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2006 National Survey on Drug Use & Health: National Results |
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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 several of these other data systems and presents selected comparisons with NSDUH results. In addition, this appendix describes surveys of populations not covered by NSDUH. Survey descriptions are presented in alphabetical order.
When considering the information presented here, it is important to understand the methodological differences between the different surveys and the impact that these differences could have on estimates of the presence of substance use and mental health problems. 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 (Gfroerer, Wright, & Kopstein, 1997; Grucza, Abbacchi, Przybeck, & Gfroerer, 2007; Hennessy & Ginsberg, 2001; Miller et al., 2004). These comparisons 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, modes of data collection, questionnaires, and estimation methods.
The Behavioral Risk Factor Surveillance System (BRFSS) is an annual, State-based telephone survey of the civilian, noninstitutionalized adult population aged 18 or older and is sponsored by the Centers for Disease Control and Prevention (CDC). Since 2002, BRFSS has 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 by State. More than 350,000 adults are interviewed each year. National data are calculated using a median score across States.
NSDUH has shown consistently higher rates of binge drinking than BRFSS. The use of audio computer-assisted self-interviewing (ACASI) in NSDUH, which is considered to be more anonymous and yields higher reporting of sensitive behaviors, was offered as an explanation for the lower rates in BRFSS (Miller et al., 2004). For further details about BRFSS, see the CDC website at http://www.cdc.gov/brfss/ (CDC, 2007a).
The Epidemiologic Catchment Area (ECA) Study (1981-83) was the first survey to administer a structured psychiatric interview and provide population-based estimates of psychiatric disorders. Prevalences were estimated by collecting data from households and group quarters (e.g., prisons, nursing homes, mental hospitals) in five local catchment areas (Baltimore, Los Angeles, New Haven, North Carolina, and St. Louis) that had been previously designated as Community Mental Health Center catchment areas. There were three waves of data collection with 20,861 respondents; the first and third waves were interviewer-assisted personal interviews, and the second wave was a telephone interview conducted with household participants only (Eaton et al., 1984). The ECA utilized the Diagnostic Interview Schedule (DIS), a structured clinical instrument that can be used by nonclinically trained interviewers to generate diagnoses of psychiatric and substance use disorders using the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) (American Psychiatric Association [APA], 1980). A supplemental sample of institutional settings, such as nursing homes, psychiatric hospitals, and prisons, also was included to capture those respondents with a high probability of having a mental disorder. For further details about the ECA, see http://webapp.icpsr.umich.edu/cocoon/ICPSR-STUDY/06153.xml (National Institute of Mental Health [NIMH], 1992-1994).
The Harvard School of Public Health's College Alcohol Study (CAS) is an ongoing survey of students at 4-year colleges and universities in 40 States. The study surveyed a random sample of students at the same colleges in 1993, 1997, 1999, and 2001. The schools and students were selected to provide nationally representative samples of schools and students. In 1993, a national sample of 195 colleges was selected from the American Council on Education's list of accredited 4-year colleges by using probability proportionate to size of enrollment; of the 195 colleges, 140 agreed to participate, for a school-level response rate of 72 percent (Wechsler, Dowdall, Davenport, & Castillo, 1995). Of these 140 colleges, 130 participated in 1997, 128 in 1999, and 120 in 2001. Student-level response rates to the two-stage mail survey were 70 percent in 1993, 59 percent in 1997 and 1999, and 52 percent in 2001. The researchers provided a short survey to nonrespondents in order to better weight the data (Wechsler et al., 2002). For further details, see the CAS website at http://www.hsph.harvard.edu/cas/Home.html (Harvard School of Public Health, 2005).
The Monitoring the Future (MTF) study is a national survey that tracks substance 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 the spring, students complete a self-administered, machine-readable questionnaire during a regular class period. An average of about 400 public and private schools and about 50,000 students are sampled annually. The latest MTF was conducted in 2006 (Johnston, O'Malley, Bachman, & Schulenberg, 2006c, 2007b).
Comparisons between the MTF estimates and estimates based on students sampled in NSDUH generally have shown NSDUH substance use prevalence levels to be lower than MTF estimates, with differences tending to be more pronounced for 8th graders (Table D.1).16 The lower prevalences in NSDUH may be due to more underreporting in the household setting as compared with the MTF school setting. However, MTF does not survey dropouts, a group that NSDUH has shown to have higher rates of illicit drug use (Gfroerer et al., 1997). Both surveys showed that rates of substance use were generally stable between 2005 and 2006. For further details, see the MTF website at http://www.monitoringthefuture.org/ (University of Michigan, 2006).
