Abstract
Background:
Nightlife attendance is an established risk factor for drug use, but studies have not focused on adolescent general population samples or compared risk according to type(s) of venues attended. We examined whether attendance of various types of venues was associated with drug use.
Methods:
Data were examined from an annual nationally representative survey of high school seniors in the US (2014–2019, N=11,565). We determined whether past-year attendance of parties, concerts, bars or nightclubs, and raves or dance music events was associated with past-year drug use using mixed-effects logistic regression. Mall and movie attendance were examined as negative controls.
Results:
Compared to those who reported not attending specific venues, attending parties was associated with higher odds of using alcohol in particular (aOR = 5.03, 95% CI: 3.92–6.44). Attending concerts was associated with higher odds for use of alcohol, cannabis, ecstasy, and nonmedical use of prescription stimulants and opioids. All drugs examined were concentrated among those who attend bars, nightclubs, raves, and dance parties. Rave or dance party attendance was associated with higher odds for use of ecstasy (aOR = 3.71, 95% CI: 2.50–5.50) and methamphetamine (aOR = 4.92, 95% CI: 2.43–9.96) in particular, and bar or nightclub attendance was associated with higher odds of use of cocaine (aOR = 6.49, 95% CI: 4.37–9.63), ecstasy (aOR = 6.49, 95% CI: 4.54–9.27), and methamphetamine (aOR = 5.49, 95% CI: 2.57–11.72) in particular. Attending movies was associated with lower odds for use of cocaine and nonmedical prescription stimulant use.
Conclusion:
We determined differential risk of drug use depending on types of venues attended by adolescents.
Keywords: Adolescents, nightlife, ecstasy, methamphetamine, cocaine
Introduction
Extensive research suggests nightlife venue attendance is a risk factor for drug use, but little is known about risks among adolescents because the majority of nightlife epidemiology research has focused on adults. While bars and nightclubs in the United States (US) typically only admit adults and can only legally serve alcohol to adults age ≥21, this does not always prevent underage individuals from entering or from consuming alcohol or other psychoactive substances 1. Alcohol consumption at nightlife venues such as bars is associated with heightened risk for aggression and fights,2,3 injuries,4 sexual assault,5,6 and for post-visit drunk driving.7 Attending certain types of nightlife venues or events also appears to place individuals at high risk for drug use and possible associated consequences.8–10 However, most studies have focused on targeted samples of adults who attend a specific type of venue. Research is needed to examine the differential risk of adolescents attending various types of nightlife venues to better inform prevention and harm reduction efforts.
Few studies have specifically examined illegal drug use among party, concert, and/or bar attendees, but many studies have examined drug use among young adults who attend nightclubs or “raves”. Raves originally referred to illegal underground dance parties that feature electronic dance music (EDM), but in recent years, such parties have largely morphed into dance festivals. A study examining a nationally representative sample of high school seniors (12th graders) in the US estimated that, compared to those who had not attended raves, those who attended raves were more likely to report use and more frequent past-year use of each of 18 drugs queried in the study.11 Many other studies of targeted non-nationally representative samples have estimated high prevalence of drug use among young adults who attend EDM parties at nightclubs and/or large dance festivals,8–10 and these types of events have been associated with clusters of drug-related poisonings and deaths.12–15 Despite extensive focus on nightclub attendance as a risk factor, research is sorely lacking with respect to (1) adolescent nightlife attendance in relation to drug use, (2) nationally representative samples rather than targeted or convenience samples, and (3) comparisons between attendance of various types of venues which may serve as unique risk factors for use of different drugs. More nuanced findings considering a variety of venues could allow for better targeting of adolescents when aiming to educate about risks associated with use of specific drugs.
In this study we sought to determine whether attending different types of nightlife venues was associated with increased risk for past-year use of different drugs. We hypothesized that party, concert, bar, nightclub, and rave attendance would be associated with higher prevalence of drug use. We also examined mall and movie attendance as negative controls and we hypothesized that such attendance would not be associated with increased risk for drug use.
