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Pregnant women who enter drug treatment from the criminal justice system: Start using at an earlier age >50% have recently used alcohol >50% leave treatment.

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Presentation on theme: "Pregnant women who enter drug treatment from the criminal justice system: Start using at an earlier age >50% have recently used alcohol >50% leave treatment."— Presentation transcript:

1 Pregnant women who enter drug treatment from the criminal justice system: Start using at an earlier age >50% have recently used alcohol >50% leave treatment AMA The odds of treatment completion among pregnant women are Greater for white patients Poorer for residential versus ambulatory treatment Greater for alcohol versus any other substance Worse among initial treatment admissions Gender, Pregnancy, and Treatment Completion by Criminal Justice Referral Status Mishka Terplan MD MPH 1, Meg Palisoul 2, Steve Lui Msc 3, Catherine Friedman MD 4 1 University of Maryland School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Baltimore, MD, USA 2 University of Maryland School of Medicine, Baltimore, MD, USA 3 University of Huddersfield, Department of Nursing and Health Studies, Centre for Health and Social Care, Yorkshire, UK 4 University of Pittsburgh Medical Center, Department of Psychiatry, Pittsburgh, PA, USA Abstract Introduction Court-mandated drug treatment has become more common in the United States over the last decades. However its effectiveness has not been investigated nationally in terms of gender and pregnancy status. Implications Results Methods Data: Treatment Episode Data Set – Discharges (TEDS-D), TEDS-D is a national-level data set that captures all admissions to drug treatment centers that receive federal funding in the United States. TEDS-D captures approximately 87% of all treatment admissions in the US. Variable Definition: Criminal Justice Referral – any referral originating from state/federal court, formal adjudication, probation/parole, DUI/DWI, or diversionary program. Treatment completion – created from the reason for discharge. Completion = completion or transfer to another treatment facility. Statistical Analysis (STATA v 11.0) Bivariate – Pearson Chi square Continuous – t- tests and ANOVA Modeling – Logistic Regression (confounding assessed via a backwards elimination method using change-in-estimate criteria) Conclusions A.Demographic Characteristics MenNon-pregnant Women Pregnant Women Age (y) 20 or younger or older 80, ,975 86, ,646 (20.6) (29.7) (21.9) (27.8) 22,456 47,267 24,063 33,303 (17.7) (37.2) (18.9) (26.2) 3,215 3, ,468 (36.5) (42.8) (4.0) (16.7) Race White African American Hispanic/Latino Other 234,770 88,224 44,493 26,684 (59.6) (22.4) (11.3) (6.8) 92,886 22,306 7,318 4,593 (73.1) (17.6) (5.8) (3.6) 6, ,596 (76.8) (2.9) (2.2) (18.1) Married†51,941(16.6)16,699(17.6)1,601(19.5) Unemployed229,974(59.0)82,551(66.6)8,495(96.4) Living Arrangement Homeless Dependent Living Independent Living 22, , ,833 (5.9) (29.7) (64.4) 7,081 39,313 78,590 (5.7) (31.5) (62.9) 142 3,428 5,190 (1.6) (39.1) (59.3) High School Diploma225,186(57.8)68,152(53.7)5,137(58.4) Region Midwest Northeast South West 109,589 84,533 78, ,116 (27.8) (21.5) (20.0) (39.7) 30,296 21,868 29,684 45,255 (23.8) (17.2) (23.4) (35.6) 1,808 1,607 3,157 2,242 (20.5) (18.2) (35.8) (25.4) Psychiatric Problems†46,523(16.4)27,079(28.4)1,715(25.0) Health Insurance† Private Insurance Medicaid Medicare/Other None 23,170 17,008 9, ,728 (13.0) (9.5) (5.5) (72.0) 5,297 4,614 6,263 36,127 (10.1) (8.8) (12.0) (69.1) 40 1,678 1,491 3,096 (0.6) (26.6) (23.7) (49.1) † More than 25% missing; p-value <0.01 for all comparisons Criminal Justice Treatment Referrals B. Treatment Characteristics MenNon-pregnant Women Pregnant Women Treatment Completed187,794(47.6)62,311(49.0)2,179(24.7) Type of Treatment Detoxification Residential Ambulatory 20,132 57, ,667 (5.1) (14.6) (80.3) 6,728 27,866 92,507 (5.3) (21.9) (72.8) 52 3,258 5,504 (0.6) (37.0) (62.5) Prior Treatment† None , ,837 15,853 (51.6) (43.5) (4.9) 69,030 38,404 4,077 (61.9) (34.4) (3.7) 6, (89.2) (10.0) (0.8) Reason for Discharge Completed Left AMA Transfer Other 187,794 80,578 45,786 73,973 (48.4) (20.8) (11.8) (19.1) 62,311 23,106 21,757 19,495 (49.2) (18.2) (17.2) (15.4) 2,179 4,649 1, (24.8) (52.9) (19.3) (3.0) Poly Drug218,015(55.3)72,142(56.8)3,906(44.3) IDU26,642(6.9)17,958(14.2)1,621(18.4) Alcohol255,076(64.7)73,097(57.5)4,938(56.0) Cocaine/Crack87,886(22.3)27,638(21.7)441(5.0) Marijuana198,966(50.5)58,597(46.1)3,705(42.0) Heroin38,329(9.7)14,425(11.4)196(2.2) Meth/Amphetamine67,604(17.2)38,832(30.6)2,201(25.0) Drug