The National Comorbidity Survey (NCS) was sponsored by NIMH, NIDA, and the W.T. Grant Foundation. It was designed to measure the prevalence of the illnesses in DSM-III-R (APA, 1987) in the general population. The first wave of the NCS was a household survey collecting data from 8,098 respondents aged 15 to 54. These responses were weighted to produce nationally representative estimates. A random sample of 4,414 respondents also were administered an additional module that captured information on nicotine dependence. The interviews took place between 1990 and 1992. The NCS used a modified version of the Composite International Diagnostic Interview (the UM-CIDI) to generate DSM-III-R diagnoses.
There have been several recent extensions to the original NCS, including a 10-year follow-up of the baseline sample (NCS-II), a replication study conducted in 2001 and 2002 with a newly recruited nationally representative sample of 9,282 respondents aged 18 or older (NCS-R), and an adolescent sample with a targeted recruitment of more than 10,000 adolescents (NCS-A) along with their parents and teachers.
The NCS-R used an updated version of the CIDI that was designed to capture diagnoses of substance abuse or dependence using current DSM-IV criteria (APA, 1994). It should be noted that in several recent NCS-R studies (Kessler et al., 2005a; Kessler, Chiu, Demler, & Walters, 2005b), the diagnosis for abuse also includes those who meet the diagnosis for dependence. In contrast, NSDUH follows DSM-IV guidelines and measures abuse and dependence separately. To make the NCS definition of abuse comparable with that of NSDUH, the rate for dependence must be subtracted from the rate for abuse. Rates of alcohol dependence or abuse and rates of illicit drug dependence or abuse were generally lower in NCS-R than NSDUH. The NCS also produces nationally representative data on psychiatric conditions (Kessler et al., 2003a, 2003b). For further details, see the NCS website at http://www.hcp.med.harvard.edu/ncs/ (Harvard School of Medicine, 2005).
The National Health Interview Survey (NHIS) is a continuing nationwide sample survey that collects data using personal household interviews through an interviewer-administered computer-assisted personal interviewing (CAPI) system. The survey is sponsored by the National Center for Health Statistics (NCHS) and provides national estimates of selected health measures, including cigarette smoking and alcohol use among persons aged 18 or older. NHIS data have been collected since 1957. In 2006, data were derived from three components of the survey: the Family Core, which collects information from all family members in each household; the Sample Adult Core, which collects information from one adult aged 18 or older in each family; and the Sample Child Core, which collects information from one child in each family with a child. In 2006, NHIS data were based on 53,043 persons in the Family Core, 17,040 adults in the Sample Adult Core, and 6,920 children in the Sample Child Core (CDC, 2007b). For further details about the NHIS, see the CDC website at http://www.cdc.gov/nchs/nhis.htm (CDC, 2007b).
The National Longitudinal Alcohol Epidemiologic Survey (NLAES) was conducted in 1991 and 1992 by the U.S. Bureau of the Census for the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Face-to-face, interviewer-administered interviews were conducted with 42,862 respondents aged 18 or older in the contiguous United States. Despite the survey name, the design was cross-sectional.
The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was conducted in 2001 and 2002, also by the U.S. Bureau of the Census for NIAAA, using a computerized interviewer-administered interview. The NESARC sample was designed to make inferences for persons aged 18 or older in the civilian, noninstitutionalized population of the United States, including Alaska, Hawaii, and the District of Columbia, and including persons living in noninstitutional group quarters. NESARC is designed to be a longitudinal survey. The first wave was conducted in 2001 and 2002, with a final sample size of 43,093 respondents aged 18 or older. The second wave was conducted from 2004 to 2005 (Grant & Dawson, 2006).
The study contains comprehensive assessments of drug use, dependence, and abuse and associated mental disorders. NESARC included an extensive set of questions, based on DSM-IV criteria (APA, 1994), designed to assess the presence of symptoms of alcohol and drug dependence and abuse in persons' lifetimes and during the prior 12 months. In addition, DSM-IV diagnoses of major mental disorders were generated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-version 4 (AUDADIS-IV), which is a structured diagnostic interview that captures major DSM-IV axis I and axis II disorders.
