Nancy Nicosia

Efficacy of frequent monitoring with swift, certain, and modest sanctions for violations: insights from South Dakota's 24/7 sobriety project

OBJECTIVES We examined the public health impact of South Dakotas 24/7 Sobriety Project, an innovative program requiring individuals arrested for or convicted of alcohol-involved offenses to submit to breathalyzer tests twice per day or wear a continuous alcohol monitoring bracelet. Those testing positive are subject to swift, certain, and modest sanctions. METHODS We conducted differences-in-differences analyses comparing changes in arrests for driving while under the influence of alcohol (DUI), arrests for domestic violence, and traffic crashes in counties to the program with counties without the program. RESULTS Between 2005 and 2010, more than 17,000 residents of South Dakota-including more than 10% of men aged 18 to 40 years in some counties-had participated in the 24/7 program. At the county level, we documented a 12% reduction in repeat DUI arrests (P = .023) and a 9% reduction in domestic violence arrests (P = .035) following adoption of the program. Evidence for traffic crashes was mixed. CONCLUSIONS In community supervision settings, frequent alcohol testing with swift, certain, and modest sanctions for violations can reduce problem drinking and improve public health outcomes.

Parent Perceptions of Neighborhood Safety and Children's Physical Activity, Sedentary Behavior, and Obesity: Evidence from a National Longitudinal Study

We examined the relationship between parent-perceived neighborhood safety and childrens physical activity, sedentary behavior, body mass, and obesity status using 9 years of longitudinal data (1999-2007) on a cohort of approximately 19,000 US kindergartners from the Early Childhood Longitudinal Study. Childrens height and weight measurements and parent perceptions of neighborhood safety were available in kindergarten and in the first, third, fifth, and eighth grades. Dependent variables included age- and gender-specific body mass index percentile, obesity status, and parent- or child-reported weekly physical activity and television-watching. Pooled cross-sectional and within-child longitudinal regression models that controlled for child, family, and school characteristics were fitted. Both cross-sectional and longitudinal models indicated that children whose parents perceived their neighborhoods as unsafe watched more television and participated in less physical activity, although the magnitude of this association was much weaker in longitudinal models. However, there was no significant association between parent-perceived neighborhood safety and childrens body mass index.

Disparities in Criminal Court Referrals to Drug Treatment and Prison for Minority Men

OBJECTIVES We investigated the extent to which racial/ethnic disparities in prison and diversion to drug treatment were explained by current arrest and criminal history characteristics among drug-involved offenders, and whether those disparities decreased after Californias Proposition 36, which mandated first- and second-time nonviolent drug offenders drug treatment instead of prison. METHODS We analyzed administrative data on approximately 170,000 drug-involved arrests in California between 1995 and 2005. We examined odds ratios from logistic regressions for prison and diversion across racial/ethnic groups before and after Proposition 36. RESULTS We found significant disparities in prison and diversion for Blacks and Hispanics relative to Whites. These disparities decreased after controlling for current arrest and criminal history characteristics for Blacks. Proposition 36 was also associated with a reduction in disparities, but more so for Hispanics than Blacks. CONCLUSIONS Disparities in prison and diversion to drug treatment among drug-involved offenders affect hundreds of thousands of citizens and might reinforce imbalances in criminal justice and health outcomes. Our study indicated that standardized criminal justice policies that improved access to drug treatment might contribute to alleviating some share of these disparities.

What economics can contribute to the addiction sciences

AIMS The addiction sciences are intrinsically multi-disciplinary, and economics is among the disciplines that offer useful perspectives on the complex behaviors surrounding substance abuse. This paper summarizes contributions economics has made in the past and could make in the future towards understanding how illegal markets operate, how prices affect use, how use generates various consequences, and how policy shapes all three. METHODS Review of literature, concentrating on illegal drugs as insights concerning markets are particularly salient, although we also mention relevant studies from the alcohol and tobacco fields. FINDINGS AND CONCLUSIONS Economics offers tools and topical expertise that usefully complement other disciplines associated traditionally with the addiction sciences. Its value goes far beyond the ability to monetize non-monetary outcomes or to calculate a cost-benefit ratio.

Decomposing Racial Disparities in Prison and Drug Treatment Commitments for Criminal Offenders in California

We assess whether black-white disparities in commitments to prison or diversions to treatment for drug offenders in California can be explained by differences in the characteristics of criminal cases and whether case characteristics are weighed differently by race. We also examine whether the influence of case characteristics changed after California implemented a mandatory prison diversion program for eligible drug offenders. Our results show that black-white disparities in prison commitments are fully explained by criminal case characteristics, but a significant share of the differences in treatment diversions remains unexplained. The unexplained racial disparity in treatment diversions did not change after California implemented mandatory diversion for eligible drug offenders. These findings suggest that case characteristics play a larger role in explaining prison commitments for drug offenders than the discretion of prosecutors and judges. Diversion to treatment appears to be driven more by the discretion of court officials, and racial disparities remain prominent.

