NIDA Resource Center for Health Services Research
DRUG ABUSE PREVENTION NEEDS ASSESSMENT METHODOLOGIES
A Review of the Literature
Barry S. Brown, Ph.D.
University of North Carolina at Wilmington
Hyperlinks to sections within this text:
Definition and Application to Drug Abuse Prevention Programming
Needs Assessment Data Collection Strategies: TABLE
Structure of Paper
Needs Assessment Strategies: Surveys
Assessment Strategies: Problem-Oriented Measures of Drug Use
Needs Assessment Strategies:
Community Resources to Provide Prevention Services
Definition and Application to Drug Abuse Prevention Programming
Needs assessment is used to understand the
nature and extent of a health or social problem in a community with the intent to respond
appropriately to that problem. The findings from a needs assessment are used to make
program, policy, and/or budget decisions. Needs assessment strategies are research based
to permit planning, programming, and resource expenditure guided by data rather than
subjective judgments or political considerations.
This report focuses on community-based needs
assessment strategies for drug abuse prevention. Therefore, the strategies described are
those that have been developed to clarify the direction and the urgency of drug abuse
prevention both nationally and within communities. Many, if not most, of the techniques
employed have relevance for treatment needs assessment as well.
Specific to drug abuse prevention, needs assessment
strategies typically are concerned with understanding the extent to which drug use is
being initiated within a community, the types of drugs used, the characteristics of new
users, and the extent and nature of continuing drug use in the community. A significant
concern is whether existing prevention programs are targeting appropriate groups with
Specific questions for needs assessment regarding
prevention may include the following: What is the incidence of drug use in the community?
What is the pattern of drug taking within the community in terms of drugs used,
characteristics of drug users, and the progression in drug taking among users? What are
the attitudes and behavioral intentions of individuals regarding drug use?
Because needs assessment is designed to meet a
communitys concerns regarding prevention efforts, the community should be involved
in setting study parameters. The involvement of community members in formulating questions
to be explored can forestall any risk that community interests and concerns are poorly
addressed. Indeed, the involvement of individuals responsible for authorizing a community
needs assessment in planning and conducting the study not only prevent later
misunderstanding, but also encourages cooperation from all segments of the community in
conducting the assessment and increases the likelihood of the ultimate utility of the
findings (Boyer & Langbein, 1991).
The prevention issue addressed has implications for
the assessment strategy employed. Where the prevention issue involves understanding and
containing the initiation of drug use, the assessment strategy may best involve a
community survey employing probability sampling with particular attention to monitoring
the incidence as well as prevalence of drug use. Where the prevention concern also
involves understanding and containing community problems associated with drug use, the
assessment strategy may best involve nonprobability sampling surveys conducted in health
care, social service, and criminal justice agencies in which the consequences of drug use
Conducting a needs assessment carries with it the
implication that the needs identified will be addressed through increased or modified
prevention programming. To identify problems in the absence of intent or capacity to
resolve those problems can only be demoralizing to the community. Responding to a
communitys identified needs will result in a commitment of people, time, and
dollars. The individuals responsible for addressing identified needs should be known, and
either the resources for responding to identified needs or a plan for acquiring those
resources should be available.
Needs assessments must be conducted in a timely
manner. The problem being addressed is usually one of some urgency. Therefore, the
community is likely to assume that the information received will result in a course of
action. The needs assessment should be conducted with the sense of urgency felt by the
community, balanced by concerns about the rigor of the study and the accuracy of its
Finally, the needs assessment should be replicated
in succeeding time periods to determine the extent to which policies and programs
initiated are effective in reducing the problems identified. Repeated needs assessments
can reveal the changing nature of community needs, for example, by identifying changes in
reported access and acceptability and/or use of a drug by a defined population. Current
information regarding availability of drugs, acceptance of drug taking, and the
characteristics of drug users is important to any prevention activity.
Overview and Conceptual Framework
Needs assessment describes the numbers and
characteristics of the population needing prevention services (i.e., immediately seeking
or requiring services). Needs assessment is a critical aspect of community prevention
planning, clarifying the needs of community residents and permitting informed decision
making regarding the allotment of resources in meeting those needs. The term need
in this context refers to the capability of deriving benefit from prevention services. A
distinction between demand and need can be made in association with the
urgency with which those services are required. Although that distinction is most often
applied to treatment, the same distinction may have relevance for prevention in terms of
individuals whose characteristics, behaviors, and/or circumstances place them at
particular risk for drug use (demand) and their age-group peers at lower levels of risk
for drug use (need).
Thus, although all members of certain age groups
(e.g., preadolescents and adolescents) may be at some level of risk for initiating drug
use, a hierarchy of need for prevention services may be created such that individuals are
characterized as being more or less vulnerable based on the presence of risk or protective
factors. A combination of individual and community characteristics may suggest that some
individuals demonstrate demand for prevention services based on heightened vulnerability,
whereas other individuals, at lower levels of vulnerability, but at a susceptible age, are
viewed as needing prevention services.
As depicted in Table 1, and as described below, the
data-gathering strategies for achieving estimates of the need and demand for prevention
services involve a mix of direct measures (i.e., population surveys employing probability
sampling), indirect measures (i.e., assessments based on the impact of drug use and drug
users on health, social service, and criminal justice systems), and ethnographic study
(i.e., information based on observation and/or description derived from individuals
experiencing the problem being addressed).
