Comparing Drug Testing and Self-Report of Drug Use among Youths and Young Adults in the General Population

2007·0.75 MB·English

by  Harrison, Lana D., Martin, Steven S., Env, Tihomir, Harrington, Deborah

Comparing Drug Testing and Self-Report of
Drug Use among Youths and
Young Adults in the General Population

Lana D. Harrison
Steven S. Martin
Tihomir Enev
Deborah Harrington

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Office of Applied Studies
Acknowledgments
This report was prepared by the Division of Population Surveys, Office of Applied Studies, SAMHSA;
the Center for Drug and Alcohol Studies, University of Delaware, Newark, Delaware; and RTI
International, a trade name of Research Triangle Institute, Research Triangle Park, North Carolina. Work
by the University of Delaware was performed under Grant No. R01 DA10930 from the National Institute
on Drug Abuse and SAMHSA Contract No. 283-98-9008. Work by RTI was performed under SAMHSA
Contract Nos. 283-97-9007 and 283-98-9008. Contributors at the University of Delaware listed
alphabetically include Tihomir Enev, Deborah Harrington, Lana D. Harrison, and Steven S. Martin.
Contributors at SAMHSA listed alphabetically include Joseph Gfroerer and Arthur Hughes. Contributors
at RTI listed alphabetically include Brian Burke, Rachel Caspar, Lucinda Casson, Patrick Chen, James
Chromy, Lee Ellen Coffey, Teresa Davis, Elizabeth (Wiebe) Dean, Steven Emrich, G.G. Frick, Rebecca
Granger, David Heller, Donna Hewitt, Marjorie Hinsdale-Shouse, Larry A. Kroutil, Mary Ellen Marsden,
Martin Meyer, Susan Meyers, Dawn Odom (now at Inveresk), Lisa E. Packer, Lanny Piper, and Thomas
G. Virag (Project Director). Staff in the Division of Workplace Programs at SAMHSA and RTI's Center
for Forensic Sciences reviewed the document. Reviewers at the National Institute on Drug Abuse listed
alphabetically include James Colliver (now at SAMHSA), Marilyn Huestis, Lucinda Miner, and Yonette
Thomas. At RTI, Richard S. Straw edited the report. Also at RTI, Joyce Clay-Brooks and Roxanne
Snaauw word processed the report, and Pamela Couch Prevatt, Teresa G. Bass, Shari B. Lambert, and
Wendy Broome prepared its press and Web versions. Final report production was provided by Beatrice
Rouse, Coleen Sanderson, and Jane Feldmann at SAMHSA.
Public Domain Notice
All material appearing in this report is in the public domain and may be reproduced or copied without
permission from the Substance Abuse and Mental Health Services Administration. However, this
publication may not be reproduced or distributed for a fee without specific, written authorization of the
Office of Communications, SAMHSA, U.S. Department of Health and Human Services. Citation of the
source is appreciated. Suggested citation:
Harrison, L. D., Martin, S. S., Enev, T., & Harrington, D. (2007). Comparing drug testing
and self-report of drug use among youths and young adults in the general population
(DHHS Publication No. SMA 07-4249, Methodology Series M-7). Rockville, MD:
Substance Abuse and Mental Health Services Administration, Office of Applied Studies.
Obtaining Additional Copies of Publication
Copies may be obtained, free of charge, from the National Clearinghouse for Alcohol and Drug
Information (NCADI), a service of SAMHSA. Write or call NCADI at:
National Clearinghouse for Alcohol and Drug Information
P.O. Box 2345, Rockville, MD 20847-2345
1-240-221-4017, 1-800-729-6686, TDD 1-800-487-4889
Electronic Access to Publication
This publication can be accessed electronically through the Internet connections listed below:
http://www.samhsa.gov and http://www.oas.samhsa.gov

