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Substance Abuse
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http://www.tandfonline.com/loi/wsub20

Drug Exposure Opportunities and Use Patterns


Among College Students: Results of a Longitudinal
Prospective Cohort Study
a a a b
Amelia M. Arria PhD , Kimberly M. Caldeira MS , Kevin E. OGrady PhD , Kathryn B.
a a c a a
Vincent MA , Dawn B. Fitzelle MSW , Erin P. Johnson BA & Eric D. Wish PhD
a
Center for Substance Abuse Research , University of Maryland , College Park, Maryland,
USA
b
Department of Psychology , University of Maryland , College Park, Maryland, USA
c
VCU School of Social Work , Virginia Commonwealth University , Richmond, Virginia,
USA
Published online: 12 Dec 2008.

To cite this article: Amelia M. Arria PhD , Kimberly M. Caldeira MS , Kevin E. OGrady PhD , Kathryn B. Vincent MA ,
Dawn B. Fitzelle MSW , Erin P. Johnson BA & Eric D. Wish PhD (2008) Drug Exposure Opportunities and Use Patterns
Among College Students: Results of a Longitudinal Prospective Cohort Study, Substance Abuse, 29:4, 19-38, DOI:
10.1080/08897070802418451

To link to this article: http://dx.doi.org/10.1080/08897070802418451

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Drug Exposure Opportunities and Use Patterns
Among College Students:
Results of a Longitudinal Prospective Cohort Study
Amelia M. Arria, PhD
Kimberly M. Caldeira, MS
Kevin E. OGrady, PhD
Kathryn B. Vincent, MA
Dawn B. Fitzelle, MSW
Erin P. Johnson, BA
Eric D. Wish, PhD
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ABSTRACT. Underage drinking and drug use among college students are major public health
concerns, yet few studies have examined these behaviors and their associated risk factors and
consequences prospectively. This paper describes the sampling and recruitment methods of a
longitudinal study of 1253 college students at a large, mid-Atlantic university. Incoming first-year
students were screened during the unique window between high school and college in order to
oversample drug users for longitudinal follow-up. Intensive recruitment strategies yielded a 95%
cumulative response rate in annual interviews and semiannual surveys. The authors report preliminary
results on exposure opportunity, lifetime prevalence, initiation, continuation, and cessation of substance
use for alcohol, tobacco, and 10 illicit and prescription drugs during the first 2 years of college. Findings
suggest that although some substance use represents a continuation of patterns initiated in high school,
exposure opportunity and initiation of substance use frequently occur in college. Implications for
prevention and early intervention are discussed.

KEYWORDS. College students, epidemiology, initiation, longitudinal studies, substance use

Amelia M. Arria is Associate Director, Kimberly M. Caldeira is Faculty Research Associate, Kathryn B.
Vincent is Faculty Research Associate, Erin P. Johnson is Graduate Assistant, and Eric D. Wish is Director, all
are affiliated with the Center for Substance Abuse Research, University of Maryland, College Park, Maryland,
USA.
Kevin E. OGrady is Associate Professor, Department of Psychology, University of Maryland, College
Park, Maryland, USA; and is affiliated with the Center for Substance Abuse Research, University of Maryland,
College Park, Maryland, USA.
Dawn B. Fitzelle is Faculty Research Associate, Center for Substance Abuse Research, University of
Maryland, College Park, Maryland, USA; and Graduate Assistant, VCU School of Social Work, Virginia
Commonwealth University, Richmond, Virginia, USA.
Address correspondence to: Amelia M. Arria, PhD, Associate Director, Center for Substance Abuse
Research (CESAR), University of Maryland College Park, 4321 Hartwick Road, Suite 501, College Park,
MD 20740 USA. (E-mail: aarria@cesar.umd.edu).
The investigators would like to acknowledge funding from the National Institute on Drug Abuse (R01
DA14845). Special thanks are given to Elizabeth Zarate, Laura Garnier, the interviewing team, and the
participants.
Substance Abuse, Vol. 29(4) 2008
Available online at http://www.haworthpress.com

C 2008 by The Haworth Press. All rights reserved.
doi: 10.1080/08897070802418451 19
20 SUBSTANCE ABUSE

INTRODUCTION number of investigators from a variety of dis-


ciplines as well as college health practitioners.
Underage drinking and illicit substance use Findings from the study have already provided
among college students are major public health a unique and comprehensive view of emerging
concerns. Annually, at least 1400 deaths are drug use problems, such as the nonmedical use
attributable to alcohol use on college campuses of prescription drugs (18). It is anticipated that
(1). High-risk drinking among young adults is the CLS will yield new knowledge that can be
associated with sexual assault, destruction of used as the basis for early interventions targeted
property, academic problems, accidental injury, toward college-bound adolescents and college
and several adverse health consequences (25). students who might be at risk for drug-related
Binge drinking and illicit drug use often co- problems.
occur (2,610), but in contrast to longitudinal
studies of alcohol consumption (11), surpris- Organization of this Paper
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ingly few longitudinal prospective studies have


This paper first describes in detail the methods
examined patterns, correlates, and consequences
that were used to sample, locate, and recruit
of illicit drug use among college students.
the CLS longitudinal cohort. Second, issues of
Little information is available on the patterns
sample representativeness and response bias are
of initiation and cessation during collegethat
addressed. This information provides the most
is, it is not known how often drug use is initiated
comprehensive description of this prospective
after coming to college versus continuing a
longitudinal sample. Third, we present weighted
pattern that began in high school, and how often
prevalence estimates for exposure opportunity to
a pattern of regular drug use resolves among
use tobacco, alcohol, and illicit drugs, including
college students. Moreover, a majority of the
nonmedical use of prescription drugs, using
conceptual models used to explain the onset
data collected in the first four waves of data
and course of early drug use were developed
collection. Fourth, we describe patterns of drug
from studying samples of adolescents, many of
use, including weighted prevalence estimates
whom were deviant and disadvantaged (1217).
of such use, as well as initiation, continuation,
Although the application of these models to
and cessation of use during the first 2 years of
samples of educated, academically achieving
college. Finally, we discuss the implications of
youths might be appropriate, other risk factors
the findings presented here, limitations of the
and consequences might be needed to fully
overall study, and some future directions of our
describe the natural history and course of drug
research with this cohort.
use and other health risk behaviors during this
unique developmental window. For example,
an important potential outcome of drug use
METHODS
among college students might be diminished
expectations regarding career goals or difficulty Overall Design of the College Life Study
establishing autonomy.
This paper describes results from the College Figure 1 displays the overall design of the
Life Study (CLS), funded by the National Insti- study. We selected one large, public, mid-
tute on Drug Abuse in October 2003 to address Atlantic university from which to recruit a sam-
critical gaps in our knowledge base concerning ple of first-time, first-year students. Sampling
the longitudinal patterns of illicit drug use occurred in two stages: first, we screened more
among college students. At the time of this writ- than 3400 incoming first-year college students
ing, the sixth wave of data collection is already during new-student orientation; and second,
underway with students in their junior year. we selected a stratified random sample of
Given the size of the sample (baseline n = 1253), screener participants for longitudinal follow-up.
excellent response rates thus far, and the breadth In the second stage of sampling, we purposively
of topics covered at multiple time points, it is oversampled drug users for the longitudinal
anticipated that the study will be of use to a cohort to ensure adequate statistical power
Arria et al. 21

