Regional patterns of tobacco, alcohol, and other substance use among adolescents in the United States

Tobacco use continues to be the leading preventable cause of death and disease in the United States and substance use is typically initiated during adolescence. Since patterns of use are influenced at the individual, environmental, and population levels, a comprehensive geographic analysis of substance use, particularly tobacco use, is warranted in building targeted evaluation approaches aimed at intervention and prevention. The primary research objective of this study is to visualize substance use among adolescents by substate regions in the US. The secondary objective is to identify potential associations between specific demographic variables and cigarette use on the substate region level. Using data from the 2006, 2007, and 2008 National Survey on Drug Use and Health, estimates of substance use in adolescents aged 12-17 were visualized for the 349 substate regions in the US for the following substances: cigarettes, tobacco products, marijuana, alcohol, binge alcohol, cocaine, and other illicit drugs. Estimates of the perception of risk of cigarette smoking and depressive episodes among adolescents were also visualized by substate region. Hot Spot analysis was performed in ArcMap 10.0 to identify statistically significant clusters of cigarette and tobacco use among adolescents. Specific county-level demographic data from the US Census was aggregated in addition to other attribute variables such as state and local excise tax rates. Tests for association with adolescent cigarette use were performed using multiple regression analysis. Overall, Geographic Information Systems can be applied to visualize, analyze, and evaluate significant patterns of substance use among adolescents in the US.