1. Critical Aspects of Vermont ATOD Data John S. Searles, Ph.D. Substance Abuse Research and Policy Analyst

3. State Epidemiological Workgroup (SEW): Data-Driven Prevention Kelly Hale LaMonda, Chair

4. x = {q + [q 2 + (r-p 2 ) 3 ] 1/2 } 1/3 + {q - [q 2 + (r-p 2 ) 3 ] 1/2 } 1/3 + p where p = -b/(3a), q = p 3 + (bc-3ad)/(6a 2 ), r = c/(3a) And The Mathematical Basis of Data Analysis

5. 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

6. 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

7. Using Epidemiological Data Some Problems State Epidemiological Data Systems (SEDS) [From CSAP] –Not up-to-date –Not complete –Sometimes not relevant to Vermont

8. Using Epidemiological Data Other 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 #

10. “Drill Down” Data Sources BRFSS –Data Limitations for 18-24 year olds YRBS –County –SU –School –Limited to students in school

11. 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

12. TOBACCO

13. Current Smokers in Vermont (BRFSS)

14. Current Smokers in Vermont YRBS

16. Binge Drinking in VT BRFSS by County and Age Group

17. ALCOHOL

19. Past 30-Day Use of Alcohol YRBS

20. Past 30-Day Binge YRBS

23. MARIJUANA

24. Past 30-Day Marijuana Use YRBS

25. Past 30-Day Mja Use by Grade and Gender - YRBS

28. OTHER DRUGS ( Including Prescription Drugs of Abuse)

29. YRBS Drug Use

30. CocaineHeroinMethamphetamineHallucinogens County20012005200120052001200520012005 Addison 4.34.43.82.58.85.516.610.3 Bennington 2.94.62.12.66.24.215.810.9 Caledonia 4.73.33.22.28.65.317.412.3 Chittenden 3.142.72.86.55.113.99.3 Essex 6.65.33.3412.65.318.55.5 Franklin 3.93.82.937.35.313.69.4 Grand Isle 6.43.4 1.49.44.717.79 Lamoille 3.72.63.41.47.94.716.88.4 Orange 4.34.44.14.48.66.11510.8 Orleans 4.23.33.12.67514.69.8 Rutland 4.25.33.33.67.76.516.412 Washington 4.13.43.93.27.54.512.89.6 Windham 65.84.23.811.48.219.714.1 Windsor 3.54.72.43.77.16.314.910.3

31. Illicit Drug Use 2002-2004 National Survey on Drug Use and Health

33. Treatment for Opiate Addiction (Other than Heroin)

34. Surrogate Indicators

35. DOC by Age and County

36. Robbery Crime Rate

37. Prescription Drug Abuse I

38. Prescription Drug Abuse II

39. Prescription Drug Abuse III

40. 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

41. DEA Arrests in Vermont

42. $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 Milwaukee Brewers Evidence- Based Prevention Programs Intervening Variables

43. “I’ll take ‘Torturing the Data’ for $1000, Alex”

44. DEA Arrests in Vermont

50. Phase 1 Prioritization Process- Phase 1 – Identify consequence and consumption data – Analyze & interpret according to certain dimensions Size/Magnitude (numbers/frequencies, rates) Impact (depth of problem across dimensions; social costs are high) – Determine epidemiological data priorities

51. Assessing Burden and Determining Substance-Related Problems Use criteria of burden to describe features of the data such as –What is the size of the problem? –What do rates of the problem look like? –Who is affected? –What is the geographic distribution? –What do trends over time look like? –How serious is the problem?

52. 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

53. Consumption and Consequences Alcohol Illicit Drugs Tobacco

54. 2005 Youth Risk Behavior Survey Ever Used Among 9-12th Graders

55. Past Month Binge Alcohol Use

56. Past Month Use of Marijuana

57. Percent of Vermont 12th Graders Who Rode or Drove Under the Influence of Alcohol or Marijuana Vermont Youth Risk Behavior Survey

58. Recommendations 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

59. Epi Workgroup Preliminary Recommendations Workgroup decided to recommend that the Advisory Council focus on: Alcohol misuse across the lifespan Driving under the influence of marijuana

60. SES by County Less than HSHSAttended College Addison6.0%28.3%65.7% Bennington9.4%26.2%64.4% Caledonia9.4%31.5%59.1% Chittenden5.7%20.2%74.2% Essex12.6%51.4%36.0% Franklin7.9%37.1%55.0% Grand Isle10.3%33.9%55.7% Lamoille9.7%29.1%61.1% Orange7.8%29.0%63.2% Orleans8.6%38.3%53.0% Rutland8.8%30.3%61.0% Washington6.5%23.8%69.6% Windham8.0%28.4%63.6% Windsor7.1%24.8%68.0% From 2005 YRBS

61. Surrogate SES and Consumption YRBS

62. DOC Census 10/06

64. Parental Attitude and Drinking

65. Grades and Drinking

66. Binge Drinking 18-25 Year Olds

68. DUI Among 18-25 Year Olds in VT

70. Heavy Drinking 18-25 in VT

72. Calculations for CIs

74. Calculating CIs

79. 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.

80. THE END

81. Questions?