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...on policy issues
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www.ProjectCork.org
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Fall 2003
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A failed norms social marketing campaign.
Clapp JD; Lange JE; Russell C; Shillington A; Voas RB. Journal
of Studies on Alcohol 64(3): 409-414, 2003. (18 refs.)
Objective: In this article we test the efficacy of an intensive norms social
marketing campaign to reduce heavy drinking among college students living in
a residence hall. Method: We employed a pretest-posttest nonequivalent comparison
group design. The study was conducted in two (experimental and comparison) comparable
residence halls located in a large urban public university. We attempted a census
at each hall, and pre- and postintervention data were collected in public areas
of each residence hall. Relative sample sizes were approximately 60% in the experimental
hall (both waves) and 38% in the comparison hall. Results: The campaign successfully
corrected students' misperceptions of drinking norms but had no effects, or counterintuitive
effects, on drinking behaviors. Conclusions: Despite the popularity of this approach,
universities would be prudent to proceed with care before adopting this approach
wholesale.
Copyright 2003, Alcohol Research Documentation, Inc. Used with
permission.
Adverse selection and generosity of alcohol treatment benefits.
Harris KM; Sturm R. Inquiry 39(4): 413-428, 2002. (28 refs.)
Concerns about attracting disproportionate numbers of employees with alcohol
problems limit the employers' willingness to offer health plans with generous
alcohol treatment benefits. This paper analyzes two potential avenues of adverse
selection, namely biased enrollment into plans and biased exit from plans offered
by 57 employers between 1991 and 1997. We compare alcohol treatment use rates
and costs of new and old enrollees between more generous and less generous plans;
we also analyze disenrollment rates and enrollment duration by plan generosity
for users and nonusers of alcohol treatment services. To avoid confounding benefit
generosity with other plan features, in particular the use of managed care mechanisms,
we compare plans that were administered in the same way by a large managed behavioral
health care organization. Overall, we find no evidence of adverse selection into
more generous plans. Contrary to the selection hypothesis, treatment costs of
new members compared to old members are lower in firms with more generous treatment
benefits than in firms with more limited benefits. Also, users of alcohol treatment
services do not remain disproportionately enrolled longer in plans with generous
benefits.
Copyright 2002, Blue Cross and Blue Shield Association.
Assessing substance abuse treatment need: A statewide hospital emergency
department study.
Rockett IRH; Putnam SL; Jia HM; Smith GS. Annals of Emergency Medicine 41(6):
802-813, 2003. (63 refs.)
Study objective: Health Care providers in hospital emergency departments rarely
take substance abuse histories or assess associated treatment need. This study
compares documentation of psychoactive drug-related diagnoses for adult ED patients
in medical records with treatment need assessed through self-report, toxicologic
screening, and Diagnostic and Statistical Manual of Mental Disorders, 4th edition
(DSM-IV), criteria. Methods: A statewide, 2-stage, probability sample survey
was conducted in 7 Tennessee general hospital EDs from June 1996 to January 1997.
Main outcome measures were the prevalence of diagnosed substance abuse problems,
positive bioassay results, denied use, and treatment need. Sensitivity and multivariate
analyses, were conducted by using varied case definitions of treatment need.
Results: Thirty-one percent (95% confidence interval [CI] 27.3% to 34.7%) of
screened ED patients (n=1,330) had positive test results for substance use. Their
prevalence of denial of use in the 30 days before the survey ranged from 10%
for alcohol (95% CI 5.7% to 14.3%) to 100% for phencyclidine. One percent of
all ED patients (n=1,502) had a recorded diagnosis of substance abuse. By contrast,
as many as 27% (95% CI 23.3% to 31.8%) were assessed as needing substance abuse
treatment on the basis of a comprehensive case definition that accounted, for
denial; and positive test results. A sensitivity analysis using other case definitions
is also presented. For example, 4% (95% CI 2.8% to 5.3%) of patients met the
very strict definition of DSM-IV current drug dependence only. Under the comprehensive
case definition, TennCare patients (adjusted odds ratio [OR] 1.63; 95% CI 1.30
to 2.05) and Medicare patients (adjusted OR 2.50; 95% CI 1.34 to 4.65) showed
excess treatment need relative to the privately insured. Excess need was also
exhibited by patients reporting I or more prior ED visits in the past year (adjusted
OR 1.62; 95% CI 1.13 to 2.31) and by patients taking 2 or more hours to reach
the ED after the onset of injury or illness (adjusted OR 1.54; 95% CI 1.16 to
2.04). Treatment need was inversely associated with age. Irrespective of case
definition, less than 10% of ED patients who needed substance abuse treatment
were receiving such treatment. Conclusion: EDs can be important venues for detecting
persons in need of substance abuse treatment.
