparing the "total" figures in Table 5.2 and Table 5.3 for those grades, the YRBS study shows a slightly higher prevalence of current drinking for twelfth graders (50.8% in YRBS and 47% in Monitoring the Future ) and for tenth graders (42% for YRBS and 33.2% for Monitoring the Future ). The Monitoring the Future data also show that the prevalence of current drinking in eighth graders was 17.1% in 2005.

The 2004 NSDUH also collected data on alcohol use. It reported that an estimated 10.8 million people aged twelve to twenty (28.2% of this age group) used alcohol in the month prior to the survey. The 2005 NSDUH, the results of which are published in Results from the 2005 National Survey on Drug Use and Health: National Findings (September 2006, http://www.oas.samhsa.gov/nsduh/2k5nsduh/2k5Results.pdf), presents rates of current alcohol use in 2005 among various age groups: 4.2% among twelve- to thirteen-year-olds (grades seventh and eighth), 15.1% of fourteen- to fifteen-year-olds (grades ninth and tenth), 30.1% of sixteen- to seventeen-year-olds (grades eleventh and twelfth), and 51.1% of eighteen- to twenty-year-olds. The peak age of current alcohol use was twenty-one to twenty-five years at 67.4% of this population. (See Figure 2.1 in Chapter 2; note that the top of the bar shows the percentage for current use.)

What can be gleaned from all these studies? Looking at all the data presented here, each study shows 2005 current rates of alcohol use in high school students rising with grade level. As students grew older, they drank more. Looking at the studies together, the percentage of tenth graders who were current alcohol users in 2005 ranged from about 15% to 42%. The percentage of twelfth graders who were current alcohol users in 2005 ranged from about 30% to 51%. Taken separately or together, data from these surveys present a picture of a high percentage of teens who use alcohol, which can cause bodily harm, serious diseases, and possibly death. (See Chapter 2.) The teens who responded to the Gallup Youth Survey that alcohol was one of the most important problems facing young people today appeared to understand the state of current alcohol use of high school students.

Alcohol Use among College Students and Other Young Adults

In the previous section, data from the 2005 NSDUH indicate that 51.1% of eighteen- to twenty-year-olds and 67.4% of twenty-one to twenty-five-year-olds (the peak age group) used alcohol in 2005. These college-aged students and recent graduates are a part of the youth of this nation; many of them are using a potentially dangerous drug, and those under twenty-one are using it illegally.

Monitoring the Future National Survey Results on Drug Use, 1975–2005, Volume 2: College Students and Adults Ages 19-45 (2006, http://www.monitoringthefuture.org/pubs/monographs/vol2_2005.pdf) reports drug use results for college students and adults. Table 5.4 shows the annual prevalence of the use of alcohol and flavored alcoholic beverages for college students and noncollege students who are one to four years beyond high school. The results show that both groups have a high annual prevalence of alcohol use (83% for full-time college students and 76.9% for noncollege students of the same age), but college students have the higher rate of use. Female college students are slightly more likely to have consumed alcohol in the past year (83.4%) than male college students (82.4%). The reverse is true for noncollege students one to four years beyond high school: Males (77.4%) are more likely than females (76.6%) to have consumed alcohol in the past year.

Table 5.5 shows the trend of lifetime prevalence of alcohol use from 1980 to 2005 among those aged nineteen to twenty-eight years. Throughout the 1980s the annual prevalence of alcohol use for this group remained relatively steady at around 94% to 95%. In the 1990s

annual prevalence fell; by 1999 the annual prevalence of alcohol use for this group was 88%. In 2004 the lifetime prevalence reached a low of 84.6% but then jumped to 86.6% in 2005. The lifetime prevalence of drinking flavored alcoholic beverages (the data for which has only recently been gathered) for nineteen- to twenty-eight-year-olds was 79% in 2004 and rose to 84.5% in 2005.

Table 5.5 also shows the trend of lifetime prevalence of alcohol use among college students one to four years beyond high school. The lifetime prevalence of alcohol use in this group is slightly higher (89.1% in 2005) than that for the nineteen- to twenty-eight-year-old group (86.6% in 2005).

Heavy Drinking, Binge Drinking, and Drunkenness

Merriam-Webster's Collegiate Dictionary defines the term drunk as "having the faculties impaired by alcohol." According to the Monitoring the Future survey, rates of occurrences of drunkenness among high school students generally declined between 2000 and 2005 from the increases of the 1990s. The highest rate for eighth graders occurred in 1996, when 9.6% reported having been drunk in the past thirty days. The highest rate for tenth graders came in 2000, when the rate hit 23.5%, although it fell to 18.2% three years later. The highest rate for twelfth graders was 34.2% in 1997. In 2005 the Monitoring the Future survey's having "been drunk" rates were 6% of eighth graders, 17.6% of tenth graders, and 30.2% of twelfth graders reported being drunk during the previous month in 2005. (See Table 5.3.)