Methods
Procedure
Monitoring the Future (MTF) is a nationally representative study of high school students in the US. A cross-section is surveyed every year in approximately 130 public and private schools throughout 48 US states using a multi-stage random sampling procedure.16 MTF randomly distributes six different survey forms to participating students. We focused on data from Form 6, which asked about past-year venue attendance. Data from the most recent six cohorts (2014–2019, N=11,565) were aggregated for analysis. This secondary data analysis of public deidentified data was exempt from review at the New York University Langone Medical Center Institutional Review Board.
Measures
Students were asked how often they go to: (1) shopping malls, (2) movies, (3) music concerts, (4) parties or other social affairs, (5) taverns, bars or nightclubs, and (6) raves or other dance music events. Response options were: (1) never, (2) a few times a year, (3) once or twice a month, (4) at least once a week, (5) almost every day, and (6) daily. We recoded responses into binary variables indicating whether or not they had attended in the past year. With respect to drug use, students were asked whether they had used alcohol, cannabis (marijuana, pot, weed), cocaine, ecstasy (MDMA, Molly), methamphetamine (meth, crank, speed, crystal meth), and they were asked about nonmedical use of prescription stimulants (e.g., Adderall, Ritalin) and opioids (“narcotics other than heroin, such as methadone, opium, morphine, codeine, Demerol, Vicodin, OxyContin, and Percocet”) in the past year. Nonmedical use was defined as using prescription drugs on one’s own without a doctor telling them to use them.16
With respect to demographic characteristics, students were asked to indicate their age (pre-coded by MTF as <18 vs. ≥18 years), sex (i.e., male, female), and race/ethnicity (i.e., White, Black, Hispanic). Students were also asked about the educational attainment of each parent (a common indicator of socioeconomic status),17,18 and we coded a variable indicating the highest level of education attained by either parent.
Statistical analyses
We first examined sample characteristics and estimated past-year attendance of each venue type and past-year use of each drug. Next, we compared the prevalence of use of each drug according to whether each venue type was attended in the past year using Rao-Scott chi-square.19 We then examined these relationships in a multivariable manner, using a mixed-effects logistic regression with random effects for each respondent, treating each drug use variable as repeated measures of a within-subject factor. Our model included main effects for drug and venue types as well as drug by venue interaction effects. We then exponentiated simple contrasts to obtain adjusted odds ratios (aORs) for each venue effect on each drug. Finally, we estimated partial interaction effects to test whether the association of venue attendance is the same or different for each drug compared to alcohol, comparing aORs across drug types. Our model was adjusted for survey year, age, sex, parents’ highest level of education, and whether the survey was administered on tablet or on paper. Race/ethnicity was unavailable for 19.9% of respondents. Due to high levels of missingness, and missingness patterns that were nonignorable in violation of multiple imputation assumptions, we excluded the race/ethnicity variable from our model and conducted two sensitivity analyses. In the first sensitivity analysis we adjusted for the race/ ethnicity variable among those with non-missing data using listwise deletion, which reduced the sample size from 11,565 to 9,772. In the second sensitivity analysis, we included the race/ethnicity variable with missing responses recoded as a category20 in order to retain more respondents in the model. All analyses were design-based for survey data19 and utilized survey sample weights provided by MTF. Stata 15 software (StataCorp, College Station, TX, USA) was used for all analyses.
Results
Sample characteristics are presented in Table 1. Past-year attendance of venues were as follows: malls (94.8%), movies (96.2%), parties or social affairs (85.5%), concerts (53.9%), raves or other dance music events (37.0%), and taverns, bars, or nightclubs (24.3%). Table 2 and Figure 1 present bivariable comparisons with respect to venue attendance and drug use. Use of alcohol and cannabis and misuse of prescription opioids were more common among mall attendees compared to non-attendees (ps<.05), and alcohol and cannabis use were more common among movie attendees than non-attendees (ps<.05). All drugs other than methamphetamine were more common among those who attended parties and/or concerts compared to non-attendees (ps<.05), and all drugs were more commonly used among those who attended raves or other dance events and/or taverns, bars, or nightclubs compared to non-attendees (ps<.0001).
Table 1.
