Minnesota Title V MCH Needs Assessment Fact Sheets

Children and Adolescents

Substance Use: Alcohol, Tobacco and Other Drugs

September 2004

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Size of the Problem

Young people are living in a world in which alcohol, tobacco and other drugs are readily available. They are surrounded by messages that glamorize chemicals, and community norms that give the message that use of alcohol and tobacco is a normal part of adolescence. Together, these influences have a significant impact on the use of alcohol, tobacco and other drugs by youth [1].

In 2001, 30 percent of 9th graders and 52 percent of 12th graders in Minnesota reported consuming alcoholic beverages on at least one occasion in the past 30 days [2].

In 2002, 34 percent of high school students and 11 percent of middle school students used any tobacco product in the past 30 days [3].

In 2001, 14 percent of 9th graders and 22 percent of 12th graders reported using marijuana in the past 30 days [2].


The use and abuse of alcohol, tobacco and other drugs by Minnesota adolescents causes problems that are pervasive and have a significant affect on their health and development. It contributes to chronic disease, injuries, violence, unsafe sexual behavior, unplanned pregnancy, decreased productivity, social and family disruption, lack of educational attainment, medical and insurance costs, and costs for treatment and law enforcement.

Minnesota 12th graders are drinking at a slightly higher rate than 12th graders nationally (52 percent vs. 50 percent) [4].

In 2001, 16 percent of 9th graders and 32 percent of the 12th graders in Minnesota reported binge drinking, consuming 5 or more drinks in a row, in the past 2 weeks [5].

In 2001, 33 percent of 12th graders in Minnesota reported driving a motor vehicle after using alcohol or drugs [2].

Twenty-five percent of 9th graders and 43 percent of 12th graders reported riding with a friend who has been drinking or using drugs [2].

People who begin drinking before the age of 15 are four times as likely to develop alcohol dependence and more than twice as likely to develop alcohol abuse than those who delay drinking until age 21 [6].

Minnesota’s overall rate of tobacco use is equal to or slightly higher than the national average [7].

While Minnesota ranks 6th lowest in the nation for adult smoking, it ranks 20th in the nation for youth smoking.

Cigarettes are by far the most commonly used tobacco product, with 29 percent of high school students and 7 percent of middle school students smoking cigarettes on one or more days in the past 30 days [8].

One of every eight high school students smoked cigars and 10 percent used smokeless tobacco in the 30-day period before the survey [8].

Economic Loss
The human and economic costs associated with alcohol use in 2001 amounted to an estimated $4.5 billion. This amounts to over $900 per person in Minnesota [9].

A national study based on 1992 data, found that much of the economic burden of alcohol abuse is borne by segments of the population other than the alcohol abusers themselves. About 45 percent of the estimated total costs were borne by alcohol abusers and their families, almost all of which was due to lost or reduced earnings. About 20 percent was absorbed by the Federal government and 18 percent by the State and local government. About 10 percent was absorbed by private insurance and 6 percent by victims of alcohol-related crimes and by non-drinking victims of alcohol-related motor vehicle crashes [10].

Tobacco use is the leading cause of preventable death and disease in Minnesota and is a huge economic burden on the state.

  • About $363 million in Medicaid expenses are spent on tobacco related illness – up from $189 million in 1993.
  • The state loses $2.6 billion annually from health care expenditures and lost productivity caused by tobacco related illness [11].

Unless youth smoking rates are reduced, Minnesotans can anticipate even larger human and financial consequences from tobacco use in the future. MDH projects that as many as 112,085 youth are projected to die if the 2000 smoking rate remains constant. This is a 15.6 percent increase since 1993 projections [11].

Racial/Ethnic Disparities
Among 9th graders in Minnesota, more American Indian and Hispanics report drinking in the past 30 days (41 percent and 38 percent respectively) than Asian, African American or Caucasian 9th graders (21 percent, 26 percent and 31 percent respectively) [12].

Between 1998 and 2001 smoking rates decreased in all racial ethnic groups; however, American Indian and Latino youth continue to have the highest rates of cigarette use. In 2001, 29 percent of Latino and 36 percent of American Indian 9th graders reported smoking during the past 30 days. This compares with 19 percent for Caucasian 9th graders, 17 percent for African American 9th graders, and 16 percent for Asian 9th graders [13].


Research on the social environment of young people identifies key risk factors that encourage alcohol, tobacco and other drug use. The careful targeting of these risk factors—on a community wide basis—has proven successful in preventing the onset and development of use among young people [14]. These communitywide efforts include:

  • Alcohol and tobacco tax increases,
  • enforcement of minors' access laws,
  • youth-oriented mass media campaigns,
  • school-based prevention programs.

Interventions can and must take place throughout the community. Parents, schools, law enforcement, judiciary, faith communities, health care providers, park and recreations departments, employers and others all play an important role intervening on youth alcohol, tobacco and other drug use. Not only do all these sectors need to be involved, they also must deliver congruent and consistent messages.

Communities and establishments that adopt non-smoking policies reinforce the message that smoking is not acceptable and encourages current smokers to quit or cut down.

Among the possible interventions [15]:

Parents – Parental interventions are most effective when their children know that they will not tolerate alcohol, tobacco and other drug use and will take action should it occur.
Research shows that young people who are exposed to smoking at home or in public settings are more likely to smoke as adolescents.

School Interventions – Schools must consistently enforce policies on alcohol, tobacco and other drug use for adults as well as students.