The data resources listed in Table 1 typically are
used to characterize drug use at a point in time and to monitor trends in drug use over
time. Increasingly, there has been an interest in developing statistical models to provide
estimates of the drug-using population for purposes of permitting still more precise
understanding of the impact of drug use on community service systems and better informing
the communitys response to drug use.
Although needs assessment involves estimating the
size and clarifying the nature of drug- using and risk populations, a second area involves
the nature and extent of services required to respond to the need or demand identified. To
determine the size and character of that response calls for a description of the size and
character of the population to be served, but it also calls for a description of services
available in the community. This suggests an assessment of the nature and quantity of
prevention services currently being provided and the extent to which available services
are and are not being accessed and, where essential services are not being accessed, the
impediments to their use. The interest and capacity of the community to provide prevention
resources also need to be assessed.
Needs Assessment Data Collection Strategies
Structure of Paper
The primary focus of this paper is a review of the strategies used
to conduct drug abuse prevention needs assessment in the community. The strategies
described are largely from the field of epidemiology and include survey techniques, field
studies, and ethnographic investigation. The paper explores the strengths and weaknesses
of each strategy, cost issues, and implementation. Estimation models, which make use of
data gathered through these strategies, are described.
Needs assessment strategies vary in their validity and in the
expense associated with conducting them. Therefore, communities may need to make difficult
choices between elaborate, rigorous, and expensive data-gathering strategies and
approaches that are more restricted in their coverage. Although the latter are more likely
to raise questions regarding credibility, they may prove more manageable in terms of cost.
In all situations, but particularly in those using less rigorous techniques, it is
important that investigators interpret their data with caution and not overinterpret their
findings. On the other hand, findings from limited, carefully conducted investigations can
provide important information about drug abuse problems and prevention programming needs
in a community. Most communities will need to purchase the best needs assessment available
to them under limited budgets. Therefore, any discussion of needs assessment must address
issues of cost and benefit associated with the range of strategies available.
Another important facet to assessing community needs is
understanding resources available to address those needs. Consequently, the paper explores
strategies to assess current and potential community resources to address the identified
prevention programming needs.
Finally, the paper examines strategies for communicating needs
assessment findings to community members to promote their use in establishing or
augmenting prevention services. If the needs assessment report is to be useful, its
communication to the community must be carefully planned and implemented.
Household Surveys Employing Probability Sampling
For both prevention and treatment planning, general
population surveys are widely regarded as "among the most common and reliable methods
of obtaining useable data for a needs assessment" (United Way of America, 1982). The
population survey employing probability sampling permits the selection of subjects who can
be seen as statistically representative of the study population. Thus, probability
sampling permits every individual in the targeted population to be available to the
survey, thereby allowing the unbiased selection of individuals and the unbiased canvasing
of needs. If the interview or questionnaire used to assess needs is found to measure needs
consistently over periods during which no change would be expected (i.e., is reliable) and
accurately reflects the behaviors or attitudes of respondents (i.e., is valid), the
resulting survey can provide a powerful tool for needs assessment. Indeed, population
surveys employing probability sampling have been the foundation of national needs
The National Household Survey on Drug Abuse (NHS),
conducted initially under sponsorship by the National Institute on Drug Abuse (NIDA) and
later by the Substance Abuse and Mental Health Services Administration (SAMHSA), has been
employed since 1974 to monitor drug use trends. The NHS is stratified (e.g., for age and
ethnicity), employs area probability sampling of persons aged 12 and older living in U.S.
households, and oversamples individuals between the ages of 18 and 34 (Turner, Lessler,
& Gfroerer, 1992). The data collection strategy involves the use of a structured,
closed-ended, face-to-face interview in which the respondent is guaranteed confidentiality
and anonymity. Self-administered answer sheets are completed by the respondent for several
sensitive questions (NIDA, 1991a; SAMHSA, 1995).
The Epidemiological Catchment Area (ECA) study also
was influential. The ECA sampled respondents in five communities between 1980 and 1984 to
determine rates of depressive disorders, anxiety disorders, drug abuse/dependence, and
alcohol abuse/dependence in the general population. The ECA used face-to-face interviews
and employed DSM-III criteria to define respondent status. The study revealed unexpectedly
high rates of psychological disorder in the general population and underscored the
importance of the relationship between substance abuse/dependence and psychological
disorders (Regier et al., 1988).
Assuming measures are valid and reliable,
well-conducted probability surveys of the population at risk afford the clearest guarantee
of obtaining samples that accurately reflect the larger population. In sampling from
households, the potential exists for making the target population virtually everyone with
stable residence in the community or, in the case of the NHS, virtually everyone with
stable residence in the country. The disadvantages of probability sampling relate
primarily, but not exclusively, to cost. The use of a household survey can have
limitations beyond cost for understanding prevention need. In that regard, the respondents
reached through a household survey constitute a comparatively stable portion of the
population and thereby are likely to provide an incomplete picture of prevention need.
That is, those in need of drug abuse prevention efforts will live both within and outside
of stable households (e.g., college dormitories) and, therefore, will be only partly
represented in a survey restricted to households. Moreover, one can assume that the more
likely that a drug is associated with a particular subgroup (e.g., "ecstasy"
with college students) or lies outside mainstream experience (e.g., heroin), the less
likely it is to be reported by respondents in a household survey. Nonetheless,
understanding the rates of use and the characteristics of the users of those drugs is
significant to prevention planning. Thus, in assessing prevention need, surveys of
households need to be augmented by studies of selected risk populations. Indeed, in 1991
the sampling frame for the NHS was broadened to include homeless shelters, military bases
(civilians only), college dorms, and other nonhousehold settings
Household and school-based surveys are particularly
important to the development or modification of prevention programming in a community.
