The different measures led to consistent and plausible relationships between quality and hospital characteristics. Thus, valid information about hospital quality can be obtained. We need to develop ways to use such information to improve care.

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The purpose of this study is to examine self-reported marijuana and cocaine use responses from two nationally representative surveys. We compared prevalence rates across birth cohorts for multiple years of the National Household Survey of Drug Abuse (NHSDA) and also analyzed longitudinal inconsistencies in self-reported drug use between two waves of the National Longitudinal Survey Youth Cohort (NLS-Y). We found the percentages of respondents admitting use within the past month, year, and lifetime were comparable to other findings and were consistent with the declining trend in drug use in the late 1980s. A comparison of lifetime prevalence rates revealed seemingly inconsistent reports between 1985 respondents and their birth cohorts in 1990. Using the longitudinal NLS-Y data, we found that roughly one-fifth of the people who had admitted using marijuana or cocaine in their lifetime on the 1984 survey subsequently denied ever having used in 1988. The majority of these cases were people who reported having used infrequently. The subsample of women had similar patterns. In addition, we discovered that women who had been pregnant between the two surveys were more likely to inconsistently deny having ever used, while those who were currently pregnant responded more honestly about their past use. Overall, we found that although most people are willing to provide accurate accounts of their use, the researcher should be aware that under-reporting or complete denial does occur. Most importantly, external factors appear to contribute to the rate of inaccurate reporting.

Do successful drug prevention programs suppress the risk factors they were intended to modify? This paper addresses that issue for Project ALERT, a school-based program for seventh and eighth graders that has been shown to curb both cigarette and marijuana use. Evaluated with over 4,000 students in an experimental test that included 30 diverse California and Oregon schools, the curriculum seeks to help young people develop both the motivation to avoid drugs and the skills they need to resist pro-drug pressures. Using regression analyses, we examine the program's impact on the intervening (cognitive) variables hypothesized to affect actual use: adolescent beliefs in their ability to resist, perceived consequences of use, normative perceptions about peer use and tolerance of drugs, and expectations of future use. The analysis depicts program effects for perceptions linked to each target substance (alcohol, cigarettes, and marijuana), across all students and for those at different levels of risk for future use. Results show that the curriculum successfully dampened cognitive risk factors from each of the above categories for both cigarettes and marijuana, indicating that social influence programs can mitigate a broad range of beliefs associated with the propensity to use drugs. However, it had a limited impact on beliefs about alcohol, the most widely used and socially accepted of the three drugs. Implications for drug prevention programs and practitioners are discussed.

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