Highlights of Study by State on Youth Drug Use
This report on substance use among youths is the second presenting State estimates from the 1999 National Household Survey on Drug Abuse (NHSDA). The Summary of Findings from the 1999 NHSDA presented national estimates, as well as State estimates, for all persons aged 12 or older. This report examines State estimates of the use of alcohol, tobacco, and marijuana by youths aged 12 to 17 and their perceptions and behaviors that may be related to that use. The national sample included approximately 25,000 youths, including samples of 1,000 youths for the eight largest States and 300 youths for each of the remaining 42 States and the District of Columbia. Estimates of substance use by States were categorized into quintiles, or fifths.
The State with the highest rate of past month use of alcohol among youths aged 12 to 17 was North Dakota (24.7 percent). The State with the lowest rate was Utah (10.3 percent). Most of the States in the highest ranked group were northern, while most of the States in the lowest ranked group were southern. Nine of the States in the highest ranked group for past month binge use of alcohol for youths were also in the highest group for past month use of alcohol.
There was a strong negative correlation at the State level between prevalence of past month use of alcohol and perceived risk of alcohol use. In other words, those States with the highest prevalence rate for past month alcohol use were the same States that had the lowest perceived risk of alcohol use. Similarly, States with high rates of reporting great risk in having five or more drinks of an alcoholic beverage once or twice a week tended to have low rates of alcohol use. The State reporting the highest rate of this type of perceived risk was Utah (51.5 percent of youths). Most of the States reporting high rates of risk among youths were southern. Seven States that reported the highest rates of great risk were the same ones in the lowest category for past month alcohol use.
Among persons who first initiated alcohol use in 1995 to 1997 at age 25 or younger, the average age at first use ranged from 14.8 years old in Montana to 16.5 years in the District of Columbia. The national average age of first alcohol use in this group was 15.7 years old. Of the 10 States in the lowest quintile for age at first use, only five-Montana, Colorado, North Dakota, South Dakota, and Wyoming-were also in the highest prevalence group for past month use of alcohol among youths.
Nationally, 17.3 percent of youths had used some form of tobacco in the past month (SAMHSA, in press). Cigarette use (14.9 percent of youths) was the main component of tobacco use, but use of cigars also was significant (5.4 percent). States that had high rates of past month cigarette use among youths also had high rates of tobacco use. Of the 10 States in the highest group for past month cigarette use, 8 States were also in the highest group for past month use of tobacco. Similarly, 9 of the 10 States in the lowest group for past month cigarette use were also in the lowest group for past month tobacco use.
The national average annual incidence rate for marijuana use among youths was 6.3 percent. At the State level, Arizona had the highest average annual incidence rate (8.9 percent). Five of the States in the highest quintile for past month marijuana use among youths were also in the top quintile for new use of marijuana: Massachusetts, Nevada, Delaware, Colorado, and Alaska. Of the 10 States with the highest estimated rates of incidence, 4 were in the West (Arizona, Nevada, Colorado, and Alaska), 2 were in the Northeast (Massachusetts and Vermont), 2 were in the Midwest (North Dakota and Wisconsin), and 2 were in the South (Oklahoma and Delaware).
The national average age at first use for persons who initiated use in 1996 or 1997 at age 25 or younger was 16.2 years of age. The average age at first use of marijuana ranged from a low of 15.1 years of age in Montana and Nevada to 17.1 years of age in Maine. Four of the States that fell into the highest quintile for rates of past month use of marijuana among youths had lower than average ages at first use of marijuana: Montana, Nevada, Minnesota, and Washington. Three of the States in the lowest quintile of past month prevalence had higher than average ages at first use: Iowa, Tennessee, and Idaho.
Risk and Protective Factors
Risk and protective factors involve attitudes and behavior associated with the higher likelihood of use or nonuse of drugs. The 1999 NHSDA collected data on risk and protective factors in several content domains, including four constructs in the “peer/individual” domain: antisocial behavior, favorable attitudes toward substance use, peer attitudes favorable toward substance use, and peer substance use. Each construct was based on averaging responses to multiple questions.
The peer substance use scale (four questions) was based on questions about how many friends used different substances, including alcohol, cigarettes, and marijuana. The following scale responses were used: 1 (none of them), 2 (a few of them), 3 (most of them), and 4 (all of them). The national mean was 1.69, with State estimates ranging from 1.46 (Utah) to 1.88(West Virginia). Because West Virginia fell into the top fifth on this list, but not in the top fifth for either past month alcohol use or past month marijuana use, its high ranking on the composite measure is probably due to its ranking near the top for past month cigarette use.
Sequence of Substance Use Initiation
Most persons who will ever initiate the use of cigarettes, alcohol, or tobacco have already done so by the time they are 20 to 25 years old. However, no sequence of use was predominant in that age group in 1999. Approximately 10 percent had not used any of the substances. About 19 percent had used only one substance (i.e., either cigarettes or alcohol). About 24 percent had used only alcohol and cigarettes: 14 percent using cigarettes before alcohol and 10 percent with the opposite pattern. Of those persons who had used all three substances (about 44 percent), the predominant patterns were (a) cigarettes, then alcohol, and then marijuana (14 percent) or (b) alcohol, then cigarettes, and then marijuana (about 13 percent).
Nationally, about 80 percent of all persons who initiated the use of marijuana in 1996 or 1997 at age 25 or younger had previously used either alcohol or cigarettes (or both) (data not shown in tables). The remainder had not previously used any alcohol and cigarettes. The 80 percent is composed of three groups: 8.6 percent had initiated only alcohol before marijuana, 16.2 percent had initiated only cigarettes first, and the majority-55.4 percent-had initiated both alcohol and cigarettes prior to their first marijuana use (data not shown in tables). Overall, therefore, 71.6 percent had initiated cigarettes before marijuana (about 64 percent had initiated alcohol before marijuana).
Among the eight States with large samples, there were significant differences in the average age at first use and in the lag between the initiation of cigarettes and marijuana. For example, the following average ages at first use were found in New York for the group who initiated both alcohol and cigarettes before marijuana: alcohol, 13.6 years; cigarettes, 14.4 years; and marijuana, 17.3 years. Florida, by contrast, displayed the more typical pattern among large States, with an age at first use of cigarettes, 13.8 years, fairly close to the age at first use of alcohol, 14.1 years, and followed by marijuana, 16.7 years.
There was no single cigarette “gateway” to first marijuana use in that (a) the average age at first use of cigarettes differed at the national level between the cigarette-only initiates (age 13.0) and the alcohol-and-cigarettes initiates (age 14.0); (b) the lag between first use of cigarettes and first use of marijuana differed between the cigarette-only group (1.9 years) and the cigarette-and-alcohol initiate group (3 years); and (c) the age and pattern of first use of alcohol, cigarettes, and marijuana varied across the large States.