FIGURE 1. Longitudinal design of the College Life Study.

currently
completed completed underway planned

6 Months:
Screening 18 Months: 30 Months:
Web-based
n=3,401)
((n=3,401) Web-based Web-based
(n=897)

Summer First Sophomore Junior Senior


Orientation Year Year Year Year
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Baseline 12 Months:
24 Months:
Interview Interview
Interview
(n=1,253) (n=1,142)
completed completed currently
underway

Note: Each wave of data collection spanned several months. The timeline depicts the approximate timing of the beginning and end of each
wave of data collection.

to investigate drug use patterns across time. Screening Survey Measures


Annual face-to-face interviews and semiannual
self-administered surveys were conducted on a The screening survey included questions on
variety of topics. The study was approved by demographic characteristics and age of onset
the University Institutional Review Board (IRB) of drug use in the format How old were
and a Federal Certificate of Confidentiality was you the first time you used. . .?. The series
obtained. The following sections describe sam- assessed use of six illicit substances (mari-
pling, measures, data collection procedures, and juana, cocaine, heroin, ecstasy, hallucinogens,
response rates for each wave of data collection. and amphetamines or methamphetamine) and
nonmedical use of three types of prescription
drugs (analgesics, stimulants, and tranquilizers).
Screening the Incoming First-Year Class Items pertaining to prescription drugs specifi-
cally asked about nonmedical use only (. . .were
The first step was to screen a large enough not prescribed for you or that you took only
group of first-year students from which a lon- for the experience or feeling they caused).1
gitudinal cohort sample could be systemati- The screening survey also assessed alcohol and
cally sampled. For this purpose, we sought to tobacco use, frequency and recency of drug
administer a screening survey at new-student use, parental monitoring, parents employment
orientation during the summer of 2004 to all status, religiosity, and planned course of study,
incoming first-time, first-year students ages 17 to but these items were not used in the second stage
19 years old. With few exceptions, orientation is to select our longitudinal cohort.
mandatory for all students attending this 4-year
university, and, in years prior to the start of Screening Survey Procedures
the study, orientation attendance had exceeded
90% of the incoming first-year class. Accessing As at most colleges, orientation sessions were
the orientation population reduced bias in our very tightly scheduled during 2-day periods
estimates of drug involvement by precluding throughout the summer. To avoid straining the
any exposure to the college environment. This orientation schedule, the university allowed us
method was critically important since transition to add our 10-minute screening survey onto
to drug use during college was of great interest. the universitys existing 30-minute survey of
22 SUBSTANCE ABUSE

student characteristics and attitudes, which had dentiality, different study identification numbers
been administered to incoming students for were assigned for the locator sheets and the
more than three decades. Students were escorted screening survey responses and linked through
into a computer lab, where a research assistant an encryption algorithm known only to the
explained both surveys, eligibility requirements, Principal Investigator and her designee. Partic-
and read informed-consent statements. Students ipant payment records were kept confidential
were instructed to view written instructions from university administrators by showing only
about the surveys on a private computer terminal identification numbers.
and enter their answers into the computer if
they were 17 to 19 years old and consented Screening Survey Response Rates
to participate. The schedule of cash incentive
payments was also explained: $5 for completion The target population of enrolled first-year
of the screening survey, and if they were selected students (ages 17 to 19), by definition, could
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for the longitudinal portion of the study, they not be identified conclusively until the end of
would receive $50 for each annual interview and the drop-add period in the fall semester of
$20 for each semiannual assessment. Informed 2004. The university provided us with two data
consent was obtained to contact students for setsone in the summer and one during the fall
longitudinal follow-up and to obtain data on semestercontaining demographic and contact
academic performance, demographics, and other information for the anticipated (n = 3802) and
domains from university administrative datasets. actual (n = 4160) class of eligible first-year
Paper versions of the screener were available students, respectively. Our recruitment efforts
in the case of computer failure, and were used were aimed at the anticipated first-year class,
for 17% of the surveys. Small but statistically but we reference the actual first-year class
significant mode effects were detected between when evaluating the representativeness of our
the paper and electronic versions with respect final sample.
to lifetime use of alcohol and marijuana, num- A total of 3347 students attended the com-
ber of illicit drugs used, religiosity, parents puter lab sessions during orientation, and 3300
employment status, and parental monitoring. of them participated in the screening survey
However, evaluation of the associated 2 and 2 (98.6%). The remainder of the anticipated
coefficients for these comparisons indicated that class did not attend orientation. To access
the amount of variance explained by the survey that population, we matched our records to
method was quite small (all 2 and 2 < .006). the university dataset, identified 502 incoming
students who had not submitted a screening
Methods to Protect Confidentiality survey response, and mailed letters to their
home addresses inviting them to complete the
Students who consented to be contacted for screening survey from home via a web link. We
follow-up in the longitudinal study provided received an additional 113 screening responses
their name and contact information on a pa- in response to this letter, bringing our total
per locator sheet. For students completing the screening sample size to 3413.
survey on paper, the locator sheet was torn Because of the discrepancy between the
off and separated from their survey responses. anticipated and actual first-year class, response
Students completing the computer-based survey rates for the screening survey are of limited
submitted their locator information on a separate value, and were further complicated by the few
sheet of paper. All students placed their locator participants who chose to remain anonymous.
sheets into the proctors box as she walked However, we estimate that, at most, a total of
through the aisles of the classroom, even if they 3849 (3347 at orientation plus 502 by letter)
chose to leave their locator form blank. In this students had the opportunity to participate in
way, the proctors had no way of tracing which the screening survey, representing 92.5% of
student placed which locator sheet in the box. the actual first-year class. Among students
Moreover, to further protect participants confi- who had the opportunity to participate, our
Arria et al. 23

response rate was at least 88.7% (3413 out 25.7% of the screened sample); and (3) low-risk
of a maximum of 3849 students), and it was cases defined as students who had used neither
considerably higher among orientation attendees marijuana nor any other illicit drug even once
(98.6%). in their life (n = 1975; 60.0% of the screened
To construct the sampling frame for the lon- sample). Prevalent cases and high-risk cases
gitudinal study, two stages of inclusion criteria were sampled with 100% probability; for low-
were applied, the first being more inclusive risk cases, we selected a 40% random sample
to maximize the sample size available for (n = 790) after stratifying by gender and race.
cross-sectional analyses. First, we excluded 12 Thus, our sample for longitudinal follow-up was
participants who were not enrolled, did not comprised of 2106 students.
meet the studys age requirements (17 to 19
years old), or reported using a fictitious drug Recruitment of the Longitudinal Cohort
included in the screening survey, resulting in a
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Recruitment for the longitudinal cohort