Originating Office
SAMHSA, Office of Applied Studies
1 Choke Cherry Road, Room 7-1044
Rockville, MD 20857
May 2007
ii
Table of Contents
Chapter Page
Highlights........................................................................................................................................1
1. Introduction.........................................................................................................................5
1.1. Background.............................................................................................................5
1.2. Summary of the Validity Study Methodology........................................................6
1.3. Urine and Hair Drug Testing..................................................................................8
1.4. Hair Testing Results for the Validity Study..........................................................11
1.5. Organization of the Report....................................................................................11
2. Validity Study Methodology............................................................................................15
2.1. Response Rates in the Validity Study and the NHSDA.......................................15
2.2. Biological Specimen Response Rates...................................................................16
2.3. Comparisons of Drug Use Generated by the Validity Study and the
NHSDA.................................................................................................................16
3. Debriefing Intervention.....................................................................................................19
3.1. Memory and Comprehension................................................................................19
3.2. Embarrassment and Confidentiality Concerns......................................................21
3.3. Truthfulness..........................................................................................................22
3.4. Privacy..................................................................................................................23
3.5. Summary...............................................................................................................24
4. Tobacco.............................................................................................................................27
4.1. Urine Testing for Tobacco....................................................................................27
4.2. Self-Reported Tobacco Use: Comparison of Responses to Core Questions
with Urinalysis......................................................................................................28
4.3. Self-Reported Tobacco Use: Comparison of Responses to Core and
Repeat Questions..................................................................................................32
4.4. Self-Reported Tobacco Use: Comparison of Responses to Repeat
Questions with Urinalysis.....................................................................................34
4.5. Comparisons of Self-Report and Urinalysis Results for 7-Day and 3-Day
Windows...............................................................................................................40
4.6. Varying Cotinine Cutoff Concentrations and Self-Report Timeframes...............44
4.7. Overreporters........................................................................................................46
4.8. Underreporters......................................................................................................52
5. Marijuana..........................................................................................................................59
5.1. Urine Testing for Marijuana and Its Window of Detection..................................59
5.2. Self-Reported Marijuana Use: Comparison of Responses to Core
Questions and Urinalysis......................................................................................60
5.3. Self-Reported Marijuana Use: Comparison of Responses to Core and
Repeat Questions..................................................................................................62
iii
Table of Contents (continued)
Chapter Page
5.4. Self-Reported Marijuana Use: Comparison of Responses to Repeat
Questions and Urinalysis......................................................................................62
5.5. Comparison of Self-Report and Urinalysis Results for 7-Day and 3-Day
Windows...............................................................................................................69
5.6. Varying Screening Cutoff Concentrations and Self-Report Timeframes.............70
5.7. Overreporters........................................................................................................71
5.8. Underreporters......................................................................................................76
6. Cocaine.............................................................................................................................83
6.1. Self-Reported Cocaine Use: Comparison of Responses to Core Questions
and Urinalysis.......................................................................................................83
6.2. Self-Reported Cocaine Use: Comparison of Responses to Core and Repeat
Questions...............................................................................................................84
6.3. Self-Reported Cocaine Use: Comparison of Responses to Repeat
Questions and Urinalysis......................................................................................85
6.4. Self-Reported Cocaine Use: Comparison of Responses to 3-Day Self-
Report and Urinalysis...........................................................................................85
7. Opiates..............................................................................................................................89
8. Amphetamines..................................................................................................................95
9. Summary and Implications.............................................................................................101
9.1. Fieldwork............................................................................................................101
9.2. Bivariate Results.................................................................................................101
9.3. Multivariate Results............................................................................................102
9.4. Implications and Lessons Learned......................................................................102
References...................................................................................................................................107

Appendices

A Prior Research on the Validity of Self-Report....................................................................119
B Methodological Design of the Validity Study....................................................................129
C Sample Design....................................................................................................................151
D Establishing Drug Testing Cutoffs......................................................................................175
E Technical Issues Concerning Drug Test Data: A Retrospective Analysis..........................181
F Detailed Tables...................................................................................................................189
G Key Definitions...................................................................................................................211

