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Appendix E:
Other Sources of State-Level Data

A variety of surveys and data systems other than the National Survey on Drug Use and Health (NSDUH) collect data on substance use and mental health problems. It is useful to consider the results of these other studies when discussing NSDUH data. This appendix briefly describes one of these other data systems that publish State estimates, presenting selected comparisons with NSDUH results. The State-level survey that collects data on substance use discussed in this appendix is the Behavioral Risk Factor Surveillance System (BRFSS), sponsored by the Centers for Disease Control and Prevention (CDC). Another CDC data system that provides State-level substance use estimates for most but not all States is the Youth Risk Behavior Survey (YRBS). Differences between the YRBS and NSDUH designs, and age groups used in NSDUH small area estimates, imply that comparisons of prevalence rates are not straightforward. However, ignoring these differences and examining estimates at a national level, the YRBS has generally shown to have higher prevalence rates but similar long-term trends compared with NSDUH (Office of Applied Studies [OAS], 2009). For further details about the YRBS, see the CDC Web site at http://www.cdc.gov/HealthyYouth/yrbs/index.htm.

When considering the information presented here, it is important to understand the methodological differences between these surveys and the impact that these differences could have on estimates of substance use. Several studies have compared NSDUH estimates with estimates from other studies and have evaluated how differences may have been affected by differences in survey methodology (Brener et al., 2006; Gfroerer, Wright, & Kopstein, 1997; Grucza, Abbacchi, Przybeck, & Gfroerer, 2007; Hennessy & Ginsberg, 2001; Miller et al., 2004). These studies suggest that the goals and approaches of surveys are often different, making comparisons between them difficult. Some methodological differences that have been identified as affecting comparisons include populations covered, sampling methods, mode of data collection, survey setting, questionnaires, and estimation methods.

BRFSS is an annual, State-based telephone survey of the civilian, noninstitutionalized adult population aged 18 or older and is sponsored by the CDC. In 2008, BRFSS collected data from all 50 States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam using a computer-assisted telephone interviewing (CATI) design. BRFSS collects information on access to health care, health status indicators, health risk behaviors (including cigarette and alcohol use), and the use of clinical preventive services. More than 350,000 adults are interviewed each year. State estimates are presented on a yearly basis. BRFSS data are weighted based on the probability of selection of a telephone number, the number of adults in a household, and the number of telephones in a household. A final poststratification adjustment is made for nonresponse and noncoverage of households without telephones. The BRFSS State prevalence rates and confidence intervals (CIs) presented in this report (in Tables E.1 and E.2 at the end of this appendix) are weighted design-based estimates (i.e., each respondent is weighted, and the survey design is accounted for in the estimates) from the 2008 survey. For more details about BRFSS, see the CDC Web site at http://www.cdc.gov/brfss.

There are three measures for which State estimates are produced for both BRFSS and NSDUH: past month alcohol use, past month binge alcohol use, and cigarette use (past month use for NSDUH and current use for BRFSS). Past month alcohol use is defined consistently in both BRFSS and NSDUH as having an alcoholic beverage in the past month. In NSDUH, past month cigarette use is defined as having smoked part or all of a cigarette during the past 30 days. In BRFSS, the cigarette use measure reported is current cigarette use, which is defined as having smoked at least 100 cigarettes during the lifetime and indicating smoking every day or some days at the time of the survey. Because of these subtle but present differences in definitions, the NSDUH estimates tend to be higher in that they catch 2 groups of people that the BRFSS estimates would not: (1) respondents who have not smoked 100 cigarettes in their lifetime but had smoked in the past month, and (2) respondents who had smoked a cigarette earlier in the month but were not smoking at the time of the survey. Lastly, both surveys ask about binge alcohol use in the past month. The definition for binge alcohol use in NSDUH is having had five or more drinks of an alcoholic beverage on the same occasion (i.e., at the same time or within a couple hours of each other) on at least 1 day in the past 30 days. In BRFSS, women are asked about drinking four or more drinks on one occasion, whereas men are asked about drinking five or more drinks on one occasion.

