A M e th o d o lo g y fo r S tu d e n t

D ru g -u s e S u rv e y s

R. G . S M A R T P. H . H U G H E S
Addiction Research Foundation, Division of Mental Health, World Health
Toronto, Canada Organization, Geneva, Switzerland

L. D . J O H N S T O N
Survey Research Centre,
University of Michigan,
Ann Arbor, MI, USA

A. A N U M O N Y E UKHANT M A R IA E L E N A M E D IN A M O R A
University of Lagos, Rangoon Psychiatric Mexican Centre of Mental Health
Nigeria Hospital, Burma Studies, Mexico City, Mexico

V. N A V A R A T N A M V IC H A I P O S H Y A C H IN D A V. K . V A R M A
University of Science Chulalongkorn University, Postgraduate Institute
ofMalaysia, Minden, Bangkok, Thailand of Medical Education & Research,
Penang, Malaysia Chandigarh, India

K. A. W A D U D
Pakistan Narcotics Control Board,
Islamabad. Pakistan

WORLD HEALTH ORGANIZATION

GENEVA
1980
WHO Offset Publication No. 50
 CONTENTS
Page
Preface ................................................................ 5
Acknowledgements .......................................................... 6

1. Introduction ....................................................... 7
1.1 Need for comparability and for a tested questionnaire............ 7

1.2 Self-administered drug-use questionnaire for young people ......... 8

1.3 Advantages and disadvantages of self-administered surveys ......... 9

1.4 Youth populations suitable for this type of survey .............. 9

1.5 Nonmedical use of drugs, drug abuse, and drug dependence ......... 9
2. Development of the questionnaire and plan for its testing ............. 10

2.1 General plan for the project .................................. 10

2.2 Rationale for the selection of data items and organization of the
questionnaire ............................................... 10

2.3 Coordination of technical work ................................ 12

2.4 Collaborating institutions .................................... 12

3. Results of testing the questionnaire in seven countries ............... 14

3.1 Overview of testing experience at each c e n t r e .................... 14
3.2 Data analysis................................................. 15

3.3 Reliability studies ........................................... 15

3.4 Validity studies ............................................. 17

3.5 Summary of results ........................................... 19

4. Application and further development of the final questionnaire ......... 21

Annex 1. Methodological guidelines for self-administered surveys of youth . . 22

Annex 2. Student drug—use questionnaire.......... 35

Annex 3. Instructions to investigators for use of the questionnaire ......... 44

Annex 4. Optional questions........................................... . 49
References................................................................. 53
 -5-

PREFACE

This report of the WHO Research and Reporting Project on the Epidemiology of Drug
Dependence describes the work of an international team of investigators to improve the
comparability and scientific quality of information on the use of drugs by young people.
In this collaborative study, teams in seven countries developed and tested a "self-adminis­
tered drug use questionnaire" — i.e., a questionnaire that may be filled in by the
young people themselves. The object was to develop an operational methodology foruse
in many different settings to assess drug use among young people.
The report describes the study and its conclusions. It provides the general rationale
for the choice of questionnaire items as well as the reasons for using the self-adminis­
tered type of questionnaire. In carrying out the study a number of reliability and
validity checks were made and the results of these are reported.
The report of the study is supplemented by a review of the methodology and practical
issues confronting the general researcher or epidemiologist who may be called upon to
implement a self-administered survey on drug use among students or other groups (Annex 1).
The review provides guidelines for selecting the sample and for the administration of
this type of survey, for carrying out checks of reliability and validity, and for ensuring
confidentiality and proper analysis of the data. The finalized questionnaire and instruc­
tions for its use are presented in Annexes 2 and 3. Optional questions are listed in
Annex 4. An effort has been made to give practical information on how such studies
should be carried out in order to yield reliable results.

The core items in this questionnaire are comparable to those in other questionnaires
that are being developed by WHO and by the United Nations Division of Narcotic Drugs for
the collection of data on drug abuse. It is hoped that the use of similar methods and
thecollection of comparable data will improve the planning and coordination of inter­
vention programmes by permitting national and international comparisons and the exchange
of information on the epidemiology of drug dependence.

Researchers and administrators who are planning surveys of drug use among students,
prisoners, military conscripts, or other youth groups capable of filling in questionnaires
themselves are invited to consider either using the present questionnaire or including its
core items in their studies. In this way, the data from their surveys will be comparable
with those of WHO collaborating investigators and others who may use the questionnaire. To
this end, it would be most helpful if investigators using the questionnaire or selected
items from it would send copies of their study reports, along with a description of the
methods used, to the Division of Mental Health, World Health Organization, 1211 Geneva 27,
Switzerland.
 - 6 -

ACKNOWLEDGEMENTS

The authors acknowledge the financial support given to the project by the United
Nations Fund for Drug Abuse Control and by the participating centres and the governments
concerned. They thank the United Nations Division of Narcotic Drugs for its close
collaboration and the International Narcotics Control Board and International Council on
Alcohol and Addictions for participating in meetings held in connexion with the project.
Thanks are due also to the Addiction Research Foundation, Toronto, Canada, which served as
a coordinating centre by providing special technical support and by analysing the data
for the study.
 - 7-
1. INTRODUCTION

A large number of excellent surveys of drug use have been carried out among young
people. Unfortunately, it has been difficult to compare the findings because each team of
investigators has tended to gather a different type of data and to employ instruments and
methods different from those used by other teams. This report describes a WHO study that
tackled this issue by bringing together teams of experts from various parts of the world
to agree on the core data items for a student drug-use questionnaire. The object was to
develop a broadly acceptable methodology that would be practical for use in various age
groups and sociocultural settings. The experts were then invited to test the questionnaire
in a variety of languages and settings to determine its general effectiveness, reliability,
and validity. On the basis of the experience gained in testing it in seven countries, the
questionnaire was finalized at a second meeting of collaborating investigators in 1977.

The study was carried out as one of the initial activities of the WHO Research and
Reporting Project on the Epidemiology of Drug Dependence - a project developed in response
to World Health Assembly resolutions WHA23.42 and WHA28.80. The first aim of the project
is to develop instruments and methods to meet the priority data-collecting needs of develop­
ing countries with serious problems of drug dependence. In addition to the research
described here, a number of studies have been carried out to develop additional methods of
obtaining information on drug abuse through case-reporting and intensive case-finding
systems, surveys of the general population and of non-student youth, and the evaluation of
methods of treating drug dependence. The results of these studies will be available soon.
To develop and test these methods, a network of collaborating institutions has been
established, primarily in developing countries with serious problems of drug dependence.
This network was mainly responsible for carrying out the present study.
The subject of this report - the development of a methodology for self-administered
surveys of drug use among students - was selected as one of the first priorities of the
project because, in many countries, young people run a high risk of becoming drug-dependent.
Furthermore, the use of self-administered questionnaires for this purpose is well estab­
lished. For literate populations, such as students, that may be brought together at one
time and place, such questionnaires offer advantages over other methods - chiefly their low
cost, ease of administration, and relatively high validity and reliability. They may also
be used for postal surveys of incidence and prevalence, for follow-up studies, and to
monitor trends and evaluate prevention programmes.

The prototype questionnaire presented in this report contains questions on demographic

characteristics; the use of 10 classes of drug in the past 30 days, in the past year, or
ever in the respondent's lifetime; the age at which the drugs were first used; and the
honesty of reporting. It was distributed to some 1655 students by collaborating centres in
7 countries: Burma, Canada, India, Malaysia, Mexico, Nigeria, and Pakistan.

Data on the rates of drug use found among the young people who participated in the
study are not reported, since the samples in individual countries were small and
unrepresentative of the total youth populations from which they were drawn. However,
because the study was directed towards the development of an operational questionnaire and
methods of using it, results are presented on the reliability and validity of the question­
naire. These results showed the questionnaire to have satisfactory reliability and
validity in most settings, but additional methodological work is clearly needed. Some
centres reported that students had difficulty in understanding certain questions and were
not familiar with the questionnaire format originally presented. The questionnaire was
revised accordingly and its final version contains improvements in both questions and
format.
1.1 Need for comparability and for a tested questionnaire

The student drug-use survey is the most common form of epidemiological study of
drug abuse. A number of such surveys based on excellent methodology have been carried
out, though mostly in developed countries. Because planners in developing countries are
becoming increasingly interested in obtaining information on the use of drugs by young
people, there is a need for a practical methodology that could be adapted to most socio­
cultural settings and applied at a relatively low cost. To be useful in developing
countries, such a methodology should yield reasonably reliable results in the hands of
researchers or epidemiologists who may not be experts in the special field of drug abuse.
An internationally acceptable methodology would also help to meet the need for compara­
bility of epidemiological information on drug abuse. Until now, it has been the tendency
for each investigator to develop and use his own instrument and methods for assessing drug
abuse. For this reason, it has not been possible to compare the results of studies from
different countries, and it is rarely possible even to compare the studies of different
investigators within the same country. Such comparisons are important for planners, who
must examine trends over time in order to assess the effectiveness of legal, educational,
and treatment programmes. Drug use trends need to be compared and monitored both within
and between countries, but no methods are available for doing so.

At the international level, comparability of data would permit (1) the identifi­
cation of real differences in the extent, patterns, and trends of drug use in different
sociocultural settings, and (2), where demographic and other explanatory variables occur
regularly, the possible identification of basic causal factors that are not peculiar to
particular settings.

An important initial step in encouraging comparability of data collection in any

field is the development of a standardized questionnaire that will yield reliable and
valid results in various sociocultural settings. If such a questionnaire were available
to investigators planning future studies, it might contribute significantly to the compara­
bility of data collected in the important area of drug—abuse research. The development
and testing of a youth survey questionnaire would also provide a rather simple data-
collecting activity to determine whether an international team of survey experts from
developing and developed countries could work effectively together. If so, the team might
then turn its expertise to collaborative survey work of a more complex nature.
1.2 SeIf-administered drug-use questionnaire for young people

For many years, people have been enquiring about the use of alcohol and drugs in
various populations. The method most frequently used is now the anonymous self-administered
questionnaire. This is popular for a number of reasons: it is inexpensive; it requires no
interviewers, since respondents complete the questionnaire themselves; it can be distri­
buted quickly to large groups of literate persons; and the. data that it yields may be
processed relatively inexpensively and efficiently because the questions asked are usually
straightforward and their answers easily interpreted..

A "self-report" or self-administered questionnaire is a form on which the individual

respondent marks his answers to a series of printed questions. The questions and the answer
possibilities are specified in advance, although in some cases answers may be open-ended —
that is, space is provided for the respondent to write in his own answer. Self-administered
questionnaires may be contrasted with interview schedules, which are completed on each
subject by a trained interviewer.

Self-administered surveys of drug use among young people have been conducted in many
countries. A partial list of such surveys is to be found in the reviews by Mercer &
Smart (1) and by Blumberg (2). Recent studies of students, by means of self-report
questionnaires, have also been carried out in many developing countries, including
Colombia (3), India (40, Malaysia (5), Mexico (6), and Thailand (7).
 - 9-
1.3 Advantages and disadvantages of self-administered surveys
Like any other method, the self-administered survey has advantages and disadvantages.
Its overwhelming advantage is surely its relatively low cost. The method may be used with
populations of 10 000 or more, at a fraction of the field cost of an interview study,
depending, of course, on the salaries paid to interviewers and the geographical dispersion
of the population. The method is well accepted in many parts of the world and refusal
rates are often below 1%. In contrast, refusal rates in household surveys are frequently
20-30% and in postal surveys non-completion rates are typically 50-60%.
Many researchers would argue that the self-administered survey is the best way to
obtain information about private behaviour because the information may be obtained anony­
mously. The method may also take advantage of the efficient technology available for
data processing, such as machine-readable and other easily processed forms. This expedites
data handling at every stage, tends to reduce costs and labour, and makes surveys of
large populations more manageable.
The limitations of the approach include the considerable technical skills, personnel
and equipment required for large-scale studies, e.g., of 3000 or more subjects, which might
not be available regularly in most developing countries. The skills involved are those
required for sampling, questionnaire administration, coding, and data analysis. Data
processing and handling are greatly facilitated if a computer is available for studies with
more than about 500 subjects and 30 or more questions. In addition, there are some
unsolved problems with reliability and validity, which will be discussed in detail later.
1.4 Youth populations suitable for this type of survey
In practice, the self-administered survey is typically used for studies of students,
soldiers, and prisoners, since these groups can be readily convened for survey administra­
tion. The method is best used in situations where cooperation may be expected from the
participants as a matter of routine. Where cooperation is unlikely to be obtained without
individually tailored explanations, interview surveys are preferable. Within the field of
alcohol and drug research, most surveys of this type have been carried out on high-school
and college students — see reviews by Berg (8) and Mercer & Smart (_1). However, such
surveys have also been made on primary-school children (9) and in military groups and
prison populations (10).

1.5 Nonmedical use of drugs, drug abuse, and drug dependence

In this study the investigators found it more practical to collect information on
nonmedical drug use than on drug abuse or drug dependence. If only drug abuse ordrug
dependence had been measured in this study, a large population of occasional drug users
would have had to be excluded. This group— which would clearly not be considered as being
drug-dependent and might not be drug abusers — is of central concern in such surveys. An
equally important reason for collecting information on drug use is that the measurement of
drug abuse or drug dependence in an epidemiological survey presents a number of technical
difficulties. At present, there is no universally agreed operational research definition
of drug abuse or drug dependence. For the purposes of this study, therefore, the term
"nonmedical drug use" has been used in the sense proposed by the WHO Expert Committee on
Drug Dependence (47) — that is, "the use of dependence-producing drugs ... other than when
medically indicated". These drugs comprise the following types: amphetamines, barbiturates
and tranquillizers, cannabis, cocaine, hallucinogens, khat, opiates, and volatile solvents.
Although use of the term "drug dependence" has been avoided wherever possible in this
report, the term "drug abuse" — a rather imprecise term — has been used. As noted in
another WHO publication (48), there is no universal agreement on the definition of "drug
abuse". The term is used here in connexion with the problems and adverse consequences
associated with nonmedical drug use.
 -10 -
2. DEVELOPMENT OF THE QUESTIONNAIRE AND PLAN FOR;ITS TESTING

A Working Group on Encouraging Comparability in Drug Use Surveys of Young People was
held in Geneva from 19 to 21 September 1976 to plan a WHO collaborative effort in that
field. A model self-administered questionnaire for use among students was to be developed
and tested in several countries by the centres participating in the trial. The main
purposes of the study were to determine whether comparable data on drug use in young people
might be obtained by means of the questionnaire and whether the answers given would be
reliable and valid.
2.1 General plan for the project
In each of the countries, some 300 students of both sexes, living in various environ­
ments, were to complete the questionnaire. This was to be given to them anonymously
except when used to check the reliability of answers (in a test-retest reliability study).
In the latter case, the questionnaires were to be identified, e.g., by number, in order to
allow the first questionnaire to be matched with a second one given 4-8 weeks later. About
100 students were to be retested at each centre.

Validity studies also were planned. For this purpose, a lie scale and questions
asking the students whether they had responded honestly were included in the questionnaire.
At one centre, comparisons were made between self-report and interview methods and between
students from schools believed to have high and low drug use.
Pilot testing would permit centres with limited resources to determine the feasibility
and difficulties of student drug use surveys. Furthermore, a simultaneous study by teams
of investigators in a wide range of countries would permit a coordinated effort leading to
the revision of questionnaires and procedures so that they might be usable in most parts of
the world.

2.2 Rationale for the selection of data items and organization of the questionnaire

It was expected that most centres would need to keep their questionnaires short in
order to hold the interest of respondents, to minimize interference with school work, and
to reduce costs. It was therefore decided to develop a questionnaire with separate units
or blocks of items, some of which were essential or "core" items and others optional. All
centres were to test the core items and optional items of particular interest. Table 1
shows the structure of the questionnaire and the main areas covered.
Core questionnaire
Originally, 32 core items were chosen to give the essential demographic, drug-use, and
validity information. In order to ensure comparability with other WHO data-collecting
activities on drug abuse, many of the items were derived from a set of core data items
previously agreed by the collaborating investigators to be the minimum essential informa­
tion required by planners of drug-abuse programmes. Most of the core items on the youth
survey questionnaire are therefore comparable with items on other WHO questionnaires for
collecting data on drug abuse and on those of the United Nations Division of Narcotic
Drugs (13)■
The demographic items included the basic variables of age, sex, and years of schooling.
For an understanding of drug use among young people, it was considered important also to
know the duration of parental education as a measure of socioeconomic status, and whether
the respondent was working full-time or part-time in addition to being at school.
 - 11 -
TABLE 1. CLASSIFICATION OF VARIABLES

Priority Drug-related
levels for 10 drug classes Demographic Other

Core Ever used (lifetime) Age Validity, i.e., self-

Use/non-use (last year) Sex report of honesty in
Frequency of use Parental education responding
(last month) Type of community Lie scale
Age at first use Years of school
completed
School status
Work status

Optional Route of administration Race*

Reasons for first use Religion*
Source of first drug Region of the country*
used History of migration*
Approval/disapproval of
drug use
Perceived availability
Social connotations

Others to Perceived harmfulness Father's Education plans

consider** Perceived problems occupation Religious participation
Frequency of use Presence of parents in Importance of religion
(lifetime, last year) home Criminal behaviour
Year of first use Social alienation
Fictitious drugs Counter-culture orien­
Exposure to use tation
Perceived parental norms Academic performance

*Standard measures have not been recommended, owing to inter-country variations.

**Further items and variables of possible interest to investigators may be obtained from
the review of Nehemkis et al. (11) or Elinson & Nurco (12) and from reference to papers
in the reviews by Mercer & Smart (1) or Blumberg (2).

Out of the large number of possible questions on drug abuse, a few were chosen. These
asked if a particular type of drug had ever been used, if it had been used in the past year
or in the past 30 days, and at what age it had first been used. The 10 types of drug
enquired about were:
tobacco hallucinogens
alcohol inhalants
cannabis tranquillizers
amphetamine or other sedatives
stimulants opiates
cocaine

Because of the importance of heroin and other opiates, such as methadone, morphine, and
codeine, additional questions were included on three subclasses of opiate. Most of these
items have been retained in the final questionnaire (see Annex 1).
 - 12 -

Optional questionnaire items

A number of items were also developed for variables judged by the collaborating
investigators to be of high or medium importance, though inappropriate for inclusion as
core items in this study. Among the drug-related variables suggested were: route of
administration (of drugs used); source of, and reason for taking, the first drug used;
approval or disapproval of drug use; perceived availability of drugs; social connota­
tions of drug use; perceived harmfulness of drugs; perceivëd problems with drug use;
frequency of drug use (during lifetime and previous year); fictitious drugs; exposure
to use; and perceived parental norms. Among the additional demographic variables
suggested for consideration were: race, religion, region of the country, history of migra­
tion, father's occupation, and parents' presence at or absence from home.
Although the core items were tested by all centres, the optional items were used by
only a few. However, the inclusion of optional items allows sufficient flexibility to
meet widely differing measurement needs in various settings, and facilitates maximum
comparability. Some of the optional items, with responses, are shown in Annex 4.

2.3 Coordination of technical work

In order to facilitate the collection and analysis of data, WHO invited the Addiction
Research Foundation, Toronto, Canada, (one of the 7 collaborating institutions) to serve
as the coordinating centre for the study. Its tasks were to: (1) finalize the core
questionnaire and instructions for its use, (2) send copies of each to collaborating
investigators, (3) receive data collected by collaborators, (4) key-punch IBM cards for the
core questionnaire items, and (5) prepare analyses of the data.
The analyses performed by the coordinating centre included: (1) frequency of users by
centre for each drug; (2) frequency of drug use, age of first use for each drug in each
centre; (3) frequencies for all demographic items; (4) cross-tabulation of demographic
characteristics, validity questions, and reliability scores for each type of drug use;
and (5) multivariate analysis of the validity and lie scale items as predictors of drug use.

It was planned that each collaborating centre should be responsible for analysing its
own data on test-retest reliability from centres in countries other than Canada. It was
originally thought that, because of the limited time available, this would be too difficult
to do at long range. In retrospect, it seems that the analysis of these data should also
have been centrally managed, since only three centres reported reliability test results.

2.4 Collaborating institutions

In addition to the Addiction Research Foundation, Toronto, which coordinated the study,
research teams from the following six institutions participated in the testing of the
questionnaire and collected data on the forms.

Chandigarh centre. The Postgraduate Institute of Medical Education and Research,

Chandigarh, India, had been invited to participate as part of a current programme of
collaborative research with WHO in drug dependence and mental health. Drug abuse in the
region of Chandigarh involves primarily cannabis, though there is also some abuse of opium
and psychotropic drugs.

Islamabad centre. The Pakistan Narcotics Control Board is the national coordinating
agency for drug-abuse prevention, treatment, and control activities in the country. It is
responsible for implementing the WHO component of the United Nations Pakistan Programme on
Prevention and Treatment of Drug Dependence, supported by the United Nations Fund for Drug
Abuse Control. Pakistan is a country with a large population of opium and cannabis users,
with increasing use of psychotropic substances during recent years.

Lagos centre. The Department of Psychiatry of the University of Lagos had prior
experience in conducting drug-abuse surveys of young people. While drug abuse in Nigeria is
not as serious as in many other countries, there is moderate use of cannabis and psycho­
tropic drugs. This appears to be a common pattern of drug abuse in many African countries.
 - 13 -
Mexico City centre. The Mexican Drug Dependence Centre was invited to participate
because of its expertise in drug—abuse surveys. The centre serves as the national
coordinating organization for drug-ahuse research, training, <jmd prevention activities in
Mexico and is a WHO collaborating centre for drug dependence. It has established
communications with investigators and governments in other Latin American countries, which
will facilitate dissemination of the results of WHO collaborative studies. Drug abuse in
Mexico City at the time of this study involved primarily the use of cannabis and psycho­
tropic drugs by adolescents and young adults and the use of inhalants among children.

Penang centre. The Drug Abuse Research Project at the University of Science of
Malaysia has recently been designated as the Malaysian National Drug Dependence Research
Centre. The university has expertise and experience in drug-use surveys of young people,
and is responsible for implementing a national integrated data-reporting system for
problems of drug abuse. In addition to the long-standing traditional use of opium and
cannabis, the country has experienced in recent years a serious spread of heroin among
urban youth, as well as the increasing use of psychotropic substances.
Rangoon centre. The Rangoon Psychiatric Hospital of the Burmese Ministry of Health is
developing a programme of epidemiological and treatment evaluation research in drug depen­
dence. Technical personnel in the Ministry are responsible for implementing the WHO
component of the United Nations/Burma Programme on Prevention and Treatment of Drug Depen­
dence, which is supported by the United Nations Fund for Drug Abuse Control. The problem
of drug abuse in Burma includes the traditional use of opium among rural populations and,
in recent years, the use of heroin and psychotropic substances among urban youth.

The network of centres involved in this WHO study thus represents most regions of the
world, and most of the centres are in developing countries. The participants included
key technical personnel involved in implementing the WHO/United Nations country programmes
on the prevention and control of drug dependence in countries of the Eastern Mediterranean
and South-East Asia. The centres had varying degrees of expertise in the type of research
that was to be undertaken, and could be expected to identify the kinds of problem
encountered in such a study in developing countries.