iv
List of Tables
Table Page
2.1 Comparison of Sampling and Interview Data between Validity Study and
NHSDA.............................................................................................................................15
2.2 Estimates for Five Substances in the Validity Study Compared with the 2000-
2001 NHSDA: Percentages...............................................................................................17
3.1 Debriefing Questions: Reported Difficulty Understanding and Remembering
Drug-Related Information from the Point of View of Most People or from the
Respondent's Own Experience: Percentages....................................................................20
3.2 Debriefing Questions: Reported Frequency of Making a "Best Guess" When
Answering Drug-Related Questions: Percentages............................................................21
3.3 Debriefing Questions: Respondent's Clearness of Memory and the Degree to
Which the Respondent Was Certain of the Accuracy of His or Her Answers:
Percentages.......................................................................................................................21
3.4 Debriefing Questions: Respondent's Level of Concern and Embarrassment When
Answering Drug-Related Questions from the Point of View of Most People or
from His or Her Own Experience: Percentages................................................................22
3.5 Debriefing Questions: Truthfulness of the Respondent and the Truthfulness of
Most People from the Respondent's Point of View When Answering Drug-
Related Questions: Percentages........................................................................................23
3.6 Debriefing Questions: Respondent's Point of View of the Accuracy with Which
Most People Report Their Frequency of Drug Use: Percentages.....................................23
3.7 Debriefing Questions: Privacy of the Interview Based on Interviewer's
Assessment, by Age Group: Percentages..........................................................................24
4.1 Tobacco Use: Self-Reported Use of Various Tobacco Products in Past 30 Days
Based on Core Questions, by Age Group: Percentages....................................................29
4.2 Tobacco Use: Comparison of Responses to 30-Day Self-Report Core Questions
and Urinalysis...................................................................................................................30
4.3 Cigarette or Cigar Use: Comparison of Responses to 30-Day Self-Report Core
and Repeat Questions........................................................................................................33
4.4 Tobacco Use: Comparison of Responses to 30-Day Self-Report Core and Repeat
Questions...........................................................................................................................35
v
List of Tables (continued)
Table Page
4.5 Cigarette or Cigar Use: Comparison of Responses to 30-Day Self-Report Repeat
Questions and Urinalysis..................................................................................................36
4.6 Cigarette or Cigar Use: Comparison of Responses to 30-Day Self-Report Repeat
Questions and Urinalysis, by Receipt of Appeal..............................................................37
4.7 Tobacco Use: Comparison of Responses to 30-Day Self-Report Core and Repeat
Questions and Urinalysis..................................................................................................38
4.8 Tobacco Use: Comparison of Responses to 30-Day Self-Report Core or Repeat
Questions and Urinalysis..................................................................................................39
4.9 Tobacco Use: Comparison of Responses to 30-Day Self-Report Core or Repeat
Questions and Urinalysis, by Age Group.........................................................................41
4.10 Cigarette or Cigar Use: Comparison of Responses to 7-Day Self-Report Repeat
Questions and Urinalysis..................................................................................................42
4.11 Cigarette or Cigar Use: Comparison of Responses to 7-Day Self-Report Repeat
Questions and Urinalysis, by Age Group.........................................................................43
4.12 Tobacco Use: Comparison of Responses to 3-Day Self-Report Follow-Up
Questions and Urinalysis..................................................................................................45
4.13 Cigarette or Cigar Use: Comparison of Responses to Self-Report Repeat
Questions on Recency of Use at Varying Urinalysis Screening Concentrations:
Percentages.......................................................................................................................46
4.14 Tobacco Use: Logistic Regression Models Predicting 3-Day Overreporting among
Youths Aged 12 to 17.......................................................................................................50
4.15 Tobacco Use: Logistic Regression Models Predicting 3-Day Overreporting among
Young Adults Aged 18 to 25............................................................................................51
4.16 Tobacco Use: Logistic Regression Models Predicting 7-Day Underreporting
among Youths Aged 12 to 17 at Varying Cotinine Cutoff Concentrations......................54
4.17 Tobacco Use: Logistic Regression Models Predicting 7-Day Underreporting
among Young Adults Aged 18 to 25 at Varying Cotinine Cutoff Concentrations...........56
5.1 Marijuana Use: Comparison of Responses to 30-Day Self-Report Core Questions