Because these surveys capture both the incidence and prevalence of drug problems, they can
be employed to clarify emerging drugs of concern as well as reporting drugs that are in
significant use in a community (i.e., these surveys are useful in assessing both
prevention demand and prevention need). With prevention programming, there is often a
particular concern with adolescent and young adult populations (as suggested by the use of
school surveys), since these groups are viewed as particularly vulnerable to the
initiation or escalation of drug use. Escalation may involve increases in frequency of
drug use and/or involvement in a broader range of substances. If the community is focused
on understanding prevention programming needs, it may be useful to oversample adolescent
and young adult populations to obtain an understanding of substance-using behaviors in
those age groups. Panel studies could help clarify changing substance use patterns in
those groups. Attitudes and beliefs regarding substances and substance use in
preadolescent, adolescent, and young adult populations also may be assessed.
In addition to the necessity of sampling all
relevant parts of the population, there is a need to determine that the instruments and
procedures used to gather data guard against error. As described by Gfroerer, Gustin, and
Turner (1992), two kinds of error are a particular concern with assessments of drug use
prevention need. On the one hand, the respondent may make cognitive errors reflecting lack
of understanding or capacity to follow the interview or questionnaire and/or deficiencies
in memory. On the other, the respondent may be inclined to give socially desirable
responses to questions designed to tap sensitive areas of behavior. A variety of
strategies have been developed to reduce ambiguity and misunderstanding of interview or
questionnaire items and to enhance recall. Self-administered answer sheets and guarantees
of confidentiality and anonymity have been used to reduce the risk of respondents giving
socially desirable responses. Finally, completed surveys are subject to quality-control
procedures to ensure that client responses are consistent across items addressing
comparable behaviors and issues.
Surveys of Targeted Populations
Surveys have been conducted of population subgroups
that are of particular interest to prevention programming. These groups, which include
various subpopulations of adolescents and young adults (e.g., school dropouts, runaway
youth, juvenile offenders, college students, enlisted military), have been targeted
because they are vulnerable to initiating or escalating drug use and because they risk
being understudied in household surveys. The surveys have used probability-sampling
strategies for high school and military populations, and nonprobability sampling for other
populations whose numbers and characteristics are unknown, making probability sampling
The Monitoring the Future study, or the National
High School Senior Survey as it is frequently known, has been conducted annually since
1974 under NIDA sponsorship by the University of Michigans Institute for Social
Research. The study currently surveys high school graduates, college students, and eighth
and tenth grade students in addition to high school seniors. The Monitoring the Future
study involves stratification (by size, geographic region, urbanicity, etc.) of schools
and a multistage process to obtain a probability sample of high school students. In
addition, beginning in 1976, panel studies have been conducted annually with a random
sample of each graduating class. Thus, data are available on drug use and attitudes for a
consistent sample of respondents. Written questionnaires, rather than face-to-face
interviews, are administered as a part of routine school activity (Johnston, O'Malley,
& Bachman, 1989, 1995). Like the NHS, the Monitoring the Future study affords an
opportunity to monitor trends in drug use for an identified population over an extended
period. Whereas the identified population for the NHS includes all those living in
households, the identified population for the Monitoring the Future study are the members
of a restricted age group.
Student populations are of special concern to
prevention programming and, therefore, have received particular attention. Not only the
federal government, but various state and local jurisdictions as well, have developed
their own school-based survey strategies. Indeed, the State of Maryland has been
conducting school surveys virtually as long as the Monitoring the Future study has been in
existence (Maryland State Department of Education, 1994). As with household surveys, the
risk in relying on student surveys to understand adolescent drug use lies in acting as if
adolescents attending school are representative of all adolescents. Thus, in understanding
the prevention needs of a community, it is important to sample the less visible
populations of school dropouts, runaway youth, and juvenile offenders. Information
regarding the substance-using behaviors and attitudes of those populations may provide a
needed corrective to the data available from school attendees. Surveys or other strategies
may be called upon to clarify the functioning of those populations.
In addition to student populations, surveys have
been undertaken of military personnel (Bray et al., 1983, 1986; Burt & Biegel, 1980)
and of offenders incarcerated in state facilities (Innes, 1988).
Surveys Using Nonprobability Sampling
Surveys of populations less accessible than
households, high school students, armed forces personnel, or prisoners used nonprobability
sampling strategies. The populations studiedrunaway youth, school dropouts, and
juvenile justice clientsare each important to understanding a communitys
prevention needs and may each demand differing prevention strategies.
These surveys require (a) a definition of the
targeted population; (b) a sampling strategy that guards against bias in the selection of
respondents; and (c) the use of an instrument that guards against error in self-reported
behaviors and other areas of inquiry. In terms of study design, the sample drawn needs to
meet criteria that accurately describe the population of concern. For example, describing
runaway youth requires a definition of some minimal period of time of absence from the
parental or foster home. The definition will set the parameters for the population and
allow the cautious generalization of findings.
