A variety of other surveys and data systems collect data on substance use, abuse, and dependence. It is useful to consider the results of these other studies when discussing the National Survey on Drug Use and Health (NSDUH) data. In doing this, it is important to understand the methodological differences between the different surveys and the impact that these differences could have on estimates of substance use prevalence. This appendix briefly describes several of these other data systems, including recent results from them. Not all survey results or variables within the surveys are available for 2002 for comparison with results from the 2002 NSDUH. For some comparisons, NSDUH estimates were generated from the first 6 months of data collection to be consistent with the data collection periods of other surveys.
In-depth comparisons of the methodologies of the three major federally sponsored national surveys of youth substance use have been done. In 1997, a comparison between the National Household Survey on Drug Abuse1 (NHSDA) and Monitoring the Future (MTF) was published (Gfroerer et al., 1997). In 2000, a series of papers comparing different aspects of the NHSDA, MTF, and the Youth Risk Behavior Survey (YRBS) was commissioned by the U.S. Department of Health and Human Services (DHHS). Under contract with the Office of the Assistant Secretary for Planning and Evaluation, Westat, Inc., identified and funded several experts in survey methods to prepare these papers. The papers were published in the Journal of Drug Issues (Hennessy & Ginsberg, 2001). The major findings of this study were as follows:
These findings suggest that differences in survey methodology may affect comparisons of prevalence estimates among youths from various surveys. This appendix investigates the similarities and differences among rates.
The Monitoring the Future (MTF) study is a national survey that tracks drug use trends and related attitudes among America's adolescents. This survey is conducted annually by the Institute for Social Research at the University of Michigan through a grant awarded by the National Institute on Drug Abuse (NIDA). The MTF and NSDUH are the Federal Government's largest and primary tools for tracking youth substance use. The MTF is composed of three substudies: (a) an annual survey of high school seniors initiated in 1975; (b) ongoing panel studies of representative samples from each graduating class that have been conducted by mail since 1976; and (c) annual surveys of 8th and 10th graders initiated in 1991. In 2002, for all three grades combined, 394 public and private schools and about 43,700 students were in the sample. The students completed a self-administered questionnaire during a regular class period (Johnston, O'Malley, & Bachman, 2003a, 2003b).
Comparisons between the MTF estimates and estimates based on students sampled in NSDUH have generally shown NSDUH substance use prevalence levels to be lower than MTF estimates, with relative differences being largest for 8th graders. The lower prevalences in NSDUH may be due to more underreporting in the household setting as compared with the MTF school setting. The MTF does not survey dropouts, a group generally shown (using NSDUH) to have higher rates of use (Gfroerer et al., 1997). In 2002, for most comparisons of estimates of lifetime, past year, and past month prevalence of use among 8th, 10th, and 12th graders between NSDUH and MTF, NSDUH estimates were lower (Table E.1).
The Youth Risk Behavior Survey (YRBS) is a component of the Centers for Disease Control and Prevention's (CDC's) Youth Risk Behavior Surveillance System (YRBSS), which biennially measures the prevalence of six priority health risk behavior categories: (a) behaviors that contribute to unintentional and intentional injuries; (b) tobacco use; (c) alcohol and other drug use; (d) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs); (e) unhealthy dietary behaviors; and (f) physical inactivity. The YRBSS includes national, State, territorial, and local school-based surveys of high school students. The latest YRBS survey was conducted in 2001. The 2001 national school-based survey used a three-stage cluster sample design to produce a nationally representative sample of students in grades 9 through 12. The 2001 State and local surveys used a two-stage cluster sample design to produce representative samples of students in grades 9 through 12 in their jurisdictions. The 2001 national YRBS sample included 13,601 students in grades 9 through 12 in the 50 States and the District of Columbia. The national survey and all of the State and local surveys were conducted during the spring of 2001, with the exception of Hawaii. The Hawaii surveys were conducted in the fall of 2001. The students completed a self-administered questionnaire during a regular class period (CDC, 2003b). In general, this school-based survey has found higher rates of alcohol, cigarette, marijuana, and cocaine use for youths than those found in NSDUH. The prevalence of illicit drug use is generally much higher in the YRBS than in NSDUH (e.g., past month marijuana use was 23.9 percent in the 2001 YRBS compared with 8.0 percent in the 2001 NSDUH and 8.2 percent for youths aged 12 to 17 in the 2002 NSDUH). This is likely due to the dissimilarity of the study designs (school-based vs. home-based).
