One of the main prevention strategies used by Maryland schools is the presentation of factual information to students in kindergarten through grade 12 that details the potential harmful effects of alcohol, tobacco, and other drug use. Students in grades 6, 8, 10, and 12 were asked to respond to 18 multiple choice items designed assess their knowledge of alcohol, tobacco, and a number of other drugs. Items selected were used in the four previous administrations of the MAS and thus, provide an opportunity to examine trends in students’ information mastery over time.

Table 7.1 provides a comparison by grade of 1998 performance with past accomplishment to these questions. Analysis of the number of items correctly answered by at least 75% of the students shows a decline in three items for tenth graders and a decline in one item for twelfth graders. Both sixth and eighth graders’ scores did not change from 1996 to 1998.

When the mean scores of students are compared, there is a small decline in scores from 1996 to 1998. The decline is greatest for tenth graders, representing a 0.9 point decline. Sixth graders represented the smallest decline (0.4 point) while eighth and twelfth graders both showed a 0.5 point decline.

Table 7.3 on the following page shows the percent of correct responses to each of the 18 knowledge questions for each grade. Generally, the percentage of students who gave a correct response to each question increased at each grade level, with one exception. For the item on the effects of long-term marijuana use, there was a slight decrease in the percentage of tenth grade students (85.4%) who answered this item correctly compared to the percentage of eighth grade students (85.9%). For all other knowledge questions, the percent of students giving correct responses increased with grade.

Two of the knowledge questions posed challenges for students across all grade levels. The item that asked students to "identify the drugs that slow down all body organs, including the heart", was the question answered incorrectly most frequently by sixth and eighth graders (72% sixth graders incorrect and 54% eighth graders incorrect). It was also the second most incorrectly answered question by tenth graders and third most incorrectly answered question by twelfth graders. Another question answered incorrectly across all grade levels was knowing that "a desire to continue taking a drug because of emotional reasons" was called psychological dependence. This item was the second most frequently missed item by sixth and eighth graders, third most frequently missed item by tenth graders, and fourth most frequently missed item by twelfth graders. The question with the most number of incorrect responses for tenth and twelfth graders was "what was the most abused drug"; 43.2% of tenth graders incorrectly answered this question while 28.3% of twelfth graders incorrectly answered this question.

When the results from analysis of the knowledge questions are compared to 1996 survey data, it can be seen that generally the percentage of students who correctly answered a knowledge question decreased across items and across grades. Sixth graders were most likely to have shown improvement or have shown no change in their scores from 1996 to 1998. Sixth graders improved one percentage point for three items: "barbiturates and alcohol taken together may cause coma or death"; "use of inhalants can cause brain damage or death"; and "the body system that is most interfered with when drinking alcohol is the brain and nervous system". Sixth graders showed no change in the percent who correctly answered "a desire to continue taking a drug because of emotional reasons is called" (psychological dependence) and for the item "if someone you know has taken an overdose of downers you should" (call emergency number 911 and keep the person awake). For eighth graders, two items showed improvement of at least one percentage point from the 1996 survey. These items were: "one of the effects of long-term marijuana use is that it" (slows down` social growth and learning) and "the first offense for possession of marijuana in Maryland for a person 18 or older can lead to" (a fine and jail sentence). Twelfth graders improved their scores by at least one percentage point on only one item: "use of inhalants" (can cause brain damage or death). Tenth graders did not show improved scores for any knowledge items in 1998 when compared to 1996 scores.

Prevention education, in part, is based on the findings of previous research which has shown an inverse relationship between perceptions of the dangerousness of substances and their use. The MAS solicited respondents’ perceptions of the dangerousness of using eight different substances. Respondents were asked to indicate whether they considered each substance to be very dangerous, dangerous, slightly dangerous, or safe.

Data on the proportion of Maryland’s eighth graders who believe the surveyed substances are very dangerous show that more than three-quarters of this population feel injections of illegal drugs (89.1%), crack (84.2%), and inhalants (79.1%) are very dangerous. Marijuana is rated as very dangerous by 70.6% of surveyed eighth graders. Fewer than half of the eighth grade respondents rated liquor (44.1%), smokeless tobacco (41.5%), cigarettes (34.3%), and beer (30.3%) as very dangerous.