The size and characteristics of these populations
are not sufficiently well known to permit probability sampling; consequently, the
investigator needs to ensure that the sample drawn reflects the population in question
adequately and contains no known biases. Thus, a sample of runaway youth would not be
drawn solely from a shelter population, but would include the streets, soup kitchens, and
so on. Ideally, respondents would be obtained from these different settings in proportion
to the use made of them by runaway adolescents. An additional strategy employed in
nonprobability surveys has been targeted sampling (Watters & Biernacki, 1989) in which
the investigators assess the characteristics of the population being sampled and correct
the sample as it is being drawn to reflect those characteristics. It is also apparent that
in nonprobability surveys, it is particularly urgent to keep refusals to be interviewed to
a minimum and to avoid biasing the sample in the direction of respondents most likely to
volunteer for study (e.g., those most in need of the compensation typically offered to
As with probability sampling, it is important to
ensure that the measure employed uses a vocabulary and format that the target population
understands. Sensitive questions must be addressed in a manner that encourages honest
responses. Again, it is crucial to guarantee each respondent's confidentiality and
Issues in Survey Methodology
A number of innovative strategies have been used in
conjunction with drug use surveys to reduce inaccuracies associated with cognition and
social desirability, and in an effort to reduce cost. Anchoring interviewees' responses to
time frames through the recall of personal experience is useful in reducing response error
(Hubbard, 1992); that is, individuals volunteer events for specific time frames that can
be used to anchor in time their responses regarding drug use or other behaviors.
Self-administered questionnaires, permitting privacy
in responding to sensitive questions, appear to reduce the influence of social
desirability on reporting. Turner, Lessler, and Devore (1992) found increased reporting of
drug use when respondents were permitted to use self-administered questionnaires than when
respondents answered face-to-face queries.
Concerns about cost have led to experimentation with
telephone surveys as an alternative to face-to-face studies. In a review of studies of
"private" behaviors including but not restricted to drug use, Gfroerer and
Hughes (1992) report that face-to-face interviewing is generally associated with
self-reports of greater drug use and of lower income and education. Studies by Aquilino
(1992), Aquilino and LoSciuto (1989), and LoSciuto, Aquilino, and Licari (1993) found
lower rates of self-reported drug use by African American respondents in telephone as
compared to face-to-face interviews. Johnson, Hougland, and Clayton (1989) found lower
rates of self-reported drug use for university respondents in telephone as compared to
face-to-face interviewing. On the other hand, McAuliffe and his colleagues (1987) have
argued that a study of Rhode Island respondents to a telephone drug use survey did not
suggest inaccuracy in reporting. Although they acknowledge lower estimates of drug use in
the studies initiated to date comparing telephone to face-to-face interviewing, McAuliffe
and colleagues (1994) assert that the differences are insignificant in relation to
estimates of prevalence, may be nonexistent in relation to rates of heavy use or
dependency, and may be further reduced through the refinements to telephone interviewing
suggested in their manual.
State planning offices report applying survey data
from national samples to their own local situations (Minugh, n.d.). Through this practice,
unwarranted assumptions may be made about the comparability of national to local
circumstances. Thus, even if efforts are made to correct for differences in demographic
characteristics, differences in community variables (e.g., drug availability, drug
potency, police activity, population density) may nonetheless make applying national
findings to local conditions inappropriate. Issues in extrapolating from available data
sets to local communities are explored further in the section "Strategies for
Estimating Drug Use."
Strategies: Problem-Oriented Measures of Drug Use
A number of strategies assess the impact of drug use
on the health, criminal justice, and social service agencies in a community. These
strategies are described as using indicator data or indirect measures (Kimmel, 1992). In
these initiatives, as with surveys, effort is made to monitor drug use over time. However,
whereas surveys are concerned with obtaining representative or unbiased samples, studies
using problem-oriented measures are typically restricted in their capacity to conduct
equally rigorous study. Thus, the clients of any one service system may differ in
important ways from the clients of another in demographic and background characteristics
generally, and in drug use characteristics specifically.
Drug Use Data from the Health Care System
Drug abuse is a health care issue that both directly
and indirectly affects a number of areas of health care delivery. Drug abuse is associated
with infectious diseases (e.g., tuberculosis, sexually transmitted diseases [STDs],
hepatitis B and C, and acquired immunodeficiency syndrome [AIDS]), with psychological and
alcohol problems, and with adverse reactions such as overdoses. Assessing the consequences
and concomitants of drug use can help us to understand the populations negatively affected
by drug use, to determine the types of drugs responsible for creating specific health care
problems in a community (Gfroerer, 1991; Kimmel, 1992), and to provide a basis for
monitoring the changing nature of drug use in a community (Gerstein & Harwood, 1990).
The extent to which drug use is associated with
medical emergencies and deaths has been determined by collecting data at hospital
emergency rooms and medical examiners' offices. The data collection strategies developed
by federal authorities include a nationwide sample of programs chosen from a mix of
metropolitan (cities and surrounding areas) and nonmetropolitan areas. In the federally
maintained Drug Abuse Warning Network (DAWN), data are collected from more than 500
hospitals (emergency rooms) in 21 metropolitan areas and additional nonmetropolitan areas,
and from 135 medical examiners' offices in 27 metropolitan areas and additional
nonmetropolitan areas. Brief forms have been developed to record demographic
characteristics, drugs used, and routes of drug administration. For emergency room
clients, sources of substances, reasons for the use of the substances reported, and
reasons for emergency room admission are recorded. For medical examiner cases, cause and
manner of death are determined. All emergency room admissions and all medical examiner
cases are included, provided they show evidence of either a medically inappropriate use of
prescription or over-the-counter drugs or a use of illicit substances. The data are used
to characterize metropolitan areas and, through repeated administration, to report trends
both locally and nationally (NIDA, 1991b, 1991c).
