Presentation Overview

Size: px

Start display at page:

Download "Presentation Overview"

Charles Park
8 years ago
Views:

1 Treatment and Self-help Availability in Disadvantaged and Minority Neighborhoods Katherine J. Karriker-Jaffe, PhD Deidre Patterson, MPH Lee Ann Kaskutas, DrPH R01AA to K.J. Karriker-Jaffe Presentation Overview Introduction Learning objectives Role of geography in alcohol and drug treatment Current study Guiding research questions Data sources and methods Results: maps and regression models Discussion 2 1

ffe, PhD Deidre Patterson, MPH Lee Ann Kaskutas, DrPH R01AA020328 to K.J.

2 Objectives After this presentation, you should be able to: List neighborhood-level characteristics associated with substance abuse treatment availability. Describe neighborhoods where AA meetings are most likely to be located. State challenges the residential neighborhood context could pose for people in the early stages of recovery from alcohol or drug problems. 3 Importance of Geography Distance to treatment is critical Determines utilization (engagement and completion) Determines length of care Affects aftercare services Neighborhoods can present barriers to treatment Living in a high-crime area decreases treatment completion Attending program in a high-crime area decreases completion 4 2

State challenges the residential neighborhood context could pose for people in the early stages of recovery from alcohol or drug problems.

3 Importance of Geography Little known about geographic effects of self-help locations More meetings in a community, more AA attendance after inpatient treatment for male veterans Patterned residential distribution in the US African Americans, Hispanics and Native Americans more likely than Whites to live in low-income neighborhoods 5 Current Study 6 3

veterans Patterned residential distribution in the US African Americans, Hispanics and

Aims and Research Questions Aim 1: Describe distribution of substance abuse treatment facilities, self-help resources and alcohol outlets relative to neighborhood characteristics over time Are

4 Aims and Research Questions Aim 1: Describe distribution of substance abuse treatment facilities, self-help resources and alcohol outlets relative to neighborhood characteristics over time Are recovery resources geographically clustered? What factors are associated with treatment program and selfhelp locations? Aim 2: Examine neighborhood effects on relapse, recovery, treatment utilization and self-help involvement over time 7 Four Northern California Counties 8 4

geographically clustered? What factors are associated with treatment program and selfhelp locations?

5 Neighborhood Context Data Treatment availability and program characteristics SAMHSA treatment locator records from 2010 Inpatient, outpatient, methadone, detox, women, Spanish, Medicaid, public funding Locations geocoded and counted at Census tract level 9 Neighborhood Context Data Self-help locations Archived meeting schedules from 2010 and 2011 Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, Marijuana Anonymous, LifeRing AA: English, Spanish, Women Only meetings Locations geocoded and number of weekly meetings counted at Census tract level 10 5

Context Data Self-help locations Archived meeting schedules from 2010 and 2011 Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous,

6 Neighborhood Context Data Population demographics and neighborhood quality 2010 Census data and American Community Survey data from Population density, vacancy rates, property values, socioeconomic status (education, employment, income), racial/ethnic composition Aggregated to Census tract level Values standardized for comparability of coefficients 11 Treatment Programs LEGEND GF Women only GF Treatment program 12 6

status (education, employment, income), racial/ethnic composition Aggregated to Census tract level Values

7 Public Treatment 13 AA Meetings 14 7

8 Other Self-help Meetings 15 Are services and relapse triggers geographically clustered? 8

9 Inpatient Tx Outpatient Tx Assessing clustering: Moran s I Outcome Moran s I P-value Moran s I P-value Detox programs Women s Tx Spanish Tx Medicaid accepted AA meetings Women s AA Spanish AA NA meetings San Francisco Moran s I Range -1 to +1 East Bay Counties Significant positive values: More clustering than expected in a random distribution Significant negative values: More dispersion than expected in a random distribution 17 Assessing clustering: Moran s I San Francisco East Bay Counties Outcome Moran s I P-value Moran s I P-value Inpatient Tx ** 0.09 <.001*** Outpatient Tx * ** Detox programs * 0.03 >.10 Women s Tx 0.13 <.001*** ** Spanish Tx 0.22 <.001*** * Medicaid accepted > * AA meetings > >.10 Women s AA 0.01 > >.10 Spanish AA >.10 NA meetings 0.04 >

expected in a random distribution 17 Assessing clustering: Moran s I San Francisco East Bay Counties Outcome Moran s I P-value Moran s I P-value Inpatient Tx 0.10.004** 0.09 <.001*** Outpatient Tx 0.

