Declining Estimated Prevalence of Alcohol Drinking and Smoking among Young Adults Nationally: Artifacts of Sample Undercoverage?
American Journal of Epidemiology Advance Access published online on October 31, 2007
A growing concern in public health surveillance surveys that
rely on random digit dialing for sampling is the exclusion of
adults in cell-phone-only households. The purpose of this study
was to examine whether recent increases in wireless substitution
have affected estimates of tobacco and alcohol use in the Behavioral
Risk Factor Surveillance System (BRFSS) in a subpopulation with
notable cell-phone usage (i.e., young adults).
BRFSS data from
2001–2005 were examined. Analyses were limited to participants
aged 18–24 years, and the sample contained approximately
18,500 persons in each year.
Prevalence estimates were generated
with SUDAAN software for three health behaviors: cigarette smoking,
binge drinking, and heavy alcohol consumption. In addition,
the authors examined sample completeness for young adults relative
to US Census estimates.
Overall, prevalences of all three health
behaviors among young adults were fairly stable between 2001
and 2003 but significantly decreased between 2003 and 2005.
These trends are not replicated in national surveys that use
area probability samples. The authors found a declining trend
in the sample completeness ratio for young adults; it declined
from 0.32 in 2001 to 0.15 in 2005.
Given the high prevalence
of wireless substitution among young adults and the declining
sample completeness ratio, the authors suspect that the observed
decreases in prevalence are artifacts of undercoverage.
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