Since this study was implemented, the functions of the centre have been expanded to
include activities in the field of mental health, and the centre is now called the Mexican
Centre of Mental Health Studies.
 - 14 -
3. RESULTS OF TESTING THE QUESTIONNAIRE IN SEVEN COUNTRIES

Approximately 300 questionnaires were handed out by each of the seven centres. Most
of the subjects surveyed were students, but the range in age, level of education, and
cultural setting permitted the questionnaire to be tested under widely varying circum­
stances.

Of the 2118 questionnaires received from the seven centres, 463 (21%) were excluded
because of incomplete or inconsistent responses, leaving a total of 1655 for analysis.
The criterion for excluding questionnaires was the presence of four or more blanks or
inconsistent responses. For example, if a student answered that he had used a given drug
in the past month but not in the last year, his response was inconsistent.
3.1 Overview of testing experience at each centre

Chandigarh centre. Both Hindi and English questionnaires were used. Data were sent
for 411 students in primary and secondary schools and universities. The original sample
was reduced to 309 by deleting every fourth questionnaire. A further 53 were eliminated
because of incomplete or inconsistent responses, leaving a total of 256 for analysis.
Islamabad centre. The questionnaire was translated into Urdu and used in a bilingual
(English/Urdu) version. Two college student groups were sampled, plus some persons in
households. Of 329 questionnaires, 88 were eliminated because of inadequate responses,
leaving 241.
Lagos centre. The questionnaire was given in English to students in five post­
secondary schools and universities. Of the 312 students surveyed,177 wereeliminated
because of blanks and inconsistencies. The final sample was135. Most ofthe blanks
and inconsistencies were on the items dealing with the use ofheroin and other opiates.
Because these drugs are rarely used in Nigeria, students weresimply not familiar with them
and chose either to leave these questions blank or to answer them inconsistently. There
were no other major difficulties with the survey.

Mexico City centre. The questionnaire was in Spanish. The study population was 335
pupils from several secondary schools. Many of the children had no previous experience with
instructions to skip certain items that did not apply. Instead they skipped entire sections
of the questionnaire. This contributed to the elimination of 106 questionnaires because of
blanks and inconsistencies, leaving 229. Both validity and reliability studies were
performed.
Penang centre. The questionnaire was translated into Malay, Chinese, and Tamil. A
stratified sample of 300 students was selected from two schools and 100 of these students
were retested 5 weeks later. No questionnaires were deleted because of blanks or inconsist­
encies. The main problems encountered in the pilot study were that: (1) the format of
the tested questionnaire was not consistent with local practice, (2) translations were often
too literal, and (3) students found it difficult to follow the instruction to skip certain
questions.

Rangoon centre. The questionnaires were given in English. In all, 300 were given,
only 3 of which were eliminated because of blanks or inconsistencies. The questionnaires
were distributed in secondary schools believed to have high, low, and intermediate levels of
drug use.

Toronto centre. In all, 233 questionnaires in English were given to high-school

students aged 14-18 years, most of whom were 15 or 16 years of age. A full sample was not
obtained because a severe snow storm kept students away from school on the day of the
testing. There were no major difficulties in administration or in students' understanding
of the questions. Of the students tested, 36 were eliminated because of blanks or inconsist­
encies. The final sample was 197. Test-retest studies were done.
 - 15 -
Collaborating investigators from Ann arbor, MI, USA, and from Bangkok participated in
the planning and review meetings but did not test the WHO questionnaire. However, they
contributed data and experience from related research conducted by their respective
institutions.

3.2 Data analysis

The plan was to collect data primarily to improve the usefulness of the pilot question­
naire, and for the reliability and validity analyses. Because of time and resource limita­
tions, it was not intended to obtain data on samples large enough to permit inter-country
comparisons or studies of particular groups within each country. The findings cannot,
therefore, be seen as indicating the extent of drug use in any of the countries in which
data were collected. Collaborating investigators felt that to publish the drug—use rates
in these small and unrepresentative samples might lead to misinterpretations. For these
reasons, data on drug use in the study populations are not included in this project.
However, Table 2 shows some major characteristics of the study subjects, such as the
type of student, language of the survey, number surveyed, sex, and median age.

3.3 Reliability studies

Three centres examined the consistency of the results of the survey with those
obtained on retesting, each centre analysing its own data.

At the Penang centre the questionnaire was administered to 150 students on two
occasions 5 weeks apart. The coefficients of association for the drug-use questions were
all significant except for alcohol and methaqualone (included as an optional item). It
may be that translation difficulties contributed to the lower statistical association for
these drugs. Consistency between tests was best for those with higher education levels.
In Toronto questionnaires were administered to 197 students on two occasions 8 weeks
apart. Students did not sign their names and a numbering system was used to compare
questionnaires for the same student from the two tests. Students' answers to demographic
questions were nearly identical at both tests. For the drug—use questions "ever used" and
"used in past 12 months", the correspondence was very high; for both sets of questions,
more than 90% of students gave the same answers at both tests. As expected, answers to
the questions on drug use in the last 30 days were less consistent. A drug-use score
comprising all reported drug use (ranging up to 96) showed a correlation of 0.88 Q?<.001)
for the two tests. However the lie-score correlation was only 0.53 (P'xO.OOl), indicating
somewhat lower reliability for the lie scale.
In Mexico City, the questionnaires we^e administered to 294 students on two occasions
about 6 weeks apart. Pearson correlations were calculated for all drugs except opium and
heroin, since there were too few answers for these two drugs to calculate correlations.
For the other drugs, the correlations ranged from 0.30 to 0.71, and all but one were over
0.60. This indicates relatively high reliability for drug-use items.

In summary, the test-retest studies at the three centres suggest generally high
reliability of answers to drug-use questions, except for rarely used drugs and some items
that might involve translation difficulties.

With this system two questionnaires are prepared, each with the student's name and
unique number typed on a two-part label, the part with the name being detachable. In class,
the student tears off the part with his name, leaving the number on the questionnaire on
both occasions when he completes the questionnaire. Of course, it is necessary to be sure
that students receive questionnaires with the same number at the first and second tests.
The numbers are used to bring together each student's questionnaires from the two tests.
Thus the student's name is not associated with his answers to drug questions and confiden­
tiality is maintained.
2
The Pearson product moment correlation coefficient varies from -1 through 0 to +1.
A coefficient of -1 indicates a high negative relationship, 0 none at all, and +1 a high
positive relationship.
 TABLE 2. CHARACTERISTICS OF STUDY POPULATIONS
Centre Language Level of Questionnaires Questionnaires Sex Median age
student received analysed M F (years)

Chandigarh English Primary

Hindi Secondary
University 309 256 109 147 17-18

Islamabad English Secondary

Urdu University
Non-student 329 241 168 73 19-20

Lagos English University 312 135 75 59 21-22

Mexico City Spanish Secondary 335 229 115 112 15-16

Penang Chinese
Malay
Tamil Secondary 300 300 150 150 15-16

Rangoon Burmese Secondary 300 297 258 39 15-16

Toronto English Secondary 233 197 72 125 15-16

 - 17 -
3.4 Validity studies
High reliability is a necessary but not sufficient condition for high validity so valid­
ity checks were carried out to determine whether the answers to the questionnaire were
accurate - that is, whether students who had used drugs reported this on the questionnaire
and whether non-users reported that they had not used drugs. Validity was further assessed
by asking direct questions about the honesty of students by using lie scales to detect
respondents who were on the defensive and by conducting special studies on validity. One
reason for using the first two of these validity checks is that they may be administered as
part of the questionnaire testing. There are other possible checks on validity that might
have been used, and these are described in Annex 1, which reviews the methodological issues.
However, most of these checks require additional substudies, which increase the time and
cost of the survey.
Honesty questions. The logic of including questions on self-reported honesty is that
they permit the respondent to verify that his answers to questions were not deliberately
falsified. Admittedly, this is a rather weak and indirect validity check, since anyone who
wishes to falsify his answers may answer honesty questions in the same manner. The results
of data generated by this validity check cannot, therefore, be given the same weight as
those of more objective methods, such as testing urine or searching official records for
evidence of drug use among surveyed subjects. However, the inclusion of honesty questions
has the advantage over these other procedures in that such questions may be collected
easily and inexpensively on all subjects as an integral part of the survey questionnaire.

Two honesty questions were selected for testing on the prototype questionnaire. The
first was: "If you had ever used any cannabis /local term/, do you think that you would
have said so in this questionnaire?" The second asked the same about "opium or heroin".
The possible answers were "No", "Not sure", and "Yes". The aim of asking these questions
was to have some indication of the level of honesty or defensiveness in the students'
replies. Table 3 shows the response to these two questions in the countries concerned.
Overall, 68% said that they would have reported the use of cannabis, 18% said "No", and 14%
were "Not sure". The figures were much the same for opium or heroin: 68% said "Yes", i.e.,
they would have reported honestly, 19% said "No", and 13% were "Not sure". Thus only a
minority of the total population stated that they wouldnot report the use of cannabis or
of opium or heroin on the questionnaire.

However, there was considerable variation from one centre to another in the proportions
of students that would have answered honestly about their use of drugs. For all but two
centres (Table 3), more than 70% of the students said they would have admitted to using
cannabis, and less than 20% stated they would not have admitted using it. Findings for the
opium/heroin question were similar; in all but the same two countries, over 70% would have
admitted to using opium/heroin and less than 20% stated that they would not have admitted
doing so. These findings suggest that the questionnaire had some validity in most of the
centres involved.

Centre E reported that subjects complained of difficulty in understanding the two

honesty questions as well as three lie scale questions, which were later omitted from the
final questionnaire (Annex 2). The reason suggested by collaborating investigators at that
centre was that, in their culture, individuals are not permitted to withhold information.
Therefore, the questions asking if they had reported honestly were seen by some respondents
as questioning their integrity. This appeared to confuse the respondents to such an extent
that all kinds of inappropriate answers were given. The poor response to these items might
also be attributed to the difficulty that individuals in this particular setting had in
answering hypothetical questions. These findings suggest that the honesty items may require
modification in certain cultural settings and may not be relevant to others.

Data from honesty questions were also examined for users andnon-users of drugs sep­
arately. Those who answered untruthfully might be expected to report less use of all drugs
than those who were truthful. This expectation was borne out by the data, which showed that
students who said they would not have reported honestly were less likely to report the use
 - 18 -
TABLE 3. COMPARISON OF ANSWERS TO THE HONESTY ITEMS IN DIFFERENT COUNTRIES*

Admit to using cannabis Admit to using opium or

Centre (n=1627) heroin
(n=1626)

(Total, all Yes Not sure No Yes Not sure No

centres, = 1655) (%) (%) (%) (%) (%) (%)

A 76.4 14.1 9.4 74.7 12.8 12.5

B 62.3 17.3 20.3 63.3 18.0 18.7
C 75.6 16.1 8.3 70.5 19.2 10.4
D 84.0 0.0 15.6 81.3 0.0 16.4
E 37.8 23.3 37.8 39.0 16.1 45.0
F 77.7 13.1 9.2 78.5 11.5 10.0
G 72.2 9.7 18.1 72.6 9.7 17.7
Total 68.4 13.7 17.7 67.6 12.7 19.4

*The table does not include data from students with two or more "problem" answers
to the nine-item lie scale.

of tobacco, alcohol, and cannabis. They were also less likely to report the use of each of
the other 9 drugs, though few of the differences are statistically significant. The find­
ings were similar for those who would have admitted to using opium or heroin. Furthermore,
both groups — those who would and those who would not have reported the use of opium or
heroin — did, in fact, report the same frequency of use of heroin, opiates, and opium.
Lie scale scores. The Eysenck lie scale (14) was included as a measure of defensive­
ness and has been used in a number of studies. The scale consists of nine questions that
have been shown to yield highly reliable and valid answers.
All centres except one were found to have 40% or more students with high lie scores.
This is an unexpected result and is almost certainly due to cultural or social variations
in the way in which these questions are read and understood. It was found also that lie
scores did not differentiate between users and non-users of drugs in a practically useful
way. For these reasons, it was the view of the majority of the collaborating investigators
that the lie scale, without additional methodological work, appears to have limited useful­
ness as a validity check for the prototype questionnaire.

Special studies of validity. Three special studies of validity were carried out by
the Mexico City centre. In one study, 50 students drawn from schools with a high preva­
lence of drug use (according to school officials and official records) were compared with
50 students from low-prevalence schools. The results were in the expected direction.
Those in the high-prevalence schools reported rates of drug use 5 to 15 times as high as
those reported for the low-prevalence schools. Though these findings do not prove the
accuracy of answers to the questionnaire, they show that the questionnaire yielded responses
indicating more frequent drug use when other information suggested that there was, in fact,
more frequent drug use.

In another study, the answers to core questions were obtained from the same subjects
by two different methods of data collecting — i.e., by a personal interview followed one
week later by the self-administered questionnaire. The subjects were 50 young males in
training schools for delinquents. For one-half of the drugs (alcohol, cocaine, tranquil­
lizers, opium, heroin, and other opiates), the total proportion of respondents reporting
 - 19 -
lifetime use was identical or within 3% on both occasions. The largest deviation for any
drug used on the two occasions was 9%. There was no consistent tendency for either data-
collecting method — i.e., questionnaire or interview - to give higher or lower results.

The third study carried out by the Mexico centre compared three methods of gathering
data on drug use among employees of the same business establishments. The methods were
(1) the seIf-administered questionnaire, (2) administration of the questionnaire at personal
interviews, and (3) obtaining estimates of the number of drug users among fellow employees.
All three methods were applied to the same small group of people and yielded very similar
results for both current and lifetime use of drugs.
Thus the results from the Mexico City centre support the validity of the questionnaire
findings, at least for the populations for which validity was checked.
3.5 Summary of results
Individual centres might be expected to have difficulties with various aspects of the
questionnaire. A wide range of countries was involved in the studies, and the testing
included both developing and developed countries. For a number of countries, the question­
naire needed to be translated; others have little experience with self-administered
studies. In some countries, studies are further complicated by the cultural and social
diversity.

In general, collaborating investigators found that the questionnaire worked well with
student groups. It was found to have test-retest reliability in three centres and it gave
generally valid results in one centre where special validity checks were used. However,
there was agreement that use of the questionnaire raised certain general problems in
addition to particular problems encountered by individual centres. These problems were as
follows :

1. A lie scale was included in the tested questionnaire, but the items were difficult and
confusing for many students. Cultural and national problems in interpreting the results
made the scale difficult to use. Also, it was found to be somewhat less reliable than
other parts of the questionnaire. Furthermore, the lie scale had been developed especially
for use in the United Kingdom on students somewhat older than those in this study. For
these reasons, the lie scale was dropped from the final version of the questionnaire.
2. The "skip" instructions were confusing to many subjects in some countries, as has
already been mentioned. The format of the questionnaire was therefore changed so that the
student is required to answer every question on drug use. Now that the "skip" instructions
have been omitted from the final questionnaire, there should be fewer blank and inconsistent
responses.
A number of less serious problems were reported by some centres :
3. Investigators in Burma, Pakistan, and Thailand observed that the level of parental
education was not a good indicator of social status in those countries. Furthermore, it is
a culturally accepted pattern not to possess information of this type or, at least, not to
repeat it to strangers.

4. In Mexico City, the question about the type of community in which the respondent lived
proved impossible to answer. This question had no meaning for many respondents who do not
differentiate between living in cities, towns, or suburbs. Indeed large cities in some of
the collaborating countries do not have suburbs as seen in North America and some European
countries. Some of these cities also have small, semirural, village-like communities
within their limits, and this contributed to the difficulty that respondents had in
answering the question.

5. In Lagos, students often did not know their age, since births are often not registered
in Nigeria, and few accurate records of ages are kept.
 - 20 -

6. In Penang, the questionnaire was translated into several languages some of which did
not have words for various types of drug (e.g., sedatives, tranquillizers) or their effects
(e.g., to settle the nerves).
7. Investigators in Mexico and Pakistan found that it was necessary to drop some descrip­
tions of drugs and to omit completely drugs that are rarely used, because school officials
feared that to include them would encourage drug use.

8. In Nigeria and Thailand, at the time of the study, almost all drugs could be purchased
without a prescription. Thus the concept of "nonmedical" use or use without the advice of
a health worker would not suggest that the drug was obtained on the illicit market, as it
does in some settings.
9. In India, it was the impression of investigators that respondents often did not under­
stand the questions_dealing with honesty of reporting — e.g., "Ifyou had ever used cannabis
/or opium or heroin/, do you think that you would have admitted itin this questionnaire?".
When asked these questions at interviews, many respondents found that they were too hypo­
thetical and simply indicated that they had answered the questionsonthe use of these drugs
earlier. They then generally repeated their earlier answers.

Some of these difficulties were corrected in the finalized questionnaire by omitting

the lie scale, the "skip" instructions, and the questions on parental education and type of
community. Other difficulties were overcome by modifying questions and their possible
answers. In addition, a number of optional changes were provided to overcome the diffi­
culties most frequently encountered with the prototype questionnaire. It was also
generally agreed by collaborating invéstigators that a flexible approach should be adopted
in using the questionnaire and that this should be modified, as required, to meet local
needs.
 - 21 -

4. APPLICATION AND FURTHER DEVELOPMENT OF THE FINAL QUESTIONNAIRE

The revised questionnaire (Annex 2) is being made available for use in countries where
self-reported measurements of drug use are needed. No other drug-use questionnaire has
been tried out in so many countries. The evidence of its validity and reliability should
generate some confidence in the use of this questionnaire in national and international
studies. Nevertheless, investigators planning to use the questionnaire should test its
validity and reliability in the particular settings where it will be used. It might also
be desirable to add to the core elements described here, in accordance with local needs or
interests. In addition, investigators might wish to add some of the optional items
suggested in Annex 4, such as those concerned with drug availability and the reasons for
use.
The revised questionnaire described in this report may be used in the following types
of study: (1) assessment of the prevalence of drug use in the populations studied at a
particular point in time, (2) comparison of trends in various types of drug use through
repeated surveys over time, (3) comparison of factors associated with drug use and
identification of high-risk groups, (4) assessment of the impact of changes in drug
policies or legislation on drug use, and (5) assessment of the effects of preventive
programmes through surveys of drug use before and after the programmes have been implemen­
ted .

As pointed out earlier, this type of questionnaire is best used with high-risk
literate populations that can be readily brought together at one time and place. Students,
soldiers, and prisoners are therefore the most likely subjects for study. The question­
naire may have to be translated into several languages if used in certain countries.
The self-administered survey is not often used to study groups or patients making
heavy use of drugs. These populations are generally studied in smaller numbers and in
greater depth through clinical interviews, psychological tests, or field observations (15).
It is rarely used for general adult populations, which are most frequently studied by means
of personal interviews or household surveys.

The questionnaire may also be used in postal surveys of drug use (16). The problem
with such surveys is that the number of questionnaires returned is frequently low, rates
below 50% being common. Although there have been no reliability studies with mailed drug-
use surveys, these may be used as an adjunct to school studies to obtain information from
students who are absent or who have recently dropped out of school. They may also be used
in general population surveys and follow-up studies, when subjects cannot be contacted
after repeated visits to their homes. However, there are likely to be serious difficulties
in conducting postal surveys in countries with low levels of literacy and with unreliable
postal services.

The questionnaire might be further developed in several ways. It might be changed

into an interview format for investigations of special populations, such as heavy drug
users or young people who are not students. In its new form, the questionnaire would
require testing with new reliability and validity studies. Other investigators might wish
to extend the range of core items by testing some of the optional questions for reliability
and validity.

Further work to improve the validity and reliability of the current questionnaire
might also be considered. For example, test-retest reliability studies might be made
during a longer period - perhaps up to a year - or test results might be compared with
evidence of drug use from observers or official sources.

If the use of this questionnaire becomes sufficiently widespread, it might be advis­

able to convene a meeting of selected investigators to modify it further with a view to
making it more practical and effective.
 - 22 -

Annex 1

METH OD OLOGIC AL G U ID E L IN E S FOR S E L F -A D M IN IS T E R E D SURVEYS OF YOUTH

The g e n e ra l a im of th is annex is to s u p p le m e n t th e d e s c r ip tio n o f m e th o d o lo g ic a l

is s u e s e n c o u n te re d in th e c o u rs e of th e c o lla b o r a tiv e s tu d y b y p r e s e n t in g a m o re g e n e ra l
r e v ie w of th e m e th o d o lo g y of s e lf- a d m in is te r e d q u e s tio n n a ir e s , e s p e c ia lly th o s e d e v e lo p e d
fo r u se w ith young p e o p le . The fo c u s w ill be on th e fo llo w in g key is s u e s : th e s e le c t io n
o f s a m p le s , th e q u e s tio n n a ir e s and a d m in is t r a t iv e p r o c e d u re s to be a d o p te d , and th e
p r o b le m s o f v a lid ity , r e lia b ilit y , and c o n f id e n t ia lit y . O nce th e s e is s u e s h a v e been d e a lt
w ith , s e lf- a d m in is te r e d q u e s tio n n a ir e s m ay be v e r y h e lp f u l in m o n ito r in g d ru g -u s e tre n d s ,
in fo llo w - u p s tu d ie s , and in p la n n in g and e v a lu a t in g p r e v e n t iv e p ro g ra m m e s .

S a m p li n g , w ith s p e c ia l r e fe r e n c e to young p e o p le

T h e m a in ta s k in s a m p lin g is to s e le c t a g ro u p of p e o p le who a re r e p r e s e n t a t iv e of th e
to ta l or s p e c ia l p o p u la t io n of in t e r e s t in te rm s of its c h ie f c h a r a c te r is tic s . The v a r io u s
w a y s i n w h ic h s a m p lin g c a n b e d o n e h a v e b e e n t h e o b je c t o f d e t a i l e d r e v ie w s ( 1 7 , 1 8 ).
T h e se g u id e lin e s c o v e r o n ly t h e m a jo r c o n s id e r a t i o n s d i r e c t l y r e l a t e d t o s u r v e y s o f th e use
of a lc o h o l and d ru g s in s tu d e n t and o th e r y o u th p o p u la tio n s .

S a m p li n g is fr e q u e n tly n o t w e ll done in a lc o h o l and d ru g use s tu d ie s . T y p ic a lly , a ll

p r o b le m s of s a m p lin g a re ig n o r e d and s tu d ie s a re m ade of th e to ta l p o p u la tio n of c o n c e rn .
For e x a m p le , S m a rt & F e je r (9 ) s tu d ie d a ll s tu d e n ts at school in s e v e ra l C a n a d ia n c o u n tie s
on a p a r t ic u la r day. T h is a m o u n te d to s a m p lin g th e days and a v o id e d th e p r o b le m of
c o n s tr u c tin g a p o p u la tio n s a m p le , but it m eans th a t o n ly s tu d e n ts at s c h o o l w e re in c lu d e d .
Yet s tu d ie s b y H a b e rm a n et a l. ( 19) have in d ic a te d th a t s tu d e n ts who a re absent fro m school
have h ig h e r ra te s of d ru g use th a n th o s e who a re p re s e n t. T h e re fo re , som e b i a s e x is ts even
in s u rv e y s of to ta l s c h o o l p o p u la tio n s if n o n -a tte n d e rs a re o m it t e d .

