Overview of Substance Use among Minnesota Youth Findings from the 2016 Minnesota Student Survey

Transcription

1 Overview of Substance Use among Minnesota Youth Findings from the 2016 Minnesota Student Survey October 2016 Monitoring adolescents substance use and estimating treatment need for substance use disorders are critical for planning prevention and treatment programs. This report summarizes the major findings on smoking, drinking and using other illicit substances by students in MN, using the data from the 2016 Minnesota Student Survey (MSS). Technical Note Data The Minnesota Student Survey (MSS) is a statewide school-based survey conducted every three years by an interagency team consisting of four state agencies (Education, Health, Human Services, and Public Safety). MSS is not a sample-based but a census-like survey where all the public schools with grades 5, 8, 9 and 11 were invited to participate. In 2016, the MSS was administered between January and June of 2016 to public school students in grades 5, 8, 9 and In total, 168,733 students had participated with 41,865 5 th graders, 44,983 8 th graders, 45,309 9 th graders, and 36, th graders. Questionnaires and the Mode of Administration There were three levels of questionnaires: Level 1 for 5 th graders, level 2 for 8 th graders and level 3 for 9 th and 11 th graders. The majority of questions on substance use were asked only in Level 2 and 3 questionnaires. Thus, this report covers data from students in grades 8, 9 and 11. In 2016, a web survey was the main mode of administration with limited number of paper surveys being offered only for the level 3 questionnaire on a first-come-first-serve basis. About a quarter of the 9 th and 11 th graders who participated in the 2016 MSS took the 1 In addition to the regular public schools, MSS is administered to students in Alternative Learning Settings as well as those in Juvenile Correctional Facilities which are not included in the estimates reported here. 1

2 survey in paper mode. In the final total for the regular school data, there were 20,587 students who completed the survey in paper mode. Participation Rates MSS is not a sample-based, but a census-like survey, where all public school districts are invited to participate and student participation is voluntary. Parents were informed in advance about the administration and offered an opt-out option. In 2016, 282 of the 330 public school districts (85.5) agreed to participate. Overall, approximately 67.6 of the statewide student population enrolled in the four grades participated in the 2016 MSS (65.7 of fifth graders, 73.4 of eighth graders, 70.7 of ninth graders, and 60.5 of eleventh graders). Socio-demographic description of participating students Gender is evenly divided across all four grades. Overall, almost one third of students (31.7) are members of a minority population or of multiple-race background. The proportion of minority students was higher among younger students (34.4 of 5 th graders; 33.9 of 8 th graders; 30.5 of 9 th graders; 27.3 of 11 th graders). Just under three in ten students (29.0) reported getting a free or reduced-price lunch at school. This is used as a proxy measure for low-income status throughout the analyses. Table 1. Socio-demographic characteristics of survey participants Grade 5 (n=41,865) Grade 8 (n=44,983) Grade 9 (n=45,309) Grade 11 (n=36,576) Total (n=168,733) Gender Female Race/Ethnicity 1 White American Indian Black Asian/Pacific Islander Hispanic Multiple race Household income Currently get a free or reduced-price lunch at school All the race categories (white, American Indian, black, Asian/Pacific Islander and multiple race) are non-hispanic. 2

3 Tobacco Use In the 2016 MSS, students in grades 8, 9 and 11 were asked about their tobacco use as follows: During the last 30 days, on how many days did you smoke a cigarette [smoke cigars, cigarillos or little cigars; use chewing tobacco, snuff or dip; use an electronic cigarette (e-cigarette, e-hookah, vaping pen); use a hookah or a waterpipe to smoke tobacco]? Figure 1-1. Percent of students who reported using each tobacco product 1 or more days during the last 30 days cigarette cigars, cigarillos or little cigars chewing tobacco, snuff or dip e-cigarette hookah or waterpipe Statewide, 4.9 of Minnesota students in grades 8, 9 and 11 reported smoking cigarettes during the 30 days preceding the 2016 MSS. About twice as many students (10.2) reported e-cigarette use during the past 30 days. While cigarette smoking among MN students had decreased over the years (It was 7.8 in 2013) e-cigarette use, which was measured for the first time in 2016, is worrisome. The use of other tobacco products, such as cigars, chewing tobacco or hookah, was reported by 3.1, 2.7 and 2.5 of students respectively. Cigarette smoking While there was not much difference across gender, cigarette smoking was more prevalent among older students: About 2.8 of 8 th graders reported cigarette smoking in the past 30 days and it was 4.3 among 9 th graders and 8.4 among 11 th graders (Figure 1-2). 3

