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Identifying the prevalence and correlates of ecstasy use among high school seniors surveyed through 2002 Monitoring the Future.

Abstract

Media reports have suggested that the use of 3, 4-methylenedioxymethamphetamine (MDMA or "ecstasy") is a significant problem across the United States. To date, however, available evidence has shown that the use of ecstasy has been concentrated among "rave" attendees, with mainstream youth remaining relative-immune from its proliferation. In the current study we build on the ecstasy literature by examining the drug-using behaviors of 2,258 high school seniors with data collected through the Monitoring the Future program in 2002. Prevalence estimates of ecstasy use are generated and associations between ecstasy use, demographic characteristics, and alcohol and other drug use are explored. Ten percent of the sample reported lifetime ecstasy use, 7% reported use within the past 12 months, and 3% reported use within the past 30 days. Compared to non-users, 12-month ecstasy users were significantly more likely than non-users to be white and to have used all other drugs of abuse during the 12 months preceding the interview. These results suggest that ecstasy-related prevention efforts should target the at-risk population of rave attendees rather than the mainstream population of high school students.

Key words: ecstasy, MDMA, MTF, raves, rave attendee

INTRODUCTION

Findings within both the psychological and pharmacological literature indicate that the use of 3, 4-methylenedioxymethamphetamine (MDMA or ecstasy) is harmful to the body. While initial effects may include feelings of peacefulness, acceptance, and empathy, ecstasy users can encounter problems similar to those experienced by amphetamine and cocaine users (Peroutka, Newman and Harris, 1988). Psychological effects, which can linger for weeks after ingestion, include anxiety, depression, insomnia, memory loss, and paranoia (Bolla, McCann, and Ricaurte, 1999; McCann, Mertl, Eligulashvili, and Ricaurte, 1999). Physical effects include blurred vision, involuntary teeth clenching, muscle tension, nausea, and sweating (Bolla et al., 1999; McCann et al., 1999). While the long-term neurotoxic effects of ecstasy use are just now being investigated, initial evidence suggests that permanent serotonin depletion (1) can also result from MDMA ingestion (Montoya, Sorrentino, Lukas, and Price, 2002).

Media reports have suggested that the use of ecstasy is a significant problem across the United States (Central Broadcasting System [CBS] Worldwide, Inc., 2001; Leinwand and Fields, 2000). Leinwand and Fields (2000), for example, described how easily ecstasy pills could be smuggled into "raves"--a culture of loud music, flashing lights, and frenzied all-night dancing- and how attendees relished the atmosphere of illegal drug acceptance. While these commentaries have popular appeal, it is scientific evidence that should guide conclusions regarding an ecstasy "problem" in the United States. To that end, the literature exploring ecstasy use in the United States has grown within the past several years (Yacoubian, Deutsch, and Schumacher, 2004; Yacoubian, 2003b, a; Yacoubian et al., 2003b, a; Urbach et al., 2003; Palacios and Fenwick, 2002; Arria et al, 2002; Yacoubian et al., 2002; Yacoubian, 2002c, b, a; Klitzman et al., 2000; Cuomo and Dyment, 1994; Meilman et al., 1990; Peroutka, 1987; Buffum and Moser, 1986).

Peroutka (1987), for example, estimated the prevalence of recreational ecstasy use at Stanford University by surveying a random sample (n = 369) of undergraduate students. Of the 369 students interviewed, 39% reported using ecstasy at least once (Peroutka, 1987). Cuomo and Dyment (1994) conducted a study of illicit drug use among undergraduate students at Tulane University in 1990 and compared the results to data collected in 1986. The use of ecstasy increased from 16% in 1986 to 24% in 1990 (Cuomo and Dyment, 1994). Klitzman et al. (2000) explored the relationship between MDMA use and high-risk sexual behaviors among a sample of 169 gay and bisexual men in New York City. A strong association was found between frequent MDMA use and high-risk sexual behavior, even after controlling for demographic characteristics and alcohol and other drug (AOD) use. The odds ratio for high-risk sexual behavior was 37% greater among frequent versus non-frequent MDMA users (Klitzman et al., 2000).

