A national survey of students in U.S. middle schools and high schools shows some important improvements in levels of substance use.
Both alcohol and cigarette use in 2014 are at their lowest points since the study began in 1975. Use of a number of illicit drugs also show declines this year.
These findings come from the University of Michigan’s Monitoring the Future study, which tracks trends in substance use among students in 8th, 10th and 12th grades. Each year the national study, now in its 40th year, surveys 40,000 to 50,000 students in about 400 secondary schools throughout the United States.
Alcohol use by the nation’s teens continued its long-term decline in 2014. All three grades showed a decline in the proportion of students reporting any alcohol use in the 12 months prior to the survey; the three grades combined dropped from 43 percent to 41 percent, a statistically significant change.
“Since the recent peak rate of 61 percent in 1997, there has been a fairly steady downward march in alcohol use among adolescents,” said Lloyd Johnston, the study’s principal investigator. “The proportion of teens reporting any alcohol use in the prior year has fallen by about a third.”
Of perhaps greater importance, the proportion of teens who report “binge drinking”, that is, consuming five or more drinks in a row at least once in the two weeks preceding the survey, fell significantly again this year to 12 percent for the three grades combined. This statistic is down from a recent high point of 22 percent in 1997. While this is an important improvement, say the investigators, still roughly one in five (19 percent) 12-graders report binge drinking at least once in the prior two weeks.
Some 12th-graders drink even more heavily, reporting having 10 or more, or 15 or more, drinks in a row on at least one occasion in the prior two weeks. Since 2005 (the first year that this “extreme binge drinking” was measured), these measures also have declined, from 11 percent to 7 percent in 2014 for 10 or more drinks, and from 6 percent to 4 percent for 15 or more drinks.
Peer disapproval of binge drinking has been rising since 2000 among teens. Declines in availability may be another contributing factor to the drops in teen drinking. In recent years, there has been a fair decline in all three grades in the proportion saying that alcohol is easy for them to get.
Cigarette smoking also reached historical lows among teens in 2014 in all three grades. For the three grades combined, 28 percent reported any smoking in the prior month in 1997, the recent peak year, but that rate was down to 8 percent in 2014.
“The importance of this major decline in smoking for the health and longevity of this generation of young people cannot be overstated,” Johnston said.
As with alcohol, there has been a substantial reduction in the proportion of students who say cigarettes are easy for them to get, and this decline continued into 2014. Increasing disapproval of smoking also has accompanied the decline in use, as well as an increased perception that smoking carries a “great risk” for the user. However, there were only modest further increases in these factors in 2014.
In 2014, more teens use e-cigarettes than traditional, tobacco cigarettes or any other tobacco product, the first time a U.S. national study shows that teen use of e-cigarettes surpasses use of tobacco cigarettes.
“As one of the newest smoking-type products in recent years, e-cigarettes have made rapid inroads into the lives of American adolescents,” said Richard Miech, a senior investigator of the study.
The survey asked students whether they had used an e-cigarette or a tobacco cigarette in the past 30 days. More than twice as many 8th and 10th-graders reported using e-cigarettes as reported using tobacco cigarettes.
Specifically, 9 percent of 8th-graders reported using an e-cigarette in the past 30 days, while only 4 percent reported using a tobacco cigarette. In 10th grade, 16 percent reported using an e-cigarette and 7 percent reported using a tobacco cigarette. Among 12th-graders, 17 percent reported e-cigarette use and 14 percent reported use of a tobacco cigarette.
The older teens report less difference in use of e-cigarettes versus tobacco cigarettes.
“This could be a result of e-cigarettes being relatively new,” said Lloyd Johnston, principal investigator of the project. “So today’s 12th-graders may not have had the opportunity to begin using them when they were younger. Future surveys should be able to tell us if that is the case.”
E-cigarettes are battery-powered devices with a heating element. They produce an aerosol, or vapor, that users inhale. Typically, this vapor contains nicotine, although the specific contents of the vapor are proprietary and are not regulated. The liquid that is vaporized in e-cigarettes comes in hundreds of flavors. Some of these flavors, such as bubble gum and milk chocolate cream, are likely attractive to younger teens.
E-cigarettes may serve as a point of entry into the use of nicotine, an addictive drug. The percentages of past 30-day e-cigarette users who have never smoked a tobacco cigarette in their life range from 4 percent to 7 percent in 8th, 10th and 12th grades.
For these youth, e-cigarettes are a primary source of nicotine and not a supplement to tobacco cigarette use. Whether youth who use e-cigarettes exclusively later go on to become tobacco cigarette smokers is yet to be determined by this study, and is of substantial concern to the public health community.
E-cigarette use among youth offsets a long-term decline in the use of tobacco cigarettes, which is at a historic low in the life of the study, now in its 40th year. In 2014, the prevalence of smoking tobacco cigarettes in the past 30 days was 8 percent for students in 8th, 10th and 12th grades combined. This is a significant decline from 10 percent in 2013, and is less than a third of the most recent high of 28 percent in 1998.
One important cause of the decline in smoking is that many more young people today have ever started to smoke tobacco cigarettes. In 2014, only 23 percent of students had ever tried tobacco cigarettes, as compared to 56 percent in 1998. Of particular concern is the possibility that e-cigarettes may lead to tobacco cigarette smoking, and reverse this hard-won, long-term decline.
“Part of the reason for the popularity of e-cigarettes is the perception among teens that they do not harm health,” Miech said.
Only 15 percent of 8th-graders think there is a great risk of people harming themselves with regular use of e-cigarettes. This compares to 62 percent of 8th-graders who think there is a great risk of people harming themselves by smoking one or more packs of tobacco cigarettes a day. Because e-cigarettes are relatively new, a comprehensive assessment of their health impact, especially their long-term consequences, has yet to be developed.