Participant Characteristics (N = 11,565).
| N () | |
|---|---|
|
| |
| Survey year | |
| 2014 | 1,936 (16.7) |
| 2015 | 1,959 (16.9) |
| 2016 | 1,809 (15.6) |
| 2017 | 1,920 (16.6) |
| 2018 | 1,982 (17.1) |
| 2019 | 1,959 (16.9) |
| Sex | |
| Male | 5,589 (48.3) |
| Female | 5,976 (57.1) |
| Parent education | |
| Less than high school | 1,096 (9.48) |
| High school Diploma/Some college | 4,274 (37.0) |
| College Degree or higher | 6,195 (53.6) |
| Venue attendance | |
| Shopping malls | |
| Never attended | 600 (5.19) |
| Any attendance | 10,965 (94.8) |
| Movies | |
| Never attended | 441 (3.81) |
| Any attendance | 11,124 (96.2) |
| Parties or other social affairs | |
| Never attended | 1,680 (14.5) |
| Any attendance | 9,885 (85.5) |
| Music concerts | |
| Never attended | 5,326 (46.1) |
| Any attendance | 6,239 (53.9) |
| Raves or other dance music events | |
| Never attended | 7,289 (63.0) |
| Any attendance | 4,276 (37.0) |
| Taverns, bars, or nightclubs | |
| Never attended | 8,749 (75.7) |
| Any attendance | 2,816 (24.3) |
| Past-year drug use | |
| Alcohol | |
| Never used | 4,859 (43.7) |
| Used | 6,251 (56.3) |
| Cannabis | |
| Never used | 7,148 (63.3) |
| Used | 4,147 (36.7) |
| Cocaine | |
| Never used | 11,220 (97.6) |
| Used | 273 (2.38) |
| Ecstasy | |
| Never used | 11,126 (96.9) |
| Used | 359 (3.13) |
| Methamphetamine | |
| Never used | 11,129 (99.4) |
| Used | 66 (0.59) |
| Prescription stimulants (nonmedical use) | |
| Never used | 10,726 (93.7) |
| Used | 720 (6.29) |
| Prescription opioids (nonmedical use) | |
| Never used | 10,981 (95.7) |
| Used | 488 (4.25) |
Missing data are as follows: sex (7.9%), race/ethnicity (19.9%), parent education (8.8%), mall attendance (1.0%), movie attendance (0.9%), party attendance (1.0%), concert attendance (1.1%), rave attendance (1.2%), bar attendance (1.1%), and past-year use of alcohol (7.0%), cannabis (5.5%), cocaine (4.5%), ecstasy (3.9%), methamphetamine (8.3%), prescription stimulants (4.3%), and prescription opioids (5.7%).
Table 2.
Past-Year Drug Use According to Past-Year Venue Attendance.
| Never attended weighted % (SE) | Ever attended weighted % (SE) | p | Never attended weighted % (SE) | Ever attended weighted % (SE) | p | |
|---|---|---|---|---|---|---|
|
| ||||||
| Shopping malls | Movies | |||||
| Alcohol | 46.35 (2.46) | 55.05 (0.58) | <.001 | 42.84 (2.91) | 55.06 (0.57) | <.0001 |
| Cannabis | 29.32 (2.25) | 35.61 (0.55) | <.01 | 29.67 (2.64) | 35.51 (0.54) | .04 |
| Cocaine | 2.34 (0.64) | 2.28 (0.17) | .93 | 3.72 (0.99) | 2.22 (0.17) | .06 |
| Ecstasy | 2.98 (0.73) | 3.05 (0.19) | .94 | 3.10 (1.07) | 3.04 (0.19) | .95 |
| Methamphetamine | 0.25 (0.17) | 0.61 (0.09) | .18 | 0.58 (0.33) | 0.59 (0.09) | .97 |