Copyright 2003, American College of Emergency Physicians. Used
with permission.
Assessing the effectiveness of minimum legal drinking age and zero tolerance
laws in the United States.
Voas RB; Tippetts AS; Fell JC. Accident Analysis and Prevention 35(4):
579-587, 2003. (24 refs.)
The objective of this research was to determine the extent to which the decline
in alcohol-related highway deaths among drivers younger than age 21 years can
be attributed to raising the minimum legal drinking age (MLDA) and establishing
zero tolerance (0.02% blood alcohol concentration (BAC) limit for drivers younger
than age 21 years) laws. Data on all drivers younger than age 21 years involved
in fatalities in the United States from 1982 to 1997 were used in the study.
Quarterly ratios of BAC-positive to BAC-negative drivers in each of the 50 states
where analyzed in a pooled cross-sectional time-series analysis. After accounting
for differences among the 50 states in various background factors, changes in
economic and demographic factors within states over time, and the effects of
other related laws, results indicated substantial reductions in alcohol-positive
involvement in fatal crashes were associated with the two youth-specific laws.
The policy of limiting youth access to alcohol through MLDA laws and reinforcing
this action by making it illegal for underage drivers to have any alcohol in
their system appears to have been effective in reducing the proportion of fatal
crashes involving drinking drivers.
Copyright 2003, Elsevier Science Ltd.
Demographic and practice characteristics of psychiatrists who primarily treat
patients with substance use disorders.
Montoya ID; Herbeck DM; Svikis DS; Fitek DJ; Marcus SC; Pincus HA. American
Journal on Addictions 12(3): 181-191, 2003. (18 refs.)
This study examined the sociodemographic and practice characteristics of psychiatrists
whose caseloads consist primarily of patients with Substance Use Disorders (SUD).
A survey instrument was completed by a random sample of 865 psychiatrists. Study
groups were defined as high-SUD providers if psychiatrists reported having 51%
or more patients with SUD (n = 92) and non-SUD providers as those who reported
not having any patients with SUD (n = 128). High-SUD providers tended to be younger,
more likely to graduate from international medical schools, have larger caseloads,
work more hours per week, and have a higher proportion of inpatients and publicly
funded patients than non-SUD providers. Results suggest that psychiatrists who
primarily treat patients with SUD are in their early careers and treat patients
with more clinical, psychosocial, and economic disadvantages. The implications
of these findings for psychiatry training programs and policy makers will be
discussed.
Copyright 2003, American Academy of Psychiatrists in Alcoholism
and Addictions.
Drug testing in the trucking industry: The effect on highway safety.
Jacobson M. Journal of Law & Economics 46(1): 131-156, 2003. (49 refs.)
This paper uses a set of "natural experiments," created by the passage of a U.
S. Department of Transportation drug-testing mandate and 13 state testing laws,
to examine the effects of testing truckers for illicit substances on highway
safety. Since truckers do not bear the full costs of their driving and employers
cannot contract on all aspects of their behavior, drug testing may be one means
for companies to either screen or monitor employees and lower expected accident
costs. Indeed, I find that testing led to a 9-10 percent reduction in truck accident
fatalities. The social benefits of mandated testing appear to outweigh the costs
of the program. However, the similarity between the effect of mandating testing
and simply clarifying state law suggests that extending the right to perform
drug tests may have been as effective at lower cost.
Copyright 2003, University of Chicago.
Drug use by parents: A challenge for family reunification practice.
Maluccio AN; Ainsworth F. Children and Youth Services Review 25(7): 511-533,
2003. (56 refs.)
