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before the


September 19, 2000

Thank you, Mr. Chairman. My name is Dr. William Raub, Ph.D., and I am the Senior Scientific Advisor to the Secretary for Science Policy at the U.S. Department of Health and Human Services (DHHS). I am pleased to come before the Subcommittee today to highlight efforts undertaken by DHHS and its agencies during the past decade to monitor and track trends in youth drug use. These efforts have proven vital to the Department's goal of developing appropriate and targeted interventions designed to reduce the numbers of our nation's youth who use illegal drugs, alcohol and tobacco.

Today's hearing examines trends in youth substance use, and attempts to assess the implications of this data for guiding prevention and treatment efforts. Complex issues of critical policy importance, such as youth substance use and abuse, often require examination and analysis from multiple perspectives. Because no survey methodology is absolute or 100% precise, it is critical to get input from multiple sources to guide decision-making. Although it is often challenging to synthesize and "make sense" of contrasting information, such processes are essential to fully understanding the nature, magnitude, and scope of complex social problems such as youth substance use. Moreover, assembling this type of informed knowledge-base is often a prerequisite to developing effective prevention and intervention strategies.

It is from this perspective that the Department of Health and Human Services approaches its data collection and analysis efforts related to substance use. Specifically, DHHS conducts several surveys that provide estimates of the percentage of youth who use illegal drugs, alcohol, and tobacco. In the interest of time, I will briefly describe each of these surveys, before discussing recent trends in youth substance use.

The Centers for Disease Control and Prevention (CDC) developed the Youth Risk Behavior Surveillance System (YRBSS) to provide vital information on specific behaviors that cause the most important health problems among youth in the United States. The system has collected comparable data among national, state, and local samples of youth, beginning in 1990, and repeatedly every other year since 1991. The YRBSS reports on behavior in six risk areas; namely: 1) tobacco use; 2) alcohol and other drug use; 3) behaviors resulting in unintentional injury and violence; 4) sexual behaviors contributing to unintended pregnancy and sexually transmitted diseases, including HIV infection; 5) unhealthy dietary behaviors; and 6) physical inactivity.

YRBSS was developed with input from state and local health and education agency representatives and experts in each categorical area. The questionnaire underwent extensive focus group and field test work at CDC's Questionnaire Design Research Laboratory to further refine the wording of the questions and their appropriateness for youth. The YRBSS questionnaire contains 87 multiple-choice questions, 30 of which focus on tobacco, alcohol, and other drug use (including marijuana, cocaine, inhalant, heroin, methamphetamine, steroid, and injected drug use and being offered or sold an illegal drug on school property). Most tobacco, alcohol, and other drug use questions have remained unchanged since 1991. In 1992 and 2000, methodological studies were conducted to measure the reliability of the questions. In both studies, the tobacco, alcohol, and other drug use questions were found to produce highly reliable data from high school students.

Survey procedures are designed to protect students' privacy by allowing for anonymous and voluntary participation. Students complete the questionnaire during a regular class period under the direction of specially trained field staff. A computer scannable questionnaire booklet is used to record responses. Local parental permission procedures are followed before survey administration. Survey administration procedures have remain unchanged since 1990.

The national Youth Risk Behavior Survey (YRBS) is a major component of the YRBSS. This survey, conducted during the spring semester among national samples of high school students, provides data that are representative of all students in grades 9 though 12 in public and private schools in the 50 states and the District of Columbia.. In 1999, 15,359 surveys were completed in 144 schools. Schools are selected using a scientifically-based sampling process, and schools with a large percentage of African American and Hispanic students are over sampled to generate stable estimates each year for these subgroups of youth.

The National Institute of Drug Abuse sponsors the Monitoring the Future (MTF) Survey through a grant to the University of Michigan's Survey Research Center. The purpose of the survey is to assess the attitudes and behaviors of high school youth in a variety of areas, including and most notably, the areas of drug, alcohol and tobacco use. The survey provides unique data on both youth substance use and the attitudes and beliefs that may contribute to such behaviors.. The survey has been conducted annually among high school seniors since 1975, and has included 8th and 10th grade samples annually as well since 1991.

