Does the Calendar Method
Enhance Illegal Drug Use
Reporting among Arrestees?[1]
George
S. Yacoubian, Jr., Ph.D.[2]
Ronald
J. Peters, Dr.Ph.
Abstract
While a plethora of research has determined that
respondents underreport their recent use of illicit drugs, few studies have
attempted to improve the validity of self-reported drug use. The Arrestee Drug Abuse Monitoring (ADAM)
Program is a federally funded drug surveillance system that has been collecting
data from arrestees since 1987. In 2000,
the ADAM Program fielded a new data collection instrument that uses a calendar
method to enhance the reporting of personal drug use. To date, however, no research has assessed
the degree to which this calendar method has improved drug use reporting among
ADAM arrestees. To address this
limitation, urinalysis results and 30-day self-report measures for marijuana,
cocaine (crack and powder), and heroin use collected in Houston in 1999 are
compared to identical drug use measures collected in Houston in 2000. In addition, kappa statistics for marijuana,
cocaine, and heroin use are generated for each of the two time frames. Results indicate that,
despite virtually identical drug-positive rates within the two samples of
arrestees, the introduction of the calendar method in 2000 had no significant
effect on the reporting of recent marijuana, cocaine, and heroin use. Implications for survey methodology are
discussed.
Introduction
One major problem of self-report drug surveys is that researchers must rely on respondents to disclose their personal use of illicit drugs. To measure recent drug use and to assess the validity of self-reported drug use information, researchers often collect an objective, biological measure of recent drug use, such as urine or oral fluid. The collection of two measures of recent drug use – self-reports and biological specimens – permits an exploration of validity, whereby the more unreliable measure (self-report) is measured against the criterion measure (biological specimen). Validity studies can determine, therefore, the extent to which arrestees are being truthful about their recent drug-using behaviors.
Previous studies have established
that arrestees underreport their recent use of illegal drugs, particularly
cocaine (Yacoubian, 2000a; Lu et al., 2000; Hser, 1997; Harrison, 1995; Fendrich and Xu, 1994; Rosenfeld and Decker,
1993; Mieczkowski et al., 1991; Wish and Gropper, 1990). Mieczkowski et al. (1991), for example,
compared self-reports of cocaine use with urinalysis results from a sample of
adult arrestees in
Underreporting of recent drug use
has also been identified in other high-risk populations (Morral et al., 2000;
Fendrich et al., 1999; Magura and Kang, 1997; U.S. Department of Health and
Human Services, 1997; Wish et al., 1997; Hubbard et al., 1984). Fendrich et al. (1999) used the National
Household Survey on Drug Abuse (NHSDA) methodology and collected self-report
survey data and hair specimens from a high-risk sample of household respondents
in
Improving the validity of self-reported drug use
A number of studies have attempted to improve the validity of self-reported drug use, with a variety of methods (Yacoubian and Wish, 2001; Wish et al., 2000a,b; Tourangeau et al., 1997; Wagenaar et al., 1993; Campanelli et al., 1987; Akers et al., 1983). Campanelli et al. (1987) used a bogus pipeline procedure with 291 students to attempt to increase the validity of self-reported alcohol use. Before completing the surveys, experimental respondents were told that a saliva specimen would be collected to check the accuracy of their self-reports. In reality, no objective drug use results were generated. No significant differences between the experimental (n=173) and control (n=118) groups were discerned (Campanelli et al., 1987). However, Tourangeau et al. (1997) surveyed 120 randomly selected adults on issues related to smoking, alcohol consumption, illicit drug use, and sexual activity. Respondents were assigned to either a bogus pipeline condition, in which they were told that untruthful answers could be detected by a recording device, or a control condition, in which face-to-face interviews were conducted without the “verifactor” machine. Respondents in the experimental group were significantly more likely than control respondents to report sensitive or potentially embarrassing behaviors, including drug use and sexual activity (Tourangeau et al., 1997).
