In 1975, the National Institutes of Health (NIH) and the National Institute on Drug Abuse (NIDA) funded a comprehensive nationwide survey of nicotine, alcohol, and drug use among high school students, college students, and young adults in the U.S. Conducted by researchers at the University of Michigan, the Monitoring the Future Survey (MTF) began with high school seniors and added eight and tenth graders in 1991. Over fifty-thousand students and young adults each year answer detailed questionnaires about their nicotine, alcohol, and drug use. The survey also includes questions about their attitudes towards nicotine, alcohol, and drug use.

In a typical year, students complete the MTF survey between February and May. In 2020, however, due to the coronavirus pandemic, researchers stopped the data collection process in mid-March. Despite the early cut-off date, they obtained data from 11,821 students in 112 schools, which is roughly a quarter of the standard MTF sample size. Nevertheless, that number satisfies the statistical criteria that for a nationally representative data set, which means that it contains sufficient information for scientists and the public to draw evidence-based conclusions on the state of nicotine, alcohol, and drug use among high school students, colleges students, and young adults in the U.S.

In this article we’ll recap the highlights and key findings. We’ll dig deeper in subsequent articles, but for now, we’ll offer the data the MTF team identified as noteworthy.

Vaping Nicotine Stabilizes After Three-Year Upward Trend

There’s good news in this year’s MTF. After three years of steady increase, rates of nicotine vaping among high school students leveled off. In response to the early data collection cutoff, the MTF team pooled data on daily nicotine vaping from 10^th and 12^th graders for the years 2017-2020. With the new data set, they analyzed trends in daily, past month, past 12 months, and lifetime use of nicotine vaping products.

Here’s what they found.

Nicotine Vaping: 10^th and 12^th Graders, 2017-2020

• 2017:
  • Daily: n/a
  • Past Month: 8%
  • Past Year: 17%
  • Lifetime: 23%
• 2018:
  • Daily: n/a
  • Past Month: 18%
  • Past Year: 27%
  • Lifetime: 31%
• 2019:
  • Daily: 9%
  • Past Month: 22%
  • Past Year: 32%
  • Lifetime: 39%
• 2020:
  • Daily: 7%
  • Past Month: 21%
  • Past Year: 31%
  • Lifetime: 41%

Let’s clarify the data for lifetime nicotine vaping between 2019-2020. Although the raw numbers indicate an increase overall, this increase is within the margin of error, and represents a clear leveling off with regards to the prevalence of use. Lifetime use rose from 23% to 31% from 2017 to 2018, rose again from 31% to 39% from 2018 to 2019, but increased only 2% between 2019. Follow along with this sentence: the rate of increase decreased from around 7%-8% per year to around 2% per year. That’s good news – as is the decline in daily vaping from 9% to 7% between 2019 and 2020.

Perceived Harm from Vaping: More Positive News

Along with this encouraging prevalence data, the 2020 MTF indicates another change that supports the conclusion that vaping rates among high schoolers have stabilized: the percentage of 10^th and 12^th graders who understand the harm that vaping can cause.

Here’s that data.

Percentage of 10^th and 12^th Graders Who Perceive

“Great Harm” From Vaping

• 2017:
  • Occasional Vaping (great harm): 16.7%
  • Regular Vaping (great harm): 28.6%
• 2018:
  • Occasional Vaping (great harm): 16.9%
  • Regular Vaping (great harm): 29.7%
• 2019:
  • Occasional Vaping (great harm): 20.9%
  • Regular Vaping (great harm): 39.0%
• 2020:
  • Occasional Vaping (great harm): 27.2%
  • Regular Vaping (great harm): 49.3%

These numbers might represent greater cause for optimism than the stabilization seen in the rates of use, because they mean that awareness and prevention campaigns appear to work. While the MTF did not ask students why they perceive great risk in vaping nicotine, we can assume – cautiously, of course – that public health campaigns about the health dangers of vaping nicotine made a positive impact on both their attitudes and behavior.

2020 MTF: Additional Highlights

We’ll start this section with the not-so-great news:

• Alcohol use has leveled off after a gradual decline over the past five years
• Amphetamine use among 8^th graders increased from 3.5% to 5.3% between 2017 and 2020
• Inhalant use among 8^th graders increased from 3.8% to 6.1% between 2016 and 2020
• Use of over-the-counter cough medicine (other than as directed) increased from 1.6% to 4.6% between 2015 and 2020

While the increase in amphetamine, inhalant, and over-the-counter cough medicine is numerically small, the proportional increase is notable: a 52% increase in amphetamine use, a 64% increase in inhalant use, and a 187% increase in the use of over-the-counter cough medicine. What these numbers tell us is that we need to redouble our awareness and prevention efforts – with a focus on these three areas – in our middle school population.

Now we’ll move on to the we’ll-take-it-but-could-be-better news:

• The percentage of high school students who report using drugs in the “other” category, such as LSD, synthetic cannabinoids, cocaine, and ecstasy has not declined but remains low.
• After a two-decade trend of steady decrease, rates of cigarette smoking leveled off.
• The prevalence of marijuana use did not change in a statistically significant way between 2019 and 2020.
• Prevalence of alcohol use leveled off after a long, gradual decline.

The only thing we’d like to note here is that marijuana is the most commonly used drug among high school students in the U.S. After a nearly two-decade decline beginning in the late 90s, marijuana use has increased gradually since 2015. The positive is that prevalence did not increase between 2019 and 2020, whereas the negative is that it did not decline: it’s still the most commonly used drug among U.S. high school students.

What the Data Mean: The Big Picture

Our overall takeaway from the 2020 MTF is realistically optimistic. We’re optimistic in that the steep upward trend in nicotine vaping finally leveled off: that’s good. We hope data from the 2021 MTF confirms this trend. With schools moving toward in-person teaching as the worst of the pandemic appears to be either behind us or almost behind us, a larger data set in 2021 will help researchers validate this finding.

On the other hand, we’re realistic in that the vaping rates still concern us. A jump from 23% to 41% lifetime prevalence between 2017 and 2020 is nothing to cheer about. We’re also concerned that the rates of marijuana use have not begun to decline – but we can work on that.

On a positive note, the leveling off of vaping prevalence tells us that awareness and prevention efforts around vaping appear to work. We can apply this template – a full court press, as it were, from school, civic, and community leaders – to marijuana, alcohol, and other drugs with the hopes that we can reduce overall use among teens. Since the prevalence of inhalant and cough syrup use for 8^th graders increased between 2019 and 2020, we think that’s a great place to start. We can leverage what we know from vaping prevention campaigns to change the trajectory of our rising, at-risk high schoolers, and help them grow into the teenagers and young adults they want to be.

Please keep your eye on this blog for more news from the 2020 MTF.