T o o o f t e n t h e p r o c e d u r e s u s e d f o r s a m p le s e le c t io n a r e n o t in c lu d e d i n s tu d y re p o rts .
For e x a m p le s o f s t u d i e s i n w h i c h t h e s a m p l i n g a p p ro a c h e s a r e d e s c r ib e d i n d e t a i l , th e
re a d e r is re fe rre d to R u s s e ll & H o lla n d e r (2 0 ), C h a m p io n (2 1 ), and J o h n s to n (2 2 ).

The p o p u la tio n of in te r e s t. B e fo re a d e c is io n c a n b e m ade a s to th e d e s ig n or s iz e

of th e s a m p le or even as to w h e th e r a s a m p lin g p ro c e d u re w ill be used in s te a d of a to ta l
p o p u la tio n s u rv e y , th e p o p u la tio n to w h ic h th e s tu d y r e s u lts a re to a p p ly m u st be p r e c is e ly
d e fin e d . For e x a m p le , s a m p lin g c o n s id e r a t io n s fo r a ll y o u th s b e tw e e n th e ages of 12 a n d
20 y e a rs in a c o u n try w o u ld be q u it e d iffe r e n t fro m th o s e fo r y o u th s a tte n d in g school in a
s p e c if ie d c ity in th a t c o u n try . T h e y w o u ld a ls o be d iffe r e n t fo r m ilita r y p e rs o n n e l at a
p a r tic u la r base. U n le s s th e p o p u la tio n is w e ll s p e c if ie d in advance, th e s a m p lin g schem e,
how ever e x c e lle n t , m ig h t be a p p lie d to th e w ro n g p o p u la tio n .

If a p o p u la tio n is s m a ll enough, it m a y b e m o re e f f ic ie n t and le s s e x p e n s iv e to s tu d y

a ll of it ra th e r th a n to s a m p le a p a rt of it . E x a m p le s of such a to ta l p o p u la tio n s u rv e y
or c e n s u s m ig h t b e a l l y o u th s a t t e n d in g s c h o o l i n a s in g le c o m m u n ity , a l l y o u n g m en s e r v in g
at a c e r t a in m i l it a r y b a s e , o r a l l w o rk e rs in a p a r t ic u la r fa c to ry . S tu d y in g t h e t o t a l
p o p u la tio n a v o id s c e r ta in p r a c tic a l and lo g is tic p r o b le m s in v o lv e d in s e le c t in g a s a m p le ,
such as th e p o s s ib le need to e n u m e ra te a c o m p le te p o p u la tio n and th e need to id e n tify
p e rs o n s s e le c t e d fo r in c lu s io n in th e s a m p le . T r a v e l b e tw e e n s a m p le s u b je c t s m u s t be
c o n s id e r e d . A s u rv e y of th e to ta l p o p u la tio n , w h e re fe a s ib le , a ls o a v o id s th e p r o b le m of
s u b je c t s s e le c t e d by a s a m p lin g schem e fe e lin g " p ic k e d on" or d is c r im in a te d a g a in s t; it m ay
a ls o be le s s d is r u p tiv e of r o u tin e in a school or o th e r in s titu tio n .

If, h o w e v e r, it is d e c id e d th a t a s a m p le is r e q u ir e d , th e s p e c if ic p o p u la tio n of
in t e r e s t m u s t be d e fin e d w ith th e n e c e s s a ry e x a c titu d e b e fo re an a p p r o p r ia te s a m p lin g schem e
ca n be c o n s tru c te d .
 - 23 -
C o n s id e r a tio n s , i n s e le c t io n of s a m p le s iz e . The o b je c t of th e s a m p lin g schem e is to
y ie ld th e m o s t p r e c is e e s tim a te s of d ru g use p o s s ib le w ith in a g iv e n b u d g e t. In c h o o s in g a
schem e, s e v e ra l fa c to rs need to be c o n s id e r e d :

(a ) The c o m p le x ity of th e p o p u la tio n s tru c tu re b e in g s tu d ie d . Some p o p u l a t i o n s m ay be

h e te ro g e n e o u s w ith re s p e c t to v a r ia b le s th a t in flu e n c e d ru g use; fo r e x a m p le , th e y m ay
not be of th e sam e a g e , sex, or s o c io e c o n o m ic s ta tu s . The schem e m u s t th e n p r o v id e fo r
th e s e le c t io n of s tu d y s u b je c t s r e p r e s e n t a t iv e of th e p o p u la tio n of in t e r e s t w ith re s p e c t
to th e s e v a r ia b le s . T h is a p p ro a c h to s a m p lin g m ay a ls o be use d to o b ta in s e p a ra te e s ti­
m a te s of d ru g use fo r each s u b g ro u p fo r c o m p a r a tiv e p u rp o s e s .

If th e p r e v a le n c e of use v a r ie s b e tw e e n s u b g ro u p s , it m ay b e d e s ir a b le to s e le c t
g r e a te r - th a n - p r o p o r tio n a l s a m p le s iz e s in s u b g ro u p s w h e re th e p r e v a le n c e is lo w . T h is
w ill e n s u re e q u a l p r e c is io n of p r e v a le n c e e s tim a te s in a ll s u b g r o u p in g .

(b ) The g e o g r a p h ic a l s p re a d of th e p o p u la tio n is im p o r ta n t in c h o o s in g th e m ost e f f ic ie n t

s a m p lin g schem e. If e s tim a te s a re needed on a n a tio n a l b a s is or fo r a p o p u la tio n th a t is
s p re a d out g e o g r a p h ic a lly , cost c o n s id e r a t io n s m ay dem and som e c l u s t e r i n g of th e p e rs o n s
to b e s a m p le d . A ls o i f th e g e o g r a p h ic a l s p re a d c u ts a c r o s s a d m i n i s t r a t i v e b o u n d a r ie s , use
of t h e sam e s a m p lin g sch e m e f o r a l l a d m i n i s t r a t i v e d i s t r i c t s m a y n o t b e p o s s ib l e . For
e x a m p le , in a s c h o o l s u rv e y th e num ber of s tu d e n ts per c la s s m ay b e g re a te r in one s ta te or
p r o v in c e th a n in a n o th e r, and a s a m p lin g schem e b y c la s s m ig h t th e re fo re o v e r-re p re s e n t
so m e s c h o o l s y s te m s . F o r th e s e re a s o n s a g e o g r a p h ic a lly d is p e r s e d p o p u la tio n m ay r e q u ir e
a m o r e c o m p le x s a m p le schem e.

(c ) Some s a m p l i n g schem es a re m o re c o s t l y a n d /o r tim e - c o n s u m in g th a n o th e rs . To

e n s u re th a t a ra n d o m s e le c t io n of p e rs o n s is m ade at som e s ta g e of th e s a m p lin g schem e, a
s a m p lin g fra m e m u s t be a v a ila b le fro m w h ic h to choose th e s u b je c t s . A s a m p lin g fra m e is
m e r e ly a lis tin g o f a ll u n it s or in d iv id u a ls fro m w h ic h a s a m p le is to be s e le c t e d . If a
s u rv e y of a ll s tu d e n ts in s e le c te d c la s s e s is w a n te d , th e s a m p le fra m e w o u ld c o n s is t of a
lis tin g of a ll c la s s e s . If o n ly c e r ta in s tu d e n ts a re to be s e le c t e d , th e s a m p le fra m e m ust
be a lis tin g of a ll s tu d e n ts .

I f th e p o p u la tio n is to be d iv id e d in t o s u b g ro u p s , in f o r m a t io n i s n e e d e d o n th e
s u b g ro u p s ta t u s f o r e a c h p e rs o n on th e l i s t . S uch l i s t s m ay b e v e r y c o s t l y o r im p o s s ib le
to o b ta in , h o w e v e r, and v e ry o fte n th e in f o r m a t io n needed to a s s ig n a p e rs o n to a s u b g ro u p
is not a v a ila b le . If, fo r e x a m p le , th e p o p u la tio n of in te r e s t is h ig h - s c h o o l y o u th in a
c e r ta in c ity , and no s u b g ro u p s of s tu d e n ts a re to be s tu d ie d , a lis tin g m ig h t be a v a ila b le
or c o m p ile d r e la t iv e ly q u ic k ly and c h e a p ly . If, on th e o th e r hand, s e p a ra te e s tim a te s
w e re r e q u ir e d fo r d iffe r e n c e s in d ru g use a c c o r d in g to sex, age, and s o c io e c o n o m ic s ta tu s ,
in f o r m a t io n on th e fir s t tw o v a r i a b l e s m ig h t b e r o u t i n e l y a v a ila b le ; in f o r m a t io n on th e
th ir d w o u ld g e n e r a lly becom e kno w n o n ly by a s p e c ia l e n q u ir y and c o m p ila tio n .

If th e in f o r m a t io n needed on s u b g ro u p s ta tu s is not a v a ila b le , th e re is a w ay to a v o id

th e c o s tly p ro c e s s of g a t h e r in g it fro m a ll p e rs o n s in th e p o p u la tio n . T h is is th e use of
" m u lti- s ta g e s a m p lin g " ( d e s c r ib e d l a t e r ) > w h ic h o b ta in s th e n e c e s s a ry in f o r m a t io n fro m a
lim ite d num ber of s m a lle r u n it s . For e x a m p le , th e in f o r m a t io n c o u ld be o b ta in e d fro m a ll
s tu d e n ts in o n ly 10 o r 15 c la s s r o o m s in a la r g e c ity . A s tu d y u s in g th is a p p r o a c h w o u ld be
d e s c r ib e d as u s in g a c lu s te r s a m p le of c la s s r o o m s .

In p r a c tic e th e s tu d y d e s ig n is tie d to an e x is tin g s a m p lin g fra m e or to a s a m p lin g

fra m e th a t can be q u ic k ly and c h e a p ly c o m p ile d . A c a u tio n a g a in s t u s in g lis ts of p e rs o n s
c o m p ile d fo r o th e r p u rp o s e s is needed h e re . U n le s s th e s e lis ts have been v e ry c a r e fu lly
checked, th e y a re u s u a lly fo u n d to be in c o m p le te or to c o n ta in m any d u p lic a t e s . T h e y m ay
a ls o be out of d a te , p a r tia lly ille g ib le , or in a p p r o p r ia t e fo r th e p o p u la tio n of in te r e s t.
The u s e of such lis ts m ay ca u s e b ia s e s o f u n k n o w n m a g n itu d e in th e e s tim a te s of d ru g use.

(d ) S a m p le d e s i g n i s a l s o a f f e c t e d b y a d m i n i s t r a t i v e c o n s id e r a t io n s . The s p o n s o r o f th e
s t u d y m a y g i v e r e a d y a c c e s s t o som e g r o u p s o f y o u t h s , b u t n o t to o th e rs . S tu d y , w o r k , o r
t r a i n i n g s c h e d u le s o f th e re s p o n d e n ts m ay d i c t a t e th e s e le c t io n o f a d m in is t r a t iv e ly d e fin e d
g ro u p s su ch as s c h o o l c la s s e s , f a c t o r y d e p a rtm e n ts , and m i l i t a r y s u b u n its , r a t h e r th a n a
s e le c t io n of p e rs o n s c u t t in g a c ro s s th e s e a d m in is tr a tiv e b o u n d a r ie s .
 - 24 -
Types of s a m p lin g d e s ig n . The b a s ic c o n c e p t u n d e r ly in g a ll fo rm s of s c ie n t if ic
s a m p lin g is th a t of th e p r o b a b ilit y s a m p le . A p r o b a b ilit y s a m p le is one in w h ic h e v e ry
p e rs o n in th e p o p u la tio n of in te r e s t has a know n p r o b a b ilit y or chance of b e in g s e le c te d
fo r th e s a m p le . A ll of th e s a m p lin g d e s ig n s m e n tio n e d h e re in v o lv e p r o b a b ilit y s a m p lin g .
O th e r fo rm s of s a m p lin g not in v o lv in g p r o b a b ilit y s a m p lin g a ls o e x is t, such as h a p h a z a rd
s a m p lin g , w h e re p e rs o n s a re chosen by o th e r th a n ra n d o m m e a n s . T h e re is a ls o p u r p o s iv e or
q u o t a s a m p l i n g w h e r e " r e p r e s e n t a t i v e " i n d i v i d u a l s a r e s o u g h t o u t , a c c o r d i n g t o s o m e o n e 's
id e a o f w h a t i s r e p r e s e n t a t iv e . T h e s e n o n - p r o b a b i l i t y s a m p lin g m e th o d s w i l l n o t b e d e a l t
w ith h e re s in c e th e y do n o t a llo w e s tim a te s of b ia s or p r e c is io n to be m ade.

Random s a m p le s re p re s e n t c o n c e p tu a lly th e s im p le s t fo rm of p r o b a b ilit y s a m p le ; each

in d iv id u a l in th e p o p u la tio n has an e q u a l p r o b a b ilit y of b e in g s e le c t e d fo r th e s a m p le .
T h e m e c h a n is m fo r s e le c t io n is u s u a lly a ta b le of ra n d o m n u m b e rs . The p o p u la tio n is lis te d
and each p e rs o n on th e lis t is a s s ig n e d a u n iq u e n u m b e r. The n e c e s s a ry num ber of s u b je c t s
to be g iv e n q u e s tio n n a ir e s a re th e n chosen by s e le c t in g th e n e c e s s a ry ra n d o m n u m b e rs fro m a
ta b le of ra n d o m n u m b e rs , d is c a r d in g th e ra n d o m n u m b e rs w h ic h exceed th e la r g e s t num ber on
th e lis t, o r w h ic h have been a lr e a d y s e le c t e d .

S im p le ra n d o m s a m p lin g is u s u a lly e m p lo y e d at one s ta g e or a n o th e r in even th e m ost

c o m p lic a te d d e s ig n s . B y i t s e l f , i t i s u s u a l l y e m p lo y e d o n l y w h e n t h e p o p u l a t i o n o f
in te r e s t is n e it h e r to o la r g e n o r to o h e te ro g e n e o u s . S in c e s im p le ra n d o m s a m p lin g r e q u i r e s
a c o m p le te lis tin g of th e p o p u la tio n to be s a m p le d , it m ay b e v e r y d if f ic u lt or e x p e n s iv e
to o b ta in th e lis t fo r la r g e p o p u la tio n s ; fo r in s t a n c e , it m ig h t be fe a s ib le to o b ta in a
l i s t i n g o f s c h o o l a tte n d e rs f o r a s in g le school or eve n a s in g le scho ol d is t r ic t , b u t n o t
f e a s ib le a t th e s ta t e o r n a t io n a l le v e l. W hen t h e p o p u la tio n o f i n t e r e s t i s h e te ro g e n e o u s
w ith re s p e c t to fa c to rs a ff e c tin g d ru g use, a s tr a tifie d s a m p lin g d e s ig n , descussed b e lo w ,
is c a lle d fo r. S im p le ra n d o m s a m p lin g m ay a ls o be r e je c t e d when, fo r b u d g e ta ry or a d m in is ­
tr a tiv e re a s o n s , it is n e c e s s a ry to s e le c t c lu s te r s of in d iv id u a ls or u n it s fro m th e
s a m p le fra m e . In s h o rt, fo r a ll its s im p lic ity , s im p le ra n d o m s a m p lin g is u s e fu l o n ly fo r
s m a ll h o m o g e n e o u s p o p u la tio n s w h e re a c o m p le te p o p u la tio n lis t is a v a ila b le or can r e a d ily
be c o n s tr u c te d . The in v e s t ig a t o r u n d e r t a k in g d ru g -u s e s tu d ie s s h o u ld a s s u re h im s e lf on
th e s e p o in t s b e fo re h a n d .

A n o th e r fo rm of ra n d o m s e le c t io n is s y s te m a tic s a m p lin g . In s te a d of ea ch p e rs o n
b e in g s e le c t e d at ra n d o m fro m th e o rd e re d p o p u la tio n lis t, o n ly th e in itia l s u b je c t is
s e le c te d r a n d o m ly . T h e re a fte r, e v e ry 1 0 th , 5 0 th , or n th p e rs o n is s e le c t e d fro m th e
o rd e re d lis t, th e v a lu e of n b e in g d e t e r m in e d by th e s iz e of th e p o p u la tio n lis t and th e
s a m p le s iz e d e s ir e d . T h is m e th o d has th e a d v a n ta g e th a t th e p ro c e s s of s e le c t io n is easy
and th e p o te n tia l a d v a n ta g e th a t th e s a m p le m a y b e s p re a d out over th e p o p u la tio n lis tin g .
W h e th e r i t p ro d u c e s a r e p r e s e n t a t iv e s a m p le depends upon th e b a s is of o r d e r in g of th e
p o p u la tio n lis t.

S t r a t if ie d s a m p lin g m ay be u s e d if th e p o p u la tio n of in te r e s t is th o u g h t to be h e te ro ­
geneous w ith re s p e c t to d ru g use, or if s p e c ia l e s tim a te s of d ru g use a re to b e m ade f o r
c e r ta in s u b g ro u p s . For th e s e p u rp o s e s a p r io r s tr a tific a tio n of th e p o p u la tio n is neces­
s a ry ; a s e p a ra te and i n d e p e n d e n t p r o b a b i l i t y s a m p le i s s e l e c t e d w i t h i n e a c h d e fin e d
s tr a tu m o r s u b g ro u p . T h i s m e th o d p r o d u c e s i n d e p e n d e n t e s t i m a t e s o f d r u g u s e t o p e r m it
c o m p a r is o n s b e tw e e n s u b g ro u p s . T h e y m ay a ls o be c o m b in e d fo r e s tim a te s of th e to ta l
p o p u la tio n .

The b a s e s fo r s tr a tific a tio n m ay v a r y (e .g ., g e o g r a p h ic a l r e g io n , s c h o o l, or c la s s r o o m )

o r m ay be based upon c h a r a c te r is tic s of th e in d iv id u a ls , such as age, sex, ra c e , or s o c io ­
e c o n o m ic s ta tu s ; but each in d iv id u a l in th e p o p u la tio n m ust be a s s o c ia t e d w ith one, and
o n ly one, s tra tu m . If s im p le ra n d o m s a m p lin g is c o m b in e d w ith s tr a tifie d s a m p lin g , e ith e r
th e re m u st be a s e p a ra te p o p u la tio n lis t fo r each s tra tu m , or each in d iv id u a l on an o v e r a ll
p o p u la tio n lis t m u st be id e n tifie d w ith a s in g le s tra tu m . It w o u ld be f u t ile to use e th n ic
g r o u p , f o r e x a m p le , a s a s t r a t i f y i n g v a r i a b l e i f t h i s i n f o r m a t i o n w a s n o t a v a i l a b l e f o r
each in d iv id u a l. I n a d d it io n , th e s iz e , o r r e l a t i v e s iz e , o f e a c h s tr a tu m m u s t be know n
in o rd e r to a llo c a te th e o v e r a ll s a m p le p r o p o r tio n a te ly am ongst th e v a r io u s s tra ta .

S t r a t i f i e d s a m p lin g i s o f t e n u s e d w h e r e c e r t a i n g r o u p s n e e d t o b e o v e r s a m p le d . T h is
c a n p e r m it e s t im a t e s o f e q u a l p r e c i s i o n t o b e m ade f o r s t r a t a w h e re d ru g use is r a re and
fo r s tra ta w h e re it is w id e s p r e a d .
 - 25 -
In s u m m a ry , s tr a tifie d s a m p lin g is a way of e n s u r in g th e r e p r e s e n t a t iv e n e s s of a
s a m p le and of in c r e a s in g th e p r e c is io n of e s tim a te s . I t is use d when th e n e c e s s a ry
in f o r m a t io n on s tra ta is a v a ila b le in an a p p r o p r ia te fo rm to be in c o r p o r a te d in to th e
s a m p lin g schem e. It can be u t iliz e d w ith s im p le ra n d o m s a m p lin g or s y s te m a tic s a m p lin g
w ith in s tra ta . S t r a t if ie d s a m p lin g m ay a ls o be c o m b in e d w i t h th e o th e r tw o p r o b a b ilit y
s a m p lin g d e s ig n s m e n tio n e d b e lo w .

R a th e r th a n s e le c t in g in d iv id u a ls at ra n d o m th ro u g h o u t th e p o p u la tio n , it is som e­
tim e s m o re e f f ic ie n t to s e le c t com pact c lu s te r s of in d iv id u a ls and to s u rv e y a ll in d iv i­
d u a ls m a k in g up th e c lu s te r ; th is is know n as c lu s te r s a m p lin g . C lu s te r s of in d iv id u a ls
m ay be d e fin e d a c c o r d in g to th e ir n a tu ra l g r o u p in g s , such as a s c h o o l, a c la s s r o o m , or a
fa c t o r y d e p a rtm e n t. The c o s ts and l o g i s t i c p r o b le m s o f a d m i n i s t e r i n g a q u e s t io n n a ir e a r e
o f t e n le s s w hen a n a d m i n i s t r a t i v e l y d e fin e d u n i t , ( e . g . , a c la s s r o o m o r m i l i t a r y b a r r a c k s )
can be ta k e n as a w h o le . I t is o fte n o p e r a t io n a lly m o re e ff ic ie n t and a d m in is tr a tiv e ly
m o re c o n v e n ie n t fo r th e s u rv e y to use such c lu s te r s . As w ith s tr a tifie d s a m p lin g , h o w e v e r,
ea ch p e rs o n m u st be a s s o c ia t e d w ith one, and o n ly one, c lu s te r , and th e r e la t iv e s iz e of
th e c lu s te r s s h o u ld be know n. A s u rv e y in w h ic h th is a p p ro a c h is u s e d m ig h t b e d e s c r ib e d
fo r e x a m p le , as a s tu d e n t s u rv e y u s in g a c lu s te r s a m p le of s c h o o ls .

T h e re a re , h o w e v e r, p o te n tia l d ra w b a c k s to c lu s te r s a m p lin g . The in f o r m a t io n

o b ta in e d on th e p r e v a le n c e of d ru g use o b ta in e d fro m 1000 s tu d e n ts in 20 c la s s e s of 50
p e rs o n s e a c h m ay n o t b e th e sam e a s th a t o b ta in e d fro m 1000 s tu d e n ts s e le c t e d by s im p le
ra n d o m s a m p lin g fro m th e sam e p o p u l a t i o n . T h is is because th e re m ay be a c o n c e n tr a tio n of
s im ila r d ru g -u s e p a tte rn s fo r s tu d e n ts in th e sam e c l a s s e s . In o rd e r to o b ta in th e sam e
p r e c is io n in e s tim a tin g d ru g use in a c lu s te r s a m p le , it m ay b e n e c e s s a r y to in c r e a s e th e
s a m p le s iz e - i.e ., in th e above e x a m p le , to m o re th a n 20 c la s s e s . The a m o u n t b y w h ic h
th e s a m p le s iz e needs to be in c r e a s e d is a f u n c tio n of th e am ount of c o r r e la tio n fo u n d
b e tw e e n th e b e h a v io u r of p e rs o n s w ith in a c lu s te r . If th is c o r r e la tio n is z e ro , th e n th e
sam e p r e c i s i o n can be o b ta in e d by c lu s te r s a m p lin g as by s im p le ra n d o m s a m p lin g . In th a t
case, c lu s te r s a m p lin g is lik e ly to be p r e fe r a b le because of th e e c o n o m ie s in c a r r y in g out
th e s a m p lin g and in d a ta c o lle c tio n .