In this appendix, the findings of the 2008 BRFSS State estimates and the combined 2007-2008 NSDUH State estimates for past month alcohol use and cigarette use ("past month" use for NSDUH and "current" use for BRFSS) are presented. In Tables E.1 and E.2, the 2008 BRFSS State estimates for adults aged 18 or older are shown alongside the pooled 2007-2008 NSDUH small area estimates for the same age group (by combining the 18 to 25 and 26 or older age groups). Table E.1 also includes p values that indicate whether the BRFSS and NSDUH estimates are significantly different from each other for a given State using an exact test described in Section E.1. As can be seen in Table E.2, the NSDUH past month cigarette use estimates tend to be higher than the current cigarette use estimates from BRFSS; no p values of differences are shown. Because the definitions for binge alcohol use in the two surveys are different for women, no comparison of binge alcohol use was done.

E.1 Methodology for Comparing BRFSS and NSDUH Estimates

The method for comparing the two estimates is similar to what is described in Section A.11 of Appendix A. Here, the null hypothesis of no difference is tested, that is, πb = πn (where πb is a State-specific BRFSS prevalence rate and πn is a State-specific NSDUH prevalence rate) or equivalently that the logs-odds ratio is zero, that is, lor = 0, where lor is defined as The log-odds ratio, lor, is defined as the natural logarithm of the ratio of two quantities. The numerator of the ratio is Pi sub b, divided by 1 minus Pi sub b. The denominator of the ratio is Pi sub n, divided by 1 minus Pi sub n, where ln denotes the natural logarithm. An estimate of lor is given by The estimate of the log-odds ratio, lor hat, is defined as the natural logarithm of the ratio of two quantities. The numerator of the ratio is p sub b, divided by 1 minus p sub b. The denominator of the ratio is p sub n, divided by 1 minus p sub n, where pb and pn are the 2008 BRFSS State estimates and 2007-2008 NSDUH State estimates, respectively (as given in Tables E.1 and E.2). To compute the variance of estimate of the log-odds ratio, lor hat, that is, variance of the estimate of the log-odds ratio, lor hat, let Theta sub b hat is defined as the ratio of p sub b and 1 minus p sub b and Theta sub n hat is defined as the ratio of p sub n and 1 minus p sub n, then Variance v of the estimate of the log-odds ratio, lor hat, is a function of three quantities: q1, q2, and q3. It is expressed as the sum of q1 and q2 minus q3. Quantity q1 is the variance of the natural logarithm of Theta sub b hat, quantity q2 is the variance of the natural logarithm of Theta sub n hat, and quantity q3 is 2 times the covariance between the natural logarithm of Theta sub b hat and the natural logarithm of Theta sub n hat..

The covariance term can be assumed to be zero because the BRFSS and NSDUH samples are independent.

The quantity variance of the natural logarithm of Theta sub n hat can be obtained by using the 95 percent PIs in Tables E.1 and E.2. For this purpose, let (lowern,uppern) denote the 95 percent PI for a given State-s:

Equation E-1,     D

where U sub n is the natural logarithm of upper sub n, divided by 1 minus upper sub n, and L sub n is the natural logarithm of lower sub n, divided by 1 minus lower sub n. .


The quantity variance of the natural logarithm of Theta sub b can be obtained by using the 95 percent CIs in Tables E.1 and E.2. For this purpose, let (lowerb,upperb) denote the 95 percent CI for a given States-s. Using the first-order Taylor series approximation, the variance can be calculated as follows:

Equation E-2,     D


The p value (given in Table E.1) for testing the null hypothesis of no difference (lor = 0) is given by p value = 2 * P[Zabs(z)], where Z is a standard normal random variate, Quantity z is the estimate of the log-odds ratio, lor hat, divided by the square root of the sum of the variance of the natural logarithm of Theta sub b hat and the variance of the natural logarithm of Theta sub n hat, and abs(z) denotes the absolute value of z.