Yacoubian et al. (2002) surveyed a sample (n = 209) of juvenile offenders through Maryland's Offender Population Urinalysis Screening (OPUS) Program in the summer of 2000. None of the offenders reported two-day ecstasy use, and 0% tested positive for MDMA by urinalysis. Palacios and Fenwick (2002) used a qualitative approach to explore the culture of club drugs among rave attendees in Tampa, FL. Their research focused primarily on the emotional state of individuals who ingested club drugs, the local market for such drugs, and the vernacular of the drug culture. Palacios and Fenwick (2002: 283) concluded that ecstasy "... is affordable, does not have the same stigma associated with other illegal drugs, and is very much a part of the local youth culture." Most recently, Yacoubian et al. (2004) collected self-report drug use information and oral fluid (OF) specimens from a sample of rave attendees in the fall of 2002. Twenty-four percent reported using ecstasy within the two days preceding the interview, and 30% tested positive for MDMA by OF analysis (Yacoubian et al., 2004).

To update the work of Yacoubian (2002b), we explore the drug-using behaviors of 2,258 high school seniors surveyed through Monitoring the Future (MTF) in 2002. The purpose of the current analysis is twofold: 1) to estimate the prevalence of recent ecstasy use among high school seniors in the United States; and 2) to explore the associations between ecstasy use, demographic characteristics, AOD use, and other behaviors among members of this population.

METHODS

The data for the current study were collected by MTF in 2002. The MTF program began in 1975 as a way to study the drug-using beliefs, attitudes, and behaviors of high school students across the United States. Today, the program surveys approximately 50,000 grade school and high school students annually (Johnston, O'Malley, and Bachman, 2003). Each data collection takes place in approximately 130 public and private high schools, thus providing an accurate cross-section of high school seniors throughout the United States (Johnston et al., 2003).

A multi-stage sampling design is utilized (Johnston et al., 2003). Stage 1 is the selection of a specific geographic area. Stage 2 is the selection of the high school(s) within that particular area. The third stage is the selection of individual students within each high school. During the fall of each academic year, a MTF representative makes initial contact with each sampled school. After securing consent from the high school principal, arrangements are made for administering the survey. Two weeks prior to its scheduled administration, MTF staff members visit the teachers and provide a brief overview of the study. Teachers are then asked to announce the study to their students.

MTF staff members follow standardized data collection procedures (Johnston et al., 2003). While parental/guardian permission is not required, youths are informed that their participation is voluntary and confidential. Questionnaires are administered during normal class periods. Most respondents complete the questionnaire within 45 minutes, although additional time is permitted if needed.

In addition to basic demographic information, the questionnaire covers areas on criminal behavior, AOD use, education, health, politics, religion, social change, and social problems (Johnston et al., 2003). The AOD-use questions are fairly specific. Respondents are first to report whether they have ever used alcohol, amphetamines, barbiturates, cigarettes, crack cocaine, ecstasy, heroin, inhalants, lysergic acid diethylamide (LSD), marijuana, powder cocaine, other psychedelic drugs (e.g., phencyclidine (PCP) and mushrooms), and tranquilizers. For those drugs respondents report having ever tried, they are asked to indicate whether they have used the drug within the past 12 months and the number of times used within the past 30 days. Respondents are also asked about their perceived ability to reduce or stop using drugs and the personal, familial, and occupational consequences of their drug use.

While the students sampled are designed to be representative of high school seniors within the 48 contiguous states, there are several ways in which the survey data might fall short of full representativeness (Johnston et al., 2003). First, some schools may decline participation. Second, survey data may not be obtained from all of the students sampled. Both of these limitations could introduce bias to the sample. Third, questions on sensitive issues, such as sexuality and drug use, could lead to distortions and thus reduce validity. Finally, limitations in sample size could place limits on the accuracy of the estimates. These caveats aside, the MTF program is generally considered to be a reliable source of drug-using behaviors among youth in the United States and is one of the primary sources of information that guide national drug control policy.

