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This study examined whether variability in young adult drinking social settings, drinking games/drink price specials, and locations differentiated daily high-intensity drinking (HID) likelihood; whether contexts varied by legal drinking age and college status (attending a 4-year college full-time); and whether legal drinking age and college status moderated drinking context/intensity associations.Participants (n = 818 people, 46.3% female) were part of the Young Adult Daily Life Study in 2019 to 2022. They were originally selected because they were past 30-day drinkers from the 2018 U.S. national probability Monitoring the Future 12th grade sample and because they reported one or more days of alcohol use during 14-day data collection bursts across the following 4 years (n = 5080 drinking days). Weighted multilevel modeling was used to estimate drinking context/intensity associations. Drinking intensity was defined as moderate (females 1 to 3, males 1 to 4 drinks), binge (4 to 7, 5 to 9 drinks), or HID (8+, 10+ drinks). Models controlled for other within-person (weekend, historical time period) and between-person (sex and race/ethnicity) covariates.Contexts differentiating HID and binge drinking days included drinking with large groups, strangers, pregaming, drinking games, and more drinking locations. Legal drinking age was associated with lower odds of free drinks but greater odds of drinking at bars/restaurants. College status was associated with lower odds of drinking alone or free drinks, but greater odds of drinking with friends, large groups, pregaming, drinking games, discounted price drinks, and at bars/restaurants, parties, and more drinking locations. Legal drinking age and college status moderated some context-intensity associations.Social settings, pregaming, drinking games, and drinking at more locations were associated with increased risk of HID on a given day. Legal drinking age and college status were associated with specific drinking contexts and moderated some context/intensity associations. Incorporating the contexts associated with HID into interventions may help to reduce HID and related consequences in young adults.

Efforts to intervene with subgroups at particularly high risk for alcohol use require information on factors that differentiate drinking intensity levels. This article summarizes existing research and provides new findings on sociodemographics and risk factors that differentiate high-intensity drinking (HID) to provide context for developing and delivering interventions for the highest-risk drinkers. Cross-sectional data were obtained in 2019 from participants who reported past 30-day alcohol use in 2018 as part of the nationally representative 12th grade Monitoring the Future study. Among past 2-week drinkers in 2019 (

The extent to which adolescent substance use is associated with alcohol use disorder (AUD) symptoms in midlife is not yet fully explored.Longitudinal data from the national Monitoring the Future study was used. The sample included 11,830 12Prevalence of midlife AUD symptoms was 27.1%. Higher relative risk of reporting AUD symptoms (vs. drinking without AUD) was associated with age 18 substance use (any cigarette use [vs. no use], any marijuana use [vs. no use], binge drinking [vs. both no use and drinking at less than binge levels]), being male (vs. female), being non-Hispanic White (vs. non-Hispanic Black), and having a 4-year college degree. Higher relative risk of reporting non-drinking (vs. drinking without AUD) was associated with no 30-day alcohol use at age 18, being non-Hispanic Black or non-Hispanic other (vs. non-Hispanic White), and not having a 4-year college degree.Findings suggest substance use at age 18 has meaningful associations with midlife AUD symptoms. Dissemination of prevention and intervention efforts in adolescence and early adulthood may be important for reducing hazardous midlife drinking.

OBJECTIVE: This study examined past-2-week driving after marijuana use (DMU) and driving after having five or more drinks (D5D) during young adulthood, specifically focusing on associations between within-person change in social roles (living situation, marriage, parenthood, education, employment) and mediators (perceived risk, evenings out, and religiosity) from modal ages 19 to 30. METHOD: Multilevel analyses were conducted using survey data collected from 2013 to 2019 from 1,873 adults (1,060 women; total number of data collection waves = 7,037) participating in the longitudinal Monitoring the Future study. RESULTS: Change across waves from not being married to married was associated with lower DMU likelihood at any particular wave both directly and via mediation through wave-level change in evenings out. Change in employment (not employed to employed full time) was associated with higher D5D likelihood at any particular wave both directly and via mediation through change in evenings out. Wave-level change in other social roles was indirectly associated with DMU/D5D likelihood via wave-level change in evenings out. CONCLUSIONS: Change in all social roles examined was associated with change in evenings out, which appears to be a primary, proximal predictor of young adult DMU/D5D. Improved understanding of how socialization change is associated with driving after substance use may strengthen efforts to reduce the harms associated with such driving behaviors.

OBJECTIVE: The purpose of this longitudinal study was to identify associations of drinking intensity at age 29/30 with symptoms of alcohol use disorder (AUD) at age 35. METHOD: Analyses used national longitudinal data from 1,253 individuals (53.5% female) participating in the Monitoring the Future study. Age 29/30 data were collected from 2005 to 2013; age 35 data were collected from 2010 to 2018. Multivariable models regressed age 35 past-5-year AUD symptoms (vs. nondisordered drinking/abstinence) on age 29/30 past-2-week drinking intensity (no/low [0–4] drinking, binge [5–9] drinking, high-intensity [10+] drinking), with key covariates being controlled for. RESULTS: At age 35, 32.6% (SE = 1.50) of respondents reported AUD symptoms. AUD symptoms at age 35 were reported by 77.5% (SE = 4.79) of participants who reported age 29/30 high-intensity drinking and 60.6% (SE = 3.95) of participants who reported age 29/30 binge drinking. Age 35 past-5-year abstinence was reported by almost no respondents reporting age 29/30 binge drinking or high-intensity drinking. AUD symptoms at age 35 were significantly more likely for those who reported binge (adjusted multivariable odds ratio [AOR] = 5.61, 95% CI [3.79, 8.30], p < .001) or high-intensity (AOR = 12.26, 95% CI [6.70, 22.41], p < .001) drinking versus no/low drinking at age 29/30. The likelihood of having AUD symptoms was significantly higher for high-intensity than for binge drinkers (AOR = 2.18, 95% CI [1.14, 4.19], p = .019). CONCLUSIONS: Nearly 80% of those young adults who reported engaging in high-intensity drinking (10+ drinks in a row) at age 29/30 later reported AUD symptoms at age 35. High-intensity drinking appears to be a strong prospective marker of risk for AUD symptoms among adults in the United States.

This study (a) examined changes in marijuana and cigarette initiation sequencing and (b) considered implications of such changes for prevention efforts by examining associations between initiation sequencing and current adolescent substance use. Analyses used 2000–2019 cross-sectional data from the national Monitoring the Future (MTF) study (78,252 U.S. 12th grade students). Models examined trends in six distinct patterns of initiation order, and multivariable associations between order of initiation and 30-day cigarette and marijuana use prevalence, cigarette and marijuana use frequency among users, and nicotine and marijuana vaping prevalence. While the percentage of students initiating neither cigarettes nor marijuana increased, increases also were observed in marijuana-only initiation (the fastest-growing pattern) and initiation of marijuana before cigarettes; these increases were accompanied by a significant decrease in cigarette-only initiation. Cigarette use prevalence and frequency were highest among students initiating cigarettes before marijuana; marijuana use prevalence and frequency were highest among students initiating marijuana before cigarettes. Cigarette and marijuana prevalence, as well as marijuana frequency, were lowest among students initiating only a single substance. Nicotine vaping was less prevalent among students initiating a single substance versus both substances, but no significant differences were observed in nicotine vaping prevalence between those initiating only cigarettes versus only marijuana. Implications of these findings for prevention efforts are discussed in the frameworks of both the common liability model and route of administration model.

