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The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013-.

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Trends in Adolescent Substance Use and Perception of Risk from Substance Use

, Ph.D.

Author Information

Published: January 3, 2013.

Background: An adolescent's perception of the risks associated with substance use is an important determinant of whether he or she engages in substance use. Methods: NSDUH asks adolescents aged 12 to 17 how much people risk physical and other harm when they drink five or more alcoholic drinks once or twice a week, use marijuana once or twice a week, use cocaine once or twice a week, use LSD once or twice a week, and use heroin once or twice a week. This report presents estimates of youth aged 12 to 17 perceptions of great risk associated with substance use and past month use of associated substances. Results: The percentage of adolescents aged 12 to 17 who perceived great risk from having five or more alcoholic drinks once or twice a week increased from 38.2 percent in 2002 to 40.7 percent in 2011; during the same period, the rate of binge alcohol use among adolescents decreased from 10.7 to 7.4 percent. Between 2007 and 2011, the percentage of adolescents who perceived great risk from smoking marijuana once or twice a week decreased from 54.6 to 44.8 percent, and the rate of past month marijuana use among adolescents increased from 6.7 to 7.9 percent. The percentages of adolescents reporting substance use in the past month were generally lower among those who perceived great risk from using substances than among those who did not perceive great risk. Conclusion: Understanding differences in the perception of risk for varying substances may be useful to policymakers, educators, and prevention program staff in making decisions about deploying prevention messages and what segments of the youth audience they should target.

Keywords:

risk perception, substance use, adolescents, National Survey on Drug Use and Health, NSDUH

In Brief

  • The percentage of adolescents aged 12 to 17 who perceived great risk from having five or more alcoholic drinks once or twice a week increased from 38.2 percent in 2002 to 40.7 percent in 2011; during the same period, the rate of binge alcohol use among adolescents decreased from 10.7 to 7.4 percent
  • Between 2007 and 2011, the percentage of adolescents who perceived great risk from smoking marijuana once or twice a week decreased from 54.6 to 44.8 percent, and the rate of past month marijuana use among adolescents increased from 6.7 to 7.9 percent
  • In 2011, the percentages of adolescents reporting substance use in the past month were generally lower among those who perceived great risk from using substances than among those who did not perceive great risk

Introduction

An adolescent's perception of the risks associated with substance use is an important determinant of whether he or she engages in substance use. For example, youths who perceive high risk of harm are less likely to use drugs than youths who perceive low risk of harm.1 Thus, providing adolescents with credible, accurate, and age-appropriate information about the harm associated with substance use is a key component in prevention programming.2 Expanding upon research that shows the predictive nature of risk perceptions to subsequent substance use among adolescents,3,4 the National Survey on Drug Use and Health (NSDUH) provides an opportunity to conduct a cross-sectional analysis of the changes over time in the prevalence of substance use and perceptions of risk. Although cross-sectional analysis cannot confirm that increases in substance use are a direct result of decreases in perceptions of risk, this report examines how rates of substance use and perceived risk vary over time and in relation to each other. Understanding the relationship between risk perception and substance use during adolescence may help to better target health promotion messages and increase the effectiveness of prevention and intervention programs.

NSDUH asks adolescents aged 12 to 17 how much people risk physical and other harm when they drink five or more alcoholic drinks once or twice a week, use marijuana once or twice a week, use cocaine once or twice a week, use LSD once or twice a week, and use heroin once or twice a week. Response choices are (1) no risk, (2) slight risk, (3) moderate risk, and (4) great risk. NSDUH also asks adolescents about their substance use in the 30 days before the interview. This issue of The NSDUH Report focuses on trends in risk perception and substance use among adolescents aged 12 to 17 between 2002 and 2011.

Changes in Alcohol Use and Risk Perception

The percentage of adolescents who perceived great risk from having five or more drinks of an alcoholic beverage once or twice a week increased from 38.2 percent in 2002 to 40.7 percent in 2011 (Figure 1). Consistent with the increase in perceived risk, adolescents' binge alcohol use decreased from 10.7 in 2002 to 7.4 percent in 2011.5