Data Analysis and Findings

Data analysis was accomplished in three phases. First, descriptive statistics were generated. Second, estimates of ecstasy use were calculated. Third, the sample was divided into recent (12-month) ecstasy users (n = 162), users who reported lifetime use, but no use in the 12 months preceding the interview (n = 69), and non-lifetime users (n = 2,027). Chi-square statistics were used to detect significant associations between ecstasy use, demographic characteristics, AOD use, and other behaviors/perceptions.

Descriptive Statistics

A majority of the high school seniors were female (53%), white (85%), 18 years of age or older (56%), and taking college preparatory classes (56%). Forty-seven percent lived in either a small town or the suburbs. Fifty percent of the respondents never or rarely attended religious services.

Self-Reported Ecstasy Use

Figure 1 displays self-reported lifetime, 12-month, and 30-day use of ecstasy. As shown, 10% of the sample reported using ecstasy at least once during their lifetime. Seven percent reported using ecstasy within the past 12 months, while 3% reported use within the 30 days preceding the interview. These prevalence estimates are slightly higher than the 1999 results published in Yacoubian (2002b).

[FIGURE 1 OMITTED]

Correlates of Ecstasy Use

Table 1 presents a comparison between the recent (12-month) ecstasy users (n = 162), the users who reported lifetime use, but no use in the 12 months preceding the interview (n = 69), and non-lifetime users (n = 2,027). Compared to the recent and non-ecstasy users, the non-recent users were significantly more likely to be 18 or older (74% v. 51% and 56%,p < 0.01). Compared to the non-users, the recent and non-recent ecstasy users were significantly more likely to be white (97% and 98% v. 84%, p < 0.001). The recent ecstasy users were significantly more likely than the non-recent users and the non-users to have used all other drugs of abuse within the past 12 months, including marijuana (95% v. 77% and 30%, p < 0.001), powder cocaine (46% v. 16% and 2%, p < 0.001), crack cocaine (17% v. 4% and 1%, p < 0.001), other psychedelic drugs (41% v. 13% and 2%, p < 0.001), and inhalants (23% v. 10% and 3%, p < 0.001).

As shown in Table 2, non-users were significantly more likely than past-year ecstasy users and the non-recent users to believe that religion was a very important part of their life (33% v. 18% and 21%, p < 0.001). Compared to the non-recent users and the nonusers, 12-month ecstasy users were significantly more likely (44% v. 33% and 26%, p < 0.001) to have been cited for a traffic violation (e.g., speeding ticket) during the 12 months preceding the interview. Compared to the recent ecstasy users and the non-recent users, the non-users were significantly more likely to only have a few friends who smoked cigarettes (36% v. 12% and 19%,p < 0.001) and used marijuana (33% v. 7% and 14%, p < 0.001).

DISCUSSION

Data for the current analysis were collected in 2002 from a sample of 2,258 high school seniors. Ten percent of the sample reported lifetime ecstasy use, 7% reported use within the past 12 months, and 3% reported use within the past 30 days. These prevalence estimates are significantly lower than those found in rave attendee and juvenile offender populations (Yacoubian et al., 2004; Yacoubian et al., 2003a; Yacoubian et al., 2002; Arria et al., 2002). The race findings are consistent with previous research (Yacoubian et al., 2004; Urbach et al., 2003; Yacoubian et al., 2003a; Yacoubian et al., 2002; Atria et al., 2002) that has identified ecstasy use as concentrated among white users, suggesting that ecstasy prevention programs might benefit from greater sensitivity to racial differences. Schools and communities comprised primarily of white students and residents, for example, would benefit from prevention efforts considerably more than schools or communities whose racial composition is predominantly non-white.