4 Figure 1-2. Percent of students who reported cigarette smoking 1 or more days during the last 30 days male female total gender grade Figure 1-3. Percent of students who reported cigarette smoking 1 or more days during the last 30 days White Black Hispanic low high American API Multi household Indian race income The prevalence of cigarette smoking was highest among American Indian students with 13.5 of them reporting cigarette smoking during the last 30 days. This was higher than white students by a ratio of almost three-to-one and higher than Hispanic students by a ratio of more than two-to-one. Asian/Pacific Islander students had the lowest prevalence at

5 Among American Indian students, females were substantially more likely than their male counterparts to smoke cigarettes with 10.7 of males vs of females reporting cigarette smoking during the past 30 days (see Table 1 in the Appendix for more details). Students from low-income households were more likely than their more affluent counterparts to report cigarette smoking (7.4 vs. 4.0; Figure 1-3). E-cigarette Use Figure 1-4. Percent of students who reported using e-cig 1 or more days during the last 30 days male female total gender grade Statewide, about one in ten students in grades 8, 9 and 11 said that they used e-cigarettes during the 30 days preceding the survey. About 5.7 of 8 th graders reported using e- cigarettes compared to 9.3 among 9 th graders and 17.1 among 11 th graders (Figure 1-4). The prevalence was highest among 11 th grade male students with almost one-in-five (19.0) reporting e-cigarette use in the past 30 days (see Table 2 in Appendix). Figure 1-5 shows that the prevalence of e-cigarette use was highest among American Indian students, closely followed by students with multiple racial backgrounds and Hispanics (14.6, 13.9 and 13.0 respectively). As with cigarette smoking, Asian/Pacific Islander students had the lowest prevalence of e-cigarette use. Students from low-income households were more likely than their more affluent counterparts to report e-cigarette use during the past 30 days (12.3 vs. 9.5; Figure 1-5). 5

6 Figure 1-5. Percent of students who reported using e- cig 1 or more days during the last 30 days White Black Hispanic low high American Multi API household Indian race income Use of any tobacco products Figure 1-6. Percent of students who reported using any tobacco products 1 or more days during the last 30 days male female total gender grade Overall, 13.0 of students in grades 8, 9 and 11 reported using any of the five tobacco products asked in the 2016 MSS (cigarettes, cigars, chewing tobacco, e-cigarettes or a hookah). The prevalence was slightly higher among male students than female students Use of any tobacco products increased as age of students and more than one in five 11 th graders (21.8) had used a tobacco product during the 30 days preceding the survey. 6

7 Figure 1-7. Percent of students who reported using any tobacco products 1 or more days during the last 30 days White Black Hispanic low American Indian API Multi race high household income About 23 of American Indian students reported using a tobacco product during the 30 days preceding the survey, it was 17.5 among those with multiple racial background, 15.9 among Hispanic students, 12.7 among white students, 10.2 among black students and 6.5 among API students. Students from low-income households were more likely than their counterparts to use a tobacco product during the past 30 days. Alcohol Use Past-month drinking Drinking in the past month was asked as follows: During the last 30 days, on how many days did you drink one or more drinks of an alcoholic beverage? Statewide, about one-in-seven (13.9) students in grades 8, 9 and 11reported drinking an alcoholic beverage on at least one day during the 30 days before the survey. This was a 2.9 percentage-point decrease from 16.8 estimated by the 2013 MSS, and the decline was observed for both male and female students and across all three grades. 7

8 Figure 2-1. Percent of students who reported drinking 1 or more days during the last 30 days male female total gender grade Compared to male students, females had a slightly higher proportion drinking alcohol in the past month, and this was true for both 8 th and 9 th graders (see Table 4 in Appendix for details). The prevalence of past-month drinking was 7.9 among 8 th graders, 11.2 among 9 th graders and 24.6 among 11 th graders. Figure 2-2. Percent of students who reported drinking 1 or more days during the last 30 days White Black Hispanic low high American API Multi household Indian race income Overall, the prevalence of drinking was highest among American Indians (18.9), followed by Hispanics (16.7) and students of multiple-race background (16.7). About 8