sample of n = 3401 screening participants for
(n = 2106) occurred on a rolling basis during
cross-sectional analyses, representing 81.8% of
the entire 20042005 academic year. Contact
the entire first-year class. Second, we excluded
information for these students was culled from
an additional 110 screening participants who
the locator sheets they submitted at the screening
did not consent to follow-up or whose drug
survey and administrative data obtained from
use responses were missing or inadequate for
the university. Students were first notified via
sampling group assignment (see below). Thus
a single e-mail message in September 2004 that
our final sampling frame consisted of 3291
they had been selected for the longitudinal study
students, or 79.1% of the first-year class.
and that they would receive $50 for participating
in a 2-hour baseline interview. Students were
Oversampling for Drug Users asked to reply with on-campus contact infor-
mation. All available contact information was
Our sampling design was stratified by sub-
entered into the studys recruitment database
stance use history, race, and gender. As men-
and printed on individual disposition sheets
tioned earlier, our goal for longitudinal follow-
for each sampled student. Follow-up contacts
up was to obtain a sample of students with
were attempted using a combination of email,
a greater risk of using drugs as compared
telephone, voicemail, and letters. Each attempt
to the general population of screened first-
to contact the student was documented on that
year college students. Even though the studys
students disposition sheet.
primary purpose was to examine the natural
history and consequences of drug use and not Response Rates for Baseline Interviews
to estimate prevalence of such use, knowing
the specific ways that our high-risk sample After the initial email was sent to all potential
differed from the first-year class with regard to participants (n = 2106), 1.9% scheduled their
their demographic characteristics enabled us to baseline interview. Gaining cooperation usually
weight back to represent the first-year class for required multiple contacts, including personal
prevalence estimation purposes when necessary. phone calls and several email messages. Staff
As shown in Figure 2, we stratified the were instructed to vary the days and times of
sampling frame into three groups based on their phone call attempts, and once phone contact
students lifetime illicit drug use as reported was made, the refusal rate was very low. In total,
in the screening survey: (1) prevalent cases we were able to intensively recruit 1449 students.
defined as students who had already used some Of these 1449 students, 1253 (86.4%) completed
illicit substance other than marijuana (n = 469; the baseline interview. For the remaining 656
14.3% of the screened sample); (2) high- students who were not intensively recruited,
risk cases defined as students who had used resources ran out before we were able to make
marijuana at least once in their lifetime but more than one email attempt. Of all students who
had not used any other illicit drugs (n = 847; completed their baseline interview, 29% of them
24 SUBSTANCE ABUSE

FIGURE 2. Sampling design for the College Life Study.

Screener Sampling
Screener SamplingFrame
Frame(n
(n==3,291)
3,291)
Sampling Group 1: Sampling Group 2: Sampling Group 3:
Prevalent Cases High-Risk Cases Low-Risk Cases
n = 469 (14%) n = 847 (26%) n = 1975 (60%)

Sampled Sampled Sampled


n = 469 n = 847 n = 790
(100%) (100%) (40%)

Recruitment for
Recruitment for Baseline
BaselineInterview
Interview(n(n==2,106)
2,106)
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Available Available Available


n = 333 (71.0%) n = 602 (71.1%) n = 515 (65.2%)

Refused Refused Refused


n = 36 n = 66 n = 95
Interviewed (10.8%) Interviewed (11.0%) Interviewed (18.4%)
n = 297 n = 536 n = 420
(89.2%) (89.0%) (81.6%)

n =1,253 Completed Interviews

required more than seven contact attempts to entire year, including the Principal Investigator
schedule and complete their baseline interview. and other full-time project staff.) The full-time
Eight percent required more than 10 attempts, recruiters role was to consolidate and centralize
and 1% required more than 20 attempts. some aspects of recruitment and scheduling, in
order to offer each participant maximum flexibil-
Interviewer Training ity and accessibility. Furthermore, the recruiter
oversaw all recruitment activities, which helped
Interviewers were graduate students, ad-
to ensure consistent adherence to recruitment
vanced undergraduates, or recent college grad-
protocols among all staff.
uates. A policy and procedures manual was
developed and used as the guide for two 4-
hour training sessions, which included stan-
Follow-Up Assessments
dard components on interviewing techniques, As shown in Figure 1, follow-up assessments
practice sessions, role playing, and detailed consisted of semiannual self-administered as-
instructions specific to our baseline interview. sessments and annual face-to-face interviews.
Before administering the interview on their own, Participation in the baseline interview consti-
interviewers completed five practice interviews tuted eligibility for longitudinal follow-up; these
with friends, reviewed those interviews with a 1253 participants comprised the study cohort
supervisor, and then administered two super- and were reapproached in each successive wave
vised interviews. Quality control and retraining of data collection.
occurred at regular intervals.
Recruitment and interview scheduling re- Recruitment Procedures for Follow-Up
sponsibilities were shared by a staff of one full- Assessments
time recruiter and up to 18 part-time interview-
ers. (A total of 30 different people were involved Each participants follow-up assessments
in recruiting and interviewing throughout the were completed on an individualized timeline
Arria et al. 25

of anniversaries and half-anniversaries projected format. Annual assessments provided repeated


