State Prevalence and Ranks of Adolescent Substance Use: Implications for Cancer Prevention

This study statistically ranked states' performance on adolescent substance use related to cancer risk (past-month cigarette smoking, binge alcohol drinking, and marijuana use).

Data came from 69,200 adolescent participants (50 states and the District of Columbia) in the National Survey on Drug Use and Health (NSDUH) and 450,050 adolescent participants (47 states) in the Youth Risk Behavior Surveillance System (YRBSS). Adolescents were aged 14 to 17 years. For 2011-2015, we estimated and ranked states' prevalence of adolescent substance use. We calculated the ranks' 95% confidence intervals (CIs) using a Monte Carlo method with 100,000 simulations. Spearman correlations examined consistency of ranks.

Across states, the prevalence of cigarette smoking was 4.5% to 14.3% in NSDUH and 4.7% to 18.5% in YRBSS. Utah had the lowest prevalence (NSDUH: rank = 51 [95% CI, 47-51]; YRBSS: rank = 47 [95% CI, 46-47]), and states' ranks across surveys were correlated (r = 0.66, P < .001). The prevalence of binge alcohol drinking was 5.9% to 14.3% (NSDUH) and 7.1% to 21.7% (YRBSS). Utah had the lowest prevalence (NSDUH: rank = 50 [95% CI, 40-51]; YRBSS: rank = 47 [95% CI, 47-47]), but ranks across surveys were weakly correlated (r = 0.38, P = .01). The prevalence of marijuana use was 6.3% to 18.7% (NSDUH) and 8.2% to 27.1% (YRBSS). Utah had the lowest prevalence of marijuana use (NSDUH: rank = 50 [95% CI = 33-51]; YRBSS: rank= 46 [95% CI, 46-46]), and ranks across surveys were correlated (r = 0.70, P < .001). Wide CIs for states ranked in the middle of each distribution obscured statistical differences among them.

Variability emerged across adolescent substance use behaviors and surveys (perhaps because of administration differences). Most states showed statistically equivalent performance on adolescent substance use. Adolescents in all states would benefit from efforts to reduce substance use, to prevent against lifelong morbidity.