9 14.1 of white students reported current drinking, and black and API students were less likely than whites to report drinking in the past month (8.0 and 7.8, respectively). Students from low-income households were slightly more likely than their more affluent counterparts to report drinking in the past month (15.1 vs. 13.5). Amount of drinks at one time reported by students who drink alcohol Typical amount of drinks at a time was measured by asking If you drink beer/wine/wine coolers/liquor, generally how much (if any) do you drink at one time? Figure 2-3. Amount of drinks at one time among those who reported drinking grade grade grade drink 2 drinks 3 drinks 4 drinks 5 or more Students in a higher grade were not only more likely to drink an alcoholic beverage, but also to have more drinks at one time. As the chart shows, the majority of 8 th graders who reported drinking had one drink at a time, but it decreased to about 30 of 11 th graders. On the other hand, about one in five (20.2) of 11 th graders who reported drinking had 5 or more drinks at a time. Onset age of drinking among 11 th graders The MSS also measured the onset age of drinking by asking How old were you when you had your first drink of an alcoholic beverage, such as beer, wine, wine coolers and liquor, other than a few sips? 9

10 The chart below compares the onset age of drinking of 11 th graders by gender. Male students in grade 11 who reported drinking were more likely than their female counterparts to have had their first drink before age 13 (23.0 vs. 15.3) Figure 2-4. Age at first drink: Percent of 11th graders who reported drinking 0 10 or younger or older Male Female Binge drinking Binge drinking is defined by having 5 or more drinks in a row and it was measured by a question During the past 30 days, on how many days did you have 5 or more drinks of alcohol in a row, that is, within a couple of hours? Statewide, 6.2 of students in grades 8, 9 and 11 reported binge drinking on at least one day during the 30 days before the survey, decreasing from 8.2 reported in The prevalence of binge drinking was similar across gender while it increased significantly as students moved up the grades from 8 to 11. The prevalence of binge drinking was less than 3 among 8 th graders whereas it was about twice as high among 9 th graders and more than five times as high among 11 th graders (Figure 2-5). 10

11 Figure 2-5. Percent of students who reported binge drinking 1 or more days during the last 30 days male female total gender grade American Indian students had the highest prevalence (11.2) of binge drinking and lowest among blacks and Asian/Pacific Islanders (3.9 and 3.6 respectively; Figure 2-6). Hispanics (7.5) and students of multiple-race background (7.6) had slightly higher prevalence than white students (6.2). American Indians were the only racial/ethnic group where the prevalence of binge drinking was substantially higher among females than their male counterparts (12.8 vs. 10.0; see Table 5 in the Appendix). Figure 2-6. Percent of students who reported binge drinking 1 or more days during the last 30 days White Black Hispanic low American Indian API Multi race high household income 11

12 Illicit Drug Use In the 2016 MSS, students in grades 8, 9 and 11 were asked about using various illicit drugs during past year as follows: During the last 12 months, on how many occasions (if any) have you used marijuana or hashish (Do Not count medical marijuana prescribed for you by a doctor)? /sniffed glue or huffed or inhaled the contents of aerosol spray cans or other gasses to get high/? used LSD (acid) PCP (wet sticks or dipped joints) or other psychedelics? used MDMA (E, X, ecxtasy), GHB (G, Liquid E, Liquid X, roofies) or Ketamine (Special K)? used crack, coke or cocaine in any form? used heroin? used methamphetamine (meth, glass, crank, crystal meth, ice)? used over-the-counter drugs such as cough syrup, cold medicine or diet pills that you took only to get high? used synthetic drugs such as bath salts (Ivory Wave, White Lightning) or synthetic marijuana (K2, Gold) that you took only to get high? used any of the following prescription drugs that were NOT prescribed for you or that you took ONLY to get high [Stimulants such as Benzedrine or diet pills; ADHD or ADD drugs like Ritalin; Pain relievers such as Oxycodone, Oxycontin (oxy), Percocet, Percodan, Vicodin or others; Tranquilizers such as Valium, Xanax, nerve pills or sedatives or barbiturates]? The following chart shows the overall prevalence of use during the past year for each illicit drug asked in the 2016 MSS. Statewide, about 12 of students in grades 8, 9 and 11 reported marijuana during the 12 months before the survey, decreasing from 14.9 reported in All the other illicit drugs were used by a lot fewer students. Among the illicit drugs other than marijuana, pain relievers and over-the-counter drugs were the ones most used by students in MN, closely followed by ADHD drugs (3.2, 3.2 and 2.7, respectively). The over-the-counter drug misuse had the most substantial increase noted in 2016: It was reported by 1.8 of students in grades 8, 9 and 11 in 2013 and 3.2 in The prescription drug use in the past year asked in 4 question items cannot be compared to the 2013 data due to methodological issues. 12

