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Substance Abuse and Mental Health Services Administration . National Survey on Drug Use and Health: Summary of Methodological Studies, 1971–2014 [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014 Nov.
CITATION: Batts, K., Pemberton, M., Bose, J., Weimer, B., Henderson, L., Penne, M., Gfroerer, J., Trunzo, D., & Strashny, A. (2014, April). CBHSQ Data Review: Comparing and evaluating substance use treatment utilization estimates from the National Survey on Drug Use and Health and other data sources. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. [PubMed: 27748104]
PURPOSE/OVERVIEW: This report presents an evaluation of the coverage, overlap, biases, strengths, and weaknesses of three data sources about the receipt of specialty substance use treatment: the National Survey on Drug Use and Health (NSDUH), the National Survey of Substance Abuse Treatment Services (N-SSATS), and the Treatment Episode Data Set (TEDS). NSDUH is an annual survey of a representative sample of individuals aged 12 or older at their places of residence that includes questions on the receipt of substance use treatment. N-SSATS is an annual census of all known drug and alcohol use treatment facilities in the United States. TEDS is a compilation of data about the demographic and substance use characteristics of admissions to and discharges from substance use treatment.
METHODS: Methodological differences among these data sources that could contribute to the differences in estimates were described. Specialty substance use treatment measures included in this paper’s comparisons were the numbers and characteristics of individuals treated in a given year, single-day treatment counts, numbers of admissions in a given year, and estimates of the numbers of individuals who needed substance use treatment but did not receive it.
RESULTS/CONCLUSIONS: NSDUH estimates of individuals treated in a given year were significantly higher than the estimates from TEDS. Single-day treatment counts from NSDUH were similar to those from N-SSATS, and both were significantly higher than those from TEDS. N-SSATS counts of annual admissions were significantly higher than counts derived from TEDS. The consistently lower counts in TEDS seemed to be due to coverage differences in the three data systems. TEDS is mostly limited to those individuals whose treatment was publicly funded, whereas N-SSATS includes a census of all facilities regardless of funding, and NSDUH includes individuals who are treated in both privately and publicly funded facilities. Precise agreement among the data sources was not generally expected, and this lack of agreement did not reduce the importance of these studies in their contribution to the understanding of specialty substance use treatment in the United States. The analyses presented in this paper provide a basis for improving the interpretation of results from these studies and facilitate developing clear guidance for future analyses to better answer some basic questions about substance use treatment, such as how many individuals receive treatment in a year, how large is the gap between treatment received and treatment needed, and how have the numbers of individuals receiving and needing treatment changed over time.
CITATION: Biondo, G., & Chilcoat, H. D. (2014). Discrepancies in prevalence estimates in two national surveys for nonmedical use of a specific opioid product versus any prescription pain reliever. Drug and Alcohol Dependence, 134, 396–400. [PubMed: 24210422]
BACKGROUND: The need to understand trends in the nonmedical use of prescription pain relievers as a class, as well as specific opioid products, is growing. Surveys such as Monitoring the Future (MTF) study and the National Survey on Drug Use and Health (NSDUH) are important tools for understanding trends in the nonmedical use of prescription drugs and the use of illegal drugs. This report compares discrepancies in prevalence estimates between these surveys for a specific opioid product (oxycodone) relative to other drugs.
METHODS: Trends in past year use of marijuana, cocaine, and nonmedical use of oxycodone and any prescription pain reliever were estimated for each survey from 2005 to 2010 for adolescents in the 12th grade. The proportion of nonmedical pain reliever users who misused oxycodone was estimated for each survey. In NSDUH, the term OxyContin® is used and refers to controlled-release oxycodone hydrochloride.
RESULTS/CONCLUSIONS: Prevalence of the nonmedical use of oxycodone in the past year was steady over time for both surveys, but it was 2.5 to 3 times higher in the MTF compared with NSDUH. Trends in the prevalence of marijuana and cocaine use were similar across both surveys, although prevalence estimates for each were on average 18 percent higher in the MTF. In contrast, prevalence estimates for any nonmedical prescription pain reliever use were on average 15 percent lower in the MTF. The proportion of nonmedical prescription pain reliever users who used oxycodone was 42 percent in the MTF versus 19 percent in NSDUH. The discrepancy between surveys in prevalence estimates for the nonmedical use of oxycodone exceeded those for other drugs, pointing to the importance of visual aids and items used to measure the nonmedical use of specific products.
