Main Study Pretest Module

Main Study Pretest Questionnaire Content and Summary of the need for each topic area

The National Survey on Drug Use and Health (NSDUH) is the primary source for statistical information on illicit drug use, alcohol use, substance use disorders (SUDs), and mental health issues for the civilian, noninstitutionalized population of the United States. Information on mental health and substance use allows the Substance Abuse and Mental Health Services Administration (SAMHSA) and other policymakers to gauge progress toward improving the health of the nation.

The purpose of this pretest is to conduct cognitive and usability testing on new and revised measures for substance use and mental health prior to their inclusion in field tests in 2020 and 2022, and then for potential inclusion in the main study NSDUH. The pretest aims to collect and analyze qualitative data from potential NSDUH respondents to evaluate if they understand the concepts and language of the new and revised questions, whether they find them difficult to answer, whether they are able to provide accurate reports of their substance use behaviors and mental health experiences, and whether they have any difficulty selecting answers or navigating through the self-administered survey platform.

Below is an overview and description of the questions and content areas covered by the Main Study Pretest.

Front End CAPI Modules

Interview administered questions at the beginning of the interview consist of initial demographic items and a respondent completed computer practice session. Demographic data are used to produce estimates of substance use and mental health for subpopulations of interest.

Introduction: No proposed changes

Core Demographics:

• Education: Modified questions on schooling to reduce redundancy, reduce cognitive burden, and to improve data accuracy.

• Partner Status: Added a follow-up question to assess partner status if a respondent indicates marital status is widowed, divorced or separated, or never married.

• Military parent or spouse: The impact of substance use and mental health on military families is a key area of interest. Added questions to assess if the respondent has a spouse or a parent/ guardian currently in the U.S. Military.

Beginning ACASI Sections: No proposed changes

Tutorial: Added a practice question to demonstrate the new grid question format.

Calendar: No proposed changes

Substance Use Modules

The first set of self-administered questions pertain to substance use, both licit and illicit substances. The NSDUH obtains information on two categories of licit substances: nicotine and alcohol, and nine categories of illicit drugs: marijuana, cocaine (including crack,) heroin, hallucinogens, inhalants, and misuse of prescription pain relievers, tranquilizers, stimulants, and sedatives. The substance use histories collected by the NSDUH allow estimation of incidence, prevalence, and patterns of use for licit and illicit substances

The substance use modules were modified to reflect changes in the type and forms of drugs available (e.g., marijuana concentrates, synthetic drugs), changes in the street names used for different substances, and changes in the methods of administration of these drugs (e.g., vaping.)

Licit substances:

Nicotine:

• Cigarette: Dropped low utility questions including brand of cigarette, cigarette type, and cigarette length questions.

• E-Cigarettes: Electronic cigarettes and other electronic vaporizers use is an emerging public health concern and is a gap in our current nicotine use data. Added questions about lifetime use, first use, recency, and number of days vaped in past 30 days.

• Smokeless tobacco: No proposed changes

• Cigars: Modified Cigar introduction for clarity and used phrase “any type of cigar” in follow-up questions. Dropped low utility questions on brand of cigar.

• Pipe Tobacco: No proposed changes

Alcohol:

• Modified Alcohol introduction and updated alcoholic beverages examples for clarity.

• Modified Alcohol module to incorporate relevant questions from the Consumption of Alcohol module to reduce redundancy and cognitive burden.

• Dropped low utility questions on using drugs and alcohol in the same occasion.

Illicit substances: Illicit drug use, including the misuse of prescription medications, affects the health and well-being of millions of Americans. Use of illicit substances can lead to substance use disorder and is associated with both physical and mental health issues. Cardiovascular disease, stroke, cancer, infection with the human immunodeficiency virus (HIV), hepatitis, and lung disease can all be affected by drug use. Some of these effects occur when drugs are used at high doses or after prolonged use. However, other adverse effects can occur after only one or a few occasions of use. 

Marijuana: NSDUH is the nation's primary source of information on marijuana use and it is critical that the questions relating to marijuana address the changing both the changing landscape of marijuana use and societal acceptance of the substance.

• Modified Marijuana introduction to reflect changes in street names (pot, weed, hashish, concentrate), and methods of administration (smoking, vaping, dabbing, eating or drinking, or apply as a lotion) and use phrase “marijuana or cannabis product” in follow-up questions.

• Added questions to assess past 12 months and past 30 day marijuana administration methods.

• Modify Marijuana module to incorporate Blunts module questions including questions on Medical Marijuana use.

