Risk and Protective Factors and Estimates of Substance Use Initiation: Results from the 2015 National Survey on Drug Use and Health

Abstract

Background Risk factors are typically associated with an increased likelihood of substance use, and protective factors are typically associated with a decreased likelihood of substance use. Efforts to prevent substance use generally aim to reduce the influence of risk factors and to enhance the effectiveness of protective factors. One major goal of substance use prevention programs is to prevent or delay the initiation of substance use (i.e., first use). Methods This report presents results from the 2016 National Survey on Drug Use and Health (NSDUH) for people aged 12 or older regarding the perceived harmfulness of using cigarettes, alcohol, and specific illicit drugs as well as the perceived availability of substances. Estimates are presented for specific age groups. Estimates of the perceived great risk of harm associated with the use of marijuana, cocaine, alcohol, and cigarettes also are presented according to whether people initiated use of these substances in the past year. In addition, the report presents estimates for youth-specific protective factors, such as perceptions about parents strongly disapproving of youth substance use. Finally, this report presents the estimated numbers of individuals who initiated substance use in the past year and the average age at first use among people who initiated use in the past year (i.e., past year initiates). Statistically significant differences are noted for estimates in the report. Results Although more than 4 out of 5 people aged 12 or older in 2016 perceived great risk of harm from weekly use of cocaine, heroin, or lysergic acid diethylamide (LSD), only about one third of people perceived great risk of harm from weekly marijuana use. An estimated 68.3 percent of people also perceived great risk from having four or five drinks of alcohol nearly every day, and 72.8 percent perceived great risk from smoking one or more packs of cigarettes per day. Perceptions of risk from substance use varied across age groups. For example, about 2 out of 5 youths aged 12 to 17 perceived great risk from weekly marijuana use compared with about 1 in 6 young adults aged 18 to 25. For marijuana and cocaine, people who had never used these substances were most likely to perceive great risk of harm from using the substance. For cigarettes and alcohol, people who used in the past year, including those who initiated use in the past year and those who initiated use more than a year ago and continued to use in the past year, were less likely than people who last used more than a year ago or who never used to perceive great risk from using those substances. The illicit drugs with the largest number of recent initiates aged 12 or older in 2016 were marijuana (2.6 million new users), prescription pain relievers (2.1 million new misusers), prescription tranquilizers (1.4 million new misusers), prescription stimulants (1.4 million new misusers), hallucinogens (1.2 million new users), and cocaine (1.1 million new users). The number of people in 2016 who initiated marijuana use in the past year was higher than the numbers in 2002 through 2008, but the numbers of recent marijuana use initiates were similar in 2009 to 2016. For cocaine, the number of recent initiates in 2016 was higher than the numbers in 2008 to 2014 and had risen to levels that were comparable with the numbers in the early 2000s. Similar numbers of people in 2015 and 2016 also were recent initiates of cocaine use. For heroin, the number of past year initiates in 2016 was similar to the numbers of recent initiates in 2007 to 2015. Among people aged 12 or older in 2016, there were 4.6 million new users of alcohol, 1.8 million people who tried a cigarette for the first time in the past year, and 1.2 million people who first used smokeless tobacco in the past year. The number of people in 2016 who smoked part or all of a cigarette for the first time in the past year was lower than the numbers in 2004 to 2014, but it was similar to the number in 2015. Conclusions Findings from NSDUH on risk perceptions and initiation of substance use are useful to the Substance Abuse and Mental Health Services Administration for gauging the overall effectiveness of prevention efforts or policies on a broad national level. However, these NSDUH data are not intended to be used to evaluate the effectiveness of individual prevention programs or policies. Because NSDUH is a cross-sectional study, its data also cannot be used to track changes in respondents’ perceptions of risk of harm from substance use over their lifetime and directly relate these changes to specific chronological events, such as the initiation of substance use.