 Figure 1 is a line graph, where the trends in perception of great risk from having five or more drinks of alcohol once or twice a week and past month binge alcohol use among adolescents aged 12 to 17 are shown on the vertical axis. Each survey year from 2002 to 2011 is shown on the horizontal axis. The graph includes two lines. The first line represents the percentage of perceived great risk from having five or more alcoholic drinks once or twice a week: 38.2 in 2002, 38.5 in 2003, 38.1 in 2004, 38.4 in 2005, 39.3 in 2006, 39.3 in 2007, 40.0 in 2008, 39.6 in 2009, 40.4 in 2010, and 40.7 in 2011. For 2002 to 2007, the difference between the estimate and the estimate for 2011 is statistically significant at the .05 level. The second line represents the percentage of past month binge alcohol use: 10.7 in 2002, 10.6 in 2003, 11.1 in 2004, 9.9 in 2005, 10.3 in 2006, 9.7 in 2007, 8.9 in 2008, 8.9 in 2009, 7.9 in 2010, and 7.4 in 2011. For 2002 to 2009, the difference between the estimate and the estimate for 2011 is statistically significant at the .05 level. The figure's source line reads "SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2002 to 2011 (revised March 2012)." If you would like someone from our staff to read the numbers on this line graph image to you, please call 240-276-1250.

Figure 1

Trends in Perception of Great Risk from Having Five or More Drinks of Alcohol Once or Twice a Week and Past Month Binge Alcohol Use among Adolescents Aged 12 to 17: 2002 to 2011

Adolescents who perceived great risk from binge drinking—having five or more drinks of an alcoholic beverage once or twice a week—were less likely than those who did not perceive great risk to report binge alcohol use in the past month (see Supporting Table S1). In 2011, 4.5 percent of adolescents who perceived great risk from binge drinking once or twice a week reported they engaged in past month binge alcohol use, compared with 9.5 percent of those who perceived moderate, slight, or no risk (Figure 2).

Table S1. Past Month Use of Selected Substances, by Risk Perceptions of Substance Use Behaviors among Persons Aged 12 to 17: Numbers in Thousands, Percentages, and Standard Errors of Percentages, 2002-2011.

Table S1

Past Month Use of Selected Substances, by Risk Perceptions of Substance Use Behaviors among Persons Aged 12 to 17: Numbers in Thousands, Percentages, and Standard Errors of Percentages, 2002-2011.

 Figure 2 is a bar graph, where the percentage of adolescents aged 12 to 17 who reported past month binge drinking and marijuana use is shown on the vertical axis. Two sets of bars representing the risk of having five or more drinks once or twice a week and the risk of smoking marijuana once or twice a week are shown on the horizontal axis. Each set of bars includes two bars, representing perceived great risk and perceived moderate, slight, or no risk. The percentage of adolescents aged 12 to 17 who perceived great risk from having five or more drinks once or twice a week is 4.5. The percentage of adolescents aged 12 to 17 who perceived moderate, slight, or no risk from having five or more drinks once or twice a week is 9.5. The percentage of adolescents aged 12 to 17 who perceived great risk from smoking marijuana once or twice a week is 0.8. The percentage of adolescents aged 12 to 17 who perceived moderate, slight, or no risk from smoking marijuana once or twice a week is 13.8. For both sets of bars, the difference between those perceiving great risk and those perceiving moderate, slight, or no risk is statistically significant at the .05 level. The figure's source line reads "SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2002 to 2011 (revised March 2012)." If you would like someone from our staff to read the numbers on this bar graph image to you, please call 240-276-1250.

Figure 2

Past Month Binge Drinking and Marijuana Use among Adolescents Aged 12 to 17, by Perceptions of Risk: 2011

Changes in Marijuana Use and Risk Perception

The percentage of adolescents who perceived great risk of harm from smoking marijuana once or twice a week increased between 2002 and 2003 but remained relatively stable until 2007; the percentage then decreased each year from 54.6 percent in 2007 to 44.8 percent in 2011 (Figure 3). The rate of past month marijuana use among adolescents was relatively stable between 2002 and 2004, and then decreased between 2004 and 2005. The rate of past month marijuana use held steady at about 6.7 percent until 2008; it increased to 7.4 percent in 2009 and 2010 and to 7.9 percent in 2011.

 Figure 3 is a line graph, where the trends in perception of great risk from smoking marijuana once or twice a week and past month marijuana use among adolescents aged 12 to 17 are shown on the vertical axis. Each survey year from 2002 to 2011 is shown on the horizontal axis. The graph includes two lines. The first line represents the percentage of perceived great risk from smoking marijuana once a month: 51.5 in 2002, 54.4 in 2003, 54.7 in 2004, 55.0 in 2005, 54.2 in 2006, 54.6 in 2007, 52.8 in 2008, 49.0 in 2009, 47.2 in 2010, and 44.8 in 2011. For 2002 to 2010, the difference between the estimate and the estimate for 2011 is statistically significant at the .05 level. The second line represents the percentage of past month marijuana use: 8.2 in 2002, 7.9 in 2003, 7.6 in 2004, 6.8 in 2005, 6.7 in 2006, 6.7 in 2007, 6.7 in 2008, 7.4 in 2009, 7.4 in 2010, and 7.9 in 2011. For 2005 to 2008, the difference between the estimate and the estimate for 2011 is statistically significant at the .05 level. The figure's source line reads "SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2002 to 2011 (revised March 2012)." If you would like someone from our staff to read the numbers on this line graph image to you, please call 240-276-1250.

