Module 2 Introduction Context Content Area: Hypothesis Generation

1. Module 2 Introduction Context Content Area: Hypothesis Generation Essential Question (Generic): What hypotheses might explain the distribution of health-related events or states? Essential Question (Drug Abuse Specific): What hypotheses might explain drug abuse? Enduring Epidemiological Understanding: Clues for formulating hypotheses can be found by observing the way a health-related condition or behavior is distributed in a population. Synopsis In Module 2, students explore how descriptive epidemiological information on person, place, and time (PPT) are used to generate hypotheses to explain “why” a health-related event or state has occurred. Students begin to uncover and develop the following epidemiological concepts and skills: evaluating PPT information; developing hypotheses to explain that distribution; understanding that there may be more than one credible hypothesis; and recognizing when a particular hypothesis does NOT explain the PPT information. Lesson 2-1: Overview of PPT and What’s My Hypothesis? Lesson 2-2: In the News Lesson 2-3: Drug Abuse by “Person” Race / Ethnicity Lesson 2-4: Drug Abuse by “Place” States in USA Lesson 2-5: Drug Abuse by “Time” Boundary Effect

2. Module 2 - Hypothesis Generation • Lesson 2-4 Drug Abuse by “Place” States in USA • Content • Brief review of descriptive epidemiology factors of person, place, and time • “Place” information from Monitoring the Future data by four areas of US • “Place” information from NSDUH by US states • “Place” information for episodes of substance abuse treatment by US states • Discussion of hypotheses that are generated from “Place” information • Big Ideas • Descriptive Epidemiology of “Place” can generate hypotheses • “Place” information in US locations is available to describe drug use, drug abuse and dependence, and admission to drug abuse treatment . • Differences are seen by region and by US states; this varies by substance. This project is supported by a Science Education Drug Abuse Partnership Award, Grant Number 1R24DA016357-01, from the National Institute on Drug Abuse, National Institutes of Health.

3. Where are we? Essential Questions Enduring Understandings

4. Sex Residence Year Occupation Events Season Age Anatomical Site Day, etc. SES Geographic Site Onset Review - Descriptive Epidemiology Epidemiological Factors (PPT) Person (who?) Place (where?) Time (when?)

5. Sex Residence Year Occupation Events Season Age Anatomical Site Day, etc. SES Geographic Site Onset Descriptive Epidemiology - Place Epidemiological Factors (PPT) Person Place Time

6. Any Illicit Drug: Trends in Annual Prevalence by Region

7. Any Illicit Drug: Trends in Annual Prevalence by Region

8. Marijuana: Trends in Annual Prevalence by Region

9. Cocaine: Trends in Annual Prevalence by Region

10. MDMA (Ecstasy): Trends in Annual Prevalence by Region

11. Descriptive Epidemiology - Place

12. Descriptive Epidemiology - Place Any Illicit Drug Use in Past Month among Persons Aged 12 or Older, by State: Percentages Does state make a difference?

13. Descriptive Epidemiology - Place Any Illicit Drug Use in Past Month among Persons Aged 12 or Older, by State: Percentages Does state make a difference?

14. Descriptive Epidemiology - Place Marijuana Use in Past Month among Persons Aged 12 or Older, by State: Percentages Does state make a difference?

15. Descriptive Epidemiology - Place Alcohol Use in Past Month among Persons Aged 12 or Older, by State: Percentages Does state make a difference?

16. Descriptive Epidemiology - Place Cigarette Use in Past Month among Persons Aged 12 or Older, by State: Percentages Does state make a difference?

17. Summary of Last Four Slides Any Illicit Drug Use in Past Month Marijuana Use in Past Month Cigarette Use in Past Month Alcohol Use in Past Month

18. Use of “Year” as the Time Frame Marijuana Use in Past Year Does state make a difference?

19. Looking at Substance Dependence or Abuse Any Illicit Drug Dependence or Abuse Use in Past Year Does state make a difference?