The findings for religion, traffic violations, and peer associations are consistent with traditional theories of juvenile delinquency. That non-ecstasy users were significantly more likely to be religious is consistent with a social bonding/control perspective of juvenile delinquency. Hirschi (1969), for example, argued that delinquency (e.g., drug use) evolved when an individual's bond to society was weak or broken. This bond is composed of four elements--attachment, commitment, involvement, and belief (Hirschi, 1969). A strong religious background would be an example of commitment to conventional values and activities. That 12-month ecstasy users were significantly more likely to have received a traffic violation (e.g., speeding ticket) is consistent with Gottfredson and Hirschi's (1990) general theory of crime, which posits that criminal behavior is a product of low-self control that manifests itself in thrill-seeking behaviors or behaviors that result in immediate gratification (e.g., speeding and drug use). Our findings that the non-ecstasy users had fewer friends who used cigarettes and marijuana, and that most of the friends of the recent ecstasy users smoked cigarettes and marijuana, is consistent with the notion that individuals seek out others who share similar behavioral preferences and/or ideologies.

There are two major areas for future research. The extent to which these high school seniors are polydrug users is difficult to ascertain. There is no way to know, therefore, the extent to which any of the drugs are used in conjunction with others. Future research should consider inquiring about patterns of ecstasy ingestion. Questions could be posed about the extent to which users typically use ecstasy with alcohol or other drugs and the extent to which users seek out ecstasy cut with other drugs.

Second, while ecstasy's availability may preclude any definite conclusions about its place within the drug-using pathway (Kane and Yacoubian,, 1999; Kandel, 1975), future research is needed to understand the place ecstasy might have in the progression to other substances. Such an analysis, however, can only be undertaken with young respondents. Because ecstasy's availability has increased only recently, older respondents may not have had the drug as an option when they first experimented with alcohol and tobacco. Analyzing ecstasy's place in the "gateway" theory can only take place with respondents who are young enough to have recently begun their experimentation with alcohol or other drugs. Such an analysis could determine whether ecstasy use is a product of deliberate temporal sequencing or whether it is simply an artifact of low ecstasy availability. This would then influence whether prevention and treatment efforts should consider the incorporation of ecstasy education into their curricula.

Of primary significance in the current study is the low prevalence rates within a population traditionally presumed to be at risk. These findings provide considerable insight into the state of the ecstasy problem in the United States. Taken collectively, the available evidence overwhelmingly suggests that rave attendees (Yacoubian et al., 2004; Yacoubian et al., 2003a; Atria et al., 2002) comprise the population at highest risk for ecstasy use, including criminal offenders, high school and college students, and youthful household respondents. If federal agencies are interested in preventing ecstasy use and abuse, a scientifically driven approach is warranted. Given the overwhelming evidence that ecstasy use is concentrated among rave attendees, prevention efforts among other populations (e.g., juvenile offenders) or within other settings (e.g., schools) may not be worthwhile. By focusing on rave attendees in their natural settings, prevention specialists would be assured that the ecstasy-related interventions are reaching the population for which they would be most beneficial.

While it is difficult to know whether the use of ecstasy will escalate like the crack cocaine epidemic of the 1980s, it is more prudent to spend prevention dollars now than treatment dollars later. That said, prevention dollars must be spent wisely. It is more important to target the population at highest risk for ecstasy use rather than distributing prevention funds to populations who need little or no protection from the underlying behavior. Given that rave attendees are at the highest risk for EOCD use relative to all other populations of youth, they should be targeted for intervention.

Community-level interventions move beyond traditional settings and attempt to make changes within the largest proportion of a given population. While the formats may differ, all community-level prevention efforts strive to place intervention activities in the context of individuals' daily lives. Community-level approaches have three primary advantages: 1) they reach more persons in the community than one-on-one interventions; 2) they involve community members; and 3) specific populations can receive explicit prevention messages (McAlister, 1984).