Identifying risk factors for alcohol use disorder (AUD) is important for public health. The social context of drinking-such as drinking alone-may be an independent and robust early risk marker for AUD symptoms later in life. We evaluated whether solitary alcohol use in adolescence (age 18) and young adulthood (age 23/24) was concurrently associated with binge drinking and prospectively predicted age 35 AUD symptoms, and whether associations differed by sex.Longitudinal data were from the Monitoring the Future study. Surveys were completed by adolescents in 12th grade at age 18 (1976-2002), young adults at age 23/24 (1981-2008), and adults at age 35 (1993-2019). Analyses included past 12-month alcohol users (n = 4464 for adolescent models; n = 4561 for young adult models). Multivariable regression analyses tested whether adolescent and young adult solitary alcohol use was associated concurrently with binge drinking frequency and prospectively with age 35 AUD symptoms.Solitary alcohol use in adolescence and young adulthood was associated (a) concurrently with binge drinking and (b) prospectively with increased risk of age 35 AUD symptoms (even after controlling for earlier binge drinking, alcohol use frequency, and sociodemographic covariates). Adolescent solitary alcohol use was associated with age 35 AUD symptoms particularly among females; no interaction was observed between sex and young adult solitary alcohol use in predicting age 35 AUD symptoms.Adolescent and young adult solitary alcohol use was associated with increased adult AUD symptoms above and beyond other risk factors; adolescent female solitary alcohol users were especially at risk.

Background The degree to which binge and high-intensity drinking prevalence estimates vary from fixed threshold frequency and continuous maximum drinks measures is unknown. The current study compared prevalence estimates for adolescent binge and high-intensity drinking (5+ drinks, 10+ drinks, respectively) and sex-specific thresholds using fixed threshold frequency and continuous maximum drinks measures. Methods Data were obtained from 7911 respondents participating in the 2018 and 2019 nationally representative Monitoring the Future 12th-grade surveys. Comparisons of frequency prevalence (e.g., any occasions of 5+ drinking using the frequency measure) versus maximum drinks prevalence (e.g., reporting 5 or more drinks using the maximum number of drinks measure) were made using all respondents and then separately within males and females. Results Among the sample overall and within sex, binge drinking estimates from the 5+ frequency prevalence and 5+ maximum drinks prevalence measures evidenced overlapping confidence intervals (estimates were slightly higher for frequency prevalence); similar results were observed for high-intensity drinking 10+ frequency prevalence and 10+ maximum drinks prevalence. For example, among the sample overall, 5+ frequency prevalence was 11.4% [95% CI 10.3, 12.6]; 5+ maximum drinks prevalence was 10.7% [9.6, 11.8]; 10+ frequency prevalence was 5.1% [4.4, 5.8]; and 10+ maximum drinks prevalence was 4.1% [3.5, 4.7]. Using sex-specific thresholds (i.e., 4+ drinks for females and 5+ drinks for males), binge frequency and maximum drinks levels also had overlapping confidence intervals. Binge drinking prevalence estimates for females were approximately 1.5 times higher using sex-specific (4+) versus universal (5+) thresholds. Conclusions In this nationally representative sample of 12th-grade students, prevalence levels for 5+ and 10+ drinking did not differ significantly when using frequency versus maximum drinks measures. Among females, binge drinking prevalence was higher using sex-specific versus universal thresholds. Both the frequency and maximum drinks measures provided comparable estimates of binge and high-intensity drinking prevalence among older adolescents.

BACKGROUND AND AIMS Long-term frequent marijuana use is associated with significant negative outcomes, yet little is known about the longitudinal course of marijuana use among those who start frequent use during adolescence. Objectives are (a) to identify latent patterns of within-person marijuana use from ages 19-30 years among 12th graders reporting frequent marijuana use, (b) to examine if membership in identified patterns has changed across historical time and (c) to examine if key covariates differentiate class membership. DESIGN, SETTING, PARTICIPANTS Longitudinal, national US panel data from 4423 individuals [53.4% of the eligible sample; 2744 (62%) males] who reported frequent marijuana use in 12th grade (modal age 18 years; senior year cohorts 1976-2006) followed biennially from ages 19/20 to 29/30. MEASUREMENTS Self-reported past 30-day marijuana use (frequent use defined as use on 20+ occasions), demographics, college graduation, marriage and parenthood. FINDINGS Repeated-measures latent class analysis (RMLCA) identified five latent classes of past 30-day marijuana use from ages 19/20 to 29/30: continued frequent users (estimated membership 23.4%); frequent to non-frequent users (15.5%); consistent non-frequent users (18.4%); non-frequent users to discontinuers (19.5%); and discontinuers (23.2%). In multivariable models, membership in the highest-risk latent class (continued frequent users) versus one or more of the lower-risk latent classes was more likely for recent cohorts (P = 0.038 to

OBJECTIVE: The current study examines the prevalence, stability, and correlates of simultaneous alcohol and marijuana (SAM) use among underage US young adults, a population at high risk for participating in this behavior. METHOD: Analyses used data from 1,719 respondents (46.8% men) who participated in the nationally representative 12(th)-grade Monitoring the Future study and provided responses to SAM use items at longitudinal follow-up at modal ages 19/20 between 2007 and 2016. Prevalence estimates and covariate associations with SAM use were estimated. RESULTS: SAM use prevalence at modal age 19/20 was 22.5%. Multivariable models indicated that odds of age 19/20 SAM use were significantly (p

BACKGROUND: Little is known regarding what sociodemographic characteristics and reasons for use are associated with adolescent solitary alcohol and marijuana use. METHODS: Data from 7,845 12(th) grade students participating in the nationally-representative Monitoring the Future study from 2015-2021 were used to examine cross-sectional associations between sociodemographics, heavy drinking/marijuana use, reasons for use, and past 12-month solitary alcohol or marijuana use among past 12-month users. Historical trends and possible differences related to the COVID-19 pandemic also were examined. RESULTS: Solitary use prevalence increased from 2015 to 2021 with no evidence of significant COVID-19 deviations. In 2021, solitary alcohol use was reported by 32.1% (SE 3.01) and solitary marijuana use by 55.8% (4.72) of those reporting past 12-month use. Common and substance-specific sociodemographic risk factors were observed. Binge drinking was associated with solitary alcohol use; frequent marijuana use was associated with solitary marijuana use. Reasons for use related to coping with negative affect were associated with solitary use. Compulsive use reasons were more strongly associated with solitary alcohol than marijuana use. Drinking to have a good time with friends was negatively associated with solitary alcohol use but this association was not seen for solitary marijuana use. CONCLUSIONS: The percentage of adolescents who use alcohol or marijuana when they were alone has increased among those who report using each substance. Associations between solitary use and (a) higher levels of consumption and (b) coping with negative affect highlight the importance of solitary use as a risk indicator.