CITATION: Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Lowery, A., Grucza, R. A., Chaloupka, F. J., & Bierut, L. J. (2014). Monitoring of non-cigarette tobacco use using Google Trends. Tobacco Control, doi:10.1136/tobaccocontrol-2013-051276 [PMC free article: PMC4122644] [PubMed: 24500269] [CrossRef]
PURPOSE/OVERVIEW: Google Trends is an innovative monitoring system with unique potential to monitor and predict important phenomena that may be occurring at a population level. The authors sought to validate whether Google Trends can additionally detect regional trends in youth and adult tobacco use.
METHODS: The authors compared 2011 Google Trends relative search volume data for cigars, cigarillos, little cigars, and smokeless tobacco with State prevalence of youth (grades 9 to 12) and adult (age 18 or older) use of these products using data from the 2011 Youth Risk Behavior Survey, which is a component of the Youth Risk Behavior Surveillance System (YRBSS), and the 2010–2011 National Survey on Drug Use and Health (NSDUH), respectively. They used the Pearson correlation coefficient to measure the associations.
RESULTS/CONCLUSIONS: The authors found significant positive correlations between State Google Trends cigar relative search volume and the prevalence of cigar use among youths (r = 0.39, R2 = 0.154, p = 0.018) and adults (r = 0.49, R2 = 0.243, p < 0.001). Similarly, the authors found that the correlations between State Google Trends smokeless tobacco relative search volume and the prevalence of smokeless tobacco use among youths and adults were both positive and significant (r = 0.46, R2 = 0.209, p = 0.003 and r = 0.48, R2 = 0.226, p < 0.001, respectively). The results of this study validated that Google Trends has the potential to be a valuable monitoring tool for tobacco use. The near real-time monitoring features of Google Trends may complement traditional surveillance methods and lead to faster and more convenient monitoring of emerging trends in tobacco use.
CITATION: Center for Behavioral Health Statistics and Quality. (2014). National Survey on Drug Use and Health: 2012 Questionnaire Field Test final report. Rockville, MD: Substance Abuse and Mental Health Services Administration.
PURPOSE/OVERVIEW: The Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Center for Behavioral Health Statistics and Quality (CBHSQ) is planning to implement changes related to a partial redesign of the National Survey on Drug Use and Health (NSDUH). These changes include use of a new sample design in 2014 and a limited update to the interview questionnaire in 2015. The new sample design will allow for continued national-, State-, and substate-level estimation comparable with estimation from previous surveys. The sample design’s improved efficiency will result in significant cost savings. The primary change to the questionnaire is an updated set of prescription drug modules, which will include current prescription drugs and incorporate a new questionnaire structure. Other planned changes to the questionnaire include a revised health module that contains new questions about drug and alcohol screening by primary care physicians. These changes will seek to achieve three main goals: (1) to revise the questionnaire to address changing policy and research data needs, (2) to modify the survey methodology to improve the quality of estimates and the efficiency of data collection and processing, and (3) to maintain trends in core substance use estimates across survey years. The 2012 Questionnaire Field Test (QFT) was meant to test the revisions to the questionnaire and protocols, and this report describes the data collection and analytic methods and results of the 2012 QFT, including comparisons of selected QFT estimates with current and comparable NSDUH data and other data sources.