Can a criminal justice alcohol abstention programme with swift, certain, and modest sanctions (24/7 Sobriety) reduce population mortality? A retrospective observational study

BACKGROUND In the UK and USA, various jurisdictions have launched new approaches for managing alcohol-involved offenders that might have public health implications. These programmes require participants to abstain from alcohol and submit to frequent alcohol testing with swift, certain, and modest sanctions for violations, with the aim to reduce crime and keep alcohol-involved offenders in the community. In this study we examine whether the 24/7 Sobriety programme in South Dakota, USA-the largest such programme to date-is associated with reductions in mortality. METHODS With a differences-in-differences design, we used variation in the timing of 24/7 Sobriety implementation across South Dakota counties between 2005 and 2011 to estimate the association between programme introduction and county-level mortality. We used monthly, county-level, aggregate counts for mortality from January, 2000, to June, 2011. We assessed total deaths, and deaths due to external injuries, circulatory disorders, digestive disorders, and cancer (as a potential placebo). FINDINGS Between January, 2005, and June, 2011, 16 932 people (about 3% of the adult population) participated in the 24/7 Sobriety programme. The analysis was based on a sample size of 9 108 county-month observations (ie, 66 counties × 12 months × 11·5 years). Implementation of 24/7 Sobriety was associated with a 4·2% (95% CI 1·5-6·9) reduction in all-cause adult mortality, with the largest associations among women (8·0%, 95% CI 3·9-11·8) and individuals older than 40 years (4·3%, 95% CI 1·4-7·0). Associations were most evident among circulatory disorders. INTERPRETATION 24/7 Sobriety might have public health benefits, which could extend beyond individuals directly enrolled in the programme. However, further research, including randomised controlled trials and analyses of individual-level data, is needed to corroborate the finding, reassess the size of these associations, and gain insight into causal mechanisms. Should a negative association be replicated, it might represent a substantial advance in our understanding of how criminal justice interventions could help shape public health. FUNDING National Institute on Alcohol Abuse and Alcoholism, US National Institutes of Health.

Junk Foods in School and Childhood Obesity: Much Ado About Nothing?

Estimates the causal effect of competitive food availability on childrens body mass index and other food- and school-related outcomes using an instrumental variables approach on a national sample of children.

Outsourcing Meals: Effects of Maternal Work on Children’s School Meal Participation

Maternal work may affect how mothers allocate time toward activities related to children’s diet and overall well-being. One potential consequence is that mothers may outsource meal preparation. In particular, school meals might replace brown-bag meals because they are subsidized, convenient, and nutritionally regulated. This study examines whether increases in maternal work influence children’s school breakfast and lunch participation, addressing the endogeneity of maternal work using local labor market indicators as instrumental variables. Results suggest that children whose mothers work are more likely to participate in school lunch. However, these children are less likely to participate in school breakfast and more likely to eat breakfast at home with family than are children of nonworking women. These results are qualitatively similar across full- and part-time work status and various socioeconomic groups, although the magnitudes vary. The article concludes with a discussion of the potential mechanisms underlying the findings and their policy implications.

Parental Deployment, Adolescent Academic and Social–Behavioral Maladjustment, and Parental Psychological Well-Being in Military Families

Objective: Increases in the frequency and length of military deployments have raised concerns about the well-being of military families. We examined the relationship between a military parent’s deployment and (1) adolescent academic and social–behavioral maladjustment and (2) parental psychological well-being. Methods: We collected data from April 2013 through January 2014 from 1021 families of enlisted US Army personnel with children aged 12 or 13 during the Military Teenagers’ Environments, Exercise, and Nutrition Study. Through online parent surveys, we collected data on deployment, adolescent academic and social–behavioral maladjustment, and parental psychological well-being. We estimated adjusted logistic and linear regression models for adolescents (all, boys, girls), military parents (all, fathers, mothers), and civilian parents. Results: Compared with no or short deployments, long deployments (>180 days in the past 3 years) were associated with significantly higher odds of decreases in adolescent academic performance (adjusted odds ratio [AOR] = 1.54), independence (AOR = 2.04), and being responsible (AOR = 1.95). These associations were also significant for boys but not for girls. Among parents, long deployments were associated with significantly higher odds of being depressed (AOR = 2.58), even when controlling for adolescent maladjustment (AOR = 2.54). These associations did not differ significantly between military and civilian parents and were significant for military fathers but not military mothers. Recent deployment (in the past 12 months) was not associated with either adolescent or parent outcomes. Conclusion: Long deployments are associated with adolescents’ academic and social–behavioral maladjustments and diminished parental well-being, especially among boys and military fathers.

Economic Analysis and Policy Studies: Special Challenges in the Prevention Sciences

There is growing pressure to view prevention interventions as “investments” and to hold them accountable for yielding favorable returns to taxpayers. This chapter reviews challenges that arise when applying such thinking (“economic analysis”) to evaluating prevention interventions.