forward from the date of their baseline interview. measures of substance use, abuse, dependence,
Participants were asked to update their con- social relationships, mental health, sexual ac-
tact information at every assessment, including tivity, and other measures, and introduced ad-
e-mail addresses and mobile phone numbers, ditional static domains such as parenting style
which tend to remain permanent and were there- and family history. Participants received $50
fore critically important to maintaining contact cash for participating in each annual assessment.
during periods of frequent relocating. Interview- Participants were also offered an additional $20
ers also employed novel technologies as needed, bonus payment if they completed the interview
such as contacting participants through social within 4 weeks of their anniversary date. This
networking Web sites and sending appointment strategy was adopted in the hope of increasing
reminders via text messaging, according to the our overall response rate and optimizing the
preferences of individual participants. For each timeliness of follow-ups by minimizing the
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follow-up assessment, the anniversary date was number of no-shows and schedule changes,
printed on a new disposition sheet, along with the which had been frequent problems during the
participants most recent contact information, baseline phase. Interviews were conducted by
and all recruitment attempts were recorded. Par- telephone, when necessary, to facilitate con-
ticipants who left the university were encouraged tinued participation among participants who
to continue participating in all phases of the had dropped out, transferred, or were studying
study. Every participant in the original baseline abroad.
sample (n = 1253) was eligible for each follow-
up waveregardless of their participation in Follow-Up Response Rates
prior wavesand was approached to participate
A total of 897 participants completed the
in every wave, unless they specifically requested
6-month assessment, for a response rate of 72%
to drop out of the study (18 individuals have
of the longitudinal cohort (n = 1253). The
dropped out as of this writing).
12-month interview was completed by 1142
Semiannual assessments were designed to
participants, or 91% of the cohort. Although
be completed in approximately 30 minutes and
these response rates were more than acceptable,
were conducted 6 and 18 months after the
we refined our procedures in subsequent waves
baseline interview. A selection of repeated mea-
to keep response rates high. For instance, an elec-
sures were obtained (e.g., general health, mental
tronic version of the timeline followback (TF)
health, and substance use), as were certain static
calendardescribed in Measures belowwas
measures such as social context of drinking and
administered as part of the 6-month assessment,
perceived risk. At the beginning of the month
but proved burdensome for many participants.
in which their semiannual assessments were
Therefore, to preserve participants enthusiasm
due, participants received an e-mail invitation
for the study and ensure high response rates,
from the College Life Study containing a link
we omitted the electronic TF from subsequent
to a Web-based survey form. The e-mail also
semiannual assessments, and adapted the an-
invited participants to contact research staff
nual interviews to capture a longer period of
to request a paper version of the survey if
time using the traditional TF. To date, more
they preferred. For participants who did not
than 95% of the original longitudinal cohort
respond to the email invitation, individualized
have participated in at least one follow-up
recruitment attempts were made via email,
assessment.
telephone, and conventional mail, and paper
copies of the survey were mailed to all avail- Measures
able addresses, along with postage-paid return
envelopes. Table 1 lists the major domains that have
Annual follow-up assessments conducted at been measured in the CLS. More detailed
12 and 24 months were face-to-face interviews discussions of each measure will be presented
similar to the baseline in terms of content and in forthcoming papers, as relevant. In this paper
26 SUBSTANCE ABUSE

TABLE 1. Domains Assessed in the College Life Study

Follow-Ups
Semiannual (6, Annual (12,
Precollege First Year 18, 30 Months) 24 Months)

Academic performance in college X X X


Behavioral dysregulation X
Conduct problems X X X
Demographics X X X X
Religiosity X X X
Drug use patterns and consequences X X X X
Tobacco dependence X X
Alcohol dependence X X
Marijuana dependence X X
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Ecstasy experiences X X
Drug knowledge X X
Family history of alcohol and drug use problems X
Health conditions and treatment utilization X X X
Academic performance in high school X X
Involvement in extracurricular activities X X X
Life event stress X X
Mental health
Anxiety X X X
Depression X X X
Social phobia X
Communication with parents X X
Parental monitoring and supervision during senior X
year in high school
Parenting style X
Perceptions of drug use
Perceived harmfulness X X
Perceived availability X X
Personality and temperament X
Quality of relationships with parents, friends, other X X
adults
Sexual activity X X X
Social relationships X X

we present results on drug exposure opportunity for the age at first opportunity (How old
and longitudinal patterns of substance use; we, were you the first time you were offered . . .)
therefore, describe these measures below. and the frequency of opportunity (How many
times in your life have you been offered . . .).
Measures of Drug Exposure Opportunity Subsequent exposure opportunities were cap-
and Use Patterns tured at each annual follow-up (How many
times in the past 12 months have you been
Participants were assessed annually for ex- offered . . .).
posure opportunity to use 12 categories of sub- Lifetime substance use was measured at the
stances: alcohol, tobacco, marijuana, inhalants, baseline assessment. Separate items captured
cocaine, hallucinogens, heroin, amphetamines lifetime use frequency (On how many days in
(including methamphetamine), ecstasy, pre- your life have you used . . .) and age of initiation
scription analgesics, prescription stimulants, and (How old were you the first time you used . . .).
prescription tranquilizers. Questions on pre- Subsequent annual interviews assessed past-year
scription drugs were restricted to nonmedical frequency of use (On how many days in the past
use. At baseline participants were assessed 12 months have you used . . .). Recency of use
Arria et al. 27

(When was the last time you used . . .) was TABLE 2. Demographic and Academic Char-
assessed annually for each substance. acteristics of First-Year Class and Screened
Frequency and patterns of substance use Sample
were assessed in even greater detail using the
timeline followback (TF) technique (19), in Freshman Screening
which participants were asked to indicate the Class Sample
quantity of each substance they consumed on (N = 4160) (N = 3401)

each calendar day. The TF has been used n % n %


extensively in the study of drinking patterns Gender
(2024) and has recently been used to study Female 2048 49.2% 1703 50.2%
patterns of other drug use, for which reliability Male 2112 50.8% 1692 49.8%
and validity has been examined and documented Race
White 2446 64.8% 2089 67.3%
(2527). However, to our knowledge, this is the 13.5%
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Black 510 366 11.8%


first time the TF has been used to study patterns Asian 582 15.4% 467 15.0%
of illicit drug use longitudinally in a sample Other 239 6.3% 184 5.9%
of college students. At baseline, participants Academic groups
Honors 1402 33.7% 1262 37.1%
completed the TF starting with college move- Athletes 177 4.3% 136 4.0%
in day, just prior to the beginning of the fall Service 86 2.1% 73 2.1%
semester of their first year, and continuing up Undecided majors 508 12.2% 428 12.6%
through the date of the interview. In order to No groups 2037 49.0% 1542 45.3%
capture each subsequent 6-month period at each
Statistically significant difference (P < .05) between screening
follow-up, we designed an electronic version of participants and freshman class.
the TF to be administered at each semiannual
assessment, as a complement to the traditional
paper-and-pencil version to be administered by The characteristics of the longitudinal cohort
interviewers at each annual assessment. After are less closely aligned with the first-year
the 6-month assessment, however, we suspended class because we deliberately oversampled ex-
future administration of the electronic version perienced substance users, who were more
for the reasons discussed above. Annual results likely to be white males. Table 3 presents
from the timeline followback will be presented the demographic and academic characteristics
in future papers. of the 2106 students selected for recruitment
into the longitudinal study, divided into three
Representativeness of the College Life groups: (1) participants in the longitudinal study
Study Sample (n = 1253); (2) unavailable students, those
for whom resources expired before we could
Table 2 presents the demographic and aca- make contact (n = 656); and (3) refusals,
demic characteristics of the entire first-year those whom we reached but who refused to
class and the screened population of first-year participate (n = 197). These three groups were
students. The characteristics of our screening essentially indistinguishable demographically;
sample were very similar to the first-year class, student athletes were the only group who were
despite some small yet statistically significant underrepresented at a statistically significant
differences. White students were slightly over- level, but the magnitude of the difference was
represented (67.3% versus 64.8%) in the study quite small ( 2 = .004, P < .01).
cohort, as were females (50.2% versus 49.2%)
and students affiliated with an honors group Differential Response Rates
(37.1% versus 33.7%). Students who identified by Demographic and Academic
as Black or African-American were slightly Characteristics
underrepresented (11.8% versus 13.5%) as were
students without an academic group affiliation Recruitment was more difficult among some
(45.3% versus 49.0%). groups of participants than others. The mean
28 SUBSTANCE ABUSE

