Understanding Substance Use Patterns in Young Adults

QHSUAs Young Adult Survey and Parent of Young Adult Surveys: Overview and Results MAEGAN BOUTOT, MS, QHSUA EPIDEMIOLOGIST

Approach YAS PYAS Survey people 19-26 years old from QHSUA region Survey the parents/former guardians of people 19-26 years old from QHSUA region Use Facebook and Instagram ads Use Facebook and Instagram ads Use flyers around the QHSUA region Use flyers around the QHSUA region Available in English/Spanish

Response Outreach efforts October-November - Postcards Postcards to everyone with Ware zipcode 3 responses total January Facebook posting in FB town groups Sessions on website: 24 Demographic Breakdown (based on who's clicked on the ad): 1. Males, 25-34 2. Females, 25-34 3. Females, 35-44 4. Males, 35-44 February Targeted ads + FB posting Ad targeted towards 19-50 year olds in the Quaboag Hills Impressions on FB: 42,541 Link clicks on FB: 109 Sessions on website: 15 March Clicks on FB ads: 226 Impressions on FB ads: 85,100 Sessions on website: 16 April closed survey on the 6th

Responses for analysis YAS, English: 20 start, 12 informative YAS, Spanish: 1 start, 0 informative PYAS, English: 17 start, 11 informative PYAS, Spanish: 0 start, 0 informative

Results YAS

Things to keep in mind Self-enrollment Small sample size 12 total 11 / 12 participants 21-26 years old Majority cis-women

Self-Reported Substance Use (YAS, 19-26 Years) % Yes, 30 days % Yes, Ever 58 50 -- 25 8*** 0 Alcoholic beverages (beer, wine, or hard liquor) Marijuana (pot, weed, cannabis) or hashish (hash, hash oil) Cigarettes Vape, e-cigarette** Nicotine in cigarettes, cigars, vapes, or e-cigs CBD-only products (for example: oils, drinks) 100 58 -- 67 92 -- Any prescription drug misuse* Prescription sedatives, incl. barbiturates or sleeping pills* Prescription tranquilizers or benzodiazepines* Prescription stimulants or amphetamines* Opioid or narcotic prescription drugs* Illegal stimulants Methamphetamines (meth, speed, crank, crystal meth) Cocaine (powder) or 'crack' cocaine (in chunk or rock) Glue, aerosol sprays, or other gases or sprays, in order to get high MDMA (X, E, ecstasy, or Molly) LSD (acid) or other hallucinogens (PCP, mescaline, peyote, mushrooms, or psilocybin) Heroin *Question specified "without a doctor telling you to take them" 17 0 8 8 0 0 0 0 33 17 25 17 25 25 8 25 0 17 0 25 0 17 0 17 **Questions on vaping/e-cigs were asked in a different manner from the other substances ***This is based only on the subsample who answered this question. It is probably an underestimate

Perceived Use Think of the average person 19-26 yo. How would you describe their [alcohol use/cannabis use/etc] relative to your use? Now think about people 19-26 yo in your town. How many of them do you think [drank alcohol/used cannabis/etc.] sometime in the past 30 days? None, 0% 0, prefer not to answer Few, 1-10% 1, far less Some, 11-30% 2, less Some to half, 31-50% 3, same amount Half to most, 51-70% 4, more Most, 71-90% 5, far more Almost all, 91-100%

Perceived 30 Day Use of 19-26 year olds by 19-26 year olds (YAS) Among 30 day non- users of any 3 71-90% 71-90% 31-50% 51-70% 11-30% 1-70%** 1-70%** 1-70%** 1-10% 0-70%*** Among 30 day users of any substance 9 71-90% 31-50%, 91-100% 31-50% 31-50% 1-10% 11-30% 1-10% 1-30%* 1-10% 1-10% Among 30 day users of specific substance -- 71-90% 31-50%, 91-100% -- -- -- -- -- -- -- -- All participants Sample 12 Alcohol Cannabis Cigarettes Vapes/E-cigs RX drug w/o RX Hallucinogenics Illegal opioids (heroin) Illegal stimulants (cocaine) Ecstasy Aerosol sprays *Two most common answers, 1-10 and 11-30% **Three most common answers: 1-10, 11-31, 51-70% **Three most common answers: 0, 11-31, 51-70% 71-90% 71-90% 31-50% 31-50% 1-10% 11-30% 1-10% 1-30%* 1-10% 1-10%

