Sandra C. Lapham

Legalized Sunday Packaged Alcohol Sales and Alcohol-Related Traffic Crashes and Crash Fatalities in New Mexico

We determined the relative risk of alcohol-related motor vehicle accidents and fatalities after New Mexico lifted its ban on Sunday packaged alcohol sales. We extracted all alcohol-related crashes from New Mexico police reports for 3652 days between July 1, 1990, and June 30, 2000, and found a 29% increase in alcohol-related crashes and a 42% increase in alcohol-related crash fatalities on Sundays after the ban on Sunday packaged alcohol sales was lifted. There was an estimated excess of 543.1 alcohol-related crashes and 41.6 alcohol-related crash fatalities on Sundays after the ban was lifted. Repealing the ban on Sunday packaged alcohol sales introduced a public health and safety hazard in New Mexico.

A multiple risk factor approach for predicting DWI recidivism.

A sample of DWI (driving while impaired) offenders was studied to compare various approaches for predicting reoffenses over a 4-year period. Logistic regression yielded multivariate predictor equations that were significant statistically, but were not helpful to clinicians in assessing risk for reoffending. As a different approach, five predictor variables that were consistently correlated with reoffense status were examined to determine the cut score at which the repeat offense rate exceeded the base rate. These were combined to yield the number of risk factors (from 0 to 5) for each offender. This method, used for the original and a hold-out sample, yields results as accurate as those derived from a logistic regression model that includes all the risk variables, and allows clinicians to classify offenders into low and high risk categories in a straightforward manner. Nearly half of offenders with four or five risk factors (age, years of education, arrest blood alcohol concentration (BAC), score on the receptive area scale of AUI and raw score on the MacAndrews scale of MMPI-2) were rearrested compared to the base rate (25%). However, this method is not sufficiently precise to accurately predict which individuals will and will not be rearrested. Although generalizability of specific algorithms across populations needs to be examined, this method appears promising as a clinically accessible way to classify, in a given offender population, those who are most likely to repeat the offense.

Use of neighbourhood parks: Does socio-economic status matter? A four-city study

OBJECTIVES To determine if neighbourhood socio-economic status (SES) is associated with park use and park-based physical activity. STUDY DESIGN Cross-sectional study. METHODS The use and characteristics of 24 neighbourhood parks in Albuquerque, Chapel Hill/Durham, Columbus and Philadelphia were observed systematically in three seasons (spring, summer and autumn), with nearly 36,000 park users observed. Twelve parks were in high-poverty neighbourhoods and 12 parks were in low-poverty neighbourhoods. In total, 3559 park users and 3815 local residents were surveyed. Park incivilities were assessed and park administrators were interviewed about management practices. RESULTS The size and number of facilities in parks in high-poverty neighbourhoods were similar to those in parks in low-poverty neighbourhoods, but the former had more hours of programming. Neighbourhood poverty level, perception of safety and the presence of incivilities were not associated with the number of park users observed. However, programmed activities and the number of activity facilities were strongly correlated with park use and energy expended in the park. CONCLUSIONS The finding that park programming is the most important correlate of park use and park-based physical activity suggests that there are considerable opportunities for facilitating physical activity among populations of both high- and low-poverty areas.

Effectiveness of Bans and Laws in Reducing Traffic Deaths

We determined the relative risk of alcohol-related motor vehicle accidents and fatalities after New Mexico lifted its ban on Sunday packaged alcohol sales. We extracted all alcohol-related crashes from New Mexico police reports for 3652 days between July 1, 1990, and June 30, 2000, and found a 29% increase in alcohol-related crashes and a 42% increase in alcohol-related crash fatalities on Sundays after the ban on Sunday packaged alcohol sales was lifted. There was an estimated excess of 543.1 alcohol-related crashes and 41.6 alcohol-related crash fatalities on Sundays after the ban was lifted. Repealing the ban on Sunday packaged alcohol sales introduced a public health and safety hazard in New Mexico.

The effect of a jail methadone maintenance therapy (MMT) program on inmate recidivism.

AIMS To evaluate the effects of a jail-based continuation of methadone maintenance therapy (MMT) on subsequent inmate recidivism risks. DESIGN Prospective, longitudinal, observational study. SETTING A large, Southwestern United States jail that continues MMT for heroin-addicted inmates on MMT at the time of booking. PARTICIPANTS A total of 589 inmates booked between 22 November 2005 (the start date for the MMT program) and 31 October 2006. MEASUREMENTS The outcome measure was time from release to subsequent re-booking in the jail. Predictors included binary dosing with methadone in the jail, final dose received (mg), age, gender, race/ethnicity, previous bookings and days in jail. FINDINGS AND CONCLUSIONS Random effects Weibull proportional hazards models were fit to the recidivism times to estimate the impact of treatment with MMT in the jail on re-booking risks. There was no statistically significant effect of receiving methadone in the jail or dosage on subsequent recidivism risks (hazard ratio = 1.16; 95% confidence interval = 0.8-1.68). Offering jail-based MMT does not increase recidivism risks by eliminating the deterrent effect of imposed withdrawal, nor does it reduce recidivism in this high-risk population.