The National Longitudinal Study of Adolescent Health (Add Health) is conducted to measure the effects of family, peer group, school, neighborhood, religious institution, and community influences on health risks, such as tobacco, drug, and alcohol use. The survey also asks about substance abuse (alcohol, tobacco, and illicit drugs). The survey consists of three phases. In Wave 1 (conducted in 199495), roughly 90,000 students from grades 7 through 12 at 144 schools around the United States answered brief questionnaires. Interviews also were conducted with about 20,000 students and their parents in the students' homes. In Wave 2, students were interviewed a second time in their homes. These interviews took place in 1996. Wave 3 consists of re-interviews of respondents from Wave 1 and began in July 2001. Survey results from the first two waves indicated that nearly one fourth of teenagers had ever smoked marijuana. Nearly 7 percent of 7th and 8th graders used marijuana at least once in the past month as did 15.7 percent of 9th through 12th graders (Resnick et al., 1997).
The Partnership Attitude Tracking Study (PATS) is an ongoing national research study that tracks drug use and drug-related attitudes among children, teenagers, and their parents. It is sponsored by the Partnership for a Drug Free America (PDFA). In the 2002 PATS, 7,084 teenagers in grades 7 through 12 completed self-administered questionnaires (PDFA, 2003a, 2003b). For the first time in 2002, PATS included questions on prescription drug abuse. The 2002 PATS found that 20 percent of youths in grades 7 to 12 had ever used prescription pain killers without a doctor's prescription; 19 percent of adolescents reported lifetime use of inhalants; and 40 percent reported lifetime use of marijuana. NSDUH reported notably lower prevalence rates than PATS. The major difference in these prevalence estimates is likely to be due to the different study designs. The youth portion of PATS is a school-based survey, which may elicit more reporting of sensitive behaviors than the home-based NSDUH.
The National Survey of Parents and Youth (NSPY) is sponsored by the National Institute on Drug Abuse (NIDA) to evaluate the Office of National Drug Control Policy's (ONDCP's) National Youth Anti-Drug Media Campaign. The survey is specifically designed to evaluate Phase III of the campaign, which began in September 1999 and will run at least until 2003. The NSPY is divided into two phases, with five waves of data collection in these two phases. In Phase I (Waves 1 through 3 of data collection), a sample of youths aged 9 to 18 and their parents were recruited to participate in the in-home survey. In Phase II (Waves 4 and 5 of data collection), the respondents from Phase I participated in two additional interviews at intervals of 6 to 24 months. In November 2002, ONDCP released its fifth semiannual report of findings that contained data from all three phases (Hornik et al., 2002a).
Wave 5's data were collected between January and June 2002 and included 4,040 youths and 2,882 parents. This wave of data showed that the past year rate of marijuana use among 12 to 18 year olds was 15.5 percent (Hornik et al., 2002a). The corresponding 2002 NSDUH estimate for past year marijuana use among youths aged 12 to 18 was 25.3 percent. Despite the differences in methodology, the two surveys produced very similar estimates for youths (see Table E.2).
In past waves of NSPY data collection, parents also have been asked about their drug use behaviors; however, parental use was not asked in the Wave 5 data collection. Lifetime use of marijuana was 53.7 percent in 2001, and past month use was 3.4 percent.
The National Health Interview Survey (NHIS) is a continuing nationwide sample survey that collects data using personal household interviews. The survey is sponsored by the National Center for Health Statistics (NCHS) and provides national estimates of selected health measures. The data presented are from January through September of 2002. The survey estimated that 22.5 percent of the population aged 18 or older were current cigarette smokers in 2002 (Ni, Schiller, Hao, Cohen, & Barnes, 2003). Among males, 25.3 percent reported current cigarette smoking compared with 19.9 percent of females aged 18 or older.
