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1998 National Household Survey on Drug Abuse
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1998 National Household Survey on Drug Abuse |
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I. Other National Surveys of Illicit Drug Use
Youth Risk Behavior Survey (YRBS)
National Longitudinal Study of Adolescent Health (Add Health)
Partnership Attitude Tracking Study (PATS)
II. Alcohol and Cigarette Use Surveys
National Health Interview Survey Year 2000 Objectives (NHIS-2000)
Youth Risk Behavior Survey (YRBS)
Surgeon General's Report on Smoking and Health
National Longitudinal Study of Adolescent Health (Add Health)
National Longitudinal Alcohol Epidemiologic Survey (NLAES)
III. Surveys of Populations Not Covered by the NHSDA
Partnership Attitude Tracking Study (PATS)
Washington, D.C. Metropolitan Area Drug Study (DC*MADS)
Worldwide Survey of Substance Abuse and Health Behaviors Among Military Personnel
Survey of Inmates in State and Federal Correctional Facilities
A variety of other substance abuse surveys are useful in providing the context for the NHSDA and are discussed below.
Monitoring the Future (MTF) is a national survey that tracks drug use trends among America's adolescents. The MTF has surveyed 8th, 10th, and 12th graders every spring in randomly selected U.S. schools since 1975 for 12th graders and since 1991 for 8th and 10th graders. This survey is conducted by the Institute for Social Research at the University of Michigan under a grant from the National Institute on Drug Abuse (NIDA). The MTF includes followup surveys of college and young adults. The press release of the 1998 results occurred in December 1998 (U.S. DHHS 1998). For all three grades combined, there were about 422 public and private schools and about 48,000 students in the sample. This sample size included approximately 140 schools and 16,000 students per grade.
Comparisons between the MTF and students sampled in the NHSDA have generally shown NHSDA prevalences to be lower than MTF estimates, with relative differences being largest for 8th graders. The direction of the estimates of change from year to year among 12th graders have generally been similar. Both surveys showed significant increases in illicit drug use among adolescents between 1992 and 1996. The MTF survey showed the use of illegal drugs by adolescents leveled off in 1997 and then declined somewhat for most drugs in 1998. The NHSDA showed an increase in substance use between 1996 and 1997 and then a decrease in the use of illicit drugs among youths between 1997 and 1998. The lower prevalences in the NHSDA may be due to more underreporting in the household setting as compared to the MTF school setting. MTF does not survey dropouts, a group shown (using the NHSDA) to have higher rates of use (Gfroerer, Wright, and Kopstein 1997). For a single grade, the NHSDA sample sizes are much smaller than the MTF sample sizes.
The YRBS is a component of CDC's Youth Risk Behavior Surveillance System, which biennially measures the prevalence of priority health-risk behaviors among youths through representative national, state, and local surveys (CDC 1998). The 1997 national YRBS used a three-stage cluster sample to obtain a representative sample of 16,262 students in grades 9-12 in the 50 states and the District of Columbia. In general, this school-based survey has found higher rates of alcohol, cigarette, marijuana, and cocaine use for youths than were found in the NHSDA.
In 1994-6, 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. The survey also asked about substance abuse (alcohol, tobacco, and illicit drugs). The surveyconsisted of three phases: 1) Roughly 90,000 students from grades 7 through 12 at 145 schools around the U.S. answered brief questionnaires; 2) interviews were conducted with about 20,000 students and their parents in the students' homes; and 3) one year later, students were interviewed a second time in their homes. Survey results indicated nearly one-third of teenagers had smoked marijuana; 6.9 percent of 7th-8th graders used marijuana at least once in the past month as did 15.7 percent of 9th-12th graders (Resnick, et al. 1997).
In April of 1999, the Partnership for a Drug Free America (PDFA) released results from the 1998 Partnership Attitude Tracking Study (PATS), the only on-going national research that tracks drug use and drug related attitudes among children as young as eight and nine, teens, and their parents. The study found drug use to be significantly lower among kids who've learned a great deal about drugs at home. Virtually all parents (98%) say they've talked to their children about drugs, but only 27 percent of teens say they are learning a lot at home a bout the risks connected with drug use (PDFA 1999). PATS found that among 4th, 5th, and 6th-graders, anti-drug attitudes are beginning to move in the right direction. Among youths in grades 7-12, marijuana usage has stabilized and there are indications that marijuana use may be at the start of a downturn. Results from the 1998 survey indicated that lifetime trial of marijuana use among grades 7-12 was 42 percent, down from 44 percent in the 1997 survey. It had been 29 percent in 1993. Past month marijuana use was 24 percent in 1997 and 23 percent in 1998. It had been 14 percent in 1993. The 1998 survey also showed the softening of attitudes that occurred in recent years has stopped.
The results of the NHIS-2000 were published in December 1997 (CDC 1997). This survey of approximately 21,000 adults was conducted by the Bureau of the Census for the National Center for Health Statistics. The survey estimated that, in 1995, 25.0 percent of the population age 18 and over were current smokers. Current smokers are defined as those who have smoked at least 100 cigarettes in their lifetime and answer that they currently smoke, including those who smoke only on some days. This definition is somewhat different from the NHSDA definition of current smoking (any use in the past month) which resulted in a prevalence of 29.8 percent for adults in 1995. The 1998 estimate for adults was 28.7 percent.
