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New epidemiological research on ‘school bonding’ and drug involvement
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Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
New epidemiological research on ‘school bonding’ and drug involvement Madhur Chandra Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, United States Aims: Conceptual models for research at the intersection of public health and public education include a focus upon constructs such as ‘school attachment’ and ‘bonding to schools as institutions’ in efforts to predict youthful drug involvement. An alternative construct of ‘affiliation with drug-using peers’ often is specified in competition with these school attachment or bonding constructs. In this research project, an affiliation with peers who drink alcohol at the start of secondary schooling is investigated as a potential determinant of the longitudinal latent growth trajectory of school bonding. Via this research approach, the affiliation with peer drinkers early in secondary school is hypothesized as a potential determinant of the ‘school bonding’ trajectory intercept and slope parameters. Methods: In this 4-wave longitudinal study of 730 adolescent students in four schools of a mid-western United States metropolitan school district (1994–1997), standardized questionnaires assessed ‘school importance’ (SI) in Grades 9–12 (i.e., a rating of ‘importance for later life of things learned in school), as well as affiliation with peers in Grade 9 who drink alcohol et alia. Sexadjusted estimates of peer drinking on LLGM outcomes are derived via Mplus7 software. Results: With male–female differences held constant, affiliation with peer drinkers in the first year of secondary schooling predicts LLGM intercept values (i.e., baseline propensity to value schooling), but does not predict LLGM slope values (i.e., growth or decline in SI values). In addition, being male predicts LLGM intercept but not slope values. Conclusions: The main discovery is that early affiliation with peer drinkers in secondary school might exert a generally dampening influence on an adolescent’s initial bonding with school achievement as an important life goal, but this early affiliation does not seem to influence subsequent youth evaluations of the importance of schooling. Extensions of this research will estimate effects of early-onset alcohol use. Financial support: NIDA T32DA021129 & MSU. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.116 Fair hearing outcomes for patients recommended discharge from methadone maintenance Jamie S. Chang ∗ , Joshua Chiu, Valerie Gruber, James Sorensen U.C. San Francisco, San Francisco, CA, United States Aims: California law states that patients in methadone treatment (MT) who are discharged against their will have the right to a fair hearing (FH) to reverse the discharge recommendation. In a retrospective analysis of 73 FH reports from a MT between 2000 and 2015, the aims of the study were to (1) identify the factors involved in patient discharge from MT, (2) describe the factors involved when FH outcomes weighed in favor of the clinic, and (3) describe the factors involved when FH outcomes weighed in favor of the patient. Methods: We transferred the files, de-identified, and analyzed the program’s 73 FH reports from 2000 to 2015. Each report contained a summary of the FH findings, conclusions, and recommendations. First, fair hearing reports were uploaded to Atlas.TI.