In the NHIS, current smokers are defined as those who smoke daily, smoked on 1 or more days in the past month, or quit smoking fewer than 30 days ago (for those who smoked 100 or more cigarettes in their lifetime). In NSDUH, current cigarette smoking is defined as any use in the past month. The 2002 NSDUH rate was 27.5 percent for those aged 18 or older. However, when using a definition similar to the NHIS definition, the 2002 NSDUH estimates indicate that 25.6 percent of adults aged 18 or older were current smokers. Among males, 39.6 percent reported current cigarette smoking compared with 25.4 percent of females. Although the two surveys employ different methodologies, NSDUH produces similar estimates when using the NHIS definition. See Table E.3 for a comparison of smoking rates between these two surveys.
The NHIS defines excessive alcohol drinkers as those who consumed greater than or equal to five drinks in 1 day at least 12 times during the past 12 months. The NHIS rate for excessive alcohol consumption among those aged 18 or older was 9.6 percent in 2002. For NSDUH, heavy alcohol use is defined as having five or more drinks on the same occasion on at least 5 different days in the past 30 days. The 2002 NSDUH rate for heavy drinking among those 18 or older was 7.2 percent. Although the two surveys use different definitions and methodologies, they have produced similar estimates for past year alcohol use over the past several years.
This school-based survey showed past month cigarette smoking rates of 10.7 percent for 8th graders, 17.7 percent for 10th graders, and 26.7 percent for 12th graders. In contrast, the 2002 NSDUH showed 7.9 percent for 8th graders, 17.6 for 10th graders, and 28.2 percent for 12th graders. See Table E.1 for a comparison of the MTF and NHSDA cigarette use estimates.
According to the 2002 MTF, alcohol consumption in the month prior to the survey was reported by 19.6 percent of 8th graders, 35.4 percent of 10th graders, and 48.6 percent of 12th graders. Table E.1 shows how these numbers compare with NSDUH estimates.
The 2001 YRBS found lifetime cigarette use was 63.9 percent and past month cigarette use was 28.5 percent among students in grades 9 to 12 (CDC, 2003b). The 2002 NSDUH lifetime cigarette rate for youths aged 12 to 17 was 33.3 percent, and the past month rate was 13.0 percent; in 2001, comparable rates were 33.6 and 13.0 percent.
Past month alcohol use among 9th to 12th graders in the YRBS was 47.1 percent in the 2001 survey. In contrast, NSDUH showed a past month alcohol use rate of 17.3 percent in 2001 and 17.6 percent in 2002. The 2002 NSDUH rate for binge alcohol use among 12 to 17 year olds also was much lower (10.6 percent in 2001 and 10.7 percent in 2002). It is important to note that the two surveys were conducted in different time periods.
Data from the 2002 PATS shows that the prevalence of past month cigarette for adolescents in grades 7 through 12 was 28 percent (PDFA, 2003). The 2002 NSDUH showed a prevalence of 13.0 percent among youths aged 12 to 17. Again, the lower prevalence estimates in NSDUH are likely due to its home-based study design.
The 2002 PATS found that 53 percent of teenagers reported using alcohol in the past year. This compares with 34.6 percent of youths aged 12 to 17 reporting past year use in the 2002 NSDUH. The 2002 PATS also found that 36 percent of teenagers reported past month alcohol use. The binge drinking estimate was 30 percent in 2002. In comparison, the 2002 NSDUH rates for past month alcohol use and binge drinking for 12 to 17 year olds were 17.6 and 10.7 percent, respectively.
BRFSS is a State-based telephone survey of the civilian, noninstitutionalized adult population sponsored by the CDC. Adults include all persons aged 18 or older. In 2001, BRFSS collected data from all 50 States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam. 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 by State. The median percentage of adults who reported having five or more alcoholic drinks on an occasion at least five times in the past month, or heavy drinking, was 7.0 percent in 2001 (CDC, 2002, 2003a). The heavy drinking rate for adults was 6.1 percent in the 2001 NHSDA and 7.2 percent in the 2002 NSDUH.