E.2 Alcohol Use

As can be seen in Table E.1, for past month alcohol use, the NSDUH and the BRFSS estimates for more than half of the States are similar (i.e., at the 5 percent level of significance, only 22 of 51 States, including the District of Columbia, are different). These estimates are also highly correlated (correlation coefficient = 0.97). Figures E.1 and E.2 were created by using the BRFSS State estimates and the NSDUH State estimates and categorizing the States into five quintiles similar to the process described in Section 1.2 of Chapter 1. Note that the BRFSS estimates and corresponding CIs are rounded to one decimal place, whereas the NSDUH small area estimates and prediction intervals (PIs) are rounded to two decimal places. Therefore, all of the tables and maps included in this appendix use that approximation.

As can be seen in Figures E.1 and E.2, 9 out of 10 States with the highest rates of alcohol use (States shown in red) were the same in the two surveys: Colorado, Connecticut, District of Columbia, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont, and Wisconsin. The lowest rate of past month alcohol use for both surveys occurred in Utah (see Table E.1).

E.3 Cigarette Use

As can be seen in Table E.2, the NSDUH estimates of past month cigarette use are always larger than the BRFSS estimates of current cigarette use. Some of this difference is the result of the differences in definitions as discussed earlier in this appendix; thus, exact tests to see significant differences between the NSDUH and BRFSS cigarette use estimates are not included. Although the NSDUH estimates are consistently larger for all 50 States and the District of Columbia, these 2 set of estimates are correlated (correlation coefficient = 0.82).

Figures E.3 and E.4 were created using the same method used to produce Figures E.1 and E.2. As can be seen in Figures E.3 and E.4, 7 out of 10 States with the highest rates of cigarette use (States shown in red) were the same in the 2 surveys: Arkansas, Indiana, Kentucky, Missouri, Oklahoma, Tennessee, and West Virginia. The lowest rate of cigarette use for both surveys occurred in Utah (see Table E.2).

E.4 Sample Size Comparisons

Note that the BRFSS estimates are design based; however, the NSDUH estimates are model based. Also, the NSDUH estimates are based on the pooled 2007 and 2008 NSDUHs (2 years of data), whereas the BRFSS estimates are based on the 2008 BRFSS survey (1 year of data). Although the BRFSS estimates are only based on 1 year of data, the BRFSS sample sizes for a given State are in general much larger than the sample sizes for NSDUH over 2 years. The 8 "large" States (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas) have a sample size of approximately 7,200 respondents for the 2007-2008 combined NSDUH data. For the 2008 BRFSS, one State (Illinois) had a smaller sample size as compared with the NSDUH data, but the other seven States had larger sample sizes. Overall, the BRFSS sample sizes for the 8 "large" States varied from a low of 5,163 respondents in Illinois to a high of 13,172 respondents in Pennsylvania, with a median sample size of 10,795. For the remaining small sample States, the NSDUH sample size for the combined 2007-2008 data were approximately 1,800 respondents for each State. The BRFSS sample sizes for the small sample States were much larger. The BRFSS sample sizes for the small sample States varied from a low of 2,664 respondents in Alaska to a high of 22,532 respondents in Washington, with a median sample size of 6,227. Sample size differences of this magnitude explain why the NSDUH PIs are generally wider than the corresponding BRFSS CIs.

