Tuesday, December 5, 2023
| Behavior/Substance | Prevalence | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 2009% | 2011% | 2013% | 2015% | 2017% | 2019% | 2021% | Linear change† | Quadratic change† | Change during2019–2021§ | |
| Current use¶ | ||||||||||
| Alcohol | 41.8 | 38.7 | 34.9 | 32.8 | 29.8 | 29.2 | 22.7 | Decreased 2009–2021 | No change | Decreased |
| Marijuana | 20.8 | 23.1 | 23.4 | 21.7 | 19.8 | 21.7 | 15.8 | Decreased 2009–2021 | Increased 2009–2013Decreased 2013–2021 | Decreased |
| Binge drinking | NA | NA | NA | NA | 13.5 | 13.7 | 10.5 | Decreased 2017–2021 | —** | Decreased |
| Prescription opioid misuse | NA | NA | NA | NA | NA | 7.2 | 6.0 | — | — | No change |
| Lifetime use | ||||||||||
| Alcohol | 68.4 | 66.7 | 63.4 | 60.9 | 56.5 | 56.5 | 47.4 | Decreased 2009–2021 | Decreased 2009–2017Decreased 2017–2021 | Decreased |
| Marijuana | 36.8 | 39.9 | 40.7 | 38.6 | 35.6 | 36.8 | 27.8 | Decreased 2009–2021 | Increased 2009–2013Decreased 2013–2021 | Decreased |
| Inhalants | 11.7 | 11.4 | 8.9 | 7.0 | 6.2 | 6.4 | 8.1 | Decreased 2009–2021 | Decreased 2009–2017Increased 2017–2021 | Increased |
| Ecstasy | 6.7 | 8.2 | 6.6 | 5.0 | 4.0 | 3.6 | 2.9 | Decreased 2009–2021 | No change 2009–2013Decreased 2013–2021 | No change |
| Cocaine | 6.4 | 6.8 | 5.5 | 5.2 | 4.8 | 3.9 | 2.5 | Decreased 2009–2021 | No change 2009–2017Decreased 2017–2021 | Decreased |
| Methamphetamine | 4.1 | 3.8 | 3.2 | 3.0 | 2.5 | 2.1 | 1.8 | Decreased 2009–2021 | No change | No change |
| Heroin | 2.5 | 2.9 | 2.2 | 2.1 | 1.7 | 1.8 | 1.3 | Decreased 2009–2021 | No change | No change |
| Injection drug use | 2.1 | 2.3 | 1.7 | 1.8 | 1.5 | 1.6 | 1.4 | Decreased 2009–2021 | No change | No change |
| Synthetic marijuana | NA | NA | NA | 9.2 | 6.9 | 7.3 | 6.5 | Decreased 2015–2021 | — | No change |
| Prescription opioid misuse | NA | NA | NA | NA | 14.0 | 14.3 | 12.2 | Decreased 2017–2021 | — | Decreased |
Table 1. Trends in prevalence of current and lifetime use of specific substances among high school students — Youth Risk Behavior Survey, United States, 2009–2021*
Abbreviation: NA = not available.
*2009: N = 16,410 respondents; 2011: N = 15,425 respondents; 2013: N = 13,583 respondents; 2015: N = 15,624 respondents; 2019:
N = 13,677 respondents; 2021: N = 17,232 respondents. Because the state and local questionnaires differ by jurisdiction, students
in these schools were not asked all national YRBS questions. Therefore, the total number (N) of students answering each question
varied. Percentages in each category are calculated on the known data.
†On the basis of trend analyses from a logistic regression model controlling for sex, race and ethnicity, and grade (p<0.05).
§On the basis of t-test analysis with Taylor series linearization (p<0.05).
¶Previous 30 days before the survey.
