Critical Aspects of Vermont ATOD Data

John S. Searles, Ph.D.

Substance Abuse Research and Policy Analyst

State Epidemiological Workgroup (SEW):

Data-Driven Prevention

Kelly Hale LaMonda, Chair

x   =   {q + [q2 + (r-p2)3]1/2}1/3   +   {q - [q2 + (r-p2)3]1/2}1/3   +   p

where

p = -b/(3a),   q = p3 + (bc-3ad)/(6a2),   r = c/(3a)

And

The Mathematical Basis of Data Analysis

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

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

Using Epidemiological DataSome Problems

• State Epidemiological Data Systems (SEDS) [From CSAP]– Not up-to-date

– Not complete

– Sometimes not relevant to Vermont

Using Epidemiological DataOther 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 #

Age Distrubtion in Vermont

13

30

27

8

22

0 5 10 15 20 25 30 35

65+

45-64

25-44

18-24

<18

Age

Gro

up

% of Population

“Drill Down” Data Sources

• BRFSS – Data Limitations for 18-24 year olds

• YRBS– County– SU– School– Limited to students in school

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

TOBACCO

Current Smokers in Vermont(BRFSS)

0

5

10

15

20

25

30

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

Per

Cen

t C

urr

ent

Sm

oke

rs

VT

US

Current Smokers in VermontYRBS

0

25

50

1993 1995 1997 1999 2001 2003 2005

PE

RC

EN

T

VT 8thVT 10thVT 12thUS 10thUS 12th

0

10

20

30

40

50

60

70

80

1999 2001 2003 2005

Year

Per

Cen

t

Perceive great risk

smoked during past 30 days

Binge Drinking in VTBRFSS by County and Age Group

0

10

20

30

40

50

60

Ad

dis

on

Ben

nin

gto

n

Cal

edo

nia

Ch

itte

nd

en

Ess

ex

Fra

nkl

in

Gra

nd

Isle

Lam

oill

e

Ora

ng

e

Orl

ean

s

Ru

tlan

d

Was

hin

gto

n

Win

dh

am

Win

dso

r

To

tal

County

% R

epo

rtin

g B

ing

e D

rin

kin

g P

ast

30-D

ays

18-24

25+

NA NA

ALCOHOL

BRFSS Results Across Time

0

5

10

15

20

25

30

35

40

45

2001 2002 2003 2004 2005

Year

Per

cen

t R

epo

rtin

g Y

es

DUI 18-24

DUI 25+

Binge 18-24

Binge 25+

Past 30-Day Use of AlcoholYRBS

29

21 19

41

50

40

50

56

61

0

50

100

1993 1995 1997 1999 2001 2003 2005

PE

RC

EN

T

8th Grade

10th Grade

12th Grade

Past 30-Day BingeYRBS

7

24

33

13

9

28

23

3841

0

50

100

1993 1995 1997 1999 2001 2003 2005

PE

RC

EN

T

8th Grade

10th Grade

12th Grade

MARIJUANA

Past 30-Day Marijuana UseYRBS

610 8

18

25302725

37

0

50

100

1993 1995 1997 1999 2001 2003 2005

PE

RC

EN

T

8th Grade

10th Grade

12th Grade

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

0

5

10

15

20

25

30

35

40

9 10 11 12

Grade

Rep

ort

ed 3

0-D

ay U

se (

%)

2005 Females

2005 Males

OTHER DRUGS(Including Prescription Drugs of Abuse)

YRBS Drug Use

0

2

4

6

8

10

12

14

16

18

20

Heroin Methamphetamine Hallucinogen Cocaine

YR

BS

Pre

vale

nce

(%

)

2001

2005

 