The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as the consumption of five or more drinks of alcoholic beverages on at least one occasion during the past month. Heavy drinking is an average of more than one drink per day for women and more than two drinks per day for men. (There is a male-female difference because the same amount of alcohol affects women more than it does men. Women's bodies have less water than men's bodies, so a given amount of alcohol becomes more highly concentrated in a woman's body than in a man's.)

The YRBS used the term episodic heavy drinking and defined it using the same definition as binge drinking, rather than asking students if they had "been drunk" (with no definition) as did the Monitoring the Future survey. According to the YRBS, in 2005 nearly 26% of high school students were current binge drinkers. The incidence of binge drinking increased with grade level: 19% in ninth grade, 24.6% in tenth grade, 27.6% in eleventh grade, and 32.8% in twelfth grade. (See Table 5.2.)

Demographic Factors in Youth Alcohol Use

GENDER, RACIAL, AND ETHNIC DIFFERENCES

In 2005 high school males were only slightly more likely (43.8%) to be current alcohol users than females (42.8%). (See Table 5.2.) Males (27.5%) were more likely than females (23.5%) to engage in episodic heavy drinking.

Similarly, results from the Monitoring the Future survey (Table 5.3) show close percentages of current alcohol use for males and females in grades eight and ten in 2005, but in this survey with the female rates slightly higher. However, the data show that twelfth-grade males (50.7%) were more likely to have been current drinkers in 2005 than females (43.3%). The 2005 results in the Monitoring the Future survey for being drunk were similar to those in the YRBS for binge drinking: males in grades ten (18.2%) and twelve (33.6%) were more likely than females in those grades (16.8% and 26.4%, respectively) to have been drunk. The data for eighth-grade males (5.9%) and females (6.2%) show a similar likelihood of having been drunk.

The Monitoring the Future survey also shows data for males and females among full-time college students versus others one to four years beyond high school. (See Table 5.4.) The 2005 annual prevalence rates for alcohol use were similar for males and females of both groups. However, the survey shows gender differences in the consumption of flavored alcoholic beverages. Full-time college females were more likely (74%) than full-time college males (55.5%) to drink these beverages. The same was true for noncollege students in the same age group: females were more likely (54%) than males (46.3%) to drink flavored alcoholic beverages. A female preference for these drinks was also seen among eighth, tenth, and twelfth graders in Table 5.3.

Table 5.2 also shows that in 2005 Hispanic high school students (79.4%) were more likely than white high school students (75.3%) or African-American high school students (69%) to have consumed alcohol in their lifetime, but whites were more likely to have engaged in episodic heavy drinking (29.9% versus 11.1% of African-Americans and 25.3% of Hispanics). White and Hispanic high school students were equally likely to be current drinkers in 2005 (46.4% and 46.8%, respectively), and African-Americans were less likely to be current drinkers (31.2%).

WHERE STUDENTS LIVE

The Monitoring the Future survey looked at population density as a factor in student drinking patterns. (See Table 5.3.) In that category MSA stands for "metropolitan statistical area," which means that the area contains at least one town that has more than fifty thousand inhabitants. Large MSAs are the biggest cities in the United States, such as New York, Los Angeles, Chicago, Philadelphia, and Boston. Little difference was found in the percentage of students who were current drinkers based on whether they lived in a large MSA, smaller-sized MSA, or non-MSA. However, students who lived in the Northeast were more likely to be current alcohol users than students who lived in other parts of the country. (See Table 5.3.)

PARENTAL EDUCATION

Table 5.3 shows an inverse relationship between current alcohol use in eighth graders and parental education: the less parental education, the more likely eighth graders were to drink. This relationship is not as strong in tenth graders and is not apparent in twelfth graders. In addition, students in all three grades who had no college plans were more likely to be current drinkers, to have been drunk in the past thirty days, and to drink flavored alcoholic beverages than those with plans to complete four years of college.

Perception of Harmfulness of Alcohol Use

The PRIDE Survey (formerly the Parents Resource Institute for Drug Education) also asks adolescents and teenagers questions about drug and alcohol use. Figure 5.1 shows results from the PRIDE Surveys Questionnaire Report for Grades 6 to 12, 2005–06 National Survey. The report reveals that most sixth graders perceived alcohol as very harmful (64.6%). Perception of alcohol being very harmful decreased with increasing grade level. Only 35.1% of twelfth graders perceived alcohol as being very harmful. Thus, when perception of risk decreased, use of alcohol increased (as shown in Table 5.2 and Table 5.3). The report also notes that easy access to alcohol increases the probability that adolescents and teenagers will drink. The survey results show that access to alcohol increased as grade level increased.