**Dashes indicate insufficient years of data to assess trends.
| Behavior/Substance | Sex | |||||||
|---|---|---|---|---|---|---|---|---|
| Male | Female | |||||||
| 2019% | 2021% | PD (95% CI) | PR (95% CI) | 2019% | 2021 % | PD (95% CI) | PR (95% CI) | |
| Current use† | ||||||||
| Alcohol | 26.4 | 18.8 | −7.7 (−0.3 to −5.1)§ | 0.7 (0.6 to 0.8)§ | 31.9 | 26.8¶ | −5.1 (−8.3 to −1.9)§ | 0.8 (0.8 to 0.9)§ |
| Marijuana | 22.5 | 13.6 | −8.9 (−1.3 to −6.4)§ | 0.6 (0.5 to 0.7)§ | 20.8 | 17.8¶ | −3.0 (−6.0 to 0.0) | 0.9 (0.7 to 1.0) |
| Binge drinking | 12.7 | 9.0 | −3.7 (−5.6 to −1.7)§ | 0.7 (0.6 to 0.8)§ | 14.6 | 12.2¶ | −2.5 (−5.2 to 0.2) | 0.8 (0.7 to 1.0) |
| Prescription opioid misuse | 6.1 | 4.0 | −2.1 (−3.5 to −0.8)§ | 0.7 (0.5 to 0.9)§ | 8.3 | 8.0¶ | −0.3 (−2.2 to 1.6) | 1.0 (0.8 to 1.2) |
| Lifetime use | ||||||||
| Alcohol | 53.1 | 42.0 | −11.1 (−14.2 to −8.0)§ | 0.8 (0.7 to 0.8)§ | 60.0 | 53.2¶ | −6.9 (−10.2 to −3.5)§ | 0.9 (0.8 to 0.9)§ |
| Marijuana | 37.0 | 24.8 | −12.3 (−15.9 to −8.7)§ | 0.7 (0.6 to 0.8)§ | 36.5 | 30.9¶ | −5.6 (−9.3 to −1.9)§ | 0.9 (0.8 to 1.0)§ |
| Inhalants | 5.7 | 6.8 | 1.1 (−0.1 to 2.3) | 1.2 (1.0 to 1.5) | 6.9 | 9.4¶ | 2.5 (1.1 to 3.9)§ | 1.4 (1.1 to 1.6)§ |
| Ecstasy | 4.6 | 2.9 | −1.7 (−2.8 to −0.7)§ | 0.6 (0.5 to 0.8)§ | 2.4 | 2.7 | 0.4 (−0.5 to 1.3) | 1.2 (0.8 to 1.7) |
| Cocaine | 4.9 | 2.6 | −2.3 (−3.3 to −1.4)§ | 0.5 (0.4 to 0.7)§ | 2.7 | 2.2 | −0.5 (−1.6 to 0.5) | 0.8 (0.5 to 1.2) |
| Methamphetamine | 2.7 | 1.9 | −0.8 (−1.6 to 0.0) | 0.7 (0.5 to 1.0) | 1.5 | 1.4 | −0.1 (−0.8 to 0.6) | 1.0 (0.6 to 1.5) |
| Heroin | 2.3 | 1.6 | −0.7 (−1.5 to 0.1) | 0.7 (0.5 to 1.0) | 1.0 | 0.8¶ | −0.3 (−0.9 to 0.4) | 0.8 (0.4 to 1.5) |
| Injection drug use | 2.1 | 1.7 | −0.4 (−1.2 to 0.4) | 0.8 (0.5 to 1.2) | 1.1 | 0.9¶ | −0.2 (−0.9 to 0.6) | 0.9 (0.4 to 1.8) |
| Synthetic marijuana | 7.2 | 5.8 | −1.4 (−2.9 to 0.1) | 0.8 (0.6 to 1.0) | 7.4 | 7.1 | −0.3 (−1.9 to 1.3) | 1.0 (0.8 to 1.2) |
| Prescription opioid misuse | 12.4 | 9.5 | −2.9 (−4.7 to −1.2)§ | 0.8 (0.7 to 0.9)§ | 16.1 | 14.8¶ | −1.4 (−3.9 to 1.1) | 0.9 (0.8 to 1.1) |
Table 2. Prevalence of and changes in prevalence of current and lifetime use of specific substances among high school students, by sex — Youth Risk Behavior Survey, United States, 2019 and 2021*
Abbreviations: PD = prevalence difference; PR = prevalence ratio.
