critical aspects of vermont atod data john s. searles, ph.d. substance abuse research and policy...
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Critical Aspects of Vermont ATOD Data
John S. Searles, Ph.D.
Substance Abuse Research and Policy Analyst
State Epidemiological Workgroup (SEW):
Data-Driven Prevention
Kelly Hale LaMonda, Chair
x = {q + [q2 + (r-p2)3]1/2}1/3 + {q - [q2 + (r-p2)3]1/2}1/3 + p
where
p = -b/(3a), q = p3 + (bc-3ad)/(6a2), r = c/(3a)
And
The Mathematical Basis of Data Analysis
The Mathematical Basis of Data Analysis - Explained
• "Reports that say that something hasn't happened are always interesting to me, because as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns -- the ones we don't know we don’t know.”– Donald Rumsfeld, Feburary 12, 2002
State Epidemiological Data Systems (SEDS)
• Key constructs (e.g., mortality) and indicators (e.g., motor vehicle crash deaths) related to substance use and consequences by type (alcohol, tobacco, illicit drugs)
• Contains data available from national sources only (at lowest level available) (e.g., YRBSS, FARS, UCR, NVSS, NSDUH)
• Downloadable zip files of State data
Using Epidemiological DataSome Problems
• State Epidemiological Data Systems (SEDS) [From CSAP]– Not up-to-date
– Not complete
– Sometimes not relevant to Vermont
Using Epidemiological DataOther State Sources
• Distribution of population (geographic, age)• Local crime data (DUI by County)• Treatment data• Hospital discharge data
• OMG Factor• ICD-9/10 Codes• No standard or uniform coding procedures• $ not #
Age Distrubtion in Vermont
13
30
27
8
22
0 5 10 15 20 25 30 35
65+
45-64
25-44
18-24
<18
Age
Gro
up
% of Population
“Drill Down” Data Sources
• BRFSS – Data Limitations for 18-24 year olds
• YRBS– County– SU– School– Limited to students in school
Gaps
• 18-24 year olds– Students– Non Students– BRFSS does not sample cell phone users– 10% of all households are now wireless
• Prescription Drug Abuse
• Data Lags– Looking at “Rapid Response” options
TOBACCO
Current Smokers in Vermont(BRFSS)
0
5
10
15
20
25
30
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Per
Cen
t C
urr
ent
Sm
oke
rs
VT
US
Current Smokers in VermontYRBS
0
25
50
1993 1995 1997 1999 2001 2003 2005
PE
RC
EN
T
VT 8thVT 10thVT 12thUS 10thUS 12th
0
10
20
30
40
50
60
70
80
1999 2001 2003 2005
Year
Per
Cen
t
Perceive great risk
smoked during past 30 days
Binge Drinking in VTBRFSS by County and Age Group
0
10
20
30
40
50
60
Ad
dis
on
Ben
nin
gto
n
Cal
edo
nia
Ch
itte
nd
en
Ess
ex
Fra
nkl
in
Gra
nd
Isle
Lam
oill
e
Ora
ng
e
Orl
ean
s
Ru
tlan
d
Was
hin
gto
n
Win
dh
am
Win
dso
r
To
tal
County
% R
epo
rtin
g B
ing
e D
rin
kin
g P
ast
30-D
ays
18-24
25+
NA NA
ALCOHOL
BRFSS Results Across Time
0
5
10
15
20
25
30
35
40
45
2001 2002 2003 2004 2005
Year
Per
cen
t R
epo
rtin
g Y
es
DUI 18-24
DUI 25+
Binge 18-24
Binge 25+
Past 30-Day Use of AlcoholYRBS
29
21 19
41
50
40
50
56
61
0
50
100
1993 1995 1997 1999 2001 2003 2005
PE
RC
EN
T
8th Grade
10th Grade
12th Grade
Past 30-Day BingeYRBS
7
24
33
13
9
28
23
3841
0
50
100
1993 1995 1997 1999 2001 2003 2005
PE
RC
EN
T
8th Grade
10th Grade
12th Grade
MARIJUANA
Past 30-Day Marijuana UseYRBS
610 8
18
25302725
37
0
50
100
1993 1995 1997 1999 2001 2003 2005
PE
RC
EN
T
8th Grade
10th Grade
12th Grade
Past 30-Day Mja Use by Grade and Gender - YRBS
0
5
10
15
20
25
30
35
40
9 10 11 12
Grade
Rep