The effects of extended-release naltrexone on holiday drinking in alcohol-dependent patients

A post hoc analysis examined the effect of extended-release naltrexone (XR-NTX) treatment combined with psychosocial support on alcohol consumption during holiday and nonholiday periods in a cohort of alcohol-dependent patients who had maintained at least 4 days of continuous abstinence before receiving their first treatment. Three parameters of drinking behavior were examined: percentage of drinking days, percentage of heavy drinking days, and the number of drinks per day. Patients receiving XR-NTX 380 mg reported significantly lower median percentages of drinking days, heavy drinking days, and the number of drinks per day compared with the placebo group. Patients treated with XR-NTX 190 mg reported similar results overall. The results suggest that treatment with XR-NTX 380 mg in combination with psychosocial intervention leads to significant reductions in alcohol consumption, with some measures indicating abstinence in alcohol-dependent patients with initial abstinence during holiday periods.

Staff perspectives on methadone maintenance therapy (MMT) in a large southwestern jail

The purpose of the study was to develop and test an instrument to measure knowledge about methadone maintenance treatment, attitudes towards drug addiction, readiness to adopt a methadone maintenance program, and to determine how the staff at a large metropolitan detention center score on these domains. We developed a 45-item “Knowledge, Attitudes, and Readiness to Adopt” survey and administered it to 114 jail staff. The anonymous survey was psychometrically sound. Younger and non-medical staff generally had low knowledge scores on the survey and had negative attitudes towards methadone as a treatment for heroin addiction. Written comments indicated that many staff members have strong and often polarized opinions about drug treatment in a correctional setting. Results of this study suggest several steps towards improving the staff support for methadone maintenance therapy, which includes better education regarding opiate replacement therapy as an effective treatment for heroin addiction.

Open-Label Pilot Study of Extended-Release Naltrexone to Reduce Drinking and Driving Among Repeat Offenders

Objectives:A high proportion of persons convicted of driving while impaired repeat the offense. Many continue drinking and driving, even when faced with long jail terms. Hence, they pose a serious public health threat. This preliminary study evaluated extended-release, injectable naltrexone suspension (XR-NTX) and supportive therapy in reducing (1) drinking and (2) attempts to drive after drinking among repeat driving while impaired offenders with an ignition interlock device installed in their vehicles. Methods:Treatment-seeking volunteers received medical management therapy and 3 monthly injections of XR-NTX. We compared data on alcohol consumption, alcohol biomarkers, and interlock information before, during, and after treatment using summary measures and Sign tests. Results:Of 12 consented subjects, 10 received at least 1 injection, and 7 received all 3 injections. All subjects receiving medication reported a decrease in average drinks per day (P < 0.01) and abstinent days (P = 0.02) while on treatment versus pretreatment levels. Average daily drinks decreased by 77%, from 3.0 to 0.69 (P < 0.01), during treatment with XR-NTX. Average drinks per drinking day also declined by 39% during treatment, from 6.6 to 4.0 (P = 0.04). Percent days abstinent increased by 31%, from 56.8 to 81.96 (P = 0.02), which persisted after treatment completion. Biomarkers were consistent with reduced drinking. The percentage of vehicular failures to start due to elevated breath alcohol decreased from 3.1% of tests to 1.29% of tests. Conclusions:A randomized, controlled clinical trial is needed to demonstrate the efficacy of this promising treatment regimen for repeat offenders.

Do Deterrence and Social-Control Theories Predict Driving after Drinking 15 years after a DWI Conviction?

OBJECTIVE This study investigates the utility of deterrence and social-control theories for prospective prediction of driving-while-impaired (DWI) outcomes of first-time DWI offenders. METHOD The sample consisted of a subset of 544 convicted first-time DWI offenders (N=337 females) who were interviewed 5 and 15 years after referral to a Screening Program in Bernalillo County, New Mexico. Variables collected at the 5-year (initial) interview were used in structural equation models to predict past 3-months, self-reported DWI at the 15-year follow-up (follow-up) interview. These variables represented domains defined by deterrence and social-control theories of DWI behavior, with one model corresponding to deterrence theory and one to social-control theory. RESULTS Both models fit the data. DWI jail time was positively related to perceived enforcement, which was negatively but not significantly related to self-reported DWI. Neither jail time for DWI nor perceived likelihood of arrest was linearly related to self-reported DWI at follow-up. Interactions between jail time and prior DWI behavior indicated relatively weaker associations between initial and 15-year DWI for those reporting more jail time. CONCLUSION Our prospective study demonstrated that for this convicted DWI offender cohort, classic formulations of deterrence and social-control theories did not account for DWI. However, results suggest that punishment may decrease the likelihood of DWI recidivism.

How important is perception of safety to park use? A four-city survey

Our purpose was to determine the relative importance of individual- and park-related characteristics in influencing both local park use and specific engagement in active sports, walking and sedentary pursuits. We surveyed 3815 adults living within 0.80 km of one of 24 study parks in four US metropolitan areas. Chi-square statistics and baseline-category logit models examined how perceived safety and park characteristics were related to park visitation and types of park activities, controlling for city, individual and park characteristics. Survey participants who perceived the parks as safe (88%) had 4.6 times the odds (95% CI 3.5–6.0) of reporting having visited the study park. Men and African Americans were more likely, and older individuals and those who self-reported being in fair or poor health less likely to perceive parks as safe. Parks having low incivilities scores and those with four or more different facilities, such as tennis courts, swimming pools, basketball courts, etc., were more likely than parks with fewer facilities to be perceived as safe. While park facilities had a much smaller odds ratio for predicting park visits (1.8), it affected 70% of the population. The implication is, if these associations are causal, modifying park facilities may have a greater population impact than improving perceptions of park safety. Our findings are consistent with studies suggesting that increasing the variety of park facilities and offering more organised activities may encourage physical activity among specific target groups.