Selecting Priorities—Measures for Measures

1. Selecting Priorities—Measures for Measures DDATA December 9, 2009

2. The Priority Selection Process Death 30-Day Use Disease Treatment Binge DUI Violence Arrests Sexual Assault Age of Onset DSM Consequences Consumption ?

3. Through the Life Course

4. Focus on differences by gender, age group, race/ethnicity

5. Context (risk and protective factors) Consumption (the problem) Consequences (the red flag) Deaths, Social Services, Justice/ Corrections, Educational Remediation, Treatment: Medical, Mental Health, Substance Abuse Focus of Prevention & Intervention Activities Priority Substances: Alcohol, Marijuana, Prescription Drugs, Heroin

6. Measures of Consumption • Initiation of use • Regular use • High risk use

7. Focus on Consequences • Provides potential opportunities for prevention efforts • NOT self-report data • More likely to catch attention of policy-makers (costs in deaths and dollars)

8. Year 1 Suggested Priorities • Health • Disease—Coronary Cancer Asthma HIV/AIDS • Accidental Injury/Fatality • Mood Disorders • ADD/HD • Addiction—Prevalence Treatment Overdose Gambling • Suicide/Self-Injury • ER/Hospital Admissions • FASD/Infant Mortality • Violence • Domestic and Dating • School • Street • Property Damage • Violation of Paroles • Productivity School—Truancy Academic Performance Attrition • Workplace –Productivity Loss of Work (Absenteeism, Sick Time) • Special Populations • Prisoner/Detainee • Homeless • Sexual Minorities • Families in service of DSCYF

9. Year 1 Suggested Priorities • Health • Disease—Coronary Cancer Asthma HIV/AIDS • Accidental Injury/Fatality • Mood Disorders • ADD/HD • Addiction—PrevalenceTreatmentOverdose Gambling • Suicide/Self-Injury • ER/Hospital Admissions • FASD/Infant Mortality • Violence • Domestic and Dating • School • Street • Property Damage • Violation of Paroles • Productivity School—Truancy Academic Performance Attrition • Workplace –Productivity Loss of Work (Absenteeism, Sick Time) • Special Populations • Prisoner/Detainee • Homeless • Sexual Minorities • Families in service of DSCYF

10. Year 3 Measures Discussed • Past 30 day alcohol use • Binge drinking • Past 30 day marijuana use • Prescription Drug abuse • Heroin Use • Treatment • Deaths • Drug/Alcohol related arrests • Health—no data on ER’s, FASD; chronic diseases take too long to measure effects; HIV/AIDS • DSM estimates—available on youth through DSS Consumption Consequences

11. 2008 Delaware Adult Admissions to Treatment Primary Drug Reported

12. Delaware Drug and Alcohol Treatment Admissions by Drug 1994-2008 % Increase: Alcohol— -32% Heroin—104% Since 1994 Marijuana—745% Other Opiates—8327%

13. Delaware Drug and Alcohol Treatment Admissions by Race/Ethnicity 1994-2008 Percent Increase: White—83% Black— -3% Hispanic—133%

14. Delaware Drug and Alcohol Treatment Admissions by Age Group 1994-2008 Percent Increase: 18-20—305% 21-24—114% 25-34—7% 35-44—17% 45-54– 179% 55-64—72% 65+-- -58%

15. Juvenile Admissions to Treatment(Unduplicated Client Count) 7/1/08-6/30/09 3 out of 4 Juvenile admissions to treatment were for marijuana use.

16. Drug-induced Deaths – Rates Delaware Health Statistics Center

17. Alcohol-induced Deaths – Rates Delaware Health Statistics Center

18. Data Highlights – Frequencies & Rates Delaware Health Statistics Center

19. Delaware’s alcohol-related robbery rate is estimated to be 16% higher than the national average.Alcohol positive fatal vehicle accidents (all ages) are 11% above the national average.

20. Adult and Juvenile Drug Arrests

21. 16% of Delaware 11th grade students report having sold or given someone marijuana in the past year.

22. Self-Reported Juvenile Suspensions/ Expulsions from School

23. Self-Reported Juvenile Arrests

24. Health data • Sixth in the nation in HIV-AIDS rates • High levels of liver disease • High rates of cancer and heart disease • Youth who report alcohol or drug use on state surveys are much more likely to also report mental health problems, intentional and unintentional injuries as well as aggression

25. 28% of Delaware 11th Graders meet the criteria for alcohol dependence and or abuse:21% abuse only1% dependence only6% dependence and abuse

26. Consumption • Age of Onset • Trends and Rates of Use

27. Age of Onset • Delaware is 9th out of 39 states participating in the YRBS in the percentage of students who report using alcohol before the age of 13—25%. The average age of onset reported by 8th graders is 11.9 years. • Delaware is 10th out of 39 states participating in the YRBS in the percentage of students who report marijuana use before age 13—10%. The average age of onset reported by 8th graders is 12.3 years.