TABLE 3. Demographic and Academic Characteristics of Students Who Participated, Were


Unavailable, or Refused to Participate in the College Life Study

Baseline Participants Unavailablea Refusalsb


n % n % n %

Gender
Female 644 51.4% 322 49.1% 95 48.2%
Male 609 48.6% 334 50.9% 102 51.8%
Race
White 885 70.8% 447 68.8% 142 72.4%
Black 121 9.7% 54 8.3% 18 9.2%
Asian 114 9.1% 72 11.1% 23 11.7%
Other 130 10.4% 77 11.8% 13 6.6%
Mothers education
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High school or less 191 16.5% 119 20.1% 36 20.3%


Some college or technical 116 10.0% 55 9.3% 20 11.3%
Four-year college degree 439 37.9% 209 35.2% 62 35.0%
Graduate degree 413 35.6% 210 35.4% 59 33.3%
Academic groups
Honors 453 36.3% 236 36.0% 57 29.1%
Athletes, 38 3.0% 35 5.3% 13 6.6%
Service 33 2.6% 10 1.5% 5 2.6%
Undecided Majors 182 14.6% 94 14.3% 32 16.3%
No Groups 559 44.8% 293 44.7% 94 48.0%

All 1253 100.0% 656 100.0% 197 100.0%


a Resource limitations prevented staff from contacting all sampled students; unavailable students are those who could not be contacted with
available resources.
b Students who were contacted but declined to participate are considered refusals.

Statistically significant difference (P < .05) between baseline participants and baseline unavailables.

Statistically significant difference (P < .05) between baseline participants and baseline refusals.

number of attempts needed to contact partici- a general lack of interest (69.5%), while another
pants was 5.82 for all completed baseline inter- 22.8% stated they were too busy and had
views. One-way analyses of variance (ANOVAs) time constraints. Only four individuals (2.0%)
confirmed that, on average, fewer attempts expressed discomfort with the idea of partici-
were needed for females (5.61, P = .0161) pating in a research study, and none expressed
and participants with a college-educated parent concerns about confidentiality. The remaining
(5.79, P = .0118), whereas more attempts were 5.6% of refusals cited miscellaneous reasons,
needed to recruit student athletes (7.13, P = mainly pertaining to a fear that participating
.0424), males (6.14), and participants without might reflect negatively on them or their parents
college-educated parents (6.65). Interestingly, because of being in the military, working for the
experienced substance users (i.e., prevalent and government, living in a small town, or because it
high-risk cases) were more easily recruited than was not required by his/her sports team. We had
low-risk cases (5.08, 5.47 and 6.92, respectively, been somewhat concerned about the possible
P < .0001). effects of over-recruitment that might have
For individuals who were contacted, but re- been created by other studies that were recruiting
luctant to participate in the interview, recruiters from the same population. However, none of
were trained to discern the underlying cause our refusals appeared to have resulted from
for concern, attempt to address that concern negative feelings about over-recruitment.
to the individuals satisfaction, and if a refusal Nor did anyone mention the inconvenience of
resulted, to document the reason for refusal. Out the interview location or time as a reason for
of 197 total refusals, more than two-thirds cited refusing.
Arria et al. 29

Statistical Analyses data were treated cumulatively, such that any


affirmative response constituted lifetime use at
Computation of Statistical Weights all subsequent times. (Because the screening
for Prevalence Estimation survey was not administered by interviewers, it
was considered to have a higher potential for
To permit computation of prevalence esti-
error, particularly with respect to nonmedical
mates, case weights were calculated for partici-
use of prescription drugs. Therefore, screening
pants in each of 30 groups, defined by crossing
data were only used cross-sectionally and did
gender (male, female) by race (White, Black,
not contribute to subsequent prevalence calcu-
Asian-American, other, and unknown) by sam-
lations.) To show the change in prevalence over
pling group (prevalent, high-risk, low-risk). The
time, estimates of lifetime use at screening, base-
weights represented the inverse of the frequency
line, and 12 months were plotted together as drug
of the group in the sample divided by the popula-
use profiles. Prevalence was computed as the
tion frequency for that group, where the popula-
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weighted number of individuals who had ever


tion was the screened sample of the universitys
used a drug, divided by the weighted number
first-year student enrollment. Thus, this weight-
of individuals in the cohort (nwt = 3,285). For
ing scheme would yield a weighted sample size
this analysis, individuals with missing data were
in each of the 30 groups equal to the number of
treated as nonusers; therefore, all frequencies at
participants in that group in the screened popu-
12 months should be considered lower-bound
lation, and the total weighted sample size would
estimates, because it is possible that additional
approximate the number of screened first-year
individuals used each substance but did not
students enrolled in the university (nwt = 3285).
provide data at 12 months.
Descriptive Analyses of Drug Exposure Longitudinal patterns of drug use transitions
were derived from comparing lifetime use at
Opportunity baseline (corresponding to the first year in
To summarize the timing of students ex- college, or Time 1) with drug use at 12 months
posure to each drug, weighted data on age at (corresponding to the sophomore year, Time 2).
first opportunity were plotted as the cumulative Three different patterns of transition were then
percent of students who ever had exposure computed as rates: Initiation is the number of
opportunity to use a drug at each year of age. As individuals who first used the drug between
noted above, opportunity to use was captured at Times 1 and 2, divided by the number of
baseline as the age in years at first offer, and at nonusers at Time 1; Continuation is the number
12 months as the number of opportunities in the who used the drug before Time 1 and again at
past year. Therefore, where the first opportunity Time 2, divided by the number of Time 1 users;
occurred between baseline and 12 months, age at and Cessation is the number of Time 1 users who
first opportunity was set to equal the participants stopped using by Time 2, divided by the number
age at the time of the 12-month interview. of Time 1 users.

Descriptive Analyses of Longitudinal


Patterns of Drug Use RESULTS
With the exception of inhalants, weighted Exposure Opportunity for Alcohol,
estimates of lifetime prevalence of use and op- Tobacco, and Illicit Drug Use
portunity to use were computed for each drug at
screening, baseline, and 12 months. Prevalence Figure 3 presents the substance use expo-
estimates for inhalant use were computed at sure opportunities for alcohol, tobacco, and 10
baseline and 12 months only, because inhalant illicit and nonmedical prescription drug use
use was not assessed at screening due to time categories. As can be seen, by their sophomore
constraints related to the orientation schedule. year in college nearly all students had the
Beginning with the baseline interview, drug use opportunity to try alcohol and a large majority
30 SUBSTANCE ABUSE

FIGURE 3. Cumulative weighted frequency of exposure opportunity to use alcohol, tobacco, and
10 other drugs, by age in years.