*2019: N = 13,677 respondents; 2021: N = 17,232 respondents. Because the state and local questionnaires differ by jurisdiction,
students in these schools were not asked all national YRBS questions. Therefore, the total number (N) of students answering
each question varied. Percentages in each category are calculated on the known data.
†Previous 30 days before the survey.
§Statistically significant results (p<0.05).
¶Significantly different from male students in 2021, on the basis of t-test analysis with Taylor series linearization (p<0.05).
| Behavior/Substance | Race and ethnicity† | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Black or African American | White | Hispanic or Latino | ||||||||||
| 2019% | 2021 % | PD (95% CI) | PR (95% CI) | 2019% | 2021% | PD (95% CI) | PR (95% CI) | 2019% | 2021 % | PD (95% CI) | PR (95% CI) | |
| Current use§ | ||||||||||||
| Alcohol | 16.8 | 13.2¶ | −3.6 (−7.7 to 0.5) | 0.8 (0.6 to 1.0) | 34.2 | 25.9 | −8.3 (−11.4 to −5.3)** | 0.8 (0.7 to 0.8)** | 28.4 | 22.9¶,†† | −5.5 (−9.5 to −1.6)** | 0.8 (0.7 to 1.0)** |
| Marijuana | 21.7 | 20.5¶ | −1.2 (−5.4 to 2.9) | 0.9 (0.8 to 1.2) | 22.1 | 14.8 | −7.3 (−10.2 to −4.5)** | 0.7 (0.6 to 0.8)** | 22.4 | 16.7†† | -5.7 (−9.2 to −2.2)** | 0.7 (0.6 to 0.9)** |
| Binge drinking | 6.2 | 4.1¶ | −2.2 (−4.8 to 0.5) | 0.7 (0.4 to 1.0) | 17.3 | 13.3 | −4.0 (−6.6 to −1.4)** | 0.8 (0.7 to 0.9)** | 12.4 | 10.1¶,†† | −2.3 (−4.8 to 0.1) | 0.8 (0.7 to 1.0) |
| Prescription opioid misuse | 8.7 | 8.6¶ | −0.1 (−4.2 to 3.9) | 1.0 (0.6 to 1.6) | 5.5 | 4.6 | −1.0 (−2.5 to 0.5) | 0.8 (0.6 to 1.1) | 9.8 | 8.3¶ | −1.5 (−4.0 to 1.1) | 0.9 (0.6 to 1.1) |
| Lifetime use | ||||||||||||
| Alcohol | 47.2 | 39.4¶ | −7.8 (−13.5 to −2.0)** | 0.8 (0.7 to 1.0)** | 58.8 | 50.0 | −8.8 (−12.0 to −5.6)** | 0.9 (0.8 to 0.9)** | 60.4 | 50.4†† | −10.0 (−14.5 to −5.5)** | 0.8 (0.8 to 0.9)** |
| Marijuana | 37.5 | 33.3¶ | −4.2 (−10.5 to 2.2) | 0.9 (0.7 to 1.1) | 36.8 | 26.2 | −10.7 (−14.1 to −7.2)** | 0.7 (0.6 to 0.8)** | 39.2 | 31.2¶ | −7.9 (−12.5 to −3.4)** | 0.8 (0.7 to 0.9)** |
| Inhalants | 7.2 | 7.0 | −0.2 (−2.5 to 2.1) | 1.0 (0.7 to 1.3) | 6.3 | 8.3 | 1.9 (0.3 to 3.6)** | 1.3 (1.1 to 1.6)** | 6.6 | 8.2 | 1.6 (−0.1 to 3.3) | 1.2 (1.0 to 1.6) |