Results from the 199495 Add Health indicate that nearly 3.2 percent of 7th and 8th graders smoked six or more cigarettes a day, as did 12.8 percent of 9th through 12th graders (Resnick et al., 1997). In addition, the Add Health study found that 7.3 percent of 7th and 8th graders used alcohol on 2 or more days in the past month, as did 23.1 percent of 9th through 12th graders.
Past waves of NSPY collected information on cigarette and alcohol use, but Wave 5 in 2002 did not. In 2001, this survey estimated that 34.9 percent of youths aged 12 to 18 had used cigarettes at some point in their lifetime and past month cigarette use was 11.7 percent. The 2002 NSDUH rates of lifetime and past month cigarette use for youths aged 12 to 18 were 38.8 and 16.7 percent, respectively. The two surveys have produced very similar smoking estimates over the past few years.
In 2001, the NSPY estimated that 45.9 percent of youths aged 12 to 18 had used alcohol at some point in their lifetime, and the estimate for past month use was 36.5 percent for the same age group. The 2002 NSDUH rates for lifetime and past month alcohol use were 43.4 and 36.0 percent, respectively.
The rate of past month cigarette use among parents in the 2001 NSPY was 25.2 percent.
In 1993, the Harvard School of Public Health conducted a mail survey of students from a nationally representative sample of colleges. The purpose of the study was to gather data on the drinking patterns of college students. The study was repeated in 1997, 1999, and 2001. The 2001 survey found that the overall rate of binge drinking was 44.4 percent (Wechsler et al., 2002). The CAS defined binge drinking as the consumption of five or more drinks in a row for men and four drinks in a row for women. The study found that the number of students who binge drank frequently was 22.8 percent and those who did not drink at all was 19.3 percent. The 2002 NSDUH binge drinking rate among full-time undergraduates aged 18 to 22 was 44.4 percent. It is useful to note that NSDUH defines binge drinking as five or more drinks in a row on at least one occasion in the past month for both men and women. Despite using different definitions of binge drinking, the CAS estimate and the NSDUH estimate are the same, but it is important to note that the two studies were conducted in different time periods.
The National Comorbidity Survey (NCS) was sponsored by the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and the W. T. Grant Foundation. It was designed to measure the prevalence of the illnesses in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) (American Psychiatric Association [APA], 1987). The NCS was a household survey consisting of more than 8,000 respondents aged 15 to 54. The interviews took place between 1990 and 1992. The NCS used a modified version of the Composite International Diagnostic Interview (the UM-CIDI) for its diagnoses. The results showed that 3.6 percent of the population abused or were dependent on some type of drug in the previous 12 months (Kessler et al., 1994). The corresponding NSDUH rate for persons aged 12 or older in 2002 was 3.0 percent. Alcohol abuse or dependence, however, showed a much higher prevalence in the NCS with 14.1 percent of the population abusing or dependent on the drug in the previous year. Alcohol abuse or dependence also had a higher prevalence in the 2002 NSDUH (7.7 percent among persons aged 12 or older), but it was well below the NCS rate. When comparing these two studies, one should keep in mind that they were conducted in two different time periods and they each use a different set of diagnostic questions. The 2002 NSDUH estimates for abuse and dependence are based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994).
The National Comorbidity Survey Replication (NCS-R) was conducted between February 2001 and December 2002 with more than 9,000 respondents aged 18 or older. Data on substance abuse and dependence are not yet available.
The National Longitudinal Alcohol Epidemiologic Survey (NLAES) was conducted in 1992 by the U.S. Bureau of the Census for the National Institute on Alcohol Abuse and Alcoholism. Face-to-face interviews were conducted with 42,862 respondents aged 18 or older in the contiguous United States. NLAES was designed to study the drinking practices, behaviors, and related problems in the general public. The survey included an extensive set of questions designed to assess the presence of symptoms of alcohol and drug abuse and dependence during the prior 12 months, based on the criteria from the DSM-IV (APA, 1994). This study based its diagnoses on the updated DSM-IV. The 1992 survey found that 7.4 percent of adults were abusing or dependent on alcohol (Grant, 1995). In 2002, NSDUH found that 7.9 percent of adults were abusing or dependent on alcohol. NLAES also found that 1.5 percent of adults were abusing or dependent on some type of illicit drug in the past year. In comparison, the 2002 NSDUH found that 2.7 percent of adults were abusing or dependent on some illicit drug. Although the estimates from these two surveys are relatively close, one should note that they were conducted in different time periods using different methodologies.