The primary goal of the field test was to measure the total effect on NSDUH estimates from all changes to the protocol planned for the 2015 redesign, using multiple indicators. This report summarized how the QFT was conducted and the results obtained to address the four main research questions as follows:
METHODS: Similar to the NSDUH main study, the respondent universe for the QFT was the civilian, noninstitutionalized population aged 12 or older. In order to control costs, individuals residing in Alaska and Hawaii, as well as those who were not able to complete the interview in English, were excluded from the QFT. A total of 5,358 dwelling units were sampled and yielded 2,044 completed interviews. Estimates for survey items from the QFT were compared with data from the 2011 NSDUH and from quarters 3 and 4 from the 2012 NSDUH (which also excluded respondents from Alaska and Hawaii and those who were not able to complete the interview in English). Estimates for some items were also compared with external benchmark data sources, such as the National Health Interview Survey (NHIS), the American Community Survey (ACS), and the Current Population Survey (CPS). In addition, data from the National Health and Nutrition Examination Survey (NHANES), the National Ambulatory Medical Care Survey (NAMCS) and the hospital outpatient clinic component of the National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to assess the ranking of mentions of prescription drugs in the QFT. Data on interview timing and missing data rates from the QFT were compared with data from the 2011 NSDUH and quarters 3 and 4 from the 2012 NSDUH. Finally, qualitative information was gathered from interviewer debriefing items, field observations, and focus groups with interviewers.
RESULTS/CONCLUSIONS: Response rates in the QFT were lower than those in the 2011 NSDUH as well as quarters 3 and 4 from the 2012 NSDUH. This may have been due to the short field period of the QFT relative to the main survey and limited flexibility to assign interviewers to particular cases in the QFT.
Some items that were moved from computer-assisted personal interviewing (CAPI) to audio computer-assisted self-interviewing (ACASI) administration in the QFT questionnaire produced significantly higher missingness rates than the 2011 and 2012 quarters 3 and 4 comparison data, particularly for items on health insurance and income.
The overall mean interview time for the QFT interviews was lower than the mean times for the 2011 and 2012 quarters 3 and 4 comparison interviews, but additions and revisions to the hallucinogens, inhalants, and prescription drug sections in the partially redesigned QFT questionnaire contributed to higher administration times for the core substance use modules compared with the 2011 and 2012 quarters 3 and 4 comparison interviews. The redesigned prescription drug modules had greater QFT administration times for these modules, primarily in the pain relievers module. Lower mean times for several back-end demographic sections (including employment, income, and administrative residual times) for the QFT interviews contributed significantly to the lower overall interview times compared with the 2011 and 2012 quarters 3 and 4 comparison interviews.
Most estimates for prevalence rates for core substances (cigarettes, alcohol, marijuana, cocaine, and heroin) in the QFT appeared similar to estimates from the 2011 and 2012 quarters 3 and 4 comparison samples.
The lifetime estimate for methamphetamine use among individuals aged 12 or older was higher in the QFT than in the comparison data from 2011 and 2012 quarters 3 and 4. Prescription drug estimates for lifetime misuse among all individuals aged 12 or older were lower in the QFT data than in the 2011 and 2012 quarters 3 and 4 comparison data for pain relievers and tranquilizers. Estimates of past year misuse for pain relievers, OxyContin®, and sedatives among individuals aged 12 or older were higher for the QFT than for the 2011 and 2012 quarters 3 and 4 comparison data.
Estimates for some items in the QFT that were administered in ACASI that were administered in CAPI in the main study were higher in the QFT than in the 2011 and 2012 comparison data. These included participation in government assistance programs, receiving supplemental security income, and participating in food stamp programs.
CITATION: Center for Behavioral Health Statistics and Quality. (2014). National Survey on Drug Use and Health: 2013 Dress Rehearsal final report. Rockville, MD: Substance Abuse and Mental Health Services Administration.
PURPOSE/OVERVIEW: The Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Center for Behavioral Health Statistics and Quality (CBHSQ) is planning to implement changes related to a partial redesign of the National Survey on Drug Use and Health (NSDUH). These changes include use of a new sample design in 2014 and a limited update to the interview questionnaire in 2015. The new sample design will allow for continued national-, State-, and substate-level estimation comparable with estimation from previous surveys. The sample design’s improved efficiency will result in significant cost savings. The primary change to the questionnaire is an updated set of prescription drug modules, which will include current prescription drugs and incorporate a new questionnaire structure. Other planned changes to the questionnaire include a revised health module that contains new questions about drug and alcohol screening by primary care physicians. These changes will seek to achieve three main goals: (1) to revise the questionnaire to address changing policy and research data needs, (2) to modify the survey methodology to improve the quality of estimates and the efficiency of data collection and processing, and (3) to maintain trends in core substance use estimates across survey years.
