High school graduation is a key milestone on the pathway to success for many Americans; however, many youths drop out of high school each year. In the United States, about 82 percent of youths who enter public high school as freshmen eventually graduate from high school in 4 years (calculated from the average freshman graduation rate and the adjusted cohort graduation rate).1,2 This indicates that approximately 1 out of 5 students did not graduate with a regular high school diploma within 4 years of the first time they started 9th grade.1,3 According to the 2012 Current Population Survey (CPS), approximately 478,000 youths aged 16 to 18 were "status dropouts," meaning that they were not enrolled in high school and had not earned a high school diploma or alternative credential.3 Younger youths were more likely than older youths to be enrolled in school.3 For example, the 2012 CPS data show that high school enrollment rates by age group were 95.4 percent for 16-year-olds and 90.1 percent for 17-year-olds.3 Students who fail to graduate face a wide array of negative consequences including higher rates of unemployment, earning less when employed, being more likely to receive public assistance, being more likely to suffer poor health, and being more likely to have higher rates of criminal behavior and incarceration.4,5,6,7,8,9 In addition, the failure to complete high school has intergenerational implications on socioeconomic attainment because children whose parents did not complete high school are more likely to perform poorly in school and eventually drop out themselves.10
The National Survey on Drug Use and Health (NSDUH) is an annual survey of the U.S. civilian, noninstitutionalized population aged 12 years or older. One of NSDUH's strengths is the stability of the survey design, which allows for multiple years of data to be combined to examine specific subgroups in the United States, such as high school dropouts. NSDUH is a face-to-face household interview survey that is fielded continuously throughout each year. NSDUH assesses current educational attainment and school enrollment status for all respondents aged 12 or older. Specifically, NSDUH asks respondents about their current age, current school enrollment status, last grade completed, and age when they last attended school. This permits NSDUH to classify each youth respondent as in school or not in school (i.e., a dropout). This measure is slightly different from alternate measures that identify whether individuals were able to attain their high school diploma or General Educational Development (GED) within 4 years of starting high school, a common metric for assessing high school completion.1
NSDUH, which is a cross-sectional study, is unable to collect this measure. For this report, the NSDUH data were used to identify 12th grade aged youths and whether they had dropped out of school. Youths aged 16 to 18 were categorized into three groups:
This issue of The CBHSQ Report focuses on the first two of these groups, which are collectively referred to as 12th grade aged youths; comparisons of past month (current) substance use between 12th grade students and 12th grade aged dropouts are provided. The remaining youths (group 3) are not included in estimates in this report. All findings in this report are annual averages from the 2002 to 2014 NSDUH data from about 136,200 respondents aged 16 to 18, including 4,800 youth who met the high school drop out critiera.
About 1 in 9 (11.3 percent) 12th grade aged youths had dropped out of high school, with males having been more likely than females to have dropped out (12.7 vs. 9.9 percent; Figure 1).12 The percentage of high school dropouts varied widely by race/ethnicity,13 ranging from 23.0 percent of American Indian or Alaska Native 12th grade aged youths to 1.1 percent of Asian 12th grade aged youths. When compared with the percentage of 12th grade aged youths in the nation overall who have dropped out of high school (11.3 percent), the percentages of White (10.0 percent) and Asian (1.1 percent) youths who had dropped out of high school were lower, whereas the percentages of American Indian or Alaska Native (23.0 percent) and Hispanic (17.8 percent) youths were higher.
Figure 1. High school dropout status among 12th grade aged youths, by gender and race/ethnicity: 2002 to 2014
Twelfth grade aged dropouts were more likely than 12th grade aged students to engage in current cigarette use, alcohol use, and binge alcohol use (Figure 2). Binge alcohol use is defined as drinking five or more drinks on the same occasion on at least 1 day in the past 30 days, and heavy alcohol use is defined as having this number of drinks on the same occasion on 5 or more days in the past 30 days. Based on combined 2002 to 2014 NSDUH data, 55.9 percent of 12th grade aged dropouts were current cigarette users compared with 20.2 percent of 12th grade aged students. Regarding alcohol use, 41.1 percent of 12th grade aged dropouts were current alcohol drinkers compared with 33.7 percent of 12th grade aged students, and 31.8 percent of 12th grade aged dropouts were current binge drinkers compared with 22.1 percent of 12th grade aged students.
Twelfth grade aged dropouts were more likely than 12th grade aged students to engage in past month illicit drug use, with 31.4 percent of 12th grade aged dropouts using any illicit drugs in the past month compared with 18.1 percent of 12th grade aged students. Illicit drug use is defined as the use of marijuana, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type drugs used nonmedically.14 As the use of marijuana and the misuse of prescription-type psychotherapeutic drugs are the two most common forms of illicit drug use in the United States,15 this report focuses on focuses on these specific substances. These forms of illicit drug use were higher among high school dropouts. For example, 27.5 percent of 12th grade aged dropouts were current marijuana users compared with 15.6 percent of 12th grade aged students. In addition, 9.5 percent of 12th grade aged dropouts were misusing prescription-type drugs compared with 4.6 percent of 12th grade aged students.