The decision to implement a specific prevention program within any population should be based on that program's empirical support. The Center for Substance Abuse Prevention (CSAP) has identified a plethora of model prevention programs that have been empirically tested across the United States (Substance Abuse and Mental Health Services Administration (SAMHSA), 2002). The AIDS Community Demonstration Projects (ACDP) is one such model. The ACDP was a five-year study (1989-1994) that evaluated the impact of community-level HIV prevention interventions in Dallas, Denver, Long Beach, New York City, and Seattle (Centers for Disease Control and Prevention (CDC), 1992). Target populations included injection drug users, female sex partners of injection drug users, female commercial sex workers, non-gay-identified men who had sex with men, and youth in high-risk situations. The two primary objectives of the ACDP were to increase the prevalence of consistent condom use among targeted groups and to increase the use of bleach to clean injection equipment among drug users (CDC, 1992). The ACDP used a quasi-experimental design with 10 matched intervention and comparison communities. A total of 15,205 field interviews were conducted across the five sites. Analyses suggested overall program success, both in terms of outcome and process evaluations (CDC, 1992).

The ACDP would be an appropriate prevention model for rave attendees. A three-pronged effort could be undertaken: 1) the development and distribution of flyers and pamphlets; 2) the development and marketing of a Web site designed specifically for rave attendees; and 3) the distribution of condoms and promotional materials. Consistent with the ACDP, flyers and pamphlets on the dangers associated with EOCD use and high-risk sexual activity could be developed and distributed to rave attendees. Because many of the pamphlets developed for this younger population, while informative, are likely to be misunderstood or discarded without careful consideration, trained staff members could attempt to engage the rave attendees in conversations about the contents of the pamphlets, thereby making them more relevant to the venue and the recipient.

The second component of the proposed prevention intervention would be the creation and marketing of a Web site tailored specifically to rave attendees. The Web site could contain general information about the dangers associated with EOCD use and high-risk sexual activity; information about the legal penalties associated with EOCD production, sale, and possession; information about the relationship between EOCD use and high-risk sexual behaviors, information a diagnostic tool to self-diagnose AOD dependence; and electronic links to national, state, and local substance abuse prevention and treatment resources [e.g., CSAP and the National Institute on Drug Abuse (NIDA)]. Moreover, dates and times for Internet chat rooms for exchanging information on EOCD use and high-risk sexual activity could be advertised. In addition to providing rave attendees with the Internet address for the Web site, laptop computers could be used to provide on-site demonstrations of the Web site.

Third, condoms and promotional materials could be distributed to rave attendees. Consistent with the environmental facilitation component of the ACDR this promotion would encourage the use of condoms by making them readily available to persons at risk. Given the college-age population, backpacks that contain a variety of promotional materials (e.g., t-shirts, magnets, pens, and key rings) could be distributed. Each item, including the backpack, would have a newly created logo and the address of the Web site.

Rave attendees comprise the population at highest risk for EOCD use, including criminal offenders, high school and college students, and youthful household respondents. If federal agencies are interesting in preventing EOCD use and abuse, a scientifically driven approach is warranted. Given the overwhelming evidence that EOCD use is concentrated among rave attendees, prevention efforts among other populations (e.g., juvenile offenders) or within other settings (e.g., schools) may not be worthwhile. By focusing on rave attendees in their natural settings, prevention specialists would be assured that the EOCD-related interventions are reaching the population for which they would be most beneficial.
Table 1. Comparisons Between Recent Ecstasy Users,
Non-Recent Users, and Non-Users (n = 2,258)

 12-Month
 Users Non-Recent Non-Users
 (n = 162) Users (n = 69) (n = 2,027)

Sex
 Female 52% 52% 53%
Age
 18 and over 51% * 74% * 56% *
Race/Ethnicity
 White 97% ** 98% ** 84% **
Type of residence
 Small town 25% 23% 30%
 Suburbs 18% 31% 28%
 Medium cite 12% 13% 13%
 Country 8% 6% 9%
 Large city 9% 9% 9%
 Very large city 7% 7% 8%
 Farm 2% 3% 3%
12-Month Use Of:
 Marijuana 95% ** 77% ** 30% **
 Powder cocaine 46% ** 16% ** 2% **
 Crack cocaine 17% ** 4% ** 1% **
 Heroin 10% ** 3% ** < 1% **
 Other psychedelic drugs 41% ** 13% ** 2% **
 LSD 29% ** 7% ** 1% **
 Amphetamines 59% ** 29% ** 7% **
 Barbiturates 44% ** 12% ** 4% **
 Tranquilizers 51% ** 22% ** 5% **
 Inhalants 23% ** 10% ** 3% **

* Chi-square significant at the p < 0.01 level.