  Cocaine Heroin Methamphetamine Hallucinogens

County 2001 2005 2001 2005 2001 2005 2001 2005

Addison 4.3 4.4 3.8 2.5 8.8 5.5 16.6 10.3

Bennington 2.9 4.6 2.1 2.6 6.2 4.2 15.8 10.9

Caledonia 4.7 3.3 3.2 2.2 8.6 5.3 17.4 12.3

Chittenden 3.1 4 2.7 2.8 6.5 5.1 13.9 9.3

Essex 6.6 5.3 3.3 4 12.6 5.3 18.5 5.5

Franklin 3.9 3.8 2.9 3 7.3 5.3 13.6 9.4

Grand Isle 6.4 3.4 3.4 1.4 9.4 4.7 17.7 9

Lamoille 3.7 2.6 3.4 1.4 7.9 4.7 16.8 8.4

Orange 4.3 4.4 4.1 4.4 8.6 6.1 15 10.8

Orleans 4.2 3.3 3.1 2.6 7 5 14.6 9.8

Rutland 4.2 5.3 3.3 3.6 7.7 6.5 16.4 12

Washington 4.1 3.4 3.9 3.2 7.5 4.5 12.8 9.6

Windham 6 5.8 4.2 3.8 11.4 8.2 19.7 14.1

Windsor 3.5 4.7 2.4 3.7 7.1 6.3 14.9 10.3

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

0

1

2

3

4

5

6

7

All PrescriptionTherapeutics

Pain Relievers Tranquilizers Stimulants Methampetamine Sedatives

Illicit Drug

Pre

vale

nce

(%

)

VT

US

26th

16th

39th22nd

40th 36th

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

0

10

20

30

40

50

60

70

All PrescriptionTherapeutics

Pain Relievers Tranquilizers Stimulants Methampetamine Sedatives

Illicit Drug

Pre

vale

nce

(%

)

VT

US

26th16th

39th 22nd

40th 36t

Treatment for Opiate Addiction(Other than Heroin)

0

5

10

15

20

25

30

35

2000 2001 2002 2003 2004 2005

12-17 YO

18-20 YO

21-25 YO

Surrogate Indicators

DOC by Age and County

0

200

400

600

800

1000

1200

1400

1600

C ounty

M al es <25

M al es 25+

Femal es < 25

Femal es 25+

Robbery Crime Rate

0

20

40

60

80

100

120

140

160

1999 2000 2001 2002 2003 2004 2005

Year

Rat

e/10

0,00

0

VT Robbery Rate

US Robbery Rate

Prescription Drug Abuse I

0

5

10

15

20

25

MTF 12th OtherNarcotics Lifetime - US

MTF 12th OtherNarcotics Past Year -

US

NHSDUH Age 12-17Nonmedical Use ofPain Relievers Past

Year - VT

YRBS Nonmedical RxUse 8th-12th Lifetime

VT

YRBS Nonmedical RxUse 12th Lifetime - VT

2004

2005

2006

Prescription Drug Abuse II

13.5

9.5

8.14

12.8

9

7.31

13.4

9

15.8

22.9

0

5

10

15

20

25

MTF 12th OtherNarcotics Lifetime - US

MTF 12th OtherNarcotics Past Year -

US

NHSDUH Age 12-17Nonmedical Use ofPain Relievers Past

Year - VT

YRBS Nonmedical RxUse 8th-12th Lifetime

VT

YRBS Nonmedical RxUse 12th Lifetime - VT

Per

cen

t

2004

2005

2006

2007

Prescription Drug Abuse III

Prevalence of Two Alcohol Constructs by Two Independent Surveys

18.6

12.5

37.6

22.1

0

5

10

15

20

25

30

35

40

30-Day Alcohol Use 30-Day Binge

NHSDUH VT 2005

YRBS VT 2005

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

DEA Arrests in Vermont

0

10

20

30

40

50

60

2001 2005

$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 Milwauk

ee Brewers

Evidence-Based

Prevention

Programs

Intervening

Variables

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

DEA Arrests in Vermont

15

56

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006

DEA Arrests in Vermont

15

34

46

56

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006

DEA Arrests in Vermont

15

51

34

46

56

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006

DEA Arrests in Vermont

64

15

51

34

46

56

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006

DEA Arrests in Vermont

64

15

51

34

46

56

36

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006

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

Consumption and Consequences

• Alcohol

• Illicit Drugs

• Tobacco

SES by County

  Less than HS HS Attended College

Addison 6.0% 28.3% 65.7%

Bennington 9.4% 26.2% 64.4%

Caledonia 9.4% 31.5% 59.1%

Chittenden 5.7% 20.2% 74.2%

Essex 12.6% 51.4% 36.0%

Franklin 7.9% 37.1% 55.0%

Grand Isle 10.3% 33.9% 55.7%

Lamoille 9.7% 29.1% 61.1%

Orange 7.8% 29.0% 63.2%

Orleans 8.6% 38.3% 53.0%

Rutland 8.8% 30.3% 61.0%

Washington 6.5% 23.8% 69.6%

Windham 8.0% 28.4% 63.6%

Windsor 7.1% 24.8% 68.0%

       