Table E.1 Alcohol Use in Past Month among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2008 BRFSS and 2007-2008 NSDUHs
State 2008 BRFSS
(Estimate)
2008 BRFSS
(95% Confidence
Interval)
2007-2008
NSDUH
(Estimate)
2007-2008 NSDUH
(95% Prediction
Interval)
p value
NOTE: NSDUH estimates are based on a survey-weighted hierarchical Bayes estimation approach, and the 95 percent prediction (credible) intervals are generated by Markov Chain Monte Carlo techniques.
BRFSS estimates are based on a survey-weighted direct estimation approach.
NOTE: p value: Probability of no difference between the BRFSS and NSDUH estimates.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007-2008, and Behavioral Risk Factor Surveillance System, 2008.
Alabama 38.2 (36.3 - 40.2) 43.39 (40.00 - 46.86) 0.009
Alaska 53.2 (50.2 - 56.3) 60.03 (56.32 - 63.63) 0.005
Arizona 54.7 (51.9 - 57.6) 57.04 (53.41 - 60.59) 0.319
Arkansas 41.4 (39.5 - 43.4) 46.26 (42.84 - 49.71) 0.016
California 52.4 (51.1 - 53.7) 53.92 (51.99 - 55.83) 0.200
Colorado 61.5 (60.2 - 62.7) 66.73 (63.41 - 69.89) 0.004
Connecticut 65.7 (64.0 - 67.4) 65.69 (62.36 - 68.87) 0.995
Delaware 57.2 (54.9 - 59.5) 59.55 (55.95 - 63.05) 0.279
District of Columbia 61.3 (59.3 - 63.4) 64.12 (60.59 - 67.50) 0.173
Florida 51.3 (49.4 - 53.2) 56.24 (54.23 - 58.22) 0.000
Georgia 46.8 (44.8 - 48.8) 52.16 (48.54 - 55.75) 0.011
Hawaii 49.2 (47.5 - 50.9) 51.82 (48.00 - 55.61) 0.219
Idaho 46.9 (44.9 - 48.8) 46.14 (42.81 - 49.50) 0.701
Illinois 57.8 (55.9 - 59.7) 59.11 (57.21 - 60.98) 0.339
Indiana 51.2 (49.0 - 53.3) 53.14 (49.72 - 56.54) 0.346
Iowa 58.0 (56.4 - 59.6) 58.23 (54.79 - 61.60) 0.903
Kansas 49.8 (48.4 - 51.3) 55.26 (51.62 - 58.85) 0.006
Kentucky 38.6 (36.9 - 40.4) 43.13 (39.66 - 46.67) 0.022
Louisiana 46.5 (44.8 - 48.2) 51.60 (48.07 - 55.10) 0.011
Maine 58.9 (57.4 - 60.4) 56.11 (52.48 - 59.66) 0.158
Maryland 56.2 (54.6 - 57.7) 59.67 (55.99 - 63.25) 0.088
Massachusetts 63.6 (62.5 - 64.7) 65.45 (61.90 - 68.84) 0.323
Michigan 57.0 (55.6 - 58.4) 59.15 (57.24 - 61.03) 0.075
Minnesota 63.3 (61.3 - 65.3) 67.73 (64.14 - 71.13) 0.034
Mississippi 37.7 (36.1 - 39.3) 41.23 (37.79 - 44.76) 0.069
Missouri 52.0 (49.9 - 54.0) 54.26 (50.85 - 57.63) 0.266
Montana 58.3 (56.6 - 60.1) 62.12 (58.53 - 65.59) 0.060
Nebraska 57.4 (55.8 - 59.0) 60.21 (56.66 - 63.66) 0.155
Nevada 56.9 (54.6 - 59.2) 56.14 (52.25 - 59.95) 0.739
New Hampshire 64.3 (62.8 - 65.9) 67.99 (64.67 - 71.13) 0.048
New Jersey 54.5 (53.1 - 55.9) 58.25 (54.47 - 61.94) 0.068
New Mexico 47.1 (45.2 - 49.0) 49.39 (45.77 - 53.01) 0.273
New York 55.6 (54.0 - 57.2) 59.30 (57.29 - 61.27) 0.005
North Carolina 44.3 (43.0 - 45.5) 48.80 (45.09 - 52.52) 0.024
North Dakota 57.8 (55.9 - 59.7) 63.50 (60.09 - 66.78) 0.004
Ohio 53.6 (52.3 - 55.0) 55.15 (53.25 - 57.03) 0.192
