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substance use is also often accompanied by other factors such as low academic attainment, health-related issues (including a mental health diagnosis and risky sexual behavior), involvement with the juvenile justice system, and overdoses. Youth who engaged in drug use are more likely to experience violence, are at greater risk for mental illness and suicidal ideation and/or suicide, and more likely to engage in risky sexual behavior such as not using a condom and having multiple partners.61 These health behaviors put youth at risk for sexually transmitted infections like HIV, and unintended pregnancy. Youth DFC & Youth Vaping Approximately three quarters of Drug-Free Communities (DFC) Support Program coalitions are engaged in activities to address vaping. Of those coalitions, 94- percent reported addressing nicotine/tobacco and 84-percent reported addressing marijuana. « « « « « « NATIONAL DRUG CONTROL STRATEGY 19 engaging in substance use and sexual behavior at an early age are also linked to poor test scores and lower educational attainment.62,63 Alcohol, marijuana, and tobacco are the substances most commonly used by adolescents.64 In 2019, almost 14-percent of high school students reported binge drinking within the past month. Seven- percent reported past month prescription opioid misuse65—most often drugs that were not prescribed to them. 66 In 2020, one in five high school students surveyed reported past month ecigarette use. From 2017 to 2019, the percentage of eighth graders who said they vaped nicotine in the past 12 months roughly doubled from 7.5-percent to 16.5-percent.67 Among lifetime use measures from 2009 to 2019, marijuana use was reported by 36.8-percent of high school students surveyed, followed by misuse of prescription opioids (14.3-percent) and use of synthetic marijuana (7.3-percent). The prevalence of youth use of cocaine (3.9-percent), methamphetamine (2.1-percent), or heroin (1.8-percent) is much smaller and they are not commonly drugs of first use. In 2020, there were 783 opioid overdose deaths in youth 5-18 years old and 1,022 overdose deaths involving all drugs in youth 5-18 years old.68 Between 2016-2019, suspected overdoses involving all drugs increased by 2-percent for youth between the ages of 0-10 years and a 2.3- percent for youth between the ages of 11-14 years. Delaying age of initiation and addressing SUDs from a life stage perspective with assessment and treatment approaches incorporating cooccurring disorders are necessary to successfully impact overall health.69 There is a strong relationship between ACEs and early initiation of youth substance use.70 The estimated nonmedical use of prescription drugs increases by 62% for each additional ACE. 71,72 Prevention interventions can have positive long-term effects in reducing substance use.73,74 While alcohol remains the primary substance of abuse for youth, rates of use have decreased substantially over time. Successful youth substance use prevention works by targeting at least two areas of the childhood experience: reducing risk factors that increase the likelihood of substance use, and enhancing protective factors that prevent or decrease the impact of a negative experience.75 Universal prevention focuses on an entire population (e.g., school or community) and are not Universal Prevention Interventions and Positive Impacts Across Generations A study looked at the impact on the offspring of children who received a universal prevention intervention. The original prevention intervention was implemented in public elementary schools serving highcrime areas in Seattle, Washington. The initial Raising Healthy Children intervention provided social and emotional training to some children while others did not receive the training. A recent analysis found that the intervention not only helped the children who received the initial social and emotional skills training, but their children benefited as well. These offspring had less substance use, fewer behavior issues, and better academic skills than the children whose parents had not received the training. The persistent impact of these positive effects of the universal prevention intervention speaks to the potential to prevent adverse childhood experiences and counter the impact and of negative social determinants of health. Reference: Hill K, Bailey J, Steeger C, et al. Outcomes of Childhood Preventive Intervention Across 2 Generations - A Nonrandomized Controlled Trial. « « « « « « 20 NATIONAL DRUG CONTROL STRATEGY directed at a specific risk group.76 There is evidence that universal prevention interventions provide sustained positive impacts on general health and behavioral outcomes years after the end of the intervention, including for youth in disadvantaged environments.77,78,79,80 A recent analysis of the Raising Healthy Children intervention indicated positive outcomes including less substance use, fewer behavioral issues, and better academic skills into the third generation.81 Early childhood interventions that enhance protective factors, such as fostering self-control and successful coping strategies, and minimize risk factors can bring persistent benefits.82,83 For example, a family history of substance use increases a child’s risk for substance use but nurturing that child in an environment with clear 

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