Citation

Steinhoff A, Shanahan L, Bechtiger L, Zimmermann J, Ribeaud D, Eisner MP, Baumgartner MR, Quednow BB. J. Am. Acad. Child Adolesc. Psychiatry 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, American Academy of Child Adolescent Psychiatry, Publisher Lippincott Williams and Wilkins)

DOI

10.1016/j.jaac.2022.11.011

PMID

36731790

Abstract

OBJECTIVE: Large-scale epidemiological research often uses self-reports to determine the prevalence of illicit substance use. Self-reports may suffer from incorrect reporting but can be verified with objective measures. This study examined 1) the prevalence of illicit and non-medical substance use using self-reports and hair toxicology, 2) the convergence of self-reported and objectively quantified substance use, and 3) the correlates of under- and overreporting.

METHOD: The data came from a large urban cohort of young adults (n = 1,002, mean age = 20.6 years, 50% female). The participants provided 3 cm of hair (covering the previous three months) and reported their illicit and non-medical substance use and sociodemographic, psychological, and behavioral characteristics. Hair toxicology analyses targeted cannabinoids, ketamine, opiates/opioids, stimulants including 3,4-methylenedioxymethamphetamine, and relevant metabolites.

RESULTS: Self-reports underestimated the prevalence of most substances by 30-60% compared to hair tests. The average detection ratio (hair test/self-report) was 1.55. Hair tests were typically more sensitive than self-reports. Underreporting was associated with low specific substance levels in hair and low self-reported delinquency and psychopathology. Overreporting was associated with infrequent self-reported use.

CONCLUSION: Our study suggests that self-reports underestimate young adults' exposure to illicit substances and non-medical use of prescription drugs. Consequently, estimates of associations between substance use and risk factors or outcomes are likely biased. Combining self-reports with hair tests may be most beneficial in study samples with occasional substance use. Researchers can use specific factors (e.g., detection ratios) to adjust prevalence estimates and correlations based on self-reports.

Language: en

Keywords

substance use; young adults; prevalence; hair toxicology; non-medical use of prescription drugs