10 Assessing clustering: Moran s I San Francisco East Bay Counties Outcome Moran s I P-value Moran s I P-value Inpatient Tx ** 0.09 <.001*** Outpatient Tx * ** Detox programs * 0.03 >.10 Women s Tx 0.13 <.001*** ** Spanish Tx 0.22 <.001*** * Medicaid accepted > * AA meetings > >.10 Women s AA 0.01 > >.10 Spanish AA >.10 NA meetings 0.04 > What factors are associated with treatment and self-help locations? 10

002** Spanish Tx 0.22 <.001*** 0.05.03* Medicaid accepted -0.01 >.10 0.05.01* AA meetings -0.01 >.10 0.03 >.10 Women s AA 0.01 >.10 0.01 >.10 Spanish AA 0.

11 Regression Models: Inpatient Treatment San Francisco Coef. SE p-value Population density % White % Vacant Median housing value % HS graduate % Unemployed % Below Poverty Alameda Cty Solano Cty Constant East Bay Coef. SE p-value Regression Models: Outpatient Treatment San Francisco Coef. SE p-value Population density % White % Vacant Median housing value % HS graduate % Unemployed % Below Poverty Alameda Cty Solano Cty Constant East Bay Coef. SE p-value

02 0.02 0.32-0.03 0.02 0.17 0.00 0.02 0.97 0.00 0.02 0.98 0.05 0.02 0.01 0.01 0.04 0.86-0.01 0.05 0.81 0.06 0.03 0.04 21 Regression Models: Outpatient Treatment San Francisco Coef.

12 Treatment Locations and Median Income LEGEND G Treatment program Median HH Income $11,440 to $41,250 $41,251 to $73,700 $73,701 to $107,308 $107,309 to $137,309 $137,310 to $185,769 Regression Models: AA Locations San Francisco Coef. SE p-value Population density % White % Vacant Median housing value % HS graduate % Unemployed % Below Poverty Outpatient Tx Alameda Cty Solano Cty Constant East Bay Coef. SE p-value

69 % HS graduate -1.13 0.97 0.25 % Unemployed 1.07 0.61 0.08 % Below Poverty -0.13 0.71 0.85 Outpatient Tx 0.68 0.54 0.20 Alameda Cty --- --- --- Solano Cty --- --- --- Constant 2.75 0.

13 AA Meetings and Population White LEGEND Percent White 5.67% to 25.12% 25.13% to 46.50% 46.51% to 61.97% 61.98% to 76.78% 76.79% to 92.15% Co-location of AA and Treatment 26 13

14 Competing Risks and Resources 27 Conclusions & Future Questions Treatment programs are located in low-ses areas Who might be more likely to attend treatment as a result? What risks might be associated with travelling to these areas during a sensitive time in recovery process? AA meetings are located in predominantly White areas Who might be less likely to attend AA as a result? AA meetings are located near treatment programs What are the associated benefits (behavioral patterns)? What are the associated risks (triggers for relapse)? 28 14

What risks might be associated with travelling to these areas during a sensitive time in recovery process?

15 Next Steps Longitudinal analysis looking at changes in neighborhoods over time ( ) Multilevel modeling with respondent data to examine neighborhood effects on relapse, recovery, treatment utilization and self-help involvement over time Drinking trajectories, AA involvement, treatment use over period of up to 7 or 11 years (depending on sub-sample) 29 APHA 2014, New Orleans, LA Monday, 11/17/14, 8:30am Session: Neighborhood disadvantage & drinking patterns over time (# ) Presentations: Effects of distance to treatment on subsequent alcohol consumption Interactive effects of social networks and neighborhood disadvantage on heavy drinking: A longitudinal study Exposure to neighborhood poverty and drinking patterns over five years 30 15

Orleans, LA Monday, 11/17/14, 8:30am Session: Neighborhood disadvantage & drinking patterns over time (# 3003.

16 Acknowledgements GIS Tech Shalika Gupta and Intern Jessica Faraj for maps Drs. Jason Bond and Paul Gruenewald for analytical support Allison Futeral, Marylou Frendo, Jamie Heisey & Vanessa Au for archival data collection, coding and entry Northern California Coastal Area AA Archive, local Central Offices, individual volunteers, and Aina Stunz for helping with our quest for meeting schedules Alcohol outlet data provided by the Prevention Research Center (P60AA06282 to P.J. Gruenewald) 31 Any questions? 16

collection, coding and entry Northern California Coastal Area AA Archive, local Central Offices, individual volunteers, and Aina

Effects of Distance to Treatment and Treatment Type on Alcoholics Anonymous Attendance and Subsequent Alcohol Consumption. Presenter Disclosure

Effects of Distance to Treatment and Treatment Type on Alcoholics Anonymous Attendance and Subsequent Alcohol Consumption Jamie L. Heisey, MA Katherine J. Karriker-Jaffe, PhD Jane Witbrodt, PhD Lee Ann