Design and Subjects
The survey was administered in 1989 and 1992 to Minnesota public school students in grades 6, 9, and 12. A comparison sample of school districts that participated in both years consisted of 81% of the state's school districts. District samples were weighted to reflect the proportion of actual enrollment by grade among participating districts.

Results
Although alcohol and other drug use declined markedly during the 3-year period studied, the proportion of students who reported at least three adverse consequences of their use was identical in 1989 and 1992: 1% of sixth graders, 7% of ninth graders, and 16% of 12th graders. Alcohol was the primary substance of abuse among students, regardless of age or level of substance involvement. The students with three or more adverse consequences of substance use were defined as "problem users" and compared with other students their age. The most commonly reported consequences of use were tolerance, blackouts, violence, and school or job absenteeism. The problem users were approximately two to seven times more likely to report parental alcohol or other drug problems, physical abuse, and sexual abuse than were students their age with fewer consequences or no history of use. They were also two to 15 times more likely than other students to report such correlates as low self-esteem, emotional distress, antisocial behavior, and suicide attempts. The greatest differences were seen among the youngest students.

Conclusion
Primary health care workers, social service providers, educators, and other front-line personnel who have contact with youths outside the home need to recognize and respond to behavioral and emotional indicators of risk among adolescents.

(Arch Pediatr Adolesc Med. 1995;149:137-144)