The current study used U.S. national data to examine drinking trends prior to and during the COVID-19 pandemic in 2020, focusing on changes in U.S. young- and middle-adult alcohol prevalence, frequency, and drinking contexts and reasons, and whether they differed by age and college status.Data from 2015 to 2020 from 16,987 young adults (ages 19-30) and 23,584 middle adults (ages 35-55) in the national Monitoring the Future study were used to model historical trends and potential 2020 shifts (data collection April 1 to November 30, 2020) in prevalence (30-day, daily, binge drinking) and frequency (30-day, binge drinking). For young adults, data on drinking contexts and negative affect reasons for drinking were examined. Moderation by age and college status was also tested.2020 was associated with (1) downward deviation in 30-day (young and middle adults) and binge drinking (young adults) prevalence; (2) upward deviation in daily drinking prevalence (middle adults); (3) among drinkers, upward deviation in frequency of 30-day (young and middle adults) and binge drinking (young adults); and (4) changes in drinking contexts and reasons among drinkers. Among college students, in particular, 2020 was associated with a downward deviation from expected historical trends in drinking prevalence. Upward deviations in daily prevalence and both binge and 30-day drinking frequency were stronger at ages 25-30 (vs. 19-24) and 35-45 (vs. 50-55).Among U.S. young and middle adults, deviations from expected historical trends in population alcohol use that occurred during the pandemic included decreases in alcohol use prevalence, increases in alcohol use frequency, and increases in the use of alcohol to relax/relieve tension and because of boredom. These shifts were likely due, in part, to drinking while alone and at home-which increased during the pandemic.

This cohort study examines changes in the rates of solitary alcohol and marijuana use among 12th grade students between 1976 and 2019.

OBJECTIVE: This study estimated the percentage of age 35 and 55 adults reporting using medical marijuana intended for someone else (diverted use) and compared demographics and health status of such users with respondents reporting recommended use (i.e., individuals with a medical marijuana recommendation for their own health conditions) and to respondents using marijuana not intended for medical use (nonmedical marijuana [NMM] use). METHOD: Cross-sectional analyses were conducted using complex sample survey data collected from 2013 to 2018 from 12,138 adults (6,998 women) at modal ages 35 or 55 participating in the U.S. national Monitoring the Future study. RESULTS: Diverted use was reported by 72.9% [95% CI, 66.4, 79.4] and 64.3% [56.0, 72.7] of age 35 and 55 past-12-month medical marijuana users, respectively. Age 35 diverted users were more likely than recommended users to not work full time and have no postsecondary education. Age 55 recommended users were more likely than NMM users to be retired. Age 35 diverted users were less likely than recommended users to report poor physical health (odds ratio [OR] = 0.40 [0.17, 0.94]). Age 55 diverted users were less likely than recommended users to report three or more poor health conditions (OR = 0.22 [0.09, 0.55]) and any qualifying conditions (OR = 0.21 [0.08, 0.58]). Prevalence of these conditions was similar between diverted and NMM users. CONCLUSIONS: Results indicated a substantial degree of nonmedical (i.e., recreational) marijuana use. Diverted and NMM users reported generally similar levels of health conditions, whereas diverted users had fewer indicators of poor health than recommended users.

Background More United States adolescents now report high-frequency marijuana use than similar use levels of alcohol or tobacco. Increased high-frequency use raises questions such as (a) is frequent use likelihood growing among adolescents who experiment with use? (b) Is such change observed equally across sex and racial/ethnic subgroups? (c) Have sociodemographic and other covariate associations with frequent use changed over time? Methods Data were obtained from 649,505 12th grade students participating in the cross-sectional, nationally-representative Monitoring the Future study from 1976 to 2019. Historical trends were modeled for any and frequent (20+ occasions) past 30-day marijuana use among all students and lifetime users, and lifetime user sex and racial/ethnic subgroups. Multivariable logistic regression estimates from 1989 to 1993 (lowest prevalence years) versus 2015−2019 (most recent years) were compared to examine covariate association changes with frequent use. Results Among all students, recent linear trends in any and frequent marijuana use were not significantly different from zero (0.023 [SE 0.156] and 0.036 [0.073], respectively); frequent use among lifetime users increased (0.233 [0.107], p = 0.048). Among lifetime users, the increase was stronger for male than female students, and for minority versus White students. Significant association changes with race/ethnicity, parental education, and perceived risk were observed. Conclusions The proportion of adolescent lifetime marijuana users reporting current frequent marijuana use increased, and is now at near-record levels. Increases were particularly strong among males and minority students. There appears to be an increasing likelihood that adolescents who experiment with marijuana use may progress to frequent use.

Purpose This study estimated self-reported perceived negative marijuana use consequences among a national sample of U.S. young adults, examining consequence prevalence differences by use frequency, college attendance, living situation, employment, sex, and race/ethnicity; and use frequency/sociodemographic characteristic interactions. Methods A subsample of 1,212 respondents from the 2004–2018 class cohorts of 12th grade students participating in the nationally-representative Monitoring the Future study was surveyed up to two times from modal ages 19 through 22 (in 2008–2019). Respondents self-reported negative consequences related to their own past 12-month marijuana use. Bivariate and multivariable models examined subgroup differences in consequence prevalence. Results Approximately 60% of those using frequently (20+ use occasions in the past 30 days) and 35% of those using non-frequently reported negative consequences. Among all young adult marijuana users, 31.1% reported emotional/physical consequences, 12.9% performance/financial consequences, and 12.3% relational consequences. Use frequency was positively associated with consequence likelihood, excluding regret and unsafe driving. Among college students, frequent use was more strongly associated with any and performance/financial consequences. Controlling for use frequency, men reported more performance/financial consequences; relational consequences were higher among Hispanic (vs. White) respondents, and those living with parents, employed full-time, and not attending 4-year colleges. Conclusion Young adults using marijuana reported a wide range of negative use consequences; likelihood of most consequences increased with higher use frequency. Perceived consequences varied by college attendance, living situation, employment, sex, and race/ethnicity. Efforts to reduce negative marijuana consequences may be strengthened by recognizing and addressing the different types of negative consequences users perceive.

