Allan R. Meyers

Impact of legislation raising the legal drinking age in Massachusetts from 18 to 20.

On April 16, 1979, Massachusetts raised its legal drinking age from 18 to 20 years. Massachusetts was compared with New York State, exclusive of New York City and Nassau County. New York State retained an 18-year-old drinking age. Random telephone surveys with approximately 1,000 16-19 year olds in each state were undertaken prior to the laws enactment and twice at yearly intervals after the law to assess the laws impact on teenage drinking, driving after drinking, and non-fatal accident involvement. Fatal crash data reported to the US Department of Transportation by each state from April 16, 1976-April 15, 1981 were also analyzed. After the law, although the modes of procuring alcohol changed. No significant changes were observed in Massachusetts relative to New York in the proportion of surveyed teenagers who reported that they drank or in the volume of their consumption. The proportion of teenagers who drove after drinking heavily (six or more drinks at one time) did not decline in Massachusetts relative to New York. However, the frequency that teenagers reported driving after any drinking declined significantly in Massachusetts. Frequency of teenage driving after marijuana use and non-fatal teenage accidents declined at comparable rates in both states. The numbers of teenage nighttime single vehicle fatal accidents declined more in Massachusetts than New York, in the 18-19 year age group. Overall fatal accident trends among 16-19 year olds in the two states were similar.

Social and Psychologic Correlates of Problem Drinking in Old Age

A study of the drinking behavior of 928 noninstitutional residents of Boston, aged 60 or older, showed that 53 per cent were abstainers; 26 per cent had less than one drink per day; 16 per cent, one to two drinks; and 6 per cent, two or more drinks. Nine subjects (1 per cent) were self‐reported problem drinkers, and another 31 (3 per cent) reported that drinking had diminished the quality of their lives. Problem drinkers and those with alcohol‐related problems were likely to be young‐old native‐born men. They were less likely to be satisfied with their relationships with family members, spouses, and close friends. All problem drinkers had long‐term drinking problems. Most had sought treatment, but only one was being treated at the time of the study. The data suggest that current theories do not adequately explain late‐life problem drinking and that current initiatives do not adequately address the needs of the elderly population at large.

Evidence for Cohort or Generational Differences in the Drinking Behavior of Older Adults

Data from a survey of 928 older Bostonians show that there is a negative correlation between age and alcohol consumption among older adults: i.e., “old-old” people-those who are seventy-five years old or older—are more likely to abstain and less likely to drink in any quantity than the “younger-old”—those aged sixty-seventy-five years old. Since the study collected only cross-sectional data, it is not clear whether there are developmental trends in alcohol consumption-that people drink less as they grow older—or whether there are cohort or generational effects. However, several retrospective data suggest that there are cohort or generational patterns of drinking behavior by older adults. Very old respondents, who now drink less than their younger counterparts, report consistently different patterns of life-long drinking habits; they report different parental drinking habits, and they have consistently different attitudes toward the effects of alcohol consumption upon health. The survey provides no insight into the nature of the historical factors which account for the differences in alcohol use. However, Prohibition, Repeal, and the Depression are likely to have played important roles.

Utilization of Pediatric Emergency Services: A Critical Review

The incidence of and reasons for inappropriate use of hospital emergency rooms are discussed. Among the approaches considered for decreasing non-emergency use of emergency rooms are educating the public as to proper use, redesigning emergency facilities to accommodate non-emergency patients, instituting hospital-based group practices, and educating health care providers as to the reasons patients seek emergency care.

The “boston model” of managed care and spinal cord injury: a cross-sectional study of the outcomes of risk-based, prepaid, managed care☆☆☆★★★

OBJECTIVE To present preliminary data on the health-related consequences for people with spinal cord injury (SCI) of participation in a prepaid, risk-based, managed care plan. DESIGN Baseline data from a longitudinal interview survey. SETTING Massachusetts. PARTICIPANTS Subjects were 114 independently living adults with SCI recruited from 6 independent living centers and 2 managed care plans; 45 received care from a risk-based prepaid managed care plan and 69 from other sources. MAIN OUTCOMES Self-reports of use of health services; self-assessments of health, health at interview versus 12 months earlier; hospital admissions; numbers of secondary conditions, and experiences of specific secondary conditions (eg, pressure ulcers, depression, fatigue, and chronic pain). RESULTS Persons in the managed care plan do not differ from their counterparts in terms of age, gender, education, level of SCI, number of comorbid conditions, activity of daily living profiles, household composition, and reliance upon health maintenance programs and routines (eg, bowel and bladder care). In terms of processes of care, they appear generally better-served. There also are a few differences in outcome that are statistically significant, or approach significance, and generally favor the managed care plan. CONCLUSION Preliminary data suggest that thoughtfully and sensitively designed and implemented risk-based managed care may improve both access and outcomes.

