Use of clinical performance measures for contraceptive care in Iowa, 2013.

OBJECTIVES: To assess feasibility of calculating clinical performance measures for contraceptive care for National Quality Forum submission: the percentage of women aged 15-44 years provided the following: (1) a most or moderately effective contraceptive method (MME) and (2) a long-acting reversible contraceptive (LARC) method. METHODS: We used 2013 Iowa Department of Public Health (IDPH) Title X and Iowa Medicaid data. We stratified Title X data by age and Medicaid data by age and benefit type (family planning waiver (FPW) vs. general Medicaid), and examined variation by residence, public health region and health plan based on program interest. FINDINGS: Among women attending IDPH Title X clinics in 2013 (N=11,584), 86% of women aged 15-20years and 83% of women aged 21-44years were provided MME; and 20% of women aged 15-20years and 20% of women aged 21-44years were provided LARC. Estimates varied across Title X subrecipient agencies, which receive federal funds from IDPH. Among Medicaid FPW clients (N=30,013), 79% of women aged 15-20years and 73% of women aged 21-44years were provided MME; and 12% of women aged 15-20years and 11% of women aged 21-44years were provided LARC. Among general Medicaid clients (N=14,737), 40% of women aged 15-20years and 28% of women aged 21-44years were provided MME; and 5% of women aged 15-20years and 5% of women aged 21-44years were provided LARC. CONCLUSION: A high percentage of IDPH Title X and FPW clients were provided an MME method. No reporting entity had a LARC percentage less than 1%-2%. IMPLICATIONS: Measure calculation using Title X and Medicaid data is feasible and can potentially be used to identify ways to increase access to contraceptive methods.

Predictors of conviction and sentencing of DWI offenders in a New Mexico County.

OBJECTIVE: To analyze predictors of conviction and dismissal of individuals charged with DWI, and predictors of the sentences of those who are convicted. METHODS: Data come from the Citation Tracking System of the State of New Mexico's Motor Vehicle Division and includes information on all individuals who were arrested for DWI in San Juan County between August 1994 and December 2000. Independent variables were: age, gender, race/ethnicity, waiver of right to an attorney, court of arraignment, year of arrest, BAC, and number of prior DWI arrests. Dependent variables were: (1) conviction or dismissal, (2) jail or no jail, (3) incarceration/treatment or not, (4) fine or no fine, (5) length of jail sentence, (6) waived right of attorney, and (7) magnitude of fine. Multiple linear and logistic regression was used in the analyses. RESULTS: Use of an attorney is associated with reduced likelihood of conviction and, if convicted, in reduced likelihood of jail sentence and reduced jail time, but greater likelihood and magnitude of a fine. Native Americans were more likely than Hispanics and non-Hispanic whites to waive their right to an attorney. Native Americans were most likely to be sentenced to the detention/treatment program. BAC and number of prior arrests were each positively associated with increased likelihood of conviction and more severe sentences. There is also substantial variability in severity of sentencing among courts. CONCLUSION: Likelihood of conviction and severity of sentences are both determined by extra-legal factors, resulting in inconsistent application of the law. This may in turn contribute to a lack of compliance with laws related to DWI.

Small-area variations in conviction rates for DWI: the significance of contextual variables in a Southwestern state.

Average annual conviction rates (1990-2000) of people arrested for driving under the influence of alcohol in each of New Mexico's 33 counties are described. Conviction rates vary from 58 to 95%. Rates are correlated with political conservatism, being higher where a higher proportion of voters voted for the republican presidential candidates, and with measures of crowding in the courts. Conviction rates are higher in rural than urban areas and are correlated with a low prevalence of alcohol-related problems in the population. The variance in conviction rates is higher in rural than urban areas, and higher where measures of court crowding are low. The results suggest that political culture and the efficiency of court functioning are each independently associated with conviction rates for DWI and may also be associated in a reciprocal fashion with both low DWI arrest rates and alcohol-involved crash rates.

Variations in jail sentences and the probability of re-arrest for driving while intoxicated.