Background This study examines the extent to which the developmental pattern of frequent marijuana use prevalence from ages 18 to 30 (overall and by gender) has varied across historical time (cohort groups) using data from a national sample of US young adults. Methods Self-reported data on frequent marijuana use (use on 20+ occasions in the past 30 days) from modal ages 18 to 30 were obtained from 58,059 individuals from 29 sequential cohorts (graduating high school classes of 1976–2004) participating in the Monitoring the Future study. Time-varying effect modeling was used to model cohort group differences in developmental patterns of frequent use overall and by gender. Results Developmental patterns of frequent marijuana use prevalence varied meaningfully across cohort groups. Frequent use at age 18 differed significantly across cohort groups as expected based on national data. Among earlier cohort groups (reaching age 30 during 1987–2008), developmental patterns converged by age 30 to relatively low frequent marijuana use prevalence. In contrast, among cohort groups reaching age 30 during 2008–2016, frequent marijuana use at age 30 was significantly higher than all previous cohort groups. Observed cohort differences did not vary significantly by gender. Conclusions Cross-cohort convergence in developmental patterns of frequent marijuana use prevalence by age 30 was not observed among recent cohort groups, among whom age 30 frequent marijuana use prevalence was at the highest levels observed since the study began. Higher frequent marijuana use prevalence in late young adulthood has meaningful health risk and service provision implications.

BACKGROUND: The overall prevalence of United States young adult alcohol use has decreased, but less is known about historical change in related behaviors such as simultaneous alcohol and marijuana (SAM) use that may increase alcohol-related risks and societal costs. The purpose of this paper is to examine historical change in SAM use prevalence among U.S. young adult alcohol users from 1977–2016, and consider the extent to which observed historical change in SAM use among alcohol users reflects co-occurring change in marijuana use during these years. METHODS: Data on past 12-month alcohol, marijuana, and SAM use at up to six modal ages (19/20, 21/22, 23/24, 25/26, 27/28, 29/30) were collected from 11,789 individuals (45.0% men) participating in the Monitoring the Future panel study. Annual prevalence estimates within modal age group were obtained; historical SAM use trends among alcohol and marijuana users were estimated. RESULTS: From 2014 to 2016, SAM use was reported by approximately 30% of alcohol users aged 19/20 and 21/22, and 20% to 25% of alcohol users aged 23/24 through 29/30. Since the mid-1990s, age-specific historical trends in SAM use prevalence among alcohol users followed one of four patterns: significant increase followed by oscillating increases/decreases (at modal age 19/20); consistent and significant increases (at modal ages 21/22, 23/24, and 25/26); stability followed by increase (at modal ages 27/28); or stability (at modal ages 29/30). In contrast, SAM use trends among marijuana users primarily reflected stability, with some evidence of a decrease across time at modal ages 19/20 and 23/24. Historical change in SAM prevalence among alcohol users was strongly and positively correlated with changes in overall marijuana use prevalence. CONCLUSIONS: A growing proportion of early- and mid-young adult alcohol users reported SAM use, with the highest risk among those in the early years of young adulthood. Young adult SAM use may continue to increase in proportion to the degree that young adult marijuana use continues to increase.

Aims Alcohol mixed with energy drink (AmED) use is associated with negative consequences including hazardous alcohol use and driving under the influence. While many studies have focused on correlates of AmED use among college samples, very few have examined patterns of AmED use during adolescence and young adulthood within the general population. Accordingly, the purpose of this study is to assess age differences in AmED use among a national sample of respondents aged 18 to 30. Methods The data for this study come from the Monitoring the Future panel study from 2012 to 2015. The sample consists of 2222 respondents between the ages of 18 and 30. Multiple logistic regression using generalized estimating equations (GEE) was used to model past-year AmED prevalence across age and other covariates. Results Nearly half (45.0%) of respondents indicated past-year AmED use at some point during the study period. The lowest prevalence rates were found at age 18 (25.9%) and the highest prevalence rates at age 21/22 (43.5%). GEE analyses indicated a statistically significant positive linear and negative quadratic trend with respect to the association between age of respondent and past-year AmED use. Namely, peak use occurred in early young adulthood (age 21/22 and 23/24) and then declined, reaching 32.0% by age 29/30. College attendance and several substance use behaviors at age 18 moderated these linear and quadratic age trends. Conclusions AmED use peaked rapidly in early young adulthood and declined into later young adulthood. Substance use during adolescence was associated with a higher incidence of AmED use across all young adult ages and a slower decline of AmED use after age 21/22. Several sociodemographic factors were associated with AmED use, particularly college attendance at the age of 21/22.

Background Perceived risk of harm has long been a key preventive factor for adolescent marijuana use. However, in recent years, perceived risk has decreased markedly and marijuana use has increased only slightly, leading to new questions about their association. This study investigates the magnitude and stability of the US adolescent marijuana risk/use association from 1991 to 2016, overall and by gender and race/ethnicity. Methods Self-reported data on past 12-month marijuana use, perceived risk of regular marijuana use, gender, and race/ethnicity were obtained from 275,768 US 12th grade students participating in the nationally representative Monitoring the Future study. Time-varying effect modeling (TVEM) was used to examine the marijuana risk/use association over time. Results Both before and after controlling for gender and race/ethnicity, perceived risk was a strong protective factor against adolescent marijuana use. The magnitude of the great risk/use association strengthened for Hispanic students; remained generally stable over time for 12th graders overall, males, females, and White students; and weakened for Black students. The magnitude of the moderate risk/use association strengthened for 12th graders overall, males, females, White and Hispanic students, but did not continue to strengthen for Black students from 2005 onwards. In general, marijuana use prevalence decreased over time within all levels of perceived risk. Conclusions Perceived risk remains a strong protective factor for adolescent marijuana use, and the protective association for moderate risk (vs. no/slight risk) is actually increasing over time. Results suggest that accurate and credible information on the risks associated with marijuana use should remain a key component of prevention efforts.

The purpose of this study was to examine associations between (a) self-reported reasons for and contexts of alcohol use and (b) high-intensity drinking (i.e., having 10+ drinks in a row in the past 2 weeks) among national samples of U.S. 12th grade students. Data were obtained from 16,902 students who reported any past 12-month alcohol use from nationally representative annual 12th grade student samples from 2005-2016. When asked about drinking behavior during the past 2 weeks, 72% reported consuming less than 5 drinks at most during 1 drinking occasion; 14% reported 5-9 drinks, 7% reported 10-14 drinks, and 7% reported 15+ drinks. Adolescent drinkers in all categories (

Background This study examined changes during the past decade, from 2005 to 2015, in binge and high-intensity drinking in 7 separate age groups of U.S. 12th graders and young adults. Methods National longitudinal data (N = 6,711) from Monitoring the Future were used to examine trends in consuming 5+, 10+, and 15+ drinks on the same occasion in the past 2 weeks from ages 18 to 29/30 overall and by gender. Results were compared with trends in past 12-month and 30-day alcohol use for the same age groups. Results Between 2005 and 2015, binge (5+) and high-intensity drinking (10+, 15+) generally decreased for individuals in their early 20s, remained somewhat stable for individuals in their mid-20s, and increased for individuals at the end of young adulthood (age 29/30). The observed historical trends in binge and high-intensity drinking were similar to those for past 12-month and past 30-day alcohol use for those aged 18 to 20, but diverged for most other age groups in young adulthood. Trends were generally similar for men and women, except that the increase in prevalence began earlier in young adulthood for women than for men. Conclusions Binge and high-intensity drinking among U.S. 12th graders and young adults are dynamic phenomena. Prevention and intervention efforts aimed at reducing the harms resulting from 5+, 10+, and 15+ drinking should acknowledge and focus on differences in trends in these behaviors by age and gender.