Drinking and Young Drivers

The National Highway Traffic Safety Administration (NHTSA), in Traffic Safety Facts, 2005 Data—Young Drivers (2006, http://www-nrd.nhtsa.dot.gov/Pubs/youngdriverstsf05.PDF), reports that in 2005 a total of 7,460 drivers aged fifteen to twenty were involved in fatal crashes—a 7% decrease from the 7,979 involved in 1995. Twenty-three percent of the drivers fifteen to twenty years of age who were killed in crashes were intoxicated (had a blood alcohol level of 0.08 grams per deciliter [g/dL] or higher). For young male drivers aged fifteen to twenty, fatalities rose 5% between 1995 and 2005, compared with a 1% decrease for females.

When alcohol is involved, the severity of a traffic accident generally increases. The NHTSA defines a traffic

accident as alcohol related if either the driver or an involved nonoccupant, such as a pedestrian, has a BAC of 0.01 g/dL of blood or greater. According to Traffic Safety Facts, 2005, of those who survived the 7,460 crashes in 2005, 4% had blood alcohol concentration (BAC) levels between 0.01 and 0.07 g/dL and 10% had levels of 0.08 g/dL or higher. For those fatally injured, 5% had BAC levels between 0.01 and 0.07 g/dL and 23% had levels of 0.08 g/dL or higher.

As of July 2004 all states, the District of Columbia, and Puerto Rico had lowered the legal BAC limit for driving to 0.08 g/dL. The NHTSA estimates that between 1975 and 2005 the minimum drinking age laws have reduced traffic fatalities involving drivers aged eighteen to twenty by 13%, saving approximately 24,560 lives since 1975.

All states and the District of Columbia have zero-tolerance laws for drinking drivers under the age of twenty-one. It is illegal for drivers under the age of twenty-one to drive with BAC levels of 0.02 g/dl or greater. Matthew Gever, in "Environmental Strategies for Preventing Underage Drinking" (September 30, 2006, http://www.ncsl.org/programs/health/forum/uderagedrinking.htm), reports that early evidence on the results of the law is encouraging. Heavy episodic drinking for both males and females has been reduced by 13% to 18%. Also, the number of drinks consumed in a month by males has decreased by 20%.

TOBACCO AND YOUTH

Health Consequences of Early Tobacco Use

John K. Wiencke et al., in "Early Age at Smoking Initiation and Tobacco Carcinogen DNA Damage in the Lung" (Journal of the National Cancer Institute, April 1999), indicate that the age at which smoking is initiated is a significant factor in the risk of developing lung cancer. Smoking in the teen years appears to cause permanent genetic changes in the lungs, increasing the risk of lung cancer—even if the smoker quits. The younger a person starts smoking, the more lasting damage is done to his or her lungs. Such damage is less likely among smokers who start in their twenties.

An earlier study, Preventing Tobacco Use among Young People: A Report of the Surgeon General (March 1994, http://www.cdc.gov/Tobacco/sgr/sgr_1994/index.htm), indicated that cigarette smoking during adolescence seems to retard lung growth and reduce maximum lung function. As a result, young smokers are less likely than their nonsmoking peers to be physically fit and more likely to experience shortness of breath, coughing spells, wheezing, and overall poorer health. These health problems pose a clear risk for developing other chronic conditions in adulthood, such as chronic obstructive pulmonary disease, including emphysema and chronic bronchitis. Early smoking has also been linked to an increased risk of cardiovascular diseases, such as high cholesterol and triglyceride levels, atherosclerosis (arterial plaque), and early onset of heart disease.

Smokeless tobacco also has undesirable health effects on young users. Adolescent use is linked to the development of periodontal disease, soft-tissue damage, and oral cancers. In addition, young people who use smokeless tobacco are more likely than their nonusing peers to become cigarette smokers.

Age of First Use

Even though these health effects of early tobacco use are known, most cigarette smokers begin their habit early in life. The results of the Monitoring the Future survey show that in 2005, 12.5% of the eighth graders surveyed reported that they had their first cigarette in the sixth and seventh grades, and 10% reported having their first cigarette even earlier—in fifth grade. The twelfth graders who were surveyed responded that their daily smoking habit began primarily in grades seven through eleven.

The Monitoring the Future survey reveals that smokeless tobacco use begins early in life as well. Smokeless tobacco is chewing tobacco or finer-cut tobacco that is inhaled (snuff). The highest rates of initiation in smokeless tobacco use are in grades seven through ten. In 2005, 5.1% of the eighth graders surveyed reported that they began to use smokeless tobacco by the sixth grade, and another 5% started by the eighth grade.

