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ADDICTION POLICY
Research Update
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Winter 2008
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Tobacco Cessation Quitlines
In 2004, states were more likely to offer tobacco cessation quitlines – telephone counseling services that offer individualized, evidence-based assistance to smokers trying to quit – if they placed high taxes on cigarettes, according to a recent study from the University of Wisconsin Center for Tobacco Research and Intervention and the North American Quitline Consortium.
The study also found that states that spent more on tobacco control generally funded their state quitlines at higher levels. This research was funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation. The paper entitled "Do State Characteristics Matter? State Level Factors Related to Tobacco Cessation Quitlines," appears in the December 2007 supplement to the journal, Tobacco Control.
Though quitlines are a proven effective tobacco cessation strategy, providing barrier-free assistance that reaches all demographics, many states lack sufficient financial resources to adequately fund and promote this service. To help states augment their tobacco control efforts including quitlines, researchers looked for answers to the following questions: What factors are at play for a state to implement a quitline, and what might affect the amount of funding that goes towards quitline operations?
The authors analyzed data from the 2004 North American Quitline Consortium survey and from publicly available sources to identify factors related to quitline implementation and funding. They also looked at state demographic characteristics, tobacco use variables, state tobacco control spending, and economic and political climate variables.
"By developing a more complete understanding of such factors, state tobacco control programs, policy makers, and others committed to supporting this treatment for tobacco dependence should be able to marshal stronger arguments for quitlines," said lead author Paula Keller, MPH. "Such findings may also inform efforts to secure state public health funding for areas other than tobacco control."
Thirty-eight states reported starting a quitline before June 2004, and 12 reported none. The researchers found that only one variable, cigarette excise tax rate, predicted the presence or absence of a quitline. States with higher cigarette excise taxes were more likely to have a quitline, and for every dollar increase in the excise tax rate, the state was 10 times more likely to have a quitline, the authors write.
Keller said that higher cigarette excise tax rates may be reflective of an interest on the part of policy makers to seek ways to drive down cigarette consumption, or attempting to increase state tax revenues to fund tobacco control and other programs, or both. She also said that policy makers and advocates may wish to evaluate whether other product-specific tax strategies can serve as levers for policy change.
In terms of funding quitlines, states with high rates of cigarette consumption and with higher per capita expenditures for tobacco control programs were most likely to spend more on quitlines.
"It makes sense to infer that states that are more likely to invest in tobacco control are similarly more likely to invest in quitlines, and our results support this," Keller said. "This suggests that concern about health and economic impacts in states with a large population of smokers may encourage adoption of tobacco control programs."
A unique characteristic of quitlines is their potential to reach almost the entire population of smokers in a state over time. A smoker merely needs to have access to a telephone to obtain cessation services, eliminating the need to acquire transportation, child care, and other resources in order to obtain assistance to quit.
Counseling services are offered at no cost to the caller, further reducing barriers to their use. As a consequence of such widespread access, quitlines have successfully reached virtually all populations of smokers—urban residents, rural residents, the elderly, as well as racial and ethnic minorities, according to the authors. While only 38 states had quitlines in 2004, all states now have quitlines in place.
If you would like to speak with the researchers or obtain a copy of the article, please contact Carol Vieira at cvieira@burnesscommunications.com.
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Ignition Locks Reduce DWIs
Interlocks, breath-testing devices that prevent a vehicle's ignition from starting if the driver is above a preset blood alcohol limit, can dramatically reduce driving-while-impaired (DWIs) offenses among first-time offenders, a new study shows.
The findings help settle a dispute over whether interlocks work as well with first-time offenders as with repeat offenders, providing key new evidence that could influence the decisions of lawmakers and judges on how to keep drunk drivers off the road. Four states now mandate interlocks for first DWI offenses: New Mexico, Louisiana, Arizona and Illinois (effective in 2009). The study was published the journal Traffic Injury Prevention and was funded in part by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation.
Researchers compared two groups of first time DWI offenders in New Mexico: those who had installed interlocks as part of their sentence, and those who had not.
"We found that first-time offenders who had interlock devices were 60 percent less likely to have a repeat offense than those who did not use interlock devices," said Paul Marques, PhD, with the Pacific Institute for Research and Evaluation "This study on first-time offenders reinforces prior studies on this issue that show a 65 percent reduction in drunk driving while interlocks are installed."
