Teens Saying Yes to Drugs, but Saying No When Questioned about Use

When it comes to both teens and parents, relying on self-reported information alone can lead to inaccurate assessments, according to new research published in Pediatrics. Findings from the first of a series of large, nonclinical teen studies using biological testing show that urban teens are 52 times more likely to test positive for cocaine compared with self-reported use.

Previous information on the prevalence of teen drug use in nonclinical samples has been derived exclusively from confidential or anonymous self-reported surveys, which suggest that few US teens use cocaine or opiates. Virginia Delaney-Black, MD, MPH, of Wayne State University, Detroit, MI, and colleagues set out to determine whether teens, when faced with sensitive questions, are more likely provide socially acceptable but untruthful answers.

“Accurate estimates of teen drug use are essential to understanding mechanisms of use/abuse and to inform development of effective intervention and prevention programs, yet teen drug-use information in nonclinical populations is typically derived from anonymous or confidential reports,” the researchers wrote.

The team evaluated the concordance between confidential self-and parent report of teen cocaine and opiate use with biomarkers (hair analysis) in a prospective cohort of 400 high-risk urban teens and parents.

Delaney-Black and colleagues found that “both teens and parents substantially underreported recent teen cocaine and opiate use.” However, compared with parents, teens were more likely to deny biomarker-verified cocaine use. Teen specimens were 52 times more likely to identify cocaine use compared with self-report, and parent hair analyses for cocaine and opiate use were 6.5 times and 5.5 times, respectively, more likely to indicate drug use than were parental self-report. The self-reported incidence of opiate use (3.3%) was significantly lower than the biological measurement for opiates (7.0%), they found.

Overall, there was a lack of concordance between self-report and bioassay, despite participant's knowledge that a “certificate of confidentiality” protected both teen and adult participants, and that the biological specimens would be tested for drugs.

These findings, they said, “confirm prior reports of adult under-reporting of their own drug use while extending our understanding of teen's self-admitted drug use.” The lack of concordance between self-reported use in teens and parent-reported teen drug use and biomarkers confirms concerns that “both teen- and parent-reported teen drug use is limited, at least for youth in high-risk urban settings,” they wrote. “Methods of ascertainment other than self- or parent-report must be considered when health care providers, researchers and public health agencies attempt to estimate teen drug-use prevalence.”

To view the study—Just Say "I Don't": Lack of Concordance Between Teen Report and Biological Measures of Drug Use—in its entirely, click here.

Were you surprised by these findings? Do you believe that underreporting of drug use is common in other teen demographics as well?