| Prescription Stimulants | 4.16 (0.89) | 6.17 (0.28) | .07 | 6.61 (1.40) | 6.04 (0.27) | .68 |
| Prescription Opioids | 2.25 (0.76) | 4.47 (0.24) | .04 | 4.40 (1.10) | 4.35 (0.23) | .97 |
| Parties or other social affairs | Music concerts | |||||
| Alcohol | 28.88 (1.34) | 59.28 (0.61) | <.0001 | 45.81 (0.83) | 62.48 (0.75) | <.0001 |
| Cannabis | 17.99 (1.11) | 38.43 (0.59) | <.0001 | 29.14 (0.74) | 40.81 (0.74) | <.0001 |
| Cocaine | 0.71 (0.22) | 2.56 (0.19) | <.0001 | 1.71 (0.22) | 2.79 (0.24) | <.01 |
| Ecstasy | 0.72 (0.19) | 3.46 (0.22) | <.0001 | 1.68 (0.22) | 4.27 (0.29) | <.0001 |
| Methamphetamine | 0.32 (0.15) | 0.64 (0.09) | .15 | 0.54 (0.11) | 0.64 (0.12) | .55 |
| Prescription Stimulants | 1.98 (0.41) | 6.80 (0.30) | <.0001 | 4.03 (0.33) | 7.89 (0.40) | <.0001 |
| Prescription Opioids | 1.58 (0.35) | 4.85 (0.26) | <.0001 | 3.14 (0.29) | 5.45 (0.35) | <.0001 |
| Raves or Other Dance Music Events | Taverns, Bars, or Nightclubs | |||||
| Alcohol | 47.92 (0.7) | 66.65 (0.9) | <.0001 | 48.26 (0.64) | 75.66 (1.02) | <.0001 |
| Cannabis | 29.87 (0.63) | 44.95 (0.92) | <.0001 | 30.22 (0.58) | 51.99 (1.15) | <.0001 |
| Cocaine | 1.25 (0.15) | 4.11 (0.37) | <.0001 | 1.10 (0.13) | 6.10 (0.55) | <.0001 |
| Ecstasy | 1.28 (0.15) | 6.15 (0.45) | <.0001 | 1.41 (0.14) | 8.32 (0.64) | <.0001 |
| Methamphetamine | 0.23 (0.06) | 1.22 (0.20) | <.0001 | 0.26 (0.06) | 1.67 (0.29) | <.0001 |
| Prescription Stimulants | 3.83 (0.26) | 10.01 (0.57) | <.0001 | 3.97 (0.25) | 12.85 (0.77) | <.0001 |
| Prescription Opioids | 3.14 (0.24) | 6.50 (0.46) | <.0001 | 3.02 (0.22) | 8.64 (0.64) | <.0001 |
SE: standard error.
Figure 1.
Adjusted odds ratios of past-year venue attendance in relation to past-year drug use.
Table 3 presents multivariable associations with respect to venue attendance and drug use. Compared to those who had not attended movies, those who attended movies were at lower odds for use of cocaine (aOR = 0.31, 95% CI: 0.15–0.68) and nonmedical use of prescription stimulants (aOR = 0.45, 95% CI: 0.22–0.96), and interaction effects suggest cocaine use and nonmedical use of prescription stimulants and opioids were at lower odds for being used than alcohol. Compared to those who had not attended parties, those who had attended parties were at higher odds for alcohol (aOR = 5.03, 95% CI: 3.92–6.44) and cannabis use (aOR = 3.31, 95% CI: 2.54–4.31), and nonmedical use of prescription stimulants (aOR = 2.22, 95% CI: 1.23–4.02) and opioids (aOR = 2.10, 95% CI: 1.19–3.68). Interaction effects further suggest all drugs were at lower odds for being used among party attendees than alcohol.
Table 3.
Associations Between Past-Year Venue Attendance and Past-Year Drug Use.
