Outline of Presentation

1. Overview of the National Survey on Drug Use and Health (NSDUH)Presented by Joe Gfroerer and Art Hughes Office of Applied StudiesState Epidemiological Outcomes Workgroup WebinarSeptember 16, 2009

2. Outline of Presentation • Survey design • NSDUH products • Uses of NSDUH data • Comparisons with other surveys • Access to NSDUH data

3. History of NHSDA/NSDUH • Primary source of data on substance use • Done by ADAMHA/SAMHSA since 1974 • Annual since 1990 • Redesign for State estimation in 1999

4. Overview of NSDUH • Annual household survey of civilian, noninstitutionalized population (CNP) aged 12 or older • Provides national, state, and substate estimates of substance abuse and mental health issues

5. NSDUH Population Coverage Civilian noninstitutionalized population ages 12 or older: • Includes: Households, college dorms, homeless in shelters, civilians on military bases, migratory workers’ camps, halfway houses • Excludes: Active-duty military, long-term hospital residents, nursing homes, prison populations, homeless not in shelters 5

6. NSDUH Sample Design • Representative nationally and in each State, and in substate areas • Target sample size is 67,500 respondents each year 6

7. NSDUH Sample Design: 900 Regions: 48 in “large” states; 12 in other states Approx. 75 interviews per year in each region

8. NSDUH Sample Design: Stage 1 • 7,200 Census tracts • 8 in each substate sampling region (2 per quarter) 8

9. NSDUH Sample Design: Stage 2 • 7,200 segments • 1 per census tract in sample • 8 in each substate sampling region (2 per quarter) • Half (3,600) are new each year, so segments remain in sample for 2 consecutive years 9

10. NSDUH Sample Design: Stage 3 • List of addresses is constructed in each sample segment (“Counting and Listing”) • 140,000 dwelling units selected from listings • About 20 per segment 10

11. NSDUH Sample Design: Stage 4 • Household Screener • List of household members, with basic demographics • 0, 1, or 2 sample persons selected • 12-25 year-olds oversampled • 67,500 interviews • 9 per segment, on average 11

12. NSDUH Data Collection • 12-month data collection period • Sample of Addresses/Dwelling Units (DUs) • “Dear Resident” letters mailed to DUs • Interviewer visits DUs • Household screener (5min.) • Select 0, 1, or 2 HH members (Oversample 12 – 25) • Face-to-face interview (1hr.) • Mainly self-admin (ACASI) • $30 given to each participant

13. NSDUH Data Collection at Sampled Addresses • Household Screener • 89% response rate (weighted) • In-person, computer-assisted, self-administered interview (ACASI) • 74% response rate (weighted) 13

14. NSDUH screening response rate: 89% Interviewer (right) Speaking with the NSDUH Screening Respondent at Doorstep

15. NSDUH interview response rate: 74% Respondent (right) Completing the ACASI Portion of the NSDUH Interview

16. Demographics Recency, Frequency, Initiation Tobacco Alcohol Marijuana Cocaine Heroin Hallucinogens Inhalants Pain relievers Tranquilizers Stimulants Sedatives NSDUH Questionnaire - Core Modules

17. NSDUH Questionnaire – Noncore Modules • Substance use disorders (DSM-IV) • Substance use treatment • Mental health • Risk/protective factors • Health conditions, service utilization • Employment, income, program participation 17

18. OAS NSDUH Products

19. OAS NSDUH Products • National, state, substate reports • Detailed tabulations • Ad hoc tabulations on request • Analytic reports

20. OAS NSDUH Products – (cont.) • Short reports • Research papers (journals, conferences) • Methodological research studies • Public use data files (no identifiable data) • Research papers by others

21. National Findings Report • Released every September with a press conference http://recoverymonth.gov/ • 2008 national data was released on September 10, 2009

22. State Findings Report • Released annually, several months after National report • Based on 2-year annual averages • 2006-07 data released in June 2009 • 2007-08 data to be released in April 2010

23. Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007. Marijuana Use in Past Month among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

24. Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007. Cigarette Use in Past Month among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

25. Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007. Alcohol Dependence or Abuse in Past Year among Persons Aged 12 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

26. Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007. Having at Least One Major Depressive Episode in Past Year among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2006 and 2007 NSDUHs

27. Substate Report • Released every 2 years • 3-year annual averages • 2004-06 data released in 2008 • 2006-08 estimates to be released in June 2010

28. Substate Region Definitions • Mainly County-based • Minimum sample = 200 • Updated by Single State Agency heads and State staff responsible for the SAPT Block Grant application

29. Substate Region Definitions • 363 substate regions in 2004-2006, 345 are displayed on maps

30. Marijuana Use in Past Month among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2004, 2005, and 2006 NSDUHs Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004, 2005, and 2006.

31. Tobacco Product Use in Past Month among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2004, 2005, and 2006 NSDUHs Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004, 2005, and 2006.

32. Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older, by Substate Region: Percentages,Annual Averages Based on 2004, 2005, and 2006 NSDUHs Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004, 2005, and 2006.

33. Binge Alcohol Use in Past Month among Persons Aged 12 to 20, by Substate Region: Percentages, Annual Averages Based on 2004, 2005, and 2006 NSDUHs Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004, 2005, and 2006.

34. Tobacco Product Use in Past Month among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2004, 2005, and 2006 NSDUHs Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004, 2005, and 2006.

35. Illicit Drug Dependence or Abuse in Past Year among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2004, 2005, and 2006 NSDUHs Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004, 2005, and 2006.

36. Alcohol Dependence or Abuse in Past Year among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2004, 2005, and 2006 NSDUHs Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004, 2005, and 2006.

37. Substate Area Correlations (2004-2006)

38. Hierarchical Bayes (HB) Estimates • “Weighted” combination of: • Direct estimates for area • Estimates for area based on national regression model and predictors for area

39. Model-based vs. Direct Estimates • Model-based • More precise • Selected measures, demographic groups

40. Model-based vs. Direct Estimates • Direct (design-based) • Can have large sampling error • Any measure, subgroup for sufficient n • Must combine several years of data for sufficient n

41. NSDUH Reports Online 2006-2007 State Report: http://www.oas.samhsa.gov/2k7State/toc.cfm 2004-2006 Substate Report: http://www.oas.samhsa.gov/substate2k8/toc.cfm

42. NSDUH Reports Online (cont.) 2008 National Findings Report: http://www.oas.samhsa.gov/ Special Topics (short reports): http://www.oas.samhsa.gov/factsNSDUH.htm

43. NSDUH Reports Online (cont.) Analytic Reports: http://www.oas.samhsa.gov/analytic.htm Methodology and Questionnaires: http://www.oas.samhsa.gov/nsduh/methods.cfm

44. Uses of NSDUH Data

45. How SAMHSA Uses NSDUH • Publications of findings • Presentations, speeches by SAMSHA Administrator, Center Directors, and staff • Respond to inquiries from states, other federal agencies, Congress, media, researchers • NOMS • Interagency initiatives, e.g., Report to Congress on Underage Drinking; Surgeon General’s Report on Tobacco; Healthy People

46. Examples • Acting Surgeon General Kicks Off 1,600 Town Hall Meetings Throughout the Nation to Address the Underage Drinking Problem http://www.samhsa.gov/newsroom/advisories/0803204849.aspx • SAMHSA Awards Almost $16 Million to Prevent and Reduce Alcohol Use among Youth http://www.samhsa.gov/newsroom/advisories/0810155838.aspx

48. Mental Health Problems among Gulf State Disaster Area Residents Aged 18+, by Length of Displacement from Home Due to Katrina and/or Rita: 2006 Percentage Serious Psychological Distress Unmet Need for Mental Health Treatment or Counseling Major Depressive Episode Note: All differences between 2+ wks and other categories are statistically significant at .05 level.

49. Mental Health Problems among Gulf State Disaster Area Residents Aged 18+, Before and After Katrina and Rita Percentage Serious Psychological Distress Unmet Need for Mental Health Treatment or Counseling Major Depressive Episode Note: None of the Pre- to Post- changes are statistically significant at the .05 level.