Wish et al. (2000a) undertook an
experiment to determine whether modifying the ADAM collection protocol could
enhance the self-reporting of drug use without adversely affecting study
response rates. A 2x2 factorial design
was used to assess the effects of two manipulations. The first experimental condition involved
administering either the standard ADAM informed consent or an enhanced consent
that told the arrestees more about the confidential nature of the research and
the capabilities of urinalysis (Wish et al., 2000a). The second condition involved collecting the
urine specimen either before or after the interview was administered (Wish et
al., 2000a). Data were collected in
three ADAM sites –
Using a modified bogus pipeline procedure, Wish et al. (2000b) exposed adult arrestees surveyed through the Substance Abuse Need for Treatment among Arrestees (SANTA) Program – an ADAM-like study – to two manipulations. The standard collection procedure involved requesting a urine specimen after subjects had completed a survey about illicit drug use. The specimen was subsequently shipped to a laboratory for analysis. The second condition employed the Test First Technique (TFT), which required that an instant urine test be administered on site and its results shared with the arrestee prior to survey administration. Wish et al. (2000b) hypothesized that arrestees surveyed with the TFT would be more likely to self-report recent illegal drug-using behaviors than respondents surveyed with the standard procedure. Their hypothesis was confirmed for cocaine and marijuana. Cocaine-positive arrestees surveyed under the TFT (n=26) were significantly more likely (81% v. 44%, p<0.001) to report cocaine use in the past three days than arrestees surveyed under the standard condition (n=25) (Wish et al., 2000b). Marijuana-positive arrestees surveyed under the TFT (n=53) were significantly more likely (94% v. 75%, p<0.001) to report marijuana use within the past 30 days (the detection period for marijuana by urinalysis) than arrestees surveyed under the standard condition (n=51) (Wish et al., 2000b).
Yacoubian and Wish (2001) replicated their earlier study
with a different sample of adult arrestees using an instant oral fluid test in
lieu of the instant urine test. Again,
cocaine-positive arrestees surveyed under the TFT (n=22) were significantly
more likely (86% v. 49%, p<0.001) to report cocaine use in the past
three days than arrestees surveyed under the standard condition (n=133)
(Yacoubian and Wish, 2001).
Opiate-positive arrestees surveyed under the TFT (n=20) were
significantly more likely (90% v. 66%, p<0.001) to report opiate use
in the past three days than arrestees surveyed under the standard condition
(n=128) (Yacoubian and Wish, 2001). The studies
by Wish et al. (2000b) and Yacoubian and Wish (2001) produced
the highest levels of concordance between urinalysis and self-reported recent
drug use ever documented in research studies of arrestees.
Calendar Method
Another technique used to improve self-reported drug use is the calendar method. The calendar method is based on the assumption that recall can be drastically improved by visually and mentally anchoring memories of these events (Rubin, 1986). For the ADAM Program, the assumption is that the reporting of personal drug use, treatment history, and criminal justice involvement will be enhanced when recalled in conjunction with more personal events (e.g., birthdays, anniversaries, and holidays). The calendar method is based on a body of work (Breslin et al., 1996; Ehrman and Robbins, 1994; Anglin et al., 1993; Sobell and Sobell, 1992; Freedman et al., 1988; Sobell et al., 1988; Nurco et al., 1975) that has illustrated increased reporting of a host of sensitive behaviors, including the use of alcohol and other drugs. In contrast, one study (Midanik et al., 1998) found lower estimates of self-reported 30-day drug use after implementation of the calendar method.
The ADAM Program first used the
calendar method in 2000. To date,
however, no studies have evaluated the efficacy of the calendar method among
ADAM arrestees. To address this
methodological limitation, 30-day drug use data collected in
Methods
The National Institute of
Justice (NIJ) established the ADAM Program – formerly the DUF Program – in 1987
(Yacoubian, 2000b; Wish, 1995). The six
primary goals of ADAM are: identifying the levels of drug use among arrestees;
tracking changing drug-use patterns; determining what drugs are being used in
specific jurisdictions; alerting local officials to trends in drug use and the
availability of new drugs; providing data to help understand the drug-crime
connection; and serving as a research platform upon which a wide variety of
drug-related initiatives can be based (Yacoubian, 2000b). Data are currently collected in 35
jurisdictions across the
Each quarter, locally trained ADAM researchers enter booking facilities and approach persons shortly after their arrest. The introduction by the interview staff includes the purpose and sponsorship of the study and informed consent provisions. Arrestees are asked to participate in a confidential, in-person interview and to provide a urine specimen after the interview is completed. Arrestees are assured that their participation is voluntary, that their responses are confidential, and that they will receive a candy bar as an incentive for participation. Subjects are interviewed in private or semi-private rooms that are out of hearing range of correctional officers or other arrestees. Interview time is approximately 30 minutes, depending on the amount and degree of drug use disclosure.