M u lt i- s t a g e s a m p lin g m ay be u se d if th e p o p u la tio n of in t e r e s t is d is t r ib u t e d over a

la r g e g e o g r a p h ic a l a re a , such as an e n tir e p r o v in c e or c o u n try , because a s a m p le fra m e is
o fte n not a v a ila b le fo r th e to ta l p o p u la tio n . F u rth e rm o re , it is o fte n u n e c o n o m ic a l t o
s e le c t a s im p le ra n d o m s a m p le over such la r g e a re a s w h e re tra v e l b e tw e e n in d iv id u a ls c o u ld
consum e a la r g e p a rt of th e s u rv e y b u d g e t. An a lte r n a t iv e , th e n , is fir s t to d iv id e th e
to ta l a re a in to c lu s te r s of u n it s . For a n a tio n a l s a m p le , th e c lu s te r s m ig h t b e p r o v in c e s
or o th e r a d m in is tr a tiv e u n it s w h ic h a re b o th m u tu a lly e x c lu s iv e and e x h a u s tiv e . As in
c l u s t e r s a m p lin g , a p r e d e te r m in e d n u m b e r o f th e s e u n it s m u s t be s e le c t e d . F o r each o f th e
s e le c t e d c lu s t e r s ( u s u a lly c a lle d f i r s t - s t a g e s a m p lin g u n i t s ) a lis t in g is m ade o f th e
p o p u la tio n w ith in th e u n it or of s t ill s m a lle r c lu s te r s w ith in th e u n it . At th is second
s ta g e , a s im p le ra n d o m s a m p le c o u ld be d ra w n , u s in g th e lis tin g of th e p o p u la tio n . A lte r n a ­
tiv e ly , a s a m p le o f c l u s t e r s c o u ld b e d r a w n a n d a l l p e r s o n s w i t h i n th e s e le c t e d c lu s te r s
w o u ld b e a d m in is te r e d th e q u e s tio n n a ir e . O ne m i g h t a l s o t a k e th e c lu s t e r s fo rm e d a fte r
t h e f i r s t s t a g e o f s a m p l i n g a n d s u b d i v i d e th e m in to s u b c lu s t e r s , w h ic h a re lis te d and
s a m p le d i n t h e i r t u r n ( s e c o n d - s t a g e s a m p l i n g ) .

A n e x a m p le of m u lt i- s t a g e s a m p lin g m ig h t b e a n a tio n a l s a m p le s u rv e y of d ru g use in

school a tte n d e rs . F ir s t- s ta g e s a m p lin g u n it s c o u ld be p r o v in c e s or s ta te s , w ith a p ro b ­
a b i l i t y s a m p le o f a f i x e d n u m b e r o f p r o v in c e s b e in g s e le c t e d ( f i r s t - s t a g e u n i t s ) . E ach
s t a t e so s e le c t e d i s th e n s u b d i v i d e d i n t o s c h o o l d i s t r i c t s , a n d a p r o b a b i l i t y s a m p le o f
sch o o l d is t r ic t s is s e le c te d (s e c o n d -s ta g e s a m p lin g u n it s ) . For th e s c h o o l d is t r ic t s
s e le c t e d e ith e r a lis tin g of a ll in d iv id u a l s tu d e n ts is c o m p ile d and a s im p le ra n d o m s a m p le
of s tu d e n ts is s e le c te d , or a lis tin g of c la s s e s is c o m p ile d and a c lu s te r s a m p le of
c la s s e s is s e le c t e d ( t h ir d - s t a g e s a m p lin g u n it s ) . I t s h o u ld be n o te d th a t th e s a m p lin g m ay
e x te n d beyond th re e s ta g e s ; e .g ., c la s s e s c o u ld have been used as th ir d - s ta g e u n it s and a
s im p le ra n d o m s a m p le of s tu d e n ts w ith in each s e le c te d c la s s fin a lly d ra w n .
 - 26 -
A d e c is io n as to th e c o m p le x ity and e x te n t of th e m u lt i- s t a g e s a m p lin g is a d if f ic u lt
one th a t depends upon th e v a r io u s cost c o m p o n e n ts of s a m p lin g at each le v e l, th e a b ilit y to
c o m p ile th e a p p r o p r ia t e s a m p lin g fr a m e a t e a c h l e v e l , and th e n e e d s o f p r e c is io n f o r th e
e s tim a te s o f d r u g u s e . S t r a t if ic a t io n c a n a l s o b e s u p e r im p o s e d a t a n y s ta g e o f s a m p lin g to
p ro d u c e a h y b r id s a m p lin g d e s ig n of even g re a te r c o m p le x ity .

Even th e s im p le s t s a m p lin g d e s ig n e x e r c is e w ill b e n e fit fro m th e p a r tic ip a tio n of an

e x p e r ie n c e d s u rv e y s t a t is t ic ia n . M u lt i- s t a g e s a m p le d e s ig n , h o w e v e r, dem ands th e s o lu t io n
of a set of c o m p le x s ta t is t ic a l q u e s tio n s ; it s h o u ld th e re fo re not be a tte m p te d w ith o u t
a p p r o p r ia te a id .

The s iz e of th e s a m p le n e e d e d fo r a d ru g -u s e s u rv e y depends upon th e fo llo w in g

fa c to rs :

- th e r a r ity of th e tr a it ( in th is case, d ru g use) b e in g e s tim a te d fo r th e p o p u la tio n

of in te r e s t;

- th e r e la t iv e (p e rc e n ta g e ) or a b s o lu te p r e c is io n d e s ir e d fo r th e e s tim a te ;

- th e s u b g ro u p s in th e p o p u la tio n fo r w h ic h s e p a ra te e s tim a te s a re r e q u ir e d ;

- th e c o m p a r is o n s to b e m ade b e tw e e n s u b g ro u p s in th e p o p u la tio n .

F o r m ost s u rv e y s it is s u g g e s te d th a t a s a m p lin g e x p e rt be c o n s u lte d fo r a d v ic e on th e

a p p r o p r ia te s a m p le s iz e based upon th e above c o n s id e r a t io n s . T h e re has, h o w e v e r, been
c o n s id e r a b le p r a c tic a l e x p e r ie n c e in c o n d u c tin g s tu d e n t d ru g -u s e s u rv e y s in re c e n t y e a rs
and th is p e r m its som e p r a c t i c a l s u g g e s tio n s to be f o r m u la t e d .

To in c lu d e a s iz a b le n u m b e r o f c a s e s o f a r a r e b e h a v io u r , s u c h a s u s in g h e r o in , i n a
s u r v e y d e s ig n e d t o c h a r a c t e r i z e u s e r s , l a r g e r s a m p le s m u s t b e s u r v e y e d o r a d is p r o p o r tio n a te
num ber o f re s p o n d e n ts m u s t com e f r o m h ig h - r is k g ro u p s . C lu s te r s a m p le s a ls o need to be
la r g e r th a n s im p le ra n d o m s a m p le s s in c e th e y a re le s s p r e c is e (s e e J o h n s to n e t a l. (24) fo r
a s ta t is t ic a l m e th o d of c o r r e c tin g fo r c lu s te r e d s a m p lin g ) .

S ta te m e n ts about d ru g use in r e la t io n to d e m o g r a p h ic , s o c ia l, and g e o g r a p h ic a l

c h a r a c te r is tic s of th e p o p u la tio n a re o fte n r e q u ir e d . G e n e r a lly , it is n e c e s s a ry to d e te r­
m in e th e s m a lle s t s u b c a te g o ry th e d a ta fo r w h ic h a re to be a n a ly s e d - e . g . , m a le s aged
1 6 -1 8 y e a rs liv in g in la r g e c itie s . As a r u le of th u m b , at le a s t 50 s u b je c t s in each
s u b c a te g o ry w i l l g e n e r a lly be r e q u ir e d in o rd e r to s ta te th e e x te n t of d ru g use.

If th e p o p u la tio n of s tu d e n ts to b e ,s tu d ie d is le s s th a n 1000, th e y s h o u ld a ll be
in c lu d e d . I f th e y a re fe w e r th a n 5 0 0 0 , a s t u d y s a m p le o f 5 0 0 m a y b e s u f f i c i e n t . W ith
p o p u l a t i o n s g r e a t e r t h a n 5 0 0 0 , s a m p le s o f 1 0 0 0 w o u l d b e a m in im u m . P r o b a b l y a s a m p le o f
5000 is th e m a x im u m t h a t w o u ld be needed fo r d e t e r m in in g m ost ty p e s of d ru g use. T h a ts iz e
of s a m p le g e n e r a lly a llo w s a lm o s t any a n a ly s is to b e m ade a n d ra re ty p e s of d ru g use to be
d e te c te d . H o w e v e r, if t h e r e a r e 10 0 0 0 s t u d e n t s , s e l e c t a b o u t 10% o f t h e c la s s r o o m s . If
th e re a re m o re th a n 10 000, a s tr a tifie d s a m p lin g p la n w i l l b e n e c e s s a r y , w it h th e num ber
s e le c t e d in c r e a s in g w it h th e t o t a l p o p u la t io n . S a m p li n g e x p e rts m u st be c o n s u lte d on th e
s a m p le s i z e f o r l a r g e n a t i o n a l s t u d i e s .

P ro c e d u re s fo r a d m in is te r in g th e s u rv e y

O ne o f th e m ost im p o r ta n t s te p s in o r g a n iz in g a s u rv e y is th e p ilo t s tu d y . A ll
q u e s tio n n a ir e s s h o u ld be tr ie d out on a s m a ll n u m b e r o f s u b je c t s of th e ty p e to be s tu d ie d
in th e a c tu a l s u rv e y . T h is a llo w s a t e s t in g o f th e q u e s t io n n a ir e a n d t h e d e v e lo p m e n t o f
a n s w e r c a t e g o r ie s . It a ls o in d ic a t e s w h e th e r th e s u b je c t s u n d e r s ta n d th e q u e s tio n s an d c a n
r e p ly to th e m in th e tim e a v a ila b le . It is o fte n fo u n d , as a r e s u lt of p ilo t s tu d ie s , th a t
th e q u e s tio n n a ir e is to o lo n g , to o d if f ic u lt , or n o t u n d e rs to o d by som e s u b je c t s . The p i l o t
s tu d y m ay a ls o id e n tify d iffic u lt ie s in o b ta in in g c o o p e r a tio n fro m s u b je c t s , so th a t
p ro c e d u re s fo r s e le c t in g th e s a m p le and a d m in is te r in g th e s u r v e y m ay a ls o be m o d ifie d .
 - 27 -
A d m in is tr a tiv e a p p ro a c h e s fo r s u rv e y s of s tu d e n t and m ilit a r y p o p u la tio n s w ill p r o b a b ly
v a ry fro m one c o u n try to a n o th e r. In m ost school s u rv e y s , it is e s s e n tia l to g a in th e
c o o p e r a tio n of at le a s t fo u r g ro u p s : th e a u t h o r it ie s r e s p o n s ib le fo r th e school d is t r ic t ,
th e p r in c ip a l or h e a d m a s te r of each s c h o o l, th e te a c h e rs , and, f in a lly , th e s tu d e n ts th e m ­
s e lv e s . The b e s t w ay is to s ta te th e re a s o n s fo r th e s u rv e y c le a r ly an d h o n e s tly to a ll
c o n c e rn e d and to e n li s t t h e i r c o o p e r a tio n . C o e r c io n at any le v e l is lik e ly to p ro d u c e
d is tu r b in g s id e - e f f e c t s .

M any la r g e s tu d ie s (_9_, 20, 24) have used s p e c ia lly tr a in e d a s s is ta n ts to a d m in is te r

th e s u rv e y s and answ er q u e s tio n s about th e m e a n in g s of th e q u e s tio n s . If te a c h e r s a re
p re s e n t in th e c la s s at th e tim e of th e s u rv e y , th e y m ust n o t be a llo w e d to wander about
and see s tu d e n ts ' a n s w e rs . S in c e te a c h e r s a re o fte n r e q u ir e d to m a in t a in o rd e r in la r g e
u n r u ly c la s s e s , th e y c a n n o t a lw a y s be b a n is h e d . H o w e v e r, th e y s h o u ld not c o lle c t
or lo o k at th e q u e s tio n n a ir e s at any tim e . S tu d e n ts s h o u ld b e m ade a w a re th a t th e s u rv e y
is b e in g c o n d u c te d by o u ts id e r s , not by th e school a u t h o r it ie s or te a c h e rs , and th a t
te a c h e r s w ill not see th e r e s u lts . O ne w a y o f c o lle c tin g th e q u e s tio n n a ir e s is to p la c e a
box a t th e back of th e ro o m so th a t th e y m ay b e re tu rn e d a n o n y m o u s ly .

In som e c a s e s , s c h o o ls and te a c h e rs s ta n d in lo c o p a r e n t is fo r s tu d e n ts who a re th e n

not r e q u ir e d to o b ta in p a re n ta l consent fo r th e ir p a r tic ip a tio n . In o th e r a re a s , s c h o o ls
r e q u ir e p a re n ta l consent fo r th e s tu d e n t to p a r tic ip a te in a s u rv e y . W hen p a r e n t a l consent
is r e q u ir e d , illic it b e h a v io u r such as d ru g abuse is lik e ly to be u n d e rre p o rte d (2 5 )■
T h u s , fr o m th e p o in t o f v ie w of h o n e s t r e p o r t in g , it is p r e fe r a b le to a v o id th e need fo r
fo r m a l p a r e n t a l c o n s e n t.

In g e n e r a l, it is a good p r a c tic e to e n s u re th a t re s p o n d e n ts do n o t s ig n th e ir nam es

to d ru g -u s e q u e s tio n n a ir e s . M o s t in v e s t ig a t o r s fe e l th a t s u b je c t s w ill b e m o re h o n e s t if
th e y do n o t s ig n th e ir nam es. T h is p e r m its th e m to re s p o n d h o n e s tly , w ith o u t fe a r of
p u n is h m e n t. C e r t a in ly th e re is le s s r is k of le g a l d if f ic u lt ie s , and re s p o n d e n ts seem t o
p re fe r a n o n y m ity , e s p e c ia lly if th e y a re o ld e r .

U n fo r tu n a te ly , re s e a rc h on th e e ffe c ts of a n o n y m ity on d ru g -u s e r e p o r t in g has g iv e n

c o n f lic t in g r e s u lts . S ix s tu d ie s have e x a m in e d th e q u e s tio n of a n o n y m ity : K in g (26) fo u n d
no d iffe r e n c e in th e p r o p o r tio n s of s tu d e n ts r e p o r t in g d ru g u se w ith and w ith o u t a n o n y m ity .
R o b in s ( 27) o b ta in e d s im ila r r e s u lts w ith in te r v ie w s a n d m a ile d q u e s tio n n a ir e s , except th a t
th e use of a lc o h o l and to b a c c o w as u n d e r r e p o r te d in in te r v ie w s . H o w e v e r, L u e tg a rt &
A rm s tro n g ( 28) fo u n d th a t s tu d e n ts re p o rte d m o re m a r iju a n a use in anonym ous s u rv e y s .

S e v e ra l s tu d ie s have a ls o been c a r r ie d o u t w ith a r a n d o m iz e d re s p o n s e m odel in w h ic h

th e re s p o n d e n t a n s w e rs a q u e s tio n w ith o u t r e v e a lin g h is ow n b e h a v io u r . For e x a m p le , he is
g iv e n s e v e ra l q u e s tio n s fro m w h ic h he m ay c h o o s e one to a n s w e r. The q u e s tio n s m ig h t in c lu d e
a d ru g -u s e q u e s tio n and a m o re in n o c u o u s one — s a y , about w h a t he had fo r b re a k fa s t.
S ta tis tic a l te c h n iq u e s a re th e n used to e s tim a te th e n u m b e rs of d ru g u s e r s .B o ru c h (2 9 )
fo u n d no d iffe r e n c e in re p o rte d d ru g use w ith th is anonym ous m e th o d and w ith coded m e th o d s .
H o w e v e r, B ro w n & H a r d in g (30) and G o o d s ta d t & G ru s o n (31) fo u n d u n d e r r e p o r tin g w ith non-
a n o n ym o u s m e th o d s . In g e n e r a l, th e r e s u lts suggest th a t a n o n y m o u s m e th o d s a re s u p e r io r to
th o s e i n w h ic h r e s p o n d e n t s a r e i d e n t i f i e d . Anonym ous a d m in is t r a t io n is to be p re fe rre d
u n le s s t h e r e i s a c o m p e llin g r e a s o n f o r g a t h e r in g i d e n t i f y i n g in f o r m a t io n .

R e lia b ilit y and v a l i d i t y

The m o s t s e r io u s w eakness o f m any d ru g -u s e s u rv e y s is th e ir la c k of r e lia b ilit y and

v a lid ity checks. O n ly a fe w in v e s t ig a t o r s have a tte m p te d to e s ta b lis h any r e lia b ilit y or
v a lid ity c o e ffic ie n ts fo r th e ir q u e s tio n n a ir e s . In v e s tig a to r s o fte n d e v is e new q u e s tio n ­
n a ir e s ra th e r th a n u s in g an e s ta b lis h e d one, and th e q u a lity of th e new q u e s tio n n a ir e s is
d i f f i c u l t t o d e t e r m in e . M o re c a r e h a s b e e n ta k e n w it h th e q u a lit y o f s c a le s f o r m e a s u r in g
d r in k i n g b e h a v io u r th a n w it h th e q u a lit y o f s c a le s f o r m e a s u r in g d r u g use. I t s h o u ld a ls o
be n o te d t h a t v a l i d i t y an d r e l i a b i l i t y a r e n o t p e rm a n e n t q u a l i t i e s o f a p a r t i c u l a r q u e s tio n ­
n a ir e . T h e y a r e e s t a b lis h e d f o r a g iv e n s e t o f c ir c u m s t a n c e s , g iv e n p o p u la t io n s , a n d e v e n
p a r tic u la r tim e p e r io d s . For e x a m p le , a q u e s tio n n a ir e m ay g iv e v a lid m e a s u re s of d ru g use
in one c o u n try but not in a n o th e r, or it m ay be v a lid fo r young s tu d e n ts in a c la s s r o o m
s u rv e y but not fo r a p o s ta l s u rv e y of a d u lts .
 - 28 -
R e lia b ility . As s ta te d b y A n a s ta s i (3 2 ), " r e lia b ility re fe rs to th e c o n s is t e n c y of
s c o re s o b ta in e d by th e sa m e i n d i v i d u a l s w hen r e - e x a m in e d w ith th e sam e t e s t on d if f e r e n t
o c c a s io n s , o r w ith d iffe r e n t s e ts of e q u iv a le n t ite m s , or under o th e r v a r ia b le e x a m in in g
c o n d itio n s " . R e lia b ilit y is im p o r ta n t because s c o re s s h o u ld be c o n s is t e n t and d e p e n d a b le
and b e ca u se " r e l i a b i l i t y a tte n u a te s v a l i d i t y " . T h is m eans t h a t o n ly th e r e l i a b l e o r c o n s is t ­
ent p o r t io n o f a s c o re ca n c o r r e la t e w ith o th e r v a r ia b le s . If a t e s t o r q u e s tio n n a ir e has
lo w r e lia b ilit y , its v a lid ity m u s t a ls o be lo w . T h e re fo re , e ffo rts s h o u ld b e m ade to
a c h ie v e r e lia b le m e a s u re s b e fo re c o n s id e r in g v a lid ity .

R e lia b ilit y te s ts a re u s u a lly m ade b y e x a m in in g e ith e r in t e r n a l c o n s is t e n c y or te s t-

re te s t r e lia b ilit y . The fo r m e r in v o lv e s m a t h e m a t i c a l m e th o d s of a s s e s s in g r e lia b ilit y . It
e x a m in e s t h e r e l i a b i l i t y o f a q u e s t i o n n a i r e e s s e n t i a l l y b y c o m p a r in g s c o r e s o n o n e - h a l f o f
t h e ite m s w i t h s c o r e s o n t h e o t h e r h a l f . In m o st d ru g -u s e s u r v e y s , i n t e r n a l c o n s is t e n c y i s
u n lik e ly s in c e s in g le q u e s tio n s a re g e n e r a lly used to m e a s u re a v a r ia b le r a t h e r th a n
m u lt ip le - it e m in d e x e s or s c a le s . H o w e v e r, when q u e s tio n s about d ru g use fig u r e in s e v e ra l
p la c e s in th e q u e s tio n n a ir e , o n e m ig h t expect to o b ta in th e sa m e a n s w e r s and, hence,
in t e r n a l c o n s is t e n c y . S t a t i s t i c a l m e th o d s fo r th e s e te s ts m ay b e fo u n d in th e w o rk of
A n a s ta s i (32).

As th e nam e s u g g e s ts , te s t-re te s t r e lia b ilit y is d e t e r m in e d by r e p e a t in g th e te s t or

q u e s tio n n a ir e on a second o c c a s io n . S uch r e l i a b i l i t y is th e d e g re e of c o n s is t e n c y b e tw e e n
a n s w e rs to th e sam e q u e s t i o n s in th e tw o te s ts . For e x a m p le , in d ru g -u s e q u e s tio n n a ir e s ,
p e o p le who r e p o r t e d use of a d ru g in th e past y e a r m ig h t b e e x p e c te d to re p o rt it a g a in
w hen a ske d th e sam e q u e s t i o n a m o n th la te r . Of c o u rs e , th e re a re m any s itu a tio n s in w h ic h
te s t-re te s t r e lia b ilit y cannot be e x p e c te d to be h ig h . If th e ty p e s of b e h a v io u r te s te d
a re h ig h ly v a r ia b le or e x p e c te d to cha nge w ith tim e , c o n s is t e n c y is a n u n r e a s o n a b le r e q u ir e ­
m e n t. T h is is s o m e t im e s th e case w h e re d ru g use is of an e x p e r im e n ta l n a tu r e and does not
p e r s is t. M ost u s e rs of d ru g s such as c a n n a b is try th e d ru g but of c u r io s it y o r because of
p e e r p re s s u re , and do not in te n d to c o n tin u e its use. C o n s e q u e n tly , t e s t in g o n tw o
o c c a s io n s m ay g iv e q u it e d iffe r e n t re s p o n s e s . T h is m ay be a v o id e d b y k e e p in g th e te s t-
re te s t in te r v a l s h o rt and by a s k in g a b o u t d ru g use over a lo n g tim e ra th e r th a n a s h o rt
one - e .g ., b y a s k in g s tu d e n ts if th e y ever used a d ru g d u r in g th e ir life tim e ra th e r th a n
d u r in g th e la s t m o n th .

P e rh a p s because of th e d if fic u lt ie s in a n a ly s is and in te r p r e ta tio n , fe w r e lia b ilit y

s t u d ie s h a v e b e e n m ade w i t h s e lf - a d m in is t e r e d q u e s t io n n a ir e s . W h it e h e a d & S m a rt (33) and
S m a r t ( 3 4 ) h a v e s u m m a r iz e d m a n y o f t h e a v a i l a b l e d a t a o n r e l i a b i l i t y .

