Tobacco, Alcohol, and Other Drug Use Among High School Students -- United States, 1991

In the United States, use of tobacco, alcohol, and other drugs is associated with the leading causes of morbidity and mortality (e.g., motor-vehicle crashes, homicide, suicide, and cancer (1)), with lower educational achievement, and with school dropout (2-5). This report presents self-reported data about the prevalence of tobacco, alcohol, marijuana, and cocaine use among students in grades 9-12 from two school-based components of the Youth Risk Behavior Surveillance System (6): 1) state and local Youth Risk Behavior Surveys (YRBSs) conducted by departments of education in 23 states and 10 cities during the spring of 1991 and 2) the national YRBS conducted during the same period.

The 33 state and local sites drew probability samples from well-defined sampling frames of schools and students in grades 9-12. Seventeen sites had adequate school- and student-response rates, which allowed computation of weighted results of known precision; 16 sites had overall response rates below 60% or unavailable documentation, which precluded making estimates of known precision. The national survey used a three-stage sample design to obtain a sample of 12,272 students representative of students in grades 9-12 in the 50 states and the District of Columbia.

For the state and local surveys, school-response rates ranged from 48% to 100%; student-response rates ranged from 44% to 96% (7). State and local sample sizes ranged from 369 to 5834 students. Students in most samples were distributed evenly across grades and between sexes. The racial/ethnic characteristics of the samples varied. The school-response rate for the national survey was 75%, and the student-response rate was 90%.

Students were asked whether they had used tobacco, alcohol, marijuana, or any form of cocaine during their lifetime and during the 30 days preceding the survey. Students also were asked whether they had used chewing tobacco or snuff during the 30 days preceding the survey, whether they had had five or more drinks of alcohol on one occasion during the 30 days preceding the survey (i.e., episodic heavy drinking), and whether they had taken steroid pills or steroid shots without a doctor's prescription during their lifetime.

Among the state and local surveys, cigarette smoking varied considerably (Table 1): 49%-82% of students (median: 71%) reported having tried cigarette smoking during their lifetime; 6%-31% of students (median: 24%) reported smoking at least one cigarette during the 30 days preceding the survey; and 2%-17% of students (median: 12%) reported frequent cigarette use * during the 30 days preceding the survey. Rates of lifetime, current, and frequent cigarette use were similar for male and female students in almost all sites.

Use of smokeless tobacco also varied among sites: 2%-20% of students (median: 11%) reported using smokeless tobacco during the 30 days preceding the survey. Rates of smokeless tobacco use were higher for male than female students in all sites.

Among the state and local surveys, rates of alcohol consumption showed similar variation (Table 2): 50%-87% of students (median: 77%) reported having consumed alcohol during their lifetime; 24%-60% of students (median: 46%) reported that they had consumed alcohol at least once during the 30 days preceding the survey. Episodic heavy drinking among students varied from 12% to 43% (median: 27%). Rates of lifetime and current alcohol consumption were similar for male and female students within most sites; however, in every site, male students reported higher rates of episodic heavy drinking than female students.

Lifetime and current use of marijuana (Table 3) varied considerably among the state and local surveys: 8%-41% of students (median: 26%) reported lifetime use of marijuana, and 4%-18% of students (median: 11%) reported having used marijuana at least once during the 30 days preceding the survey. In almost all sites, rates of marijuana use were higher for male than female students. Lifetime and current use of cocaine and lifetime use of steroids also varied among sites: 2%-9% of students (median: 5%) reported lifetime use of cocaine, 1%-4% of students (median: 2%) reported current use of cocaine, and 2%-5% of students (median: 4%) reported lifetime use of steroids.

For all behaviors, the national prevalence estimates were similar to the median prevalence estimates from the state and local surveys (Tables 1-3).