The methodology developed to assess and monitor drug
use in the health care system on a national level is also available to local
jurisdictions. Fewer resources are required than for surveys; however, such an effort
requires the commitment of staff to perform data collection and entry and to carry out
analysis as well as to conduct quality-control procedures to assure the integrity of data
collected. Savings may result from the use of time sampling strategies as long as the
times at which data are gathered are chosen without bias.
Assessment of drug use involving the health care
system or other indicator data cannot provide the estimates of incidence and prevalence
available through use of population surveys employing probability sampling. Such
assessment can, however, clarify selected issues regarding drug use and prevention need in
a community. Specifically, we can determine the drugs creating a problem for individuals
in a community and the nature of individuals experiencing difficulties in association with
the nonmedical use of drugs. Through the regular collection of data, we can establish
trends in the nature of drugs abused and the characteristics of abusers. That information
then can be used to understand issues to develop or extend the community's prevention
Because the data collected are from one segment of
the community service delivery system (i.e., from one component of the health care
system), they must be interpreted cautiously. That is, the data clarify community drug
problems and identify characteristics of drug users affecting a significant, although
limited, portion of the communitys service systems. The value of indicator data can
be enhanced by collecting additional data from other segments of the community (i.e.,
regarding other indicators) to clarify the nature of the drug use and to identify
characteristics of the drug users seen in other parts of the communitys service
Within the health care system, data also can be
gathered from agencies providing treatment for STDs, hepatitis, tuberculosis, and AIDS.
All are diseases of significance to the community, and all are diseases to which drug
users are particularly vulnerable. Monitoring clients of these systems can provide
significant information about characteristics of drug users at high risk and the
association between drug use and infectious disease. In addition, agencies serving
pregnant women and infants may provide useful data regarding women in the community.
Monitoring the mental health and alcoholism
treatment systems provides an opportunity to assess drug use and drug users from a
population that may differ significantly from those found in facilities treating
infectious diseases, since mental health and alcoholism programs are more likely to see
noninjection drug users. The issue of psychiatric comorbidity makes it apparent that these
populations have, and will continue to have, significance for understanding community drug
use and drug users (McLellan, 1991).
Within the health care system, we should seize the
opportunity to study and monitor admissions to drug treatment. Both drugs used and
characteristics of users are of concern in developing a picture of drug use in the
community and establishing an appropriate prevention response.
Drug Use Data from the Criminal Justice System
The criminal justice system includes a significant
number of drug users. As with entrants into the health care system, strategies have been
devised for assessing and monitoring criminal justice clients. The Drug Use Forecasting
(DUF) program, initiated in 1988 by the Department of Justice, obtains structured
interviews and urine specimens from a sample of adult and juvenile booked arrestees
(consecutive admissions) in 24 cities nationwide (not all cities gather data on
juveniles). Data are analyzed by demographic characteristics, drugs reported/identified,
charges, and so on. (National Institute of Justice [NIJ], 1995). As with DAWN health care
settings, using a consistent instrument and uniform sites permits trends in drug use to be
monitored over time.
As with any survey strategy, the accuracy of
findings can be compromised by inaccurate self-reports or by refusals to participate. The
risk of inaccuracies and refusals would seem to be heightened in working with a criminal
justice populationparticularly a criminal justice population awaiting adjudication
(i.e., a population whose drug use could be used against them). Indeed, studies suggest a
significant underreporting of drug use by both adult arrestees (Mieczkowski, Barzelay,
Gropper, & Wish, 1991) and juvenile offenders (Feucht, Stephens, & Walker, 1994).
It is important to clarify that confidentiality and anonymity will be maintained with all
self-report information provided. Biological data also should be gathered when feasible.
In fact, the DUF program obtains response rates of greater than 90% of arrestees sampled
and obtains urine specimens from more than 80% of those sampled (NIJ, 1995).
In reporting drug use by arrestees, DUF relies on
the results of urine testing, thereby increasing accuracy through the use of a biological
measure rather than risking the influence of memory or social desirability on self-report.
Urine drug testing identifies recent drug use only, thus risking a conservativeand
incompletereport of arrestees' drug use. Nonetheless, the capacity to understand
drug use associated with danger to the health and safety of the community makes DUF
reporting a significant contribution to prevention planning. Hair assay may be used to
extend the reporting period (Cone, Yousefnejad, Darwin, & Maguire, 1991; DuPont &
Baumgartner, 1995; Mieczkowski, Landress, Newel, & Coletti, 1993; Wang, Cone, &
Zacny, 1993; Wang, Darwin, & Cone, 1994), although caution has been urged in
association with the potential for environmental contamination (Goldberger, Caplan,
Maguire, & Cone, 1991; Wang & Cone, 1995).
In addition to arrestee data, information regarding
drug use in a community may be obtained through law enforcement activities involving
purchases of street drugs, the interdiction of drugs entering a community, and arrests for
drug violations. Drug buys can provide data regarding the types of drugs available on the
street as well as their strength and purity, thereby helping to identify drugs having
implications for prevention needs. However, it may not be readily apparent whether a given
drug buy accurately represents the type and potency of drugs available in a community.
Similarly, drugs obtained through interdiction may have high or low claims to being
representative of drugs available. In addition, drug arrests require clarification
regarding circumstances under which the data have been collected. Arrestee numbers and
types may represent normal police activity or may reflect a special concern of the
community, such as an effort to "clean up" a particular area, and thereby be
atypical of the drug problem in the larger community. Although gathered under far less
rigorous conditions than other data described in this section, data from law enforcement
can be useful if placed in a context of community events and if used in conjunction with
data from other sources.