Between
1987 and 1999, the type of data collected by ADAM was relatively limited. Arrestees were first asked several
demographic questions, including education level, marital and employment
status, and income level. Participants
were then asked to report whether they had ever
used a panel of specific drugs. For
those drugs the arrestees reported having ever
tried, they were asked to indicate age of first use, whether they had used the
drug within the past 12 months, the number of days used within the past 30 days,
and whether they had used the drug within the past three days. Participants who admitted to drug use were
also asked whether or not they considered themselves drug-dependent, and
whether they were under the influence or in need of drugs at the time of arrest
(Yacoubian, 2000b). Several questions
also focused on treatment – whether the person had ever received treatment, was
currently in a treatment program, or perceived a need for treatment.
In 2000, a
new data collection instrument was fielded (NIJ, 2000). The seven primary sections of the instrument
are: face sheet, demographics, criminal justice involvement, personal drug use,
treatment history, dependence and abuse, and market and use (NIJ, 2000). Face
sheets are completed on all eligible arrestees with information
collected from official records. These
data include arrest and booking dates, arrest location, date of birth, gender,
primary criminal charges, race, and residence zip code. If respondents consent to the interview, demographic data – ethnicity,
citizenship, education, employment, health insurance, marital status, and
living arrangements – are collected via self-report. The collection of demographic information is
followed by questions on criminal justice activity, personal drug use, and
treatment history. The dependence and abuse section allows
for the clinical diagnosis of drug abuse and/or dependency. The abuse and dependence section is based on
the Substance Use Disorders Diagnostic Schedule (SUDDS). Respondents are asked, for example, if their
use of alcohol or drug use has caused them to neglect their usual
responsibilities and whether they used alcohol or drugs more than they
intended. The market and use section inquires cash vs. non-cash drug
transaction, location of purchase, quantity purchased, amount paid, frequency
of purchases, and market availability.
In addition
to the survey, a urine sample is obtained as an objective measure of recent
drug use and to validate the self-report data.
The Enzyme Multiplied Immunoassay Test (EMIT)
screens for 10 drugs: amphetamines, barbiturates (e.g., Phenobarbital),
benzodiazepines, marijuana, metabolite (crack and powder) cocaine, methadone,
methaqualone, opiates, PCP, and propoxyphene (Darvon). All positive results for amphetamines are
confirmed by gas chromatography (GC) to eliminate any over-the-counter
medications.
The
calendar method is introduced prior to administration of the personal drug use
questions. Respondents are first asked
if they have ever used marijuana, crack cocaine, powder cocaine, heroin,
and methamphetamine. For those drugs
respondents report having ever tried, they are asked to report age of first use
and whether they have used the drugs within the past 12 months. If 12-month use is indicated, the calendar is
initiated. After noting major holidays
(e.g., Thanksgiving) on the calendar, interviewers ask respondents to recall
personal events that occurred during the previous 12 months (e.g., birthdays,
anniversaries, and arrests). These
events are designed to serve as anchors for recalling specific events related
to alcohol and other drug (AOD) use.
Following the completion of the calendar, arrestees are asked to report
the number of days a drug has been used within the past 30 days. Given that the calendar method is not
introduced until after the 12-month use question is asked, the variables
of interest are self-reported 30-day use of marijuana, crack cocaine, powder
cocaine, and heroin.[3] With this framework, data analysis and
findings are presented below.
