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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
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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.
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
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)
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.
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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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%)
Recruitment for
Recruitment for Baseline
BaselineInterview
Interview(n(n==2,106)
2,106)
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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
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
Follow-Ups
Semiannual (6, Annual (12,
Precollege First Year 18, 30 Months) 24 Months)
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)
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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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
FIGURE 3. Cumulative weighted frequency of exposure opportunity to use alcohol, tobacco, and
10 other drugs, by age in years.
Marijuana, Mean=16.0
80%
70%
60%
50th Percentile
Prescription Stimulants, Mean=17.7
50%
Hallucinogens, Mean=17.4
40%
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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)
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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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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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.
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