Case Study: Reducing Youth Substance Use in Charlotte, NC
The challenge
Youth substance use is associated with both short- and long-term health risks across the life course for a variety of substances:
Alcohol: Prior research has shown that alcohol use among youth is associated with high risk behaviors, risk of overuse/overdose, and is a primary contributor to the main causes of death in youth (motor vehicle crashes, homicide, and suicide).
Marijuana: Despite changing public attitudes and legislation about marijuana use, research indicates that marijuana use is associated with short-term health risks including impaired memory, judgement, and coordination, as well as long-term risks of addiction, altered brain development, cognitive impairment, and poor educational outcomes.
E-Cigarettes and Prescription Drugs: There are also increasing concerns about health risks related to the rise in youth e-cigarette use and non-medical use of prescription drugs.
30-day substance use trends in Mecklenburg County, North Carolina, from 2002-2020, as reported in the 2020 YDS.
One of the best strategies for addressing youth substance use is to take a preventative approach. But critical to a preventative approach is an understanding of the problem – not just among individuals, but at the population-level within a community.
The Center for Prevention Services (CPS) has been working in the Charlotte community for decades to reduce youth substance use. Since 1972, they’ve used the Youth Drug Survey to track substance use behaviors so as to better understand this challenge and target resources and programs to reduce youth substance use. However, CPS wanted to make new changes to the survey, including modifying survey questions, generating custom reports, and launching the survey for the first time fully online and capturing a larger sample of students for analysis.
In 2017, the Center for Prevention Services started working with Common Good Data to address these new needs. The first report was released in 2018, the second in 2020, with new reports forthcoming for Mecklenburg County every two years. The 2018 and 2020 surveys include responses from thousands of youth in 6th, 8th, 10th, and 12th grades across a large and culturally and linguistically diverse metropolitan school district.
Fabbiana Gutierrez moderating a panel at a presentation of Latino substance use data hosted by the Alianza coalition.
In addition, Common Good Data is supporting the data and evaluation needs of the Aliana Coalition, a Drug-Free Coalition in the Charlotte area committed to reducing Latino substance use. In addition to working with coalition leaders to collect, analyze, and report data on Latino substance use in Mecklenburg County, Common Good Data is supporting program design and implementation efforts with coalition members.
What we achieved
The data from the 2020 report illuminated key differences in the local conditions compared to available national data on substance use patterns in youth, underscoring the importance of collecting population-level data at the local level. The report found:
Alcohol emerged as the primary substance used by youth, with 14.3% of youth in grades 6, 8, 10, and 12 reporting using alcohol in the past 30 days.
Gender emerged as an important predictor in the type of alcohol used. Youth who identified as male were more likely to choose beer, youth who identified as female were more likely to choose liquor/mixed drinks, and youth who identified as other were more likely to choose wine/wine coolers.
Of all the alcohol types, liquor/mixed drinks were the main type of alcohol used by youth.
30-day use of traditional cigarettes is at an all-time low (2.7%), though the rate of e-cigarette use (11.7%) remains high, particularly among White high school youth (27.1%).
In general, rates for use of cigarettes, alcohol, and opioids without a prescription were lower in comparison to state and national averages, though rates for use of marijuana and e-cigarettes were higher than national averages.
For the first time, the YDS captured more detailed race and ethnicity data, including categories for youth identifying as Hawaiian/Pacific Islander and Middle Eastern. Both groups were at risk for use of particular substances, pointing to potential new areas for prevention.
When comparing racial and ethnic differences in substance use patterns, White youth were particularly at risk for e-cigarette, cigarette and alcohol use in comparison to their peers.
30-day use for prescription drug use without a prescription remained constant across middle and high school grade levels, suggesting use does not increase with age. 5
When examining risk and protective factors, parents, peers, norms, and access were all factors that can help explain youth substance use. In general, peers emerged as important predictors of cigarette and e-cigarette use, parents played important roles for alcohol use, and both peer and parental approval played a primary role in use of marijuana.
How we did it
Obtaining population-level data from a large metropolitan school district requires thoughtful planning and careful work. With the 2018 and 2020 surveys, Common Good Data worked with the Center for Prevention Services to:
Use the SAMHSA Strategic Prevention Framework to develop logic models with the Alianza Drug Free Coalition to identify and track key indicators related to cultural norms, access, and other factors related to substance use
Revise the existing Youth Drug Survey questionnaire and launch the survey for the first time fully online, reaching a sample population of over 10,000 students.
Design research protocols that received approval from an external Institutional Review Board and the school district research office, ensuring that the survey was conducted in a manner that included strong protections for research human subjects.
Implement the survey over 60+ schools in the school district
Present the data at a release event.
Publications
The results of the survey were disseminated to the public to inform local practitioners and substance use prevention leaders across the county on key substance use trends.
The data were also cited in two articles from the Charlotte Observer:
· Why Charlotte youths smoke less but use e-cigarettes and marijuana more
· In no time, addictive e-cigarettes have sucked our kids in
Next steps
The work of the first YDS in 2018 and second in 2020 is only the beginning. Since the launch of the first survey, Common Good Data has worked with the Center for Prevention Services to:
Launch the 2020 survey with updated questions and detailed sub-group data to collect some of the strongest data on the substance use behaviors of often under-researched groups, including Middle Eastern youth as well as within-group analyses of Latino (e.g. Mexican, Puerto Rican, Cuban, and others) and Asian (Chinese, Indian, Japanese, Filipino, and more) youth. Results forthcoming.
Earn 1.2M in grant funding for the five-year, SAMHSA-funded Partnership for Success grant to address the opioid crisis in Stanly County, NC. Common Good Data will support the Center for Prevention Services with this grant in evaluation and reporting, including launching for the first time the YDS in Stanly County and leading the evaluation of the Botvin Life Skills Training program.
Conduct a program review of the Alianza Coalition’s Youth programs and support new evaluation initiatives of the evidence-based program Familia Adelante.
We are excited to partner with the Center for Prevention Services to bring data-driven approaches to prevention work throughout the Charlotte Community.