This study was replicated in 2002 as the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), and many of the original items were retained. Data are not available at this time.
The NSPY, described above, is distinct in that it measures drug use and attitudes among youths as young as 9. The earlier NSPY results showed that youths aged 9 to 11 were strongly opposed to marijuana use. Wave 3 of the survey estimated that only 0.3 percent of youths aged 9 to 11 had used marijuana in the past year. The corresponding rates for Waves 1 and 2 were 0.8 and 0.0 percent, respectively (ONDCP, 2003).
The Washington, DC, Metropolitan Area Drug Study (DC*MADS) was designed (a) to estimate the prevalence, correlates, and consequences of drug abuse among all types of people residing in one metropolitan area of the country during one period of time with special focus on populations who were underrepresented or unrepresented in household surveys and (b) to develop a methodological model for similar types of research in other metropolitan areas of the country. Sponsored by NIDA and conducted from 1989 to 1995 by RTI and Westat, Inc., as the principals, the project included 11 separate but coordinated studies that focused on different population subgroups (e.g., homeless people, institutionalized individuals, adult and juvenile offenders, new mothers, drug abuse treatment clients) or different aspects of the drug abuse problem (e.g., adverse consequences of drug abuse). DC*MADS provided a replicable methodological approach for developing representative estimates of the prevalence of drug abuse among all population subgroups, regardless of their residential setting, in a metropolitan area. The key population domains in DC*MADS were the homeless, the institutionalized, and the household. A major finding of DC*MADS was that, when data are aggregated for populations from each of the three domains, the overall prevalence estimates for use of drugs differ only marginally from those that would be obtained from the household population alone (i.e., from NSDUH), largely because the other populations are very small compared with the household population. However, a somewhat different picture emerged when the numbers of drug users were examined. Adding in the nonhousehold populations resulted in an increase of approximately 14,000 illicit drugs users compared with the corresponding estimates for the household population. About 25 percent of past year crack users, 20 percent of past year heroin users, and one third of past year needle users were found in the nonhousehold population (Bray & Marsden, 1999).
The 1998 DoD Survey of Health Related Behaviors Among Military Personnel (7th in a series of studies conducted since 1980) was sponsored by the DoD and conducted by RTI. The sample consisted of 17,264 active-duty Armed Forces personnel worldwide who anonymously completed self-administered questionnaires that assessed substance use and other health behaviors. For the total DoD, during the 30 days prior to the date that a survey was completed, heavy alcohol use declined from 20.8 percent in 1980 to 15.4 percent in 1998; cigarette smoking decreased from 51.0 percent in 1980 to 29.9 percent in 1998; and use of any illicit drugs declined from 27.6 percent in 1980 to 2.7 percent in 1998 (Bray et al., 1999). For the latest survey, military personnel exhibited significantly higher rates of heavy alcohol use than their civilian counterparts (14.2 vs. 9.9 percent) when demographic differences between the military and civilian populations were taken into account (civilian data were drawn from the 1997 NHSDA and adjusted to reflect demographic characteristics of the military). Differences in military and civilian heavy alcohol use rates were largest for men aged 18 to 25. Among this age group, the military rate was nearly twice as high as the adjusted civilian rate (26.9 vs. 14.9 percent). In contrast, military personnel showed lower rates of cigarette use (29.1 vs. 32.8 percent) compared with civilians, a finding that seems largely due to an increase in smoking among civilians rather than a significant decrease among military personnel since the prior survey in 1995. Similarly, rates of illicit drug use in the military were significantly lower than those observed for the comparable civilian population when demographic differences between the military and civilian populations were taken into account (2.6 vs. 10.7 percent). Differences in illicit drug use between the military and civilian populations were more pronounced for males than females. For males aged 18 to 55, 2.8 percent of those in the military used drugs in the 30 days prior to the survey compared with 11.4 percent of the civilian population (adjusted). For females aged 18 to 55, 1.9 percent of those in the military used drugs in the 30 days prior to the survey compared with 6.2 percent of the civilian population (adjusted). Nearly all military personnel reported having been tested for drugs since joining the military.
