Drug treatment program ownership, Medicaid acceptance, and service provision.

The Institute of Medicine noted that effective substance abuse treatment (SAT) programs integrate individual therapeutic approaches with transitional/ancillary services. In addition, research suggests that type of ownership impacts SAT services offered and that Medicaid plays a key role in SAT access. Data from the National Survey of Substance Abuse Treatment Services for the years 2000 and 2002-2006 were used to examine relationships among SAT program Medicaid acceptance, program ownership, and transitional/ancillary service accessibility. Multivariate logistic regression models controlling for state- and program-level contextual factors were used to analyze the data. Nonprofit SAT programs were significantly more likely to offer transitional/ancillary services than for-profit programs. However, programs that accepted Medicaid, regardless of ownership, were significantly more likely to offer most transitional/ancillary services. The data suggest that Medicaid may play a significant role in offering key transitional/ancillary services related to successful treatment outcome, regardless of program ownership type.

Factors related to Medicaid payment acceptance at outpatient substance abuse treatment programs.

OBJECTIVE: To examine factors associated with Medicaid acceptance for substance abuse (SA) services by outpatient SA treatment programs. DATA SOURCES: Secondary analysis of 2003-2006 National Survey of Substance Abuse Treatment Services data combined with state Medicaid policy and usage measures and other publicly available data. STUDY DESIGN: We used cross-sectional analyses, including state fixed effects, to assess relationships between SA treatment program Medicaid acceptance and (1) program-level factors, (2) county-level sociodemographics and treatment program density, and (3) state-level population characteristics, SA treatment-related factors, and Medicaid policy and usage. DATA EXTRACTION METHODS: State Medicaid policy data were compiled based on reviews of state Medicaid-related statutes/regulations and Medicaid plans. Other data were publicly available. Principal Findings. Medicaid acceptance was significantly higher for programs: (a) that were publicly funded and in states with Medicaid policy allowing SA treatment coverage; (b) with accreditation/licensure and nonprofit/government ownership, as well as mental- and general-health focused programs; and (c) in counties with lower household income. CONCLUSIONS: SA treatment program Medicaid acceptance related to program-, county, and state-level factors. The data suggest the importance of state policy and licensure/accreditation requirements in increasing SA program Medicaid access.

Mental- and physical-health indicators and sexually explicit media use behavior by adults.

INTRODUCTION: Converging evidence from culturally diverse contexts indicates that sexually explicit media use behavior (SEMB; i.e., pornography consumption) is associated with risky sexual health perceptions and behaviors, many that involve high risks of HIV/STD transmission. AIM: Essentially unexplored, and the focus here, are potential relationships between SEMB and nonsexual mental- and physical-health indicators. MAIN OUTCOME MEASURE: Variability in six continuously measured health indicators (depressive symptoms, mental- and physical-health diminished days, health status, quality of life, and body mass index) was examined across two levels (users, nonusers) of SEMB. METHODS: A sample of 559 Seattle-Tacoma Internet-using adults was surveyed in 2006. Multivariate general linear models parameterized in a SEMB by respondent gender (2 × 2) factorial design were computed incorporating adjustments for several demographics. RESULTS: SEMB was reported by 36.7% (n = 205) of the sample. Most SEMB users (78%) were men. After adjusting for demographics, SEMB users, compared to nonusers, reported greater depressive symptoms, poorer quality of life, more mental- and physical-health diminished days, and lower health status. CONCLUSIONS: The findings show that mental- and physical-health indicators vary significantly across SEMB, suggesting the value of incorporating these factors in future research and programmatic endeavors. In particular, the findings suggest that evidence-based sexual health promotion strategies simultaneously addressing individuals' SEMB and their mental health needs might be a useful approach to improve mental health and address preventable sexual health outcomes associated with SEMB.

Evidence for Connections Between Prosecutor-Reported Marijuana Case Dispositions and Community Youth Marijuana-Related Attitudes and Behaviors.

This article examines relationships between local drug policy (as represented by prosecutor-reported case outcomes for first-offender juvenile marijuana possession cases) and youth self-reported marijuana use, perceived risk, and disapproval. Interviews with prosecutors and surveys of 8th-, 10th-, and 12th-grade students in the United States were conducted in 2000. Analyses include data from 97 prosecutors and students from 127 schools in 40 states. Results indicate significant relationships between local drug policy and youth marijuana use and attitudes. In general, more-severe dispositions are associated with less marijuana use, higher disapproval rates, and increased perceptions of great risk. Associations primarily appear to be specific to marijuana-related outcomes. Results are discussed within the framework of both deterrence and broader social norms regarding substance use.