and Urinalysis...................................................................................................................61
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List of Tables (continued)
Table Page
5.2 Marijuana Use: Comparison of Responses to 30-Day Self-Report Core and
Repeat Questions..............................................................................................................63
5.3 Marijuana Use: Comparison of Responses to 30-Day Self-Report Repeat
Questions and Urinalysis..................................................................................................64
5.4 Marijuana Use: Comparison of Responses to 30-Day Self-Report Repeat
Questions and Urinalysis, by Receipt of Appeal..............................................................65
5.5 Marijuana Use: Comparison of Responses to 30-Day Self-Report Core and
Repeat Questions and Urinalysis......................................................................................66
5.6 Marijuana Use: Comparison of Responses to 30-Day Self-Report Core or Repeat
Questions and Urinalysis..................................................................................................67
5.7 Marijuana Use: Comparison of Responses to 30-Day Self-Report Core or Repeat
Questions and Urinalysis, by Age Group.........................................................................68
5.8 Marijuana Use: Comparison of Responses to 7-Day Self-Report Repeat Questions
and Urinalysis...................................................................................................................69
5.9 Marijuana Use: Comparison of Responses to 3-Day Self-Report Follow-Up or
Repeat Questions and Urinalysis......................................................................................70
5.10 Marijuana Use: Comparison of Responses to Self-Report Repeat Questions on
Recency of Use at Varying Urinalysis Screening Cutoff Concentrations:
Percentages.......................................................................................................................71
5.11 Marijuana Use: Logistic Regression Models Predicting 3-Day and 7-Day
Overreporting among Youths Aged 12 to 17....................................................................73
5.12 Marijuana Use: Logistic Regression Models Predicting 3-Day and 7-Day
Overreporting among Young Adults Aged 18 to 25.........................................................74
5.13 Marijuana Use: Logistic Regression Models Predicting 7-Day and 30-Day
Underreporting among Youths Aged 12 to 17..................................................................77
5.14 Marijuana Use: Logistic Regression Models Predicting 7-Day and 30-Day
Underreporting among Young Adults Aged 18 to 25.......................................................80
6.1 Cocaine Use: Comparison of Responses to 30-Day Self-Report Core Questions
and Urinalysis...................................................................................................................84
vii
List of Tables (continued)
Table Page
6.2 Cocaine Use: Comparison of Responses to 30-Day Self-Report Core and Repeat
Questions...........................................................................................................................85
6.3 Cocaine Use: Comparison of Responses to 30-Day Self-Report Repeat Questions
and Urinalysis...................................................................................................................86
6.4 Cocaine Use: Comparison of Responses to 7-Day Self-Report and Urinalysis...............87
6.5 Cocaine Use: Comparison of Responses to 3-Day Self-Report and Urinalysis...............87
7.1 Opiate and Prescription Pain Reliever (PPR) Use: Comparison of Responses to
30-Day Self-Report Core Questions and Urinalysis.........................................................90
7.2 Opiate Use: Comparison of Responses to 30-Day Self-Report Core and Repeat
Questions...........................................................................................................................91
7.3 Opiate and Prescription Pain Reliever (PPR) Use: Comparison of Responses to 7-
Day Self-Report Repeat Questions and Urinalysis...........................................................92
7.4 Opiate and Prescription Pain Reliever (PPR) Use: Comparison of Responses to 3-
Day Self-Report Repeat Questions and Urinalysis...........................................................93
8.1 Stimulant Use: Comparison of Responses to 30-Day Self-Report Core Questions
and Urinalysis for Amphetamines....................................................................................96
8.2 Stimulant Use: Comparison of Responses to 30-Day Self-Report Repeat
Questions and Urinalysis for Amphetamines...................................................................97
8.3 Stimulant Use: Comparison of Responses to 7-Day Self-Report Repeat Questions
and Urinalysis for Amphetamines....................................................................................98
8.4 Stimulant Use: Comparison of Responses to 3-Day Self-Report Repeat Questions
and Urinalysis for Amphetamines....................................................................................98
B.1 Organization of the 2001 NHSDA Validity Study Questionnaire..................................133
B.2 Validity Study Screening Cutoff Concentrations for Urine............................................146
B.3 Validity Study Confirmatory Cutoff Concentrations for Urine......................................146
B.4 Validity Study Screening Cutoff Concentrations for Hair..............................................147