Self-Reported vs Perceived Substance Use (YAS, 19-26 Years) % Yes, 30 days % Yes, Ever % Perceived 30 day use Perception vs actual rate (most common choice) 71-90 Alcoholic beverages (beer, wine, or hard liquor) Marijuana (pot, weed, cannabis) or hashish (hash, hash oil) Cigarettes Vape, e-cigarette** Any prescription drug misuse Illegal stimulants Glue, aerosol sprays, or other gases or sprays, in order to get high MDMA (X, E, ecstasy, or Molly) LSD (acid) or other hallucinogens (PCP, mescaline, peyote, mushrooms, or psilocybin) Heroin 58 100 Perception higher 50 58 71-90 Perception higher -- 25 17 0 -- 67 33 25 31-50 31-50 1-10 1-30 -- Probably equal? Perception lower Perception higher 0 17 1-10 Perception higher 0 25 1-10 Perception higher 0 17 11-30 Approximately equal 0 17 1-10 Perception lower

Perceived Friend Approval and Substance Harmfulness (YAS) Friends approve? Perceived harm Substance Alcohol Marijuana Cigarettes Vapes/e-cigs Use type 1-2 drinks/day Every day [In general] Every day % Disapprove 30% 30% 80% 40% Use type 1-2 drinks/day Every day Pack+/day [In general] % Consider harmful 36% 18% 91% 82%

Perceived Friend Approval and Substance Harmfulness (YAS) Friends approve? Perceived harm Substance Alcohol Marijuana Cigarettes Vapes/e-cigs Use type 1-2 drinks/day Every day [In general] Every day % Disapprove 30% 30% 80% 40% Use type 1-2 drinks/day Every day Pack+/day [In general] % Consider harmful 36% 18% 91% 82%

Perceived Friend Approval and Substance Harmfulness (YAS) Friends approve? Perceived harm Substance Alcohol Marijuana Cigarettes Vapes/e-cigs Use type 1-2 drinks/day Every day [In general] Every day % Disapprove 30% 30% 80% 40% Use type 1-2 drinks/day Every day Pack+/day [In general] % Consider harmful 36% 18% 91% 82%

Perceived Friend Approval and Substance Harmfulness (YAS) Friends approve? Perceived harm Substance Alcohol Marijuana Cigarettes Vapes/e-cigs Use type 1-2 drinks/day Every day [In general] Every day % Disapprove 30% 30% 80% 40% Use type 1-2 drinks/day Every day Pack+/day [In general] % Consider harmful 36% 18% 91% 82%

Results PYAS

Things to keep in mind Self-enrollment Small sample size 11 total 10/11 participants 45+ Number of children 19-26: Range 1-10 children Most common answer: 1 child Most were not living with their children in this age range 7 out of 11 participants had children 19-20 years old Could skip any question

Questions asked to parents/FG about substance use Community use Think about all people 19-26 years old in your town. How many of them do you think drank alcohol sometime in the past 30 days? Are you concerned about the alcohol use of all people 19-26 years-old in your community? Are you concerned about unsafe opioid use of all people 19-26 years-old in your community? Opioid use includes using heroin, using fentanyl, or using prescription opiates in a way not prescribed by a doctor. Are there any other substances - such as LSD, cocaine, synthetic marijuana - that you think many people age 19-26 are using? Their own children s use Do any of your children age 19-26 years old drink alcohol (beer, wine, spirits)? Do you worry about the amount of alcohol any of your children 19-26 years old drink? Do any of your children use [list of substances, including LSD, Rx misuse, heroin]

