Trends in Substance Use Prevention Program Participation among Adolescents in the United States

Abstract

Purpose:

To examine national trends in adolescent participation in substance use prevention programming (SUPP).

Methods:

We examine fifteen years of cross-sectional data (2002–2016) from the National Survey on Drug Use and Health. Main outcomes were participation in past-year school and community-based SUPP (no/yes). Logistic regression was used to examine trends in the prevalence of participation.

Results:

Participation in school-based SUPP decreased significantly from 48% among adolescents in 2002–2003 to 40% in 2015–2016, a 16.5% proportional decline. Significant declines for school-based participation were observed in all demographic and drug involvement subgroups examined. Youth participation in community-based SUPP also decreased significantly. However, this downward trend was significant only among younger teens, females, youth in very low (< $20,000) and moderate ($40,000-$74,999) income households, and in rural areas.

Conclusions:

Participation in SUPP has decreased since the early 2000s, with noteworthy declines among Latino youth and youth from rural areas and socioeconomically disadvantaged backgrounds.

Substance use affects millions of United States (US) adolescents. Estimates indicate that most high school seniors have tried alcohol (61%), nearly half have “been drunk” (45%), and many have tried illicit drugs (20% excluding marijuana, 48% including marijuana).[1]

Prevention is a critical component of the substance use continuum of care, with efforts ranging from universal programs designed for all youth, to selective interventions designed for individuals experiencing elevated risk or exhibiting substance-related problems.[2,3] Regardless of the implementation setting (e.g., school-based, community-based), it is well-established that participation in evidence-based programs can decrease use.[4]

Federal funding for substance use prevention decreased by nearly 50% between the 2005 and 2015.[5] Moreover, recent evidence suggests that rates of adolescent participation in prevention programs targeting violence has declined nationally since the early-to-mid 2000s.[6] It is possible that rates of participation in substance use prevention programs (SUPP) may have declined as well, but evidence of trends in participation is presently lacking. Thus, the aim of the present study is to examine trends in SUPP participation among US adolescents.

Methods

Data and Sample

This study used data from the National Survey on Drug Use and Health (NSDUH). The NSDUH provides annual estimates for substance use risks among a nationally representative sample of civilian, noninstitutionalized Americans ages 12 and older. The present study’s analytic sample included 234,803 adolescents, ages 12–17, interviewed between 2002 and 2016. The first author’s IRB did not require approval for this study as it used de-identified, secondary data.

Measures

SUPP Participation.

Two dichotomous variables examined past-year SUPP participation. School-based participation was measured by asking youth: “Have you had a special class about drugs or alcohol in school?” Community participation was measured asking youth: “Have you participated in an alcohol, tobacco or drug prevention program outside of school, where you learn about the dangers of using, and how to resist using, alcohol, tobacco, or drugs?”

Sociodemographic Characteristics.

Sociodemographic variables, found to be related to youth prevention participation in prior studies [6], include: age, sex, race/ethnicity, household income, and urbanicity. We also examined any past-year tobacco, alcohol, or illicit drug use.

Analyses

We presented the prevalence estimates for participation across all survey years (see Figure 1) and tested the significance of linear trends for the full sample, controlling for sociodemographic factors.[7] We also conducted supplementary analyses (Table 1) examining the significance of trend, percentage point (pp) change and the percent change by sociodemographic and substance use categories. All estimates were weighted to account for the NSDUH’s sampling design using Stata 13.

Figure 1.

Prevalence of School and Community-Based Participation in Substance Use Prevention Programming, Layered on Prevalence of Past-Year Substance Use among Adolescents 2002–2016. Left y-axis displays values for substance use prevention program participation. Right y-axis displays values for past year substance use

Table 1.

Past Year Prevalence of Community-Based and School-Based Substance Use Prevention Program Participation among Youth, 2002–2016

	School-Based Program Participation						Community-Based Program Participation
	2002–2003		2015–2016		Δ pp	% change	2002–2003		2015–2016		Δ pp	% change
	%	95% CI	%	95% CI			%	95% CI	%	95% CI
Total	48.14	47.49–48.79	40.2	39.37–41.13	−7.94	−0.16	13.18	12.73–13.64	11.46	10.96–11.97	−1.72	−0.13
Subgroups
Age
12–14	55.79	54.71–56.87	45.1	43.87–46.34	−10.69	−0.19	14.81	14.12–15.52	12.76	11.92–13.66	−2.05	−0.14
15–17	40.66	39.76–41.57	35.7	34.19–37.23	−4.96	−0.12	11.5	10.88–12.15	10.23	9.72–10.76	−1.27	−0.11
Sex
Female	50.78	49.75–51.81	41.43	40.25–42.61	−9.35	−0.18	13.59	13.02–14.19	10.86	10.16–11.60	−2.73	−0.20
Male	45.61	44.67–46.55	39	37.75–40.26	−6.61	−0.14	12.78	12.07–13.53	12.03	11.31–12.80	−0.75	−0.06
Race/Ethnicity
White	49.04	48.19–49.88	42.51	41.35–43.69	−6.53	−0.13	11.69	11.2–12.28	10.06	9.41–10.76	−1.63	−0.14
Black	45.88	43.77–48.15	37.75	35.77–39.77	−8.13	−0.18	18.04	16.46–19.73	15.98	14.71–17.35	−2.06	−0.11
Latino	46.34	44.54–48.15	36.08	34.42–37.78	−10.26	−0.22	14.53	13.34–15.81	12	10.63–13.51	−2.53	−0.17
Income
<$20,000	45.33	43.61–47.06	35.06	33.17–37.00	−10.27	−0.23	16.58	15.13–18.14	14.08	12.56–15.75	−2.50	−0.15
$20,000–$39,999	45.34	43.98–46.71	36.68	34.47–39.06	−8.66	−0.19	14.23	13.27–15.24	13.08	11.85–14.42	−1.15	−0.08
$40,000–$74,999	47.98	46.67–49.329	39.16	37.35–41.00	−8.82	−0.18	12.36	11.69–13.06	10.74	9.83–11.72	−1.62	−0.13
≥$75,000	52.15	50.94–53.35	44.34	43.10–45.59	−7.81	−0.15	11.03	10.27–11.83	10.07	9.28–10.91	−0.96	−0.09
Urbanicity
Rural	48.99	46.48–51.51	38.2	35.50–40.98	−10.79	−0.22	15.51	13.78–17.42	12.69	10.94–14.68	−2.82	−0.18
Urban	48.08	47.41–48.74	40.32	39.37–41.27	−7.76	−0.16	13	12.53–13.48	11.38	10.84–11.95	−1.62	−0.12
Drug Involvement
Any tobacco, alcohol, marijuana, or other drug use—Past Year
No	52.43	51.37–53.47	42.13	41.13–43.13	−10.3	−0.20	13.92	13.30–14.57	12.04	11.38–12.74	−1.88	−0.14
Yes	42.81	41.89–43.73	35.81	34.32–37.233	−7.00	−0.16	12.23	11.64–12.85	10.09	9.10–11.18	−2.14	−0.17