Current Use of Tobacco by High School Students

The 2005 NSDUH determines that 13.1% of students aged twelve to seventeen used various tobacco products in the month prior to the survey; that is, they were current users. The use of tobacco products among this age group declined from 15.2% in 2002. This decline was due primarily to the decline in the use of cigarettes. In 2002, 13% of students aged twelve to seventeen were current cigarette smokers, and in 2005, 10.8% were. Use of other tobacco products—cigars, smokeless tobacco, and pipe tobacco—remained relatively steady. In 2005, 4.2% of students aged twelve to seventeen were current cigar smokers, 2.1% were smokeless tobacco users, and 0.6% were pipe tobacco users.

Table 5.6 shows the results for current tobacco use, current smokeless tobacco use, and current cigar use from the YRBS. The YRBS focuses on students in grades nine through twelve, not students aged twelve to seventeen as does the NSDUH. The YRBS finds that 28.4% of high school students in 2005 reported current tobacco use. The Monitoring the Future results are lower (13.1% of twelve- to seventeen-year-olds), but it includes younger students, who are less likely to use

tobacco, and does not include eighteen-year-olds, who are more likely to use tobacco and who are likely present in the cohort of high school seniors surveyed for the YRBS. The YRBS finds that 14% of high school students in 2005 were current cigar smokers (Monitoring the Future reports 4.2%) and 8% were current smokeless tobacco users (Monitoring the Future reports 2.1%). The YRBS results also show that, in general, tobacco use increases with grade level.

Trends in Prevalence of Cigarette Use in High School Students

The YRBS also determined trends in the prevalence of cigarette smoking in high school students from 1991 to 2005. The YRBS results reveal that in 2005, 23% of high school students were current cigarette smokers. (See Table 5.7.) This rate is down from the 1991 rate of 27.5%. Current cigarette smoking rates rose from 1991 to 1993, however, and continued to rise through 1997. The rates then fell to 21.9% in 2003 before rising again slightly by 2005.

What are the causes of the general decrease in current smoking rates among high school students after 1997? Monitoring the Future provides a possible answer to this question:

We think that the extensive adverse publicity generated by the state attorneys general, the President, and Congress in the debate over a possible legal settlement with the tobacco companies likely contributed importantly to this turnaround by influencing youth attitudes toward cigarette companies and their products. Substantial price increases, the removal of some forms of advertising (such as billboard advertising and the Joe Camel campaign), the implementation of vigorous antismoking advertising (particularly that launched by the American Legacy Foundation and some of the states), and strong prevention programs in some states all may have contributed.

According to the YRBS, lifetime cigarette use among high school students was also lower in 2005 than in 1991. In 1991 nearly three-quarters (70.1%) of all high school students had tried smoking. In 2005 slightly more than half (54.3% had tried.) The lifetime rates did not begin to fall, however, until the turn of the twenty-first century. The percentage of high school students who are current, frequent users of cigarettes is also down from 1991 (12.7% versus 9.4%), as is the percentage of students who smoked cigarettes on school property (13.2% in 1993 versus 6.8% in 2005).

Tobacco Use among College Students and Other Young Adults

The Monitoring the Future survey reports drug use results for college students and adults. In 2005 the rates of current cigarette smoking for young adults increased steadily by age, from 23% for eighteen-year-olds to 31% for twenty-five- to twenty-six-year-olds. It then decreased to 24% for twenty-nine- to thirty-year-olds. These current smoking rates are down considerably from the past. Current cigarette use rates for eighteen-year-olds were 38.8% in 1976 and dropped to 23.2% by 2005. Decreases are apparent in all age groups, but they are not as dramatic as with the eighteen-year-olds. For example, current smoking rates for twenty-five- to twenty-six-year-olds were 33.7% in 1984 and dropped only to 30.7% in 2005.

The Monitoring the Future survey looked at trends in current cigarette smoking among college students and noncollege students who are one to four years beyond high school. In 2005 noncollege students had a higher rate of current cigarette use (35%) than college students (23%), opposite to the results of alcohol use described earlier in this chapter. This difference in current cigarette use between college and noncollege students of the same age has been documented since 1980, when Monitoring the Future first assessed these rates in these populations.

