DRUG USE gg nn AA oo mm NATIONAL INSTITUTE ON DRUG ABUSE R /E AC IA L THN I C M I N O R I T I E S REVISED U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL INSTITUTES OF HEALTH Drug Use Among Racial/Ethnic Minorities U.S. Department of Health and Human Services National Institutes of Health National Institute on Drug Abuse Division of Epidemiology, Services & Prevention Research 6001 Executive Blvd, Room 5164 Bethesda, MD 20892-9589 www.drugabuse.gov ACKNOWLEDGMENTS This publication was produced for the National Institutes of Health, National Institute on Drug Abuse (NIDA), Division of Epidemiology, Services and Prevention Research, by faculty and staff of the Johns Hopkins University, Bloomberg School of Public Health, Department of Mental Hygiene, under an order for services commissioned through Management Assistance Corporation of Rockville, Maryland. Leslie Cooper, Ph.D., M.P.H., R.N., National Institute on Drug Abuse, provided scientific oversight, critical review, and substantive comments for this publication. PUBLIC DOMAIN NOTICE All material appearing in this volume is in the public domain and may be reproduced or copied without per­ mission from NIDA. Citation of the source is appreciated. For questions or comments on this document, please send an e-mail to Dr. Leslie Cooper at: [email protected] National Institute on Drug Abuse NIH Publication No. 03-3888 Printed 1995 Revised September 1998 Revised September 2003 CONTENTS LIST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v LIST OF FIGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Chapter 1. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 DEFINITION OF RACE AND ETHNICITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 American Indians/Alaska Natives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Asian/Pacific Islanders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 African Americans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Hispanics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 OVERVIEW OF DRUG USE AND DRUG-RELATED PROBLEMS . . . . . . . . . . . . . . . . 12 METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 DATA SOURCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Census of the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 National Household Survey on Drug Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Partnership Attitude Tracking Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Monitoring the Future Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 National Longitudinal Survey of Youth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Dropout Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 American Indian/Alaska Native Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Youth Risk Behavior Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Drug Abuse Warning Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 AIDS Surveillance Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Arrestee Drug Abuse Monitoring Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 ORGANIZATION OF THIS REPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Chapter 2. POPULATION STATISTICS FOR RACIAL/ETHNIC MINORITIES IN THE UNITED STATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 POPULATION STATISTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Chapter 3. DRUG USE IN THE GENERAL POPULATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 PREVALENCE OF DRUG USE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 ATTITUDES AND PERCEPTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 iii Contents Chapter 4. PREVALENCE OF DRUG USE AMONG YOUTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 AGE AT FIRST USE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 PREVALENCE TRENDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 School-Attending Youth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 American Indian/Alaska Native Students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 LONGITUDINAL TRENDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Chapter 5. YOUTH DRUG USE AND RISK BEHAVIORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 SCHOOL DROPOUT TRENDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 RISK BEHAVIOR TRENDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Chapter 6. ADVERSE SOCIAL, BEHAVIORAL, AND HEALTH CONSEQUENCES . . . . . . . . . . 101 AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 DRUG-RELATED EMERGENCY ROOM EPISODES . . . . . . . . . . . . . . . . . . . . . . . . . 104 DRUG-RELATED DEATHS AND INTENTIONAL AND UNINTENTIONAL INJURIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Chapter 7. DRUGS AND CRIME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 DRUG USE AMONG BOOKED ARRESTEES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 DRIVING UNDER THE INFLUENCE OF ALCOHOL OR ILLEGAL DRUGS . . . . . 133 SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Chapter 8. SUMMARY AND FUTURE DRUG ABUSE PROGRAM AND RESEARCH NEEDS . . 139 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 APPENDICES Appendix 1. NIDA POSITION STATEMENT, HEALTH DISPARITIES: DEFINITIONS . . . . . . . . . 157 Appendix 2. NIDA STRATEGIC PLAN ON REDUCING HEALTH DISPARITIES . . . . . . . . . . . . . 159 iv LIST OF TABLES Table 1. Estimated Percentage Distribution of U.S. Population, by Race/Ethnicity and Hispanic Origin: 1990–2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table 2. Weighted Average Poverty Thresholds, by Size of Family: Selected Years . . . . . . . . . . . . . . . . . . 26 Table 3. Poverty Thresholds, by Size of Family and Number of Related Children Under 18 Years of Age (in dollars): 2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Table 4. Person and Families Living Below Poverty Level, According to Selected Characteristics, Race, and Hispanic Origin: 1990–2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 5. NHSDA Sample Sizes and U.S. Civilian Noninstitutionalized Population Totals, by Sex and Age Across Race/Ethnicity for Age 12 and Older: 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Table 6. Estimated Prevalence of Use of Selected Drugs Among Persons Age 12 and Older in the United States: 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table 7. Estimated Prevalence of Past-Month Drug Use in the United States, by Age and Sex (by percent): 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table 8. Estimated Prevalence of Past-Month Drug Use in the United States, by Age, Sex, and Race/Ethnicity (by percent): 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Table 9. Estimated Prevalence of Past-Month Drug Use Among Hispanics in the United States, by Age and Sex (by percent): NHSDA 1997 and 1998 Data Combined . . . . . . . . . . . . . . . . . . 