MN Chapter 691 requires communication between law enforcement/prosecutors and schools. If a student is charged with an alcohol or other drug violation anywhere in the state, the law enforcement agency or prosecutor is required to notify the student’s school. The law also requires the school to have a pre-assessment team investigate and make recommendations. In addition the schools can intervene by enforcing their own policies and State High School League rules if the student is involved in sanctioned activities.

Law Enforcement Interventions – Besides following the law requiring communication with schools, proactively enforcing laws pertaining to youth alcohol, tobacco and other drug use is a proven effective intervention.

Judiciary Interventions – Judicial interventions have been proven to be most effective when they are timely and the consequences are appropriate.

Faith Communities – Faith communities play an important role when they raise the issue of youth use as well as intervening and providing support and referrals when appropriate.

Health Care Providers – Health care providers are most helpful when they screen patients about their use and provide brief interventions and referrals when appropriate.

Parks and Recreation – Park and recreation departments can adapt and enforce policies similar to school policies for youth who participate in activities. Substance-free parks are also beneficial policies.

Employers – Employers of youth can reinforce messages about youth use. They also can be effective when they take action with an employee who is using alcohol, tobacco or other drugs.


There is growing community support to address underage alcohol, tobacco and other drug use. Some estimate that every dollar of prevention saves seven dollars.

The Minnesota Department of Health, through its Chemical Health Promotion and Tobacco Control Programs, has been providing statewide leadership, consultation and technical assistance for population-based chemical health promotion to local public health partners and others since. An infrastructure has been created with effective communication systems and excellent working relationships with other state agencies, local public health and other community-based organizations. As a result, a public health approach to substance abuse prevention utilizing assessment, planning, implementation and evaluation has become the standard for many community-based organizations throughout the state.

The Tobacco Prevention and Control Program currently administers $3.4 million in Tobacco-Free Communities grants for locally driven tobacco prevention activities. Twenty-one grants were awarded to organizations to create tobacco-free environments and reduce youth tobacco use by 25 percent by 2005.

The 2003 Legislature designated $3.4 million in tobacco prevention funding for community-based initiatives. This funding replaces the Tobacco Endowment, which previously funded the Minnesota Youth Tobacco Prevention Initiative.

Local public health agencies, community coalitions and other groups have gained experience using population-based health promotion strategies to address alcohol, tobacco and other drugs. They have built relationships and established credibility in their communities and are demonstrating competence at implementing population-based approaches.

Minnesota organizations and groups using public health approaches to substance abuse prevention have applied for and been awarded Minnesota Department of Human Services Chemical Health grants as well as OJJDP grants from the Minnesota Department of Public Safety and grants from other agencies and organizations.

Substance use and abuse by adolescents has been identified as a federal priority with numerous Healthy People 2010 Indicators addressing youth use of alcohol and other drugs. Minnesota has also identified alcohol, tobacco and other drug use as a public health priority under the Healthy Minnesotans 2004 goal of “reducing the behavioral risks that are primary contributors to morbidity and mortality.

The National Initiative to Improve Adolescent Health by the Year 2010 has identified alcohol/drug-related motor vehicle fatalities and injuries, riding with a drinking driver, binge drinking, tobacco use and use of marijuana as five of their 21 critical objectives to improve adolescent health by the year 2010.


1. Minnesota Department of Health. (2003). Being, belonging, becoming: Minnesota’s adolescent health action plan. St. Paul: Minnesota Department of Health.
2. Minnesota Departments of Education and Human Services. 2001 Minnesota Student Survey. Online resource: www.mnschoolhealth.com/resources.html?ac=data [Attn: Non-MDH Link
3. Minnesota Department of Health, Center for Health Statistics. (2002). Teens and tobacco in Minnesota: Summary of results from the MYTS.
4. Johnston, L., O’Malley, P. & Bachman, J. (2002). Monitoring future national results on adolescent drug use: Overview of key findings, 2001. NIH Publication No. 02-5105. Bethesda, MD: National Institute on Drug Use.
5. Minnesota Department of Education. Minnesota student survey: Key trends through 2001. Minnesota Department of Education.
6. Grant, B. & Dawson, D. (1997). Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence. Journal of Substance Abuse, 9: 103-110.
7. Minnesota Department of Health, Center for Health Statistics. (2000). Teens and tobacco in Minnesota: Results from the Minnesota Youth Tobacco Survey.
8. Minnesota Department of Health, Center for Health Statistics. (2002). Teens and tobacco in Minnesota: Summary of results from the MYTS.
9. Minnesota Department of Health. (2004). Fact sheet: The human and economic cost of alcohol use in Minnesota.
10. National Institute on Alcohol Abuse and Alcoholism. (2000). 10th special report to the U.S. Congress on alcohol and health. U.S. Department of Health and Human Services.
11. Minnesota Department of Health. (2002). The human and economic costs of tobacco in Minnesota fact sheet.
12. Minnesota Department of Health Community Health Division, Center for Health Statistics. (2003). Adolescent health among Minnesota’s racial/ethnic groups: Progress and disparities. Population Health Assessment Quarterly, 4(1).
13. Minnesota Department of Health, Center for Health Statistics. (2003). Adolescent health among Minnesota’s racial/ethnic groups: Progress and disparities. Population Health Assessment Quarterly, 4(1).
14. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994.
15. See additional strategies online at: www.health.state.mn.us/divs/hpcd/chp/alcohol/overview.html