Parent Reported Substance Use for Community 19-26 yo. (PYAS) % Perceived community using, % Think this substance is a concern for community % 30 day Mode % answering mode Alcoholic beverages (beer, wine, or hard liquor) Marijuana (pot, weed, cannabis) or hashish (hash, hash oil) Cigarettes 31-50% 36% 73% 71-90% <50% 31-50% 51-70% <10% -- -- -- -- -- 36% 55% 46% 27% 27% -- -- -- -- -- 73% 55% Vape, e-cigarette 82% Any illicit opioid use or misuse Cocaine* Benzodiazapines* LSD* "Pills - Percocet and others like that"* 82% 27% 9% 9% 9% *From open response text

Parent Reported Substance Use for Own Children 19-26 yo. (PYAS) At least one child uses Worried about use % Yes* 66% 83% 100% % Yes 60% 60% 40% % No 20% 40% 60% % Unsure 20% -- -- Alcohol Cannabis Nicotine *among parents/FG who report use in their children Other substances parents/guardians reported their children using: LSD MDMA Heroin

So How Do These Data Compare?

Perception vs reported use YA = Young adult PYA = parent/former guardian of young adults YA and PYA s perception of cannabis use is higher than reported use YA and PYA s perception of vape/e-cig use is higher than reported use YA s perception of alcohol use is higher than reported use

Alcohol Substance use measures across sources QH 12th Graders MTF, 12 grade Mass CCIS, youth <18, all Mass YAS, self report, 19-26 NSDUH 18-25Mass CCIS, Mass CCIS for QH, 25-36 Who 18-24 When Time frame Alcohol Binge alcohol 2021 30 day 29 2021 30 day 26 Fall 2020 30 days 7 -- 2021-2022 30 day 58 17 2020 Fall 2020 30 days 48 -- Fall 2020 30 days 40 -- Past month 52 31 In our study, the % of people using alcohol was: Higher than the CCIS Similar to the NSDUH

Marijuana Substance use measures across sources QH 12th Graders MTF, 12 grade Mass CCIS, youth <18, all Mass YAS, self report, 19-26 NSDUH 18-25Mass CCIS, Mass CCIS for QH, 25-36 Who 18-24 When Time frame Marijuana 2021 30 day 20 2021 30 day 20 Fall 2020 30 days 6 2021-2022 30 day 50 2020 Fall 2020 30 days 27 Fall 2020 30 days 16 Past month 23 In our study, the % of people using marijuana was: Higher than the CCIS Higher than the NSDUH Is CCIS an underestimate? Lower than 12th grader rates

Other substances Substance use measures across sources QH 12th Graders MTF, 12 grade Mass CCIS, youth <18, all Mass YAS, self report, 19-26 NSDUH 18-25Mass CCIS, Mass CCIS for QH, 25-36 Who 18-24 When Time frame Vaping 2021 30 day 2021 30 day Fall 2020 30 days 2021-2022 30 day 2020 Fall 2020 30 days Fall 2020 30 days Past month Any 17 -- 0.4 36 64 24 24 2 4 -- 3 -- 83 25* 8* 17 75 25 -- 12 2 -- -- 10 -- 6 -- 38 -- -- -- -- -- Nicotine Rx misuse Any substance No substance -- -- Vaping: Our study rates similar to MTF, lower than CCIS CCIS vape rate seems low Rx misuse: Our study rates higher than all other studies

Other services the community may need

Self-reported Mood, Support, and Situations (YAS) Question: Do you consider your housing situation stable? Difficulty finding affordable childcare Issues with reliable transportation Difficulty finding or affording healthy food Discrimination for any reason, inc. race/ethnicity, age, sexual orientation, or gender identity Lack of access to technology or internet. In the past year, I felt depressed or sad MOST days. % Agree 89% 11% 0% 0% Our community has strong networks! 0% 0% 50% In the past year, I have felt anxious or nervous MOST days. 38% Speaking to a mental health specialist, like a therapist, is a sign of weakness. I have a family member or friend who I feel close to. I have a family member or friend who I can talk about anything with. There is someone in my life who I could turn to if I had a problem with addiction. There is someone in my life who I could turn to if I had a problem with housing. There is someone in my life who I could turn to if I had a problem with affording food. 0% 100% 100% 100% 100% 100%

