1. In a nationally representative survey of American adolescents, there was a fivefold increase in prevalence of lifetime abstinence from substance use among high school seniors.
2. Prevalence of lifetime abstinence from cigarettes and alcohol increased most drastically, whereas rates of marijuana and other substance use have remained more steady.
Substance use is an important modifiable health behavior, and previous studies have focused on use of individual substances. In this cross-sectional study, researchers sought to characterize trends in substance nonuse among adolescents by analyzing responses to the Monitoring the Future Project (MTF), a survey of nationally representative samples of 8th-, 10th-, and 12th-grade students between 1976 and 2014. Prevalence of lifetime abstinence from substance use among high school seniors has risen from 5% in 1976 to 26% in 2014, with similar trends among 8th- and 10th-grade students. Abstinence from cigarettes and alcohol increased dramatically during the study period, while abstinence of marijuana and other illicit substances increased only slightly and, in the case of marijuana, have fallen from peak levels in the 1990s. Students who were male, African American, or reported higher levels of religious involvement were significantly more likely to report lifetime abstinence. Lower odds of reporting lifetime abstinence were noted among students with low grade point average, past-month truancy, employment during the school year, and living in a single-parent household.
These findings are limited by self report bias. True prevalence may be underestimated because adolescents who were not in school to take the survey and those who were missing data for any substance were excluded from analysis. Nonetheless, the study is strengthened by its large, nationally representative sample of high school students. For physicians, these results highlight the importance of identifying and discussing the use of marijuana and other substances with adolescents and parents.