Data were analyzed for both user and nonuser populations. Not surprisingly, nonusers are more likely to perceive substances as "dangerous" and "very dangerous" than their substance-using peers. Figure 7.1 shows that among eighth grade survey respondents who had tried beer/wine/wine coolers, 13.5% found them "very dangerous" compared to 39.0% who had not tried them. On the other end of the scale, 15.8% of users thought them safe to drink while only 2.4% of nonusers thought them safe to drink. Similar differences are seen between eighth grade users and nonusers of liquor (Figure 7.2). Only 19.0% of liquor users found liquor "very dangerous" while half (49.6%) of nonusers found using liquor to be "very dangerous". Figure 7.3 presents the perceived danger of using cigarettes by eighth grade users and nonusers while Figure 7.4 presents the perceived danger of using marijuana for these youth. In Figure 7.3, one sees that 42.2% of nonusers of cigarettes found cigarettes to be "very dangerous" while only 14.4% of users indicated they were very dangerous. It is interesting to note that more than three-fourths (76.6%) of nonusers of marijuana perceived the drug to be "very dangerous" while in contrast only one-quarter of users (24.3%) found marijuana to be "very dangerous". Across all drugs, this represented the largest number of nonusers who perceived the drug to be "very dangerous".

*Pie charts do not always add to 100% due to rounding and deletion of multiple responses

When the findings presented in Figures 7.1 through 7.4 are compared to 1996 survey data, it can be determined that overall, the percentage of eighth grade students who found drugs very dangerous, slightly dangerous, or dangerous decreased for both users and nonusers across all substances. There were, however, a few exceptions. A full percentage point more of eighth grade nonusers indicated they found beer/wine/wine coolers "very dangerous" in 1998 than in 1996 while almost a full percentage point more of nonusers found liquor to be "dangerous" in 1998 than in 1996. For cigarettes and marijuana, there were gains in the user population. A full percentage point more of eighth grade users of cigarettes in 1998 indicated cigarettes were "very dangerous" than in 1996. The biggest change between 1996 and 1998 data was for marijuana users¾ only 21.4% of marijuana users indicated marijuana was "very dangerous" in 1996 while 24.3% of eighth grade marijuana users indicated the drug was "very dangerous" in 1998.

Parents provide the earliest formative influences on children’s values, personal standards, and behavior. Even when teenage peer groups become significant forces in the lives of young people, the potential for parental influence remains strong. The MAS assesses differences in parental behavior reported by sixth, eighth, tenth, and twelfth graders who do and do not use alcohol, tobacco, and other drugs. Eleven items regarding parental behavior, drawn from the following four content domains, were included in the 1998 questionnaire and are presented in the sections following:

• Parental responsibility
• Limits and consequences
• Family activities
• Communication

Across all grade levels and substances, nonusers were more likely to report an adult always makes sure they wake up for school than users of alcohol, tobacco, or other drugs (Table 7.4). The greatest difference between users and nonusers for surveyed sixth graders was between alcohol users and nonusers. Of sixth grade alcohol nonusers, 78.9% indicated an adult always made sure they woke up for school while only 70.5% of alcohol users indicated this occurred. At the eighth grade level, the biggest difference was found among users of other drugs. Only 62.6% of users reported an adult always made sure they woke up for school compared to 71.4% nonusers. For tenth graders, the biggest difference was found between alcohol users and nonusers (55.1% users vs. 61.4% nonusers). For twelfth graders, the biggest difference was between cigarette users and nonusers (47.8% users vs. 54.4% nonusers). It is interesting to note that the smallest difference between users and nonusers across all grade levels was for twelfth graders who used alcohol and those who did not; there was only a 3.9% difference between users and nonusers.

In each grade, nonusers reported more frequently that an adult would always worry if they were late from school of if the adult did not know where they were (Tables 7.5 and 7.6). This relationship was consistent across grades and categories of drugs (alcohol, tobacco, and other drugs). As students aged, the proportion of adults/parents who worried (late from school or did not know where student was) decreased. For instance, 56.1% of sixth grade cigarette users indicated their parents would always worry if they were late from school compared to 73.9% of nonusers. By twelfth grade, 43.4% of cigarette users indicated their parents would worry if they were late from school compared to 56.0% of nonusers. Alcohol users represented the largest group of using students across all grade levels who indicated their parents would worry if they were late from school or their parents did not know where they were.

The survey included three questions focused on the limits parents set for their children. Two items asked respondents if they could change the minds of adults who wished to impose restrictions on their behavior. The third item asked youth if their parents have rules regarding who they may associate with.