13 Figure 3-1. Percent of students in grades 8, 9 and 11 who reported using illicit drugs during the last 12 months Marijuana use in past month In addition to the past year use, students were asked about marijuana use during the past month: During the last 30 days, on how many days did you use marijuana or hashish? (Do NOT count medical marijuana prescribed for you by a doctor) Figure 3-2. Percent of students who reported using marijuana 1 or more days during the last 30 days male female total gender grade Statewide, 8.6 of students in grades 8, 9 and 11 used marijuana on at least one day during the 30 days before the survey, decreasing slightly from 10.1 in Overall, 13

14 there was no substantial gender difference in the use of marijuana during the past month but the detailed table shows that among 11 th graders, male students were more likely than females to have used marijuana in the past month (16.8 vs. 14.7; see Table 6 in the Appendix). It should be noted, however, that among American Indians, female students were more likely than their male counterparts to report marijuana use in the past month (26.0 vs. 18.2; see Table 6 in the Appendix). The prevalence of past-month marijuana use was 4.6 among 8 th graders, 6.8 among 9 th graders and 15.7 among 11 th graders. Figure 3-3. Percent of students who reported using marijuana 1 or more days during the last 30 days White Black Hispanic low high American API Multi household Indian race income Compared to white students in grades 8, 9 and 11, the prevalence of past-month marijuana use was higher among all minority subgroups, except Asian/Pacific Islander students who had the lowest prevalence as in tobacco and alcohol use. The prevalence was highest among American Indians with more than one-in-five of them (21.6) reporting marijuana use during the past month. Different from tobacco and alcohol use, black students were more likely than whites to report marijuana use. Students from low-income households were more likely than their more affluent counterparts to report marijuana use in the past month (12.1 vs. 7.3). Onset age of marijuana use among 11 th graders The MSS also measured the onset age of marijuana use by asking How old were you when you tried marijuana (pot, weed) or hashish (hash, hash oil) for the first time? (Do NOT count medical marijuana prescribed for you by a doctor) 14

15 The chart below compares the onset age of marijuana use reported by 11 th graders across gender. Male students in grade 11 who reported marijuana use were more likely than their female counterparts to have had their first use at age 13 or younger (25.5 vs. 19.1). Figure 3-4. Age at first use of marijuana: Percent of 11th graders who reported using marijuana or younger or older Male Female Prescription misuse in past month In addition to the past year use, students were asked about misuse of prescription drugs during the 30 days before the survey: During the last 30 days, on how many days did you use prescription drugs not prescribed for you? Statewide, 4.7 of students in grades 8, 9 and 11 reported that they had misused prescription drugs during the past month. Unlike marijuana, prescription misuse was reported slightly more by female students than male students. While the 11 th graders were more likely than students in grades 8 or 9 to misuse prescription drugs in the past month, the difference was not as stark as in marijuana use where the use rate of 11 th graders was more than three times higher than for 8 th graders and the use rate of 9 th graders was more than two times higher. 15