This report summarizes the data collection and analytic methods and results for NSDUH’s 2013 Dress Rehearsal (DR). Using multiple indicators and data sources, the primary goal of the DR was to measure the total effect on NSDUH estimates and outcomes from all changes to the materials, questionnaire, and procedures planned for the 2015 partial redesign. This report summarizes how the DR was conducted and the results obtained to address the five main research questions as follows:
METHODS: Similar to the NSDUH main study, the respondent universe for the DR was the civilian, noninstitutionalized population aged 12 or older. In order to control costs, individuals residing in Alaska and Hawaii were excluded from the DR. A total of 4,392 dwelling units were sampled and yielded 2,087 completed interviews. The respondent sample was allocated to three age groups in the following proportions: 25 percent aged 12 to 17, 25 percent aged 18 to 25, and 50 percent aged 26 or older. This allocation matched the allocation for the QFT and 2014 NSDUH but differed from the allocation for the 2012 and 2013 NSDUHs.
One major difference between the QFT and the DR was the inclusion of Spanish-language interviews in the DR sample in order to allow for an assessment of the redesigned Spanish-language instrument. To achieve a higher yield of Spanish-language interviews in the DR sample than what would be observed with a probability proportional to size (PPS) sample, a special certainty stratum was created for State sampling regions (SSRs) with a historically high percentage of interviews conducted in Spanish. SSRs that had 10 percent or more of their 2011 NSDUH interviews conducted in Spanish were assigned to the certainty stratum.
Estimates for survey items from the combined DR and QFT samples (for non-Hispanic respondents who completed the interview in English) were compared with comparable data from the 2012 NSDUH and from quarters 3 and 4 from the 2013 NSDUH. Outcomes and estimates from the Spanish-language interviews in the DR were compared with Spanish-language interviews from the 2012 main study and 2013 quarters 3 and 4 main study.
Estimates for some items were also compared with external benchmark data sources, including the National Health Interview Survey (NHIS), the National Health and Nutrition Examination Survey (NHANES), the American Community Survey (ACS), the Current Population Survey (CPS), the General Social Survey (GSS) and the National Survey of Family Growth (NSFG). Data on interview timing and missing data rates from the QFT were compared with data from the 2011 NSDUH and quarters 3 and 4 from the 2012 NSDUH. Finally, qualitative information was gathered from interviewer debriefing items, field observations, and focus groups with interviewers.
RESULTS/CONCLUSIONS: Screening and interview response rates in the DR were lower than those in the 2012 NSDUH comparison sample and similar to those obtained in the QFT.
Overall, item missingness rates and variable imputation rates examined in the DR results were similar to the QFT results. Items that were moved from computer-assisted personal interviewing (CAPI) to audio computer-assisted self-interviewing (ACASI) administration in the QFT and DR questionnaires produced significantly higher missingness rates than in the main study comparison data.
Overall interview times were lower or similar for DR interviews compared with interviews from the 2012 and 2013 quarters 3 and 4 comparison data, and the QFT interviews for most age groups. Spanish-language DR respondents aged 12 or older, however, had higher overall interview times when compared with the Spanish-language 2012 respondents and the Spanish-language 2013 quarters 3 and 4 respondents. Interview times for Spanish-language DR data were much higher than either the Spanish-language 2012 main study or the Spanish-language 2013 quarters 3 and 4 interviews for respondents aged 65 or older; however, despite this larger difference in average times for respondents aged 65 or older, the overall timing differences for Spanish-language interviews were not of a large magnitude.
Similar to what was found in the QFT, estimates of lifetime misuse of prescription drugs were lower in the DR sample than in the NSDUH comparison data, but estimates of past year misuse were higher in both the QFT and combined QFT-DR data relative to the corresponding NSDUH comparison datasets.