| Ecstasy | 3.8 | 2.7 | −1.1 (−2.9 to 0.7) | 0.7 (0.4 to 1.2) | 2.7 | 2.9 | 0.1 (−0.9 to 1.2) | 1.1 (0.7 to 1.5) | 4.4 | 2.7 | -1.7 (−2.7 to −0.7)** | 0.6 (0.5 to 0.8)** |
| Cocaine | 4.0 | 1.9 | −2.1 (−3.8 to −0.4)** | 0.5 (0.3 to 0.8)** | 2.9 | 2.4 | −0.5 (−1.4 to 0.4) | 0.8 (0.6 to 1.1) | 5.6 | 2.9 | −2.7 (−4.4 to −1.0)** | 0.5 (0.3 to 0.8)** |
| Methamphetamine | 3.8 | 2.0 | −1.9 (−3.7 to 0.0) | 0.5 (0.3 to 0.9)** | 1.2 | 1.4 | 0.2 (−0.3 to 0.7) | 1.2 (0.8 to 1.7) | 2.7 | 2.3¶ | −0.4 (−1.6 to 0.8) | 0.9 (0.5 to 1.3) |
| Heroin | 3.4 | 1.7 | −1.7 (−3.4 to −0.1)** | 0.5 (0.3 to 0.9)** | 0.9 | 1.0 | 0.1 (−0.3 to 0.5) | 1.2 (0.8 to 1.8) | 2.4 | 1.6¶ | −0.9 (−2.1 to 0.4) | 0.7 (0.4 to 1.1) |
| Injection drug use | 2.9 | 1.9 | −0.9 (−3.0 to 1.1) | 0.7 (0.3 to 1.5) | 0.8 | 1.1 | 0.3 (−0.3 to 0.8) | 1.4 (0.8 to 2.4) | 2.5 | 1.8 | −0.7 (−1.8 to 0.3) | 0.7 (0.4 to 1.2) |
| Synthetic marijuana | 5.7 | 6.8 | 1.1 (−1.2 to 3.3) | 1.2 (0.8 to 1.7) | 6.7 | 6.5 | −0.2 (−1.6 to 1.3) | 1.0 (0.8 to 1.2) | 9.8 | 6.8 | −3.1 (−4.9 to −1.3)** | 0.7 (0.6 to 0.9)** |
| Prescription opioid misuse | 15.3 | 13.6 | −1.7 (−5.4 to 1.9) | 0.9 (0.7 to 1.1) | 12.7 | 11.2 | −1.4 (−3.7 to 0.8) | 0.9 (0.7 to 1.1) | 16.0 | 13.8 | −2.2 (−5.5 to 1.2) | 0.9 (0.7 to 1.1) |
Table 3. Prevalence of and changes in prevalence of current and lifetime use of specific substances among high school students, by race and ethnicity — Youth Risk Behavior Survey, United States, 2019 and 2021*
Abbreviations: PD = prevalence difference; PR = prevalence ratio.
*2019: N = 13,677 respondents; 2021: N = 17,232 respondents. Because the state and local questionnaires differ by jurisdiction,
students in these schools were not asked all national YRBS questions. Therefore, the total number (N) of students answering
each question varied. Percentages in each category are calculated on the known data.
†Persons of Hispanic or Latino (Hispanic) origin might be of any race but are categorized as Hispanic; all racial groups are
non-Hispanic.
§Previous 30 days before the survey.
¶Significantly different from White students in 2021, on the basis of t-test analysis with Taylor series linearization (p<0.05).