Users of cigarettes, alcohol, and other drugs were asked if they could talk their family out of punishing them and if they could change the mind of an adult who says "no" (Tables 7.7 and 7.8). As seen in both tables, more substance users than non-users across all surveyed grade levels indicated they could "always" change the mind of an adult or talk their family out of punishment. Except at the sixth grade level, users of other drugs were slightly more likely than users of cigarettes or alcohol to talk family out of punishment (Table 7.7). Users of other drugs were also slightly more likely to change the mind of an adult to get their way than users of cigarettes or alcohol across all grade levels (Table 7.8).

More nonusers than users in each grade and substance group report that their parents have rules about the people they can be with (Table 7.9). When these data are examined across substances, it can be seen that nonusers of alcohol are more likely to have parents with rules about people they can be with than nonusers of other substances (other drugs or cigarettes); this finding holds true across all grade levels. Not surprisingly, the percentage of users who indicate their parents have rules about the people they can be with decreases as grade level increases; the smallest percentage of respondents indicating their parents have rules is twelfth grade user respondents.

Three survey items focused on communication with adults. Two pertained to communicating with adults regarding personal problems while the third dealt with an adult at home telling respondents not to use alcohol and drugs.

At every grade level, more nonusers of alcohol and drugs indicate they "always" can communicate with an adult when they have problems and that an adult always listens. For users and nonusers of alcohol (Table 7.10), it can be seen that differences between users and nonusers decreases as grade level increases. For users and nonusers of drugs (Table 7.11) this pattern only holds true for talking about problems with an adult.

As with other items, nonuser surveyed students were more likely to indicate an adult always talked about not using alcohol (or drugs) than users across all grade levels. The proportion of students who indicated an adult always talked about not using alcohol or drugs decreased as grade level increased. As might be expected, the difference between users and nonusers decreases as grade level increases. For drugs, however, this pattern does not hold as the difference between users and nonusers increases at the eighth grade level (15.5 percentage points) from that at the sixth grade level (14.3 percentage points). It then continues to drop through the twelfth grade.

Two items on the MAS questionnaire asked students about the frequency of activities that involve all family members. Respondents were asked how often the family ate together and how often they engaged in a weekly activity such as watching a movie together.

As with other similar items in the MAS, more nonusers at all grade levels responded that their families always eat at least one meal together each day (Table 7.12). The number of respondents indicating their families did this remained fairly constant across substances in both the user and nonuser groups. The proportion of students who indicated their family ate together at least once a day declined as grade level increased across all substances as well as users and nonusers.

More nonusers than users say their families shared at least one weekly activity (Table 7.13) and the number of respondents indicating their families shared at least one weekly activity remained fairly constant across substances in both users and nonuser groups. Generally, the percentage of students who indicated their families did this declined as grade level increased with three exceptions. For alcohol nonusers, there was an increase between the percentage of tenth graders (27.8%) and twelfth graders (28.9%) who indicated their families shared at least one family activity. For users of other drugs and cigarette users, there was also an increase between the percentage of tenth graders and twelfth graders who indicated their families shared at least one family activity a week.

Parental Responsibility. With the exception of twelfth grade non-users, there was a decrease from 1996 in the percentages of surveyed students who indicated their parents woke them up for school. For twelfth grade nonusers of alcohol, 1998 data showed an increase of 1.2 percentage points from 1996 for the item an adult always makes sure they wake up for school. The change in twelfth grade nonusers of other drugs was somewhat less¾ 0.8 percentage points between 1996 and 1998. For the measure of adolescents whose parents would always worry if they were late from school, fewer students reported this as occurring in 1998 than in 1996, across grades and users/nonusers. Although there were some increases, the difference was less than a percentage point from 1996 findings (e.g., tenth grade nonusers of other drugs). There were decreases from 1996 levels in the percentages of students who said someone at home would always worry about them if they didn’t know where they were across all surveyed grades, substances, and users/nonusers.

Limits and Consequences. There was a change (increase) between 1996 and 1998 in the percentage of tenth and twelfth grade users of cigarettes, alcohol, and other drugs who indicated they can always talk family out of punishment. On average, the increase between 1996 and 1998 was 1.5 percentage points. The smallest increase was for tenth grade cigarette users (0.6 percentage points) while the largest gain was for twelfth grade cigarette users (2.6 percentage points). For the percent of adolescents who say they can always change the mind of an adult to get their way, there were increases, although very slight, from 1996 levels across all grade levels. Overall, the largest gains were in the tenth grade population. Changes in tenth graders from 1996 data were cigarettes (1996 10.5% vs. 1998 11.1% users; 1996 4.4 % vs. 7.7% nonusers), alcohol (1996 9.3% vs. 11.2% 1998 users; 1996 3.9% vs. 6.5% nonusers), and other drugs (1996 11.2% vs. 1998 13.0% users; 1996 4.7% vs. 1998 6.1% nonusers). Similarly, the percentage of adolescents who say their parents have rules about the people they can be with decreased somewhat from 1996 levels with a few exceptions in the nonuser population. For sixth grade nonusers of alcohol, there was a 1.2 percentage point increase from 1996 in the percentage of adolescents who say their parents have rules about the people they can be with. For sixth grade nonusers of other drugs, the increase was 1.9 percentage points from 1996. For tenth grade nonusers of alcohol, there was an increase of 1.7 percentage points from 1996 levels and for twelfth graders who did not use alcohol, an increase of 2.7 percentage points from 1996.