| Association of attendance with drug use | Partial interaction effect (vs. alcohol) | Association of attendance with drug use | Partial interaction effect (vs. alcohol) | |
|---|---|---|---|---|
|
| ||||
| Shopping malls |
Movies |
|||
| aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | |
|
| ||||
| Alcohol | 0.93 (0.64, 1.35) | – | 1.26 (0.79, 2.03) | – |
| Cannabis | 1.02 (0.68, 1.54) | 1.10 (0.70, 1.75) | 0.99 (0.62, 1.58) | 0.79 (0.48, 1.29) |
| Cocaine | 0.71 (0.35, 1.47) | 0.77 (0.35, 1.68) | 0.31 (0.15, 0.68) | 0.25 (0.11, 0.59) |
| Ecstasy | 0.56 (0.26, 1.19) | 0.60 (0.26, 1.36) | 0.54 (0.18, 1.63) | 0.43 (0.12, 1.51) |
| Methamphetamine | 2.08 (0.51, 8.52) | 2.24 (0.53, 9.47) | 0.67 (0.18, 2.56) | 0.53 (0.13, 2.17) |
| Prescription stimulants | 1.25 (0.67, 2.35) | 1.35 (0.68, 2.68) | 0.45 (0.22, 0.96) | 0.36 (0.15, 0.89) |
| Prescription opioids | 1.82 (0.76, 4.36) | 1.96 (0.80, 4.80) | 0.56 (0.27, 1.14) | 0.44 (0.20, 0.96) |
| Parties or other social affairs |
Music Concerts |
|||
| aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | |
|
| ||||
| Alcohol | 5.03 (3.92, 6.44) | – | 2.09 (1.75, 2.50) | – |
| Cannabis | 3.31 (2.54, 4.31) | 0.66 (0.49, 0.88) | 1.62 (1.36, 1.94) | 0.78 (0.64, 0.94) |
| Cocaine | 1.78 (0.80, 3.96) | 0.35 (0.16, 0.80) | 1.04 (0.70, 1.56) | 0.50 (0.33, 0.76) |
| Ecstasy | 1.77 (0.89, 3.50) | 0.35 (0.17, 0.72) | 1.71 (1.12, 2.60) | 0.82 (0.53, 1.26) |
| Methamphetamine | 0.52 (0.16, 1.70) | 0.10 (0.03, 0.34) | 0.53 (0.27, 1.03) | 0.25 (0.13, 0.50) |
| Prescription stimulants | 2.22 (1.23, 4.02) | 0.44 (0.23, 0.84) | 1.63 (1.21, 2.21) | 0.78 (0.56, 1.08) |
| Prescription opioids | 2.10 (1.19, 3.68) | 0.42 (0.23, 0.76) | 1.47 (1.04, 2.08) | 0.70 (0.49, 1.02) |
| Raves or Other Dance Music Events |
Taverns, Bars, or Nightclubs |
|||
| aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | |
|
| ||||
| Alcohol | 1.60 (1.32, 1.95) | – | 4.88 (3.89, 6.12) | – |
| Cannabis | 1.62 (1.34, 1.95) | 1.01 (0.82, 1.24) | 3.39 (2.76, 4.16) | 0.69 (0.55, 0.88) |
| Cocaine | 2.35 (1.56, 3.52) | 1.46 (0.95, 2.25) | 6.49 (4.37, 9.63) | 1.33 (0.87, 2.04) |
| Ecstasy | 3.71 (2.50, 5.50) | 2.31 (1.52, 3.53) | 6.49 (4.54, 9.27) | 1.33 (0.89, 1.98) |
| Methamphetamine | 4.92 (2.43, 9.96) | 3.07 (1.49, 6.35) | 5.49 (2.57, 11.72) | 1.12 (0.51, 2.46) |
| Prescription stimulants | 2.16 (1.60, 2.92) | 1.35 (0.97, 1.89) | 4.02 (2.99, 5.40) | 0.82 (0.59, 1.15) |
| Prescription opioids | 1.52 (1.06, 2.16) | 0.95 (0.64, 1.40) | 3.34 (2.35, 4.74) | 0.68 (0.46, 1.02) |
Results are based on multivariable models which adjusted for survey year, age, sex, parental education, and whether the survey was administered on a tablet or on paper. aOR: adjusted odds ratio; CI: confidence interval.
[Bold estimates indicate that p < .05.]
Compared to those who had not attended concerts, those who had attended concerts (Table 3 continued) were at higher odds for alcohol (aOR = 2.09, 95% CI: 1.75–2.50), cannabis (aOR = 1.62, 95% CI: 1.36–1.94), and ecstasy (aOR = 1.71, 95% CI: 1.12–2.60) use, and nonmedical use of prescription stimulants (aOR = 1.63, 95% CI: 1.21–2.21) and opioids (aOR = 1.47, 95% CI: 1.04–2.08). Interaction effects further suggest cannabis, cocaine, and methamphetamine were at lower odds for being used among attendees than alcohol. Compared to those who did not attend raves or other dance parties, those who did attend were at higher odds for alcohol (aOR = 1.60, 95% CI: 1.32–1.95), cannabis (aOR = 1.62, 95%: 1.34–1.95), cocaine (aOR = 2.35, 95% CI: 1.56–3.52), ecstasy (aOR = 3.71, 95% CI: 2.50–5.50), and methamphetamine use (aOR = 4.92, 95% CI: 2.43–9.96), and nonmedical use of prescription stimulants (aOR = 2.16, 95% CI: 1.60–2.92) and opioids (aOR = 1.52, 95% CI: 1.06–2.16). Interaction effects suggest ecstasy and methamphetamine were at higher odds for being used than alcohol. Finally, compared to those who did not attend bars or nightclubs, those who had attended were at higher odds for alcohol (aOR = 4.88, 95% CI: 3.89–6.12), cannabis (aOR = 3.39, 95% CI: 2.76–4.16), cocaine (aOR = 6.49, 95% CI: 4.37–9.63), ecstasy (aOR = 6.49, 95% CI: 4.54–9.27), and methamphetamine (aOR = 5.49, 95% CI: 2.57–11.72) use, and nonmedical use of prescription stimulants (aOR = 4.02, 95% CI: 2.99–5.40) and opioids (aOR = 3.34, 95% CI: 2.35–5.74). Interaction effects suggest cannabis was at higher odds for being used than alcohol.
