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

Authors

SAMHSA: Rachel N. Lipari and Matthew R. Williams; RTI International: Elizabeth A. P. Copello and Michael R. Pemberton

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 2015 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 and 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 these various estimates. Results. Although more than 3 out of 4 people aged 12 or older in 2015 perceived great risk of harm from weekly use of cocaine, heroin, or lysergic acid diethylamide (LSD), only about one third perceived great risk from weekly marijuana use. An estimated 68.7 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 a 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 5 young adults aged 18 to 25. For marijuana, cocaine, cigarettes, and alcohol, people who had never initiated use of the substance were most likely to perceive great risk from using the substance. For marijuana and cocaine, people who had initiated use over a year ago were also more likely than past year initiates to perceive great risk from using those substances. The illicit drugs with the largest number of recent initiates aged 12 or older in 2015 were marijuana (2.6 million new users), prescription pain relievers (2.1 million new misusers), prescription tranquilizers (1.4 million new misusers), prescription stimulants (1.3 million new misusers), and hallucinogens (1.2 million new users). The number of people in 2015 who initiated marijuana use in the past year was higher than the numbers in 2002 through 2008, but the numbers of recent marijuana initiates were stable from 2009 to 2015. For cocaine, the number of recent initiates in 2015 was higher than the numbers in 2008 to 2014 and had risen to levels that were comparable with the numbers in the early 2000s. For heroin, the number of past year initiates in 2015 was similar to the numbers of recent initiates in 2002 to 2014. There were 4.8 million new users of alcohol, 2.0 million people who tried a cigarette for the first time in the past year, and 1.3 million people who first used smokeless tobacco in the past year. The number of people in 2015 who smoked part or all of a cigarette for the first time in the past year was lower than the numbers in 2005 to 2012, but it was similar to the numbers in 2002 to 2004 and in 2013 and 2014. 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 on a broad national level. However, these NSDUH data are not intended to be used to evaluate the effectiveness of individual prevention programs. Because NSDUH is a cross-sectional study, its data 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.