Sustainability of State-Level Substance Abuse Prevention Infrastructure After the Completion of the SPF SIG.

Recent national substance abuse prevention efforts that have been disseminated at the state level have provided fertile ground for addressing the dearth of systematic research on state-level substance abuse prevention infrastructure. The Strategic Prevention Framework State Incentive Grant Program (SPF SIG), a national public health initiative sponsored by the US Substance Abuse and Mental Health Services Administration and its Center for Substance Abuse Prevention, is one such effort, providing an opportunity to examine state-level substance abuse prevention infrastructure across the country. The aims of the SPF SIG initiative include reducing substance abuse and its related problems, as well as enhancing state and local prevention infrastructure and capacity. In this article, we describe the status of state-level substance abuse prevention infrastructure and capacity 1 year after the first 26 funded states ended their projects, based on follow-up interviews with state prevention decision-makers. We found that, in five of the six prevention domains we measured, prevention infrastructure capacity increased during the 12-month period after the grants ended. The evidence for further SPF capacity development even after the conclusion of the grants suggests that states recognized the benefits of using the SPF and took deliberate steps to sustain and enhance the integration of this framework into their state prevention systems. In addition, the findings suggest that state agencies and organizations can benefit from time-limited resources aimed at increasing their capacity and that such efforts can have a lasting impact on measures of state prevention system capacity.

Effects of the Strategic Prevention Framework State Incentives Grant (SPF SIG) on state prevention infrastructure in 26 states.

The Strategic Prevention Framework State Incentive Grant (SPF SIG) program is a national public health initiative sponsored by the U.S. Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention to prevent substance abuse and its consequences. State grantees used a data-driven planning model to allocate resources to 450 communities, which in turn launched over 2,200 intervention strategies to target prevention priorities in their respective populations. An additional goal was to build prevention capacity and infrastructure at the state and community levels. This paper addresses whether the state infrastructure goal was achieved, and what contextual and implementation factors were associated with success. The findings are consistent with claims that, overall, the SPF SIG program met its goal of increasing prevention capacity and infrastructure across multiple infrastructure domains, though the mediating effects of implementation were evident only in the evaluation/monitoring domain. The results also show that an initiative like the SPF SIG, which could easily have been compartmentalized within the states, has the potential to permeate more broadly throughout state prevention systems.

Gender-sensitive substance abuse treatment and arrest outcomes for women.

The present study links an empirically-developed quantitative measure of gender-sensitive (GS) substance abuse treatment to arrest outcomes among 5109 substance abusing women in mixed-gender short-term residential programs in Washington State. Frailty models of survival analysis and three-level hierarchical linear models were conducted to test the beneficial effects of GS treatment on decreasing criminal justice involvement. Propensity scores were used to control for the pre-existing differences among women due to the quasi-experimental nature of the study. Men's arrest outcomes were used to control for confounding at the program level. Results show that women in more GS treatment programs had a lower risk of drug-related arrests, and women in more GS treatment programs who also completed treatment had a significant reduction in overall arrests from 2 years before- to 2 years after treatment, above and beyond the reduction in arrests due to treatment alone. Implications and directions for future research are discussed.

Assessing state substance abuse prevention infrastructure through the lens of CSAP's Strategic Prevention Framework.

Although the organizational structures and operating procedures of state substance abuse prevention systems vary substantially across states, there is scant empirical research regarding approaches for rigorous assessment of system attributes and which attributes are most conducive to overall effectiveness. As one component of the national cross-site evaluation of the SPF State Incentive Grant Program (SPF SIG), an instrument was developed to assess state substance abuse prevention system infrastructure in order to measure infrastructure change and examine the role of state infrastructure in achieving prevention-related outcomes. In this paper we describe the development of this instrument and summarize findings from its baseline administration. As expected, states and territories were found to vary substantially with respect seven key characteristics, or domains, of state prevention infrastructure. Across the six domains that were assessed using numeric ratings, states scored highest on data systems and lowest on strategic planning. Positive intercorrelations were observed among these domains, indicating that states with high capacity on one domain generally have relatively high capacity on other domains as well. The findings also suggest that state prevention infrastructure development is linked to both funding from state government and the presence of a state interagency coordinating body with decision-making authority. The methodology and baseline findings presented will be used to inform the ongoing national cross-site evaluation of the SPF SIG and may provide useful information to guide further research on state substance abuse prevention infrastructure.

Measurement of gender-sensitive treatment for women in mixed-gender substance abuse treatment programs.

BACKGROUND: Gender-sensitive (GS) substance abuse treatment services have emerged in response to the multidimensional profile of problems that women display upon admission to substance abuse treatment. The present study examines the extent to which treatment programs vary in GS programming for women in real-world mixed-gender treatment settings, where most women are treated. METHODS: Data were collected through site visits using semi-structured interviews with program directors, clinical directors, and counselors in 13 mixed-gender treatment programs from Washington State. Rasch modeling techniques were used to analyze the data. RESULTS: Naturally occurring variation was revealed within and across the treatment programs, and demonstrated that reliable measures of three GS domains (Grella, 2008) can be constructed despite a small number of programs. CONCLUSIONS: This is the first study to quantify GS treatment for substance abusing women. The identified treatment services and practices and the way they clustered together to form scales have practical implications for researchers, service providers, clinicians, and policy makers. The scales can be used to study treatment outcomes and to evaluate the effectiveness, cost-effectiveness, and cost-benefit of GS programming for women.