With respect to our sensitivity tests, most estimates were similar to the presented model results (with regard to direction and magnitude), although there were a few noteworthy differences. As is shown in Supplemental Table 1, when including race/ethnicity in the model (without a missing data category), the associations between attendance of concerts and raves were attenuated with respect to nonmedical prescription opioid use. In addition, compared to those who did not attend concerts, attending concerts was associated with decreased odds for use of methamphetamine (aOR = 0.40, 95% CI: 0.18–0.87). When including race/ethnicity in the model with an extra category indicating missing data (Supplemental Table 2), the association between concert attendance and nonmedical prescription opioid use was also attenuated, and again, compared to those who did not attend concerts, attending concerts was associated with decreased odds for methamphetamine use (aOR = 0.49, 95% CI: 0.25–0.96).
Discussion
This was the first nationally representative study of adolescents to examine attendance of various types of venues as a risk factor for drug use. Almost all high school seniors have attended malls, movies, and/or parties or social affairs in the past year, almost half have attended concerts, over a third have attended raves or other dance parties, and almost a quarter have attended taverns, bars, or nightclubs. Given that alcohol tends to be served at taverns, bars, and nightclubs in particular, our estimate of almost a quarter of high school seniors in the US attending such venues in the past year may be cause for concern—not only because of alcohol availability but also because individuals who use other drugs are more likely to congregate in such venues as well.
Bar and nightclub attendance were associated with increased odds for use of all drugs in this nationally representative study of high school seniors. MTF asked about both bar and nightclub attendance within the same question, so we were not able to parse out who attended which type(s) of venue, but results still provide insight regarding adolescent risk. Bars, which are commonly defined in the US as venues that primarily serve alcohol,21 have been found to be associated with heavier alcohol consumption compared to other venues such as homes and restaurants, and events such as parties.22–24 Few studies, however, have focused on illegal drug use in relation to bar attendance. Similar to our findings, bar attendance has been previously linked to increased risk for use of cannabis, cocaine, amphetamine, and ecstasy,25–27 and cocaine in particular appears to used more in bars than at nightclubs, parties, or homes.28 A population study in the United Kingdom also found that these drugs are more prevalent among people age ≥16 who visit nightclubs, especially cocaine and ecstasy.27 Among adult EDM party attendees in New York City who were mainly recruited entering nightclubs, cocaine was the most prevalent drug used in 2019 (35.2%), followed by ecstasy (25.8%), and nonmedical use of amphetamine (14.9%).8 Therefore, our results add to previous research—mainly focusing on adults—that bar and nightclub attendance is strongly associated with drug use among adolescents as well.
Our results also corroborate previous studies suggesting that rave attendance is strongly associated with drug use.11 Similar to our findings regarding bar and nightclub attendance, attendance of raves or other dance parties was consistently associated with increased odds for use of all drugs examined. In addition, while alcohol use was most common among students who attended each venue type examined in this study, those who attended raves were at even higher odds for using ecstasy and methamphetamine than for using alcohol. Drugs such as ecstasy and methamphetamine in particular tend to be used at such parties to enhance the music, lights, socialization, and all-night dancing.29,30
Rave, bar, and nightclub attendance were most consistently associated with increased odds for drug use in this study, but concert and party attendance were also determined to be associated with use of various drugs. Students who had attended concerts were at increased odds for using all drugs other than cocaine and prescription opioids. Alcohol is the most prevalent psychoactive substance available at most concerts31 so it should not be surprising that adolescents who attend such events—or other events or venues that serve alcohol—are at high odds for alcohol use. Most instances of medical response at concerts tend to involve drug use,32 with adolescents at particularly high risk for drug-related poisonings at such events, often related to excessive alcohol use.33 Drug use at concerts, though, appears to be somewhat dependent on the type of music performed.32 For example, drug use, including use of psychedelics, appears to be particularly prevalent at rock concerts.31 Although we could not determine whether (and which) drugs were used at such events, we did determine a strong link between attendance and use.