Self-reported Mood, Support, and Situations (YAS) Question: Do you consider your housing situation stable? Difficulty finding affordable childcare Issues with reliable transportation Difficulty finding or affording healthy food Discrimination for any reason, inc. race/ethnicity, age, sexual orientation, or gender identity Lack of access to technology or internet. In the past year, I felt depressed or sad MOST days. % Agree 89% 11% 0% 0% 0% 0% 50% In the past year, I have felt anxious or nervous MOST days. 38% Speaking to a mental health specialist, like a therapist, is a sign of weakness. I have a family member or friend who I feel close to. I have a family member or friend who I can talk about anything with. There is someone in my life who I could turn to if I had a problem with addiction. There is someone in my life who I could turn to if I had a problem with housing. There is someone in my life who I could turn to if I had a problem with affording food. 0% There are some places for us to provide support 100% 100% 100% 100% 100%

Are any of these areas of concern for people 19-26 years old in our region? (PYAS) In general "Your children" Topic Transportation Access to physical health services Access to mental health services, therapy Access to affordable child care Finding steady work (part or full time) Finding full-time work Affording higher education None of the above. "Affordable housing" "Finding GOOD mental health providers" % Agree 60% 30% 80% 70% 50% 50% 80% 10% % Agree 20% 0% 30% 0% 20% 30% 10% 40% [Write in] [Write in]

Are any of these areas of concern for people 19-26 years old in our region? (PYAS) In general "Your children" Topic Transportation Access to physical health services Access to mental health services, therapy Access to affordable child care Finding steady work (part or full time) Finding full-time work Affording higher education None of the above. "Affordable housing" "Finding GOOD mental health providers" % Agree 60% 30% 80% 70% 50% 50% 80% 10% % Agree 20% 0% 30% 0% 20% 30% 10% 40% [Write in] [Write in]

Are any of these areas of concern for people 19-26 years old in our region? (PYAS) In general "Your children" Topic Transportation Access to physical health services Access to mental health services, therapy Access to affordable child care Finding steady work (part or full time) Finding full-time work Affording higher education None of the above. "Affordable housing" "Finding GOOD mental health providers" % Agree 60% 30% 80% 70% 50% 50% 80% 10% % Agree 20% 0% 30% 0% 20% 30% 10% 40% [Write in] [Write in]

Are any of these areas of concern for people 19-26 years old in our region? (PYAS) In general "Your children" Topic Transportation Access to physical health services Access to mental health services, therapy Access to affordable child care Finding steady work (part or full time) Finding full-time work Affording higher education None of the above. "Affordable housing" "Finding GOOD mental health providers" % Agree 60% 30% 80% 70% 50% 50% 80% 10% % Agree 20% 0% 30% 0% 20% 30% 10% 40% [Write in] [Write in]

Any questions?

Extra Slides

Substance use measures across sources YAS, QH 12th Graders MTF, 12 grade Mass CCIS, youth <18, all Mass YAS, self report, 19-26 PYAS, Mass CCIS for QH, 25-36 Who perceived**, NSDUH 18-25 Mass CCIS, 18-24 perceived** When Time frame Alcohol Binge alcohol Marijuana Vaping 2021 30 day 29 2021 30 day 26 Fall 2020 30 days 7 -- 6 2021-2022 30 day 58 17 50 2021-2022 30 day 71-90% -- 71-90% 2021-2022 30 day 31-50% -- 71-90%, <50% 2020 Fall 2020 30 days 48 -- 27 Fall 2020 30 days 40 -- 16 Past month 52 31 23 20 20 Any 17 -- 0.4 36 64 24 24 2 4 -- 3 -- 83 25* 8* 17 75 25 31-50% -- 11-30% -- -- 51-70% <10% -- -- -- -- -- 12 2 -- -- 10 -- 6 -- 38 -- -- -- -- -- Nicotine Rx misuse Any substance No substance -- --

Alcohol Additional Qs Think back over the last 30 days. How many times have you had five or more alcoholic drinks in a row? 17% all participants 29% among all people who consumed alcohol in past 30 days