Fewer teens smoke cigarettes than smoke marijuana. Cigarette smoking by high-school students peaked in 1996–1997 and has declined continuously since then. In contrast, marijuana use has been rising in recent years. Now, while 17.1 percent of 12th graders were current (past-month) cigarette smokers—the lowest it has been in the history of the survey—22.9 percent were current marijuana smokers. The use of hookah water pipes and small cigars has raised public health concerns and has recently been added to the MTF survey. In 2012, 18.3 percent of 12th graders had smoked a hookah in the past year, and 19.9 percent had smoked a small cigar.

Alcohol use among teens has dropped to historically low levels. In 2012, 3.6 percent of 8th graders, 14.5 percent of 10th graders, and 28.1 percent of 12th graders reported getting drunk in the past month, continuing a long-term, downward trend.. Significant declines include 5-year drops in daily alcohol use by 8th, 10th and 12th graders (0.3 percent, 1.0 percent and 2.5 percent, respectively, in 2012). In 2012, 23.7 percent of high-school seniors reported binge drinking (defined as 5 or more drinks in a row in the past 2 weeks)—a drop of one-quarter since the late 1990s.

Illegal drug use among teenagers has continued at high rates, largely due to the popularity of marijuana. Marijuana use by teenagers declined from the late 1990s until the mid-to-late 2000s, but has been on the increase since then. In 2012, 6.5 percent of 8th graders, 17.0 percent of 10th graders, and 22.9 percent of 12th graders used marijuana in the past month—an increase among 10th and 12th graders from 14.2 percent, and 18.8 percent in 2007. Daily use has also increased; 6.5 percent of 12th graders now use marijuana every day, compared to 5.1 percent in the 2007. Synthetic marijuana is a new and major concern. Also known as Spice or K2, synthetic marijuana refers to herbal mixtures laced with synthetic cannabinoids, chemicals that act in the brain similarly to THC, the main active ingredient in marijuana. These mixtures could be obtained legally until recently and are still wrongly perceived as a safe alternative to marijuana. Synthetic marijuana was added to the MTF survey in 2011. In that year, 11.4 percent of 12th graders—one in nine—reported using it in the past year. This year 4.4 percent of 8th graders, 8.8 percent of 10th graders, and 11.3 percent of 12th graders reported past-year use.