Reorder Illicit Substance after Marijuana from less stigmatized substances to more stigmatized substance, to engage respondents by asking about substances that they are more likely to have experience with first and to ease them into reporting about less socially acceptable substances as they move through the survey.

Inhalants:

• Modified Inhalant introduction to accommodate new yes/ no grid for lifetime inhalant use questions. Ordered substances in grid from most common to least common and modified the other specified to “Other liquids, sprays, and gases.”

• Changed the phrase “to get high or to make them feel good” to “for fun or to get high”

Hallucinogens

• Modified Hallucinogens introduction to include methods of administration and to accommodate new yes/no grid for lifetime hallucinogens use. Ordered substances in grid from most common to least common.

• Dropped low utility recency and past 30 day use for PCP questions

Cocaine

• Moved lifetime and recency of needle use to inject cocaine questions from Special Drugs module to Cocaine module to reduce cognitive burden

Crack

• Added question to assess if crack is the only form of cocaine used by respondents

• Added lifetime and recency of needle use to inject crack questions for completeness of needle measure

Heroin

• Modified Heroin introduction to include heroin types (powder or tar) and methods of administration (smoked, snorted, or injected.)

• Move lifetime and recency of needle use to inject heroin questions from Special Drugs module to the Heroin module

Methamphetamines

• Modified Methamphetamines introduction to include “meth” as a street name and remove reference to methamphetamines as a stimulant

Misuse of Prescription Drugs including Pain Relievers, Tranquilizers, Stimulants, Sedatives:

• Added questions about lifetime use and recency of needle use to inject prescription pain relievers and stimulants for completeness of needle measure

Other Substance Related Question

The following section ask about a variety of sensitive topics related to substance use. These topics include (but are not limited to) injection drug use, perceived risk of substance use, substance use disorder (SUD), arrests, and treatment for substance use problems.

Special Drugs: This section contains questions about additional substances and mode of administration of interest to the agency.

• Added question to assess if respondents have vaped nicotine, marijuana, flavor only without nicotine or other drug added, or other substance in the last 12 months

• Added question to asses if respondent had vaped something without knowing what it was in the past 12 months

• Add lifetime and recency questions for synthetic marijuana, synthetic stimulants, and illegally made fentanyl (IMF)

• Added lifetime and recency questions about needle use to inject IMF

• Added lifetime and recency question for needle use to inject any drug/ any other drug

• Added question to assess if respondent has received an overdoes reversal medicine in the last 12 months

• Add questions to assess past 30 day use of alcohol with any endorsed substances and marijuana use with any endorsed substances

• Added a question on any other substance respondent use for fun or to get high

• Dropped low utility questions on OTC cough or cold medicine, GHB, other modes of heroin use, and needle hygiene questions

Substance Use Disorder (SUD): Reducing SUDs and related problems is critical to Americans' mental and physical health, safety, and quality of life. These disorders contribute heavily to the burden of disease in the United States. Excessive substance use and SUDs are costly to our nation due to lost productivity, health care, and crime. Annual estimates of the prevalence of substance use disorders can help determine the need for treatment and other services in the nation.

• Redesign and update SUD module to provide high-quality data on SUDs that reflect the DSM-5 criteria. The SUD module was cognitively tested in 2015 and additional testing was conducted in 2018 (both under NSDUH’s generic clearance, OMB Control No. 0930-0290.) The redesigned SUD module will be validated as part of the 2020 NSDUH Main Study package.

Risk and Availability: Whether someone engages in substance use is often related to exposure to factors that are typically associated with an increased likelihood of substance use (i.e., risk factors) or factors that are typically associated with a decreased likelihood of substance use (i.e., protective factors) as well as the availability of certain substances.

• Modified Risk and Availability introduction for cognitive ease

• Add questions to assess level of risk in vaping nicotine nearly every day and routinely once or twice a week

• Add questions to assess level of risk of using prescription opioid pain relievers and prescription stimulants once or twice a week in a way a doctor did not direct them

• Add questions to assess level of risk in using Ecstasy/ Molly/ MDMA and methamphetamine routinely once or twice a week

• Add questions to assess availability of prescription opioid pain relievers and prescription stimulates without a prescription of their own

• Add question to assess availability of Ecstasy/ Molly/ MDMA

Alcohol Treatment and Drug Treatment: The Alcohol and Drug Treatment modules ask about experiences with treatment for a drug or alcohol problem. Drug treatment items are needed to determine the prevalence of treatment receipt and the need for treatment. The substance use treatment modules currently used in NSDUH were last updated in 2009. Since that time, several changes to the substance use treatment field have occurred. The changes in the landscape of treatment are reflected in the complete redesign of the NSDUH treatment modules.

