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Youth Alcohol, Tobacco, and Other Drug Use (see data for this topic)

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Why This Topic Is Important
Youth alcohol, tobacco, and other drug use is a significant public health concern and is associated with a wide range of academic, social, and health problems (1, 2). Alcohol is the most widely used substance among the nation's young people and binge drinking, in particular, has been linked to risky health behaviors (e.g., unprotected sex, smoking), injuries, motor vehicle accidents, impaired cognitive functioning, poor academic performance, physical violence, and suicide attempts (1, 2). Drinking during adolescence increases the likelihood of alcohol dependence in adulthood, and excessive alcohol consumption can have long-term health consequences, including liver disease, cancer, and cardiovascular disease (1, 2).

Cigarette smoking is the leading cause of preventable and premature death in the U.S., resulting in more than 480,000 deaths annually (3). Smoking has cumulative, irreversible negative health effects, and most long-term smokers start when they are teens or young adults (3, 4). Tobacco use or smoking in any form—including electronic cigarettes—is unsafe (3, 4). Marijuana use, too, is linked to adverse effects such as respiratory problems, anxiety attacks, cognitive difficulties, and coordination loss, as well as aggressive behavior and poor academic performance among youth (5).
Opioid misuse is a national crisis; among adolescents ages 15-19, the rate of opioid-related overdose death tripled between 1999 and 2015, from 0.8 to 2.4 per 100,000 (6). Data from a 2017 survey of teens, however, show historically low rates of opioid use, along with declines in perceived availability (7).

For more information on this topic, see's Research & Links section.

Sources for this narrative:

1.  Child Trends Databank. (2016). Binge drinking. Retrieved from:

2.  Substance Abuse and Mental Health Services Administration. (2015). Report to congress on the prevention and reduction of underage drinking. U.S. Department of Health and Human Services. Retrieved from:

3.  Child Trends Databank. (2016). Daily cigarette use. Retrieved from:

4.  Centers for Disease Control and Prevention. (2017). Youth and tobacco use. Retrieved from:

5.  Child Trends Databank. (2016). Marijuana use. Retrieved from:

6.  Curtain, S. C., et al. (2017). Drug overdose deaths among adolescents aged 15–19 in the United States: 1999–2015. National Center for Health Statistics. Retrieved from:

7.  National Institute on Drug Abuse. (2017). Vaping popular among teens; opioid misuse at historic lows. Retrieved from:
Policy Implications
Public policy can promote early identification of known risk factors for youth substance use, such as poor school performance, truancy, lack of parental supervision, aggressive behavior, drug availability, and substance use by peers (1, 2, 3). Policies and programs also can promote protective factors, such as school engagement, positive community connections, and academic success (1). Screening and early intervention can be effective, especially when specifically tailored to the population and risk factors (3, 4). Controlling youth smoking (including e-cigarettes) and alcohol consumption also requires particular attention to mass media and marketing (5, 6).

Policy and program options for addressing youth alcohol, tobacco, and other drug use include:
  • Prioritizing screening and early identification of risk factors correlated with substance use, especially among middle school youth; screening should include mental health issues, as they often co-occur with substance abuse (3, 4, 7)
  • Developing comprehensive policies that promote school and community connectedness among youth and help them develop the knowledge, skills, and motivation to avoid substance use; such policies should focus on preadolescence through young adulthood and involve support from families, schools, colleges, community organizations, government, and others (5, 6, 7)
  • Promoting youth-focused, mass media counter-marketing strategies to combat tobacco and alcohol advertising; also reducing youth exposure to tobacco and alcohol marketing, including monitoring compliance with marketing standards (5, 6)
  • Ensuring adequate funding, accessibility, and availability of developmentally appropriate, research-based treatment for youth substance abuse (3, 4)
  • Continuing to enforce, strengthen, and extend evidence-based legislation, such as increased prices on alcohol and tobacco products, and keg registration requirements (5, 6, 8)
For more information, see's Research & Links section or visit the Interagency Coordinating Committee on the Prevention of Underage Drinking, the Campaign for Tobacco-Free Kids, and the National Institute on Drug Abuse. Also see Policy Implications for School Connectedness and Children's Emotional Health.

Sources for this narrative:

1.  Patrick, M. E., & Schulenberg, J. E. (2014). Prevalence and predictors of adolescent alcohol use and binge drinking in the United States. Alcohol Research: Current Reviews, 35(2), 193-200. Retrieved from:

2.  Marshall, E. J. (2014). Adolescent alcohol use: Risks and consequences. Alcohol and Alcoholism, 49(2), 160-164. Retrieved from:

3.  American Public Human Services Association. (2013). Behavioral health—Prevention, early identification, and intervention. Retrieved from:

4.   Wachino, V., & Hyde, P. S. (2015). Coverage of behavioral health services for youth with substance use disorders. Substance Abuse and Mental Health Services Administration & Center for Medicaid and CHIP Services. Retrieved from:

5.  Substance Abuse and Mental Health Services Administration. (2015). Report to congress on the prevention and reduction of underage drinking. U.S. Department of Health and Human Services. Retrieved from:

6.  Centers for Disease Control and Prevention. (2012). Preventing tobacco use among youth and young adults: A report of the Surgeon General. Retrieved from:

7.  National Institute on Alcohol Abuse and Alcoholism. (2017). Underage drinking. Retrieved from:

8.  Sacks, V. H., et al. (2014). An analysis of state underage drinking policies and adolescent alcohol use. Child Trends. Retrieved from:

How Children Are Faring
According to 2013-15 estimates, 10% of 7th graders, 23% of 9th graders, and 33% of 11th graders in California public schools used alcohol or drugs in the previous 30 days. Among students in non-traditional programs (community day schools and continuation education), alcohol or drug use in the past month was higher than 60%—almost double the estimate for 11th graders. Statewide, 16% of 11th graders binge drank at least once in the previous month, and 18% had either driven when they had been drinking, or had ridden with a driver who had been drinking, at least once in their lifetimes. E-cigarette use typically was more common than cigarette smoking: 31% of 11th graders had used e-cigarettes at least once, compared to 17% who had smoked cigarettes. Lifetime marijuana use among California 11th graders was 64% overall, and ranged from 45% to 74% across counties with data.

Gay, lesbian, and bisexual students more frequently report substance use, as do students with low levels of school connectedness and those whose parents did not finish high school. Across all grade levels in 2013-15, estimates of alcohol or drug use in the previous month were higher for girls than for boys.

High school staff reports from the same period show that 44% considered student alcohol and drug use a moderate to severe problem. At the same time more than six out of ten agreed that substance abuse prevention was an important goal at their school, and seven out of 10 reported that their school provided at least some substance use prevention education.