B.5 Validity Study Confirmatory Cutoff Concentrations for Hair........................................147
viii
List of Tables (continued)
Table Page
B.6 SAMHSA June 2000 Draft Screening Cutoff Concentrations for Hair..........................148
B.7 SAMHSA June 2000 Draft Confirmatory Cutoff Concentrations for Hair....................148
B.8 Drugs and Drug Groups as Shown in Pill Cards for Pain Reliever and Stimulant
Prescription Psychotherapeutic Drugs in NHSDA.........................................................149
B.9 Location of Validity Study Questions Used to Produce 30-Day, 7-Day, and 3-Day
Self-Reported Use of Various Substances......................................................................150
C.1 Projected Relative Standard Error for Estimated False-Negative Rate for Past
Month Cigarette and Marijuana Use...............................................................................156
C.2 Distribution of the Field Interviewer Regions for Each Marijuana Stratum..................157
C.3 Validity Study Number of Selected Field Interviewer Regions per Marijuana
Stratum............................................................................................................................159
C.4 Validity Study Segment Identification Number Suffixes...............................................160
C.5 Validity Study Exhausted Segments and Their Replacements.......................................161
C.6 Quarterly Dwelling Unit Sample Sizes and Percent Released........................................164
C.7 2000 and 2001 Validity Study Weighted Sum and Census Population Estimates
for VANALWT...............................................................................................................173
C.8 2000 and 2001 Validity Study Weighted Sum and Census Population Estimates
for BVANALWT............................................................................................................174
D.1 Immunoassay Test Cutoffs for Urine..............................................................................176
D.2 Gas Chromatography/Mass Spectrometry (GC/MS) Test Cutoffs for Urine.................176
D.3 Comparison of Responses to Self-Reports Versus Urinalyses Based on Validity
Study Cutoffs..................................................................................................................178
D.4 Comparison of Responses to Self-Reports Versus Urinalyses Based on SAMHSA
Workplace Cutoffs..........................................................................................................179
E.1 Validity Study Hair Testing Cutoffs...............................................................................182
E.2 Test Data for Marijuana Metabolites in Hair and Urine.................................................183
E.3 Test Data for Cocaine Metabolites in Hair and Urine....................................................184
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List of Tables (continued)
Table Page
E.4 Test Data for Amphetamines in Hair and Urine.............................................................185
E.5 Test Data for Opiates in Hair and Urine.........................................................................186
E.6 Comparison of Drug-Positive Rates in Urine and Hair: Percentages.............................187
F.1 Summary of Validity Study Sample Sizes, by Data Collection Year and Quarter.........190
F.2 Sample Size and Weighted Percentage of Respondents Providing Urine or Hair
Specimens during the Interview......................................................................................191
F.3 Sample Size and Weighted Percentage of Respondents Providing Urine or Hair
Specimens during the Interview, by Demographic Characteristics................................191
F.4 Number of Persons Interviewed in Validity Study (Unweighted n), by Age Group
and Demographic Characteristics Compared with 2000-2001 NHSDA........................192
F.5 Tobacco Product Use: Responses to Lifetime, Past Year, and Past Month Self-
Report Core Questions from the Validity Study and from the 2000-2001 NHSDA,
by Age Group: Percentages............................................................................................193
F.6 Tobacco Use: Responses to Self-Report Core Questions on Recency of Any
Tobacco Use among Those Tested for Cotinine in Their Urine: Percentages................194
F.7 Tobacco Use: Responses to Self-Report Core Questions on the Number of Days
Used in the Past 30 Days and Average and Median Cotinine Screening
Concentrations for Various Tobacco Products among Past Month Tobacco Users
Tested for Cotinine in Their Urine..................................................................................195
F.8 Tobacco Use: Responses to Self-Report Core Questions on Number of Cigarettes
Smoked Per Day in the Past 30 Days and Average and Median Cotinine
Screening Concentrations among Past Month Cigarette Users Tested for Cotinine
in Their Urine..................................................................................................................196
F.9 Tobacco Use: Responses to 30-Day Self-Report Follow-Up Questions on
Recency of Any Tobacco Use and Average and Median Cotinine Screening
Concentrations among Past Month Tobacco Users Tested for Cotinine in Their
Urine...............................................................................................................................197
F.10 Cigarette or Cigar Use: Responses to Self-Report Repeat Questions on Recency
of Use: Percentages.........................................................................................................198
x