of Choice Alcohol Cocaine Marijuana Heroin Methamphetamine Other 162,059 39, ,556 27,044 46,879 9,636 (41.2) (10.1) (27.4) (6.9) (11.9) (2.5) 38,449 14,803 29,420 13,505 28,761 2,094 (30.3) (11.7) (23.2) (10.6) (22.6) (1.7) 3, , ,021 1,449 (35.8) (2.9) (20.4) (1.5) (23.0) (16.5) Age at First Use < , ,950 27,723 10,493 (12.0) (78.1) (7.2) (2.7) 16,291 86,794 16,690 6,854 (12.9) (68.5) (13.2) (5.4) 1,588 5,589 1, (18.1) (63.6) (18.1) (0.3) Days Waiting to Enter Treatment (Mean) Length of Stay (Mean) MenNon-Pregnant Women Pregnant Women Crude Odds Ratio (95% CI) Criminal Justice Referral0.95 (0.94, 0.96)1.38 (1.37, 1.40)1.35 (1.27, 1.44) Adjusted Odds Ratio (95% CI) Criminal Justice Referral1.37 (1.36, 1.39)1.96 (1.93, 2.00)1.57 (1.40, 1.76) Treatment Detox vs Ambulatory Residential vs Ambulatory 3.72 (3.67, 3.78) 2.98 (1.95, 2.00) 7.77 (7.59, 7.95) 1.70 (1.67, 1.74) 3.26 (2.29, 4.64) 0.78 (0.68, 0.89) High School1.18 (1.17, 1.19)1.15 (1.13, 1.17)2.20 (1.95, 2.49) Employed1.44 (1.42, 1.45)2.83 (2.78, 2.89)1.26 (1.02, 1.57) Race Black vs White Latino/Hisp vs White Other vs White 0.77 (0.76, 0.78) 0.97 (0.96, 0.99) 0.95 (0.93, 0.97) 0.87 (0.85, 0.89) 0.48 (0.47, 0.50) 0.81 (0.78, 0.84) 0.09 (0.08, 0.11) 0.68 (0.56, 0.82) 0.47 (0.36, 0.61) Drug of Choice Cocaine vs ETOH MJ vs ETOH Opiate vs ETOH Meth vs ETOH Other vs ETOH 0.58 (0.57, 0.59) 0.69 (0.68, 0.70) 0.44 (0.43, 0.45) 0.56 (0.55, 0.57) 0.76 (0.73, 0.79) 1.23 (1.20, 1.26) 0.57 (0.55, 0.58) 0.41 (0.40, 0.42) 0.69 (0.67, 0.70) 1.58 (1.51, 1.60) 0.05 (0.05, 0.07) 0.05 (0.04, 0.06) 0.04 (0.03, 0.05) 0.09 (0.07, 0.10) 0.01 (0.01, 0.02) Age < 20 vs vs vs (1.07, 1.11) 1.03 (1.02, 1.05) 1.18 (1.17, 1.20) 1.56 (1.51, 1.60) 1.24 (1.21, 1.26) 1.09 (1.07, 1.12) 2.97 (2.51, 3.51) 0.73 (0.62, 0.85) 0.72 (0.48, 1.08) No Prior treatment1.23 (1.22, 1.24)1.37 (1.35, 1.39)0.05 (0.04, 0.06) Odds of Treatment Completion by Criminal Justice Referral (95% CI) Pregnant women who enter drug treatment from the criminal justice system are an important sub-group of pregnant women with a unique set of needs. Their poor treatment completion and high rates of alcohol consumption are concerning. Better retention in treatment for this population is critical. Background Court-mandated drug treatment has become more common in the United States over the last decades. However its effectiveness has not been investigated nationally in terms of gender and pregnancy status. Methods We used the 2006 Treatment Episode Data Set. The primary outcome was treatment completion including transfers to further care. The primary exposure was criminal justice referrals. Demographic and treatment characteristics were compared with chi-squared and t-tests. Confounding was assessed via a backwards elimination method using change-in-estimate criteria. Logistic regression models were stratified by gender and pregnancy. Results are reported as Odds Ratios (OR) with 95% confidence intervals (CI). Results Of the 1.5 million treatment admissions, 38% of men, 29% of women, and 35% of pregnant women entered treatment from the criminal justice system. Overall pregnant women were younger, with lower educational achievement and employment, less likely to use alcohol, and more likely to use methamphetamines. Pregnant women were less likely to complete treatment (55%) than non-pregnant women (57%) or men (61%). After controlling for confounders, the subset of pregnant women (OR 1.37 [1.29, 1.46]) and non-pregnant women (1.25 [1.23, 1.26]) who entered treatment via the criminal justice system had a higher odds of treatment completion than men (0.95 [95% CI: 0.94, 0.96]). Conclusion Criminal justice referral appears to be an important effect measure modifier in drug treatment completion. The reasons why pregnant women especially do better in this context needs to be further explored. Summary Of the 1.5 million treatment admissions, 38% of men, 29% of women, and 35% of pregnant women entered treatment from the criminal justice system. Overall pregnant women were younger, with lower educational achievement and employment, less likely to use alcohol, and more likely to use methamphetamines. They also had more IDU and a greater proportion of Medicare health insurance. Pregnant women were less likely to complete treatment (55%) than non-pregnant women (57%) or men (61%). p-value <0.01 for all comparisons


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