For items on receipt of income from government assistance programs, participation in food stamp programs, employment and health insurance, some of the key differences in estimates observed between the QFT data, main study comparison data, and external data sources were observed for the DR data. The majority of these observed differences suggested that the DR sample was comprised of a higher proportion of respondents with lower socioeconomic status.
CITATION: Center for Behavioral Health Statistics and Quality. (2014). National Survey on Drug Use and Health: Investigation into text to speech software. Rockville, MD: Substance Abuse and Mental Health Services Administration.
PURPOSE/OVERVIEW: Implementing text to speech (TTS) technology in the audio computer-assisted self-interviewing (ACASI) module of the National Survey on Drug Use and Health (NSDUH) interview offers an opportunity for work process efficiencies and cost savings in NSDUH’s ACASI development. Although TTS software cannot match the audio quality of human voice recording, the evaluation presented in this report, along with the experience of both the National Survey of Family Growth (NSFG) and the Population Assessment of Tobacco and Health (PATH) survey, indicate that it was of sufficient quality to serve as a replacement for human voice recordings in ACASI. This report summarizes a follow-up investigation of TTS software, assesses commercially available TTS products that are potentially viable for use on NSDUH, and presents the pros and cons of utilizing each on NSDUH.
METHODS: The investigation was conducted in three phases: Phase 1 focused on researching different TTS systems and identifying products suitable for further evaluation; Phase 2 consisted of an evaluation of selected products; and Phase 3 focused on the development of the report and a recommendation regarding which of the evaluated products was most promising for NSDUH’s ACASI modules.
RESULTS/CONCLUSIONS: The evaluation results indicated that a dynamic implementation offered a higher quality audio experience than the static implementation largely because of the elimination of audio files. Therefore, if TTS software is adopted for use with NSDUH, a dynamic implementation mode should be pursued over a static mode. With respect to the TTS products evaluated, Microsoft’s Speech Platform was recommended. Considering the evaluated TTS products in both English and Spanish, the Microsoft product was ranked the highest by the evaluation team. Also, the Microsoft product offered a significant advantage over NeoSpeech because it was freely available and required no licensing agreement or user fees.
CITATION: Curtin, G. M., Sulsky, S. I., Van Landingham, C., Marano, K. M., Graves, M. J., Ogden, M. W., & Swauger, J. E. (2014, May 20). Primary measures of dependence among menthol compared to non-menthol cigarette smokers in the United States. Regulatory Toxicology and Pharmacology: RTP. doi:10.1016/j.yrtph.2014.05.011 [PubMed: 24852490] [CrossRef]
PURPOSE/OVERVIEW: Previously published studies provide inconsistent evidence on whether menthol in cigarettes is associated with increased dependence. A few national studies, including the National Health and Nutrition Examination Survey (NHANES), National Survey on Drug Use and Health (NSDUH), National Health Interview Survey (NHIS), and Tobacco Use Supplement to the Current Population Survey (TUS-CPS), collect data on current cigarette type preference and primary measures of dependence. These studies allow researchers to examine whether menthol smokers are more dependent than nonmenthol smokers.
METHODS: The authors used the data from several surveys (NHANES, NSDUH, and NHIS and TUS-CPS) to get the number of cigarettes smoked per day among menthol and nonmenthol cigarette smokers and the time to first cigarette after waking and Heaviness of Smoking Index. To properly estimate variances, they weighted the dataset to the U.S. population and used survey statistics to account for the complex sample designs and conducted the analyses with the goal of maximizing comparability across datasets.
RESULTS/CONCLUSIONS: Analyses based on combined data from multiple administrations of each of these four nationally representative surveys, using three definitions for current smokers (i.e., smoked 1 day, 10 days, and daily during the past month), consistently demonstrated that menthol smokers did not report smoking more cigarettes per day than nonmenthol smokers. Moreover, two of the three surveys that provided data on the time to first cigarette after waking indicated no difference in urgency to smoke among menthol compared with nonmenthol smokers, while the third suggested menthol smokers may experience a greater urgency to smoke; estimates from all three surveys indicated that menthol versus nonmenthol smokers did not report a higher Heaviness of Smoking Index. Collectively, these findings indicated no difference in dependence among U.S. smokers who use menthol compared with nonmenthol cigarettes.