ort
ed 3
0-D
ay U
se (
%)
2005 Females
2005 Males
OTHER DRUGS(Including Prescription Drugs of Abuse)
YRBS Drug Use
0
2
4
6
8
10
12
14
16
18
20
Heroin Methamphetamine Hallucinogen Cocaine
YR
BS
Pre
vale
nce
(%
)
2001
2005
Cocaine Heroin Methamphetamine Hallucinogens
County 2001 2005 2001 2005 2001 2005 2001 2005
Addison 4.3 4.4 3.8 2.5 8.8 5.5 16.6 10.3
Bennington 2.9 4.6 2.1 2.6 6.2 4.2 15.8 10.9
Caledonia 4.7 3.3 3.2 2.2 8.6 5.3 17.4 12.3
Chittenden 3.1 4 2.7 2.8 6.5 5.1 13.9 9.3
Essex 6.6 5.3 3.3 4 12.6 5.3 18.5 5.5
Franklin 3.9 3.8 2.9 3 7.3 5.3 13.6 9.4
Grand Isle 6.4 3.4 3.4 1.4 9.4 4.7 17.7 9
Lamoille 3.7 2.6 3.4 1.4 7.9 4.7 16.8 8.4
Orange 4.3 4.4 4.1 4.4 8.6 6.1 15 10.8
Orleans 4.2 3.3 3.1 2.6 7 5 14.6 9.8
Rutland 4.2 5.3 3.3 3.6 7.7 6.5 16.4 12
Washington 4.1 3.4 3.9 3.2 7.5 4.5 12.8 9.6
Windham 6 5.8 4.2 3.8 11.4 8.2 19.7 14.1
Windsor 3.5 4.7 2.4 3.7 7.1 6.3 14.9 10.3
Illicit Drug Use 2002-2004National Survey on Drug Use and Health
0
1
2
3
4
5
6
7
All PrescriptionTherapeutics
Pain Relievers Tranquilizers Stimulants Methampetamine Sedatives
Illicit Drug
Pre
vale
nce
(%
)
VT
US
26th
16th
39th22nd
40th 36th
Illicit Drug Use 2002-2004National Survey on Drug Use and Health
0
10
20
30
40
50
60
70
All PrescriptionTherapeutics
Pain Relievers Tranquilizers Stimulants Methampetamine Sedatives
Illicit Drug
Pre
vale
nce
(%
)
VT
US
26th16th
39th 22nd
40th 36t
Treatment for Opiate Addiction(Other than Heroin)
0
5
10
15
20
25
30
35
2000 2001 2002 2003 2004 2005
12-17 YO
18-20 YO
21-25 YO
Surrogate Indicators
DOC by Age and County
0
200
400
600
800
1000
1200
1400
1600
C ounty
M al es <25
M al es 25+
Femal es < 25
Femal es 25+
Robbery Crime Rate
0
20
40
60
80
100
120
140
160
1999 2000 2001 2002 2003 2004 2005
Year
Rat
e/10
0,00
0
VT Robbery Rate
US Robbery Rate
Prescription Drug Abuse I
0
5
10
15
20
25
MTF 12th OtherNarcotics Lifetime - US
MTF 12th OtherNarcotics Past Year -
US
NHSDUH Age 12-17Nonmedical Use ofPain Relievers Past
Year - VT
YRBS Nonmedical RxUse 8th-12th Lifetime
VT
YRBS Nonmedical RxUse 12th Lifetime - VT
2004
2005
2006
Prescription Drug Abuse II
13.5
9.5
8.14
12.8
9
7.31
13.4
9
15.8
22.9
0
5
10
15
20
25
MTF 12th OtherNarcotics Lifetime - US
MTF 12th OtherNarcotics Past Year -
US
NHSDUH Age 12-17Nonmedical Use ofPain Relievers Past
Year - VT
YRBS Nonmedical RxUse 8th-12th Lifetime
VT
YRBS Nonmedical RxUse 12th Lifetime - VT
Per
cen
t
2004
2005
2006
2007
Prescription Drug Abuse III
Prevalence of Two Alcohol Constructs by Two Independent Surveys
18.6
12.5
37.6
22.1
0
5
10
15
20
25
30
35
40
30-Day Alcohol Use 30-Day Binge
NHSDUH VT 2005
YRBS VT 2005
Indicator of Increasing Problems with Potential Drugs of Abuse
• FACT: From 2001 to 2005, DEA drug arrests in Vermont went from 15 to 56
• INTERPRETATION: There is an increasing problem with prescription drugs in Vermont
DEA Arrests in Vermont
0
10
20
30
40
50
60
2001 2005
$400
$600
$800
$1000
$200
$400
$600
$800
$1000
$200
$400
$600
$800
$1000
$200
$400
$600
$800
$1000
$200
$400
$600
$800
$1000
$200
Torturing the
Data
History of VDH
Obscure Milwauk
ee Brewers
Evidence-Based
Prevention
Programs
Intervening
Variables
“I’ll take ‘Torturing the Data’ for $1000, Alex”
DEA Arrests in Vermont
15
56
0
10
20
30
40
50
60
70
2000 2001 2002 2003 2004 2005 2006
DEA Arrests in Vermont
15
34
46
56
0
10
20
30
40
50
60
70
2000 2001 2002 2003 2004 2005 2006
DEA Arrests in Vermont
