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Health Objectives for the Nation Current Tobacco, Alcohol, Marijuana, and Cocaine Use Among High School Students -- United States, 1990

Patterns of tobacco, alcohol, and other drug use usually are established during youth, often persist into adulthood, contribute substantially to the leading causes of mortality and morbidity (1), and are associated with lower educational achievement and school dropout (2-5). This report presents selected data on current use of tobacco, alcohol, marijuana, and cocaine among 9th-12th grade students from two components of the Youth Risk Behavior Surveillance System (6): 1) the 1990 national school-based Youth Risk Behavior Survey (YRBS) conducted during April-May 1990 and 2) similar surveys conducted by departments of education in 22 states and four cities during the same time period.

The national survey used a three-stage sample design to obtain a probability sample of 11,631 students in grades 9-12 in the 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands. The 26 state and local sites used a variety of sampling schemes: 14 drew probability samples from well-defined sampling frames of schools and students, allowing computation of weighted results of known precision; nine drew probability samples of both schools and students, but either low overall response rates or unavailable documentation precluded weighting the data or making estimates of precision; and three used nonprobability samples of either schools or students (Table 1).

For the state and local surveys, school response rates ranged from 31% to 100%; student response rates ranged from 54% to 94%. Sample sizes ranged from 378 to 5675 students. Students in most samples were distributed evenly across grades and between genders. The racial/ethnic characteristics of the samples varied considerably (Table 1).

Among the state and local surveys, rates varied for current tobacco, alcohol, and drug use during the 30 days preceding the survey (Table 2): 9%-37% of students (median: 31%) reported smoking at least one cigarette; 1%-20% (median: 11%) reported using smokeless tobacco; 28%-64% (median: 54%) reported having at least one drink of alcohol; 17%-47% (median: 35%) reported having five or more drinks on one occasion; 3%-17% (median: 12%) reported using marijuana at least once; and 1%-4% (median: 2%) reported using any form of cocaine, including powder, crack, or freebase. At most sites, more male than female students reported these behaviors. The median prevalence estimates from the state and local surveys were similar to the national prevalence estimates (Table 2). Reported by: J Moore, Alabama State Dept of Education. D Sandau-Christopher, State of Colorado Dept of Education. J Sadler, District of Columbia Public Schools. G Davis, Georgia Dept of Education. J Grosko, Kansas State Dept of Education. I Mudd, Kentucky Dept of Education. T Dunn, Massachusetts Dept of Education. A Jordan, Mississippi State Dept Bur of School Improvement. J Owens-Nausler, Nebraska Dept of Education. B Grenert, New Hampshire State Dept of Education. B Blair, New Mexico State Dept of Education. A Sheffield, New York State Education Dept. P Hunt, North Carolina Dept of Public Instruction. J Reynolds, Oklahoma State Dept of Education. P Ruzicka, Oregon Dept of Education. M Sutter, Pennsylvania Dept of Education. J Fraser, South Carolina State Dept of Education. M Carr, South Dakota Dept of Education and Cultural Affairs. E Word, Tennessee State Dept of Education. L Lacy, Utah State Board of Education. L Zedosky, West Virginia Dept of Education. B Nehls-Lowe, Wisconsin Dept of Public Instruction. D Scalise, The School Board of Broward County; AN Gay, The School Board of Dade County, Florida. D Chioda, Jersey City Public School District, New Jersey. P Simpson, Dallas Independent School District, Texas. A Blanken, Div of Epidemiology and Prevention Research, National Institute on Drug Abuse, Alcohol, Drug Abuse, and Mental Health Administration. Office on Smoking and Health and Div of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Because the quality of the samples varied among the state and local surveys, comparisons of data across sites should be made with caution. Nonetheless, these results can be useful in planning and evaluating broad national, state, and local interventions and monitoring progress toward achieving National Education Goals and health objectives. Goal 6 of the National Education Goals (7) aims to have every school in the United States free of drugs and violence and offer a disciplined environment conducive to learning by the year 2000. The results presented in this report will be incorporated in the first progress report on the status of the National Education Goals to be released September 30, 1991.

Year 2000 national health objectives 3.5, 3.9, 4.5, 4.6, 4.7, 4.8, and 4.11 are to reduce the use of tobacco, alcohol, and other drugs among youth (8). For example, objective 4.6 states that among youth aged 12-17 the prevalence of alcohol use during the previous 30 days should be no more than 12.6%, that of marijuana use no more than 3.2%, and that of cocaine use no more than 0.6%. Prevalence rates from the national YRBS for 9th-12th grade students were four times higher for alcohol and marijuana use and three times higher for cocaine use than these objectives. Furthermore, most states and cities that conducted a YRBS have not reached these national objectives. To meet the National Education Goals and the national health objectives, efforts to help youth reduce current use of tobacco, alcohol, and other drugs will need to increase among federal, state, and local education, health, and drug-control agencies; families; media; legislators; relevant community organizations; and youth themselves.


  1. CDC. Results from the National Adolescent Student Health Survey. MMWR 1989;38:147-50.

  2. Jessor R, Jessor S. Problem behavior and psychosocial development: a longitudinal study. New York: Academic Press, 1977.

  3. Kolbe LJ, Green L, Foreyt J, et al. Appropriate functions of health education in schools: improving health and cognitive performance. In: Krasnegor NA, Arasteh JD, Cataldo MF, eds. Child health behavior: a behavioral pediatrics perspective. New York: Wiley and Sons, 1986.

  4. Dryfoos J. Adolescents at risk: prevalence and prevention. New York: Oxford University Press, 1990.

  5. Mensch BS, Kandel DB. Dropping out of high school and drug involvement. Sociology of Education 1981;61:95-113.

  6. Kolbe LJ. An epidemiological surveillance system to monitor the prevalence of youth behaviors that most affect health. Health Education 1990;21:44-8.

  7. National Education Goals Panel. Measuring progress toward the National Education Goals: potential indicators and measurement strategies--discussion document. Washington, DC: National Education Goals Panel, 1991.

  8. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

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