16 Figure 3-5. Percent of students who reported misusing Rx drugs 1 or more days during the last 30 days male female total gender grade American Indian students had the highest prevalence of prescription misuse in the past month with 9.3 reporting it. All the other minority subgroups also had higher prevalence than white students except Asian/Pacific Islanders who had the lowest prevalence. Students from low-income households were more likely than their more affluent counterparts to report prescription misuse in the past month (6.7 vs. 4.0). Figure 3-6. Percent of students who reported misusing Rx drugs 1 or more days during the last 30 days White Black Hispanic low American Indian API Multi race high household income 16

17 Prevalence of Substance Use Disorder The 2016 MSS asked students in grades 8, 9 and 11 a series of questions, following the criteria in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM- 5) 3, to estimate the prevalence of substance use disorders. The substance use disorders are estimated using the questions about tolerance, substance use in a larger amount than intended, failed attempts to control substance use, a great deal of time spent to obtain the substance or to get over the effects, interference in important social activities, continued use despite physical/emotional problems, failure to fulfill major role obligations at work, school or home, recurrent substance use in physically hazardous situations, craving for the substance, continued substance use despite having social and/or interpersonal problems caused by it. Following the DSM-5 criteria, anyone who had four or more symptoms listed above are defined to have a substance use disorder. The estimation of substance use disorders from the MSS data is not substance specific. Figure 4-1. Percent of students who had substance use disorders during past year by gender and grade male female total gender grade Overall, 3.5 of students in grades 8, 9 and 11 had substance use disorders (SUDs) during the 12 months before the survey. The prevalence was similar across genders. The 11 th graders had substantially higher prevalence of SUDs than 8 th or 9 th graders (7.0 compared to 1.6 and 2.6 for 8 th and 9 th graders respectively). American Indian students had the highest prevalence of SUDs (8.4), followed by students of multi-racial background (5.1), Hispanics (4.8), blacks (3.3), whites 3 American Psychiatric Association, Diagnostic and Statistical Manual of mental Disorders, Fifth Edition, 2013, Washington, D.C. A new set of criteria for substance use disorders (DSM-5) replaced the categories of substance abuse and dependence in the earlier criteria of DSM-IV with a single classification of substance use disorder. 17

18 (3.3) and Asian/Pacific Islanders (1.7). Students from low-income households were more likely than their more affluent counterparts to have SUDs (4.6 vs. 3.1). Figure 4-2. Percent of students who had substance use disorders during past year by race/ethnicity and household income White American Indian Black API Hispanic Multiple race low high household income There is an interesting interaction between gender and race/ethnicity in prevalence of SUDs that should be noted (see Table 8 in the Appendix). Among white students, girls and boys had similar prevalence of SUDs, but there were some substantial gender differences observed among minority subgroups. Among American Indians, female students had substantially higher prevalence of SUDs than their male counterparts (10.5 vs. 6.8). On the other hand, among black students, male students had substantially higher prevalence of SUDs than their female counterparts (4.0 vs. 2.4). The prevalence of substance use disorders among students who started using alcohol or marijuana before age 13 was about twice as high as those who started using them at age 13 or later (see Figure 4-3). More than one in five (22.5) of the11 th graders who had their first drink before age 13 had SUDs during the year before the survey, compared to just over one in ten (11.3) of those who had their first drink at age 13 or older age. Similarly, about 37.5 of the11 th graders who reported smoking their first marijuana before age 13 had SUDs while it was 21.2 of those who reported smoking their first marijuana at age 13 or older age. 18

19 Figure 4-3. Prevalence of substance use disorders by age at first use of alcohol and drug (11 th graders only) first use before age 13 first use at age 13 or older alcohol marijuana Concluding remarks This report reviewed the prevalence of substance use among Minnesota youth using the 2016 MSS data and its variation across socio-demographic subgroups. Several findings are worth noting: E-cigarette is the most popular tobacco product among students with about one in ten (10) students in grade 8, 9 and 11 reporting its use during the past month and it was almost one in five (19) among 11 th grade male students. For each substance examined in this report, American Indian students had the highest prevalence of use as well as the highest prevalence of SUDs. Among American Indian students, the prevalence was higher for each substance examined in this report among females than males, and female American Indian students were more likely than male counterparts to have SUDs (11 vs. 7). Students from low-income households were more likely than their counterparts to use tobacco products, to report drinking and to use illicit drugs, and this disparity was more pronounced among female students than male students. Other than marijuana, prescription drugs (pain relievers and ADHD drugs) and over-the-counter drugs were the most popular illicit drugs misused by students. Students who started using a substance, such as alcohol or marijuana, at a younger age were more likely than their counterparts to have a substance use disorder. 19