This school-based survey showed increases in smoking rates among students from 1991 to 1996. However, cigarette use among 8th and 10th graders has declined between 1996 and 1998. Past-month smoking rates found in the Monitoring the Future Study (MTF) were 14.3 percent in 1991, 21.0 percent in 1996, 19.4 percent in 1997, and 19.1 percent in 1998 for 8th graders. For tenth graders, rates were 20.8 percent in 1991, 30.4 percent in 1996, 29.8 percent in 1997, and 27.6 percent in 1998. For 12th graders, smoking rates rose steadily from 28.3 percent in 1991 to 36.5 percent in 1997 but then declined (not significantly) between 1997 and 1998 to 35.1 percent (USDHHS 1998).
The Youth Risk Behavior Survey found increases in current cigarette use among students in grades 9-12. Current smoking rose from 27.5 percent in 1991 to 36.4 percent in 1997 (CDC 1998). Overall prevalences of lifetime, current, and frequent cigarette use in the 1997 survey were 70.2%, 36.4% and 16.7%, respectively. While the NHSDA trend for youth (age 12-17) smoking has not shown these increases, the NHSDA estimates for years prior to 1994 were apparently substantial underestimates because the data were collected without private self-administered answer sheets. When the NHSDA converted to the use of these answer sheets in 1994, the smoking rate for adolescents approximately doubled. This raises questions about the accuracy of the NHSDA measurement of the trend prior to 1994, even after adjustments are made to account for the effect of the new questionnaire.
The Surgeon General's Report on Smoking and Health (US DHHS 1994) included smoking prevalence data from a number of sources, including the NHSDA. Comparisons between the various sources were made and methodological differences were assessed. These comparisons were based on NHSDA data prior to 1994, which were based on the interviewer-administered smoking questions, and thus show low rates of smoking in the NHSDA, particularly among youth.
Results from the September 1994 to April 1995, the National Longitudinal Study of Adolescent Health (Add Health described above) indicate that nearly 3.2 percent of 7th-8th graders smoked 6 or more cigarettes a day as did 12.8 percent of 9th-12th graders (Resnick, et.al. 1997). In addition, 7.3 percent of 7th-8th graders used alcohol 2 or more days in the past month as did 23.1 percent of 9th-12th graders.
NLAES was conducted by the Bureau of the Census for the NIAAA in 1992. Face-to-face interviews were conducted with 42,862 respondents age 18 and older in the contiguous U.S. It 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 abuse and dependence during the prior 12 months, based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994). NLAES estimated that 4.4 percent of adults were alcohol dependent and another 3.0 percent were classified as abusing alcohol, but not dependent, within the past year (Grant et. al. 1995). Using combined 1997 and 1998 data from the NHSDA, an estimated 4.5 percent of adults and 4.0 percent of youths age 12-17 were dependent on alcohol.
In 1999, the Partnership for a Drug Free America (PDFA) released results from the 1998 Partnership Attitude Tracking Study (PATS), the only on-going national research that tracks drug use and drug related attitudes among children ages 9 to 11 as well as older teens. The study documented a gap between parents' perceptions about their children and drugs and what teenagers and children are actually experiencing (PDFA 1999).
The Washington, D.C. Metropolitan Area Drug Study (DC*MADS) was designed to (1) 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 and (2) to develop a methodological model for similar types of research in other metropolitan areas of the country. Sponsored by the National Institute on Drug Abuse and conducted in 1991 and 1992, the project focused on hard-to-reach populations, such as adult and juvenile offenders, new mothers, and school dropouts. 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 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 the NHSDA). However, for some categories of drug users, the nonhousehold population was found to include a substantial proportion of users. About 20 percent of past month crack users, 20 percent of past year heroin users, and one-third of past year needle users were found in the nonhousehold population (Bray and Marsden 1999).
The 1998 Worldwide Survey of Substance Abuse and Health Behaviors Among Military Personnel was sponsored by the Department of Defense and conducted by Research Triangle Institute. The survey interviewed 17,264 Armed Forces personnel worldwide. Military personnel exhibited lower rates of tobacco use than the civilian population, but this finding seems largely due to an increase in smoking among civilians rather than significant decreases among military personnel. Illicit drug use declined steadily and dramatically in the Military from 1990 to 1998 and this decrease was not explained by changes in the demographic composition of the Military. Rates of substance use in the Military are significantly lower than those observed for the civilian population. Differences between the military and civilian population were more pronounced for males than females, especially among younger males. For males ages 18 to 55, 2.8% of those in the Military used drugs in the 30 days prior to survey compared to 11.4% of the civilian population. For females ages 18 to 55, 1.9% of those in the Military used drugs in the 30 days prior to survey compared to 6.2% of the civilian population This survey indicated nearly all military personnel had been tested for drugs since joining the military (Research Triangle Institute 1999).
The 1997 Survey of Inmates in State and Federal Correctional Facilities samples 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 4,401 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%) were more likely than men (56%) to have used drugs in the month before the offense. Women were also more likely to have committed their offense while under the influence of drugs (40% compared to 32% of male prisoners). Among Federal prisoners, men (45%) were more likely than women (37%) 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 (23% of male and 19% of female prisoners) and to have committed their offense under the influence of drugs. The survey results indicate substantially higher rates of drug use among convicted inmates (BJS 1999) as compared to the household population.
The FBI maintains records of arrests for drug abuse violations from 1970 through 1997. Arrests for drug abuse violations are at their highest levels ever for adults and juveniles. The number of actual arrests for drug abuse violations has almost doubled for adults (from 629,196 in 1985 to 1,019,621 in 1997). Of these arrests, 234,022 were for the sale and manufacturing of drugs and approximately 785,599 were for drug possession in 1997. Among juveniles, drug related arrests have risen even more dramatically (from 68,122 in 1986 to 154,761 in 1997) (Maguire and Pastore 1998). For juveniles, 30,665 of the 1997 arrests were for the sale and manufacture of drugs and 124,096 arrests were for possession.
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