Family reunification practice has been a cornerstone of child welfare services
for the last decade or more. This practice is now challenged by a significant
rise in the number of children entering out-of-home care due to abuse and neglect
associated with parental drug use. These parents present a special problem for
agencies in relation to reunification. Is it possible to ensure a child's safety
and future development if reunification is pursued where parental drug use is
ongoing? This article does three things. First, it cites the evidence about the
incidence of drug use by parents of children in care. Second, it reviews the
recent family reunification research and in so doing confirms the importance
of family reunification efforts. Third, it proposes a three-stage model of enhanced
reunification practice for use with parents to test the viability of reunification
in situations where drug use remains an issue.
Copyright 2003, Pergamon Press Ltd.
Effect of lowering the alcohol limit in Denmark.
Bernhoft IM; Behrensdorff I. Accident Analysis and Prevention 35(4): 515-525,
2003. (8 refs.)
On I March 1998, the Danish per se limit was lowered from 0.08 to 0.05% blood
alcohol concentration (BAC) for motor vehicle drivers. Based on accident data
and drivers' drinking habits before and after the amendment, the effect of the
new limit has been evaluated. Interviews revealed a significant decrease in the
number of drinks that drivers allow themselves to drink within a 2-h period before
driving. The proportion of drivers, who would not drink at all or only have one
drink, increased from 71% before the amendment to 80% after the amendment. Drivers
with changed drinking habits most often stated the lower limit as the main reason
for having less alcohol. However, based on accident data from the first year
after the amendment, this has not resulted in a marked decrease in the proportion
of injury accidents with impaired motor vehicle drivers (BAC greater than or
equal to 0.05%) compared to all injury accidents. On the contrary, the proportion
of fatal accidents with drink-drivers compared to all fatal accidents has increased
in the after-period. The total number of drink-driving sentences were a little
larger in 1999 than in 1997 because of the lower limit, but a significant change
from higher towards lower alcohol levels can be seen.
Copyright 2003, Elsevier Science Ltd.
Policy from a harm reduction perspective.
Lenton S. Current Opinion in Psychiatry 16(3): 271-277, 2003. (76 refs.)
Purpose of review: The present review addresses recent literature on the effectiveness
of reducing drug-related harm in a number of domains that might be promoted,
facilitated, hindered or prohibited by drug policy. Recent findings: Increasingly,
there is recognition among health professionals, the judiciary and the public
that it is possible to design a system of drug control that has less of an emphasis
on criminal law. However, for countries contemplating models of drug law other
than strict prohibition, the three main international drug treaties limit the
scope of changes to domestic laws. During the past 25 years alcohol policies
have shifted from reducing the total population consumption to addressing risky
drinking situations and patterns of use in order to reduce alcohol-related problems.
With regard to drug use, the evidence supports needle and syringe provision schemes
in the community; prison drug substitution treatment and needle exchange programmes;
removal of criminal penalties for minor cannabis offences; and supervised injecting
facilities in localized areas with open, public drug scenes and associated amenity
problems. Schemes that divert drug offenders from the criminal justice system
to treatment are increasingly common, but their effectiveness is yet to be demonstrated.
Provision of naloxone hydrochloride to heroin users and their friends and family
to aid in management of heroin overdose has promise, but more research is needed
before widespread distribution can be advocated. Summary: Clinical and research
practitioners should use their influence to call for policy that facilitates
interventions that have been shown to be effective in reducing drug-related harm.
Copyright 2003, Rapid Science Publishers.
Pregnancy, drug testing, and the fourth amendment: Legal and behavioral implications.
Bornstein BH. Journal of Family Psychology 17(2): 220-228, 2003. (31 refs.)
In its efforts to protect the health of unborn children, the government is increasingly
attempting to regulate pregnant women's conduct. As with other policies affecting
pregnant women's autonomy, these policies have constitutional overtones. In Ferguson
v. City of Charleston (2001), the Supreme Court struck down a South Carolina
hospital's policy of testing pregnant women for cocaine and turning positive
results over to law enforcement for prosecution. This article discusses the basis
of the decision and its legal and behavioral implications. Although the decision
came down on the side of pregnant women's rights, it left unresolved the issue
of whether a similar policy could be constructed that would pass constitutional
muster. The article concludes with a consideration of the likely effects of,
and alternatives to, such a policy.