15
51
34
46
56
0
10
20
30
40
50
60
70
2000 2001 2002 2003 2004 2005 2006
DEA Arrests in Vermont
64
15
51
34
46
56
0
10
20
30
40
50
60
70
2000 2001 2002 2003 2004 2005 2006
DEA Arrests in Vermont
64
15
51
34
46
56
36
0
10
20
30
40
50
60
70
2000 2001 2002 2003 2004 2005 2006
Assessing Burden and Determining Substance-Related Problems
The most influential criteria used by the SEW to identify statewide priorities were:
•Vermont’s ranking relative to other states
•Relative prevalence within Vermont
•Trends
Consumption and Consequences
• Alcohol
• Illicit Drugs
• Tobacco
SES by County
Less than HS HS Attended College
Addison 6.0% 28.3% 65.7%
Bennington 9.4% 26.2% 64.4%
Caledonia 9.4% 31.5% 59.1%
Chittenden 5.7% 20.2% 74.2%
Essex 12.6% 51.4% 36.0%
Franklin 7.9% 37.1% 55.0%
Grand Isle 10.3% 33.9% 55.7%
Lamoille 9.7% 29.1% 61.1%
Orange 7.8% 29.0% 63.2%
Orleans 8.6% 38.3% 53.0%
Rutland 8.8% 30.3% 61.0%
Washington 6.5% 23.8% 69.6%
Windham 8.0% 28.4% 63.6%
Windsor 7.1% 24.8% 68.0%
From 2005 YRBS
Surrogate SES and ConsumptionYRBS
0
10
20
30
40
50
60
< HS HS College Post Graduate
Mother's Highest Level of Education
% R
epo
rtin
g C
on
sum
pti
on
Beh
avio
r
Drank Past 30 Days
Binged Past 30 Days
DOC Census 10/06
0
200
400
600
800
1000
1200
1400
1600
C ounty
M al es <25
M al es 25+
Femal es < 25
Femal es 25+
DOC Census 10/06
0
5
10
15
20
25
30
35
40
45
50
C ounty
M al es < 25
Femal es < 25
Parental Attitude and Drinking
0
10
20
30
40
50
60
70
0 1 2 3
Number of Parental Risk Factors
% C
on
sum
ing
Alc
oh
ol P
ast
30 D
ays
Females
Males
Grades and Drinking
0
10
20
30
40
50
60
70
80
Mostly A's Mostly B's Mostly C's Mostly D's Mostly F's
Grades
Per
Cen
t R
epo
rtin
g C
on
seq
uen
ce
30-Day Use
Binged Past 30-Days
Binge Drinking 18-25 Year Olds
0
10
20
30
40
50
60
70
Ad
dis
on
Ben
nin
gto
n
Cal
edo
nia
Ch
itte
nd
en
Fra
nkl
in/G
ran
dIs
le Lam
oill
e
Ora
ng
e
Orl
ean
s/E
ssex
Ru
tlan
d
Was
hin
gto
n
Win
dh
am
Win
dso
r
Sta
te
COUNTY
PE
RC
EN
T
1990-1996
1997-2001
2002-2006
Binge Drinking 18-25 Year Olds
0
10
20
30
40
50
60
70
Ad
dis
on
Ben
nin
gto
n
Cal
edo
nia
Ch
itte
nd
en
Fra
nkl
in/G
ran
dIs
le Lam
oill
e
Ora
ng
e
Orl
ean
s/E
ssex
Ru
tlan
d
Was
hin
gto
n
Win
dh
am
Win
dso
r
Sta
te
County
Per
cen
t
1990-1996
1997-2001
2002-2006
DUI Among 18-25 Year Olds in VT
0
5
10
15
20
25
30
35
40
45
50
Ad
dis
on
Ben
nin
gto
n
Cal
edo
nia
Ch
itte
nd
en
Fra
nkl
in/G
ran
dIs
le
Lam
oil
le
Ora
ng
e
Orl
ean
s/E
ssex
Ru
tlan
d
Was
hin
gto
n
Win
dh
am
Win
dso
r
Sta
te
COUNTY
PE
RC
EN
T
1990-1996
1997-2001
2002-2006
DUI Among 18-25 Year Olds in VT
0
5
10
15
20
25
30
35
40
45
50
C OU NT Y
1990- 1996
1997- 2001
2002- 2006
Heavy Drinking 18-25 in VT
0
5
10
15
20
25
30
35
40
Ad
dis
on
Ben
nin
gto
n
Cal
edo
nia
Ch
itte
nd
en
Fra
nkl
in/G
ran
dIs
le
Lam
oil
le
Ora
ng
e
Orl
ean
s/E
ssex
Ru
tlan
d
Was
hin
gto
n
Win
dh
am
Win
dso
r
ST
AT
E
COUNTY
PE
RC
EN
T
1990-1996
1997-2001
2002-2006
Heavy Drinking 18-25 in VT
0
5
10
15
20
25
30
35
40
C ounty
1990- 1996
1997- 2001
2002- 2006
Calculations for CIs
Calculations for CIs
Calculating CIs
Calculating CIs
Final Recommendations
• Reduce underage drinking
• Reduce high-risk drinking among persons under 25
• Reduce marijuana use among persons under age 25
• Build prevention capacity and infra-structure at the state and community levels, including a sustainable evaluation system for prevention grantees.
THE END
Questions?