Drug Use Data from the Social Service System
Data from social service agencies have been far less
frequently employed for needs assessment than have data from health care and criminal
justice agencies. Among social service agencies, only shelters for homeless individuals
and runaway youth have received significant attention as sites for assessing or serving
drug users. Awareness and concern about the numbers of drug users in those facilities have
accompanied increasing concerns about both psychiatric comorbidity and HIV infection.
Large numbers of homeless individuals show evidence of drug use and psychological
dysfunction (Task Force on Homelessness and Severe Mental Illness, 1992), while the
runaway population is perceived to be significantly involved in drug use and unprotected
sex to obtain drugs and survive on the streets (Pires & Silber, 1991). Surveys of
homeless and runaway populations have been undertaken as one-time initiatives to
characterize the population in question rather than as part of a monitoring strategy to
assess ongoing community need for prevention efforts (e.g., NIDA, 1993, regarding homeless
persons; Rotheram-Borus & Koopman, 1991, regarding runaway youth).
Other social service settings may be significant to
understanding numbers and characteristics of drug users as well as the relationship
between a selected community concern (e.g., abuse and neglect cases) and substance abuse.
However, in association with both the expense and the imposition on individuals and agency
staff, those settings should be selected carefully in terms of their significance for drug
abuse and the likelihood of locating individuals not found in other settings from which
samples are being drawn.
Drug Use Data from the Work Site
Drug testing in the workplace is now a common
practice (DuPont, Griffin, Siskin, Shiraki, & Katze, 1995; Willette, 1986). Urine
screens for a range of drugs of concern to employers and to the community provide another
data source regarding drug use (American Management Association, 1995). Biological data
have the advantage of being viewed as more valid than the self-report data available in
other assessments and are collected from a segment of the public that is not otherwise
available. Correlating drug use with community problems and negative consequences leads to
sampling from populations that survive largely on the fringes of society. The use of data
from job applicants provides information on drug use in the community from a population
more likely to have a stake in mainstream life. Additional findings may be available from
Employee Assistance Programs (EAPs) or from random urine screens of current employees.
Data from job applicants and employees, collected over time, provide a significant
perspective on drug use in the community. Collecting as many data points as possible
enhances an understanding of drug use and the characteristics of drug users in order to
plan prevention programming or to modify existing programs.
Data from employers should be obtained without
individual identifiers; that is, the anonymity of individuals is protected. Investigators
have a responsibility to individuals and to the community to have procedures in place to
guarantee the confidentiality and security of all data collected.
Drug Use Data from Community Experts
Teachers and school counselors, probation
officers, caseworkers in the social service system, administrators of homeless shelters,
police, housing authority personnel, and medical practitioners are community experts in a
position to observe and monitor different aspects of the community. They can be viewed as
"key informants" regarding various aspects of community functioning (although,
as described below, the term key informant is also used to describe those who are
more intimately a part of the drug scene). The views of community experts are important,
not only because they are uniquely positioned to describe drug use within their areas of
responsibility, but also because they can influence community opinion regarding drug use
within those areas. The viewpoints of individuals in positions of significant
responsibility and authority have the potential to reverberate through the community.
Two strategies are often employed to gather
information. First, individuals can be interviewed using open-ended questions relating to
several general themes the interviewer plans to explore, allowing latitude for the
interviewer to pursue issues that the key informant may introduce. A second strategy
involves the use of focus groups in which community experts meet to discuss issues the
group leader poses in an effort to share ideas and observations and to clarify issues. The
capacity of community experts to clarify trends in the nature and extent of drug use
problems as well as to identify needed community prevention services has significant
Uses of Data from Surveys Employing Probability and Nonprobability
Although no data collection strategy is perfect,
most researchers would agree that surveys employing probability sampling provide the best
estimate of drug use in a community. As discussed above, obtaining accurate findings with
that strategy requires that all segments of the population of interest be represented in
the sample drawn, and that the instrument used is capable of obtaining unbiased responses
(i.e., of minimizing the risk of cognitive errors and of errors associated with social
desirability). When properly conducted, surveys using probability sampling provide data
that can be used to estimate incidence and prevalence of drug use and consequently are the
most useful strategies for determining the prevention needs in a community. Survey
strategies using nonprobability sampling explore drug use in relation to problems created
by, or in association with, that drug use. These strategies measure drug use by
individuals who are already experiencing and creating problems in the community.
Consequently, they are generally seen as less well suited to a determination of issues for
the prevention of drug use.
Strategies for Estimating Drug Use
Needs assessment for both prevention and treatment
has been concerned with constructing estimation models that can be used to describe the
prevalence of drug use in the general population and in selected subpopulations. Thus, the
NHS has been used to generate estimates of drug use prevalence through the application of
weights for age, sex, and ethnicity to approximate their representation in the general
population while compensating for survey nonresponse and undercoverage (NIDA, 1991a,
1991b). In this manner, the number of users of different drugs has been estimated (within
certain confidence intervals), and those estimates have been used to understand prevention
needs and, at times, to judge the success or failure of national drug abuse strategies.
In instances in which a particular community is
concerned with estimating the rate of drug use but lacks specific data, the community may
elect to develop synthetic estimates. As described by Wickens (1993), a calibration
population (or populations) for which drug use is known is used to generate information
about drug use in the target population for which drug use information is lacking.
