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WILLIAM RAUB, Ph.D.
SENIOR SCIENTIFIC ADVISOR TO THE SECRETARY
FOR SCIENCE POLICY
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
U.S. HOUSE OF REPRESENTATIVES, COMMITTEE ON GOVERNMENT REFORM,
SUBCOMMITTEE ON CRIMINAL JUSTICE,
DRUG POLICY, AND HUMAN RESOURCES
"IS DRUG USE UP OR DOWN? WHAT ARE THE IMPLICATIONS?"
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
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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