"Part-Time" Current Smokers

According to the Monitoring the Future study and the CDC, in the late 1990s there was a noticeable increase in people who currently smoked, but only occasionally. These individuals have been described as "part-time" or "social" smokers. These smokers do not see the harm in having the occasional cigarette—for example, after a meal or with their morning coffee. As reported by Tom Majeski in "Young Smokers Playing with Fire" (Knight Ridder/Tribune News Service, July 25, 2003), Marc Manley, the executive director for the Center for Tobacco Reduction and Health Improvement at Blue Cross/Blue Shield of Minnesota, warns of the dangers of such thinking: "Everyone who becomes addicted does so because it sneaks up on them. There are many people who don't consider themselves smokers because they only smoke on weekends. However, many of them will wake up some day and realize they want a cigarette. People are playing with fire when they take on risks with nicotine."

Demographic Factors in Youth Tobacco Use

GENDER, RACIAL, AND ETHNIC DIFFERENCES

According to the YRBS, in 2005 high school males were much more likely to currently use various tobacco products (31.7%) than females (25.1%). (See Table 5.6.) They were also much more likely to be current cigar smokers (19.2% for males versus 8.7% for females) and current smokeless tobacco users (13.6% for males versus 2.2% for females). The Monitoring the Future survey shows similar differences in current smokeless tobacco use between males and females in grades eight (5.3% for males and 1.5% for females), ten (9.7% versus 1.6%), and twelve (12.7% versus 1.9%).

Looking at current cigarette use alone, the Monitoring the Future survey shows female rates of cigarette smoking to be slightly higher than that of males in the eighth grade (9.7% for females versus 8.7% for males) and the tenth grade (15.1% for females versus 14.5% for males). However, there was a dramatic shift in twelfth grade: 24.8% of males were current smokers, whereas 20.7% of females were.

In 2005 female and male college students had equal rates (nearly 25%) of current cigarette smoking, but it has not always been that way. According to the Monitoring the Future study, female college students were more likely to be current smokers than male college students from 1980 to 1994. In 1994 their current rates of smoking were the same—nearly 25%. The rates for both increased during the mid- to late 1990s, with males generally leading females, but then both rates dropped to the 1994 level again in 2005.

The YRBS study shows in Table 5.6 that in 2005 white high school students (32.5%) were more likely than Hispanic high school students (24.9%) or African-American high school students (16.5%) to be current tobacco users, but whites and Hispanics were equally likely to be current cigar smokers (14.9% of whites and 14.6% of Hispanics) and African-Americans were less likely to be current cigar smokers (10.3%). In addition, whites were much more likely to currently use smokeless tobacco (10.2%) than Hispanics (5.1%) or African-Americans (1.7%).

WHERE STUDENTS LIVE

The Monitoring the Future survey looked at population density as a factor in student patterns of tobacco use. Eighth, tenth, and twelfth graders who lived in the largest cities in the United States (large MSAs such as Boston, New York, and Los Angeles) were the least likely to be current smokers. Those who lived in smaller cities (other MSAs) were somewhat more likely to be current smokers, and those who lived in rural areas (non-MSAs) were the most likely to be current smokers. In "Prevalence and Trends in Smoking: A National Rural Study" (National Rural Health Association, April 2006), Mark P. Doescher et al. determine:

The higher prevalence of smoking in rural areas compared to urban areas … can be explained, in part, by lower levels of income and education attainment among rural residents and by the greater likelihood of rural residents being white or American Indian; both groups have high rates of smoking. Additionally, persons with lower levels of income and education who reside in rural counties smoke at slightly higher rates than their urban counterparts.

PARENTAL EDUCATION

The Monitoring the Future survey shows an inverse relationship between current cigarette use in eighth graders and parental education: the less parental education, the more likely eighth graders were to be current smokers. This relationship is the same for tenth and eleventh graders except for the lowest parental educational level. In addition, students in all three grades who had no college plans or had plans to complete less than four years of college were much more likely to be current smokers and to have used smokeless tobacco than those with plans to complete four years of college.

Perception of Harmfulness of Tobacco Use

Figure 5.2 shows results from the PRIDE Surveys Questionnaire Report for Grades 6 to 12, 2005–06 National Survey. The report reveals that 75.5% of sixth graders perceived the use of tobacco as very harmful. Perception of tobacco being very harmful decreased with increasing grade level to about grade nine. About 60% of ninth, tenth, eleventh, and twelfth graders perceived tobacco use as being very harmful. Thus, a higher percentage of students in grades six through twelve perceived tobacco use as harmful than the percentage who perceived alcohol use as harmful. (See Figure 5.1.) Even though perception of risk of tobacco use stayed relatively steady in grades nine through twelve, the use of tobacco increased in these grades as the grade level increased (as shown in Table 5.6). The report also notes that, as with alcohol, easy access to tobacco increases the probability that adolescents and teenagers will use tobacco. The survey results show that access to tobacco increased as the grade level increased.