Synthetic estimates may employ a variable or variables related to drug use, such as rates
of drug arrests or of AIDS, which are known for other communities (calibration
populations) as well as for the community of concern (target population). The relationship
between these variables related to drug use (i.e., ancillary variables) and actual drug
use can then be calculated for the calibration populations and the resulting linear
interpolation applied to the target community. Simeone, Rhodes, and Hunt (1995) propose
the use of this model to estimate the number of "hardcore" drug users for cities
and to describe a strategy for obtaining the needed data and developing estimates.
Synthetic estimates may employ data from a
calibration population in which rates of drug use can be calculated by demographic
characteristics (e.g., gender, ethnicity, socioeconomic status) and extrapolated to a
target community for which rates of drug use are not known, but the composition of the
community by demographic characteristics is known. In this way, rates of drug use may be
developed for subpopulations and for the full population of the target community.
Using a comparable strategy, Kandel and Yamaguchi
(1985) calculated "hazard rates" for initiation of different drugs (i.e., the
incidence expected over a 12-month period), in accord with data regarding drug use in
relation to age and gender. In a related effort, Kandel and Davies (1992) explored the
predictor variables that might be employed to project rates of marijuana initiation as
well as rates of progressive use of marijuana. Indeed, the variables associated with the
adoption of drug and alcohol use, and of protection against that use, have been
comprehensively described (Hawkins, Catalano, & Miller, 1992) and explored in general
population models (Newcomb, 1992) and in models applied to specific subpopulations
(Brunswick, Messeri, & Titus, 1992); thus it may be feasible to explore estimation
strategies for incidence as well as prevalence and thereby clarify the prevention needs of
The accuracy of synthetic estimates depends on the
comparability of the calibration population to the target population. As described by
Wickens (1993), there is a risk that target and calibration communities may differ in ways
that compromise accurate estimation. Thus, variables such as drug availability, police
presence, treatment availability, prevention services, and community attitudes toward drug
use may exist between communities, reducing their comparability. In addition, Kimmel
(1992) notes that drug use patterns may vary between communities in ways unrelated to
their demography such that amphetamine use may be prevalent in one community and PCP in
another despite apparent similarities in population characteristics.
As described by Hser (1993a, 1993b) and Wickens
(1993), drug use prevalence in a community also can be estimated where the frequency of
entry into a selected data system is known for some portion of the drug-using
populationprovided that the data are seen as following a Poisson distribution. That
is, if the population can be assumed to be homogeneous and rates of entry can be seen as
largely constant over time independent of the individual or of extraneous events, an
estimate can be made of the portion of the population that has not entered the data system
based on the numbers and frequency of entry of those who have, and thereby an estimate can
be made of the total population. The result is a truncated Poisson estimate of population
size. Homogeneity among population members is a particular concern (Wickens, 1993).
Individuals who do not enter into the data system may differ in important ways from those
who do, and/or those with varying frequencies may differ from each other, leading to an
inaccurate estimate of the unobserved portion of the population.
Multiple-capture models for estimating drug use
prevalence use findings for individuals who have an opportunity to enter one or more data
systems over time (Brecht & Wickens, 1993; Frank, Schmeidler, Johnson, & Lipton,
1978; Wickens, 1993; Woodward, Bonett, & Brecht, 1985). Estimation procedures then
involve the calculation of the unknown (i.e., unobserved) portion of the population based
on statistical models applied to the observed entries into data systems over time. Again,
a Poisson distribution is seen as governing the distribution of drug use cases, and the
assumptions underlying the Poisson distribution are seen as operative.
System dynamics models (Homer, 1993; Wickens, 1993)
explore prevalence in the context of the system dynamics in which drug use occurs. Thus,
as described by Wickens, "an estimate of the prevalence of drug use might be made in
the context of a description that includes measures of drug distribution, drug
consumption, and the societal response to consumption and use" (p. 211). Four types
of variables are involved in constructing the model. Exogenous variables involve
quantitative data available with regard to drug use (e.g., drug arrests). Level
variables represent relevant but unavailable data (e.g., numbers of drug users). Rate
variables describe the rate of change over time of the level variable. Constants
are quantitative variables that govern the connections between level variables (e.g.,
constants would be employed to relate change in drug availability to change in drug-user
patterns). Formulas are then developed showing rates of change of level as functions of
exogenous and level variables and of constants. Wickens suggests that system dynamics
analysis lends itself best to policy analysis.
A policy analysis strategy is also described by
Kahan, Rydell, and Setear (1995), in this instance making use of a computer model allowing
participants to test the effectiveness and measure the costs of control and prevention
strategies designed to affect rates of heavy and light drug users in a hypothetical
community as well as affecting initiation and transitions within drug use. The seminar
gaming initiative they describe in association with this computer modeling lends itself to
planning initiatives in which data, available from the community sources described above,
are used in conjunction with findings from prevention evaluation research. Thus, differing
scenarios of community prevention might be tested relative to data appropriate to that
Assessment Strategies: Ethnographic Measures
As described by Feldman and Aldrich (1990),
ethnographic research involves the study of social phenomena from the viewpoint of the
individual experiencing those phenomena. Most typically, the tools of the ethnographer are
observation and open-ended questioning of members of the group or culture under
observation (i.e., fieldwork involving qualitative rather than quantitative methodology).