Communication. There was an increase from 1996 in the percentage of non-using (alcohol) students across grade levels who indicated an adult always talked about not using alcohol. The greatest increases were seen at the sixth and tenth grade levels, with sixth grade nonusers of alcohol showing a 3 percentage point increase from 1996 levels while tenth graders had a 2.7 percentage point increase from 1996 levels. There was also a slight increase (0.9 percentage points) from 1996 levels in the percentage of eighth grade alcohol users who indicated they could always talk about their problems with an adult. Twelfth grade alcohol users who indicated that they could always talk about their problems with an adult increased 2 percentage points from 1996 levels. Sixth grade alcohol nonusers also reported a 1 percentage point increase from 1996 for this measure. For drugs, the largest percentage increase from the 1996 survey was for sixth grade nonusers of drugs who indicated an adult always talks about not using drugs (increase of 3.6 percentage points from 1996). The next largest increase was for twelfth grade drug users¾ 2 percentage points more than in 1996 indicated they could always talk about their problems with an adult. Interestingly, this change from 1996 was also paralleled in the non-drug using twelfth grade population; 1.8 percentage points more non-drug using twelfth grade students indicated they could always talk about their problems with an adult in 1998 than in 1996.

Family Activities. Two items within family activities showed the greatest gains across all parenting practice survey items between 1996 and 1998. First, for sixth graders who used other drugs, there was a 9.7 percentage point increase in the number of sixth grader other drug users who reported their family ate together daily. For twelfth grade non-users of alcohol, there was a 5.4 percentage point increase from 1996 to 1998 for the percent of twelfth grade alcohol nonusers who said their family did one activity together each week. Gains were also seen for twelfth grade nonusers of other drugs (3.8 percentage point increase from 1996) who reported their family did one activity together each week and for eighth grade non-alcohol users (2.4 percentage point increase from 1998) who reported their family ate together daily.

Although the older teen years are a time when independence from family begins to be established, peer groups provide a transition from family dependence to independence. During this time of rapid maturation, peer groups often supplant parents as dominant influences over teens’ behavior. Previous years of the MAS document this transition through an examination of respondents’ perceptions of support and approval for societal disapproved behaviors of alcohol, marijuana, crack cocaine, and needle use. Eighth, tenth, and twelfth graders were asked to respond to a number of items regarding their perception of their families’ and friends’ approval or disapproval of substance use.

Table 7.14 shows that substance users are influenced by their friends more than their parents. For instance, 85.3% of surveyed twelfth graders users’ friends indicated it was okay for them to use beer while these students reported only 29.9% of their parents approved of using beer. It is interesting to note that users friends’ approval of using crack or needles to inject drugs such as heroin is fairly evenly split between those who think using these substances is okay and those who do not (crack: 46.1% okay vs. 50.4% not okay, inject drugs: 45.3% okay vs. 46.0% not okay).

For nonusers, 88% or more of twelfth graders indicated their parents did not approve of them using any type of substance; very few twelfth graders indicated their parents approved of a substance. Based on these data, it appears the parental influence on nonusers is quite strong.

Beer was the substance reported by the largest group of twelfth graders as a substance their parents would approve of using (5.8%). At least half of nonuser twelfth graders indicated their friends did not support the use of any substance. These students reported that at least 91% of their friends did not approve of using crack or needles to inject drugs (91% and 92.3% respectively). It is interesting to note that nonuser twelfth graders reported their friends were somewhat evenly divided on whether beer was okay to use¾ 43.2% of twelfth graders indicated their friends would approve of the use of beer while 50.5% would not approve of the use of beer.