  From 2005 YRBS  

Surrogate SES and ConsumptionYRBS

0

10

20

30

40

50

60

< HS HS College Post Graduate

Mother's Highest Level of Education

% R

epo

rtin

g C

on

sum

pti

on

Beh

avio

r

Drank Past 30 Days

Binged Past 30 Days

DOC Census 10/06

0

200

400

600

800

1000

1200

1400

1600

C ounty

M al es <25

M al es 25+

Femal es < 25

Femal es 25+

DOC Census 10/06

0

5

10

15

20

25

30

35

40

45

50

C ounty

M al es < 25

Femal es < 25

Parental Attitude and Drinking

0

10

20

30

40

50

60

70

0 1 2 3

Number of Parental Risk Factors

% C

on

sum

ing

Alc

oh

ol P

ast

30 D

ays

Females

Males

Grades and Drinking

0

10

20

30

40

50

60

70

80

Mostly A's Mostly B's Mostly C's Mostly D's Mostly F's

Grades

Per

Cen

t R

epo

rtin

g C

on

seq

uen

ce

30-Day Use

Binged Past 30-Days

Binge Drinking 18-25 Year Olds

0

10

20

30

40

50

60

70

Ad

dis

on

Ben

nin

gto

n

Cal

edo

nia

Ch

itte

nd

en

Fra

nkl

in/G

ran

dIs

le Lam

oill

e

Ora

ng

e

Orl

ean

s/E

ssex

Ru

tlan

d

Was

hin

gto

n

Win

dh

am

Win

dso

r

Sta

te

COUNTY

PE

RC

EN

T

1990-1996

1997-2001

2002-2006

Binge Drinking 18-25 Year Olds

0

10

20

30

40

50

60

70

Ad

dis

on

Ben

nin

gto

n

Cal

edo

nia

Ch

itte

nd

en

Fra

nkl

in/G

ran

dIs

le Lam

oill

e

Ora

ng

e

Orl

ean

s/E

ssex

Ru

tlan

d

Was

hin

gto

n

Win

dh

am

Win

dso

r

Sta

te

County

Per

cen

t

1990-1996

1997-2001

2002-2006

DUI Among 18-25 Year Olds in VT

0

5

10

15

20

25

30

35

40

45

50

Ad

dis

on

Ben

nin

gto

n

Cal

edo

nia

Ch

itte

nd

en

Fra

nkl

in/G

ran

dIs

le

Lam

oil

le

Ora

ng

e

Orl

ean

s/E

ssex

Ru

tlan

d

Was

hin

gto

n

Win

dh

am

Win

dso

r

Sta

te

COUNTY

PE

RC

EN

T

1990-1996

1997-2001

2002-2006

DUI Among 18-25 Year Olds in VT

0

5

10

15

20

25

30

35

40

45

50

C OU NT Y

1990- 1996

1997- 2001

2002- 2006

Heavy Drinking 18-25 in VT

0

5

10

15

20

25

30

35

40

Ad

dis

on

Ben

nin

gto

n

Cal

edo

nia

Ch

itte

nd

en

Fra

nkl

in/G

ran

dIs

le

Lam

oil

le

Ora

ng

e

Orl

ean

s/E

ssex

Ru

tlan

d

Was

hin

gto

n

Win

dh

am

Win

dso

r

ST

AT

E

COUNTY

PE

RC

EN

T

1990-1996

1997-2001

2002-2006

Heavy Drinking 18-25 in VT

0

5

10

15

20

25

30

35

40

C ounty

1990- 1996

1997- 2001

2002- 2006

Calculations for CIs

Calculations for CIs

Calculating CIs

Calculating CIs

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.

THE END

Questions?