O n ly H a b e rm a n et a l. ( 19) have c a r r ie d out a te s t-re te s t s tu d y w ith s tu d e n ts . The

p r o p o r tio n s of s tu d e n ts w ho h a v e n e v e r u s e d c a n n a b is w e re id e n tic a l in th e tw o s tu d ie s .
About 80% r e p o r t e d th a t th e y had a n s w e re d q u e s tio n s a b o u t d ru g s h o n e s tly . T h is illu s tr a te s
r e lia b ilit y in th e a g g re g a te s t a t i s t i c s but not n e c e s s a r ily h ig h r e lia b ility fo r in d iv id u a l
s tu d e n ts in t h e tw o t e s t i n g s .

Some s o c i o l o g i s t s d e t e r m in e r e lia b ilit y by c o m p a r in g d a ta fro m tw o s o u rc e s .

S te p h e n s (35) s tu d ie d 100 a d u lts b y m eans of a m a ile d q u e s tio n n a ir e and c o m p a re d th e r e s u lts
fo r th e sam e i n d i v i d u a l s fro m a n o th e r s o u rc e , th a t is h o s p ita l c o u n s e llo r s and r e la t iv e s .
A h ig h d e g re e of a g re e m e n t was fo u n d fo r th e q u e s tio n s a b o u t d ru g use and a rre s ts . A
s im ila r s tu d y by B a ll (36) a ls o o b ta in e d h ig h ly r e lia b le r e s u lts w ith a d d ic ts .

V a lid ity . The c o n c e p t o f v a l i d i t y is c o n c e rn e d w it h w h e th e r th e t e s t o r q u e s tio n n a ir e

m e a s u re s w h a t i t i s s u p p o s e d to m e a s u re . V a l i d i t y c o e f f ic ie n t s t e l l how w e ll t h is has been
done (s e e 13 an d 34. f ° r r e v ie w s ) . In d ru g -u s e s u rv e y s , it is d e s ir a b le to o b ta in a c c u ra te
d a ta fro m e v e ry re s p o n d e n t - th a t is , e a c h r e s p o n d e n t w ho h a s a c tu a lly used d ru g s s h o u ld
in d ic a te th is on th e q u e s tio n n a ir e and n o n -u s e rs s h o u ld re p o rt th a t th e y have not used
d ru g s .

I t i s o f t e n d i f f i c u l t t o e s t a b lis h th e v a l i d i t y o f in f o r m a t io n o n d ru g u s e b e c a u s e su c h
b e h a v i o u r i s o f t e n o f a p r i v a t e a n d s o m e t im e s i l l e g a l n a t u r e . I t i s n o t r e a d i l y s u b je c t t o
o b s e r v a t io n o r v e r if ic a t io n by o th e rs . Thus it is d if f ic u lt to o b ta in a n o u ts id e m e a s u re
 - 29 -
a g a in s t w h ic h to c o m p a re s u rv e y r e s u lts fo r in d iv id u a l cases. A fu rth e r p r o b le m is th a t
s u rv e y s at best can re p o rt o n ly th e d ru g s th a t th e re s p o n d e n t b e lie v e s he to o k . It is know n
fro m la b o r a to r y a n a ly s e s th a t illic it d ru g s f r e q u e n tly do n o t c o n ta in any of th e s u b s ta n c e s
th a t th e y a re supposed to c o n ta in .

V a r io u s a p p ro a c h e s to v a lid ity in d ru g s u rv e y s have been a tte m p te d , so m e o f w h i c h a re

d e s c r ib e d b e lo w .

Q u e s tio n s on " fic titio u s " d ru g s . Some e a r l y s u rv e y s (3 3 ) e x a m in e d th e use of " fic ti­
tio u s " d ru g s such as C .H .D ., L o v a r-2 5 (L o v e P ills ) , a n d m o n o x y t r ip t a m a t e (M O T) in an e ffo rt
to assess o v e r r e p o r tin g . A la r g e s u rv e y in T o ro n to in d ic a te d th a t o n ly 0 .8 % of re s p o n d e n ts
re p o rte d th e use of M O T. H o w e v e r, about 6% o f a d d ic ts under tre a tm e n t re p o rte d th e use of
fic titio u s d ru g s . P e rh a p s th e re is a g re a te r o v e r r e p o r tin g p r o b le m w ith heavy u s e rs .

C o m p a r is o n of s e lf- r e p o r t w ith o th e r r e p o r t in g m e th o d s . An e a r ly s tu d y by S m a rt &

J a c k s o n ( 3 7 ) c o m p a re d th e e x te n t o f s e lf- r e p o r te d d r u g u s e r e v e a le d b y a q u e s tio n n a ir e
s u r v e y w it h e s tim a te s o f d r u g u s e m ade b y e le c t e d s tu d e n t le a d e r s . T h is s tu d y i n d ic a t e d
t h a t s e l f - r e p o r t e d c a n n a b is u s e w as s o m e w h a t g r e a t e r fo r b o t h m a le s and fe m a le s th a n th e
e s tim a te s o f u s e p r o v id e d b y s tu d e n t le a d e r s .

C o m p a r is o n of s e lf- r e p o r t w ith d o c u m e n ta ry e v id e n c e . S tim s o n & O g b o rn e (38) fo u n d

c lo s e a g re e m e n t b e tw e e n d ru g use re p o rte d by a d d ic ts and th a t in d ic a te d by c lin ic a l case-
n o te s . R o b in s (27) s tu d ie d know n h e r o in u s e rs and fo u n d v a r y in g a g re e m e n t b e tw e e n in te r v ie w
d a t a , c a s e r e c o r d s , a n d la b o r a t o r y r e p o r t s o n u r in e ta k e n a t th e tim e o f th e in t e r v ie w .
A g r e e m e n t w a s h i g h f o r t h e u s e o f h e r o i n (9 7 % ) a n d o p iu m (8 0 % ) i n t h e in t e r v ie w and c a s e -
n o te s but lo w fo r u r in a ly s is re p o rts . H o w e v e r, te c h n ic a l d iffic u lt ie s w ith th e u r in a ly s e s
m ay h a v e c o n tr ib u te d to th is .

Som e s t u d i e s have c o m p a re d s e lf- r e p o r te d ra te s of d ru g use in g e n e ra l p o p u la tio n s w ith

ra te s e x p e c te d fro m p r e s c r ip tio n d a ta . P a rry et a l. (39) in te r v ie w e d a d u lts know n to have
h a d p r e s c r ip t io n s f o r p s y c h o a c tiv e d r u g s i n t h e p a s t y e a r . A b o u t 83% o f t h o s e k n o w n t o
h a v e r e c e iv e d t r a n q u i l l i z e r s a n d 7 2 % o f th o s e w ho r e c e iv e d s e d a tiv e s s a id so a t th e i n t e r ­
v ie w .

L ie , s c a le to assess t r u t h f u ln e s s . S m a rt et a l. (40) used a n in e - ite m lie s c a le d e v e l­

oped b y E ysenck & E ysenck (1 4 ), and fo u n d th a t s tu d e n ts w ith h ig h lie - s c a le s c o re s w e re
le s s lik e ly to re p o rt th e use o f m any le g a l and i llic it d ru g s . H o w e v e r, th e d iffe r e n c e s
w e re s m a ll f o r m ost d ru g s . F u rth e rm o re , s tu d e n ts w ith h ig h lie s c o re s w e re fe w in num ber
and th u s had a m in o r e ffe c t on th e o v e r a ll ra te s of a lc o h o l and d ru g use. L a te r s tu d ie s by
t h e sam e t e a m , u s i n g m u l t i v a r i a t e a n a l y s i s , h a v e show n t h a t l i e s c o re s a r e f a r le s s a d e q u a te
p r e d i c t o r s o f r e p o r t e d d r u g u s e t h a n d e m o g r a p h ic c h a r a c te r is tic s a re . T h is e x p e r ie n c e i s
c o n s is t e n t w it h th e f in d in g s of th e c o lla b o r a tiv e s tu d y d e s c r ib e d in th e m a in b o d y of th is
re p o rt and it s u p p o rts th e d e c is io n to o m it th e lie s c a le fro m th e f in a liz e d WHO q u e s t i o n ­
n a ir e .

In c o n c lu s io n , s tu d ie s in a num ber of d e v e lo p e d c o u n tr ie s have show n t h a t r e lia b ilit y

and v a l i d i t y d a ta fo r d ru g s u rv e y s a re g e n e r a lly a d e q u a te fo r re s e a rc h p u rp o s e s , p r o v id e d
th a t g ro s s c a t e g o r iz a t io n s a re used. M o re w o rk on b o th a s p e c ts is r e q u ir e d , p a r tic u la r ly on
te s t-re te s t r e lia b ilit y . An im p o r ta n t need is fo r m o re d a t a on v a l i d i t y and r e lia b ilit y of
d ru g -u s e s u rv e y s in d e v e lo p in g c o u n tr ie s .

Types of in s tr u m e n t used in s tu d ie s of y o u th fu l d ru g use

The fo rm a t or p h y s ic a l la y o u t of th e q u e s tio n n a ir e is e x t r e m e ly im p o r ta n t f o r p u rp o s e s
of d a ta p r o c e s s in g . In s e lf- a d m in is te r e d s u rv e y s of d ru g use, th re e g e n e ra l ty p e s of
in s tr u m e n t have been u se d: f ill- in fo rm s , s e p a ra te answ er s h e e ts , a n d m a c h in e - r e a d a b le
fo r m s . E x a m p le s of th e d iffe r e n t ty p e s a re a v a ila b le in a p u b lic a tio n b y N e h e m k is et a l.
( 1 1 ) w h ic h c o n ta in s c o p ie s of so m e 4 0 q u e s tio n n a ir e s used in d ru g -u s e s u rv e y s in N o rth
A m e r ic a .
 - 30 -
The f ill- in fo rm was u s e d in m any e a r l i e r s tu d ie s . W ith th is fo rm th e s u b je c t m a rk s
h is answ er d ir e c t ly on th e q u e s tio n n a ir e . The y o u th s u rv e y q u e s tio n n a ir e show n e a r lie r in
th is re p o rt is of th is ty p e . The a n s w e rs a re u s u a lly "c o d e d " or tra n s fe rre d by hand o n to
c o d in g s h e e ts , fo r w h ic h c o m p u te r punch c a rd s a re m ade. T h is m e th o d r e q u ir e s th e le a s t
fro m th e re s p o n d e n t: h e m e r e ly has to re a d th e q u e s tio n a n d m a rk h is a n sw e r w ith a tic k or
c ro s s , or in any o th e r o b v io u s w ay. T h is m e th o d w o r k s b e s t w ith c h ild r e n b e lo w th e age of
13, who o fte n have d if f ic u lt y w ith s e p a ra te answ er s h e e ts . T h e d is a d v a n ta g e of th e m e th o d
is th a t it te n d s to be la b o u r - in t e n s iv e , s in c e a s s is ta n ts a re r e q u ir e d to do th e c o d in g
and key p u n c h in g . These ta s k s a re m anual and r a th e r te d io u s , so th a t e rro rs a re lik e ly .
C a re fu l c h e c k in g of c o d in g and of key p u n c h in g a re n e c e s s a ry .

The a n sw e r sheet fo rm a t is one in w h ic h th e q u e s tio n n a ir e and answ er sheet a re sep­

a ra te . The answ er sheet is n u m b e re d in th e sam e w a y as th e q u e s tio n n a ir e , w ith a n u m b e re d
box fo r each a n s w e r. In som e c a s e s b o th th e a n s w e rs and th e boxes to r th e m m a y b e on th e
answ er s h e e t, but u s u a lly th e a n s w e rs a re o n ly on th e q u e s tio n n a ir e . At th e end of th e
s u rv e y , th e answ er s h e e ts a re c o lle c te d and c o m p u te r c a rd s m ay be p u n c h e d d ir e c tly fro m
th e s h e e ts . T h is m e th o d a v o id s th e a d d itio n a l ta s k of c o d in g th e a n s w e rs , and a llo w s
q u e s tio n n a ir e s to be re u s e d . H ence, it is som ew hat cheaper th a n th e f ill- in fo rm .

T h e m o s t m o d e r n m e th o d i n v o l v e s m a c h in e - r e a d a b le fo r m s . No p e r s o n n e l a r e r e q u ir e d to
code o r k e y - p u n c h th e a n s w e rs , s in c e t h e " r e a d e r " m a c h in e w i l l s c a n t h e a n s w e r sheet
v is u a lly and a u to m a tic a lly k e y -p u n c h th e a n s w e rs on to c a rd s or c o m p u te r ta p e . In som e
s tu d ie s , answ er s h e e ts have b e e n m ade m a c h in e - r e a d a b le and in o th e r s tu d ie s q u e s tio n n a ir e s
have b e e n m ade m a c h in e - r e a d a b le . B o th m e th o d s a re r e la t iv e ly c o s tly in te rm s o f m a te r ia ls
and e q u ip m e n t, but a re e x t r e m e ly la b o u r - e ffic ie n t. A fu rth e r p r o b le m is t h a t s tu d e n ts m ust
m a rk th e ir a n s w e rs c a r e fu lly and d is t in c t ly . S in c e s tra y m a rk s on th e p a g e m ay be re a d as
a n s w e rs , s u b je c t s m ust c o n s ta n tly be c a r e f u l w h e re th e y put th e ir a n s w e rs , e s p e c ia lly if
th e y le a v e b la n k s .

U s u a lly , m a c h in e - r e a d a b le answ er s h e e ts m ust be s p e c ia lly d e s ig n e d fo r each s tu d y and

m ay c o s t s e v e r a l h u n d re d US d o l l a r s per s tu d y . M a c h in e - r e a d a b le q u e s tio n n a ir e s a re even
m o re e x p e n s iv e , and a s e p a ra te one is r e q u ir e d fo r each s u b je c t . They a re not r e u s a b le as
is th e c a s e w i t h t h e a n s w e r - s h e e t m e th o d . A l s o , s o p h i s t i c a t e d r e a d i n g m a c h in e s a re needed
if th e a n s w e rs a r e to b e d i r e c t l y e n te re d o n t o t h e c o m p u te r t a p e . T h i s m e th o d is th e
m ost s u ita b le w h e re s o p h is tic a te d d a ta p r o c e s s in g e q u ip m e n t is a v a ila b le , w h e re la b o u r
c o s ts f o r c o d in g a n d k e y p u n c h in g a re h ig h , and when th e num ber o f re s p o n d e n ts is v e ry
la r g e - e .g ., ove r 5000.

D a ta a n a ly s is

In m o st d ru g -u s e s u rv e y s , d a ta a n a ly s is is not d if f ic u lt . A dvance p la n n in g is neces­

s a ry to e n s u re th a t th e a n a ly s is is s u ita b le fo r th e d a ta s to r a g e s y s te m used. For e x a m p le ,
if a n a ly s is is to ta k e in to a c c o u n t m any v a r ia b le s on la r g e s a m p le s , c o m p u te r s to r a g e is
e s s e n tia l. I f s a m p le s a r e s m a l l a n d o n l y g r o s s d ru g -u s e ra te s a re r e q u ir e d , a n a ly s is m ay
be done b y hand o r w ith a d e s k c a lc u la t o r .

D ru g -u s e s u rv e y s u s u a lly r e q u ir e " u n iv a r ia te " a n a ly s is , w h ic h e x a m in e s th e d a ta fo r

o n ly o n e v a r ia b le a t a tim e - e . g . , o v e r a l l r a t e s o f c a n n a b i s o r a l c o h o l u s e i n t h e s a m p le r.
T h e y a ls o r e q u ir e " b iv a r ia te " a n a l y s e s , i n w h i c h v a r i a b l e s a r e e x a m in e d t w o a t a t i m e - f o r
e x a m p le , d r u g - u s e r a t e s b y a g e , s e x , o c c u p a t io n o r o t h e r d e m o g r a p h ic c h a r a c t e r i s t i c s . If
th e re is a n e e d f o r m u l t i v a r i a t e a n a ly s e s , i n w h ic h m any v a r ia b l e s a r e c o n s id e r e d , th e n
la r g e n u m b e rs of s u b je c t s w ill be r e q u ir e d . B e n tle r et a l. ( 41) have d e s c r ib e d th e m a jo r
ty p e s of m u lt iv a r ia t e a n a ly s is t h a t m ay b e u s e d in d ru g -u s e s u rv e y s , in c lu d in g c lu s te r
a n a ly s is , d is c r im in a n t a n a ly s is , and a u to m a tic in te r a c tio n d e te c tio n a n a ly s is . They have
a ls o s p e c if ie d th e v a r ia b le s an d s a m p le s iz e s r e q u ir e d fo r each ty p e of a n a ly s is and show n
th e a c t u a l m e th o d s o f a n a l y s i s .

In any s u rv e y , a v a r y in g p r o p o r tio n of in c o m p le te q u e s tio n n a ir e s w ill be re tu rn e d .

Some a r e to ta lly u n u s a b le , e ith e r because th e re s p o n d e n t d id not fo llo w in s tr u c tio n s or
because he d id not ta k e th e s u rv e y s e r io u s ly . Q u e s tio n n a ir e s th a t have a s ig n ific a n t num ber
of in c o m p le t e a n d /o r in c o n s is te n t re s p o n s e s fo rm an in t e r m e d ia t e g ro u p . For th e s e , th e
 - 31 -
in v e s t ig a t o r m u s t d e c id e on s p e c if ic c r ite r ia fo r d e t e r m in g w hat q u e s tio n n a ir e s a re to be
in c lu d e d i n th e a n a ly s is . F o r e x a m p le , i n t h e WHO c o l l a b o r a t i v e s t u d y r e v i e w e d i n t h i s
r e p o r t , q u e s t io n n a ir e s w e re e x c lu d e d i f t h e y h a d f o u r o r m o re in c o m p le t e o r i n c o n s i s t e n t
a n s w e rs . The a d v a n ta g e s o f l i b e r a l c r i t e r i a f o r i n c l u s i o n a r e t h a t m o re q u e s t io n n a ir e s c a n
b e a n a ly s e d a n d t h a t t h e s a m p le w i l l b e l a r g e r a n d m o r e r e p r e s e n t a t i v e o f t h e p o p u l a t i o n
s u rv e y e d . The d is a d v a n ta g e s a re th a t th e d a ta a re not as r e lia b le and th a t th e num ber o f
a n s w e rs fo r each q u e s tio n n a ir e ite m w ill v a ry . If ra th e r s tr ic t c r ite r ia a re a d o p te d , th e
d a ta a n a ly s is w ill be p e rfo rm e d o n q u e s tio n n a ir e s th a t a re fo r th e m ost p a rt p r o p e r ly
c o m p le te d — hence th e d a ta w ill b e m o re r e l i a b l e . T h e d is a d v a n t a g e is t h a t m o re q u e s tio n ­
n a ir e s a re r e je c te d , so th e r e s u lts a re le s s r e p r e s e n t a t iv e of th e p o p u la tio n s u rv e y e d .
In v e s tig a to r s who h a v e c o n s id e r a b le e x p e r ie n c e in s e lf- a d m in is te r e d q u e s tio n n a ir e s u rv e y s
g e n e r a lly expect to o m it 5 -1 0 % of q u e s tio n n a ir e s fro m th e a n a ly s is fo r re a s o n s of in c o m ­
p le t e n e s s or in c o n s is te n c y . The p r o p o r tio n of in c o n s is te n t and in c o m p le t e q u e s tio n n a ir e s
is g re a te s t when th e s a m p le c o n ta in s young s tu d e n ts — e . g . , b e lo w th e age of 14— and le a s t
w ith o ld e r s tu d e n ts .

Types of q u e s tio n s in d ru g -u s e s u rv e y s fo r y o u th

U s u a lly d ru g -u s e s u rv e y s in c lu d e q u e s tio n s o n d e m o g r a p h ic c h a r a c te r is tic s and d ru g -u s e

ite m s , but th e re has been g re a t v a r ia t io n in th e m e a s u re s of th e s e v a r ia b le s , so th a t no
" s ta n d a rd " set e x is ts . A p p a r e n t ly , o n ly th re e te a m s of in v e s t ig a t o r s have used s im ila r
q u e s tio n n a ir e s in a lo n g s e r ie s of s u rv e y s . S im ila r , but not id e n tic a l, d e m o g r a p h ic and
d ru g -u s e q u e s tio n s w e re u s e d in B la c k f o r d 's s tu d ie s in San M a te o , C a lifo r n ia (4 2 ), th e
s tu d ie s by J o h n s to n et a l. e ls e w h e r e in th e USA (2 4 ), and th o s e by S m a rt & F e je r in T o ro n to
(9 ). H o w e v e r, o th e r q u e s tio n s have been changed fro m one s u rv e y to a n o th e r - f o r e x a m p le ,
th o s e c o n c e r n in g p e r s o n a lity , a t t it u d e s , and o p in io n s a b o u t d ru g s .

W h a t s h o u ld be in c lu d e d i n a d ru g -u s e s u rv e y is la r g e ly a m a t t e r o f t h e g o a ls o f th e
s u r v e y , th e tim e a v a ila b le , and th e re s p o n d e n ts ' c a p a c it ie s . I f t h e s u r v e y g o a ls a r e
lim ite d to g ro s s e s tim a te s of th e fre q u e n c y of d ru g use, o n ly a fe w q u e s tio n s about th e
m a jo r p o p u la r d ru g s a re r e q u ir e d . The m o s t im p o r ta n t c a t e g o r ie s o f q u e s tio n have been
c o v e re d in th e d is c u s s io n o f c o r e an d o p t io n a l ite m s (c h a p te r 2 .2 ) . T he a d v a n ta g e o f
in c o r p o r a t in g ite m s fr o m th e q u e s t io n n a ir e m e n tio n e d in th is re p o rt i s t h a t th e d a ta
o b ta in e d w ill be c o m p a r a b le w i t h d a ta p ro d u c e d by o th e r in v e s t ig a to r s c o lla b o r a tin g w ith
WHO a n d th e U n ite d N a tio n s in th e assessm ent o f d ru g -a b u s e p r o b le m s . To cover a ll a re a s of
in q u ir y in a s e lf- a d m in is te r e d s u r v e y m ay b e im p o s s ib le and u n n e c e s s a ry . If d a ta on th e
c o r r e la te s of d ru g use a re d e s ir e d , at le a s t d e m o g r a p h ic c h a r a c te r is tic s s h o u ld be in c lu d e d .
Age, sex, o c c u p a tio n , and e d u c a tio n ha ve u s u a lly been c lo s e ly r e la t e d to a ll ty p e s of use
and a b u s e . O th e r c o r r e la t e s , s u c h a s a t t it u d e s o r p e r s o n a l i t y t r a i t s , m ay a ls o b e d e s ir e d
and a la r g e n u m b e r o f in v e s t ig a t io n s h a v e in c lu d e d q u e s tio n s on th e s e a s p e c ts (s e e M e rc e r &
S m a rt ÇO f o r a r e v ie w ) . H o w e v e r, i t h a s b e e n r e c o g n i z e d t h a t d r u g —u s e q u e s t i o n n a i r e s a re
u s u a l l y t o o lo n g a n d t e d io u s ( 1 2 ) . T h e y s h o u ld b e m ade a s s h o r t a n d i n t e r e s t i n g a s
p o s s ib le .