28. TRENDS IN DELAWARE STUDENTS' CIGARETTE USE BY GRADE SELF-REPORTED REGULAR USE*, 1989-2009 Note: *Regular use is defined as reports of about once a month or more often; see note, page 20. Source: Data Base/DiagnosticsPlus (1989-1993); Department of Public Instruction, 1994; 1995-2009 Delaware School Survey, Center for Drug and Alcohol Studies, University of Delaware.

29. TRENDS IN DELAWARE STUDENTS' ALCOHOL USE BY GRADE SELF-REPORTED REGULAR USE*, 1989-2009 Note: *Regular use is defined as reports of about once a month or more often; see note, page 20. Source: Data Base/DiagnosticsPlus (1989-1993); Department of Public Instruction, 1994; 1995-2009 Delaware School Survey, Center for Drug and Alcohol Studies, University of Delaware.

31. Past 30 Day Alcohol Use by Age Group—Delaware BRFSS 2001-2008

32. Binge Drinking, Delaware 8th Grade-College

33. University students binge drink at a rate nearly 50% higher than the national rate of 45%.

34. Binge Drinking by Age Group, Delaware BRFSS

35. Delaware is in the top quartile for drinking and binge drinking among women aged 18-44 (child bearing age). There is no data on the number of children born with Fetal Alcohol Spectrum Disorder.

36. 11th Grade Alcohol Use (Past 30 Days) with Monitoring the Future Trends Source: Delaware School Survey, University of Delaware Center for Drug and Alcohol Studies The Monitoring the Future Study, The University of Michigan

37. 11th Grade Binge Drinking with Monitoring the Future Trends Source: Delaware School Survey, University of Delaware Center for Drug and Alcohol Studies The Monitoring the Future Study, The University of Michigan

38. TRENDS IN DELAWARE STUDENTS' MARIJUANA USE BY GRADE SELF-REPORTED REGULAR USE*, 1989-2009 Note: *Regular use is defined as reports of about once a month or more often; see note, page 20. Source: Data Base/DiagnosticsPlus (1989-1993); Department of Public Instruction, 1994; 1995-2009 Delaware School Survey, Center for Drug and Alcohol Studies, University of Delaware.

39. 11th Grade Marijuana Use with Monitoring the Future Trends Source: Delaware School Survey, University of Delaware Center for Drug and Alcohol Studies The Monitoring the Future Study, The University of Michigan

40. 11th Grade Marijuana Use with Monitoring the Future Trends Source: Delaware School Survey, University of Delaware Center for Drug and Alcohol Studies The Monitoring the Future Study, The University of Michigan

41. Of the 39 states participating in the CDC’s 2007 Youth Risk Behavior Survey, Delaware ranked 1st in the percentage of high school students who smoked marijuana in the past 30 days.

42. Adult Prevalence • 18-25 year olds are highest for past month alcohol use–65% and binge drinking 45% • 18-25 year olds are highest for past month marijuana use—19% • 18-25 year olds are highest for other illicit drug use—8% • 18-25 year olds are highest for non-medical pain reliever use—12% • All of the above are higher than national norms

43. 11th Grade Painkiller Use with Monitoring the Future Trends Source: Delaware School Survey, University of Delaware Center for Drug and Alcohol Studies The Monitoring the Future Study, The University of Michigan

44. Prescription Pills vs. Prescription Painkillers 13% of 8th grade students have used prescription drugs without a prescription in the past year. Of them: 21% of 11th grade students have used prescription drugs without a prescription in the past year. Of them:

46. Decision Rules should be: • Decided before decisions are made • Simple, Simple, Simple • Organized and Well-documented • Inclusive • Aware of data limitations

47. Measures of the Measures • Trends • Relative Comparisons • Magnitude/Size • Seriousness/Severity • Relative Costs

48. Measures Require Numbers • Score for Magnitude (how many people—rates, numbers, percentages) • Score for Economic Costs • Score for Relative Comparisons (national, other states, set standards—Healthy Delaware 2010) • Score for Trends—direction and slope • Score for Severity—Years of Life Lost, Quality of Life Lost

49. Potential Rating Schemas • Categorical—Low/Medium/High • Unweighted Scoring—Low=1/Medium=2/High =3 or Likert scale of 1=Low to 10=High • Weighted Scoring—Assigns weights for specific dimensions (unweighted score X weight = weighted score)

50. Score Sheet for Selection of Prevention Priorities – 12/09 Seriousness/Severity refers to loss of life or loss of quality of life; Economic/Social Cost refers to overall costs to the state; Feasibility refers to extent of public concern and readiness, gap between resources and need, evidence that problem can be changed, political will.