Copyright 2003, American Psychological Association, Inc.
Teen penalties for tobacco possession, use, and purchase: Evidence and issues.
Wakefield M; Giovino G. Tobacco Control 12( 2): I6-I13, 2003. (72 refs.)
A handful of empirical studies have related changes in youth smoking to popular
laws that penalise tobacco possession, use, and purchase ( PUP). In this paper,
we review the literature and outline reasons why PUP laws may be unlikely to
reduce youth smoking significantly at the population level. In theoretical terms,
we argue that PUP laws lack important features required for punishment to be
effective in changing behaviour. In practical terms, PUP transgressions seem
difficult to detect. Conceptually, there is potential for PUP laws to undermine
conventional avenues of discipline, such as the parent-child relationship and
the school environment. Strategically, PUP laws may divert policy attention from
effective tobacco control strategies, relieve the tobacco industry of responsibility
for its marketing practices, and reinforce the tobacco industry's espoused position
that smoking is for adults only. To assist further debate and discussion, we
identify research issues requiring attention.
Copyright 2003, BMJ Publishing Group.
Tobacco industry strategies to undermine the 8th World Conference on Tobacco
or Health.
Muggli ME; Hurt RD. Tobacco Control 12(2): 195-202, 2003. (27 refs.)
Objective: To demonstrate that Philip Morris and British American Tobacco Company
attempted to initiate a wide ranging campaign to undermine the success of the
8th World Conference on Tobacco or Health held in Buenos Aires, Argentina, in
1992. Data sources: Publicly available tobacco industry documents housed in Minneapolis,
Minnesota, USA; Guilford, UK; on-line document websites; and telephone interviews
with informed parties. Study selection: Those documents determined to be relevant
to the companies' campaigns against the 8th World Conference on Tobacco or Health.
Data extraction: Revision of chapter VIII of the July 2000 WHO report by a committee
of experts, entitled: Tobacco Company Strategies to Undermine Tobacco Control
Activities at the World Health Organization: Report of the Committee of Experts
on Tobacco Industry Documents. Data synthesis: Internal documents describe proposed
media and science orientated campaigns developed by BAT, Philip Morris, and their
consultants to divert attention away from the conference. Results and conclusion:
This work shows that the tobacco industry has the resources and vested interest
to combat perceived threats in its regional operating markets, in this case its
Latin American market. It is important for the worldwide public heath community
to become aware of the numerous ways in which the tobacco industry and its front
groups can work against international tobacco control meetings, even including
the manipulation of or working with other public health groups to oppose tobacco
control efforts. Future world conference planners and participants should be
aware that the tobacco industry is likely to continue to employ such methodology.
There is no reason to think that the industry is paying less attention to such
conferences in the present or future. Rather, it is likely the industry will
adopt and expand strategies that were successful while abandoning those that
were not effective. Required disclosure of financial support by all participants
at all tobacco scientific conferences is recommended. For the tobacco control
community, we also recommend careful coalition building and networking with other
public health groups on the ways tobacco is implicated in other public health
issues.
Copyright 2003, BMJ Publishing Group.
The relation of retail tobacco availability to initiation and continued smoking.
Pokorny SB; Jason LA; Schoeny ME. Journal of Clinical Child and Adolescent
Psychology32(2): 193-204, 2003. (55 refs.)
Used an ecological analysis employing multilevel random-effects regression analyses
to model Level 1 (individual and social) and Level 2 (environmental) correlates
of smoking initiation and continued smoking among 6th-, 7th-, and 8th-grade students.
Data from 5,234 youth in 11 Midwestern communities were examined. Results indicate
higher levels of retail tobacco availability (RTA) were associated with increased
odds that a youth initiated smoking but not continued smoking. Among the Level
1 factors, youth who were older, male, had an adult tobacco user in the home,
and had more peers who use tobacco had increased odds of initiating smoking.
In contrast, only the presence of an adult tobacco user in the home and the number
of peers who use tobacco were associated with increased odds that a youth continued
smoking. Examining individual, social, and environmental factors simultaneously
provides a clearer and more accurate model of these complex ecological influences.
Copyright 2003, Lawrence Erlbaum Associates, Inc.
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