In v e s tig a to r s s h o u ld in c lu d e o n ly what is e s s e n tia l in th e q u e s tio n n a ir e . O n e m e th o d

of in c r e a s in g th e num ber o f v a r ia b le s is to h a v e m o re th a n on e v e r s io n of th e q u e s tio n n a ir e .
C e r t a in c o re ite m s m ay b e com m on t o a ll fo rm s , but o th e r v a r ia b le s m ay b e in c lu d e d in o n ly
one fo rm . Of c o u rs e , th is m e th o d w i l l w o rk o n ly if th e re is a s u f f ic ie n t num ber of re s p o n ­
d e n ts to p r o v id e a d e q u a te s a m p le s fo r e a ch fo rm .

W hen s u r v e y s a re c o n d u c te d in c la s s r o o m s , th e y m u st be c o m p le te d in one c la s s p e r io d
(3 0 - 45 m i n u t e s ) . T h is in c lu d e s t im e f o r g i v i n g i n s t r u c t i o n s , a n s w e r in g q u e s t io n s , and
c o lle c t in g a n s w e r s h e e ts . T h e a c t u a l tim e s p e n t w i l l b e d i c t a t e d b y t h e r e a d in g and
a n s w e r in g s p e e d o f th e s lo w e s t c h i l d i n th e s a m p le b e i n g t e s t e d . T h u s s a m p le s t h a t i n c l u d e
a w id e r a n g e o f ages w i l l r e q u ir e d if f e r e n t le n g th s o f s u r v e y tim e . U s u a lly s tu d e n ts ag ed
1 2 - 13 y e a r s w i l l t a k e t w ic e a s lo n g t o a n s w e r a q u e s t io n n a ir e as th o s e a g e d 17 - 18 y e a r s .
R e a d in g l e v e l s m a y a l s o v a r y a m o n g s a m p le s o f t h e sa m e a g e , a n d s tu d e n ts r e c e iv in g s p e c ia l
e d u c a tio n fo r th e re ta rd e d or " s lo w p ro g re s s " c la s s e s w ill o fte n ta k e c o n s id e r a b ly lo n g e r to
c o m p le te q u e s tio n n a ir e s . C a re s h o u ld be ta k e n to p re te s t th e q u e s tio n n a ir e on th e s lo w e s t-
w o r k in g as w e ll as th e f a s t e s t - w o r k in g s u b je c t s of th e s a m p le . S o m e tim e s in v e s t ig a t o r s d ra w
 - 32 -
up tw o q u e s tio n n a ir e s : one fo r younger s tu d e n ts , c o n ta in in g o n ly d e m o g r a p h ic and d ru g -u s e
ite m s , and a n o th e r fo r o ld e r s tu d e n ts , w ith th e sa m e i t e m s p lu s a d d itio n a l a t t it u d e or
p e r s o n a lity ite m s . T h is a llo w s e v e ry o n e to fin is h at about th e sam e t i m e and a ls o a llo w s
th e c o lle c tio n of som e d a t a on th e c o r r e la te s of d ru g u s e .

The g e n e ra l fo rm a t a n d w o r d in g of q u e s tio n n a ir e s a re im p o r ta n t. T h e re is a te n d e n c y
fo r som e in v e s t ig a to r s to p re fe r a n o p e n -e n d e d s ty le - i.e ., w h e re th e s u b je c t w r ite s in
th e a n s w e r - r a t h e r th a n a c lo s e d s t y l e , w h e re t h e p o s s ib le a n s w e rs a r e s p e c if ie d an d th e
r e s p o n d e n t m a rk s o n e o f th e m . T h e o r e t i c a l l y , o p e n -e n d e d q u e s t io n s a l l o w m o re s p e c i f i c i t y
a n d m a y b e m o re s e n s i t i v e t o c h a n g e s o v e r t im e . H o w e v e r, re s p o n d e n ts f r e q u e n t ly have
d i f f i c u l t y i n s p e c if y in g c e r t a i n i n f o r m a t io n — s u c h a s t h e e x a c t n u m b e r o f t im e s a d ru g w as
used— and a re a b le to m ake o n ly ro u g h e s tim a te s . S p e c ifie d answ er c a te g o r ie s ta k e th is
lim ita tio n in to account and m ay be p re c o d e d to s im p lify d a ta p r o c e s s in g . M any o p e n -e n d e d
q u e s tio n s , on th e o th e r hand, have to be coded e v e n t u a lly if th e y a re to be c o m p u te r-
p ro c e s s e d , and th is adds e n o r m o u s ly to th e d u r a tio n and cost of th e s u rv e y re s e a rc h .
U ncoded or o p e n -e n d e d q u e s tio n s a re best le ft fo r s m a ll p ilo t s tu d ie s .

A n o th e r a s p e c t r e g a r d in g fo rm a t c o n c e rn s " s k ip " d ir e c tio n s . As d is c u s s e d e a r lie r (s e e

page 1 9 ), th e s e a re in s tr u c tio n s to re s p o n d e n ts not to answ er p a r tic u la r q u e s tio n s if th e y
have a n s w e re d an e a r lie r one in a c e r ta in w ay. For e x a m p le , " if you have no fa th e r, do n o t
answ er th e q u e s tio n s on f a t h e r 's o c c u p a tio n or e d u c a tio n " .I n g e n e r a l, " s k ip " d ir e c tio n s
a re best a v o id e d , s in c e m any re s p o n d e n ts fa il to re a d th e m c a r e f u l l y . T h is is p a r t ic u la r ly
th e case w ith c h ild r e n aged 14 y e a r s or b e lo w . If such d ir e c tio n s a re a b s o lu te ly n e c e s s a ry ,
th e y s h o u ld be fe w in n u m b e r, c le a r ly m a rk e d on th e q u e s tio n n a ir e , and, if p o s s ib le ,
e x p la in e d to re s p o n d e n ts o r a lly .

C o n f id e n t ia lit y v e rs u s th e need to id e n tify s u b je c t s

The le g a l and e th ic a l is s u e s c re a te d b y d ru g -u s e s u rv e y s v a ry fro m c o u n try to c o u n try

d e p e n d in g on lo c a l la w s and c u s to m s . In som e c o u n tr ie s such c o n c e rn s a re m in im a l; in
o th e rs , re s p o n d e n ts ' r ig h ts a re p ro te c te d th ro u g h th e le g a l and p r o fe s s io n a l g u id e lin e s fo r
re s e a rc h . In som e c o u n t r i e s , s ig n e d q u e s tio n n a ir e s s t a t in g th a t a g iv e n s tu d e n t has used
illic it d ru g s a re c o n s id e r e d as "h e a rs a y e v id e n c e " and cannot be u se d a g a in s t th e s u b je c t in
c o u rt. H o w e v e r, it is p o s s ib le th a t th e y m ig h t be u s e d in in v e s t ig a t io n s . B eyond th e s e
le g a l q u e s tio n s , re s p o n d e n ts w o u ld n o t w is h th e ir q u e s tio n n a ir e s to be used fo r p u rp o s e s
beyond re s e a rc h . I n g e n e r a l, re s p o n d e n ts have th e r ig h t to c o n f id e n t ia lit y and to fre e d o m
fro m h a rm if th e y p a r t ic ip a t e in d ru g -u s e s u rv e y s .

For th e ty p e o fre s e a rc h u n d e r d is c u s s io n , th e re a re o n ly th re e s itu a tio n s in w h ic h it

is n e c e s s a ry to have nam es o r id e n tify in g m a rk s : w h e re te s t-re te s t r e l i a b i l i t y s tu d ie s a re
p la n n e d ; w h e re q u e s tio n n a ir e d a ta a re b e in g c o m p a re d w i t h d a ta fro m o th e r s o u rc e s , such as
sch o o l re c o rd s ; an d w h e re fo llo w - u p s tu d ie s a re p la n n e d . In a sense a ll th e s e a re " f o llo w -
up" s tu d ie s , s in c e th e in v e s t ig a t o r w is h e s to m a tc h q u e s tio n n a ir e re s p o n s e s w ith o th e r d a ta
about th e in d iv id u a l. The in d iv id u a l's r ig h t to p r iv a c y has to b e m e a s u re d a g a in s t th e need
of th e in v e s t ig a t o r and of s o c ie ty at la r g e to know th e r e s u lts of fo llo w - u p s tu d ie s .

A n u m b e r o f m e th o d s f o r p r o t e c t i n g t h e r i g h t s o f s u b je c t s h a v e b e e n d e v e lo p e d . I n som e
c a s e s , a c o d e h a s b e e n d e v e lo p e d w h e r e b y e a c h s u b je c t i s g iv e n a u n iq u e n u m b e r , w h ic h i s
p la c e d o n th e q u e s t io n n a ir e . F o r th e p e rs o n s c o n d u c tin g th e s u r v e y o r h a n d lin g th e s u rv e y
q u e s tio n n a ir e s th e d a ta a r e i d e n t i f i e d o n ly b y n u m b e r. A t h i r d p a r t y k e e p s th e lis t of
n u m b e rs w ith th e id e n tify in g n a m e s ., but does not have th e q u e s tio n n a ir e d a ta . In som e cases
th e n a m e -n u m b e r lis t w ill have been sent out of th e c o u n try to a d is ta n t th ir d p a rty .

O th e r m e th o d s h a v e b e e n d e v e lo p e d fo r th e assessm ent o f te s t-re te s t r e lia b ilit y , in

w h ic h re s p o n d e n ts a re asked to f i l l in id e n tic a l q u e s tio n n a ir e s on tw o o c c a s io n s . O ne m e th o d
is to p re p a re la b e ls w ith th e nam e a n d u n iq u e num ber of each re s p o n d e n t. Tw o q u e s t i o n n a i r e s
w ith th e sa m e n a m e a n d num ber a re p re p a re d fo r ea ch re s p o n d e n t. A t th e tim e of th e fir s t
te s t re s p o n d e n ts te a r o ff th e ir nam es and hand in th e q u e s tio n n a ir e th a t has o n ly a num ber
on i t . A t th e re te s t, it is n e c e s s a ry to m ake s u re th a t each re s p o n d e n t r e c e iv e s th e r ig h t
q u e s tio n n a ir e .
 - 33 -
In fo llo w - u p s tu d ie s , th e m o s t u s u a l m e th o d of p r o te c tin g th e id e n tity of re s p o n d e n ts
is to use s e lf- g e n e r a te d codes. T h e s e m ig h t be u s e fu l in fo llo w - u p and te s t-re te s t s tu d ie s ,
but le s s so in s tu d ie s a s s o c ia t in g q u e s tio n n a ir e d a ta w ith o th e r ca se m a te r ia l. V a r io u s
p o s s ib ilit ie s e x is t. J. S w is h e r ( u n p u b lis h e d o b s e r v a t io n s , 1977) tr ie d u s in g th e s t u d e n t 's
te le p h o n e n u m b e r, but fo u n d th a t m a ny n u m b e rs w e re w ro n g at th e second t e s t in g . H. A n n is &
P. Kohn ( u n p u b lis h e d o b s e r v a t io n s , 1977) have begun a fo llo w - u p s tu d y u s in g 4 ite m s : th e
fir s t le tte r of th e r e s p o n d e n t 's m o t h e r 's fir s t nam e, th e day of th e m o n th in w h ic h th e
re s p o n d e n t w as b o r n , th e fir s t le tte r of h is fir s t nam e, and th e s tre e t num ber of h is house
at th e tim e of th e fir s t te s t. T h is 4 - it e m code does not ta x th e m e m o ry a n d s h o u ld not
change w ith tim e . S tu d e n ts s h o u ld be a b le to use such a s y s te m w ith o u t d if f ic u lt y . In
p r a c tic e , h o w e v e r , so m e c a s e s a r e l o s t t o a n a ly s is b e c a u s e e a r lie r and la te r d a ta c a n n o t be
m a tc h e d . T h e r e fo r e , o t h e r te c h n iq u e s a r e p r e fe r a b le .

In c o n c lu s io n , r e lia b ilit y and fo llo w - u p s tu d ie s c re a te c e r ta in e th ic a l and c o n fid e n ­

tia lity p r o b le m s . H o w e v e r, such s tu d ie s a re v a lu a b le a n d m e th o d s of c a r r y in g th e m out a re
im p r o v in g .

M o n ito r in g tre n d s and e v a lu a t in g p r e v e n t io n p ro g ra m m e s

In v e s tig a to r s w ho u s e th e q u e s tio n n a ir e p re s e n te d h e re w ill h a v e v a r io u s a im s . Some

w ill be c o n d u c tin g th e ir d ru g -u s e s u rv e y s o le ly in o rd e r to o b ta in in f o r m a t io n on th e n a tu re
an d e x t e n t o f u s e a t a g iv e n tim e . M o s t i n v e s t ig a t o r s a r e i n t e r e s t e d o n ly i n d e t e r m in in g a
p o in t p r e v a le n c e e s t im a t e . H o w e v e r, som e w i l l b e i n t e r e s t e d i n e x a m in in g t r e n d s a n d i n
p ro g ra m m e e v a lu a t io n .

M o n ito r in g tre n d s . D ru g -u s e p a tte rn s a re c o n s ta n tly c h a n g in g , and u s u a lly o n ly

in f o r m a l or in d ir e c t m eans a re a v a ila b le fo r e x a m in in g th e s e changes — e .g ., h o s p ita l
re c o rd s , a rre s t d a ta , and d ru g s e iz u r e s . Tw o lo n g - te r m s tu d ie s have b e e n m ade of d ru g use
in h ig h - s c h o o l s tu d e n ts . B la c k fo r d (42) has s u rv e y e d s a m p le s of C a lifo r n ia s tu d e n ts
a n n u a lly and S m a rt & F e je r (9 ) have s tu d ie d T o ro n to s tu d e n ts over 6 y e a rs . These s tu d ie s
p e r m it an e x a m in a tio n of how d ru g use is c h a n g in g , w hat ty p e s of use a re b e c o m in g m o r e
p o p u la r (fo r e x a m p le , le s s illic it use a n d m o re d r in k in g ) , and w h a t c o r r e la te s of use a re
c h a n g in g (s u c h a s m o re use by fe m a le s ) . R e p e a te d annual s u rv e y s a ls o p r o v id e an o p p o rtu n ­
ity fo r s p e c ia l s tu d ie s , fo r e x a m p le , in th e T o ro n to s tu d ie s , s p e c ia l s e c tio n s on d ru g
e d u c a tio n , d r in k in g and d r iv i n g , an d p e r s o n a lit y v a r ia b le s . E a ch r e p e a t s u r v e y in v o lv e s
t h e sa m e d e m o g r a p h i c a n d d r u g - u s e q u e s t i o n s w i t h d iffe r e n t, s p e c ia lly c o n s tr u c te d s e c tio n s
cho sen w ith a v ie w to th e ir t im e lin e s s and p r io r it y .

R e p e a te d c r o s s - s e c tio n a l s u rv e y s a re fa r cheaper a n d m o re e a s ily m anaged th a n fo llo w -

up s o f in d iv id u a ls a re . I f re p e a te d s u rv e y s a re p la n n e d t o m o n it o r t r e n d s i n s c h o o ls , i t
i s n e c e s s a r y t o r e t a i n t h e sam e s a m p lin g s y s te m , a d m in is tr a tiv e p ro c e d u re s , and p a r ts o f
th e q u e s tio n n a ir e to be c o m p a re d over tim e . So e ffo rt is m ade to re s u rv e y th e sam e
in d iv id u a ls .

Of c o u rs e , such s tu d ie s m ust be of f a ir ly s h o rt d u r a tio n , s in c e tru e s a m p lin g s im i­

la r it y is d if f ic u lt to m a in t a in . S c h o o ls change w ith tim e , and a p a r tic u la r s a m p le of
s c h o o ls th a t is r e p r e s e n t a t iv e of th e to ta l at th e o u ts e t of th e s tu d y m ay n o t c o n tin u e to
be r e p r e s e n t a t iv e . S c h o o ls m ay be c lo s e d , th e y m ay b e g in to s e rv e d iffe r e n t p o p u la tio n s ,
or th e ir f u n c tio n m ay c h a n g e . W hen t h e s e e v e n ts o c c u r, it m ay b e n e c e s s a r y to d ra w new
s a m p le s o f s c h o o l s , w h i c h w i l l c o n tin u e to y ie ld s a m p le s of s tu d e n ts r e p r e s e n t a t iv e of th e
r e g i o n b e in g m o n it o r e d ( 2 4 ) .

E v a lu a t in g p ro g ra m m e s . O n ly r a r e l y have d ru g -u s e s u rv e y s been used in p ro g ra m m e

e v a lu a t io n , a lth o u g h th e y c o u ld be. They s h o u ld be c o n s id e r e d to e x a m in e th e im p a c t of
e d u c a t io n a l p ro g ra m m e s and c e r ta in le g a l changes. If e ff e c tiv e p r e v e n t iv e e d u c a tio n
p ro g ra m m e s a re in tr o d u c e d , d ru g -u s e s u rv e y s c o u ld d e te c t d e c lin in g d ru g use or c h a n g in g
p a tte rn s of use. S y s te m a tic e v a lu a t io n s tu d ie s c o u ld be im p l e m e n t e d if e d u c a tio n a l
p ro g ra m m e s w e re im p l e m e n t e d in so m e s c h o o ls but not in o th e rs , and if b e fo re -a n d -a fte r
s u rv e y s w e re m ade in b o th ty p e s of s c h o o l.
 - 34 -
D ru g -u s e s u rv e y s m ig h t a ls o be u se d to e x a m in e th e e ffe c ts of le g a l changes. For
e x a m p le , it has been fo u n d in som e c o m m u n i t i e s th a t, a fte r th e le g a l d r in k in g age has been
lo w e r e d , a n in c r e a s e i n t h e d r i n k i n g p r o b le m h a s b e e n d e t e c t e d i n s t u d e n t s u r v e y s ( 4 3 ) .
D ru g -u s e s u r v e y s m ig h t b e u s e d t o m o n i t o r t h e e f f e c t s o f c h a n g e s i n la w s r e g a r d i n g p e n a l t i e s
fo r d ru g use - e .g ., th e lib e r a liz a tio n of c a n n a b is la w s , th r o u g h w h ic h p e n a ltie s a re
re d u c e d , m ig h t r e s u l t in an in c r e a s e in c a n n a b is use am ong s tu d e n ts .
 - 35 -

A nnex 2

STUDENT D R U G -U SE Q U E S T IO N N A IR E

The q u e s tio n n a ir e w as f in a liz e d a fte r t e s t in g fo r r e lia b ilit y and v a l i d i t y in seven

c o u n tr ie s . I t has th re e s e c tio n s : q u e s tio n s 1 -6 re q u e s t in f o r m a t io n o n d e m o g r a p h ic
c h a r a c te r is tic s , q u e s tio n s 7 -2 0 c o n c e rn fre q u e n c y and age a t fir s t use fo r 13 ty p e s of
d ru g in c lu d in g a lc o h o l and to b a c c o , and q u e s tio n s 21 and 22 r e la t e to th e h o n e s ty w ith
w h ic h th e q u e s tio n s w e re a n s w e re d .

E s s e n t ia lly th e sa m e q u e s t i o n - a n d - a n s w e r s e ts w e re used in th e te s t, w ith so m e i m p r o v e ­

m e n ts in th e ite m s on d ru g use and d e m o g r a p h ic c h a r a c te r is tic s . A lie s c a le w as in c lu d e d
in th e te s te d q u e s tio n n a ir e , but th is has been o m it t e d fro m th e q u e s tio n n a ir e g iv e n in th is
annex, because of th e n u m e ro u s d iffic u lt ie s of in t e r p r e t a t io n .

The fo rm a t of th e fin a l q u e s tio n n a ir e is s lig h tly d iffe r e n t fro m th a t of th e te s te d

v e r s io n . For e x a m p le , th e q u e s tio n s fo r each ite m a re now w r it t e n out in fu ll ra th e r th a n
b e in g a b b r e v ia t e d . A ls o , th e f i n a l q u e s tio n n a ir e d o e s n o t c o n ta in " s k ip " in s tr u c tio n s ,
w h ic h , i n th e e a r l i e r v e r s io n , r e q u ir e d t h e r e s p o n d e n t t o d is r e g a r d ite m s on d ru g s th a t he
or she had n e v e r u s e d . The re s p o n d e n t is now re q u e s te d to answ er a ll ite m s , because
in v e s t ig a t o r s fe lt th a t th e " s k ip " q u e s tio n s w e re to o c o m p le x in som e s e t t in g s , e s p e c ia lly
fo r younger s tu d e n ts .
 - 36 -
YOUTH SURVEY QUESTIONNAIRE

T h is q u e s tio n n a ir e has been d e v e lo p e d by th e W o r ld H e a lth O r g a n iz a t io n in c o o p e r a tio n

w ith th e U n ite d N a tio n s F u n d f o r D ru g A b u s e C o n t r o l. The q u e s tio n s a s k a b o u t d r u g u s e as
w e ll a s y o u r a g e , w h e t h e r y o u a r e a m a le o r a f e m a l e , a n d s o o n . Y o u r a n s w e rs w i l l be
lo o k e d at b y p e o p le who a r e tr y in g to le a r n m o re a b o u t d ru g use and w i l l be c o m p a re d w i t h
th e a n s w e rs m ade b y y o u n g p e o p le in o th e r p a rts of th e w o r ld .

If th is s tu d y is to be h e lp f u l, it is im p o r ta n t th a t you s h o u ld answ er each q u e s tio n

as c a r e fu lly as p o s s ib le . A ll your a n s w e rs w ill be kept s tr ic tly c o n f id e n t ia l an d we a r e
not a s k in g you y o u r nam e.

M o s t p e o p le e n jo y fillin g in th is q u e s tio n n a ir e , and we h o p e th a t you w i l l to o . Be

s u re to re a d th e in s tr u c tio n s b e fo re you b e g in to a n s w e r.

IN S T R U C T I O N S

This is not a test: ther e a r e n o ri g h t o r w r d n g answers, b u t p l e a s e a n s w e r carefully.

Fo r ea ch q u es ti on p i c k the a n s w e r that fi ts you the b e s t a n d p u t an X in the b o x

o p p o s i t e that answer. P i c k o n l y o n e a n s w e r f o r each question. L o o k a t the e x am pl e below:

H a v e you dr u n k a n y w a t e r d u r i n g the la st 30 da ys ?

□ A No

□ B Yes, on 1-5 days

□ C Yes, on 6-19 days

0 D Yes, on 20 or m o r e da ys

The a n s w e r chosen w a s "D", i n d i c a t i n g that the p e r s o n w h o a n s w e r e d the q u e s t i o n h a d

dr un k w a t e r on 2 0 o r m o r e da ys d u r i n g the p r e v i o u s 30 days.