Oklahoma 41.5 (40.0 - 43.0) 45.13 (41.68 - 48.63) 0.059
Oregon 56.3 (54.4 - 58.2) 63.40 (59.84 - 66.83) 0.001
Pennsylvania 54.6 (53.1 - 56.0) 58.02 (56.15 - 59.86) 0.005
Rhode Island 62.7 (60.7 - 64.6) 65.77 (62.28 - 69.10) 0.130
South Carolina 43.2 (41.5 - 44.9) 50.38 (47.06 - 53.70) 0.000
South Dakota 58.3 (56.6 - 60.1) 61.74 (58.30 - 65.07) 0.080
Tennessee 33.6 (31.3 - 35.8) 43.36 (39.90 - 46.89) 0.000
Texas 48.5 (46.8 - 50.1) 51.14 (49.28 - 53.00) 0.038
Utah 25.4 (23.9 - 27.0) 30.56 (27.35 - 33.96) 0.004
Vermont 64.9 (63.4 - 66.3) 64.81 (61.24 - 68.22) 0.962
Virginia 53.4 (50.9 - 56.0) 57.73 (54.24 - 61.14) 0.049
Washington 58.6 (57.7 - 59.6) 60.98 (57.50 - 64.35) 0.194
West Virginia 31.0 (29.2 - 32.8) 40.57 (37.30 - 43.93) 0.000
Wisconsin 66.6 (64.6 - 68.6) 64.99 (61.61 - 68.22) 0.411
Wyoming 54.1 (52.7 - 55.5) 57.07 (53.52 - 60.55) 0.126
Table E.2 Cigarette Use among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2008 BRFSS and 2007-2008 NSDUHs
State 2008 BRFSS1
(Estimate)
2008 BRFSS1
(95% Confidence
Interval)
2007-2008
NSDUH2
(Estimate)
2007-2008 NSDUH2
(95% Prediction Interval)
1 BRFSS respondents were classified as current smokers if they reported having smoked at least 100 cigarettes during their lifetime and indicated that they smoked every day or some days at the time of the survey.
2 NSDUH respondents were classified as past month cigarette users if they smoked all or part of a cigarette during the past 30 days.
NOTE: NSDUH estimates are based on a survey-weighted hierarchical Bayes estimation approach, and the 95 percent prediction (credible) intervals are generated by Markov Chain Monte Carlo techniques.
BRFSS estimates are based on a survey-weighted direct estimation approach.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007-2008, and Behavioral Risk Factor Surveillance System, 2008.
Alabama 22.1 (20.3 - 24.0) 28.94 (26.28 - 31.77)
Alaska 21.5 (19.0 - 24.0) 26.16 (23.45 - 29.06)
Arizona 15.9 (13.8 - 18.1) 25.64 (22.96 - 28.51)
Arkansas 22.3 (20.6 - 24.0) 33.10 (30.24 - 36.09)
California 14.0 (13.1 - 15.0) 20.88 (19.44 - 22.40)
Colorado 17.6 (16.6 -18.7) 26.77 (24.13 - 29.58)
Connecticut 15.9 (14.5 - 17.4) 23.30 (20.87 - 25.93)
Delaware 17.8 (16.0 - 19.6) 28.15 (25.38 - 31.10)
District of Columbia 16.2 (14.6 - 17.9) 28.60 (25.72 - 31.67)
Florida 17.5 (16.2 - 18.9) 25.50 (23.94 - 27.11)
Georgia 19.5 (17.9 - 21.2) 27.94 (25.32 - 30.72)
Hawaii 15.4 (14.1 - 16.8) 23.09 (20.39 - 26.04)
Idaho 16.9 (15.3 - 18.4) 23.24 (20.88 - 25.78)
Illinois 21.3 (19.6 - 23.0) 26.94 (25.41 - 28.53)
Indiana 26.0 (24.0 - 28.1) 29.35 (26.61 - 32.24)
Iowa 18.8 (17.4 - 20.2) 25.18 (22.74 - 27.80)
Kansas 17.9 (16.7 - 19.1) 26.92 (24.26 - 29.76)
Kentucky 25.2 (23.5 - 26.9) 34.08 (31.17 - 37.12)