Data Analysis and Findings
For each year, data analysis was accomplished in four phases. First, participation rates were calculated. Second, descriptive statistics were generated. Third, rates of self-reported 30-day marijuana, cocaine (crack or powder), and heroin use were calculated. Fourth, 30-day self-reports of marijuana, cocaine (crack or powder), and heroin use were compared to their respective urinalysis results for each year.[4] Kappa statistics were generated and the validity of self-reported recent marijuana, crack cocaine, powder cocaine, and heroin use was examined.
Participation rates
As shown in
Table 1, 2,683 adult arrestees were approached for interviewing in 1999. Of these, 71% completed the interview. Of those who completed the interview, 83%
provided a urine specimen, for an overall participation rate of 59%. Rates of participation were slightly lower in
2000.[5] A total of 1,446 arrestees were approached
for interviewing in
Table
1. Participation Rates, 1999 and 2000
|
|
1999 |
2000 |
|
Total
number of eligible arrestees Of
eligible, completed interview Of
completed interview, provided urine specimen Overall
participation rate |
2,683 71% (n=1,905) 83% (n=1,572) 59% |
1,446 57% (n=829) 88% (n=728) 50% |
Demographic characteristics
As shown in
Table 2, arrestees surveyed in 2000 were significantly more likely to be male
(92% v. 57%, p<0.01) and significantly less likely to have earned a
high school diploma or General Equivalency Degree (GED) (37% v. 61%, p<0.01)
than arrestees surveyed in 1999. The
racial, age, and primary charge distributions between the two samples were
similar. With the exception of gender
and education, the results suggest comparability between the two samples. Because a respondent’s sex has been shown to
effect willingness to participate, there may not be enough data to assess the
efficacy of the calendar method with female arrestees.
Table 2. Demographic Characteristics, by Year
|
Characteristic |
1999 (n=1,572) |
2000 (n=728) |
|
Gender Male |
57%* |
92%* |
|
Race Black White Hispanic Other |
56% 20% 23% 1% |
49% 23% 27% 1% |
|
Age 20 and under 21-25 26-30 31-35 36 and over Mean
age (in years) |
23% 22% 17% 13% 25% 29.4 |
22% 24% 16% 11% 27% 29.5 |
|
Education High school graduate/GED |
61%* |
37%* |
|
Primary charge Property offense Personal offense Drug or alcohol offense Miscellaneous offense |
17% 14% 16% 53% |
17% 12% 29% 42% |
*Chi-square significant at the p<0.01 level.
Note: Personal offenses include assault and robbery. Drug or alcohol offenses include
drug
possession and sale. Property offenses include theft and receiving stolen
property. Miscellaneous offenses include loitering and unspecified
parole/probation violations.
Personal drug use
Table 3 presents 30-day self-reports and urinalysis results for marijuana, cocaine, and heroin. In 1999, 31% of the arrestees tested positive for marijuana, while 35% reported using marijuana in the 30 days preceding the interview. Thirty percent tested positive for cocaine, while 16% self-reported 30-day crack or powder cocaine use. Also in 1999, 7% tested positive for heroin, while only 1% reported heroin use in the 30 days preceding the interview. In 2000, 35% of the arrestees were marijuana-positive, with 34% reporting 30-day marijuana use. Thirty-one percent of the sample was cocaine-positive, with 15% reported 30-day crack or powder cocaine use. Also in 2000, 7% of the sample tested positive for heroin, while 1% reported using heroin in the 30 days preceding the interview.
Table 3. Estimates of Drug Use from Self-Reports and
|
|
1999 |
2000 |
|
Marijuana 30-day Urinalysis Kappa Cocaine (Crack or Powder) 30-day Urinalysis Kappa Heroin 30-day Urinalysis Kappa |
35% 31% .64 16% 30% .48 1% 7% .08 |
34% 35% .59 15% 31% .47 1% 7% .06 |
*Comparison between urinalysis and 30-day self-reports.