Two researchers independently reviewed the reports, developed an initial code list, and then coded all of the reports. Through successive iterations of coding and analyzing, the reports were organized into data-driven thematic categories. Data queries were generated to analyze the data thematically. Results: Of the 73 FH meetings, 52 cases (71%) ruled in favor of the clinic. The client was present at the FH meeting in 31/52 cases (60%) in favor of the clinic and 18/21 cases (86%) in favor of the client. The reasons for discharge were (1) suspected diversion or “double dosing” (outcome: 20/52 clinic favored; 11/21 patient favored), (2) clinic policy violations (e.g. interpersonal, behavioral) (14/52 clinic favored; 3/21 patient favored), 3) repeat unexcused absences (11/52 clinic favored; 5/21 patient favored), and (4) co-occurring substance use (7/52 clinic favored; 2/31 patient favored). Conclusions: The reasons for recommended discharge from the methadone program were suspected diversion, “double dosing”, unexcused absences, other clinic policy violations (e.g., loitering, conflicts with staff or other clients), and co-occurring substance use. FHs were more likely to rule in the patient’s favor when patients were present. Financial support: NIDA (T32 DA007250) Postdoctoral Training Program in Drug Abuse Treatment/Services Research. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.117 Causes of death and expected years of life lost among opioid-dependent individuals using agonist therapy in the U.S. and Taiwan Kun-Chia Chang 1,∗ , Andrew Saxon 4 , George E. Woody 3 , Jung-Der Wang 5 , Yih-Ing Hser 2 1
General Psychiatry, Jianan Psychiatric Center, Ministry of Health & Welfare, Tainan, Taiwan, Tainan, Taiwan 2 Department of Psychiatry & Behavioral Sciences, UCLA, Los Angeles, CA, United States 3 Psychiatry, University of Pennsylvania, Philadelphia, PA, United States 4 Veterans Affairs Puget Sound Health Care System, USA, Seatle, WA, United States 5 Public Health, National Cheng Kung University, Taiwan, Tainan, Taiwan Aims: Opioid addiction is associated with substantial mortality, which is decreased but not eliminated by Opioid Agonist Therapy (OAT). This study compared the cause-specific mortality ratios (SMRs) and expected years of life lost (EYLL) between two different regions, US and Taiwan. Methods: Survival data through 2014 came from two cohorts: (1) the U.S. (START) study was a randomized controlled trial of 1267 opioid dependent participants between 2006 and 2009; (2) an analysis of 983 patients entering OAT in Taiwan since the 2006 implementation of OAT. A Kaplan–Meier estimation was extrapolated to 70 years to obtain the life expectancy using a semi-parametric method. EYLL for both cohorts were estimated by subtracting their life expectancies from the age- and gendermatched referents of the general population. SMRs were calculated and compared with each national cohort to demonstrate the real world picture. Results: Compared with each age- and gender-matched referent, the EYLLs and the SMRs were higher in the Taiwanese cohort: START (7.7 years; 3.2); Taiwan (16.4 years; 7.8). Half of decedents among both cohorts were due to unnatural causes; overdose deaths dominated that of START sample, suicide in OAT.
Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
New epidemiological research on ‘school bonding’ and drug involvement Madhur Chandra Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, United States Aims: Conceptual models for research at the intersection of public health and public education include a focus upon constructs such as ‘school attachment’ and ‘bonding to schools as institutions’ in efforts to predict youthful drug involvement. An alternative construct of ‘affiliation with drug-using peers’ often is specified in competition with these school attachment or bonding constructs. In this research project, an affiliation with peers who drink alcohol at the start of secondary schooling is investigated as a potential determinant of the longitudinal latent growth trajectory of school bonding. Via this research approach, the affiliation with peer drinkers early in secondary school is hypothesized as a potential determinant of the ‘school bonding’ trajectory intercept and slope parameters. Methods: In this 4-wave longitudinal study of 730 adolescent students in four schools of a mid-western United States metropolitan school district (1994–1997), standardized questionnaires assessed ‘school importance’ (SI) in Grades 9–12 (i.e., a rating of ‘importance for later life of things learned in school), as well as affiliation with peers in Grade 9 who drink alcohol et alia. Sexadjusted estimates of peer drinking on LLGM outcomes are derived via Mplus7 software. Results: With male–female differences held constant, affiliation with peer drinkers in the first year of secondary schooling predicts LLGM intercept values (i.e., baseline propensity to value schooling), but does not predict LLGM slope values (i.e., growth or decline in SI values). In addition, being male predicts LLGM intercept but not slope values. Conclusions: The main discovery is that early affiliation with peer drinkers in secondary school might exert a generally dampening influence on an adolescent’s initial bonding with school achievement as an important life goal, but this early affiliation does not seem to influence subsequent youth evaluations of the importance of schooling. Extensions of this research will estimate effects of early-onset alcohol use. Financial support: NIDA T32DA021129 & MSU. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.116 Fair hearing outcomes for patients recommended discharge from methadone maintenance Jamie S. Chang ∗ , Joshua Chiu, Valerie Gruber, James Sorensen U.C. San Francisco, San Francisco, CA, United States Aims: California law states that patients in methadone treatment (MT) who are discharged against their will have the right to a fair hearing (FH) to reverse the discharge recommendation. In a retrospective analysis of 73 FH reports from a MT between 2000 and 2015, the aims of the study were to (1) identify the factors involved in patient discharge from MT, (2) describe the factors involved when FH outcomes weighed in favor of the clinic, and (3) describe the factors involved when FH outcomes weighed in favor of the patient. Methods: We transferred the files, de-identified, and analyzed the program’s 73 FH reports from 2000 to 2015. Each report contained a summary of the FH findings, conclusions, and recommendations. First, fair hearing reports were uploaded to Atlas.TI.