Young adult binge drinking prevalence has been widely researched. However, beverage-specific binge drinking rates for beer, liquor, wine, and wine coolers have not yet been documented for this age group. This study examines consumption of specific beverages (i.e., 5+ drinks in a row in the past two weeks) by young adults aged 19/20. Data from the national Monitoring the Future study were collected one or two years after high school from 2004 to 2014 ( n = 2004). Logistic regression was used to examine associations between beverage-specific 5+ drinking and gender, race/ethnicity, parent education, college status, and cohort year. Overall 5+ drinking in the past two weeks was reported by 31.4% of young adults. Beverage-specific 5+ drinking was most common with liquor (22.6%) and beer (22.4%), followed by wine (4.5%) and wine coolers (3.0%). Men were more likely than women to engage in 5+ drinking with beer and liquor; women were more likely than men to do so with wine and wine coolers. Beverage-specific patterns differed by college attendance. Compared to four-year college students, two-year college/votech students were less likely to have 5+ drinks of liquor or wine, and more likely to have 5+ wine coolers; those not in college were less likely to have 5+ drinks of liquor and more likely to have 5+ wine coolers. Differences in beverage-specific 5+ drinking by gender and college enrollment suggest that intervention efforts should focus on the beverages that are most commonly consumed at high levels within specific early young adult populations.

High-intensity drinking (HID; ie, having 10+ drinks in a row) is a recognized public health concern due to the individual and public risks (eg, alcohol-related injuries, alcohol poisoning, memory loss, sexual risk) associated with consumption of a large quantity of alcohol over a relatively short time period. Using nationally representative samples of US 8th, 10th, and 12th grade students, and follow-up of subsamples of 12th graders, we present overall and sex-specific prevalence estimates of past 2-week HID from 29 966 individuals at the modal ages of 14 to 30 in 2016-2017. Similar data for the more commonly studied measure of binge drinking (having 5+ drinks in a row) is provided for comparison. HID prevalence ranged from 1% to 11.5% and was significantly higher for males than females at all ages other than modal age 14 (8th grade). Binge drinking prevalence ranged from 3.5% to 32.5%; males reported a higher prevalence than females at approximately half of the ages examined. Peak binge drinking and HID age for males was earlier (modal age 21/22) than that for females (modal age 21-24 for binge drinking and 25/26 for HID). The observed rapid increase in HID from adolescence through the early to mid-20s highlights the importance of prevention and intervention efforts targeted to these ages.

Introduction This study presents the first nationally-representative estimates of adolescent nicotine prevalence that take into account adolescent reports of substances vaped. These reports allow nicotine estimates that consider the impact of the newly-emerged group of adolescents who report vaping only non-nicotine substances such as flavoring and/or marijuana and do not use nicotine in any form – a group typically treated as nicotine users. Methods Data come from Monitoring the Future and are a randomly-selected subsample of 2231 U.S. 12th grade students who answered surveys with detailed questions on tobacco use and vaping in 2017. Results Among 12th grade students 24.7% used nicotine in the last 30 days. This estimate does not include the 3.8% of students who vaped only non-nicotine substances and did not use nicotine in any other form. These students more closely resemble their peers who do not use nicotine than those who do, in terms of perceived risk and disapproval of cigarettes, as well as percentage of friends who use cigarettes. Conclusions A decline in nicotine prevalence was statistically significant, but not strikingly large, after taking into account students who vape non-nicotine substances and do not use nicotine in any form. These students are largely similar to their peers who do not use nicotine, which underscores the importance of efforts to alert youth that they may be vaping nicotine unknowingly, and prevent them from doing so., Highlights • Some teens who vape report vaping non-nicotine substances and do not use nicotine in any other form; • National estimates of youth nicotine prevalence significantly decline when taking into account these teens; • While this decline is statistically significant it is not alarmingly large; • This group of teens warrants efforts to ensure that they do not end up using nicotine unknowingly

Background: Alcohol use is a key risk factor for young adult mortality and disease, but limited research has focused on high-risk alcohol use among individuals moving from early young adulthood into building and maintaining an initial structure of adult life. This study estimated the prevalence of a range of alcohol use behaviors among US young adults aged 25/26, examined evidence for historical change in prevalence rates, and estimated associations between alcohol use and key demographic, substance use, and adult social role characteristics. Methods: Data were obtained from 3542 individuals selected for follow-up from the nationally representative 12th-grade student Monitoring the Future study. Respondents self-reported alcohol use behaviors at age 25/26 during calendar years 2005–2014. Results: Two fifths (39.9%) of young adults aged 25/26 reported being intoxicated at least once in the past 30 days; 25.6% reported usually experiencing a sustained high of 3 or more hours when drinking alcohol. Past-2-week binge drinking (5+ drinks in a row) was reported by 36.3% of respondents. Past-2-week high-intensity drinking (10+ drinks in a row) was reported by 12.4%. These age 25/26 alcohol use prevalence rates remained stable over the 10 years of data examined, in contrast to significant declines over historical time in alcohol prevalence rates among these same individuals at age 18. High-risk drinking was particularly associated with being male, white, unmarried, employed, a nonparent, and an alcohol user before finishing high school. Conclusions: Among US young adults in their mid-20s, alcohol use was highly normative and frequently included participation in high-risk drinking behaviors. High-risk alcohol use prevention approaches developed specifically to reach young adults in their mid-20s are needed, as well as efforts to increase proactive clinician screening to identify young adults participating in high-risk alcohol use.

AIMS: To estimate (1) the prevalence of underage binge drinking, high-intensity drinking, and intoxication among young adults aged 19/20; (2) change in these behaviors across the transition out of high school and across historical time; and (3) associations between these behaviors and key covariates, including college status. Design, Setting, & Participants Longitudinal data from the U.S. nationally representative Monitoring the Future study included 1,657 respondents first surveyed as 12th graders (modal age 18) in 2005-2013 and again at modal age 19/20 in 2006-2014. MEASUREMENTS: Self-reported measures of alcohol use, demographics, college attendance, and living situation. FINDINGS: Binge drinking (5+ drinks on one occasion) was reported by 24.2% (95% confidence interval (CI) = 22.0, 26.5) of young adults aged 19/20; 10.3% (CI = 8.7, 11.9) reported high-intensity drinking of 10+ drinks; 4.2% (CI = 3.1, 5.2) reported 15+ drinks. Usual moderate/high intoxication when drinking was reported by 33.1% (CI = 30.6, 35.6); 29.6% (CI = 27.2, 32.0) reported usual sustained intoxication of 3+ hours. Significant variability (p CONCLUSIONS: Young adult underage binge drinking (5+ drinks on one occasion), high-intensity drinking (10+ and 15+ drinks), and intoxication are relatively common in the USA, and show meaningful variability across the transition out of high school. Four-year college students and those who do not live with their parents are more likely to engage in high-intensity drinking than their peers. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved. Language: en

