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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 linked to a wide range of academic, social, and health problems (1). Alcohol is the most widely used substance among the nation's young people and initiation peaks in the years between Grades 7 and 11 (2). Underage drinking is associated with risky health behaviors (e.g., unsafe sexual practices), injuries, motor vehicle accidents, impaired cognitive functioning, poor academic performance, physical violence, and suicide attempts; binge drinking places youth and those around them at even higher risk for negative outcomes (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 (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 causes cumulative, irreversible harm, and most long-term smokers start when they are teens or young adults (3, 4). Tobacco use or smoking in any form—including e-cigarettes—is unsafe (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 (5). Data from a 2017 survey of teens, however, show historically low rates of opioid use, along with declines in perceived availability (6).

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

Sources for this narrative:

1. (n.d.). Substance use/misuse. Interagency Working Group on Youth Programs. Retrieved from:

2.  Substance Abuse and Mental Health Services Administration. (2018). Report to Congress on the prevention and reduction of underage drinking. U.S. Department of Health and Human Services. Retrieved from:

3.  Office of the Surgeon General. (2014). The health consequences of smoking—50 years of progress. U.S. Department of Health and Human Services. Retrieved from:

4.  Wang, T. W., et al. (2019). Tobacco product use and associated factors among middle and high school students — United States, 2019. Morbidity and Mortality Weekly Report, 68(12), 1-22. Retrieved from:

5.  National Institute on Drug Abuse for Teens. (2019). Marijuana. 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 misuse, such as poor school performance, truancy, lack of parental supervision, aggressive behavior, drug availability, and substance use by peers (1, 2). 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). Controlling youth smoking (including e-cigarettes) and alcohol consumption also requires particular attention to mass media and marketing (4, 5).

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; assessments should target mental health issues, as they often co-occur with substance abuse (3, 6)
  • 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 (4, 5, 6)
  • Recognizing that substance misuse and mental health disorders are inherently health conditions, embedding research-based prevention and treatment services into mainstream health care settings, and expanding behavioral health care accessibility, coverage, and coordination across systems (3)
  • Promoting youth-focused, mass media counter-marketing strategies to combat tobacco and alcohol advertising; also reducing youth exposure to tobacco and alcohol marketing by monitoring compliance with marketing standards (4, 5)
  • Continuing to enforce, strengthen, and extend evidence-based legislation, such as increased prices on alcohol and tobacco products, and keg registration requirements (4, 5, 7)
For more information, see’s Research & Links section or visit the Interagency Coordinating Committee on the Prevention of Underage Drinking, Campaign for Tobacco-Free Kids, and National Institute on Drug Abuse for Teens. Also see Policy Implications for School Climate and Children's Emotional Health.

Sources for this narrative:

1.  Patrick, M. E., & Schulenberg, J. E. (2013). 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.  Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. U.S. Department of Health and Human Services. Retrieved from:

4.  Substance Abuse and Mental Health Services Administration. (2018). Report to Congress on the prevention and reduction of underage drinking. U.S. Department of Health and Human Services. Retrieved from:

5.  Office of the Surgeon General. (2012). Preventing tobacco use among youth and young adults. U.S. Department of Health and Human Services. Retrieved from:

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

7.  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 2015-2017 estimates, 7% of 7th graders, 20% of 9th graders, and 29% of 11th graders in California public schools used alcohol or drugs in the previous 30 days. Alcohol or drug use in the past month was 44% among students in non-traditional programs—one and a half times the estimate for 11th graders. Statewide, 11% of 11th graders binge drank at least once in the previous month, and 13% 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 with 11% who had smoked cigarettes. Lifetime marijuana use among California 11th graders was 31% in 2015-2017, down from 41% in 2011-2013, with percentages ranging from 13% to 56% across counties with data.

With the exception of e-cigarette use by 11th graders, the estimated proportion of students in each grade level who have never used alcohol, tobacco, e-cigarettes, and marijuana is on the rise. In general, students with low levels of school connectedness, those whose parents did not finish high school, and gay, lesbian, and bisexual students more frequently report substance use than their peers in other groups.

High school staff reports from 2015-2017 show that 39% considered student alcohol and drug use a moderate or severe problem. During the same period, two-thirds agreed that substance abuse prevention was an important goal at their school, and seven out of ten reported that their school provided at least some substance use prevention education.