Two researchers independently reviewed the reports, developed an initial code list, and then coded all of the reports. Through successive iterations of coding and analyzing, the reports were organized into data-driven thematic categories. Data queries were generated to analyze the data thematically. Results: Of the 73 FH meetings, 52 cases (71%) ruled in favor of the clinic. The client was present at the FH meeting in 31/52 cases (60%) in favor of the clinic and 18/21 cases (86%) in favor of the client. The reasons for discharge were (1) suspected diversion or “double dosing” (outcome: 20/52 clinic favored; 11/21 patient favored), (2) clinic policy violations (e.g. interpersonal, behavioral) (14/52 clinic favored; 3/21 patient favored), 3) repeat unexcused absences (11/52 clinic favored; 5/21 patient favored), and (4) co-occurring substance use (7/52 clinic favored; 2/31 patient favored). Conclusions: The reasons for recommended discharge from the methadone program were suspected diversion, “double dosing”, unexcused absences, other clinic policy violations (e.g., loitering, conflicts with staff or other clients), and co-occurring substance use. FHs were more likely to rule in the patient’s favor when patients were present. Financial support: NIDA (T32 DA007250) Postdoctoral Training Program in Drug Abuse Treatment/Services Research. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.117 Causes of death and expected years of life lost among opioid-dependent individuals using agonist therapy in the U.S. and Taiwan Kun-Chia Chang 1,∗ , Andrew Saxon 4 , George E. Woody 3 , Jung-Der Wang 5 , Yih-Ing Hser 2 1
General Psychiatry, Jianan Psychiatric Center, Ministry of Health & Welfare, Tainan, Taiwan, Tainan, Taiwan 2 Department of Psychiatry & Behavioral Sciences, UCLA, Los Angeles, CA, United States 3 Psychiatry, University of Pennsylvania, Philadelphia, PA, United States 4 Veterans Affairs Puget Sound Health Care System, USA, Seatle, WA, United States 5 Public Health, National Cheng Kung University, Taiwan, Tainan, Taiwan Aims: Opioid addiction is associated with substantial mortality, which is decreased but not eliminated by Opioid Agonist Therapy (OAT). This study compared the cause-specific mortality ratios (SMRs) and expected years of life lost (EYLL) between two different regions, US and Taiwan. Methods: Survival data through 2014 came from two cohorts: (1) the U.S. (START) study was a randomized controlled trial of 1267 opioid dependent participants between 2006 and 2009; (2) an analysis of 983 patients entering OAT in Taiwan since the 2006 implementation of OAT. A Kaplan–Meier estimation was extrapolated to 70 years to obtain the life expectancy using a semi-parametric method. EYLL for both cohorts were estimated by subtracting their life expectancies from the age- and gendermatched referents of the general population. SMRs were calculated and compared with each national cohort to demonstrate the real world picture. Results: Compared with each age- and gender-matched referent, the EYLLs and the SMRs were higher in the Taiwanese cohort: START (7.7 years; 3.2); Taiwan (16.4 years; 7.8). Half of decedents among both cohorts were due to unnatural causes; overdose deaths dominated that of START sample, suicide in OAT.