• Both Alcohol and Drug Use Treatment modules ask the same set of questions including: self-help/ support groups, peer counselor/ recovery coach, treatment in an ER/ ED, inpatient and outpatient treatment locations, treatment in prison, jails, or juvenile detention centers, medication-assisted treatment, detox, telemedicine, need for treatment, and barriers to care. Drug Treatment also includes a question to determine for which substance the respondent received treatment.

Mental Health

The following sections ask about a variety of sensitive topics related to health and mental health. Understanding the percentage of the population with mental disorders is important for gauging progress toward preventing the occurrence or progression of mental health concerns and in assessing the need for mental health services among adolescents or adults.

Because mental health issues are correlates of substance abuse, NSDUH continues to include questions on mental health and utilization of mental health services in NSDUH. Questions on mental health, in conjunction with questions on substance use, treatment for substance use, and mental health services, greatly enhance the ability to characterize and understand the co-occurrence and treatment of mental illness and substance use problems in the United States.

The mental health modules were modified to improve NSDUH’s current mental health measures by: 1) adding questions on non-suicidal self-injury (NSSI); 2) adapting the current NSDUH questions on adult suicide ideation for youth respondents; and 3) improving measures of mental health treatment.

Adult Suicide and Self-Harm

• Adapted current adult suicide question for adolescents

• Added a question on non-suicidal self-injury for both adults and adolescents

Adult Treatment for Depression

• Added questions to assess inpatient/outpatient treatment and whether medication was prescribed

Adult Mental Health

• No proposed changes

Youth Mental Health

• Adding modules from a validated scale, the Diagnostic Interview Schedule for Children (DISC) Predictive Scales (DPS).

Mental Health Service Utilization

• Similar to Alcohol and Drug use treatment, Mental Health Services Utilization has been redesigned to capture the evolving area of treatment. This module asks the same questions as the Alcohol and Drug Treatment modules, using the phrase “mental health, emotions, or behavior” and does not include a question about detox. Questions include: self-help/ support groups, peer counselor/ recovery coach, treatment in an ER/ ED, inpatient and outpatient treatment locations, treatment in prison, jails, or juvenile detention centers, medication, telemedicine, need for treatment, and barriers to care.

Correlates of Substance Use and Mental Health

These sections include correlates of substance use and mental health that allow for estimates by subpopulations of interest. Recent literature reviews have shown measures such as sleep, chronic pain and experiences with the criminal justice system are important covariates of substance use and mental health.

Health: This section includes several important correlates of substance use and mental health including pregnancy status, height and weight, and health conditions.

• Added question about screening for mental health issues in primary care settings, diabetes types, sleep issues including falling back to sleep, getting back to sleep, and waking up early, and chronic pain including how often respondent experiences pain and if pain limited their life or work activities

• Dropped low utility age at first diagnosis questions

Special Topics: This section includes questions about behavioral issues and encounters with police and the court system which are highly correlated with substance use and are of interest to the Bureau of Justice Statistics (BJS) and the agency. Estimates of mental health and substance use are needed by criminal justice status.

• Moved questions from Youth Experience to Special topics including: youth respondent argue/ fighting with parents, fighting at school or work, fighting a group, carrying a handgun and all respondent sold illegal drugs, stole $50, and attacked someone with intent to harm.

• Added new questions to better capture the criminal justice needs of BJS including placement in juvenile detention centers/ jails/ prisons, offense, probation and parole, and driving a vehicle under the influence of alcohol and drugs.

Parenting and Youth Experiences: These data are used to assess demographic patterns and trends in the prevalence of substance use and mental health factors, as well as examining their relationships with measures of substance use. Data are used to assess the impact of prevention efforts at the national level.

• Minor changes to Parenting Experiences include questions about vaping and talking about mental health

• Minor changes to Youth Experiences to balance response option scales, add questions about use of devices besides television, and limits on social media use. Also, added questions about the misuse of prescription drugs and vaping.

Back End ACASI

The following sections ask additional questions about marijuana purchasing information, disability, employment, and workplace issues.

Market Information for Marijuana: No proposed changes

Back End Demographics:

• Added question on lifetime and past 12 months in foster care, group home, or orphanage and updated disability questions

Employment: No proposed changes

Back End CAPI

The interviewer-administered CAPI section at the end of the interview ask about the household composition, the respondent’s health insurance coverage, and the respondent’s personal and family income.

• Household Roster: No proposed changes

• Health Insurance: No proposed changes

• Income: No proposed changes

• Verification: No proposed changes