Epidemiology of substance use in adolescence: prevalence, trends and policy implications

This paper reviews the epidemiology of substance use among adolescents. The re is a public health imperative in all countries to assess the population rates of tobacco, alcohol and illicit drug use among adolescents. In additi on, monitoring trends over time may reflect the net effects of activities a nd programs carried out to prevent adolescent substance use. School based s urveys provide prevalence estimates of substance use, but do not capture st reet and homeless youth and other high risk adolescents not found in the sc hool environment. Overall, the results of this review suggest that tobacco, hazardous alcohol use, and most categories of illicit drug use have shown consistent increases in prevalence since about 1990 in most developed count ries, for school-based adolescents, suggesting that the substance use probl em among adolescents remains unsolved. These trends are remarkably similar across substance use behaviours, and among most developed countries, althou gh limited data has emanated from adolescents in the developing world. Inte rventions to reduce or prevent substance use have shown mixed results, with those focusing on the adolescents' social environment showing the most pro mise. Broader public health approaches, including the linkage to community- wide prevention, and greater enforcement or regulatory and legislative appr oaches to tobacco and alcohol access are future directions for research and practice. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.