Wyndy L Wiitala | PubMed Health

PubMed2006

Medicaid coverage and access to publicly funded opiate treatment.

This observational study examines changes in access to methadone maintenance treatment following Oregon's decision to remove substance abuse treatment from the Medicaid benefit for an expansion population. Access was compared before and after the benefit change for two cohorts of adults addicted to opiates presenting for publicly funded treatment. Propensity score analysis helped model some selective disenrollment from Medicaid that occurred after the benefit change. Logistic regression was used to compare access to methadone by cohort controlling for client characteristics. Opiate users presenting for publicly funded treatment after the change were less than half as likely (OR = 0.40) to be placed in an opiate treatment program compared to the prior year. Further analysis revealed that those with no recent treatment history were less likely to present for treatment after the benefit change. These results have implications for states considering Medicaid cuts, especially if the anticipated increases in illegal activity, emergency room utilization, unemployment, and mortality can be demonstrated.

Adolescent↗

PubMed2003

Meta-analysis of raw mean differences.

This article discusses the meta-analysis of raw mean differences. It presents a rationale for cumulating psychological effects in a raw metric and compares raw mean differences to standardized mean differences. Some limitations of standardization are noted, and statistical techniques for raw meta-analysis are described. These include a graphical device for decomposing effect sizes. Several illustrative data sets are analyzed.

Data Interpretation, Statistical↗

PubMedDate not supplied

Team awareness, problem drinking, and drinking climate: workplace social health promotion in a policy context.

PURPOSE: (1) To determine the effectiveness of classroom health promotion/prevention training designed to improve work climate and alcohol outcomes; (2) to assess whether such training contributes to improvements in problem drinking beyond standard workplace alcohol policies. DESIGN: A cross-sectional survey assessed employee problem drinking across three time periods. This was followed by a prevention intervention study; work groups were randomly assigned to an 8-hour training course in workplace social health promotion (Team Awareness), a 4-hour informational training course, or a control group. Surveys were administered 2 to 4 weeks before and after training and 6 months after posttest. SETTING AND SUBJECTS: Employees were surveyed from work departments in a large municipality of 3000 workers at three points in time (year, sample, and response rates are shown): (1) 1992, n = 1081, 95%; (2) 1995, n = 856, 97%; and (3) 1999, n = 587, 73%. Employees in the 1999 survey were recruited from safety-sensitive departments and were randomly assigned to receive the psychosocial (n = 201), informational (n = 192), or control (n = 194) condition. INTERVENTION: The psychosocial program (Team Awareness) provided skills training in peer referral, team building, and stress management. Informational training used a didactic review of policy, employee assistance, and drug testing. MEASURES: Self-reports measured alcohol use (frequency, drunkenness, hangovers, and problems) and work drinking climate (enabling, responsiveness, drinking norms, stigma, and drink with co-workers). RESULTS: Employees receiving Team Awareness reduced problem drinking from 20% to 11% and working with or missing work because of a hangover from 16% to 6%. Information-trained workers also reduced problem drinking from 18% to 10%. These rates of change contrast with changes in problem drinking seen from 1992 (24%) to 1999 (17%). Team Awareness improvements differed significantly from control subjects, which showed no change at 13%. Employees receiving Team Awareness also showed significant improvements in drinking climate. For example, scores on the measure of coworker enabling decreased from pretest (mean = 2.19) to posttest (mean = 2.05) and follow up (mean = 1.94). Posttest measures of drinking climate also predicted alcohol outcomes at 6 months. CONCLUSION: Employers should consider the use of prevention programming as an enhancement to standard drug-free workplace efforts. Team Awareness training targets work group social health, aligns with employee assistance efforts, and contributes to reductions in problem drinking.

Adult↗