Note. Δ pp = percentage point change from 2002–2003 to 2015–2016. Δ pp in bold represent a significant (p < .05) trend. % change determined by dividing the pp change by the 2002–2003 value.

Results

School-Based Participation

As shown in Figure 1, youth participation in school-based SUPP decreased from 48.14% in 2002–2003 to 40.20% in 2015–2016, a 16.5% proportional decline that was significant while controlling for sociodemographic characteristics (AOR =0.973, 95% CI=0.970–0.975). Notably, we observed significant declines not only in the full sample, but also in all sociodemographic and substance subgroups. Supplemental analyses revealed particularly steep declines among younger adolescents, Latino youth, youth from very low-income families (< $20,000 annually), youth in rural areas, and youth reporting no past-year substance use.

Community-Based Participation

Youth participation in community-based SUPP decreased significantly from 13.18% in 2002–2003 to 11.55% in 2015–2016 (AOR=0.994, 95% CI=0.990–0.998). Upon further examination, we found that this downward trend was significant only among adolescents ages 12–14, females, youth in very low (<$20,000) and moderate-income ($40,000-$74,999) households, and youth in rural areas.

Discussion

Findings from the present study provide clear evidence that adolescent participation in SUPP has decreased meaningfully since 2002. Although our study findings do not speak to the specific nature (e.g., quality, duration) of the programs in which youth participated, they provide an important overview of participation that previously was unavailable.

Rates in school-based participation dropped from 48.14% in 2002–2003 to 40.20% in 2015–2016, reflecting a 16.5% change in the proportion of youth engaged in school-based prevention programs. Across all years, the rate of participation in community-based prevention programming was roughly one quarter that of school-based programs. As such, although the pp change in community-based programing from 13.18% in 2002–2003 to 11.46% in 2015–2016 is small compared to that of school-based programing, it is, nevertheless, a noteworthy decrease (­ 13%) in relative terms. These declines echo decreases in funding for school and community-based prevention programming [5] and a broader decline in funding for public education [8].

Beyond the declines among all youth, results of the present study provide compelling evidence of differences in rates of participation and in differences in the rate of the observed decrease over the study period. For instance, the largest relative change observed for school-based program participation was among youth living in households in the lowest income category (<$20,000 annual household income), decreasing by 23% in relative terms to the lowest participation rate among all income categories (35%).

Interestingly, the observed downward trend in adolescent substance prevention programming mirrors research describing a decline in youth substance use.[1,9] However, national data suggest that rates of substance use among adults have substantially increased.[10] Although data do not allow us to assess the link between adolescent SUPP and adult substance use trends, we know that increasing numbers of Americans are using substances. This speaks to the continued importance of youth participation in evidence-based SUPP in the US.

Study Limitations

This study has some limitations. First, data were derived from adolescent self-reports and may be susceptible to recall or other biases. Second, the SUPP participation questions do not provide information on the quality/dosage of programs. Similarly, our measures do not allow us to speak to the impact of participation on substance use risk. Third, differences in the wording of survey items suggest caution in comparing rates of school and community-based participation. Finally, all data are cross-sectional and do not allow causal interpretation.

Conclusions

Evidence from the present study indicate that only a minority of adolescents participate annually in school- and community-based SUPP. Notably, we see clear evidence that participation rates have decreased significantly since the early 2000s, with particularly large declines in participation observed among Latino youth as well as youth from rural areas and economically disadvantaged backgrounds.

Implications and Contributions:

Only a minority of teens participate annually in substance use prevention programming. Rates have decreased significantly since the early 2000s, with large declines observed among Latino youth and youth from rural areas and economically disadvantaged backgrounds. These findings are noteworthy, particularly in light of rising rates of substance use among adults in the US.

Abbreviations:

US

United States

NSDUH

National Survey on Drug Use and Health

SUPP

Substance use prevention program

AOR

Adjusted Odds Ratio

CI

Confidence Interval