100% Alcohol, Mean=14.6

90% Tobacco, Mean=14.9


Percent of Students Who Ever Had Opportunity

Marijuana, Mean=16.0
80%

70%

60%
50th Percentile
Prescription Stimulants, Mean=17.7
50%
Hallucinogens, Mean=17.4
40%
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Prescription Analgesics, Mean=17.5


Ecstasy, Mean=17.1
30%
Cocaine, Mean=17.9

20% Prescription Tranquilizers, Mean=17.3


Inhalants, Mean=16.7
Amphetamines, Mean=17.4
10%
Heroin, Mean=17.8
0%
10 11 12 13 14 15 16 17 18 19 20 21
Age

Graphed lines depict the weighted cumulative percent of all students who ever had the opportunity to try a substance by each age, as of the sophomore
year of college. Circles on the graph indicate the age by which 50% of all students who were ever exposed to the substance had experienced their first
opportunity. The mean age at first opportunity is reported for all students who ever had the opportunity to try a substance. Amphetamines include
methamphetamine, but do not include prescription or over-the-counter medications.

had the chance to try marijuana and tobacco. school, increased in exposure by the time stu-
About half had the chance to try prescription dents were 19.
stimulants nonmedically. Importantly, several On average, the oldest ages of first exposure
other illicit drugs were also available to a opportunity were observed for cocaine (17.9),
substantial minority of students, with expo- heroin (17.8), and prescription stimulants (17.7).
sure opportunity exceeding 20%wt for hallu- In fact, as indicated by the 50th percentile marks,
cinogens, prescription analgesics, ecstasy, and the majority of students who were ever exposed
cocaine. to these drugs were at least 18 years old the
Exposure opportunity generally occurred ear- first time it was offered to them. The same was
liest for alcohol, tobacco, and marijuana. The true for hallucinogens, although the mean age
data depict a general trend of tobacco exposure of first opportunity was slightly lower (17.4).
occurring about half a year after alcohol, on aver- These findings indicate that for many students,
age, followed by marijuana approximately 1 year the timing of their first introduction to illicit
later. During the high school years, exposure to drugs coincided with their transition from high
all other drugs remained low until age 16, when school to college.
certain drugs became more available: ecstasy,
hallucinogens, and prescription analgesics and
Lifetime Prevalence of Use
stimulants. Later, prescription stimulants and
hallucinogens further diverged from that group Figure 4 displays profiles of the lifetime
to become noticeably more available by the prevalence (weighted frequencies) of 10 illicit
time students were 18, after which exposure drugs at screening (precollege), baseline (first
to stimulants continued to increase relative to year), and 12 months (sophomore year), as
hallucinogens. Similarly, cocaine, which was well as the percent increase in prevalence
one of the least available drugs during high between screening and 12 months. As expected,
Arria et al. 31

FIGURE 4. Profile analysis of weighted lifetime prevalence of drug use in the College Life Study
for three consecutive assessments.

70%

60% 55.6%
47.5%
Sophomore Year

50%
First Year
Lifetime Prevalence of Use

40%
Prior to College
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30%
22.6%
16.9%
318.5%
85.7%
20% 11.5%
105.4%
7.1%
102.9% 7.3%
10% 4.2% 305.6%
6.0% 2.1%
75.0% 0.4%
31.3%
33.3%

0%
Prescription Hallucin- Prescription Prescription Amphet-
Marijuana Analgesics Inhalants Ecstasy Cocaine eroin
Heroin
H
ogens Stimulants Tranquilizers amines

Percentages in bold correspond to lifetime prevalence of use by sophomore year. Percentages in italics correspond to the percent
increase in lifetime prevalence from pre-college to sophomore year. Amphetamines include methamphetamine, but do not include
prescription or over-the-counter medications. Use of inhalants was not assessed prior to college, so no percent change is reported.

marijuana was the most prevalent drug, used scription analgesics were the most prevalent
by nearly 40%wt of students prior to starting drug used in high school (after marijuana),
college, 50%wt by their first year of college, they were quickly outpaced by prescription
and nearly 60%wt by their sophomore year. stimulants once students began college. By
Lifetime prevalence was less than 10%wt for sophomore year, more than one in five students
all other drugs prior to starting college, with had used prescription stimulants (22.6%wt ),
prescription analgesics, hallucinogens, and pre- one in six had used prescription analgesics
scription stimulants being the most prevalent. (16.9%wt ), and one in 10 had used hallucinogens
For all other drugs, lifetime prevalence was (11.5%wt ).
below 5%wt prior to starting college. With respect to the change in lifetime preva-
During the first year of college, modest lence from precollege to sophomore year, the
increases in use were observed for prescrip- largest increases were observed for prescrip-
tion analgesics, hallucinogens, and cocaine, but tion stimulants and cocaine, both of which
lifetime use of prescription stimulants doubled, more than quadrupled (increases of 318.5% and
surpassing use of prescription analgesics and 305.6%, respectively). This finding is particu-
hallucinogens. These trends continued into the larly concerning, given the relatively brief time
sophomore year, when prescription analgesics elapsed between assessments, and considering
and hallucinogens increased substantially and the high prevalence of prescription stimulant
prescription stimulants doubled again. Inter- use (22.6%wt ) by sophomore year. On the
estingly, use of cocaine also doubled in the other hand, fewer than 1 in 10 students used
sophomore year, and use of prescription tran- cocaine (7.3%wt ) by sophomore year, yet this
quilizers increased for the first time. It is still represents an estimated 240 students in
also interesting to note that although pre- the class under study. Substantial increases
32 SUBSTANCE ABUSE

TABLE 4. Rates of Initiation, Cessation, and Continuation of Drug Use During the First Two Years
of College, By Drug (weighted n = 2969)

Time 1 Initiated Use Time 1 Ceased Use Continued Use


Drug Nonusers by Time 2 Users by Time 2 at Time 2

Marijuana 1504 12.8% 1460 19.6% 80.4%


Prescription stimulants 2591 11.7% 377 39.3% 60.7%
Prescription analgesics 2642 6.5% 319 58.6% 41.4%
Cocaine 2862 4.1% 99 36.4% 63.6%
Hallucinogens 2700 3.1% 263 43.0% 57.0%
Prescription tranquilizers 2798 3.0% 128 63.3% 36.7%
Inhalants 2833 1.3% 136 67.6% 32.4%
Ecstasy 2877 1.3% 93 69.9% 30.1%
Amphetamines 2916 0.7% 46 89.1% 10.9%
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Heroin 2947 0.2% 5 100.0% 0.0%

Note: Longitudinal data represent lifetime and past-year drug use reported during the first year (Time 1) and second year (Time
2) of college, respectively. Initiation is computed as the number of new users at Time 2 who had never used at Time 1,
divided by all nonusers at Time 1. Cessation is the number of Time 1 users who did not use at Time 2, divided by all Time
1 users. Continuation is the number of students who used at both Time 1 and Time 2, divided by all the Time 1 users.

