Building State Substance Abuse Epidemiological Capacity

1. Building State Substance Abuse Epidemiological Capacity Idaho

3. So what is a substance abuse epidemiologist anyway? Problems in definition Relatively new field Relies more on behavioral than physiological or biological criteria

4. Idaho�s Model for Building Epi Capacity In-house epidemiologist, WITHIN state substance abuse program Other alternatives considered Contracting out Work done by Health program epidemiologists Contracting out was considered but the main drawback would be that SA program wouldn�t have direct management (ex., wouldn�t be able to respond to substance use-related questions from legislators quickly). Also, it�s difficult to access Health & Welfare data when you are a part of the Department, it is nearly impossible when you are not. Health 1) big issue is they didn�t have the capacity to devote someone�s time to SEOW, 2) Health and Substance Abuse really I think see each other as separate entities rather than two programs dealing with a number of issues which act in a synergistic fashion (ex., substance abuse is largely off the radar as a health issue and vice versa for how SA views diseases such as Hep. C, COPD, and STDs). Contracting out was considered but the main drawback would be that SA program wouldn�t have direct management (ex., wouldn�t be able to respond to substance use-related questions from legislators quickly). Also, it�s difficult to access Health & Welfare data when you are a part of the Department, it is nearly impossible when you are not. Health 1) big issue is they didn�t have the capacity to devote someone�s time to SEOW, 2) Health and Substance Abuse really I think see each other as separate entities rather than two programs dealing with a number of issues which act in a synergistic fashion (ex., substance abuse is largely off the radar as a health issue and vice versa for how SA views diseases such as Hep. C, COPD, and STDs).

6. Building Epi Capacity Within Idaho�s Substance Abuse Program Pre-SEOW project epi capacity: 0 Post-implementation epi capacity: 2 1 epidemiologist and 1 research analyst Major barrier: unfamiliarity with the field �Now we have a substance abuse epidemiologist, but what do we do with him?�

7. Breaking Barriers: building epi capacity within substance abuse �Your project (SEOW) sounds fascinating�but I just don�t see how I can help� Bureau of Health Policy and Vital Statistics Emergency Medical Services (EMS) Bureau Poison Control Division of Medicaid A big part of building capacity has simply been showing others how their data relates to substance abuse. Vital stats- first to really show interest in substance related mortality data, questioned utility and had initial real concerns w/confidentiality, but once provided with examples of how others used data became enthusiastic collaborators. EMS- Again, once interest explained then they became enthused and saw us as an example to use when explaining to EMTs the justification for collecting �all of this data�. Poison Control- to date this data was being collected but not being used by anyone, again eager to help once they understood the purpose Medicaid- still working on Medicaid, likely they have something relevant but unsure what it is and was told that they didn�t have any substance use related data.A big part of building capacity has simply been showing others how their data relates to substance abuse. Vital stats- first to really show interest in substance related mortality data, questioned utility and had initial real concerns w/confidentiality, but once provided with examples of how others used data became enthusiastic collaborators. EMS- Again, once interest explained then they became enthused and saw us as an example to use when explaining to EMTs the justification for collecting �all of this data�. Poison Control- to date this data was being collected but not being used by anyone, again eager to help once they understood the purpose Medicaid- still working on Medicaid, likely they have something relevant but unsure what it is and was told that they didn�t have any substance use related data.

8. Building Capacity: Today Now people increasingly see substance abuse epi work as relevant AND applicable to their own scope of work

9. Building Capacity: Tomorrow Use early success of substance abuse epi work to leverage and build both epi and general research capacity Need to go beyond epi perspective of �Identify risk factors + Share with population= Disease prevention� Identify disease risk factors+share with pop.=disease prevention Doesn�t work because people have lives to lead. Limiting work to specific diseases and disease specific risk factors will remove us from the things people care about in daily lives- the �fundamental determinants� of disease susceptibility such as jobs, family, children, debt, happiness. USE EX. from book Ask what if questions What if drugs are more like consumer products and thus epidemics are better understood as diffusion of a commodity model than as an infection by disease model? Need for cultural context (hidden in plain sight article). Epi indicators may remain stable yet still have shift in cult. meaning of use that is vital to prevention/educational efforts- �do a line of coke at a swanky party and nobody will notice but pull out a cigarette and people would think you�d pulled out a gun�.Identify disease risk factors+share with pop.=disease prevention Doesn�t work because people have lives to lead. Limiting work to specific diseases and disease specific risk factors will remove us from the things people care about in daily lives- the �fundamental determinants� of disease susceptibility such as jobs, family, children, debt, happiness. USE EX. from book Ask what if questions What if drugs are more like consumer products and thus epidemics are better understood as diffusion of a commodity model than as an infection by disease model? Need for cultural context (hidden in plain sight article). Epi indicators may remain stable yet still have shift in cult. meaning of use that is vital to prevention/educational efforts- �do a line of coke at a swanky party and nobody will notice but pull out a cigarette and people would think you�d pulled out a gun�.