Ethnographic methods become significant where the population of concern is not readily
accessible for more usual survey methods (i.e., can be described as a "hidden
population"), or where the functioning of groups, or of individuals within groups,
cannot be detailed through quantitative methodology (Lambert, 1990). Individuals engaged
in illicit behaviors cannot be sampled in a manner that permits representativeness on the
one hand or study of social and commercial interactions in the comparative comfort of a
university laboratory on the other. Researchers enter the drug users' world and seek out
individuals and situations that will allow data collection regarding typical events and
people without claim to an unattainable representativeness.
Thus, runaway youth cannot be studied in a manner
that permits both probability sampling and easy study of social and commercial
interactions. Nonetheless, ethnographers entering and reporting the world of the runaway
adolescent (i.e., drugs used, frequency of use, situations determining use) may develop
valuable data for constructing innovative prevention strategies specific to that
population. The use of key informants is sometimes described as critical to such study
(Adler, 1990; Goldstein, Spunt, Miller, & Belluci, 1990). Key informants are a major
source of information about the behaviors or events in question and can provide entree to
others in the community being studied. Thus, the key informant in this instance is a study
subject with some standing in the community. Key informants can provide information
regarding the nature and functioning of the drug culture and can facilitate the
recruitment of additional subjects for study.
An advantage of ethnographic study is that
ethnographers obtain information directly from an otherwise inaccessible population. A
disadvantage is that data collected can never be assumed to represent more than the
individuals or locales selected. Also, the interpreting and reporting of that data may be
selective in association with the theoretical orientation and beliefs of the ethnographer,
although strategies have been developed to provide safeguards regarding the reliability
and validity of ethnographic data (Fritz, 1990).
Community Resources to Provide Prevention Services
The determination of community resources in terms of drug abuse
prevention services demands assessments of both current activities (i.e., space, staff,
and money) and attitude (i.e., the willingness to provide prevention services). The
former, at least, can be determined largely by use of questionnaires, records review, and
observation. Care should be taken to sample individuals who are knowledgeable about their
agencies and who have significant administrative responsibility in those organizations.
Interviewers should represent a broad-based community group rather than the narrow
interests of drug abuse prevention agencies. Oetting and colleagues (1995) describe an
interview strategy involving the sampling of a broad range of community
"gatekeepers" that is designed to allow the community to be characterized in
terms of attitude (i.e., readiness to undertake drug prevention programming). Using the
interview data collected, beliefs about the communitys readiness for prevention
programs are captured on five rating scales, each of which makes use of empirically
determined anchor statements.
The assessment of attitudes and, by extension, of the openness of
community service providers to make available prevention services can be determined in
interviews or questionnaires and also may be addressed in the context of focus groups
designed to bring together relevant community members to explore issues in providing
prevention services. The use of focus groups has several advantages. It can set in motion
a process involving not only the elaboration of shared concerns, but the exploration of
possible solutions. There is an advantage to discussion of new initiatives in a public
forum. Thus, the commitment to explore a particular strategy or to designate an area for
study is a commitment made publicly.
It should be apparent that the assessment of prevention resources,
like the assessment of prevention needs, must be undertaken by a community group or
coalition that possesses the will and authority to command cooperation in the assessment
process and to provide leadership to the process of systems change and expansion. In
short, assessments of community prevention needs and resources are best underwritten by a
community group that understands its role to be that of an agent of change, has the
authority to act in that role, and awaits the results of those assessments in order to
take remedial action on behalf of the community.
Selecting an Assessment Strategy
A needs assessment strategy is determined by the
questions being asked, the data sources available, and the resources that exist for making
that assessment. Where the concern is with understanding the prevention needs of the
community, information regarding emergency room admissions and medical examiner cases are
likely to be less helpful than a survey of community households or of school-aged
populations supplemented by the use of problem-oriented measures focused on youth, such as
studying drug use by juvenile offenders.
Surveys employing probability sampling are likely to
be the most costly assessment strategies available. Alternatively, surveys involving
nonprobability sampling can be employed to explore drug use in the health care, criminal
justice, and social service systems. As discussed above, the more data sources (i.e., the
more populations for study), the more confidence that can be placed in the trends
Finally, emphasis should be placed on the importance
of testing and refining needs estimation models. Ultimately, the greatest utility of the
data collection systems described may come in their capacities to generate reliable
estimates of community need, through the use of that data in estimation models and through
the use of simulation models in the study of prevention strategies designed to affect the
initiation and/or escalation of drug taking.
Reporting the Findings of Needs Assessment Study
The findings from a prevention needs assessment
study should be reported in a manner that permits their use to achieve community change.
The findings must be clearly grounded in science (i.e., must possess credibility) but must
be stated in a language and format that permit their effective use by a community group or
coalition. Additionally, the findings from a needs assessment must be released in a timely
manner. Typically, there is a window of opportunity to produce change in a community that
may be tied to political forces, to the timing of budgetary decisions, or to other issues.
Disseminating study findings can be undertaken
through a combination of oral presentations to the community group under whose auspices
the needs assessment has been conducted and written materials to establish a permanent
record and reference source for the community. Both the presentation and the written
materials should make substantial use of clearly articulated tables and figures.
Typically, programmatic change is a distant goal of
research and often depends on the fortuitous use of findings published or reported by the
investigator. In that paradigm, the investigator's responsibility is discharged with the
appearance of study findings in the professional literature or at a scientific conference.
Needs assessment carries a differing set of responsibilities for the investigative team.
In the instance of prevention needs assessment, responsibility can be discharged only
consequent to the acceptance and understanding of study findings by the sponsoring
community group. A successful study outcome is less a matter of academic research results
and more the initiation of community change.
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