Amphetamines include methamphetamine but do not include prescription or over-the-counter medications.

were also observed for hallucinogens (105.4% Overall, the risk of initiation of drug use
increase), prescription tranquilizers (102.9%), between the first year and sophomore year
prescription analgesics (85.7%), and marijuana was relatively low, fewer than one in ten for
(47.5%). Although their absolute prevalence most drugs. Only marijuana (12.8%wt ) and
estimates remained low, use of ecstasy, heroin, prescription stimulants (11.7%wt ) were initiated
and amphetamines also increased. (Lifetime at rates exceeding 1 in 10. Interestingly, more
prevalence of amphetamine use appeared to students initiated prescription stimulants than
decrease between precollege and first year; al- any other drug (nwt = 303, data not shown
though, by definition, this would be impossible, in a table). Greater variability was observed
these data reflect the modest inconsistencies in in the rates of cessation and continuation of
how some individuals responded to drug use use among individuals who had used the drugs
questions in different waves of data collection.) by Time 1. In general, for the less-prevalent
drugs, most users ceased using by Time 2.
Whereas this pattern held true for prescription
tranquilizers (63.3%wt ceased using), inhalants
Initiation, Continuation, and Cessation
(67.6%wt ), ecstasy (69.9%wt ), amphetamines
of Use (89.1%wt ), and heroin (100.0%wt ), the notable
Table 4 presents the weighted rates of drug use exception was cocaine, with only one in three
initiation, cessation, and continuation between users ceasing use (36.4%wt ). Conversely, the
the first (Time 1) and second (Time 2) years of drugs with the highest rates of continuation were
college. For example, the first row of the table marijuana (80.4%wt continued using), cocaine
describes the transition patterns of marijuana (63.6%wt ), prescription stimulants (60.7%wt ),
use in this longitudinal analysis. Of the 1504 and hallucinogens (57.0%wt ).
individuals who had never used marijuana at
Time 1, 12.8%wt started using marijuana by
DISCUSSION
Time 2. Of the 1460 individuals who had used
marijuana at least once in their lives at Time 1, Longitudinal Patterns of Drug Use
one in five (19.6%wt ) ceased using while four
out of five (80.4%wt ) continued using it between In this prospective study of 1253 college
Times 1 and 2. students, exposure opportunity and initiation of
Arria et al. 33

substance use frequently occurred after starting cannot determine the extent to which these
college. By the sophomore year in college, pre- events actually occurred at college. In fact,
scription stimulants (for nonmedical use) were the trends are consistent with epidemiologic
the most widely available drug after marijuana evidence in the general young-adult population
and had been used by one in five students. (28,29). Thus, the implication is that college
Prescription analgesics (for nonmedical use) and students are exposed to at least as much risk
hallucinogens were the next most prevalent, used of drug use as nonstudents, and that the college
by more than 1 in 10 students by their sophomore environment is at least as risky as the noncollege
year. The rate of increase in lifetime prevalence environment with respect to substance use in
during the first 2 years of college was greatest for general, and possibly more risky with respect to
cocaine, hallucinogens, prescription stimulants, certain specific drug classes (e.g., prescription
and prescription tranquilizers. These findings stimulants). The college environment, therefore,
expand on those of other large-scale studies of does not appear to provide a sheltering influence
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lifetime prevalence and exposure opportunity for students who are at risk for substance use.
among high school and college students (2830). The prospective nature of this study per-
mits it to address important questions about
Concordance with Other Findings the timing and context of the initial exposure
in the Literature of College Drug Use opportunity and onset of substance use. The
findings presented here with respect to alcohol,
Although it is tempting to compare these re- marijuana, and tobacco lend support to the
sults to the findings from the national Monitoring hypothesis that substance use patterns in college
the Future (MTF) study (29), which reports sub- represent a continuation of patterns that were
stantially higher lifetime prevalence estimates initiated in high school (3133). For other illicit
for ecstasy (10.2%), cocaine (9.5%), nonmedical drugs, however, this study provides evidence that
use of prescription tranquilizers (10.6%), and exposure opportunity and initiation frequently
inhalants (8.5%) among their college student occur in college. For example, in this study,
sample, caution should be exercised in doing most students had already been offered alcohol,
so for several reasons. First, the MTF sampled tobacco, and marijuana by age 16, whereas ex-
students ages 19 to 22, whereas our estimates posure to other illicit drugs (including nonmed-
are derived from a somewhat younger sample ical use of prescription stimulants, analgesics,
of incoming college students, ages 17 to 19 at and tranquilizers) tended to coincide with the
study outset. Second, the MTF includes students transition to college. Similarly, relatively few
attending 2-year colleges, including community students initiated use of alcohol, tobacco, or mar-
colleges, whereas the CLS sample is drawn from ijuana after starting college, but proportionately
a single 4-year university in the mid-Atlantic speaking, initiation of other illicit substances
region. As such, the CLS sample does not was much more common during college than
represent the drug use opportunities of students in high school.
residing in all parts of the United States. Some Findings from this study pertaining to several
illicit drug problems, such as methamphetamine, specific drug classes were especially concern-
are more regional than others, which could ing. Our estimates confirm recent findings of
account for the difference between our estimate other investigators in college-student and young-
of lifetime amphetamine use (1.5%) and the adult populations showing that nonmedical use
estimate from the MTF survey (12.7%). Lastly, of prescription drugs is the most prevalent
as a face-to-face interview, the CLS assessments form of illicit substance use after marijuana
obtain detailed information on a broader range of and alcohol (2830,34,35). For hallucinogens,
nonmedical use of prescription drugs than what cocaine, and prescription analgesics and pre-
is unavailable to date in the MTF survey. scription stimulants, both exposure opportunity
It is important to note that although exposure and lifetime prevalence increased dramatically
opportunity and drug use initiation may have between the first 2 years of college. Cocaine and
occurred during the college years, this study prescription stimulants exhibited the greatest
34 SUBSTANCE ABUSE