ILLICIT DRUGS AND YOUTH

Age of First Use

The use of alcohol and tobacco often begins early in life; the initiation data are presented previously in this chapter. Regarding the initiation of other drugs, the Monitoring the Future survey reveals that inhalants and marijuana are the drugs next most likely to be initiated early in life. Peak initiation rates for illicit drugs other than marijuana generally do not occur until grades nine through eleven in high school, and initiation rates for cocaine and crack generally occur in grades ten through twelve. The first volume of Monitoring the Future states:

Of all the 12th graders who reported prior use of any drug, the proportion reporting an initial use of that drug by the end of grade 9 is presented here. This listing is a good indicator of the order of age initiation….:

• cigarettes (67%)
• inhalants (61%)
• alcohol (56%)
• marijuana (54%)
• smokeless tobacco (50%)
• been drunk (49%)
• PCP (46%)
• sedatives (barbiturates) (46%)
• LSD (46%)
• daily cigarette smoking (44%)
• heroin (40%)
• crack (37%)
• narcotics other than heroin (36%)
• tranquilizers (35%)
• amphetamines (32%)
• hallucinogens (30%)
• hallucinogens other than LSD (28%)
• cocaine (25%)
• other forms of cocaine (21%)

Trends in Annual Prevalence of Drug Use in Youth

TRENDS ACROSS FIVE POPULATIONS

Annual prevalence means that a person has tried a particular drug at least once during the year prior to being surveyed about its use. Figure 5.3 compares trends in the annual prevalence of drug use across five populations: eighth-, tenth-, and twelfth-grade students, full-time college students aged nineteen to twenty-two, and all young adults through the age of twenty-eight who are high school graduates (a group that includes the college students and is referred to in Figure 5.3 as "adults"). In the early 1980s rates of drug use decreased, and college students had a higher rate of drug use than high school seniors. By the mid-1980s the annual prevalence of drug use of these two groups was somewhat equivalent. In the late 1980s, when data for young adults were added, drug use annual prevalence rates in all three groups declined dramatically. The annual prevalence of drug use by college students and twelfth graders was about the same during those years, and the annual prevalence of drug use by young adults was slightly lower.

In 1991 data for eighth and tenth graders were added. The annual prevalence of drug use rose dramatically for high school students, but the increase was less dramatic for college students. The annual prevalence of drug use increase for young adults was minor. Thus, the annual prevalence of drug use for twelfth and tenth graders became higher than the annual prevalence for college students and young adults. Around 1997 the annual prevalence of drug use for twelfth graders began to slowly drop. It dropped, then rose, then dropped again for tenth graders, and it dropped dramatically for eighth graders. However, annual prevalence rates continued to slowly climb for college students and young adults. Thus, in 2005 the annual prevalence rate of drug use was highest for twelfth graders at nearly 40%, followed by college students at about 38%, young adults at about 33%, tenth graders at about 30%, and eighth graders at about 17%.

TRENDS IN INHALANT USE IN HIGH SCHOOL STUDENTS

Inhalants have an early high rate of initiation. Of all the twelfth graders who reported prior use of inhalants in the Monitoring the Future survey, 61% reported an initial use of this drug by the end of ninth grade. Inhalants are volatile liquids, such as cleaning fluids, glue, gasoline, paint, and turpentine, the vapors of which are inhaled. Sometimes the sprays of aerosols are inhaled, such as those of spray paints, spray deodorants, hair spray, or fabric protector spray. These products are legal and easily accessible.

Figure 5.4 shows trends in annual prevalence of inhalant use for eighth, tenth, and twelfth graders. Since 1991, when data collection began for all three of these grade levels, eighth graders have had the highest annual prevalence of inhalant use, followed by tenth graders and then twelfth graders. Between 1991 and 1995 the annual prevalence of inhalant use rose by more than one-third among eighth and tenth graders to reach 12.8% and 9.6%, respectively, and rose by about one-fifth in twelfth graders to reach 8.4%. Annual prevalence rates for inhalant use then fell through 2002 for eighth graders to 7.7%, and through 2003 for tenth and twelfth graders to 5.4% and 4.5%, respectively. Rates rose quite steeply for eighth graders since 2002, reaching 9.6% in 2004 and steadying in 2005 at 9.5%. Rates rose less dramatically through 2005 for tenth and twelfth graders to 6% and 5.4%, respectively. Monitoring the Future researchers comment that "the inhalant situation may well be in the middle of an unwelcome turnaround."

TRENDS IN MARIJUANA USE IN HIGH SCHOOL STUDENTS

Besides inhalants, marijuana is one of the first drugs tried by school students. Of all the twelfth graders who reported prior use of marijuana in the Monitoring the Future survey, 54% reported an initial use of this drug by the end of ninth grade.