The 1997 Survey of Inmates in State and Federal Correctional Facilities sampled inmates from a universe of 1,409 State prisons and 127 Federal Prisons for the Bureau of Justice Statistics (BJS). Systematic random sampling was used to select the inmates for the computer-assisted personal interviews. The final numbers interviewed were 14,285 State prisoners and 4,041 Federal prisoners. Among other items, these surveys collect information on the use of drugs in the month before the offense for convicted inmates. Women in State prisons (62.4 percent) were more likely than men (56.1 percent) to have used drugs in the month before the offense (BJS, 1999, 2000). Women also were more likely to have committed their offense while under the influence of drugs (40.4 vs. 32.1 percent of male prisoners). Among Federal prisoners, men (45.4 percent) were more likely than women (36.7 percent) to have used drugs in the past month. Male and female Federal prisoners were equally likely to report the influence of drugs during their offense (22.7 percent of male and 19.3 percent of female prisoners). The survey results indicate substantially higher rates of drug use among State and Federal prisoners as compared with the household population.
Table E.1 Use of Specific Substances in Lifetime, Past Year, and Past Month among 8th, 10th, and 12th Graders in NSDUH and MTF: Percentages, 2002
|Drug/Current Grade Level||SURVEY/TIME PERIOD|
|Lifetime||Past Year||Past Month||Lifetime||Past Year||Past Month|
*Low precision; no estimate reported.
-- Not available.
MTF = Monitoring the Future.
Sources: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
The Monitoring the Future Study, University of Michigan, 2002.
Table E.2 Lifetime, Past Year, and Past Month Marijuana Use among Youths Aged 12 to 18 in NSPY and NSDUH, by Age Group: 2002
|Use Measure||Age Group||Percent Reporting Use|
|Lifetime||12 to 13||4.9||4.4|
|14 to 15||19.5||19.8|
|16 to 18||38.9||43.0|
|12 to 18||23.0||25.3|
|Past Year||12 to 13||3.2||2.8|
|14 to 15||13.2||16.6|
|16 to 18||26.3||31.6|
|12 to 18||15.5||19.1|
|Past Month||12 to 13||1.1||1.4|
|14 to 15||6.2||8.1|
|16 to 18||15.3||17.1|
|12 to 18||8.4||10.0|
NSPY = National Survey of Parents and Youth.
Sources: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
National Institute on Drug Abuse, National Survey of Parents and Youth, January-June 2002.
Table E.3 Past Month Cigarette Use among Persons Aged 18 or Older in NHIS and NSDUH, by Gender and Age Group: Percentages, 2002
|Gender/Age||NHIS (January September)||NSDUH (January September)|
|18 to 44||26.6||31.4|
|45 to 64||22.4||23.6|
|65 or Older||9.1||9.8|
|18 to 44||29.9||34.2|
|45 to 64||24.2||26.9|
|65 or Older||10.2||12.3|
|18 to 44||23.4||28.7|
|45 to 64||20.7||20.5|
|65 or Older||8.3||7.9|
Note: For the NHIS, past month cigarette use is defined as currently smoking daily or smoking 1 or more days in the past month or quitting smoking less than 30 days ago (for those who smoked 100+ cigarette in lifetime). The analysis excluded those with unknown use status (about 1 percent each year). For NSDUH, past month cigarette use is defined as having smoked in the past month. For comparison purposes, the NSDUH definition was adjusted to include those that have smoked in the past month and smoked at least 100 cigarettes in their lifetime.
NHIS = National Health Interview Survey.
Sources: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
National Center for Health Statistics, National Health Interview Survey, 2002.
1 Beginning with the 2002 survey year, the survey name was changed from the National Household Survey on Drug Abuse (NHSDA) to the National Survey on Drug Use and Health (NSDUH).
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