US Public Health Agency involvement in youth-focused illicit drug policy, planning, and prevention at the local level, 1999-2003.

OBJECTIVES: We examined local public health agencies' involvement in community illicit drug policy advocacy and provision related to youths to determine the extent to which public health agencies were involved in local drug policy activities and could potentially provide an infrastructure for policy alternatives. METHODS: We conducted telephone interviews from 1999 to 2003 with 1793 US public health agencies in 804 communities surrounding schools participating in the Monitoring the Future study. Respondents reported public health agency planning, priorities, and involvement in alternative drug policy advocacy and prevention activities. We examined results for variance by site sociodemographic characteristics. RESULTS: Most students lived where public health agencies provided resources for community- and school-based drug use prevention. More than one third resided where public health agencies advocated for drug policy alternatives and more than one quarter where public health agencies were involved in juvenile drug court programs. Such activities were significantly higher in urban communities, in the West, and in sites where the proportion of African Americans was above the national average. CONCLUSIONS: Although local public health agencies could increase participation levels in drug policy alternatives, current involvement suggests that agencies may provide a base for supporting the development of public health alternatives to deterrence-based drug policies. Such a base may be more likely in communities with the highest need for such policies and services.

State policies matter: the case of outpatient drug treatment program practices.

This study examined relationships between state policy requirements governing outpatient substance abuse treatment services and reported outpatient treatment program practices. State policies effective as of February 1, 2003, and February 1, 2004, were collected and analyzed via primary legal research; data were validated by state officials (88% response rate; >90% validation rate). Treatment practice data were obtained from the National Survey of Substance Abuse Treatment Services for the years 2003 and 2004. Multivariate analyses clustered by state were conducted, controlling for state, program, and state-aggregated client admission characteristics. Results indicated that treatment programs located in states with requirements for comprehensive substance abuse assessment, family counseling, substance abuse and infectious disease/sexually transmitted disease testing services, HIV/AIDS education, and aftercare services had significantly higher odds of offering such services (p values ranging from < .05 to < .001). This study presents new information regarding the potential role that state policy context may play in understanding treatment program practices.

Does state certification or licensure influence outpatient substance abuse treatment program practices?

In the United States, state governments legally authorize outpatient substance abuse treatment programs. In some states, programs are certified or accredited (ideal standards). Other states license programs (minimal standards). Additionally, some states authorize programs through "deemed status", which is afforded to programs attaining accreditation from a national accrediting body. Primary legal research and the National Survey of Substance Abuse Treatment Services' (N-SSATS) data were used to examine the relationships between state authorization type (certification/accreditation vs licensure with and without deemed status) and outpatient treatment program practices. Programs in certification/accreditation (vs licensure) states had significantly higher odds of offering wrap-around and continuing care/after care services associated with better long-term treatment outcome. Programs in states that allowed for certification/accreditation with deemed status had significantly lower odds of infectious disease testing, but higher odds of providing group and family counseling. Results suggest that state authorization type may impact services offered by outpatient treatment programs.

Developing healthy kids in healthy communities: eight evidence-based strategies for preventing high-risk behaviour.

Australian youth engage in behaviour that threatens their health and wellbeing. National surveys report that about a third of young Australians have tried an illicit drug. High rates of substance use and risky sexual behaviour among young Australians suggest that effective prevention efforts based on empirical evidence need to be expanded. Church-associated organisations are an untapped resource that could be used to improve the health and welfare of young people. We describe eight evidence-based elements to consider in designing strategies to prevent high-risk behaviour in young people.

The role of public health agencies in providing access to adolescent drug treatment services.

PURPOSE: To examine the role of public health agencies (PHAs) in providing access to drug treatment services for adolescents by describing the proportion of youth who obtain access to these services through PHA involvement in school health clinics, juvenile drug courts, and other community agencies. METHODS: Analysis of cross-sectional telephone interview data collected from 1999-2003 from a national sample of 1793 PHA key informants from communities surrounding schools in the nationally representative Monitoring the Future (MTF) study of 8th, 10th and 12th grade students. RESULTS: Fifty-eight percent of youth in the MTF sample were served by PHAs that participated in some way in school health clinics, with 30% served by PHAs that provided resources for drug treatment in schools. Twenty-nine percent of youth were served by PHAs involved in juvenile drug court (JDC) programs, 23% by PHAs acting as JDC referral agencies, and 13% by PHAs providing direct JDC drug assessment, treatment and monitoring services. In addition, 44% of youth were served by PHAs providing drug treatment resources in community settings. Treatment access for youth through PHAs varied by region, race/ethnicity, urbanicity, community income level, and youth population density. The largest variation occurred in access via JDC programs. CONCLUSIONS: PHAs may help bridge gaps between drug treatment need and service provision for adolescents who need access to drug treatment services. Strengthening the linkages between PHAs and schools, juvenile drug courts, and other community settings may serve to increase youth access to drug treatment.