Figure 5.5 shows trends in annual prevalence rates of marijuana use for eighth, tenth, and twelfth graders. Since 1991, when data collection began for all three of these grade levels, twelfth graders have had the highest annual prevalence of marijuana use, followed by tenth graders and then eighth graders. Annual prevalence rates of marijuana use for eighth graders rose from 1991 to 1996, reaching 18.3%. These rates then dropped steadily to 11.8% in 2004 and then rose slightly to 12.2% in 2005. For tenth and twelfth graders annual prevalence rates of marijuana use rose from 1992 to 1997, reaching 34.8% and 38.5%, respectively. The rates for both held

relatively steady from 1998 through 2001 and then dropped to the 2005 levels of 26.6% and 33.6%, respectively.

TRENDS IN TRANQUILIZER USE IN HIGH SCHOOL STUDENTS

Of all the twelfth graders who reported prior use of tranquilizers in the Monitoring the Future survey, 35% reported an initial use of this drug by the end of ninth grade. Tranquilizers are drugs prescribed by physicians to relieve a patient's tension and anxiety. Drugs such as Valium, Librium, and Xanax are tranquilizers. This illicit drug and the rest to follow generally do not have high rates of early initiation as do inhalants and marijuana.

Figure 5.6 shows trends in annual prevalence rates of illicit tranquilizer use for eighth, tenth, and twelfth graders. Since 1991, when data collection began for all three of these grade levels, twelfth graders and tenth graders have had the highest prevalence of use. Eighth graders have had a lower annual prevalence rate of tranquilizer use. Annual prevalence rates for eighth graders rose slowly from 1.8% in 1991 to 3.3% in 1996. The rates then declined slightly to 2.9% in 1997 and then leveled off. The 2005 annual prevalence rate for tranquilizer use in eighth graders was 2.8%.

Annual prevalence rates of tranquilizer use for tenth and twelfth graders are hard to distinguish from one another throughout the 1990s in Figure 5.6. For tenth graders, annual prevalence rates remained fairly steady from 1991 to 1994. These rates then rose steadily from 3.3% in 1994 to 7.3% in 2001 and then declined to 4.8% in 2005. For twelfth graders, the annual prevalence rate fell from 3.6% in 1991 to 2.8% in 1992. The rate then rose steadily from 1992, reaching 7.7% in 2002. It then declined in 2003, rose in 2004, and declined again in 2005. The 2005 annual prevalence rate of tranquilizer use in twelfth graders was 6.8% in 2005.

TRENDS IN AMPHETAMINE USE IN HIGH SCHOOL STUDENTS

Of all the twelfth graders who reported prior use of amphetamines in the Monitoring the Future survey, 32% reported an initial use of this drug by the end of ninth grade. Amphetamines are stimulants (uppers), drugs that produce a sense of euphoria or wakefulness. They are used to increase alertness, boost endurance and productivity, and suppress the appetite. Other stimulants include caffeine, nicotine, methamphetamine, and cocaine.

Figure 5.7 shows trends in annual prevalence rates of amphetamine use for eighth, tenth, and twelfth graders. Since 1991, when data collection began for all three of these grade levels, tenth and twelfth graders have had the highest rate of use. From 1992 through 2001 tenth-grade annual prevalence rates were higher than twelfth-grade rates. From 1991 through 2005 eighth-grade annual prevalence rates were consistently lower than those of their older classmates.

Annual prevalence rates for eighth graders rose from 6.2% in 1991 to 9.1% in 1996. The rates then declined to 6.9% in 1999 and then declined in short plateaus to 4.9% by 2005. Annual prevalence rates of amphetamine use for tenth and twelfth graders are hard to distinguish from one another throughout most years in Figure 5.7. For tenth graders, annual prevalence rates rose from 8.2% in 1991 to 11.7% in 2001, and then declined to 7.8% in 2005. For twelfth graders, the annual prevalence rate of amphetamine use generally rose throughout the 1990s and after 2000 in a slight up-and-down fashion, from 8.2% in 1991 to 11.1% in 2002. Since 2002 the annual prevalence rate of amphetamine use in twelfth graders declined to 8.6% in 2005.

TRENDS IN HALLUCINOGEN USE IN HIGH SCHOOL STUDENTS

Of all the twelfth graders who reported prior use of hallucinogens in the Monitoring the Future survey, 30% reported an initial use of this drug by the end of ninth grade. Hallucinogens, also known as psychedelics, distort the perception of reality. They cause excitation, which can vary from a sense of well-being to severe depression. The experience may be pleasurable or quite frightening. The effects of hallucinogens vary from use to use and cannot be predicted.