proportional increases, raising several questions drug and alcohol use in this way among college
of epidemiological significance. Because we students.
only sampled students at one university, it is
possible that this trend is confined to the campus Limitations
or the immediate geographic region. However,
This study is subject to a number of limita-
it is also possible that these drugs are linked
tions, including the potential for response bias,
more generally with college life today. Other
which is inherent to all studies using self-report
recent studies have documented the increasing
methods (37,38). Some participants may not
prevalence of prescription stimulant use among
have been accurate historians in recalling events
college students (36), but to our knowledge, no
that occurred several years ago, such as the age
other studies have detected a similar trend in
they were first offered alcohol. Also, because we
cocaine use among either college students or
sampled students from one university, the gen-
young adults in general. Moreover, few data have
eralizability of the findings is unknown. Some
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been available previously to indicate whether


potential exists for attrition bias, as with other
nonmedical use of prescription stimulants begins
prospective studies, in that not every participant
before or during college.
was assessed at each follow-up. However, the
Another major contribution of this study is
cumulative response rate exceeds 95% thus far,
the finding that many students stopped using
and no substantial differences were observed be-
drugs by their sophomore year in college. Most
tween responders and nonresponders. Because
users of prescription analgesics, prescription
the annual assessments were administered on
tranquilizers, inhalants, ecstasy, amphetamines,
a rolling basis over the duration of the entire
and/or heroin prior to Time 1 had quit by Time 2.
academic year, prevalence estimates should
Marijuana, on the other hand, appears to be
be interpreted with caution, because responses
a drug that many students initiate early and
reflect slightly different time periods. Future
continue to use well into their college years.
studies on these data will control for relevant
Rates of cessation were also low for prescription
background factors such as time elapsed in the
stimulants and cocaine.
current year and time of year (e.g., midterms,
The strengths of this study include its large
spring break). Finally, ages of initiation and
sample size (n = 1253), representativeness
exposure opportunity were not collected with
of the target population, and high response
sufficient precision to permit absolute estimation
rate (95%). Importantly, this studys first wave
of whether the event occurred before or after
of data collection occurred after high school
starting college; this limits our ability to make
graduation and before the start of the first year
inferences about the relative importance of envi-
of college. This timing provided uniformity in
ronment versus maturation with respect to these
how precollege behaviors were assessed and the
events. Future studies using timeline followback
ability to capture a true picture of student life
data from this cohort will permit more precise
before any exposure to the college environment.
estimates regarding initiation, continuation, and
A broad range of domains are assessed in this
cessation of substance use, and these data will
study, using measures that were based in large
continue to be tracked in future waves of data
part on other large national studies. Measures
collection.
of substance use are particularly thorough,
including daily consumption as reported in Implications of the Current Findings
the timeline followback. This unique method, for Prevention
although labor-intensive, provides considerable
flexibility in assessing patterns of substance use, These findings clearly demonstrate the need
such as the ability to detect concurrent use for prevention programs to be sustained through-
of multiple substances, and to characterize the out all stages of adolescent development. Today
periodicity of drug and alcohol consumption most prevention occurs in middle schools, but
as it relates to life events. To our knowledge, our findings suggest that most initiation occurs
this is the first study to measure patterns of during the high school and college years (at
Arria et al. 35

least for college-bound students). Thus it follows the patterns of use developed in high school,
that prevention programs would be worthwhile universities ought to provide early assessment
during the later years of high school and even and referral. As demonstrated in this study,
into college. incoming students may be screened for prior
The institutional nature of the college setting substance use to help identify high-risk popu-
provides a uniquely controlled environment lations. Third, university policies should involve
in which high-risk students could be targeted and educate parents around prevention. Parents
efficiently. Armed with information about the need to know that their college-bound children
prevalence of drug use among college students, continue to face risks for substance use after
colleges and universities can position themselves they leave for college, and should be encouraged
to support research investigating what strategies to continue to maintain good communication
are effective in influencing college students, with their college-attending child and express
and to design innovative programs aimed at disapproval of underage drinking and illicit drug
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enhancing protective factors and controlling the involvement.


risk for substance use. Few studies are available
to evaluate harm reduction strategies in college Future Directions for Research
students (39), but there is some evidence that
offering substance-free activities (40) may help Although college students may have certain
provide appealing alternatives to students who advantages over their nonstudent counterparts
might otherwise choose to drink or use drugs. in terms of risk and protective factors, as young
Prevention programs can also capitalize on the adults they experience high rates of substance
fact that college students tend to overestimate use and other risky behaviors. An important
the amount of drinking and drug use their peers implication of these findings is the need for
are engaging in (41,42), and regard substance additional research into the predictors of sub-
use as much more normative than it really is. stance use among college students, in order to
Social marketing strategies aimed at correcting facilitate identification of high-risk students and
this misconception may be one effective way to appropriate targeting of secondary interventions.
decrease the risk of use. Additionally, future studies should strive to un-
derstand the potential academic consequences of
Implications of the Current Findings substance useincluding from the nonmedical
for Early Intervention and Treatment use of prescription drugslike dropout and
academic dismissal. Moreover, given what is
Finally, universities must make substance- already known about the prevalence of polydrug
abuse treatment services available for the sub- use (30,34,4749) and its consequences (5053),
stantial number of college students who need investigators should focus on the total impact of
them, because prior evidence indicates that substance use in general, rather than attempting
college students experience dependence and to disentangle the consequences of individual
abuse at rates similar to the general population drugs.
(43,44). Treatment programs should be designed In this study, college students proved to be
to address the specific challenges intrinsic to a highly accessible population for longitudinal
college life, especially regarding the intensity of follow-up, at least during the first 2 years
the social environment and academic pressures. of college. Considering the scientific value of
Universities can also implement more proac- longitudinal data in all disciplines and the dif-
tive policies to address the substance-related ficulties inherent in recruiting and maintaining
problems experienced by their students. First, contact with a longitudinal cohort of participants
campus health centers need comprehensive ser- (5458), investigators should consider college
vices to respond to the prevention and treatment student populations as a starting point in future
needs of students, yet health centers are typically longitudinal studies. In our experience, the ubiq-
resource poor (45,46). Second, given that much uity of personal mobile phones in this population
substance use in college is a continuation of was highly advantageous to recruitment efforts;
36 SUBSTANCE ABUSE

mobile phones provide a relatively permanent or characteristics of college students who de-
and direct line of communication for follow-up crease their drug use, who experience serious
contacts, and they optimize convenience and drug-related consequences such as dropout, and
flexibility of communication between interview- whose experiences lie somewhere in between.
ers and participants attempting to coordinate
their busy schedules. The extent to which the NOTE
present cohort continues to be highly responsive
in future waves of data collection remains to be 1. Henceforth in this paper, to save space, when we refer
seen. to use of stimulants, tranquilizers, and analgesics,
Future analyses are underway to understand we are referring to the nonmedical use of each these
the factors associated with the continuation of prescription drugs as described in this section.
high school drug use patterns as well as what
factors might be associated with the initiation REFERENCES
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