52 Table 10. Estimated Percentage of Women of Childbearing Age (15–44) Using Drugs, by Age, Race/Ethnicity, and Population Density: 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Table 11. Estimated Percentage of Live-Born Infants’ Mothers Who Reported Smoking During Pregnancy, by Year and Race/Ethnicity, U.S. Final Natality Statistics: 1993–1999 . . . . . . . . . . . 55 Table 12. Estimated Percentage of Respondents Who Believe That Selected Drugs Are Easy to Get for Themselves (Youth and Teens) and by Their Children (Parents), by Race/Ethnicity: 1997–2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Table 13. Estimated Percentage of Respondents Who Associate Danger/Great Risk with the Use of Selected Drugs, by Race/Ethnicity: 1997–2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Table 14. Estimated Percentage of Respondents Who Agree With Selected Statements About Specific Drugs, by Race/Ethnicity: 1997–2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Table 15. Estimated Average Age of First Use of Cigarettes, Alcohol, and Marijuana for Youth Ages 12–17, by Race/Ethnicity: Selected Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 v List of Tables Table 16. Estimated Prevalence of Lifetime, Annual, 30-Day, and Daily Use of Selected Drugs, by Race/Ethnicity for Students in Grades 8, 10, and 12 (by percent): 2000 . . . . . . . . . . . . . . . . . . 72 Table 17. Trends in the Estimated Percentage of 12th-Graders Who Were Previous-Month Smokers, by Race/Ethnicity and Gender: 1976–1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Table 18. Estimated Prevalence of Use of Selected Substances in the Past Year, Cigarette Use in the Past 30 Days, and Binge Drinking in the Past 2 Weeks Among 12th-Graders and 8th-Graders, by Sex and Race/Ethnicity (by percent): Selected Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table 19. Estimated Percentage of African-American and White 12th-Graders Who Reported Using or Not Using Tobacco Cigarettes and Other Substances in the Past 30 Days: 1976–1994 Aggregate Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Table 20. Estimated Prevalence of Youth Age 12 and Older Having Used Alcohol, Marijuana, Cocaine, or Crack-Cocaine in Lifetime or Past Month, by Age, Sex, Race/Ethnicity (by percent): 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Table 21. Estimated Percentage of American Indian 7th–12th Graders Living on Reservations Who Reported Lifetime Use of Drugs: 1975–1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table 22. Estimated Lifetime Prevalence of Drug Use for American Indian and Non-Indian 8th, 10th, and 12th-graders (by percent): 1997–1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table 23. Estimated Percentage of American Indian 4th–6th Graders Who Reported Lifetime Use of Drugs: Selected Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table 24. Estimated Percentage of National Longitudinal Survey of Youth Cohorts Who Admitted Using Marijuana and Cocaine, by Race/Ethnicity and Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table 25. Rate, Number, and Distribution of Status Dropouts, by Sex, Race/Ethnicity, Age, Region, and Recency of Immigration: 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Table 26. Status Dropout Rates for Persons Ages 16–24, by Family Income and Race/Ethnicity (by percent): 1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Table 27. Event Dropout Rates for Persons Ages 15–24 Who Dropped Out of Grades 10–12, by Sex and Race/Ethnicity (by percent): October 1972–October 1999 . . . . . . . . . . . . . . . . . . . 95 Table 28. Reasons for Dropping Out of School, by Sex and Race/Ethnicity (by percent): 1992 . . . . . . . . . 96 Table 29. High-School Completion Rates and Method of Completion for Persons Ages 18–24 Years, by Race/Ethnicity and Year (by percent): October 1995–October 1999 . . . . . . . . . . . . . . . . . . 97 Table 30. Estimated Percentage of Youth Engaging in Risk Behaviors, by Drug Users and Nonusers and Race/Ethnicity: 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 vi List of Tables Table 31. Female Adult/Adolescent AIDS Cases, by Exposure Category and Race/Ethnicity: Cumulative Totals Through December 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Table 32. Male Adult/Adolescent AIDS Cases, by Exposure Category and Race/Ethnicity: Cumulative Totals Through December 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Table 33. Estimated Rates of Emergency Department Drug Abuse Episodes and Mentions of Selected Drugs per 100,000 Population in the Coterminous United States, by Sex and Age: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Table 34. Drug Mentioned Most Frequently by Hospital Emergency Departments, by Sex and Race/Ethnicity of Patients: 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Table 35. Estimated Number of DAWN Hospital Emergency Department Visits, by Race/Ethnicity and Age: 1994–2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Table 36. Estimated Number of DAWN Emergency Department Visits With Mention of Cocaine, by Race/Ethnicity and Age: 1994–2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Table 37. Estimated Number of DAWN Emergency Department Visits With Mention of Heroin/Morphine, by Race/Ethnicity and Age, 1994–2000 . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Table 38. Estimated Number of DAWN Emergency Department Visits With Mention of Methamphetamine/Speed, by Race/Ethnicity and Age, 1994–2000 . . . . . . . . . . . . . . . . . . . . 121 Table 39. Estimated Number of DAWN Emergency Department Visits With Mention of Marijuana/Hashish, by Race/Ethnicity and Age, 1994–2000 . . . . . . . . . . . . . . . . . . . . . . . . . 123 Table 40. Percentage of DAWN Hospital Emergency Department Drug Abuse Episodes, by Selected Episode Characteristics, Sex, and Race/Ethnicity: 2000 . . . . . . . . . . . . . . . . . . . . . 125 Table 41. Comparison of Race/Ethnicity Distribution for Total DAWN Hospital Emergency Episodes with Race/Ethnicity Distribution for Selected Drug Mentions: 2000 . . . . . . . . . . . . 125 Table 42. Drugs Mentioned Most Frequently by Medical Examiners, by Sex and Race/Ethnicity of Decedents: 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Table 43. Estimated Prevalence of Positive Urinalysis Tests from the Arrestee Drug Abuse Monitoring Program: 1987–1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Table 44. Estimated Percentage of People Having Driven a Vehicle Under the Influence of Alcohol or Illegal Drugs in the Past 12 Months, by Race, Sex, and Age: 1998 . . . . . . . . . . . . . . . . . . . 138 vii