Recent research indicates that (a) prevalence estimates for substance use were generally higher in NSDUH than in NESARC; (b) rates of past year substance use disorder (SUD) for cocaine and heroin use were higher in NSDUH than in NESARC; (c) rates of past year SUD for use of alcohol, marijuana, and hallucinogens were similar between NSDUH and NESARC; and (d) prevalence estimates for past year SUD conditional on past year use were substantially lower in NSDUH for the use of marijuana, hallucinogens, and cocaine (Grucza et al., 2007). A number of methodological variables might have contributed to such discrepancies, including factors related to privacy and anonymity (NSDUH is self-administered, while NESARC is interviewer administered, which may have resulted in higher use estimates in NSDUH) and differences in SUD diagnostic instrumentation (which may have resulted in higher SUD prevalence among past year substance users in NESARC). For further details about NLAES or NESARC, see the NIAAA website at http://www.niaaa.nih.gov/ (NIAAA, 2007).
The National Longitudinal Study of Adolescent Health (Add Health) was 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. Initiated in 1994 under a grant from the National Institute of Child Health and Human Development (NICHD) with cofunding from 17 other Federal agencies, Add Health is the largest, most comprehensive survey of adolescents ever undertaken. Data at the individual, family, school, and community levels were collected in two waves between 1994 and 1996. In Wave 1 (conducted in 1994-95), roughly 90,000 students from grades 7 through 12 at 144 schools around the United States answered brief, machine-readable questionnaires during a regular class period. Interviews also were conducted with about 20,000 students and their parents in the students' homes using a combined CAPI and ACASI design. In Wave 2, students were interviewed a second time in their homes. In 2001 and 2002, 4,882 of the original Add Health respondents, now aged 18 to 26, were re-interviewed in a third wave to investigate the influence that adolescence has on young adulthood. Identifying information was obtained from participants in order to track them over time. For further details, see the Add Health website at http://www.cpc.unc.edu/addhealth (University of North Carolina, Carolina Population Center, 2005).
The National Survey of Parents and Youth (NSPY) was sponsored by NIDA to evaluate the Office of National Drug Control Policy's (ONDCP's) National Youth Anti-Drug Media Campaign. NSPY was a national, household-based survey of youths aged 9 to 18 years old and their parents. Data were collected using a combination of computer-assisted interviewing technologies, including CAPI for nonsensitive portions of the survey and ACASI for the sensitive portions.
NSPY employed a panel survey design with nine waves of data collection for youths between November 1999 and June 2004. Wave 1 included 3,298 youths and 2,284 of their parents, who were interviewed between November 1999 and May 2000. Wave 9 was conducted between January and June 2004 with 3,142 youths and 2,381 parents.
Data from NSPY and NSDUH produced similar estimates of marijuana use for youths For example, Wave 9 of NSPY data indicated that 16.7 percent of youths aged 12 to 18 had used marijuana in the past year, and the 2004 NSDUH yielded an estimate of 17.1 percent among this age group for this time period (Orwin et al., 2006). One explanation for the similarity in estimates is that both surveys used ACASI. For further details, see the NSPY Center website at https://www.nspycenter.com/default.asp (AMSAQ, Inc., & Westat, 2007).
The Partnership Attitude Tracking Study (PATS), an annual national research study that tracks attitudes about illegal drugs, is sponsored by the Partnership for a Drug-Free America (PDFA). PATS consists of two nationally projectable samples—a teenage sample for students in grades 7 through 12 and a parent sample. Adolescents complete self-administered, machine-readable questionnaires during a regular class period with their teacher remaining in the room. In 2002, PATS included questions on prescription drug abuse, and in 2005, it included questions on use of over-the-counter cough medicine to get high. The teenage sample is administered to approximately 7,000 youths annually. The latest PATS was conducted in 2005 (PDFA, 2006a).
In general, NSDUH estimates of prevalence for youths aged 12 to 17 are lower than PATS estimates for youths in grades 7 through 12. The differences in prevalence estimates are 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. In addition, the PATS survey is conducted with a sample of students in the 7th through 12th grades, which is a slightly older sample than that of the NSDUH 12- to 17-year-old sample (PDFA, 2006b). For further details about PATS, see the PDFA website at http://www.drugfree.org/ (PDFA, 2006a).