Generally, the percentage of parents and friends who expressed approval or disapproval of use of a substance decreased from 1996 across all types of substances. There were, however, two notable exceptions. There was an increase from 1996 in the percentage of using students’ friends who indicated use of crack or use of needles to inject drugs was "not okay". For crack, there was an increase of 4 percentage points from 1996 to 1998 and for use of needles, an increase of 2.4 percentage points. A second area of change from 1996 to 1998 was for friends of non-using twelfth graders and marijuana. In 1996, 64.3% of non-using twelfth graders indicated their friends did not approve of marijuana use. This percentage increased to 66.9% in 1998.

Young people are often subjected to strong social pressures to use alcohol, tobacco, and other drugs. In order to help them in resisting the pressure from friends and peers, the State has implemented educational programs in grades K through 12 in all school systems. These programs provide advice on the steps that may be taken to effectively avoid being pressured into using substances such as alcohol, tobacco, and other drugs. The 1998 MAS included several items designed to examine the extent to which adolescents are aware of the avoidance strategies, and whether they would feel comfortable using them. The MAS also asked whether students have used these strategies and whether they planned to use them in the future. Survey responses were analyzed for the populations of smokers, drinkers, and other drug users, by grade level. Tables 7.15 through 7.17 present the results from these survey items.

In general, the number of users and nonusers who acknowledge they were taught the steps to say "no" is substantial (at least 67%) and constant across grade levels and substances. Among twelfth graders over three-quarters of surveyed students¾ 75.8% of smokers, 77.4% of drinkers, and 82.1% of drug users¾ reported they were given this training. Eighth and tenth graders have similar percentages for users, although somewhat less than that for twelfth graders. Sixth grade users have the lowest percentage of surveyed students who indicated they were taught the steps to say "no"; only 72.2% of sixth grade smokers, 66.8% of sixth grade drinkers, and 68.6% of sixth grade drug users reported receiving this training.

When survey results from users are compared to nonusers, it becomes clear that across survey items percentages are lower for substance users. This means that fewer substance users in each grade realize they have been taught the resistance strategies, fewer say they would be comfortable using them, and fewer say they have used them or plan to do so. There is, however, one exception to this finding. For sixth graders, more users than nonusers reported using the steps across all types of substances. This pattern is reversed (fewer users) across the three remaining grade levels and substances.

With the exception of sixth grade smokers, at least half of all users and nonusers of cigarettes, alcohol, and other drugs indicated they were comfortable saying no to social pressure to engage in substance use. In addition, the percentages of user and nonuser students who are comfortable saying no increases with grade level.

In examining students’ use of the resistance strategy, two patterns emerge. First, for all nonusers of cigarettes, alcohol, and other drugs, the use of the resistance strategy appears to increase by grade level. For example, 41.3% sixth grade nonusers of other drugs indicate they used the steps while 68.0% of twelfth grade nonusers of other drugs indicated they did so. This increase by grade level also held true for users of other drugs. For users of cigarettes and alcohol, there is a decrease in the percentage of eighth grade users from the percentage of sixth grade users who used the steps. For example, 42.9% of sixth grade smokers indicated they had used the strategy while only 37.4% of eighth grade smokers indicated they had used the steps. Similarly, 42.9% of sixth grade drinkers stated they used the steps while 37.5% of eighth graders indicated this.

For users and nonusers of cigarettes and other drugs, the percentage of students who plan to resist use of these substances increases by grade level. For alcohol nonusers, this pattern also holds true. For alcohol users, however, data show there is a decrease in the percentage of students between sixth and eighth grades who plan to resist use of alcohol; the percentage then increases from eighth through twelfth grade for alcohol users.

There were a few areas in which 1998 data show changes from 1996 survey data. For cigarette smokers, there was an increase in the percentage of smokers at the eighth, tenth, and twelfth grade level who were taught the steps to resist peer pressure to smoke. There was also a slight increase in the percentage of smokers at the tenth and twelfth grade level who indicated they planned to resist smoking the future.

For alcohol, there was an increase in 1998 in the percentage of drinkers at the eighth, tenth, and twelfth grade level who indicated they were taught the steps to resist social pressure to drink. The largest change was seen at the twelfth grade level (1996: 70.1% of users who were taught the steps vs. 1998: 77.4% of users who were taught the steps).

The changes between 1996 and 1998 data were most visible for data specific to other drugs. First, the percentage of sixth grade other drug users who indicated they were taught the steps, comfortable saying no, used the steps, and planned to resist in the future, increased at least one percentage point from 1996 levels. Second, the percentage of sixth, eighth, tenth, and twelfth grade drug users who planned to resist social pressure to use drugs in the future increased from that found in 1996. The lowest increase was for tenth grade users (0.8 percentage points) with the highest increase found in sixth grade users (4 percentage points).

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