OBJECTIVE: The probability of re-arrest for driving while intoxicated (DWI) is compared for four different groups of individuals classified by whether the individual was convicted and, if so, the type of sentence received. METHOD: Subsequent re-arrests for DWI were examined for all individuals whose index arrest for DWI had occurred between 1994 and 2001 in a county in New Mexico. The groups included (1) those convicted as a result of the index arrest and sentenced to a 28-day jail/treatment program (N (#)=(#) 2,703); (2) all those not convicted as a result of the index arrest (N = 709); (3) those who were convicted but not sentenced to jail (N = 1,047); and (4) those convicted and sentenced to jail (N = 1,290). RESULTS: Adjusting for covariates of BAC, number of prior arrests, ethnicity, age, and sex, the probability of not being re-arrested was greatest among those sentenced to the jail/treatment program (Group 1), next highest in the two groups convicted but not sentenced to jail/treatment (Groups 3 and 4), and lowest in the group that was not convicted (Group 2). Length of jail sentence among people convicted but not sentenced to the jail/treatment program was unrelated to the probability of re-arrest. CONCLUSION: Conviction for DWI, regardless of the sentence, appears to reduce the probability of re-arrest, and being sentenced to a multi-modal treatment/incarceration program further reduces the probability of re-arrest. However, the other types of sentences do not appear to differ in their impact on probability of re-arrest.

The prevention paradox, traffic safety, and driving-while-intoxicated treatment.

BACKGROUND: In San Juan County, New Mexico, a 28-day jail/treatment program for first-time driving-while-intoxicated (DWI) offenders was established in 1994 to reduce both DWI recidivism and alcohol-related crashes. This paper assesses the impact of the program on both outcomes. METHODS: The data are composed of driving records of all people arrested for DWI in San Juan County from August 1994 through December 2001. Subsequent re-arrests and crashes were analyzed to compare people who had been sentenced to the jail/treatment program and those who had not. Kaplan-Meier survival curves and Cox proportional hazards regression analyses were used. Covariates included age, gender, blood alcohol content (BAC), number of prior arrests, and ethnicity (Native American, non-Hispanic white, and Hispanic). RESULTS: Re-arrest rates were significantly lower for the treatment than the nontreatment group. Each of the three major ethnic groups showed similar effects. This was not observed for subsequent alcohol-related crashes, possibly as a result of insufficient numbers. BAC and number of previous arrests were, however, significant risk factors for subsequent crashes. Finally, although BAC and previous arrests were important risk factors for subsequent crashes, the vast majority of subsequent alcohol-related crashes occurred among people in the intermediate risk ranges. CONCLUSIONS: The jail/treatment program is effective in reducing the probability of DWI re-arrests. The evidence with respect to crashes is equivocal. That most crashes occur to people in the intermediate risk range exemplifies the prevention paradox, and means that the courts, which deal most severely with high-risk individuals, cannot be expected to have a major impact on alcohol-related crashes.

Effectiveness of customized Victim Impact Panels on first-time DWI offender inmates.

This study investigates the effectiveness of a customized Victim Impact Panel (VIP) on reducing 'driving while impaired' recidivism, alcohol consumption and drinking and driving behavior. The study was conducted at a 28-day Detention/Treatment Program in a largely rural county in northwestern New Mexico. Study participants were randomly assigned to attend or not attend a VIP while participating in the program for court-defined first-time driving while intoxicated (DWI) offenders. There were no significant differences between the two groups on alcohol consumption, drinking and driving behavior, or recidivism within 2 years. These findings support the findings of other studies that VIPs do not produce a differential benefit with regards to recidivism of those convicted as a first-time DWI offenders.

Rearrest rates after incarceration for DWI: a comparative study in a southwestern US county.

OBJECTIVES: This study was undertaken to assess a 28-day detention and treatment program's effect, in a multiethnic county with high rates of alcohol-related arrests and crashes, on first-time offenders sentenced for driving while impaired (DWI). METHODS: We used comparison of baseline characteristics, survival curves of subsequent arrest, and Cox proportional hazards regression to examine probability of rearrest of those sentenced and those not sentenced to the program. RESULTS: Probability of not being rearrested was significantly higher for the treatment group after adjustment for covariates. At 5 years, probability of not being rearrested for the treatment vs the nontreatment group was 76.6% vs 59.9%. CONCLUSIONS: Results suggest that this county's program has significantly affected rearrest rates for Native Americans, Hispanics, and non-Hispanic Whites.