CITATION: Lattimore, P. K., Steffey, D. M., Gfroerer, J., Bose, J., Pemberton, M. R., & Penne, M. A. (2014, August). CBHSQ Data Review: Arrestee substance use: Comparison of estimates from the National Survey on Drug Use and Health and the Arrestee Drug Abuse Monitoring Program. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality.
PURPOSE/OVERVIEW: To address the treatment needs of arrestees and to develop proper programs and policies for dealing with drug use among arrestees, it is important for policymakers to have accurate information on the substance use treatment needs among the arrestee population. Two primary sources of such data are available: the Arrestee Drug Abuse Monitoring (ADAM) Program and the National Survey on Drug Use and Health (NSDUH).
ADAM was established by the National Institute of Justice and was fully implemented in 2000 in 35 communities around the United States. It consisted of interviews with and drug tests of arrestees in local jails within 48 hours of their being booked and was expanded to 39 communities including 41 counties in 2003. The survey captured information from respondents about substance use, including self-reported use and urine test results, receipt of substance use treatment, and drug market participation, including information about how illicit drugs were acquired and whether drugs were obtained in cash transactions or through other exchanges. ADAM data collection ended after 2003; however, a similar program, ADAM II, samples arrestees and conducts interviews and urinalysis drug screens in booking facilities in 10 communities nationwide. Data from ADAM and ADAM II sites were collected during nonrandomly selected 1- to 4-week data collection periods and are not generalizable to the sites or to the Nation as a whole. Thus, the calculation of site-specific or national estimates for substance use among arrestees is not straightforward for ADAM data. In addition to questions about alcohol use and illicit drug use, NSDUH also asks about arrests in the past 12 months and whether a respondent is on probation or parole. This CBHSQ Data Review attempts to evaluate the coverage and quality of drug use estimates of arrestees in the NSDUH data based on comparisons with ADAM data and Uniform Crime Reporting (UCR) data. The Federal Bureau of Investigation’s UCR data provide annual estimates of arrests at the county level.
METHODS: The analyses compared results of substance use in self-reports by adult males from the 2003 ADAM data collected within 48 hours of arrest and by adult males who reported at least one arrest in the previous year from the NSDUH data collected in the 39 ADAM sites. NSDUH data from 2002 to 2008 were combined for this analysis in order to yield a large enough sample for reliable estimates, resulting in a total of approximately 1,800 NSDUH adult male past year arrestees in these 39 sites. For this study, ADAM subjects were classified as NSDUH eligible or NSDUH ineligible based on their response to an ADAM interview question on where they had lived most of the time during the 30 days prior to arrest. Those who reported living in a house, mobile home, apartment, residential hotel, rooming house, dormitory, group home, student housing, or a shelter were considered to be eligible for inclusion in NSDUH and therefore were treated as NSDUH eligible for the purposes of the comparative analyses.
Of the 22,903 adult male ADAM cases in 2003, 20,457 were classified as NSDUH eligible, and 1,953 were classified as NSDUH ineligible. ADAM respondents with unknown NSDUH eligibility (n = 493) were excluded from the NSDUH-eligible and the NSDUH-ineligible estimates.
RESULTS/CONCLUSIONS: NSDUH data provide generalizable national-level estimates for arrestees and a depth of contextual information about their drug use, mental health conditions, health status, and demographics. Despite difficulties in making comparisons with ADAM data because of ADAM’s lack of generalizability, it appears that in addition to known undercoverage due to the NSDUH eligibility rules (about 9 percent of arrests), there was some additional undercoverage, which was estimated to be about 15 percent. Also, substance use and dependence and abuse rates from NSDUH appeared to be lower for reasons beyond differences in coverage, such as the difference in the reference period (i.e., past month in NSDUH vs. the 30 days prior to the arrest in ADAM).
All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS.
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