** Chi-square significant at the p < 0.001 level.

Table 2. Comparisons Between Recent Ecstasy Users,
Non-Recent Users, and Non-Users (n = 2,258)

 12-Month Users Non-Recent
 (n = 162) Users (n = 69)

Is religion important in your life?
 Not important 23% ** 23% **
 A little important 32% 27%
 Somewhat important 27% 29%
 Very important 18% ** 21% **
Have you been cited for a traffic
 violation within the past 12
 months?
 Yes 44% ** 33% **
How many of your friends smoke
 cigarettes?
 None 1% ** 2% **
 A few 12% ** 19% **
 Some 30% 32%
 Most 49% ** 46% **
 All 9% 2%
How many of your friends smoke
 marijuana?
 None 0% ** 3% **
 A few 7% ** 14% **
 Some 29% 33%
 Most 46% ** 48% **
 All 19% ** 2% **

 Non-Users
 (n = 2,027)

Is religion important in your life?
 Not important 13% **
 A little important 24%
 Somewhat important 31%
 Very important 33% **
Have you been cited for a traffic
 violation within the past 12
 months?
 Yes 26% **
How many of your friends smoke
 cigarettes?
 None 15% **
 A few 36% **
 Some 32%
 Most 16% **
 All 2%
How many of your friends smoke
 marijuana?
 None 21% **
 A few 33% **
 Some 30%
 Most 14% **
 All 3% **

* Chi-square significant at the p < 0.01 level.

** Chi-square significant at the p < 0.001 level.


(1) The use of MDMA stimulates the release and inhibits the reuptake of serotonin (5-HT) and other neurotransmitters such as dopamine to a lesser extent. This acute boost in monoamine activity can generate feelings of elation, emotional closeness, and sensory pleasure. In the hot and crowded conditions of raves, mild versions of the serotonin syndrome often develop, when hyperthermia, mental confusion, and hyperkinesia predominate. This acute serotonergic overactivity is exacerbated by the high ambient temperatures, overcrowding (aggregate toxicity), and use of other stimulant drugs.

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Yacoubian, G., Green, M. K., and Peters, R. (2003b). Identifying the prevalence and correlates of ecstasy and other club drug (EOCD) use among high school seniors. Journal of Ethnicity in Substance Abuse, 2(2), 53-66.

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Author Note

George S. Yacoubian, Jr., Pacific Institute for Research Evaluation (PIRE), Calverton, Maryland; Department of Sociology, Catholic University of America. Ronald J. Peters, School of Public Health, University of Texas Health Science Center at Houston.

The data for this study were obtained via the website of the Inter-University Consortium for Political and Social Research (ICPSR) at the University of Michigan (www.icpsr.umich.edu).

Correspondence concerning this article should be addressed to Dr. George S. Yacoubian, Jr., PIRE, 11710 Beltsville Drive, Suite 300, Calverton, MD, 20705. (301) 755-2790 Office; (301) 755-2799 Fax; E-mail: gyacoubian@pire.org.

George S. Yacoubian, Jr., Pacific Institute for Research Evaluation Ronald J. Peters, University of Texas Health Science Center at Houston
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Title Annotation:"MONITORING THE FUTURE"--ECSTASY
Author:Peters, Ronald J.
Publication:Journal of Alcohol & Drug Education
Geographic Code:1USA
Date:Mar 1, 2005
Words:4775
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