While many studies have focused on drug use at parties among adults, particularly as use relates to risky sexual behavior among men who have sex with men,34 little is known about drug use among adolescents who attend parties or similar social events. We determined that students who attend parties are at higher odds for use of alcohol and cannabis, and for nonmedical use of prescription stimulants and opioids. Findings add to results from a recent study of 15–20-year-olds suggesting a strong link between party attendance and use of alcohol and cannabis.35 This study found that 72.3% used alcohol only at their last party attended, 5.2% used cannabis only, and 22.5% used both alcohol and cannabis, suggesting that concomitant use at parties may indeed be common among adolescents. Cannabis use is also more likely to occur at private parties than bars,36 likely because smoking it in a public venue can place users at higher risk for detection or arrest.
With respect to the negative controls in this study—mall attendance was not significantly associated with increased odds of use of any of the substances queried, while movie attendance was associated with decreased odds for cocaine use and nonmedical prescription stimulant use. We did not hypothesize that attending such venues would be positively associated with drug use but did not expect such attendance to be protective. These findings help highlight the differential risk associated with attendance of various types of venues. Specifically, mall and movie attendance appear to be somewhat benign or even protective against drug use; students who attend concerts and parties are at increased risk for drug use, and risk increases even more among those who attend bars, nightclubs, or raves. More research is needed regarding the mechanisms for increased risk for drug use among adolescents who attend certain types of venues, but exposure to people using (or offering) drugs in particular appears to be a driving factor.37–39
Limitations
This study was cross-sectional in nature so temporality of associations cannot be inferred. Students who dropped out of school or were chronically absent were not surveyed and this may lead to underestimates of both drug use and of nightlife attendance. Since data were not collected at the event level, we could not determine whether drug use occurred at specific types of venues. Another limitation was that a fifth of the sample did not have data for race/ethnicity. According to sensitivity tests, however, results were similar whether or not race/ethnicity was included in the models, but a few results did shift. Finally, MTF combined some venue types into the same question (e.g., bars and nightclubs) so we were unable to determine associated risk with such individual venue types.
Conclusions
Nightlife venue attendance is not only associated with use of alcohol, but also with use of various other drugs. Although we could not determine the extent to which such use occurred at such venues, attendance tended to be highly associated with past-year use of alcohol and various illegal drugs. We believe results can inform prevention and harm reduction efforts targeted to adolescents. Stricter door policies limiting patrons to those age ≥21 in bars and nightclubs may help prevent underage entry or underage alcohol consumption. Further, venues that allow adolescents admission (e.g., age ≥18) may require stricter oversight regarding who is served alcohol. Given that many adolescents will still gain admission (or acquire alcohol after entering), education needs to be targeted to this young group to help reduce potential harm that can result from underage use. Illegal drug use is also prevalent at various types of nightlife venues, particularly those with all-night dancing, and such venues often have little control over drugs being smuggled and used inside. We believe prevention efforts need to target illegal drug use behavior in particular among adolescents who attend such venues, and information is needed to ensure that those who insist on using—both inside and outside of such venues—know how best to avoid drug-related harm. Partying in nightlife settings is a rite of passage for many adolescents and young adults, and more attention needs to be paid to ensuring that those who attend are well-educated about potential risks and are free from harm.
Supplementary Material
Funding
Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Numbers R01DA044207 (PI: Palamar), K01DA038800 (PI: Palamar), and P30DA011041 (PI: Hagan). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Footnotes
Disclosure statement
No potential conflict of interest was reported by the author(s).
Supplemental data for this article is available online at https://doi.org/10.1080/08897077.2021.2010253
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