20. Case Definition of Dependence Diagnostic and Statistical Manual IV A maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following, occurring at any time in the same 12 month period: • Substance is often taken in larger amounts or over longer period than intended • Persistent desire or unsuccessful efforts to cut down or control substance use • A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain smoking), or recover from its effects • Important social, occupational, or recreational activities given up or reduced because of substance abuse • Continued substance use despite knowledge of having a persistent or recurrent psychological, or physical problem that is caused or exacerbated by use of the substance • Tolerance, as defined by either: • need for read amounts of the substance in order to achieve intoxication or desired effect; or • markedly diminished effect with continued use of the same amount • Withdrawal, as manifested by either: • characteristic withdrawal syndrome for the substance; or • the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms

21. Case Definition of Abuse Diagnostic and Statistical Manual IV A maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, occurring at any time in the same 12 month period: • Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household) • Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use) • Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct) • Continued substance use despite having a persistent or recurrent social, or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights Symptoms have never met criteria for Substance Dependence.

22. Dependence or Abuse - Age 12 and Over - by Place Any Illicit Drug Dependence or Abuse in Past Year Any Illicit Drug Dependence in Past Year Alcohol Dependence in Past Year Alcohol Dependence or Abuse in Past Year

23. Other Variables by Place Needing But Not Receiving Treatment for Illicit Drug Use in Past Year Needing But Not Receiving Treatment for Alcohol Use in Past Year Serious Mental Illness in Past Year (age 18 and over)

24. Admissions by Location - Age 12 and Older As recent findings from the National Survey on Drug Use and Health (NSDUH) show, substance abuse varies across States. Admissions to substance abuse treatment also demonstrate geographic differences, and admissions for various substances of abuse show specific geographic concentrations and patterns. These patterns also change over time.Admissions to substance abuse treatment by State can be monitored with the Treatment Episode Data Set (TEDS), an annual compilation of data on the demographic characteristics and substance abuse problems of those admitted to substance abuse treatment, primarily at facilities that receive some public funding. TEDS records represent admissions rather than individuals, as a person may be admitted to treatment more than once during a single year.Among the six primary substances of abuse that dominate TEDS admissions, the rates of substance abuse treatment admissions in the Nation as a whole increased for three (marijuana, methamphetamine/amphetamine, and opiates other than heroin) and decreased for three (alcohol, cocaine, and heroin). This report focuses on trends in admission rates for methamphetamine/ amphetamine and marijuana, which have the largest number of admissions among the substances with increased admission rates and, therefore, have the greatest impact on the treatment system.

25. Admissions by Location - Age 12 and Older • In the Nation as a whole, admission rates to substance abuse treatment facilities increased between 1995 and 2005 for marijuana, methamphetamine/amphetamine, and opiates other than heroin • In both 1995 and 2005, methamphetamine/ amphetamine admission rates were generally highest in the Pacific and Mountain States • In both 1995 and 2005, marijuana treatment admission rates were generally highest in the West North Central and Pacific States

26. Admissions by Location - Age 12 and Older Source: 2005 SAMHSA Treatment Episode Data Set (TEDS).

27. Admissions by Location - Age 12 and Older Source: 2005 SAMHSA Treatment Episode Data Set (TEDS).

28. Admissions by Location - Age 12 and Older Source: 2005 SAMHSA Treatment Episode Data Set (TEDS).

29. Re-Cap • Big Ideas in this Lesson (2-4) • Descriptive Epidemiology of “Place” can generate hypotheses • “Place” information in US locations is available to describe drug use, drug abuse and dependence, and admission to drug abuse treatment • Differences are seen by region and by US states; this varies by substance This project is supported by a Science Education Drug Abuse Partnership Award, Grant Number 1R24DA016357-01, from the National Institute on Drug Abuse, National Institutes of Health.

30. Sex Residence Year Occupation Events Season Age Anatomical Site Day, etc. SES Geographic Site Onset Next Lesson Epidemiological Factors Person Place Time