Marijuana initiation among American youth and its risks as dynamic processes: prospective findings from a national longitudinal study.

The aim of this study was threefold: (1) to prospectively estimate population incidence rates of marijuana use from late childhood to adolescence, (2) to identify important risk factors, and (3) to examine and demonstrate the dynamic nature of risk factors of marijuana initiation, that is, the degree to which influences change as youth age. The longitudinal data from seven nationally representative age cohorts (aged 10-16 years) of marijuana never-users (N = 4,607) and their parents were used. These data were collected during 1999-2004 under the National Institute on Drug Abuse (NIDA) contract N01DA-8-5063, USA, using the National Survey of Parents and Youth. This survey was designed in part to measure changes in drug-related beliefs, attitudes, and behaviors in American youth and their parents. A series of lagged logistic regression analyses were performed with a cohort-sequential design. Multiple imputation was used to handle missing data and longitudinal replicate weights were incorporated into the analyses. Results showed that the population incidence rates of marijuana use increased from 1.30% to 16.29% from age 11 to 16 years and then appeared to level off. A sharp increase was found during ages 13-15 years. Among six identified important factors, alcohol and/or tobacco use and marijuana offers appeared to be the most important risk factors across ages and age cohorts. Consistent with hypotheses, parental influence and peer influence varied as youth age. Both parental influence and peer influence had significant effects during early adolescence and peer influence continued to middle adolescence. Parental monitoring functioned as a protective factor against peer influence on marijuana initiation, but the effect vanishes during late adolescence. Results provide some empirical evidence of a shift from parental influence to peer influence. The study's limitations are noted.

Effects of the National Youth Anti-Drug Media Campaign on youths.

OBJECTIVES: We examined the cognitive and behavioral effects of the National Youth Anti-Drug Media Campaign on youths aged 12.5 to 18 years and report core evaluation results. METHODS: From September 1999 to June 2004, 3 nationally representative cohorts of US youths aged 9 to 18 years were surveyed at home 4 times. Sample size ranged from 8117 in the first to 5126 in the fourth round (65% first-round response rate, with 86%-93% of still eligible youths interviewed subsequently). Main outcomes were self-reported lifetime, past-year, and past-30-day marijuana use and related cognitions. RESULTS: Most analyses showed no effects from the campaign. At one round, however, more ad exposure predicted less intention to avoid marijuana use (gamma = -0.07; 95% confidence interval [CI] = -0.13, -0.01) and weaker antidrug social norms (gamma = -0.05; 95% CI = -0.08, -0.02) at the subsequent round. Exposure at round 3 predicted marijuana initiation at round 4 (gamma = 0.11; 95% CI = 0.00, 0.22). CONCLUSIONS: Through June 2004, the campaign is unlikely to have had favorable effects on youths and may have had delayed unfavorable effects. The evaluation challenges the usefulness of the campaign.

Does gender-specific substance abuse treatment for women promote continuity of care?

Research has stressed the value of providing specialized services to women and suggests the importance of treatment duration. This quasi-experimental retrospective study reports on the continuity of care for women with children who were admitted to long-term residential substance abuse treatment. Women were admitted to 7 agencies offering specialized, women's only treatment (SP, n = 747) or to 9 agencies that provided standard mixed-gender treatment (ST, n = 823). Client and treatment data were gathered from administrative sources. We hypothesized that women in specialized treatment would demonstrate higher continuing care rates after controlling for treatment completion and length of stay. Women in SP programs (37%) were more likely than those in ST programs (14%) to continue care. Multivariate analyses revealed that SP clients who completed treatment with longer stays were most likely to continue care. The findings show that specialized treatment for women promotes continuing care and demonstrate the importance of treatment completion.

Transitions through homelessness and factors that predict them: three-year treatment outcomes.

The course of homelessness was examined among adults entering treatment in the Chicago Target Cities sample, which was aimed at improving the service delivery system in large metropolitan areas across the U.S. The objectives of the present study were: (1) Examine transitions in and out of homelessness over 3 years post entry into treatment; and (2) Determine the treatment and non-treatment factors that predict achieving and sustaining residential stability. Sixty-one percent of initially homeless participants were stably housed at 36 months. By contrast, only 14% of initially housed participants were homeless at 36 months. Sample-wide, homelessness was reduced by 43% over 3 years. In conditional logistic regression models, the most consistent and persistent predictors were crack as the primary problem substance, which appears to be a risk factor for becoming and remaining homeless, and whether or not others were dependent on the participant for food/shelter, which appears to be a protective factor for achieving housing and preventing homelessness. In general, specific treatment factors did not predict outcomes. Limitations and implications for treatment are discussed.