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SAMHSA suspended in-person data collection on the 2020 NSDUH on March 16, 2020, because of COVID-19, a situation that affected virtually all national surveys that collect data in person, including NSDUH. A small-scale data collection effort was conducted in July 2020 to test protocols to reduce the risk of COVID-19 infection through in-person data collection. Because of ongoing COVID-19 infection rates in the United States, however, it became evident that a return to full-scale in-person data collection would not be feasible for obtaining a representative sample with a sufficient number of interviews to produce national estimates with acceptable precision for people aged 12 or older. Therefore, SAMHSA approved multimode data collection (in-person and web-based data collection) for the 2020 NSDUH beginning in Quarter 4 (i.e., October to December 2020). In-person data collection resumed on October 1, 2020 (in locations where COVID-19 infection metrics were sufficiently low), and web-based data collection began on October 30, 2020. Therefore, in addition to the collection of data through multiple survey modes in 2020, there was a gap in full-scale data collection between Quarter 1 and Quarter 4. For these reasons, SAMHSA decided not to compare 2020 estimates with those from prior years in the detailed tables and key substance use and mental health indicators report for the 2020 NSDUH (CBHSQ, 2021e, 2021h). Detailed descriptions of methodological changes to the 2020 NSDUH because of the COVID-19 pandemic are provided in Chapters 2, 3, and 6 (see Section 1.2).
Details about the web-based screening and interviewing procedures, as well as the key differences compared with in-person data collection, will be provided in the 2020 data collection final report (CBHSQ, forthcoming b). Implications of the multimode data collection for 2020 NSDUH estimates are discussed in Chapter 6.
Variables imputed using PMN for 2020 were (1) the initial demographic variables; (2) substance use variables for cigarettes, smokeless tobacco, cigars, pipe tobacco, alcohol, marijuana, cocaine, crack, and heroin (recency of use, frequency of use, and age at first use); (3) income; (4) health insurance; and (5) demographic variables for work status, immigrant status, and the household roster. Variables imputed using modified PMN for 2020 were the drug use variables for hallucinogens, inhalants, methamphetamine, pain relievers, tranquilizers, stimulants, and sedatives (recency of any use, recency of misuse, frequency of misuse, past year initiation status, and age at first misuse among past year initiates of misuse). Additionally, modified PMN was used in 2020 to impute variables related to DSM-5 SUD outcomes28 (i.e., past year disorder and disorder severity) for alcohol and illicit drugs and the most recent use of the following: vaping of any substance, nicotine or tobacco vaping, kratom, synthetic marijuana, and synthetic stimulants.
The third modification for the 2020 person-level weights was the addition of educational attainment to the poststratification adjustment models for 2020. In Quarter 4, the web data for educational attainment (less than high school, high school graduate, some college or associate degree, and college graduate) showed a higher percentage of college graduates and a somewhat smaller proportion of adults with a high school education or less compared with distributions from prior NSDUH years and distributions from the American Community Survey (ACS). The educational distribution for in-person data from Quarter 1 and prior NSDUH years aligned well with ACS distributions. Therefore, the 2019 ACS data were used to create control totals for educational attainment. The control totals for educational attainment were obtained by multiplying the ACS educational attainment proportions by the 2020 civilian, noninstitutionalized population estimates received from the U.S. Census Bureau. Educational attainment was added to the poststratification adjustment models for Quarter 1 and Quarter 4.
Significance testing also was conducted using SUDAAN to compare estimates for individual subgroups with the corresponding estimate among the overall population (e.g., northeast region vs. all regions). In the 2020 detailed tables, these significance tests were conducted for select demographic measures (i.e., race/Hispanic origin and region). However, comparing estimates between a subgroup and the overall population increases the covariance in the denominator of the t test formula described at the beginning of this section; subtracting this covariance term from the sum of the variance terms for the individual estimates will decrease the size of the denominator and increase the size of the t statistic. For this reason, small differences between a subgroup and the overall population can be statistically significant. These tests could be used to aid authors in writing NSDUH reports, but they are not published in the detailed tables.
As discussed in Sections 18.104.22.168 and 22.214.171.124, web-based data collection in Quarter 4 for the 2020 NSDUH resulted in lower response rates and yielded respondents with higher educational attainment compared with results from in-person data collection. To address potential nonresponse bias from sample members with less education being less likely to participate via the web, education was included in the poststratification adjustments for weighting the 2020 data (see Sections 126.96.36.199 and 188.8.131.52).
Also, the SRR in Quarter 4 was substantially lower than in Quarter 1 (11.1 vs. 67.8 percent) (Table 3.3). The lower SRR in Quarter 4 is likely explained by SDU members being responsible for starting the screening process for web-based data collection, whereas FIs contacted SDUs for in-person data collection. Consequently, the ORR in Quarter 4 for the population aged 12 or older was only 6.6 percent compared with the rate of 45.8 percent in Quarter 1. However, lower response rates are not atypical for web-based data collection compared with in-person data collection. For example, response rates among adults in the experimental 2020 Household Pulse Survey ranged from 1.3 to 3.8 percent in the first 3 weeks of data collection (see Section 5.1.3) (National Center for Health Statistics, n.d.-a). The web-based 2015 Department of Defense (DoD) Health Related Behaviors Survey had an overall response rate of 8.6 percent (Meadows et al., 2018).
A limited set of statistical models was run to compare odds ratios and risk ratios for multiple quarters of preliminary data for the same 20 key binary outcomes noted previously. The models indicated a tendency for web respondents to be less likely to report substance use (across a combination of age groups), but respondents in Quarter 4 of 2020 were more likely to report substance use (i.e., during a period of increased COVID-19 infection rates). That is, effects due to the mode change and effects due to COVID-19 may have worked in opposite directions on some of the outcomes. Although these results cannot be considered definitive, two independent modeling exercises hinted at similar tendencies. As noted previously, however, these modeling investigations were not extensive and were conducted using preliminary data and preliminary analysis weights. Therefore, results from these initial investigations may not generalize to all 2020 NSDUH data and to all population subgroups. Also, odds ratios and risk ratios from these investigations indicate the general direction of influences of the data collection mode change and elapsed time during the pandemic for the outcomes that were investigated, but they cannot be used to construe what the 2020 estimates would have been if all data had been collected in person.
In summary, data users should exercise caution when comparing the 2020 NSDUH estimates with estimates from prior years because the reasons for differences in estimates across years cannot be determined conclusively. The COVID-19 pandemic and the resulting addition of the web mode of data collection in Quarter 4 happened in tandem without the benefit of a controlled experiment to measure the effects of each. As mentioned elsewhere in the report, data collection in 2020 also differed from that in prior years because of the pause in data collection in the middle of 2020. For these reasons, the Substance Abuse and Mental Health Services Administration (SAMHSA) decided not to compare 2020 estimates with those from prior years in the detailed tables and key substance use and mental health indicators report for the 2020 NSDUH (CBHSQ, 2021e, 2021h). 2b1af7f3a8