Kappa,
which measures the agreement between the evaluations of two raters
(self-reports and urinalysis) when both are rating the same object (recent drug
use), is considered an appropriate measure of agreement when the time periods
covered by both are similar (Magura and Kang, 1996). As shown in Table 3, 1999 kappa statistics
were moderate for marijuana (.64), but low for cocaine (.48) and heroin (.08),
suggesting poor agreement between the two raters (Magura and Kang, 1996). The 2000 kappa statistics were comparable to
those from 1999 – .59 for marijuana, .47 for cocaine, and .06 for heroin. These findings indicate that, despite
virtually identical drug-positive rates within the two samples of arrestees,
the introduction of the calendar method in 2000 had no significant effect on
the reporting of recent marijuana, cocaine, and heroin use or on the agreement
between the two raters.
Discussion
The calendar method has been shown in previous research to
enhance self-reported recent AOD-using behaviors (Breslin et al., 1996; Anglin
et al., 1993; Sobell and Sobell, 1992; Freedman et al., 1988; Sobell et al.,
1988; Nurco et al., 1975). In 2000, the
ADAM Program fielded a new data collection instrument that uses a calendar
method to enhance the reporting of personal drug use. If 12-month drug use is indicated during the
interview, the calendar is initiated.
Arrestees are subsequently asked to report the number of days a drug has
been used within the past 30 days. Given
that the calendar method is not introduced until after the 12-month use
question is asked, the variables of interest in the current study were
self-reported 30-day use of marijuana, cocaine (crack or powder), and
heroin. We compared urinalysis results
and 30-day self-report measures for marijuana, cocaine, and heroin use
collected in
Several
methodological limitations should be noted.
First, while the calendar is introduced after arrestees indicate
12-month drug use, the 30-day drug use questions in the ADAM interview are not
asked immediately after completion of the calendar. A host of drug market questions are posed to
the arrestees prior to the questions about recent drug use. It is difficult to ascertain, therefore, the
direct effect of the calendar method on self-reported recent drug use. Rather, the current analysis was based on a
spillover effect between the calendar and questions about recent drug use. Second, given the detection capabilities of
urinalysis, generating kappa statistics with three-day self-reported
drug use measures would have been more appropriate than the 30-day drug use
measures. Unfortunately, ADAM data
collected in 1999 queried past three-day drug use, while data collected
in 2000 asked about two-day drug use.
The only appropriate alternative, therefore, was generating kappa
statistics by comparing the self-reported 30-day drug use measures to
the urinalysis results – the only recent time frame for which comparable data
were available in both 1999 and 2000.
Third, while the ADAM protocol required the collection of a urine
specimen, urinalysis did not distinguish between the types of cocaine for which
self-reported data were collected.
Because urinalysis can now distinguish between crack and powder cocaine
(Riley et al., 2001; Lu et al., 2000), future research should replicate the
current analysis and distinguish between cocaine urinalysis results rather than
combining the self-reported crack and powder cocaine use variables. Fourth, the current study focused on arrestees
from one ADAM site.
The extent to which these findings are comparable across ADAM sites, and
other populations, is an empirical question that can only be addressed with
future research. We recommend,
therefore, that the calendar method be introduced to other populations to
assess its utility. Fifth, interviews
conducted with ADAM arrestees are conducted by trained interviews and are thus
not self-administered. Previous research
has suggested that underreporting may be more problematic when responses are
not provided in complete privacy.
These caveats aside, the current study has illustrated
that the calendar method did not enhance self-reported recent marijuana,
cocaine, or heroin use among
While the current analysis cannot definitively state that the calendar method was ineffective in enhancing self-reported drug use within these two samples of arrestees, the results suggest that this might be the case. Future work should consider a cross-sectional experimental design in which arrestees are randomly assigned to a control condition, in which no calendar is utilized, and an experiment condition that uses the calendar method. This design would be more appropriate for detecting the effects of the experimental stimulus and would demonstrate concretely whether the calendar method is yielding its desired effect with ADAM arrestees.
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[1] The data
for this study were obtained from the National Archive of Criminal Justice Data
(NACJD) maintained by the Inter-University Consortium for Political and Social
Research (ICPSR) at the
[2] George
S. Yacoubian, Jr. is the Director of Research at McFarland & Associates,
Inc. Ronald J. Peters, Jr., is an
assistant professor of Behavioral Sciences at the University of Texas Health
Science Center at