Louisiana 20.5 (19.0 - 21.9) 28.49 (25.80 - 31.34)
Maine 18.2 (16.9 - 19.5) 27.90 (25.11 - 30.87)
Maryland 14.9 (13.8 - 16.0) 23.01 (20.58 - 25.62)
Massachusetts 16.1 (15.2 - 17.0) 21.15 (18.78 - 23.73)
Michigan 20.5 (19.3 - 21.6) 27.23 (25.72 - 28.80)
Minnesota 17.6 (15.9 - 19.2) 26.73 (24.19 - 29.44)
Mississippi 22.7 (21.3 - 24.1) 27.27 (24.59 - 30.12)
Missouri 25.0 (23.1 - 26.8) 29.00 (26.39 - 31.75)
Montana 18.5 (17.1 - 20.0) 24.64 (22.16 - 27.30)
Nebraska 18.4 (17.0 - 19.8) 26.26 (23.60 - 29.10)
Nevada 22.2 (20.1 - 24.3) 28.52 (25.43 - 31.84)
New Hampshire 17.1 (15.8 - 18.3) 23.76 (21.42 - 26.26)
New Jersey 14.8 (13.7 - 15.8) 24.00 (21.24 - 27.00)
New Mexico 19.4 (17.8 - 20.9) 24.04 (21.46 - 26.83)
New York 16.8 (15.6 - 18.0) 22.65 (21.15 - 24.23)
North Carolina 20.9 (19.9 - 21.9) 28.27 (25.59 - 31.11)
North Dakota 18.1 (16.5 - 19.7) 26.49 (24.01 - 29.13)
Ohio 20.1 (19.0 - 21.3) 30.02 (28.45 - 31.63)
Oklahoma 24.7 (23.4 - 26.1) 29.05 (26.14 - 32.14)
Oregon 16.3 (14.8 - 17.8) 25.92 (23.28 - 28.74)
Pennsylvania 21.3 (20.0 - 22.6) 26.34 (24.86 - 27.87)
Rhode Island 17.4 (15.7 - 19.0) 26.23 (23.67 - 28.97)
South Carolina 20.0 (18.6 - 21.4) 29.16 (26.58 - 31.88)
South Dakota 17.5 (16.2 - 18.9) 26.01 (23.62 - 28.55)
Tennessee 23.1 (21.1 - 25.2) 30.18 (27.48 - 33.02)
Texas 18.5 (17.1 - 19.9) 25.23 (23.75 - 26.78)
Utah 9.3 (8.2 - 10.4) 16.64 (14.53 - 18.99)
Vermont 16.8 (15.6 - 18.0) 23.72 (21.21 - 26.43)
Virginia 16.4 (14.8 - 18.0) 24.66 (22.12 - 27.40)
Washington 15.7 (15.0 - 16.4) 24.09 (21.69 - 26.67)
West Virginia 26.5 (24.8 - 28.3) 30.63 (27.88 - 33.54)
Wisconsin 19.9 (18.3 - 21.4) 29.10 (26.43 - 31.93)
Wyoming 19.4 (18.1 - 20.6) 28.85 (26.07 - 31.81)

Below is a map; click here for the text describing this map.

Figure E.1 Alcohol Use in Past Month among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2008 BRFSS

Figure E.1

Source: Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System, 2008.

Below is a map; click here for the text describing this map.

Figure E.2 Alcohol Use in Past Month among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2007-2008 NSDUHs

Figure E.2

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

Below is a map; click here for the text describing this map.

Figure E.3 Current Cigarette Use among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2008 BRFSS

Figure E.3

Source: Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System, 2008.

Below is a map; click here for the text describing this map.

Figure E.4 Cigarette Use in Past Month among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2007-2008 NSDUHs

Figure E.4

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2007 and 2008.

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