Back to basics: the role of health insurance in getting a physical exam.

The social work profession has a long history of advocacy to improve the human condition, especially for groups of people at high risk of discrimination and marginalization. Social workers have been instrumental in identifying, assessing, treating, and preventing illicit drug use as part of this commitment to advocacy. One component of social work's endeavors on behalf of drug users and other populations- at-risk has been advocating for increased access to health care. This article examines the role that having health insurance plays in obtaining the most basic of all health care-getting a physical examination. Featuring a sample of 1,271 chronic and injecting street drug users and comparison group non-users, the analysis demonstrates that having health insurance enhances access and utilization of health care among this at-risk population. Subjects who had health insurance for even one month of the past twelve were twice as likely to participate in basic health care by having a physical exam.

The process of research in international settings: from risk assessment to program development and intervention.

Although there are many challenges, international HIV prevention research and program evaluation are critical to advances in the health and welfare of people around the globe. While there is an increasing amount of literature describing outcomes of international prevention programs, there is sparse information regarding the process of developing and implementing international research. This brief report describes key elements in the development of collaborative international prevention research and programmatic implementation.

An assessment of HIV/AIDS risk in higher education students in Yerevan, Armenia.

Armenia's current sociopolitical and economic instability and the alarming HIV incidence rates in neighboring countries amplify its risk for a national epidemic. The goals of this study were to assess HIV/AIDS knowledge and risk behaviors among higher education students in Yerevan. Knowledge of HIV transmission through sexual intercourse was markedly higher than that on intravenous transmission and prevailing myths; however, HIV/AIDS knowledge was not related to risk behaviors. Tobacco and alcohol prevalence was relatively high. Students reported risky sexual behaviors, including inconsistent condom use, casual sex, and multiple partners. In addition to descriptive statistics delineating gender differences across the target behavioral domains, bivariate and multivariate statistical analyses were used to understand factors that contributed to increased risk, including early age of initiation and the relationship between substance use and risky sexual activity. The study results provide much-needed information for the development of school- and community-based AIDS prevention programs in Armenia.

"The rock always comes first": drug users' accounts about using formal health care.

Illicit drug use remains a significant public health threat. The issues surrounding drug use are recognized by public health professionals as important for several reasons. The incidence and prevalence of drug use persists in spite of the extensive societal, interpersonal, and individual consequences. In addition, the chronic health issues and health care costs associated with drug use continue to spiral. A wide variety of quantitative studies have examined the extent of health care problems, access, cost, and health care satisfaction among illicit drug users. While these studies offer important information through survey formats, fewer studies focus on subjective constructions of health care management from the users' perspective. This article examines the elements of the decision-making process involved in accessing formal health care among chronic and injecting street drug users. Twenty-eight in-depth interviews provide the data for this analysis, which is part of a large quantitative study of 1,479 injecting and chronic drug users and nondrug users in Miami, Florida. By exploring the elements of health care access through the eyes of the drug users, researchers and treatment professionals may gain insights into new ways to improve health care access for this at-risk population.

A decade of drug treatment court research.

As drug treatment courts have multiplied over the past decade, so too have research evaluations conducted on their implementation and effectiveness. This article explores the decade of drug treatment court research conducted at RAND, starting with the experimental field evaluation of Maricopa's drug testing and treatment options to the most current 14-site national evaluation of courts funded in 1995-96 by the Drug Court Program Office. The article presents summaries of findings, a brief description of a drug treatment court typology, and suggestion of where future research might focus.

Chronic Drug Use and Crime.

This paper used bivariate and multivariate analyses to estimate the relationships between chronic drug use and various measures of criminal activity. The data for these analyses were derived from the 1993 (1) and 1995 (2) National Household Surveys on Drug Abuse (NHSDA). Measures of criminal justice system contact and criminal activity included ever arrested, arrested during the previous year, commission of a predatory crime (e.g., assault, fighting) during the previous year, and commission of a property crime (e.g., theft, property damage, car theft, breaking and entering) during the previous year. The analysis was conducted separately for males, females, and age groups, and it distinguished between chronic drug users, nonchronic drug users, and nondrug users. The results consistently showed a significant linear relationship between criminal activity and frequency of drug use. These findings have implications regarding the potential reduction in predatory and property crime that could occur from a decrease in drug use. Significant differences in criminal behavior between chronic drug users and other cohorts may signal a critical need to develop targeted interventions for this particular type of drug user.