**Statistically significant results (p<0.05).
††Significantly different from Black or African American students in 2021, on the basis of t-test analysis with Taylor series linearization (p<0.05).
| Behavior/Substance | Heterosexual % | Lesbian, gay, or bisexual % | Questioning or other % |
|---|---|---|---|
| Current use† | |||
| Alcohol | 21.6 | 29.3§ | 20.9¶ |
| Marijuana | 14.0 | 25.6§ | 16.5§,¶ |
| Binge drinking | 10.3 | 13.6§ | 7.6§,¶ |
| Prescription opioid misuse | 4.3 | 11.7§ | 10.3§ |
| Lifetime use | |||
| Alcohol | 45.8 | 58.0§ | 46.2¶ |
| Marijuana | 25.8 | 41.2§ | 27.5¶ |
| Inhalants | 6.0 | 15.1§ | 13.4§ |
| Ecstasy | 2.1 | 6.0§ | 3.9§,¶ |
| Cocaine | 1.8 | 4.4§ | 3.1§ |
| Methamphetamine | 1.1 | 3.4§ | 3.0§ |
| Heroin | 0.8 | 1.9§ | 2.4§ |
| Injection drug use | 1.0 | 1.9§ | 2.7§ |
| Synthetic marijuana | 5.9 | 9.7§ | 6.1¶ |
| Prescription opioid misuse | 9.4 | 21.5§ | 18.6§ |
Table 4. Prevalence of current and lifetime use of specific substances among high school students, by sexual identity — Youth Risk Behavior Survey, United States, 2021*
*N = 17,232 respondents. Because the state and local questionnaires differ by jurisdiction, students in these schools were
not asked all national YRBS questions. Therefore, the total number (N) of students answering each question varied. Percentages
in each category are calculated on the known data.
†Previous 30 days before the survey.
§Significantly different from heterosexual students, based on t-test analysis with Taylor series linearization (p<0.05).
¶Significantly different from lesbian, gay, or bisexual students, based on t-test analysis with Taylor series linearization (p<0.05).
Physicians - maximum of 0.75 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.75 ABIM MOC points
Nurses - 0.75 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
Pharmacists - 0.75 Knowledge-based ACPE (0.075 CEUs)
This activity is intended for primary care clinicians, pediatricians, addiction medicine specialists, and other healthcare professionals who treat and manage adolescents.
The goal of this activity is for members of the healthcare team to be better able to assess trends in the epidemiology of substance use among US high school students.
Upon completion of this activity, participants will:
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.75 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.
Awarded 0.75 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.00 contact hours are in the area of pharmacology.
Medscape designates this continuing education activity for 0.75 contact hour(s) (0.075 CEUs) (Universal Activity Number: (JA0007105-0000-23-342-H01-P)).
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability
and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those
credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the
activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.
Follow these steps to earn CME/CE credit*:
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it.
Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print
out the tally as well as the certificates from the CME/CE Tracker.
*The credit that you receive is based on your user profile.
CME / ABIM MOC / CE Released: 10/3/2023
Valid for credit through: 10/3/2024, 11:59 PM EST
processing....
Adolescence is a critical phase of development and is frequently a period of initiating and engaging in risky behaviors, including alcohol and other substance use. The COVID-19 pandemic and associated stressors might have affected adolescent involvement in these behaviors. To examine substance use patterns and understand how substance use among high school students changed before and during the COVID-19 pandemic, CDC analyzed data from the nationally representative Youth Risk Behavior Survey. This report presents estimated prevalences among high school students of current (i.e., previous 30 days) alcohol use, marijuana use, binge drinking, and prescription opioid misuse and lifetime alcohol, marijuana, synthetic marijuana, inhalants, ecstasy, cocaine, methamphetamine, heroin, and injection drug use and prescription opioid misuse. Trends during 2009–2021 were assessed using logistic regression and joinpoint regression analyses. Changes in substance use from 2019 to 2021 were assessed using prevalence differences and prevalence ratios, stratified by demographic characteristics. Prevalence of substance use measures by sexual identity and current co-occurring substance use were estimated using 2021 data. Substance use prevalence declined during 2009–2021. From 2019 to 2021, the prevalence of current alcohol use, marijuana use, and binge drinking and lifetime use of alcohol, marijuana, and cocaine and prescription opioid misuse decreased; lifetime inhalant use increased. In 2021, substance use varied by sex, race and ethnicity, and sexual identity. Approximately one third of students (29%) reported current use of alcohol or marijuana or prescription opioid misuse; among those reporting current substance use, approximately 34% used two or more substances. Widespread implementation of tailored evidence-based policies, programs, and practices likely to reduce risk factors for adolescent substance use and promote protective factors might further decrease substance use among U.S. high school students and is urgently needed in the context of the changing marketplaces for alcohol beverage products and other drugs (e.g., release of high-alcohol beverage products and increased availability of counterfeit pills containing fentanyl).