Figure 5.8 shows trends in annual prevalence rates of hallucinogen use for eighth, tenth, and twelfth graders. Since 1991, when data collection began for all three of these grade levels, twelfth graders have had the highest annual prevalence of hallucinogen use, followed by tenth graders and then eighth graders.

Annual prevalence rates of hallucinogen use for eighth graders rose from 1.9% in 1991 to 4.1% in 1996. (See Figure 5.8.) The rate then declined to 2.2% in 2004 with a "blip" of a rise in 2005 to 3.4%, which may have been because of a change that was implemented in the question for all grades the year prior. The trend patterns of annual prevalence rates of hallucinogen use for tenth and twelfth graders were similar to that of eighth graders and to each other. Annual prevalence rates for tenth and twelfth graders rose from 1991 to 1996, from 4% in 1991 to 7.8% in 1996 for tenth graders and from 5.8% in 1991 to 10.1% in 1996 for twelfth graders. The rates for both grades then declined through 2005, with some small ups and downs along the way. In 2005 the annual prevalence rates of hallucinogen use for tenth and twelfth graders were 4% and 5.5%, respectively.

TRENDS IN MDMA/ECSTASY USE IN HIGH SCHOOL STUDENTS

MDMA (3,4-methylenedioxy-methamphetamine), or ecstasy, is a mind-altering drug with hallucinogenic properties. It is related to amphetamine and is made in illicit laboratories by making minor modifications in the chemical structure of this drug. Thus, it is called a designer drug and is one of the most popular.

Figure 5.9 shows trends in annual prevalence rates of ecstasy use for eighth, tenth, and twelfth graders. Since 1996, when data collection began for this drug, twelfth graders have had the highest annual prevalence of ecstasy use, followed by tenth graders and then eighth graders.

Annual prevalence rates of MDMA/ecstasy use for eighth graders declined initially from 2.3% in 1996 and 1997 to 1.7% in 1999. It then peaked in 2001 at 3.5% but then dropped sharply through 2004. In 2005 it held steady at the 2004 annual prevalence rate of 1.7%. The trend patterns of annual prevalence rates of MDMA/ecstasy use for tenth and twelfth graders were similar to that of eighth graders and to each other, with an initial drop, a sharp peak in 2001, and then a drop. The peak annual prevalence rate for ecstasy use for tenth graders was 6.2% and for twelfth graders was 9.2%, both in 2001. The annual prevalence rates for tenth and twelfth graders in 2005 were 2.6% and 3%, respectively. (See Figure 5.9.)

Current, Past-Year, and Lifetime Use of Illicit Drugs in Youth

Figure 4.1 in Chapter 4 shows that young people have the highest rate of current illicit drug use in the U.S. population. In 2005 the rate of current drug use starting with twelve-year-olds increased with age, peaking with eighteen- to twenty-year-olds, who had a current drug use rate of 22.3%. The rate of illicit drug use then declined with age.

Table 4.1 in Chapter 4 compares age groups twelve to seventeen, eighteen to twenty-five, and twenty-six and older regarding their past month (current), past-year, and lifetime prevalence of drug use. Those aged eighteen to twenty-five showed the highest rates of illicit drug use in all categories in both 2004 and 2005. Those aged twelve to seventeen had the next highest prevalence rate for past-year and current use.

Perception of Harmfulness of Illicit Drug Use

Figure 5.10 shows results from the PRIDE Surveys Questionnaire Report for Grades 6 to 12, 2005–06 National Survey. The report reveals that nearly 90% or more of students in all grades perceived the use of any illicit drug as very harmful. Only a small proportion of students (from 2.3% to 3.2%) thought that illicit drugs posed no harm to the individual. Even though perception

of risk of illicit drug use was high, approximately one out of every five students aged twelve to seventeen had used an illicit drug at least once in the past year, and one out of every three young people aged eighteen to twenty-five had used an illicit drug at least once in the past year. (See Table 4.1 in Chapter 4.)

A Youth Phenomenon

Monitoring the Future sums up the situation of drugs and youth quite well:

Young people are often at the leading edge of social change—and this has been particularly true of drug use. The massive upsurge in illicit drug use during the last 35 to 40 years has proven to be a youth phenomenon, and the "relapse" in the drug epidemic in the early 1990s occurred initially almost exclusively among adolescents, as this study has demonstrated. Adolescents and young adults in their 20s fall into the age groups at highest risk for illicit drug use. The original epidemic began on the nation's college campuses and then spread downward in age, but the more recent relapse phase in the epidemic first manifested itself among secondary school students and then started moving upward in age as those cohorts matured. From one year to the next, particular drugs rise or fall in popularity, and related problems occur for youth, their families, governmental agencies, and society as a whole.