I f you do n o t k n o w the a n s w e r to a question, or i f you feel that you ca nn ot a n sw er

h o n e s t l y , le av e the q u e s t i o n blank. C o m p l e t e as m a n y qu es t i o n s as possible.
 - 37 -

A r e you a m a l e o r a f e m a l e I I A Male
I I B Female

What is yo ur age? Years

H o w m a n y ye ar s o f sc ho ol h a v e you Years
c o mp le te d? (Do n o t c o u n t k i n d e r g a r t e n )

F o r m o s t o f the la st 12 mo nths, we re u I was n o t a s t ud en t d u r i n g m o s t

you a student, f u l l - t i m e or o f the la st 12 m o n t h s
part-time? □ I was a p a r t - t i m e st ud en t
n I was a f u l l - t i m e st ud en t

I h a v e n o t w o r k e d on a p a i d j o b
F o r m o s t o f the l a s t 12 months, h a v e □ d u r i n g m o s t o f the last 12 m o n t h s
you w o r k e d on a p a i d job, f u l l - t i m e
I h a v e w o r k e d on a p a r t - t i m e p a i d
or p a r t - t i m e ?
jo b
I h a v e w o r k e d on a f u l l - t i m e p a i d
jo b

I h a v e n o t w o r k e d on an u n p a i d j o b
F o r m o s t o f the la st 12 months, h a v e □ d u r i n g m o s t o f the la st 12 m o n t h s
you w o r k e d on a n . u n pa id job, f u l l - t i m e
I h a v e w o r k e d on a p a r t - t i m e un pa id
or part-time? □ job
I h a v e w o r k e d on a f u l l - t i m e un pa id
□ job

FOR EVERY Q U E S T IO N YOU MUST READ PARTS (a ), (b ), (c ),.a n d (d ), AND ANSWER EACH PART

(a) H a v e you ev er smoked, chewed, or I 1 A No

s n i f f e d an y to ba cc o p r o d u c t (such
! j B Yes
as cigarettes, cigars, p i p e tobacco,
chewing tobacco)?

(b) H a v e y o u smoked, chewed, o r sn if fe d □ A No

a tobacco p r o d u c t i n the p a s t 12
□ B Yes
months?

(c) H a v e you smoked, chewed, o r s n if fe d □ A No

a to ba cc o p r o d u c t d u r i n g the p a s t
□ B Yes
30 days?

H a v e n e v e r smoked, chewed, or
(d) H o w o l d w e r e you w h e n you fi r s t □ n
sn if fe d to bacco p r o d u c t s
smoked, chewed, o r s n i f f e d a
to ba cc o p r o d u c t ? □ B l o year s old, or less

□ C 11-12 year s ol d

□ D 13-1 4 year s ol d

□ E 15-1 6 year s old

□ F 17-1 8 year s old

□ G 19 years o l d , or m o r e
 - 38 -

8. (a) H a v e you e v e r dr u n k an y a l c o h o l i c □ il No
b e v e r a g e (including beer, wine,
□ B Yes
and spirits)?

(b) H a v e you dr un k a n y a l c o h o l i c □ A No
b e v e r a g e in the p a s t 12 m o n t h s ?
□ B Yes

(c) H a v e you d r u n k a n y a l c o h o l i c □ A No
b e v e r a g e d u r i n g the p a s t 30 days ?
□ B Yes, on 1-5 days

□ C Yes, on 6-19 days

□ D Yes, on 20 o r m o r e days

1_
— 1 H a v e n e v e r dr un k alcoholic
(d) H o w o l d w e r e you wh en you fi rs t 1 1 /7i1
beverages
h a d a driiik o f beer, wine, or
s p ir it s — m o r e than j u s t a sip? □ B 1 0 years old, o r less

□ C 11-1 2 year s old

□ D 13-14 year s old

□ E 15 - 1 6 year s old

□ F 1 7 - 1 8 year s old

□ G 19 year s old, or m o r e

9. (a) H a v e you ev er taken a n y ca nn ab is □ A No

(marijuana, pot, hashish, grass,
□ B Yes
bhang, ganja) ?

(b) H a v e you taken an y c a n n ab is in the □ A No

p a s t 12 m o n t h s ?
□ B Yes

(c) H a v e you taken an y c a n n a b i s d u r i n g □ A No

the p a s t 3 0 days?
B Yes, on 1-5 days
a
□ C Yes, on 6-19 days

□ D Yes, on 2 0 o r m o r e days

(d) H o w o l d w e r e you wh en you first □ A H a v e n e v e r taken cann ab is

took cann ab is ?
□ B 1 0 years old, o r less

□ C 11-1 2 year s ol d

□ D 13-14 year s old

□ E 15-1 6 year s old

□ F 17-1 8 year s o l d

□ G 19 year s old, o r m o r e
 - 39 -
10. (a) H a v e you ev er taken a n y co caine? □ A No

□ B Yes

(b) H a v e you taken a n y c o ca in e in the □ A No

p a s t 12 m o n t h s ?
□ B Yes

(c) H a v e you taken a n y co ca in e d u r i n g n A No

the p a s t 30 days?
□ B Yes, on 1-5 days

u C Yes, on 6-19 days

□ D Yes, on 20 or m o r e days

(d) H o w o l d we re you w h e n you firs t □ A H a v e ne v e r t a k e n c o c a i n e

took cocaine?
□ B 1 0 years old, or less

□ C 11-1 2 year s old

□ D 13-14 years old

! 1 E 15 -1 6 year s o l d

□ F 17 -1 8 year s old

n G 19 years old, or m o r e

11. (a) H a v e you ev er take n any u A No

a m p h e t a m i n e s or o t h e r s t i m u l a n t s
u B Yes
(u p p e r s , bennies, speed, p e p pills,
di et pills) w i t h o u t a d o c t o r o r h e a l t h
w o r k e r t e ll in g you to do so?

(b) H a v e you taken a n y a m p h e t a m i n e s or □ A No

o t h e r s t i m u l a n t s in the p a s t 12
□ B Yes
m o n t h s w i t h o u t a d o c t o r or h e a l t h
w o r k e r t e ll in g you to do so?

(c) H a v e y o u taken a n y a m p h e t a m i n e s or □ A No
o t h e r s t i m u l a n t s d u r i n g the p a s t
□ B Yes, on 1-5 days
30 da ys w i t h o u t a d o c t o r or h e a l t h
w o r k e r t e ll in g you to do so? □ C Yes, on 6-19 da ys

□ D Yes, on 2 0 o r m o r e days

(d) H o w o l d w e r e you wh en you fi r s t □ A H a v e n e v e r take n am ph et a m i n e s

took an a m p h e t a m i n e o r ot he r
□ B 1 0 years old, o r less
stimulant without a doctor or health
w o r k e r t e l l i n g you to ta ke it? n C 11-1 2 ye ar s old

□ D 13-14 years old

□ E 15 - 1 6 ye ar s old

□ F 17-18 years old

u G 19 years old, or m o r e

(e) I f you h a v e e v e r taken am ph et a m i n e s

o r ot he r stimulants, w r i t e in the
n a m e o f the o n e you h a v e taken
m o s t recently.
 - 40 -

12. (a) H a v e you ev er taken a n y h a l l u c i n o g e n s | | A No

(LSD, me sc al in e, pe yote, ps il oc yb in , i— i
B Yes
PCP)? '— '

(b) H a v e you taken a n y h a l l u c i n o g e n s Q A No

in the p a s t 12 m o n t h s |— |
B Yes

(c) H a v e you taken a n y h a l l u c i n o g e n s Q A No

d u r i n g the p a s t 3 0 days ? j— j
B Yes, on 1-5 days

□ C Yes, on 6-19 days

□ D Yes, on 20 o r m o r e days

(d) H o w o l d w e r e you when you fi r s t took [^ ] A Have n e v e r taken h a l l u c i n o g e n s

a ha l l u c i n o g e n ?
□ B lo years old, o r less

□ C 11-1 2 year s o l d

D 13-1 4 year s o l d
. □
□ E 15 -1 6 ye ar s old

□ F 17 -1 8 ye ar s old

□ G 19 year s old, o r m o r e

(e) I f you h a v e e v e r taken halluc in og en s,

w r i t e in the n a m e o f the o n e you
took m o s t recently.

13. (a) H a v e you e v e r s n i f f e d o r i n h a l e d □ A No

th in gs (such as glue, ae rosol
□ B Yes
sprays, o r o t h e r gases) to g e t h i g h ?
(Do n o t i n c l u d e smoke)

(b) H a v e you s n i f f e d or i n h a l e d th in gs n A No
to get h i g h in the p a s t 12 m o n t h s ?
□ B Yes

(c) H a v e yo u s n i f f e d o r i n h a l e d things n A No
to g e t h i g h d u r i n g the p a s t 30 days ?
□ B Yes, on 1-5 days

□ C Yes, on 6-19 days

□ D Yes, on 20 or m o r e d a y :

1— I Have never sniffed or .

(d) H o w o l d w e r e you wh en you fi rs t !__ 1 /2i
a n y t h i n g to get hi gh
s n i f f e d o r i n h a l e d s o m e t h i n g to
get hi g h ? n B 10 years old, o r less

□ C 11-1 2 year s old

□ -D 13-14 year s old

□ E 15-1 6 year s o l d

□ F 17 - 1 8 year s o l d

□ G 19 years old, o r m o r e
(e) I f y o u h a v e e v e r s n i f f e d or i n h a l e d
things, w r i t e in the n a m e o f the _
th i n g you h a v e s n i f f e d o r i n h a l e d
m o s t recently.
 - 41 -
14. (a) H a v e you ev er taken any j | A No
t r an qu il li ze rs (Librium, Valium,
j 1 B Yes
Mi ltown) wi t h o u t a d o c t o r o r h e a l t h
w o r k e r t e l l i n g you to do so?

(b) H a v e you taken a n y tr an qu i l l i z e r s |_____I A No

in the p a s t 12 m o n t h s w i t h o u t a
| j B Yes
do c t o r or h e a l t h w o r k e r t e ll in g
you to do so?

(c) H a v e you taken a n y tr an qu i l l i z e r s | | A No

d u r i n g the p a s t 30 da ys wi t h o u t a
‘_____j B Yes, on 1 - 5 days
doctor or health worker telling
you to do so? ' | C Yes, on 6-19 days

j D Yes, on 2 0 o r m o r e days

(d) H o w o l d we re you when you fi r s t | j A H a v e n e v e r taken t r a n q u il iz er s

took a t r a n q u i l l i z e r wi t h o u t a
■____ j B 10 years old, o r less
d o c t o r or h e a l t h w o r k e r t e ll in g
you to take it? j C 11-1 2 year s old

j D 13 -1 4 years old
j E 15 -1 6 year s old

1 F 17-18 years o l d

I j G 19 years old, o r more

(e) I f you h a v e e v e r taken tr an qu i l l i z e r s

w r i t e in the n a m e o f the o n e you
h a v e taken m o s t recently.

15. (a) H a v e you e v e r taken a n y se da t i v e s ' I A No

(barbiturates, downers, goofballs,
~ B Yes
Seconal) w i t h o u t a d o c t o r or h e a l t h
w o r k e r t e ll in g you to do so?

(b) H a v e you taken a n y s e d a t i v e s in the ,~ j A No

p a s t 12 m o n t h s w i t h o u t a d o c t o r or
! B Yes
h e a l t h w o r k e r t e l l i n g you to do so?

(o) H a v e you taken a n y s e d a t i v e s d u r i n g A No

the p a s t 30 d a y s w i t h o u t a d o ct or
B Yes, on 1-5 days
or h e a l t h w o r k e r t e l l i n g you to do
so? C Yes, on 6-19 days

D Yes, on 2 0 or m o r e days

(d) H o w o l d we re you wh en you fi rs t A Have n e v e r taken s e da ti ve s

took a s e d a t i v e wi th ou t a d o ct or
B 10 years old o r less
or h e a l t h w o r k e r t e l l i n g you to do
so? C 11-12 years old
D 13-14 years old

E 15-1 6 years old

F 17-1 8 ye ar s o l d
G 19 years old, o r m o r e
(e) I f you h a v e ev er taken sedatives,
wr i t e in the n a m e o f the one you
h a v e taken m o s t recently.
 - 42 -

16. (a) H a v e you ev er s m o k e d o r eaten any u A No

op i u m w i t h o u t a d o c t o r o r h e al th
□ B Yes
w o r k e r t e ll in g you to do so?

(b) H a v e you s m o k e d or eate n an y op i u m 1 A No

in the p a s t 12 m o n t h s wi t h o u t a
d o c t o r o r h e a l t h w o r k e r te ll in g
□ B - Yes

you to do so?
(c) H a v e you s m o k e d or eaten any op i u m □ A No
d u r i n g the p a s t 30 da ys wi thout
a d o ct or o r h e a l t h w o r k e r te ll in g
p B Yes, on 1-5 days

you to do so? □ C Yes, on 6-19 days

□ D Yes, on 20 o r m o r e days

(d) H o w o l d w e r e you wh en you firs t .A H a v e n e v e r s m o k e d or ea te n op iu m

□
s m o k e d o r a t e op iu m wi th ou t a
□ B 10 year s old, or less
d o c t o r o r h e a l t h w o r k e r te ll in g
you to do so? □ C 11-1 2 years old

n D 13-14 year s old

□ E 15-1 6 years ol d

□ F 1 7 - 1 8 years ol d

□ G 19 ye ar s old, or m o r e

17. (a) H a v e you ev er taken a n y h e ro in i ; A No

(horse, smack, H) ?
□ B Yes

(b) H a v e yo u taken a n y h e r o i n in the □ A No

p a s t 12 m o nt hs ?
i_i B Yes

(c) H a v e you taken a n y h e r o i n d u r i n g □ A No

the p a s t 30 days?
□ B Yes, on 1-5 days

□ C Yes, on 6-19 days

□ . D Yes, on 20 or m o r e days

(d) H o w o l d we re you when you firs t □ A H a v e n e v e r taken h e ro in

took h e ro in ?
! ! B 1 0 year s old, or less

□ C 11-1 2 years old

j i D 13-14 years old
E 15-1 6 years old

□ F 1 7 - 1 8 year s old

□ G 19 year s old, o r m o r e
 - 43 -
18. (a) H a v e you e v e r taken a n y o t h e r op iate No
(methadone, morp hi ne / codeine,
□ B Yes
D e merol, p a re go ri c) wi t h o u t a d o c t o r
or h e a l t h w o r k e r t e ll in g you to do so?

(b) H a v e you taken a n y o f thes e o p ia te s □ A No

in the p a s t 12 m o n t h s w i th ou t a
□ B Yes
d o c t o r o r h e a l t h w o r k e r t e l l i n g you
to do so?

(c) H a v e you taken an y o f thes e op ia te s A No

□
d u r i n g the p a s t 30 days w i t h o u t a
□ B Yes, on 1-5 da ys
do c t o r o r h e a l t h w o r k e r t e l l i n g you
to do so ? □ C Yes, o n 6-19 days

□ D Yes, on 20 or m o r e days

(d) H o w o l d w e r e y o u when y o u firs t n A H a v e n e v e r taken op ia te s

took a n y o f th es e o p i a t e s w i th ou t
□ B l O years old, or less
a d o c t o r or h e a l t h w o r k e r te l l i n g
yo u to do so? C 11 -1 2 year s old
□
□ D 13-14 years o l d

□ E 15-1 6 ye ar s old

i i F 17-1 8 year s old

n G 19 years old, o r m o r e

19. (a) A r e th e r e a n y o t h e r dr u g s n o t □ A No
m e n t i o n e d that you h a v e taken in
□ B Yes
the p a s t y e a r w i t h o u t a d o c t o r or
h e a l t h w o r k e r t e l l i n g you to do so?
(b) I f yes, w r i t e in the n a m e o f the
d r u g o r drug s here.

20. (a) D o you k n o w o f a n y o t h e r drug s that □ A No

p e o p l e a r e n o w t a k i n g to m a k e them
□ B Yes
feel g o o d or in to xi c a t e d ?

(b) I f yes, what a r e thes e dr u g s called?

21. I f you h a d ev er us ed a n y cannabis, wo ul d □ No

you h a v e a d m i t t e d i t in this q u e s t i o n ­
□ B N o t su re
naire?
□ Yes

22. I f you h a d e v e r us ed an y o p i u m or heroin, A No

w o u l d you h a v e a d m i t t e d it in this
B N o t sure
questionnaire?
C Yes

TH ANK YOU FOR C O M P LE TIN G T H IS Q U E S T IO N N A IR E

 - 44 -
Annex 3

IN S T R U C T IO N S TO IN V E S T IG A T O R S FOR USE OF THE Q U E S T IO N N A IR E

P la n n in g of th e s u rv e y

In v e s tig a to r s w ill need to p la n th e im p le m e n ta tio n of any s u rv e y c a r e fu lly . The

a c tu a l tim e r e q u ir e d fo r any s u rv e y depends on its s iz e and th e f a m ilia r it y of th e
o r g a n iz e r s in c o n d u c tin g such s tu d ie s . T im e fo r e a c h e le m e n t in th e p la n m u s t b e m o re th a n
a d e q u a te to a llo w fo r som e e l e m e n t s to be la te . T h e m a jo r e le m e n ts of p la n n in g a re lis te d
in th e a c c o m p a n y in g ta b le , a lo n g w ith a s a m p le tim e - t a b le fo r im p le m e n tin g th e v a r io u s
s ta g e s of a h y p o th e tic a l s u rv e y to be c o m p le te d in 15 m o n th s .

T IM E -T A B L E FOR SURVEY IM P L E M E N T A T IO N

D u r a tio n (m o n th s )
A c tiv itie s
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

P la n n in g

Q u e s tio n n a ir e d e s ig n

S a m p li n g p la n

P ilo t te s t q u e s tio n n a ir e
and p ro c e d u re s

A rra n g e m e n ts w ith school

T r a in in g of s u p e r v is o r s

A d m in is tr a tio n of s u rv e y

D a ta a n a ly s is

W r itin g of re p o rt

S a m p lin g

Some f o r m of r a n d o m iz e d s a m p lin g is re c o m m e n d e d in s tu d e n t s u rv e y s . In o rd e r to do
th is , it is n e c e s s a ry to ha ve a lis t of c la s s e s and s c h o o ls fro m w h ic h to s a m p le . U s u a lly ,
c la s s e s and not s tu d e n ts a re th e s a m p lin g u n it in th e s e s tu d ie s . An a lt e r n a t iv e is to use
th e e n tir e s c h o o l p o p u la tio n of a g iv e n a re a or to use a ll c la s s e s of a c e r ta in ty p e of
s tu d e n t.

A d a p ta tio n of th e q u e s tio n n a ir e

M uch o f th is q u e s tio n n a ir e c o n s is t s of a s ta n d a rd set of q u e s tio n s about d ru g use,

w h ic h is re p e a te d fo r each d ru g . T h e re fo re , it is im p o r ta n t to e x a m in e th e q u e s tio n s in
th is set to be s u re th a t th e y w ill w o rk w e ll in th e s tu d y b e in g p la n n e d . Each in v e s t ig a t o r
can th e n a d a p t th e q u e s tio n n a ir e t o h is n e e d s and to th e lo c a l s itu a tio n . The f o llo w in g
a re som e o p t i o n a l c h a n g e s t o c o n s i d e r .

(1 ) In v e s tig a to r s m ay f i n d , on e x a m in in g q u e s tio n s on th e use of a d ru g in th e r e s p o n d e n t 's

life tim e , or in th e p a s t y e a r, th a t th e y w o u ld lik e to h a v e m o re d e ta ile d in f o r m a t io n th a n
s im p ly a "Y e s /N o " a n s w e r. If so, th e y m ig h t r e p h r a s e , fo r e x a m p le , q u e s tio n 9 (a ) fro m
"H a v e you ever ta k e n any c a n n a b is ? " to "O n h o w m a n y o c c a s i o n s ( if any) have you ta k e n
c a n n a b is ? " . Then th e answ er s e t m ig h t be e la b o r a te d to s o m e th in g on th e fo llo w in g lin e s .

A. N ever D. 6 to 9 o c c a s io n s

B. 1 or 2 o c c a s io n s E. 10 to 49 o c c a s io n s

C. 3 to 5 o c c a s io n s F. 50 o r m o re o c c a s io n s
 - 45 -
The answ er c a t e g o r ie s c o u ld b e m o re or le s s d e ta ile d , d e p e n d in g on th e d is t in c t io n s needed
in th e r e s u lts . The q u e s tio n oh c a n n a b is use in th e p r e v io u s year /9 ( b m ig h t be e la b o ­
ra te d in m uch th e sam e w a y . For p u rp o s e s of in t e r n a t io n a l c o m p a r is o n , th e p r o p o r tio n s of
a n s w e rs to each of th e q u e s tio n s B -F m ay b e c o m b in e d . The r e s u lt in g p r o p o r tio n m ay be
c o m p a re d w ith th e p r o p o r tio n of "Y e s " a n s w e rs to th e q u e s tio n in its o r ig in a l fo rm . S uch
e la b o r a tio n s m ake th e q u e s tio n n a ir e lo n g e r and r e q u ir e m o re r e s p o n d e n t tim e , so it w o u ld
be a good id e a to p re te s t th e m b e fo re m a k in g a fin a l d e c is io n .

(2 ) A n o th e r v e ry im p o r ta n t aspect of d ru g -u s e q u e s tio n s is th e d e fin itio n of th e d ru g or

d ru g c la s s . O b v i o u s l y , t h e p u r p o s e i s t o c o m m u n ic a t e c le a r ly to re s p o n d e n ts , in te r m s th e y
w ill u n d e r s ta n d , th e ty p e o f d r u g i n q u e s tio n . T h e re a r e v a r io u s m e th o d s , w h ic h w i l l be
e ffe c tiv e in v a r io u s c o u n tr ie s , so th e w o r d in g s h o u ld be a lte r e d as m uch as n e c e s s a ry to
c la r ify th e c o m m u n ic a tio n . S o m e tim e s g e n e r ic or tra d e nam es fo r d ru g s w ill b e m e a n in g fu l
id e n tifie r s fo r re s p o n d e n ts ; s o m e t im e s g iv in g th e le g itim a te m e d ic in a l p u rp o s e w ill h e lp .
U s u a lly p o p u la r or s la n g nam es h e lp to id e n tify th e d ru g s , and so m e i n v e s t i g a t o r s m ay w is h
to use a c o m b in a tio n of a ll th e s e a p p ro a c h e s . E x a m p le s of th e s e a p p ro a c h e s have been g iv e n
in p a re n th e s e s in th e p r e c e d in g q u e s tio n n a ir e . The q u e s tio n s as th e y a re c u r r e n t ly w o rd e d
have been c a r e fu lly th o u g h t out by th e c o lla b o r a tin g in v e s t ig a t o r s , so an e ffo rt s h o u ld be
m ade t o r e t a i n t h e e s s e n c e o f t h e i r m e a n in g . In som e s itu a tio n s , h o w e v e r, th e y m ay h a v e
to be s u b s t a n t ia lly r e fo r m u la te d .

For d ru g s such as b a r b itu r a te s and tr a n q u illiz e r s , w h ic h a re s o m e t im e s g iv e n by a

d o c to r or h e a lth w o rk e r, th e q u e s tio n s ask o n ly a b out use th a t o c c u rre d w ith o u t such
m e d ic a l s u p e r v is io n . It m ay be th a t in v e s t ig a to r s a ls o want in f o r m a t io n about th e e x te n t
to w h ic h th e s e d ru g s a re b e in g used u n d e r m e d ic a l s u p e r v is io n . In th a t case, an a d d it io n a l
but s im ila r set of q u e s tio n s c o u ld be asked ju s t b e fo re or a fte r th e q u e s tio n s about
n o n m e d ic a l u s e . H o w e v e r, to do so w o u ld le n g t h e n an a lr e a d y fa ir ly lo n g and r e p e titiv e
s e c tio n a b o u t d ru g use.