BACKGROUND: This study is the first to examine the developmental course of high-intensity drinking (i.e., consuming 10+ drinks in a row) across late adolescence and the transition to adulthood. METHODS: National longitudinal data (N = 3,718) from Monitoring the Future were used to examine trajectories of 10+ high-intensity drinking from age 18 through 25/26 overall and across sociodemographic subgroups; results were compared with similar analysis of 5+ binge drinking trajectories. RESULTS: Results document that 10+ drinkers consume not just a greater quantity of alcohol on a given drinking occasion, but also engage in 5+ drinking more frequently than drinkers who do not report having 10 or more drinks. Developmental patterns for 10+ and 5+ drinking were similar, with peak frequencies reported at age 21/22. Greater peaks in both 10+ and 5+ drinking were documented among men and among college attenders, compared with women and nonattenders, respectively. However, there was a steeper decline in 10+ drinking after age 21/22, indicating that risk for consumption of 10 or more drinks in a row is more clearly focused on the early 20s. Patterns of developmental change in both behaviors were driven largely by college students: No significant age-related change in 10+ drinking was observed among men and women who did not go to college, and no significant age-related change in 5+ drinking was observed among female nonattenders. CONCLUSIONS: Findings underscore the importance of recognizing high-intensity drinkers as a unique high-risk group, and that college attendance is associated with particularly strong peaks in the developmental course of high-intensity drinking.Copyright © 2016 by the Research Society on Alcoholism. Language: en

Purpose This study estimated the prevalence of negative consequences associated with alcohol use in a national sample of young adults one or two years after graduating from high school, focusing on differences by college attendance, living situation, binge drinking, and sex. Methods A subsample (N = 1068) of U.S. nationally representative Monitoring the Future study 12th grade students from 2006 to 2016 cohorts was followed-up at modal age 19 or 20 (in 2008–2017) and asked about negative consequences related to their own alcohol use during the past 12 months. Differences in prevalence were estimated and multivariable models examined associations with college attendance, living situation, binge drinking, and sex. Results Half of surveyed U.S. 19/20 year-old alcohol users (a third of non-binge drinkers and almost three-quarters of binge drinkers) experienced negative consequences in the past year. The likelihood of experiencing several consequence types was significantly associated with college attendance prior to controlling for living situation. In multivariable models controlling for living situation, unsafe driving due to drinking remained more likely for students attending 2-year colleges or vocational/technical schools than for 4-year college students or non-attenders. In general, negative consequence risk was elevated among young adults not living with parents (vs. those living with parents) and women (vs. men). Conclusion Negative consequences from alcohol use are prevalent among young adults and differ by college attendance, living situation, binge drinking, and sex. Students at 2-year/vocational/technical schools are at particular risk for unsafe driving, warranting specific research attention and targeted intervention.

Aims In the last decade the relatively lower levels of marijuana use for black relative to non-black high school seniors has grown smaller and disappeared, drawing to a close a unique disparity that actually favored a disadvantaged group for at least thirty years. In this study we test trends in cigarette smoking and religiosity as possible explanations for this closing disparity. The study also examines whether increasing marijuana levels for black adolescents is better characterized as a cohort effect or an historical period effect. Design Analyses use relative risk regression and focus on data from yearly, cross-sectional surveys from the time period 2008–2017. Setting and participants Data comes from the nationally-representative Monitoring the Future survey, which conducts in-school surveys of secondary school students. The analysis uses data from 114,552 high school seniors (in 12th grade), 123,594 in 10th grade, and 136,741 in 8th grade. Findings Past 12-month marijuana prevalence significantly increased for black as compared to non-black adolescents from 2008 to 2017 in 12th grade, 10th grade, and 8th grade. The increase attenuated by more than half and was not statistically significant after adjusting for cigarette smoking. In contrast, the increase was little changed after adjusting adolescent levels of religiosity. The increase is better characterized as a cohort effect than a period effect. Conclusions These results support the increase in marijuana use for black relative to non-black adolescents as an unexpected consequence of the great decline in adolescent cigarette smoking, which has occurred slower for black adolescents.

Introduction Age of first drink is a key risk factor for adolescent high-risk alcohol use. The current study examined whether speed of escalation from first drink to first intoxication is an additional risk factor, and whether these two factors are associated with binge and high-intensity drinking among adolescents. Methods Data collected in 2005–2017 from a nationally-representative sample of 11,100 U.S. 12th grade students participating in the Monitoring the Future study were coded to indicate grade of first drink, grade of first intoxication, and speed of escalation from first drink to first intoxication. Logistic regression models estimated bivariate and multivariable odds of past 2-week binge (5+ drinks in a row) and high-intensity (10+ drinks in a row) drinking in 12th grade. Results Of those who reported intoxication by 12th grade, almost 60% reported first drunkenness in the same grade in which they first drank. The likelihoods of 12th grade binge and high-intensity drinking were significantly associated with both grade of first drink and speed of escalation to intoxication. Past two-week high-intensity drinking prevalence was 17.4% among those with immediate (same-grade) escalation from first drink to first intoxication; 15.8% among those with a 1-grade delay, and 12.6% among those with a 2+ grade delay to intoxication. Conclusions The majority of students escalate quickly from having their first drink to being intoxicated for the first time. Both earlier age of first drink and a faster escalation from first drink to first intoxication are important indicators of binge and high-intensity drinking risk among adolescents.

Background This study examined the extent to which the developmental pattern of prevalence of binge drinking in the past 2 weeks from ages 18 through 30 has changed across 29 cohorts of U.S. young adults, and whether the changes differed by gender. Methods Analyses used national longitudinal data from 58,019 12th-grade students (from graduating high school classes 1976 to 2004) participating in the Monitoring the Future study followed through modal age 30 (with age 29/30 data collected from 1987 to 2016). Weighted time-varying effect modeling was used to model cohort group differences in age-related patterns of binge drinking. Results The age of peak binge drinking prevalence increased across cohorts (from age 20 in 1976 to 1985 to 22 in 1996 to 2004 for women, and from 21 in 1976 to 1985 to 23 in 1996 to 2004 for men). Historical change in the developmental pattern of binge drinking across all ages of young adulthood differed for men and women. Even after controlling for key covariates, women in the more recent cohort group reported significantly higher binge drinking prevalence than women in earlier cohorts from ages 21 through 30. Men in the more recent cohort group reported higher binge drinking prevalence at ages 25 to 26, but prevalence levels then converged to those seen in earlier cohort groups by age 30. Conclusions An older age of peak binge drinking and a decreased rate of decline in the prevalence of binge drinking in later young adulthood among more recent cohorts have resulted in an extension of individual and societal risks associated with binge drinking, particularly for women, across young adulthood. High-risk alcohol use prevention efforts are needed throughout at least the third decade of life.