The Youth Risk Behavior Survey (YRBS) is a component of the CDC's Youth Risk Behavior Surveillance System (YRBSS), which measures the prevalence of six priority health risk behavior categories: (a) behaviors that contribute to unintentional injuries and violence; (b) tobacco use; (c) alcohol and other drug use; (d) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infections; (e) unhealthy dietary behaviors; and (f) physical inactivity. The YRBSS includes national, State, territorial, and local school-based surveys of high school students conducted every 2 years. The national school-based survey uses a three-stage cluster sample design to produce a nationally representative sample of students in grades 9 through 12 who attend public and private schools. The State and local surveys use a two-stage cluster sample design to produce representative samples of students in grades 9 through 12 in their jurisdictions. The YRBS is conducted during the spring, with students completing a self-administered, machine-readable questionnaire during a regular class period. The latest YRBS was conducted in 2005 (Eaton et al., 2006).
In general, the YRBS school-based survey has found higher rates of substance use for youths than those found in NSDUH (Table D.2). The lower prevalence rates in NSDUH are likely due to the differences in study design; specifically, the YRBS is school-based, which likely has resulted in higher rates of reported use as compared with the home-based NSDUH. For further details about the YRBS, see the CDC website at http://www.cdc.gov/HealthyYouth/yrbs/index.htm (CDC, 2007c).
The 2005 Department of Defense (DoD) Survey of Health Related Behaviors among Military Personnel was the 9th in a series of studies conducted since 1980. The sample consisted of 16,146 active-duty Armed Forces personnel worldwide who anonymously completed self-administered questionnaires that assessed substance use and other health behaviors (Bray et al., 2006). In recent administrations of this survey, comparisons with NSDUH data have consistently shown that, even after accounting for demographic differences between the military and civilian populations, the military personnel had higher rates of heavy alcohol use than their civilian counterparts, similar rates of cigarette use, and lower rates of illicit drug use. For further details, see the DoD Lifestyle Assessment Program (DLAP) website at http://dodwws.rti.org/index.cfm (DoD & RTI International, 2006).
The Survey of Inmates in State and Federal Correctional Facilities (SISCF) is conducted by the Bureau of Justice Statistics (BJS) every 5 years, providing information on individual characteristics of prison inmates, current offenses and sentences, family background, prior drug and alcohol use and treatment, as well as other characteristics. The SISCF is the only national source of detailed information on criminal offenders, particularly special populations such as drug and alcohol users and offenders who have mental health problems. The latest administration of this survey was conducted in 2004. Inmates were from a universe of 1,585 facilities. Systematic random sampling was used to select the inmates for computer-assisted personal interviewing. The final numbers interviewed were 14,999 State prisoners and 3,686 Federal prisoners.
Prior drug use among State prisoners remained stable on all measures between 1997 and 2004, while the percentage of Federal inmates who reported prior drug use rose on most measures (Mumola & Karberg, 2006). For the first time, half of Federal inmates reported drug use in the month before their offense. In 2004, measures of drug dependence and abuse based on criteria in DSM-IV were introduced. Fifty-three percent of the State and 45 percent of Federal prisoners met the DSM-IV criteria for drug abuse or dependence. The survey results indicate substantially higher rates of drug use among State and Federal prisoners as compared with NSDUH's rates for the general household population. For further details about the SISCF, see http://www.icpsr.umich.edu/NACJD/sisfcf/ (BJS, 2007).