20 There is a national trend toward legalization of medical marijuana. In 2015, Minnesota became the 22 nd state with a medical cannabis program, which raised some concern about its possible impact on illicit use of marijuana. The 2016 MSS data did not show any increase in illicit use of marijuana among students. In fact, the prevalence of marijuana use had slightly decreased from 2013 for both past month and past year use. The medical marijuana had been available in Minnesota for only about 6 months when the survey started in January of So, we need to keep monitoring for any possible ramification of the new policy. It is well documented in research that an early onset of substance use increases the likelihood of developing substance use disorders. This is clearly supported by the 2016 MSS data. The importance of early intervention cannot be overemphasized. Prevention needs to start early in childhood and should be implemented through orchestrated efforts among families, schools and communities, to be effective. 20

21 Appendix Table1. Percent of students who reported cigarette smoking by grade, race/ethnicity and household income for each gender. Smoked cigarettes during the 30 days before the survey. Category Grade Race/Ethnicity White American Indian Black Asian/Pacific Islander Hispanic Multiple race Household income 1 Low High Male Female Total Total Those who reported getting free or reduced-price lunch at school are coded as low-income household. 21

22 Table 2. Percent of students who reported using e-cigarettes by grade, race/ethnicity and household income for each gender. Used e-cigarettes during the 30 days before the survey. Category Grade Race/Ethnicity 1 Those who reported getting free or reduced-price lunch at school are coded as low-income household White American Indian Black Asian/Pacific Islander Hispanic Multiple race Household income 1 Low High Male Female Total Total

23 Table 3. Percent of students who reported using any tobacco products by grade, race/ethnicity and household income for each gender. Used any tobacco products (cigarettes, cigars, chewing tobacco, e-cig or a hookah) during the 30 days before the survey. Category Grade Race/Ethnicity 1 Those who reported getting free or reduced-price lunch at school are coded as low-income household White American Indian Black Asian/Pacific Islander Hispanic Multiple race Household income 1 Low High Male Female Total Total

24 Table 4. Percent of students who reported drinking by grade, race/ethnicity and household income for each gender. Drank alcoholic beverages during the 30 days before the survey. Category Grade Race/Ethnicity White American Indian Black Asian/Pacific Islander Hispanic Multiple race Household income 1 Low High Male Female Total Total Those who reported getting free or reduced-price lunch at school are coded as low-income household. 24

25 Table 5. Percent of students who reported binge drinking past month by grade, race/ethnicity and household income for each gender. Binged (5 or more drinks in a row) during the 30 days before the survey. Category Grade Race/Ethnicity 1 Those who reported getting free or reduced-price lunch at school are coded as low-income household White American Indian Black Asian/Pacific Islander Hispanic Multiple race Household income 1 Low High Male Female Total Total

26 Table 6. Percent of students who reported using marijuana past month by grade, race/ethnicity and household income for each gender. Used marijuana (excluding medical use) during 30 days before the survey. Category Grade Race/Ethnicity 1 Those who reported getting free or reduced-price lunch at school are coded as low-income household White American Indian Black Asian/Pacific Islander Hispanic Multiple race Household income 1 Low High Male Female Total Total

27 Table 7. Percent of students who reported misusing prescription drugs past month by grade, race/ethnicity and household income for each gender. Misused prescription drugs during 30 days before the survey. Category Grade Race/Ethnicity 1 Those who reported getting free or reduced-price lunch at school are coded as low-income household White American Indian Black Asian/Pacific Islander Hispanic Multiple race Household income 1 Low High Male Female Total Total

28 Table 8. Percent of students who had substance use disorders during past year by grade, race/ethnicity and household income for each gender. Had substance use disorders in the 12 months before the survey. Category Grade Race/Ethnicity 1 Those who reported getting free or reduced-price lunch at school are coded as low-income household White American Indian Black Asian/Pacific Islander Hispanic Multiple race Household income 1 Low High Male Female Total Total