Figure 3

Trends in Perception of Great Risk from Smoking Marijuana Once or Twice a Week and Past Month Marijuana Use among Adolescents Aged 12 to 17: 2002 to 2011

Adolescents who perceived a great risk of harm from smoking marijuana had lower substance use rates than adolescents who did not perceive great risk (see Supporting Table S1). In 2011, past month marijuana use was reported by 0.8 percent of adolescents who saw great risk in smoking marijuana once or twice a week compared with 13.8 percent of those who saw moderate, slight, or no risk (Figure 2).

Changes in Cocaine, LSD, and Heroin Use and Risk Perception

With roughly 78 percent of adolescents in 2011 perceiving great risk from using cocaine once or twice a week, the percentages have remained stable since 2007 and are down only slightly since 2002 (Table 1). Despite the relatively stable trend in perception of great risk, the rate of past month use of cocaine among adolescents decreased from 0.6 percent in 2002 to 0.3 percent in 2011. The percentage of adolescents who perceived great risk from using LSD once or twice a week decreased from 76.2 percent in 2002 to 71.3 percent in 2010 and 70.4 percent in 2011; however, there was no change in the rate of past month use of LSD among adolescents during this period with roughly 0.1 percent of youths using LSD.

Table 1. Trends in Perception of Great Risk from Using Selected Substances Once or Twice a Week and Past Month Substance Use among Adolescents Aged 12 to 17: Percentages, 2002 to 2011.

Table 1

Trends in Perception of Great Risk from Using Selected Substances Once or Twice a Week and Past Month Substance Use among Adolescents Aged 12 to 17: Percentages, 2002 to 2011.

Similarly, the percentage of adolescents who perceived great risk from using heroin once or twice a week decreased from 82.5 percent in 2002 to 80.4 percent in 2010 and 79.7 percent in 2011; however, there was no change in the rate of past month use of heroin among adolescents during this period with up to 0.1 percent of youths using heroin. The association between perceived risk of using cocaine, LSD, and heroin and the use of these substances was not as strong as it was for alcohol and marijuana (see Supporting Table S1).

Demographic Differences in Risk Perception in 2011

In 2011, adolescent females were more likely than adolescent males to perceive great risk from having five or more alcoholic drinks once or twice a week (44.9 vs. 36.6 percent) and from smoking marijuana once or twice a week (49.2 vs. 40.5 percent; Figure 4). There were no differences between males and females in perceived risk from using cocaine once or twice a week, using heroin once or twice a week, or using LSD once or twice a week.

 Figure 4 is a bar graph, where the percentage of adolescents aged 12 to 17 who perceived great risk from using selected substances once or twice a week, for 2011, is shown on the horizontal axis. Five sets of bars representing perceived great risk from using various substances are shown on the vertical axis. Each set of bars includes two bars, representing males and females. The percentages of adolescents aged 12 to 17 who perceived great risk from having five or more alcoholic drinks once or twice a week were 36.6 for males and 44.9 for females. The difference between the estimate for males and the estimate for females is statistically significant at the .05 level. The percentages of adolescents aged 12 to 17 who perceived great risk from smoking marijuana once or twice a week were 40.5 for males and 49.2 for females. The difference between the estimate for males and the estimate for females is statistically significant at the .05 level. The percentages of adolescents aged 12 to 17 who perceived great risk from using cocaine once or twice a week were 78.2 for males and 78.0 for females. The percentages of adolescents who perceived great risk from using heroin once or twice a week were 79.8 for males and 79.6 for females. The percentages of adolescents who perceived great risk from using LSD once or twice a week were 70.1 for males and 70.8 for females. The figure's source line reads "SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2002 to 2011 (revised March 2012)." If you would like someone from our staff to read the numbers on this bar graph image to you, please call 240-276-1250.

Figure 4

Perception of Great Risk from Using Selected Substances Once or Twice a Week among Adolescents Aged 12 to 17, by Gender: 2011

Adolescents aged 12 to 14 were more likely than those aged 15 to 17 to perceive great risk from having five or more alcoholic drinks once or twice a week (41.7 vs. 39.8 percent) and from smoking marijuana once or twice a week (54.7 vs. 35.6 percent; Figure 5). However, younger adolescents were not consistently more wary than older adolescents of the risks of illegal substances. Adolescents aged 15 to 17 were more likely than those aged 12 to 14 to perceive great risk from using cocaine once or twice a week (82.2 vs. 73.7 percent), using heroin once or twice a week (86.3 vs. 72.5 percent), and using LSD once or twice a week (75.0 vs. 65.3 percent).