| Drug/Current Grade Level | SURVEY/TIME PERIOD | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MTF | NSDUH (January – June) | |||||||||||
| Lifetime | Past Year | Past Month | Lifetime | Past Year | Past Month | |||||||
| 2005 | 2006 | 2005 | 2006 | 2005 | 2006 | 2005 | 2006 | 2005 | 2006 | 2005 | 2006 | |
| -- Not available. NOTE: NSDUH data have been subset to persons aged 12 to 20 to be more comparable with MTF data. a Difference between estimate and 2006 estimate is statistically significant at the .05 level. b Difference between estimate and 2006 estimate is statistically significant at the .01 level. MTF = Monitoring the Future. Sources: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2005 and 2006 (January-June). The Monitoring the Future Study, University of Michigan, 2005 and 2006. |
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| Marijuana | ||||||||||||
| 8th grade | 16.5 | 15.7 | 12.2 | 11.7 | 6.6 | 6.5 | 8.0 | 8.7 | 6.3 | 6.9 | 2.6 | 3.3 |
| 10th grade | 34.1a | 31.8 | 26.6 | 25.2 | 15.2 | 14.2 | 24.5 | 25.8 | 19.3 | 20.3 | 9.0 | 10.1 |
| 12th grade | 44.8 | 42.3 | 33.6 | 31.5 | 19.8 | 18.3 | 38.7 | 39.7 | 26.8 | 27.2 | 15.1 | 14.4 |
| Cocaine | ||||||||||||
| 8th grade | 3.7 | 3.4 | 2.2 | 2.0 | 1.0 | 1.0 | 0.5 | 0.6 | 0.4 | 0.3 | 0.2 | 0.1 |
| 10th grade | 5.2 | 4.8 | 3.5 | 3.2 | 1.5 | 1.5 | 2.7 | 2.8 | 2.2 | 2.1 | 0.6 | 0.7 |
| 12th grade | 8.0 | 8.5 | 5.1 | 5.7 | 2.3 | 2.5 | 6.3 | 7.5 | 3.9 | 5.2 | 1.1 | 1.9 |
| Inhalants | ||||||||||||
| 8th grade | 17.1 | 16.1 | 9.5 | 9.1 | 4.2 | 4.1 | 11.9 | 11.7 | 5.2 | 4.9 | 1.4 | 2.0 |
| 10th grade | 13.1 | 13.3 | 6.0 | 6.5 | 2.2 | 2.3 | 11.4 | 11.5 | 4.6 | 4.5 | 1.2 | 1.5 |
| 12th grade | 11.4 | 11.1 | 5.0 | 4.5 | 2.0 | 1.5 | 11.3 | 10.3 | 3.6 | 3.3 | 0.3 | 0.6 |
| Cigarettes | ||||||||||||
| 8th grade | 25.9 | 24.6 | -- | -- | 9.3 | 8.7 | 17.4 | 18.2 | 10.3 | 10.6 | 5.0 | 4.9 |
| 10th grade | 38.9b | 36.1 | -- | -- | 14.9 | 14.5 | 37.3 | 35.5 | 24.1 | 23.6 | 15.9 | 15.6 |
| 12th grade | 50.0a | 47.1 | -- | -- | 23.2 | 21.6 | 50.2 | 49.4 | 34.9 | 36.7 | 23.9 | 25.8 |
| Alcohol | ||||||||||||
| 8th grade | 41.0 | 40.5 | 33.9 | 33.6 | 17.1 | 17.2 | 27.6 | 29.9 | 21.1 | 22.6 | 8.0 | 9.1 |
| 10th grade | 63.2 | 61.5 | 56.7 | 55.8 | 33.2 | 33.8 | 53.9 | 55.5 | 45.5 | 46.7 | 22.3 | 23.6 |
| 12th grade | 75.1a | 72.7 | 68.6a | 66.5 | 47.0 | 45.3 | 70.7 | 72.1 | 62.5 | 64.0 | 38.7 | 38.7 |
| Substance/Period of Use | YRBS | NSDUH (January – June) | ||
|---|---|---|---|---|
| 2003 | 2005 | 2003 | 2005 | |
| YRBS = Youth Risk Behavior Survey. -- Not available. Sources: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, January-June for 2003 and 2005. Centers for Disease Control and Prevention, Youth Risk Behavior Survey, 2003 and 2005. |
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| Marijuana | ||||
| Lifetime Use | 40.2 | 38.4 | 32.5 | 28.2 |
| Past Month Use | 22.4 | 20.2 | 13.2 | 11.2 |
| Cocaine | ||||
| Lifetime Use | 8.7 | 7.6 | 5.3 | 3.9 |
| Past Month Use | 4.1 | 3.4 | 1.2 | 0.8 |
| Inhalants | ||||
| Lifetime Use | 12.1 | 12.4 | 11.8 | 12.2 |
| Past Month Use | 3.9 | -- | 0.9 | 1.0 |
| Cigarettes | ||||
| Lifetime Use | 58.4 | 54.3 | 46.0 | 39.3 |
| Past Month Use | 21.9 | 23.0 | 20.2 | 17.4 |
| Alcohol | ||||
| Lifetime Use | 74.9 | 74.3 | 63.1 | 58.0 |
| Past Month Use | 44.9 | 43.3 | 29.1 | 26.2 |
16To examine estimates that are comparable with MTF data, NSDUH estimates presented in Table D.1 are based on data collected in the first 6 months of the survey year and are subset to ages 12 to 20.
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