Adolescence is a critical phase of physical, cognitive, social, and emotional development and is frequently a period of initiating and engaging in risky behaviors, including alcohol and other substance use. The majority of adolescents engage in some form of substance use before finishing high school.[1,2] Substance use during adolescence is associated with adverse health outcomes, such as mental health problems, teen pregnancy, and sexually transmitted diseases as well as consequences, such as delinquency, violence, and academic underachievement.[2,3] Substance use initiation during adolescence can increase the risk for substance use later in adulthood and increase the risk for substance use disorders (https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf). Adolescent substance use is of particular concern as overdose deaths among adolescents have increased dramatically.[4] The Drug Enforcement Administration has warned of readily available counterfeit pills containing highly lethal substances (e.g., illicit fentanyl) and other synthetic opioids that are designed to look like commonly misused prescription medications that might be contributing to these increases (https://www.dea.gov/press-releases/2021/05/21/dea-issues-warning-over-counterfeit-pills; https://www.dea.gov/sites/default/files/2021-05/Counterfeit%20Pills%20fact%20SHEET-5-13-21-FINAL.pdf). The alcohol industry and regulatory environment is also changing, including the release of high-alcohol content products (https://www.samhsa.gov/resource/ebp/implementing-community-level-policies-prevent-alcohol-misuse). In addition, alcohol-related deaths, including those involving other substances, have increased among adolescents.[5]
In 2021, CDC's Adolescent Behaviors and Experiences Survey (ABES) found that students experienced adversities and challenges during the COVID-19 pandemic, such as poor mental health, persistent feelings of sadness or hopelessness, suicidal ideation, and physical and emotional abuse, all of which are risk factors for substance use (https://www.cdc.gov/healthyyouth/data/abes/reports.htm). In addition, measures to protect adolescents from COVID-19 infection, such as remote schooling, social isolation, and event cancelation, might have contributed additional risk for adolescent substance use. One third of students participating in ABES who had ever drunk alcohol or used drugs used those substances more during the pandemic.[6]
Other studies examining adolescent substance use during the pandemic have had varying findings. For example, the Monitoring the Future survey indicated declines in current marijuana use, alcohol use, and binge drinking when comparing 2020 and 2021 prevalence estimates.[1] However, another study comparing prevalence estimates from the early stages of the pandemic to prepandemic estimates found increases in the frequency of both marijuana and alcohol use,[3] and another demonstrated no change in the use of either substance.[7]
The variability in the previous studies highlighted the need for additional studies of nationally representative data to assess changes in alcohol and other substance use before and during the pandemic. This report used Youth Risk Behavior Survey (YRBS) data to improve understanding of how substance use changed before and during the COVID-19 pandemic. Specifically, this report examined overall trends in alcohol and other substance use, characterized changes in alcohol and other substance use by demographic groups, and examined co-occurring substance use among U.S. high school students. Public health practitioners, clinicians, school officials, and policymakers can use these findings to expand evidence-based prevention programs, practices, and policies that reduce adolescent substance use risk factors and promote protective factors.
