Validity of Self-Report of Drug Use Among STD Patients, ER Patients, and Arrestees

Abstract

This paper examines the validity of self-report of drug use in several important high-risk samples by comparing survey answers with urinalysis results. The analyses include data obtained from face-to-face interviews with 1536 patients in sexually transmitted disease (STD) clinics, 1564 patients in hospital emergency rooms (ERs), and 2034 recent arrestees in jails. Using urinalysis as the criterion measure, considerable underreporting was observed, particularly among STD and ER subjects using cocaine and opiates. A logistic regression analysis on factors related to the underreporting was conducted for both cocaine and opiates. The results showed that a lower degree of underreporting was associated with subjects at jail sites (compared to STD subjects) and those who self-reported lifetime drug dependence.

Notes

^* Although urine was requested from all subjects, about 6.4% of STD patients, 20% of ER patients, and 0.7% of arrestees did not provide it. Some subjects gave outright refusals. Others had a variety of reasons for not providing a specimen. Particularly among ER subjects, medical conditions often prevented either urination or travel to the rest room. Some patients became unavailable as they were suddenly admitted to the hospital and taken quickly to another floor, called into X-ray, or discharged. In the STD clinics, patients had provided a urine specimen to a doctor immediately prior to the interview and could not provide again. Comparisons of selected background characteristics were made between subjects who provided urine and those who did not among STD and ER samples (a very low percentage of arrestees did not provide urine, and therefore they are not included in the analyses). The two groups did not differ in age or gender. However, a disproportionate number of African-American ER patients did not provide the urine specimen. Since urinalysis was used as a criterion to examine the validity of self-report of recent drug use, the present analyses only includes subjects for whom urine was available.