Increased Drug Use Among Old-for-Grade Adolescents

OBJECTIVE: To determine whether students older than most other students at their grade level ("old for grade") are more likely to report engaging in alcohol, tobacco, and drug-related behaviors. DESIGN: Cross-sectional analyses of the Centers for Disease Control and Prevention Youth Risk Behavior Survey. SETTING: Monroe County, New York. PARTICIPANTS: A total of 1396 high school students from selected classrooms; 68 classrooms randomly selected within schools with the number of students per school proportionally selected from the 28 schools in the county. MAIN OUTCOME MEASURE: Rates of drug-related behaviors by age-for-grade status. RESULTS: Thirty-six percent of adolescents surveyed were old for grade. Adjusting for multiple potential confounders, old-for-grade high school students were more likely to report being regular smokers, chewing tobacco, drinking alcoholic beverages, driving in a car with someone who had been drinking, using alcohol or other drugs before last sexual intercourse, using cocaine in the past month, ever using crack, and using injected or other illicit drugs. CONCLUSIONS: Old-for-grade status is a potentially important marker for drug-related behaviors in adolescents. The antecedents of adolescent risk-taking behavior may begin before the teen years, and prevention of school failure or interventions targeted toward old-for-grade children could affect their propensity to experiment with or use drugs during adolescence.