Understanding racial/ethnic drinking patterns and service provision preferences is critical for deciding how best to use limited alcohol prevention, intervention, and treatment resources. We used nationally representative data from 150,727 U.S. high school seniors from 2005 to 2016 to examine differences in a range of alcohol use behaviors and the felt need to reduce or stop alcohol use based on detailed racial/ethnic categories, both before and after controlling for key risk/protective factors. Native students reported particularly high use but corresponding high felt need to reduce/stop use. White and dual-endorsement students reported high use but low felt need to stop/reduce alcohol use.

Objective To present data on trends in foods and beverages offered through the National School Lunch Program (NSLP) in public middle and high schools in the years immediately preceding and following implementation of new NSLP standards. Method From 2011 to 2013, primary data collection through the annual Youth, Education, and Society study involved use of mailed questionnaires to obtain data on NSLP meals from schools attended by nationally representative samples of US 8 th , 10 th , and 12 th grade students (N = 792 middle schools and 751 high schools). Each school was weighted to represent the percentage of target grade students enrolled, thus allowing analyses examining changes over time in the percentage of students enrolled in (attending) schools with specified NSLP measure outcomes, as well as disparities in NSLP measures based on school characteristics. Results Significantly more US secondary students attended schools with specified NSLP measures in 2013 than in 2011; increases were observed at both middle and high school levels. Increase rates for some NSLP measures were moderated by school characteristics; where this was the case, moderating associations decreased prior NSLP nutrition environment disparities that were especially evident in smaller schools and schools with higher percentages of minority students. Conclusion Meaningful improvements have been made in the nutritional content of NSLP meals offered to US secondary students; these improvements have reduced prior NSLP meal disparities associated with school characteristics. Schools will need continued help with implementation and compliance monitoring in order to have the best opportunity to improve the nutrition environments for US students.

Aims To measure changes over time in cigarette smoking uptake prevalence and timing during young adulthood (ages 19-26), and associations between time-invariant/-varying characteristics and uptake prevalence/timing.

Alcohol and marijuana are the most commonly used substances among adolescents but little is known about patterns of co-use.This study examined patterns of concurrent (not overlapping) and simultaneous (overlapping) use of alcohol and marijuana among adolescents.Data from US-national samples of 12th graders (N = 84,805, 48.4% female) who participated in the Monitoring the Future study from 1976 to 2016 and who used alcohol and/or marijuana in the past 12 months were used to identify latent classes of alcohol use, marijuana use, and simultaneous alcohol and marijuana (SAM) use.A four-class solution indicated four patterns of use among adolescents: (1) Simultaneous alcohol and marijuana (SAM) use with binge drinking and recent marijuana use (SAM-Heavier Use; 11.2%); (2) SAM use without binge drinking and with recent marijuana use (SAM-Lighter Use; 21.6%); (3) Marijuana use and alcohol use but no SAM use (Concurrent Use; 10.7%); and (4) Alcohol use but no marijuana or SAM use (Alcohol-Only Use; 56.4%). Membership in either SAM use class was associated with a higher likelihood of truancy, evenings out, and use of illicit drugs other than marijuana. SAM-Heavier Use, compared to SAM-Lighter Use, class members were more likely to report these behaviors and be male, and less likely to have college plans.Among 12th graders who use both alcohol and marijuana, the majority use simultaneously, although not all use heavily. Given the recognized increased public health risks associated with simultaneous use, adolescent prevention programming should include focus on particular risks of simultaneous use.

Objective Using a national sample of young adults, this study identified latent classes of alcohol use including high-intensity drinking (10+ drinks) from ages 18 to 25/26, and explored associations between time-invariant covariates measured at age 18 and class membership. Method Longitudinal data from the national Monitoring the Future study were available for 1078 individuals (51% female) first surveyed as 12th grade students in 2005–2008, and followed through modal age 25/26. Repeated measures latent class analysis was used to identify latent classes based on self-reported alcohol use: no past 30-day drinking, 1–9 drinks per occasion in the past 2 weeks, and 10+ drinks per occasion. Results Four latent classes of alcohol use from ages 18 to 25/26 were identified: (1) Non-Drinkers (21%); (2) Legal Non-High-Intensity Drinkers (23%); (3) Persistent Non-High-Intensity Drinkers (40%); and (4) High-Intensity Drinkers (16%). Membership in the High-Intensity Drinkers class was characterized by higher than average probabilities of high-intensity drinking at all ages, with the probability of high-intensity drinking increasing between ages 18 and 21/22. Both gender and race/ethnicity significantly differentiated class membership, whereas neither parental education (a proxy for socioeconomic status) nor college plans at 12th grade showed significant associations. Conclusions More than one in seven individuals who were seniors in high school experienced a long-term pattern of high-intensity drinking lasting into middle young adulthood. Young adult high-intensity drinking is often preceded by high-intensity drinking in high school, suggesting the importance of screening and prevention for high-intensity drinking during adolescence.

Introduction This study assessed the prevalence of current high-intensity drinking (i.e., having ten or more drinks in a row in the past 2 weeks) among national samples of U.S. eighth and tenth grade students (at modal ages 14 and 16 years, respectively). Methods Data on high-intensity drinking were provided by 10,210 students participating in the nationally representative Monitoring the Future study in 2016, and analyzed in 2016–2017. Prevalence levels and interactions between grade and key covariates were estimated using procedures that adjusted for the Monitoring the Future study’s complex sampling design. Results Approximately 2% of adolescents reported current high-intensity drinking, with significant differences by grade (1.2% of eighth graders; 3.1% of tenth graders) and gender (1.7% female; 2.3% male). High-intensity drinking was significantly higher among eighth and tenth grade students who reported any cigarette or marijuana use than among students who reported never using either substance. Conclusions A meaningful percentage of young adolescents in the U.S. engage in high-intensity drinking.

Background Simultaneous alcohol and marijuana (SAM) use poses threats to health, particularly among adolescents. These risks would be exacerbated to the extent that high-intensity drinking (e.g., 10+ drinks in a row) and marijuana use (e.g., 1+ joints per day) are associated with a higher likelihood of SAM use. The current study examines the extent to which the intensity of alcohol use and of marijuana use are associated with adolescent SAM use prevalence, and whether associations remain after controlling for key covariates known to associate with both alcohol and marijuana use; it identifies alcohol and marijuana use intensity levels associated with the highest risk of adolescent SAM use. Methods Data come from nationally representative samples of US 12th graders who participated in the Monitoring the Future study from 2005 to 2014 ( N = 24,203 respondents; 48.4% boys, 51.6% girls). Results SAM use during the past year was reported by 20% of 12th graders overall. SAM use prevalence was strongly and positively associated with alcohol and marijuana use intensity even after controlling for covariates. High school seniors at highest risk for engaging in SAM use were those who reported 10+ drinks and those smoking at least 1 joint/day. Approximately 60% of those who had 10–14 or 15+ drinks in a row during the past 2 weeks and 76%–80% of those who had 1 or 2+ joints per day on average during the past 30 days reported SAM use. Conclusions Results suggest that high school seniors who consume high quantities of alcohol and marijuana are very likely to consume these substances so that their effects overlap.