(3 ) W h e re a p p r o p r ia te , " p h a r m a c is t" m ay b e added to th e l i s t o f h e a lth p r o f e s s i o n a l s w ho

m ay " p r e s c r ib e " s u b s ta n c e s fo r m e d ic a l u s e (s e e s u b it e m s ( a ) - ( d ) o f q u e s tio n s 1 1 -1 9 ).

(4 ) The fo rm a t of d ru g -u s e ite m s m ay be a lte r e d to in c o r p o r a t e " s k ip " or b r a n c h in g

in s tr u c tio n s , if su ch d ir e c tio n s can be fo llo w e d e a s ily and a c c u r a t e ly . T h is m ig h t re d u c e
th e tim e needed to c o m p le te th e q u e s tio n n a ir e and to m o n ito r r e p e titiv e ite m s , but c a u tio n
is a d v is e d , s in c e such in s tr u c tio n s m ay b e d if f ic u lt fo r so m e s tu d e n ts to fo llo w .

(5 ) Age c a t e g o r ie s f o r t h e f i r s t u s e o f a s u b s ta n c e m a y b e a l t e r e d , d e p e n d in g o n th e age
ra n g e o f t h e s a m p le s u r v e y e d . F o r e x a m p le , i f q u e s t i o n n a i r e s a r e a d m i n i s t e r e d t o u n iv e r s it y
s tu d e n ts o r a d u lt s , i t w i l l be n e c e s s a ry t o e xp a n d on th e re s p o n s e c h o ic e " 1 9 y e a r s o ld , or
m o r e " ( a n d t o c o m b in e y o u n g e r a g e r a n g e s ) f o r t h e ( d ) p a r t s o f t h e d r u g - u s e ite m s .
S im ila r ly , th e q u e s tio n m ig h t be changed to "In what year d id you fir s t ta k e .... (n a m e of
d ru g )? ". T h is w o u ld r e q u ir e answ er boxes to be p r o v id e d fo r th e y e a r, such as 19 ( [ |.

(6 ) R e g a r d in g th e ite m on to b a c c o u s e , th e i n v e s t i g a t o r m ay w is h to in q u ir e about th e m e th o d
of in g e s tio n b y p r o v id in g th e fo llo w in g re s p o n s e c a t e g o r ie s : c ig a r e tte s m o k in g , p ip e
s m o k in g , c i g a r , s m o k in g , to b a c c o c h e w in g , and to b a c c o s n iffin g . S im ila r ly , fo r o th e r ty p e s
of d ru g , it m ay be d e s ir a b le to o ffe r th e fo llo w in g re s p o n s e c a t e g o r ie s : b y m o u th , by
in je c tio n , by s m o k in g , by s n iffin g , or by in h a lin g .

(7 ) F o r d ru g s th a t a re r e la t iv e ly unknow n lo c a lly , th e in v e s t ig a t o r m ay e lim in a te ite m s

p e r ta in in g to t h e ir use.

(8 ) W h e re n e c e s s a r y , th e in v e s t ig a t o r m ay f e e l th a t th e fo llo w in g d e s c r ip tio n s of th e m e d i­
cal a p p lic a tio n s of v a r io u s s u b s ta n c e s w ill h e lp th e re s p o n d e n t to d iffe r e n tia te d ru g
c la s s e s .In such cases, he m ay w is h to p r o v id e re s p o n d e n ts w ith th e f o llo w in g in f o r m a t io n .

T r a n q u illiz e r s D o c to rs p r e s c r ib e th e s e to c a lm p e o p le down.

S e d a tiv e s D o c to rs p r e s c r ib e th e s e to h e lp p e o p le to r e la x and fa ll a s le e p .
 - 46 -
O p ia te s V a r io u s d r u g s a r e m ade fr o m o p iu m a n d m a y b e p r e s c r i b e d b y d o c to rs to
re d u c e p a in , s to p c o u g h in g , c o n t r o l d ia r r h o e a , and so o n . T h e y in c lu d e
s y n th e tic d ru g s , such a s m e th a d o n e , as w e ll as d e r iv a tiv e s of n a tu ra l
o p iu m .

(9 ) The o r ig in a l d ru g -u s e q u e s tio n s have b e e n m o d ifie d to in c lu d e th e s u b q u e s t io n (e ) " If

you have ever ta k e n /a m p h e ta m in e s , h a llu c in o g e n s , in h a la n ts , tr a n q u illiz e r s , s e d a tiv e s ,
e tc ^ 7 w r ite in th e nam e o f th e one you have ta k e n m ost r e c e n tly " . The re a s o n fo r th is
q u e s tio n is th a t it g iv e s in f o r m a t io n on th e s p e c if ic d ru g s m o st r e c e n tly abused.

At tim e s , th e re m ay b e a need fo r e v e n m o re in f o r m a t io n on a s p e c if ic d ru g . For

e x a m p le , g o v e rn m e n t or i n t e r n a t i o n a l a u t h o r i t i e s m ay w is h t o k n o w th e e x t e n t o f u s e o f a
s p e c if ic s u b s ta n c e in o r d e r t o d e t e r m in e w h e t h e r t h e l e g a l c o n t r o l s s h o u ld b e c h a n g e d . In
th is case, it w o u ld b e p o s s ib le to add an a d d itio n a l q u e s tio n to o b ta in a n s w e rs to d ru g -u s e
s u b q u e s t io n s (a ) - (d ) r e g a r d in g th e use o f: t h e s p e c if ic d ru g a b o u t w h ic h th e re is c o n c e rn .

B ecause d r u g - a b u s in g p o p u la tio n s fr e q u e n tly do n o t know th e c o rre c t g e n e r ic nam es of

th e d ru g s th a t th e y use, it w o u ld be u s e fu l to g iv e as m uch d e s c r ip t iv e in f o r m a t io n as
p o s s ib le in th e q u e s tio n to h e lp th e s u b je c t to id e n tify th e c o rre c t d ru g . H o w e v e r, th e
in v e s t ig a t o r is c a u tio n e d not to in s e r t to o m any a d d itio n a l q u e s tio n s of th is ty p e : th e
d ru g s a v a ila b le on th e lic it and illic it m a rk e t num ber in th e th o u s a n d s and it w o u ld not be
fe a s ib le to ask about even a s m a ll p e rc e n ta g e of th e m .

(1 0 ) If an ite m on th e ty p e of c o m m u n it y is to be in c lu d e d — e .g ., p la c e of c u rre n t
r e s id e n c e : c i t y , s u b u rb , to w n , r u r a l a re a , o r v illa g e — t h e r e s p o n s e c a t e g o r ie s s h o u ld b e
a p p r o p r ia te t o l o c a l n o rm s . If re s p o n d e n ts a re c u r r e n t ly l i v i n g a w ay fr o m t h e i r hom es ( i n
s c h o o l r e s id e n c e s , i n s t i t u t i o n s , e t c . ) , th e i n v e s t ig a t o r m u s t d e t e r m in e b e fo r e h a n d w h e t h e r
th e d a ta a re to r e f e r t o t h e i r p r e s e n t l i v i n g a re a o r to t h e i r hom e l o c a t i o n , i f th e s e
d iffe r . Some i n v e s t i g a t o r s have fo u n d it u s e fu l to ask b o th th e p re s e n t a d d re s s and th e
p e rm a n e n t a d d r e s s . ,

(1 1 ) In v e s tig a to r s m ay w a n t to add an ite m about th e am ount of s p e n d in g m o n e y a v a i l a b l e to

s tu d e n ts fro m a ll s o u rc e s , s in c e th is m ay r e la t e to th e ir d ru g -u s e p a tte rn s .

(1 2 ) R e g a r d in g s o c ia l s ta tu s , som e ite m s — s u c h as p a re n ta l e d u c a tio n , p la c e of r e s id e n c e ,

o c c u p a tio n , and in c o m e of th e head of th e h o u s e h o ld — s h o u ld be in c o r p o r a te d in to th e
q u e s tio n n a ir e . U se th e ite m s th a t a re r e le v a n t in your s e t t in g fo r d e t e r m in in g an in d e x of
s o c io e c o n o m ic s ta tu s . B ecause of th e g re a t v a r ia t io n in s o c ia l- s ta tu s in d ic a to r s in
d iffe r e n t p a rts of th e w o r ld , no s ta n d a r d iz e d ite m s a re p r o v id e d in th is re p o rt.

(1 3 ) If n e c e s s a ry (p e rh a p s fo r younger re s p o n d e n ts ), in s tr u c tio n s m ay be expanded to

p r o v id e m o re d e ta ile d d ir e c tio n s and e x a m p le s of how to c o m p le te th e q u e s tio n n a ir e .

(1 4 ) A d d itio n a l q u e s tio n s can be added, d e p e n d in g on th e in v e s t ig a t o r 's p u rp o s e s and th e

a b ility of re s p o n d e n ts to h a n d le a lo n g e r q u e s tio n n a ir e . G e n e r a lly , in v e s t ig a t o r s have a
te n d e n c y to u n d e r e s tim a te th e tim e it w ill ta k e , so th e y s h o u ld keep tra c k of th e t im e
r e q u ir e d fo r s u rv e y a d m in is tr a tio n in th e p re te s t. It is a ls o a good id e a in th e p re te s t
to d is c u s s th e q u e s tio n n a ir e in fo r m a lly w ith re s p o n d e n ts once th e y have fin is h e d , to see
w h e re th e y had d i f f i c u l t i e s and w h a t t h e ii'g e n e r a l r e a c tio n w as.

(1 5 ) M any s u rv e y re s e a rc h e rs fe e l th a t, u n le s s you ask th e sam e q u e s t i o n s , in th e sam e

o rd e r, w ith th e sa m e in s tr u c tio n s , and in a s im ila r s e t t in g , c o m p a r a b ility w ill be re d u c e d .
T h e i n v e s t i g a t o r w ho u s e s t h i s q u e s t io n n a ir e s h o u ld th e re fo re n o t m ake any of th e m o d ific a ­
t i o n s m e n tio n e d a b o v e u n le s s t h e r e i s g o o d r e a s o n .

T r a n s la t io n of th e q u e s tio n n a ir e

T h is re p o rt, in c lu d in g th e fin a l q u e s tio n n a ir e , w ill b e p u b lis h e d a ls o in F re n c h .

In a d d itio n , it has been tr a n s la te d fo r t e s t in g in to C h in e s e , M a la y , S p a n is h , H in d i, and
U rd u . If th e WHO y o u t h s u rv e y q u e s tio n n a ir e is to be tr a n s la te d in to o th e r la n g u a g e s , it
w ill be im p o r ta n t to e n s u re th a t th e re is la n g u a g e e q u iv a le n c e b e tw e e n th e q u e s tio n n a ir e
as p u b lis h e d in th is re p o rt and th e tr a n s la te d q u e s tio n n a ir e as it is to be a p p lie d .
 - 47 -
A num ber of a p p ro a c h e s have been used to e n s u re th e e q u iv a le n c e of tr a n s la te d v e r s io n s
of q u e s tio n n a ir e s . In th e WHO I n t e r n a t i o n a l P ilo t S tu d y of S c h iz o p h r e n ia (4 4 ) a tra n s -
la tio n /b a c k - tr a n s la tio n a p p ro a c h w as u s e d . The p ro c e d u re w as to have one p e rs o n tr a n s la te
th e in s tr u m e n t fro m th e "s o u rc e " la n g u a g e , in th is case E n g lis h , in to th e "ta rg e t" la n g u a g e ;
th is tr a n s la tio n w as th e n g iv e n to a n o th e r p e rs o n fo r tr a n s la tio n back in to E n g lis h . They
th e n c o m p a re d th e o r ig in a l and th e b a c k - tr a n s la tio n . In o rd e r to g u a ra n te e a r e a s o n a b ly
s a tis fa c to r y tr a n s la tio n , th is p ro c e d u re m ay be re p e a te d s e v e ra l tim e s .

A n o th e r w ay t o e n s u re e q u iv a le n c e of tr a n s la tio n is to have each ite m d is c u s s e d

i n t e n s i v e l y a n d a t le n g t h b y i n d i v i d u a l s w ho s p e a k b o t h s o u r c e a n d t a r g e t la n g u a g e s . For
m o re d e t a i l e d d is c u s s io n o f th e s e a n d r e l a t e d p r o c e d u r e s t h e r e a d e r i s r e f e r r e d t o th e
r e le v a n t lite r a tu r e (44, 45, 4 6 ).

Q u e s tio n n a ir e a d m in is tr a tio n

E ach in v e s t ig a t o r s h o u ld adapt th e in s tr u m e n t to h is lo c a l s e t t in g an d m o d ify th e

q u e s tio n n a ir e fo rm a t when n e c e s s a ry . W h e re school a u t h o r it ie s b e lie v e th a t c e r ta in
q u e s tio n s w o u ld s t im u la t e in t e r e s t in d ru g s , th o s e q u e s tio n s c a n b e d e le t e d .

M o s t d a ta c o lle c tio n w ill be c a r r ie d out in g ro u p a d m in is tr a tio n s e t t in g s such as

c la s s r o o m s or a u d ito r ia . It is s tr o n g ly re c o m m e n d e d th a t a d m in is tr a tio n of th e s u rv e y be
d ir e c te d by th e re s e a rc h te a m and n o t by te a c h e r s or o th e r in s titu tio n a l s ta ff, s in c e
re s e a rc h e rs can p re s e n t th e s tu d y m o re e f f e c t i v e l y and g iv e m o re r e a s s u r in g p r o m is e s of
c o n f id e n t ia lit y . Some i n v e s t i g a t o r s m ay w is h te a c h e rs to be p re s e n t, if th e y a re im p o r ta n t
fo r m a in t a in in g o rd e r.

The s ta n d a rd p ro c e d u re c a lls fo r r e s e a rc h s t a f f t o (a ) b r i e f l y in tr o d u c e th e s tu d y to
th e r e s p o n d e n t s , ( b ) r e m a in a v a ila b le t o a n s w e r q u e s tio n s w h ile th e q u e s t io n n a ir e s a r e b e in g
c o m p le te d , ( c ) c o l l e c t t h e q u e s t io n n a ir e s u p o n c o m p le tio n a n d , i f d e s ir e d ( d ) i n f o r m a l l y
d i s c u s s t h e q u e s t i o n n a i r e w i t h som e o r a l l o f t h e r e s p o n d e n t s a f t e r t h e s u r v e y a d m i n i s t r a ­
tio n is fin is h e d . It is s u g g e s te d th a t te a c h e rs s h o u ld not p a r tic ip a te in th e s e a c tiv i­
tie s .

I t i s s t r o n g l y re c o m m e n d e d t h a t t h e q u e s t i o n n a i r e s h o u l d b e a d m i n i s t e r e d a n o n y m o u s l y ,
and t h a t n o na m es o r i d e n t i f y i n g m a rk s s h o u ld b e p la c e d o n i t , e x c e p tw h e re r e q u ir e d f o r
p u rp o s e s of fo llo w - u p or r e lia b ilit y and v a l i d i t y s tu d ie s .

It is a ls o re c o m m e n d e d th a t r e lia b ilit y and v a l i d i t y s tu d ie s s h o u ld be c o n d u c te d th a t

a re a p p r o p r ia te fo r th e g ro u p s o n w h ic h th e q u e s tio n n a ir e s w o u ld be u se d . Some r e l i a b i l i t y
and v a l i d i t y c h e cks use d b y c o lla b o r a tin g in v e s t ig a to r s in th e t e s t in g of th is q u e s tio n n a ir e
a r e d e s c r ib e d e ls e w h e r e i n t h e r e p o r t .

D a ta a n a ly s is and r e p o r t in g

T h e m a in p u rp o s e of th e d a ta a n a ly s is w o u ld be to p r o v id e a s ta t is t ic a l p ic tu r e of th e
e x te n t of d ru g use in th e to ta l s a m p le and in v a r io u s s e g m e n ts of it , r e la t iv e to age, sex,
and s o c ia l c la s s g r o u p in g s . D a ta a n a ly s is w o u ld in c lu d e :

(1 ) R e lia b ility in f o r m a t io n in th e fo rm of c o r r e la tio n s b e tw e e n a n s w e rs on v a r io u s

t e s t in g s .

(2 ) V a lid ity in f o r m a t io n a d ju s t e d to th e s tu d ie s a c tu a lly done.

(3 ) The fre q u e n c y o f v a r io u s d e m o g r a p h ic c h a r a c te r is tic s in th e s a m p le chosen.

(4 ) The fre q u e n c y of use of each ty p e of d ru g and fo r e a c h p e r io d of tim e .

(5 ) C r o s s —t a b u l a t i o n o f d ru g u se w ith d e m o g r a p h ic and o th e r c h a r a c te r is tic s to id e n tify th e

g ro u p s m o st l i k e l y to use d ru g s .
 - 48 -
The re p o rt fro m th e s tu d y s h o u ld in c lu d e th e fo llo w in g : when th e s tu d y to o k p la c e ,
th e s iz e and n a tu re of th e s a m p le s , th e r e s u lts and re s p o n s e ra te s , th e m e th o d of a d m in is 1
te r in g th e q u e s tio n n a ir e s , th e s p e c if ic in s tr u m e n ts used, any e v id e n c e about v a lid ity or
r e lia b ilit y , and a d e s c r ip tio n of th e in s titu tio n s w h e re th e w o rk w as d o n e .
 - 49 -
Annex 4

O P T IO N A L Q U E STIO N S

Route o f drug administration | 1 S n i f f i n g o r "snorting"

| 1S m o k in g
Wh at m e t h o d s h a v e you u s e d f o r t a k i n g
heroin? (Mark all that apply) | [ In je ct io n

| | By mo u t h

I | Ot h e r (please specify)

So u r c e o f i n t r o d u c t i o n to d r u g use I | Family

I | Casual ac qu ai n t a n c e
Who i n t r o d u c e d you to n o n m e d i c a l d r u g
use? (Please ch ec k o n e b o x only) I j Friends

| j D r u g pu s h e r

□ D o c t o r (physician)
H Other health practitioner
I | P h a r m a c i s t or d r u g gi st
! 1O t h e r (please specify)
[ | D o n 't k n o w

R eason fo r f i r s t n o n m e d i c a l d r u g use □ R e l i g i o u s c u st om

□ To b e a c c e p t e d b y ot hers
What was the r e a s o n f o r y o u r fi r s t
no n m e d i c a l d r u g use? (Please chec k □ To b e so ci ab le
o n e b o x only)
n En jo y m e n t

En h a n c e m e n t o f sex
Cu ri o s i t y

□ Tr ea tm en t o f h e a l t h d i s o r d e r

n R e l i e f o f p s y c h o l o g i c a l s t re ss
R e l i e f o f cold, hunger, o r fa t i g u e
Improvement of work performance
Other (please specify)
D o n 't k n o w

Q u e s t i o n s d r o p p e d f r o m the te st ed
questionnaire

A. Wher e do you l i v e no w? On a f a r m o r in a vi llage

In a small o r m e d i u m - s i z e d ci ty or
town

In a s u bu rb o f a la r g e ci ty

□ In a la rg e city
 - 50 -

H o w m u c h e d uc at io n d i d your f a t h e r □ N o fo rmal s c h o o l i n g
receive? (Mark the h i g h e s t level
□ P r i m a r y school
attended)
□ Se co n d a r y o r h i g h school
U n i v e r s i t y o r ot he r p o s t - s e c o n d a r y
□ educ at io n

□ D o n 't k n o w

C. H o w m u c h ed uc a t i o n d i d yo ur m o t h e r □ N o fo rm al s c h o o l i n g
r e c e iv e? (Mark the h i g h e s t level
attended)
□ P r i m a r y school

□ S e c o n d a r y o r h i g h school

Un i v e r s i t y or ot h e r p o s t - s e c o n d a r y
□ ed uc at io n

n D o n 't k n o w

5. A p p r o v a l o r d i s a pp ro va l o f d r u g use

In di v i d u a l s d i f f e r in w h e t h e r or n o t they
d i s a p p r o v e o f p e o p l e d o i n g c e rt ai n things.
D o you d i s a p p r o v e o f p e o p l e (who a r e 18 or
older) d o i n g the f o l l o w i n g ? (Mark one
b o x f o r each question)

A. S m o k i n g 2 0 o r m o r e c i ga re tt es a da y □ Do n ' t d i sa pp ro ve

□ Disapprove

□ Strongly disapprove

T r y i n g m a r i j u a n a (cannabis, pot, I | Do n ' t d i s a p p r o v e

grass) o n c e o r twice
| | Disapprove

| | Strongly disapprove

C. Smoking marijuana occasionally I | Do n ' t d i s a p p r o v e

| | Disapprove

I | St r o n g l y d i s a p p r o v e

D. Smoking marijuana regularly | | D o n ' t d i sa pp ro ve

I | Disapprove

I | St r o n g l y d i sa pp ro ve

E.
I | Don't disapprove
(Other d r u g - r e l a t e d b e h a v i o u r o f
I | Disapprove
in t e r e s t to the invest ig at or )
I | Strongly disapprove
 - 51 -

6. Perceived availability
H o w di f f i c u l t do you thin k it w o u l d b e
fo r you to get each o f the f o l l o w i n g
types o f d r u g i f you w a n t e d some?
(Mark one b o x f o r each question)

A. Marijuana (c a n n a b i s , pot, grass) Q P r o b a b l y i m po ss ib le

□ Ve ry di ff ic ul t

□ F a i r l y difficult

□ F a i r l y easy

□ Very easy

B. Amphetamines and other stimulants |__ j Probably impossible

□ Ve ry di ff ic ul t

□ F a i r l y diff ic ul t

Lj F a i r l y easy

□ Ve ry easy

c.
Probably impossible
(Other d r u g o f i n t e r e s t to the
in ves tig a t o r ) Very diff ic ul t
F a i r l y diff ic ul t
F a i r l y easy
□ Ve ry easy

7. The so rt o f p e o p l e w h o use drugs

D r u g use h a s d i f f e r e n t me a n i n g s for
d i f f e r e n t people. We w a n t to k n o w h o w
you th i n k m o s t p e o p l e o f y o u r a g e v i e w
o t h e r s w h o u s e v a ri ou s drugs.

M o s t p e o p l e o f m y a g e b e l i e v e that those who

use m a r i j u a n a and o t h e r su ch dr ug s are:

A. Ambitious M u c h less than av e r a g e

□ L e s s than a v er ag e

□ A b o u t av erage
M o r e than a v er ag e

□ Much more th a n average

B. Antisocial M u c h le ss than av e r a g e

L e s s than av er ag e
H A b o u t av er ag e
M o r e than av er ag e
M u c h m o r e than av er ag e
 - 52 -

Note

A series of ques t i o n s m i g h t follow, on other social characteristics, such as

c. Co n f o r m i n g
D. Criminal
E. E m o t i o n a l l y unstable
F. Interesting
G. Reb e l l i o u s
H. S e n sible
I. Sexually permissive
J. W e ak-willed

The r e s p o n s e categories w o u l d be the sam e as for A a n d B.

 - 53 -

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