The survey is fielded in approximately 435 schools across the country, reflecting a nationally representative sample of both public and private high schools. The MTF is administered to 50,000 8th, 10th, and 12th grade students annually, with slightly more students in lower grades participating in the sample. Students complete self-administered paper-and-pencil questionnaires given to them in their classrooms by survey personnel. Participation is entirely voluntary, and students can refuse to participate if they so wish. In general, students' responses are confidential, however, respondents do provide some identifying information on a tear-off card. Beginning in 1999, all 8th and 10th grade responses are anonymous with no identifying information requested.

The Substance Abuse and Mental Health Services Administration (SAMHSA) sponsors the National Household Survey on Drug Abuse (NHSDA). Conducted by the Federal Government periodically since 1971, and annually since 1990, the NHSDA is the primary source of statistical information on the use of illegal drugs by the United States population. Moreover, the Household Survey provides the only source of nationally-representative data on adult substance use in this country.

The survey is conducted with a nationally representative sample of the population through face-to-face interviews at their place of residence. The population covered by the survey is the civilian, noninstitutional population age 12 and older in the U.S., including all 50 States and the District of Columbia. The survey incorporates procedures that are likely to increase respondents' cooperation and willingness to report honestly about their illicit drug use behavior. Confidentiality is emphasized in all written and verbal communications with potential respondents, respondents' names are not collected with the data, and computer-assisted interviewing, including audio computer-assisted self-interviewing, are used to provide a private and confidential setting to complete the interview.

In 1999, the NHSDA underwent a major redesign, moving from a paper questionnaire administration to computer-assisted administration, and dramatically expanding the sample to almost 70,000 individuals (including approximately 25,000 youth between the ages of 12 and 17) to permit state as well as national prevalence estimates of substance use. However, due to these differences in methodology and the impact of the new design on data collection, only limited comparisons can be made between data from the 1999 survey and data obtained from surveys prior to 1999. In order to permit some trend comparisons, SAMHSA included within the 1999 survey a supplemental national sample of over 13,000 individuals employing the pre-1999 survey administration methodology. This supplemental sample permits SAMHSA to assess trends from 1979 to 1999 for a limited set of substance use measures for youth age 12 to 17 as well as for some other age groups.

Taken together, these three surveys provide an unparalleled source of information to monitor and more fully understand trends in substance use and abuse. Each survey provides unique and important information that is useful to local, state, and national decision-makers attempting to address problems of substance use. Moreover, all three surveys were recently reviewed by a panel of outside experts who concluded that each survey is methodologically strong, well-designed for its intended purpose, and well administered.

I am please to report to you that data from these three surveys can help to resolve the central question posed in today's hearing: namely, is drug use going up or down. Generally, the reality is that all three Department-sponsored surveys indicate that the use of illegal drugs and tobacco among youth has leveled, and in some cases, declined over the last three years. However, despite the success of the last three years, it is also true that the use of illegal drugs and tobacco among youth remains higher than at the historically low-point of youth use in 1991. In other words, all of the Department-sponsored surveys that track youth substance use have consistently shown that rates which increased during the early to mid part of the 1990's have leveled and begun to decline during the latter part of the decade.

It is understandable that the fluctuations in youth substance use during the past decade, and the subsequent efforts to accurately report these trends, might have been inadvertently confusing to some. Nevertheless, as I noted earlier, information from multiple data sources are essential, and these sources are consistent in suggesting a leveling, and in some cases, declining use of illegal drugs and tobacco among youth during the past three years. While it is clear that far too many of our nation's young people and their families continue to experience the destructive and often fatal consequences of drug addiction, these recent trends also provide some cautious optimism that the joint efforts of parents, teachers, counselors, and public officials to educate youth about the dangers of illegal drug and tobacco use are beginning to bear fruit.

We must all continue to work together to build upon the momentum we have gained in reducing illegal drug use among youth in this country. Without sustained attention to prevention and treatment efforts, we will undoubtedly see these trends in youth substance use begin again to increase.

I thank the members of this Subcommittee for their interest in this important topic. I and my colleagues from the Department stand ready to address questions you may have.

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