Young America is in crisis, depicts a new Centers for Disease Control and Prevention (CDC) report on teenage mental health and behaviors. Mental health concerns and suicidality are increasing, while sexual activity and drug use are falling overall—but also getting riskier. Addressing this will require a new approach to meeting young people’s needs, with harm reduction a potent strategy.
The CDC’s Youth Risk Behavior Survey is released every two years. It covers a nationally representative sample of public and private high school students, while also breaking down stats by gender, sexual orientation, race and ethnicity.
To focus on the substance-use section, high schoolers are consuming less alcohol and cannabis. Current drinking, in particular—”current” is defined as having used in the past 30 days—has shown a pronounced, steady decline from 39 percent of respondents in 2011 to 23 percent in 2021, the year to which the new survey applies. Current cannabis use fell from 22 percent in 2019 to 16 percent in 2021, refuting claims from some opponents of legalization that its spread would increase youth use.
The figure for students who have ever used an illict drug has now remained steady at 13 percent for four surveys in a row, having stood at 19 percent in 2011. Current non-prescribed use of pharmaceutical opioids has also remained about the same, at 6 percent.
Current use of vaping products (this includes vaping of cannabis and other substances, as well as nicotine), has meanwhile jumped around in the past few surveys—going as low as 13 percent in 2017 and as high as 33 percent in 2019. The figure given for 2021 is 18 percent. While the CDC frames this as “concerning,” in the case of nicotine, vapes are harm reduction tools. Research has suggested that teens who vape nicotine would be smoking instead if vapes weren’t available; teen use of deadly cigarettes is now extremely low.
This brutal reality of steady rates of use but increased risk of death points to an obvious strategy: teaching harm reduction to children and young people.
Demographically, girls and LGBTQ-identifying students were found to be more likely to be using substances overall. Black and Asian students were less likely than other racial groups to have ever used drugs. White students were the likeliest to currently drink alcohol, while Black students were likeliest to currently use cannabis. Black, Hispanic and LGBTQ students were likeliest to be currently using non-prescribed pharmaceutical opioids.
Despite static trends for opioid and other drug use, we also know that youth overdose deaths have been surging. From 2019-2020, such fatalities doubled, and they continued to rise in 2021. So rates of drug use are not the key issue. As Morgan Godvin wrote for Filter, “Instead, the problem is that illicitly manufactured fentanyls have turned the drug supply into a minefield.”
This brutal reality of steady rates of use but increased risk of death points to an obvious strategy that is nonetheless still often considered controvsial: teaching harm reduction to children and young people.
Many schools nationwide already teach a form of harm reduction—we call it “sex education,” and even that has become a “culture war” political battleground. But the basic premise of teaching children about condoms, other forms of contraception and sexually transmitted diseases—instead of “abstinence only” messaging—has buy-in from most reasonable parents. Why we don’t apply these principles to drug education in schools is a question increasingly being asked in recent years.
In 2022, researchers published a study that looked at a harm reduction education pilot program in public schools in New York City and San Francisco. A sample of first-year high school students participated, using the “Safety First” curriculum developed by the Drug Policy Alliance. The program consists of 15 lessons of 45-60 minutes.
The study results showed, unsurprisingly, that this program increased students’ knowledge of harm reduction practices. But the students were also less likely to choose to use drugs after going through these classes, especially cannabis and prescription drugs. Students additionally learned about inequalities caused by drug policies and how they hurt people differently based on income, race and gender—becoming more likely to advocate for reforms to these laws.
“Substance-use education is driven strongly by ideological perspectives and not necessarily evidence.”
Other research has also shown benefits from teaching youth about harm reduction. In 2019, University of British Columbia and University of Calgary researchers interviewed 83 teenagers about their attitudes to drug education. Youth were more likely to “tune out” abstinence-only and zero-tolerance messaging, because it didn’t help those who were either already using drugs themselves or had loved ones who used.
“Youth were more receptive when their parents talked–in a non-judgmental way–about substance use or could point to resources or strategies to help minimize the harms of use,” said study coauthor Emily Jenkins at the time. “This approach seemed to work better in preserving family relationships and youth health.”
In Canada, “we struggle with similar problems [to the US] where substance-use education is driven strongly by ideological perspectives and not necessarily evidence, so we continue to have a lot of outdated education that’s abstinence-based or fear-based,” Jenkins, a UBC nursing school associate professor, told Filter.
“When I say that harm reduction really resonated with youth across different contexts and identities, what they were telling us is that too much leniency from adults in their life isn’t helpful, and on the other end shutting down opportunities to talk about substance use and a ‘just say no’ approach was also unhelpful,” she continued. “What they really want is the opportunity to talk with trusted adults in their life about substance use and decision-making.”
Fewer young people are having sex but of those who do, more are having unsafe sex.
The new CDC survey gave other important insights into teen mental health and behaviors. In 2021 compared with 2011, fewer students reported lifetime or current sexual activity, and fewer had had multiple sexual partners. But the proportion of youth using condoms decreased, and fewer are being tested for HIV and other STDs. Put simply, fewer young people are having sex but of those who do, more are having unsafe sex.
Young people are also at increased risks of violence. More students are missing school because they don’t feel safe, and more have experienced lifetime sexual violence—with girls and LGBTQ, Black, Hispanic and Indigenous youth being hurt the most. And mental health and suicide metrics are getting worse, with 22 percent of students seriously considering suicide in 2021.
It all points to an overall reality of worsening health and life outcomes for young people, with severe disparities based on gender, sexual orientation, and race or ethnicity. Harm reduction—with its emphasis on evidence, empowerment, equity, and meeting people’s needs while respecting their agency—is desperately needed.
Photograph by ThoseGuys199 used via Flickr/Creative Commons 2.0.