 Figure 5 is a bar graph, where the percentage of adolescents aged 12 to 17 who perceived great risk from using selected substances once or twice a week, for 2011, is shown on the horizontal axis. Five sets of bars representing perceived great risk from using various substances are shown on the vertical axis. Each set of bars includes two bars, representing adolescents aged 12 to 14 and adolescents aged 15 to 17. The percentages of adolescents who perceived great risk from having five or more alcoholic drinks once or twice a week were 41.7 for those aged 12 to 14 and 39.8 for those aged 15 to 17. The percentages of adolescents who perceived great risk from smoking marijuana once or twice a week were 54.7 for those aged 12 to 14 and 35.6 for those aged 15 to 17. The percentages of adolescents who perceived great risk from using cocaine once or twice a week were 73.7 for those aged 12 to 14 and 82.2 for those aged 15 to 17. The percentages of adolescents who perceived great risk from using heroin once or twice a week were 72.5 for those aged 12 to 14 and 86.3 for those aged 15 to 17. The percentages of adolescents who perceived great risk from using LSD once or twice a week were 65.3 for those aged 12 to 14 and 75.0 for those aged 15 to 17. For all selected substances, the difference between the estimate for those aged 12 to 14 and the estimate for those aged 15 to 17 is statistically significant at the .05 level. The figure's source line reads "SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2002 to 2011 (revised March 2012)." If you would like someone from our staff to read the numbers on this bar graph image to you, please call 240-276-1250.

Figure 5

Perception of Great Risk from Using Selected Substances Once or Twice a Week among Adolescents Aged 12 to 17, by Age Group: 2011

Discussion

As shown in this report, changes in perceived risk at the national level typically preceded or occurred simultaneously with changes in substance use rates in the Nation. In the 10-year period between 2002 and 2011, trends in the perception of great risk from alcohol use increased while binge alcohol use decreased. Rates of perception of great risk from smoking marijuana and marijuana use remained stable between 2004 and 2008; however, when rates of perception of risk decreased in 2007 through 2011, rates of smoking marijuana increased. This report also shows that perceptions of risk from using alcohol and marijuana are lower for older adolescents, which may increase their risk of use in comparison with younger adolescents. In contrast, older adolescents reported higher rates of perceived risk from using cocaine, heroin, and LSD than younger adolescents. Notably, the vast majority of adolescents, regardless of age group, perceived great risk associated with use of cocaine, heroin, and LSD.

Although this report provides details on the statistical associations between risk perception and substance use, it cannot be determined from cross-sectional data if (1) perception of great risk from using a particular drug causes youths to abstain, (2) abstaining from drug use causes youths to have perceptions of great risk from using, or (3) both. However, the findings reported here reinforce the importance of teaching youths about the dangers associated with substance use. Understanding differences in the perception of risk for varying substances may be useful to policymakers, educators, and prevention program staff in making decisions about deploying prevention messages and what segments of the youth audience they should target.

Suggested Citation

Lipari, R.N. Trends in Adolescent Substance Use and Perception of Risk from Substance Use. The CBHSQ Report: January 3, 2013. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.

Footnotes

1

Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2012). Monitoring the Future national survey results on drug use, 1975-2011: Volume I, secondary school students. Ann Arbor, MI: Institute for Social Research, the University of Michigan. Retrieved from http:​//monitoringthefuture​.org/pubs/monographs​/mtf-vol1_2011.pdf

2

Palmgreen, P., & Donohew, L. (2006). Effective mass media strategies for drug abuse prevention campaigns. In Z. Sloboda & W. J. Bukoski (Eds.), Handbook of drug abuse prevention (pp. 27-43; Part II, Handbooks of Sociology and Social Research). New York, NY: Springer US.

3

Hawkins J. D., Catalano R. F., Miller J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early childhood: Implications for substance abuse prevention. Psychological Bulletin, 112(1), 64-105. 10.1037/0033-2909.112.1.64 [PubMed: 1529040] [CrossRef]

4

Bauman, K. E. (1980). Research methods for community health and welfare: An introduction. New York, NY: Oxford University Press.

5

Binge alcohol use is defined as drinking five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past 30 days.

Copyright Notice

All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS.

Bookshelf ID: NBK385059PMID: 27656743

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