BACKGROUND The 2013-2014 school year involved preparation for implementing the new US Department of Agriculture (USDA) competitive foods nutrition standards. An awareness of associations between commercial supplier involvement, food vending practices, and food vending item availability may assist schools in preparing for the new standards. METHODS Analyses used 2007-2012 questionnaire data from administrators of 814 middle and 801 high schools in the nationally representative Youth, Education, and Society study to examine prevalence of profit from and commercial involvement with vending machine food sales, and associations between such measures and food availability. RESULTS Profits for the school district were associated with decreased low-nutrient, energy-dense (LNED) food availability and increased fruit/vegetable availability. Profits for the school and use of company suppliers were associated with increased LNED availability; company suppliers also were associated with decreased fruit/vegetable availability. Supplier “say” in vending food selection was associated with increased LNED availability and decreased fruit/vegetable availability. CONCLUSIONS Results support (1) increased district involvement with school vending policies and practices, and (2) limited supplier “say” as to what items are made available in student-accessed vending machines. Schools and districts should pay close attention to which food items replace vending machine LNED foods following implementation of the new nutrition standards.

Background: No national studies have examined associations between (1) school food availability and accessibility and (2) secondary student fruit and vegetable (FV) consumption. This article uses 5 years of nationally representative data from secondary school students to examine associations between the school food environment and student fruit and green vegetable consumption. Methods: From 2008 to 2012, cross-sectional, nationally representative data from US middle and high school students were collected annually on self-reported fruit and green vegetable consumption. Each year, data from administrators at each relevant school were collected on food item availability (any venue) and accessibility (total number of school sources). Data were obtained from 10,254 eighth-grade students in 317 schools and 18,898 tenth- and 12th-grade students in 518 schools. Associations were estimated by multi-level models controlling for student- and school-level characteristics. Results: Availability showed minimal association with student consumption. Candy/regular-fat snack accessibility was associated negatively with middle school fruit consumption. Salad bar availability and accessibility were positively associated with middle school green vegetable consumption; FV accessibility was associated positively with high school fruit and green vegetable consumption. Significant associations were consistent across student racial/ethnic and socioeconomic groups. Conclusions: Forthcoming USDA nutrition standards for school foods and beverages sold outside of reimbursable meal programs should result in the removal of school candy/regular-fat snacks. In deciding which items to make available under the new standards, schools should consider increasing the number of FV sources—including salad bars—thereby potentially increasing student FV consumption.

This article examines noncausal associations between high school seniors' alcohol and marijuana use status and rates of self-reported unsafe driving in the past 12 months.Analyses used data from 72,053 students collected through annual surveys of nationally representative cross-sectional samples of U.S. 12th-grade students from 1976 to 2011. Two aspects of past-12-month alcohol and marijuana use were examined: (a) use frequency and (b) status as a nonuser, single substance user, concurrent user, or simultaneous user. Measures of past-12-month unsafe driving included any tickets/warnings or accidents, as well as tickets/warnings or accidents following alcohol or marijuana use. Analyses explored whether an individual's substance use frequency and simultaneous use status had differential associations with their rate of unsafe driving.Higher substance use frequency (primarily alcohol use frequency) was significantly and positively associated with unsafe driving. The rate of engaging in any unsafe driving was also significantly and positively associated with simultaneous use status, with the highest rate associated with simultaneous use, followed by concurrent use, followed by use of alcohol alone. Individuals who reported simultaneous use most or every time they used marijuana had the highest likelihood of reporting unsafe driving following either alcohol or marijuana use.This article expands the knowledge on individual risk factors associated with unsafe driving among teens. Efforts to educate U.S. high school students (especially substance users), parents, and individuals involved in prevention programming and driver's education about the increased risks associated with various forms of drug use status may be useful.

OBJECTIVES: Examine energy drink/shot and regular and diet soft drink use among United States secondary school students in 2010-2011, and associations between such use and substance use. METHODS: We used self-reported data from cross-sectional surveys of nationally representative samples of 8th-, 10th-, and 12th-grade students and conducted multivariate analyses examining associations between beverage and substance use, controlling for individual and school characteristics. RESULTS: Approximately 30% of students reported consuming energy drinks or shots; more than 40% reported daily regular soft drink use, and about 20% reported daily diet soft drink use. Beverage consumption was strongly and positively associated with past 30-day alcohol, cigarette, and illicit drug use. The observed associations between energy drinks and substance use were significantly stronger than those between regular or diet soft drinks and substance use. CONCLUSIONS: This correlational study indicates that adolescent consumption of energy drinks/shots is widespread and that energy drink users report heightened risk for substance use. This study does not establish causation between the behaviors. Education for parents and prevention efforts among adolescents should include education on the masking effects of caffeine in energy drinks on alcohol- and other substance-related impairments, and recognition that some groups (such as high sensation-seeking youth) may be particularly likely to consume energy drinks and to be substance users. Language: en

Background Simultaneous alcohol and marijuana (SAM) use raises significant concern due to the potential for additive or interactive psychopharmacological effects. However, no nationally representative studies are available that document prevalence, trends, or related factors in US youth SAM use. Methods Nationally representative cross-sectional samples of 12th grade students surveyed in the Monitoring the Future project from 1976 to 2011 provided data on SAM use. Analyses were conducted in 2012. Results In 2011, 23% of all US high school seniors reported any SAM use. Among seniors reporting any past 12-month marijuana use, 62% reported any SAM use and 13% reported SAM use most or every time they used marijuana. SAM use consistently followed trends for past 30-day alcohol use over time. SAM use showed significant variation by psychosocial and demographic characteristics and was strongly associated with higher substance use levels, but occurred across the substance use spectrum. Certain reasons for alcohol or marijuana use (to increase effects of another drug; I’m hooked) and situations of alcohol or marijuana use (park/beach, car, party) were strongly associated with SAM use. Conclusions A sizable proportion of US high school seniors reported SAM use, and it appeared to occur frequently in social use situations that could impact both the public as well as youth drug users. SAM use appears to be a complex behavior that is incidental to general substance use patterns as well as associated with (a) specific simultaneous reasons (or expectancies), and (b) heavy substance use and perceived dependence, especially on alcohol.

Over the past 12 years, 31 states have implemented a wide variety of policies to curb methamphetamine production in small toxic labs. This qualitative study explores the perceived impact of methamphetamine precursor laws in five states. Researchers conducted individual and focus group interviews with 77 key state policy makers and law enforcement personnel. Themes included barriers to development, perceived effectiveness and impact, effective provisions, and unintended consequences. Researchers suggest policy recommendations in light of renewed calls by policy makers and law enforcement personnel to address the recent rapid rise in small toxic lab seizures.