Reported by: J Moore, EdD, Alabama State Dept of Education. J Campana, MA, San Diego Unified School District; M Lam, MSW, San Francisco Unified School District. D Sandau-Christopher, State of Colorado Dept of Education. J Sadler, MPH, District of Columbia Public Schools. D Scalise, MS, School Board of Broward County; N Gay, MSW, School Board of Dade County, Florida. R Stalvey, MS, Georgia Dept of Education. J Schroeder, Hawaii Dept of Education. J Pelton, PhD, Idaho Dept of Education. B Johnson Biehr, MS, Chicago Public Schools. J Harris, MEd, Iowa Dept of Education. N Strunk, MS, Boston Public Schools. R Chiotti, Montana Office of Public Instruction. J Owens-Nausler, PhD, Nebraska Dept of Education. B Grenert, MEd, New Hampshire State Dept of Education. D Chioda, MS, Jersey City Board of Education; D Cole, MEd, New Jersey State Dept of Education. K Meurer, MS, New Mexico State Dept of Education. G Abelson, CSW, New York City Board of Education; A Sheffield, MPH, New York State Education Dept. P Ruzicka, PhD, Oregon Dept of Education. C Balsley, EdD, School District of Philadelphia; M Sutter, PhD, Pennsylvania Dept of Education. M del Pilar Cherneco, MPH, Puerto Rico Dept of Education. J Fraser, EdD, South Carolina State Dept of Education. M Carr, MS, South Dakota Dept of Education and Cultural Affairs. E Word, MA, Tennessee State Dept of Education. P Simpson, PhD, Dallas Independent School District. L Lacy, MS, Utah State Office of Education. S Tye, PhD, Government of the Virgin Islands Dept of Education. B Nehls-Lowe, MPH, Wisconsin Dept of Public Instruction. B Anderson, Wyoming Dept of Education. Div of Epidemiology and Prevention Research; National Institute on Drug Abuse; Alcohol, Drug Abuse, and Mental Health Administration. Office on Smoking and Health, and Div of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Tobacco, alcohol, and other drug use among youth causes serious public health problems in cities and states throughout the nation. Because the quality of the samples varied among the state and local surveys, data across sites may not be comparable. Nonetheless, these results can be useful in planning and evaluating broad national, state, and local interventions and monitoring progress toward achieving national education goals and national health objectives.

National education goal 6 (8) aims to have every school in America free of drugs and violence and offer a disciplined environment conducive to learning by the year 2000. The results presented in this report will be used in the second progress report on the status of the national education goals to be released September 30; results from similar surveys conducted during 1990 were used in the first progress report on the status of the national education goals (8,9).

National health objectives 3.5, 3.9, 4.5, 4.6, 4.7, 4.8, and 4.11 are to reduce the use of tobacco, alcohol, and other drugs among youth (1). The results presented in this report measure progress toward achieving these objectives in participating cities and states.

For example, objective 3.9 is to reduce smokeless tobacco use by males aged 12-24 years to a prevalence of no more than 4%. In 19 of the 33 sites, the prevalence of smokeless tobacco use among male students is three or more times higher than this national health objective. Objective 4.6 states that among youth aged 12-17 years the prevalence of alcohol use during the previous 30 days should be no more than 12.6%, of marijuana no more than 3.2%, and of cocaine no more than 0.6%. In all but one site, the current prevalence of alcohol use is at least two times higher than thisnational health objective; in all but three sites, the current prevalence of marijuana use is at least three times higher; and in all but four sites, the current prevalence of cocaine use is at least two times higher. Objective 4.7 is to reduce to no more than 28% the proportion of high school seniors engaging in recent occasions of episodic heavy drinking. Rates of episodic heavy drinking among students in grades 9-12 are higher than this national health objective in 14 of the 33 sites. Objective 4.11 is to reduce to no more than 3% the proportion of male high school seniors who use anabolic steroids. Rates of anabolic steroid use among male students in grades 9-12 are higher than this national health objective in all but one site.

To meet the national health objectives, efforts to help youth reduce the use of tobacco, alcohol, and other drugs will need to increase among federal, state, and local education, health, and drug-control agencies, and among families, the media, legislators, community organizations, and youth.

References

1. Public Health Service. Healthy people 2000: national health

promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212. 2. Jessor R, Jessor S. Problem behavior and psychosocial development: a longitudinal study. New York: Academic Press, 1977. 3. Kolbe LJ, Green L, Foreyt J, et al. Appropriate functions of health education in schools: im proving health and cognitive performance. In: Krasnegor NA, Arasteh JD, Cataldo MF, eds. Child health behavior: a behavioral pediatrics perspective. New York: Wiley and Sons, 1986. 4. Dryfoos J. Adolescents at risk: prevalence and prevention. New York: Oxford University Press, 1990. 5. Mensch BS, Kandel DB. Dropping out of high school and drug involvement. Sociology of Education 1981;61:95-113. 6. Kolbe LJ. An epidemiological surveillance system to monitor the prevalence of youth behaviors that most affect health. Health Education 1990;21:44-8. 7. CDC. Participation in school physical education and selected dietary patterns among high school students -- United States, 1991. MMWR 1992;41:597-601,607. 8. National Education Goals Panel. The national education goals report. Washington, DC: National Education Goals Panel, 1991. 9. CDC. Current tobacco, alcohol, marijuana, and cocaine use among high school students -- United States, 1990. MMWR 1991;40:659-63.

• Smoking on 20 or more of the 30 days preceding the survey.

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