Researchers examined the records of 1,461 first time DWI offenders who had interlocks installed in their vehicles, and compared them to 17,562 first offenders who didn’t use the devices. The two groups were matched up by age, gender, and blood alcohol concentration (BAC) at the time of arrest.
Two other earlier studies questioned whether interlocks changed the behavior of first-time DWI offenders. But researchers in the New Mexico study noted that in the earlier studies: only a small proportion of those required to install the interlocks actually did so. The New Mexico study included only drivers who installed the devices.
"The idea that there should be any important difference between the risk posed by a first offender and a repeat offender is unsupported," Marques says. "The average first offender has driven drunk many times before he or she was arrested. The big risk difference is between non-offenders and first offenders. The risk difference between first offenders and repeat offenders is small by comparison."
The authors also found an economic benefit to vehicle interlocks. One device costs the offender $2.25 per day, a small price for the public compared to the damage and destruction caused by DWI crashes. The study estimated that for every dollar spent on interlocks for first offenders, the public saves $3. Only about 10 percent of arrested DWIs nationally are ordered a period of interlock-controlled driving, says Marques.
"For so many years we’ve managed DWIs as criminals, but this is more then just a crime issue since many DWI offenders are alcohol dependent. Interlocks present an opportunity to help change behavior rather than simply punishing or incarcerating the offender," Marques says. "It’s not enough to revoke a license - 75 percent of all people with revoked licenses drive anyway - but you don’t want to sentence an entire family to poverty if they’re dependent on that driver getting to and from his or her job. By installing an interlock, the risk that the DWI offender poses is controlled, and interlocks become a public benefit."
New Mexico has been using interlocks for about a decade. The state recently enacted a law that mandates use of interlocks for all DWI offenders.
Other funding agencies for this study include the National Highway Traffic Safety Administration and the National Institute on Alcohol Abuse and Alcoholism. Co-authors include Dr. Robert Voas of the Pacific Institute and Dr. Richard Roth of Impact DWI in New Mexico.
If you would like to speak with the researchers or obtain a copy of the article, please contact Carol Vieira at cvieira@burnesscommunications.com
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The Impact of Adult Trauma on Homeless Mothers
For years, the widespread assumption was that homeless mothers become separated from their children because of substance abuse or the long-lasting hurtful impact from abuse when they were young girls.
But a new study, using a nationally-representative data set, found that the traumas homeless mothers experience as adults play a major role in whether their children stay with them. The study was done by researchers affiliated with the Center for the Vulnerable Child at Children's Hospital & Research Center in Oakland, Calif., and was funded by the Robert Wood Johnson Foundation's Substance Abuse Policy Research Program (SAPRP).
"We went into the study with an hypothesis that long-ago traumas during childhood as well as diseases connected to alcohol or drug abuse would determine whether homeless moms would keep their children with them," said Cheryl Zlotnick, the lead author of the study, which was published in Community Mental Health Journal.
But Zlotnick found that although many homeless mothers had histories of childhood trauma, it was the accumulation of adulthood traumas that was associated with not living with one’s children, the authors write.
Homeless mothers living without their children were more likely to be physically assaulted, raped, jailed or suffer from chronic homelessness than those living with their children.
In addition to the adverse impact of adulthood traumas on homeless women and children, the women’s mental health problems contributed to being separated from their children.
"It’s hard to know which came first, mental health problems or adulthood traumas," Zlotnick said. "The combination of the two likely force many homeless women to place their children in a safer environment or in some circumstances, the child may be removed and placed into foster care."
Zlotnick said a challenge for policymakers will be to make mental health services available to homeless mothers in a way that would not be perceived by them as a threat to losing their children. Such strategies, she said, "would support positive parenting, promote family integrity, provide needed child care, and assist with finding a stable living situation for the family."
Overall, most homeless adults do not have children living with them. Past research, using the National Survey of Homeless Assistance Providers and Clients (NSHAPC), found that 57 percent of homeless men and 76 percent of homeless women had children under the age of 18. But just 2 percent of the men and 43 percent of the women had minor children living with them. Experts have estimated that at any time roughly 20 percent of the homeless population consists of homeless families, and almost all of them are headed by single women.
The Center for the Vulnerable Children’s study, which used data from the NSHAPC, found that most homeless mothers were between the ages of 22-34, African American, and not married. Slightly more than half had less than a high school education. And many had experienced adverse childhood events – a third were physically or sexually abused before the age of 18, for instance.
If you would like to speak with the researchers or obtain a copy of the article, please contact Carol Vieira at cvieira@burnesscommunications.com
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