A prospective evaluation of the effect of managed care on medical care utilization among severely disabled independently living adults.

We conducted an 18-month longitudinal evaluation of a model-managed medical care program for severely disabled, independently living adults. Regression analyses using an additive model (no interaction effects) suggest that persons in the study group did not have statistically significantly different utilization experiences than members of the comparison group. Regression analyses that include interaction effects suggest that, for certain segments of the cohort, the study groups utilization experience was significantly lower than that of members of the comparison group. Persons in the study group with higher baseline emergency room (ER) utilization had significantly fewer hospital admissions (P = 0.0055). The participants with better self-assessments of health experienced significantly fewer hospital days per person (P = 0.0075) and days per person hospitalized (P = 0.0056), and persons with organizational affiliations reported significantly fewer ER visits (P = 0.0264).

Discretionary leniency in police enforcement of laws against drinking and driving: Two examples from the state of Maine, USA

Abstract This article examines discretionary leniency in police enforcement of two laws against drinking and driving in the state of Maine: a criminal law against operating under the influence of alcohol (OUI; BAC ≥ .10) and a law making it an administrative offense for teenagers to drive with BACs ≥ .02. A telephone survey of 200 randomly selected police officers showed that in the year before the survey twenty-one percent reported decisions not to apprehend and forty-two percent not to arrest drivers suspected of OUI. Nine percent of officers reported decisions not to apprehend, thirty-five percent not to request BAC tests, and thirty-five percent not to cite teenaged drivers suspected of having BACs ≥ .02. Those who reported discretionary OUI decisions did so in a mean of nineteen percent of possible apprehensions and twenty-four percent of possible arrests. Those who reported .02 discretion did so in twenty-six percent of apprehensions, fifty-one percent of possible breath tests, and fifty-two percent of possible citations. Stepwise logistic regression analysis showed three predictors of decisions not to apprehend OUI suspects: beliefs that officers may have higher police priorities, that OUI jail sentences should be longer, and that OUI cases are difficult to prosecute. There were no predictors of decisions not to arrest. Officers who favored the .02 law were less likely to exercise discretionary leniency in .02 apprehensions, as were those who believed that OUI cases take too long to come to trial and those with longer police careers. Officers who felt that penalties were too severe were more likely to report discretionary decisions not to request breath tests, as were those with shorter service careers. Officers with shorter service careers reported more discretionary decisions not to cite, as did those who reported that penalties for teenaged OUI offenders are too severe.

Cops and drivers: Police discretion and the enforcement of Maine's 1981 OUI law

Abstract This study examined police discretionary behavior in stopping and arresting drivers suspected of drunken driving in the state of Maine (U.S.A.). A sample of 186 officers was questioned at the beginning and end of a one-year period with respect to their attitudes toward OUI (Operating Under the Influence of Alcohol) law enforcement and their discretionary behavior in regard to OUI. Significant minorities of police officers reported that they made decisions either not to apprehend (thirty-three percent) or not to arrest (forty-one percent) OUI suspects in the study year. Officers who reported discretionary decisions not to apprehend or arrest generally did so infrequently—i.e. five percent of possible apprehensions and ten percent of possible arrests. Type of police department was significantly associated with decisions not to stop OUI suspects: officers in large departments ( ≥ 20 officers) reported more discretion. Officers with longer service careers, administration responsibilities, high personal priorities on OUI enforcement, and favorable opinions of the climate of OUI enforcement were less likely not to arrest OUI suspects.

The social epidemiology of alcohol use by urban older adults.

A sample survey of 928 Bostonians, aged sixty years or older, indicates that there are low levels of alcohol consumption: more than half report that they are abstainers; 6 percent indicate that they have two or more drinks daily. Levels of abstinence are particularly high among women, blacks, Jews, widows and widowers, the foreign-born, those with low levels of formal education, and those aged seventy-five years or older. Among social psychological variables, locus of control is most consistently associated with drinking: those who report little influence upon their futures—in terms of work, marriage, income, and leisure activities—are more likely to abstain. There is also an association with optimisim; those who are least optimistic about their prospects for work and leisure activities are most likely to abstain. Analysis of variance shows that gender, education, ethnicity, religion, age, and locus of control regarding work are independent correlates of alcohol use. The data suggest that older people drink mainly in social contexts and to facilitate social interaction.

Temporary Disability among Independently Living Adults with Major Disabling Conditions

There is substantial evidence of the permanent disabling effects of such conditions as spinal cord and head injuries, cerebral palsy, paralytic polio, and such degenerative neurologic conditions as multiple sclerosis and muscular dystrophy.1 There is also considerable evidence that people with these conditions require extraordinary amounts of acute hospital care.1-7 However, there are few data on temporary morbidity or disability among those with major disabling conditions, particularly those who live independently in the community rather than in institutions.