Figure 2. Past month substance use among 12th grade aged youths, by dropout status: 2002 to 2014
The pattern of higher past month substance use among 12th grade aged dropouts persisted for both male and female youths. Substance use was more likely among 12th grade aged male dropouts than among similarly aged male students (Figure 3). For example, 12th grade aged male dropouts were much more likely than similarly aged male students to be current cigarette users (59.0 vs. 21.9 percent). There were also higher percentages of 12th grade aged male dropouts than similarly aged male students who were past month alcohol users (45.5 vs. 35.6 percent) or who were binge alcohol users (37.0 vs. 25.6 percent). Illicit drug use was also more likely among 12th grade aged male dropouts than among similarly aged male students. Specifically, 12th grade aged male dropouts were much more likely than similarly aged male students to be current any illicit drug users (35.7 vs. 20.3 percent), to engage in marijuana use (32.3 vs. 18.0 percent), and to engage in nonmedical use of prescription-type drugs (9.7 vs. 4.7 percent).
Figure 3. Past month substance use among 12th grade aged male youths, by dropout status: 2002 to 2014
As shown in Figure 4, differences in past month substance use by dropout status among females were similar to those for males. Overall, substance use was also more likely among 12th grade aged female dropouts than similarly aged female students (Figure 4). Specifically, 12th grade aged female dropouts were much more likely than similarly aged female students to be current cigarette users (51.7 vs. 18.6 percent). With regards to past month alcohol use, 12th grade aged female dropouts were much more likely than similarly aged female students to drink alcohol (35.1 vs. 31.8 percent) and to engage in binge alcohol use (24.6 vs. 18.5 percent). In addition, there were also differences in past month illicit drug use with 12th grade aged female dropouts being more likely than similarly aged female students to engage in any illicit drug use (25.5 vs. 15.9 percent), engage in marijuana use (21.1 vs. 13.2 percent), and engage in nonmedical use of prescription-type drugs (9.1 vs. 4.5 percent).
Figure 4. Past month substance use among 12th grade aged female youths, by dropout status: 2002 to 2014
NSDUH asks a series of questions about race/ethnicity. First, respondents are asked about their Hispanic origin, then they are asked to identify which racial group best describes them: white, black or African American, American Indian or Alaska Native, Native Hawaiian, Other Pacific Islander, Asian, or other. Respondents may select more than one race. This analysis focuses on comparisons between 12th grade aged dropouts and similarly aged students for respondents who were non-Hispanic White, non-Hispanic Black, or Hispanic (Figures 5-7). Estimates of substance use by dropout status are not presented for youth in other racial/ethnic groups because of low precision.
Substance use varied by dropout status among racial/ethnic groups; however, the relationship between high school drop out status and substance use was similar for those youth who were non-Hispanic White and non-Hispanic Black. For example, non-Hispanic White and Black youths who were 12th grade aged dropouts were consistently more likely to engage in past month substance use than their peers who were still in school (Figures 5 and 6). For example, current cigarette use was nearly 3 times higher among non-Hispanic White dropouts than among non-Hispanic White students (68.4 vs. 24.3 percent). Similarly, the percentage of non-Hispanic Black dropouts who were current smokers was also higher than the percentage of smokers among non-Hispanic Black students (47.5 vs. 10.7 percent). By contrast, substance use did not differ significantly between 12th grade aged Hispanic dropouts and those who were still in school, with the exception of cigarette use (36.9 percent among dropouts vs. 16.6 percent among students) and binge alcohol use (26.7 percent among dropouts vs. 20.8 percent among students) (Figure 7).16
Figure 5. Past month substance use among 12th grade aged White youths, by dropout status: 2002 to 2014
Figure 6. Past month substance use among 12th grade aged Black youths, by dropout status: 2002 to 2014
Figure 7. Past month substance use among 12th grade aged Hispanic youths, by dropout status: 2002 to 2014
Dropping out of high school is related to many negative socioeconomic and health outcomes.4,5,6,7,8,9 According to combined 2002 to 2014 NSDUH data, an annual average of about one in nine 12th grade aged youths drop out of high school. This report shows that 12th grade aged dropouts (with a few exceptions) were more likely than similarly aged youths who were still in school to have used various substances in the past month (e.g., cigarettes, alcohol, binge alcohol use, marijuana, nonmedical use of prescription-type drugs, any illicit drugs). The NSDUH data are not suited for determining whether a youth's substance use preceded dropping out of high school or developed after dropping out. Regardless, this report indicates that youth who have dropped out of high school have an elevated risk of substance use.
Substance use is a preventable public health issue. Prevention efforts targeted to youths and to those at risk of dropping out of high school might improve youths' future educational, employment and financial, and health outcomes. Continuing efforts are needed to educate youths, parents, teachers, physicians, service providers, and policymakers about youth substance use. For more information on addressing substance use, the Substance Abuse and Mental Health Services Administration and the National Institute on Drug Abuse have developed several educational resources on substance use for youths, parents, and other adults, including the following:
14. From 2002 to 2014, the NSDUH defined nonmedical use as the use of prescription drugs without a prescription of the individual’s own or simply for the experience or feeling the drugs caused.
15. Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf
16. The sample size from other racial/ethnic subgroups does not allow examination of differences in their prevalence of substance use by dropout status.
Tice, P., Lipari, R.N. and Van Horn, S. L. Substance use among 12th grade aged youths, by dropout status. The CBHSQ Report: August 15, 2017. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.