Michael T. French

The Impact of Parental Drinking on Children's Use of Health Care

Michael T. French et al. — Mon, 26 Mar 2012 12:01:27 PDT

While a significant body of literature documents the health problems of children caused by and/or associated with parental alcohol misuse, little research has been conducted on the relationship between parental problem drinking and children's use of health care. We should expect to see an increase in children's health care if alcohol-misusing parents were responsive to their children's higher physical and mental health needs. Contrarily, it would decrease (conditional on health status) if alcohol-misusing parents were irresponsive to those needs. Analyzing a nationally representative sample of parents and children, we find a positive and significant association between parental high intensity drinking and pediatric visits for their children. We also find evidence linking parental drinking to more emergency room use. These findings suggest that the impact of parental drinking on child well-being should be considered when assessing the full costs of alcohol misuse.

Disseminating quality improvement: study protocol for a large cluster-randomized trial

Michael T. French et al. — Thu, 05 Jan 2012 07:02:21 PST

Background: Dissemination is a critical facet of implementing quality improvement in organizations. As a field, addiction treatment has produced effective interventions but disseminated them slowly and reached only a fraction of people needing treatment. This study investigates four methods of disseminating quality improvement (QI) to addiction treatment programs in the U.S. It is, to our knowledge, the largest study of organizational change ever conducted in healthcare. The trial seeks to determine the most cost-effective method of disseminating quality improvement in addiction treatment. Methods: The study is evaluating the costs and effectiveness of different QI approaches by randomizing 201 addiction-treatment programs to four interventions. Each intervention used a web-based learning kit plus monthly phone calls, coaching, face-to-face meetings, or the combination of all three. Effectiveness is defined as reducing waiting time (days between first contact and treatment), increasing program admissions, and increasing continuation in treatment. Opportunity costs will be estimated for the resources associated with providing the services. Outcomes: The study has three primary outcomes: waiting time, annual program admissions, and continuation in treatment. Secondary outcomes include: voluntary employee turnover, treatment completion, and operating margin. We are also seeking to understand the role of mediators, moderators, and other factors related to an organization’s success in making changes. Analysis: We are fitting a mixed-effect regression model to each program’s average monthly waiting time and continuation rates (based on aggregated client records), including terms to isolate state and intervention effects. Admissions to treatment are aggregated to a yearly level to compensate for seasonality. We will order the interventions by cost to compare them pair-wise to the lowest cost intervention (monthly phone calls). All randomized sites with outcome data will be included in the analysis, following the intent-to-treat principle. Organizational covariates in the analysis include program size, management score, and state. Discussion: The study offers seven recommendations for conducting a large-scale cluster-randomized trial: provide valuable services, have aims that are clear and important, seek powerful allies, understand the recruiting challenge, cultivate commitment, address turnover, and encourage rigor and flexibility.

This Recession is Wearing Me Out! Health-Related Quality of Life and Economic Downturns

Michael T. French et al. — Thu, 05 Jan 2012 06:56:11 PST

Previous research on the relationships between macroeconomic conditions and health status reveal improvements in physical health during economic downturns. However, few studies have examined whether mental health status improves or declines during tough economic times. This paper estimates the effect of a key macroeconomic indicator, the state-level unemployment rate, on health-related quality of life. Analyzing recent data from Waves 1 and 2 of the NESARC and controlling for individual heterogeneity with fixed-effects models, our study suggests that health-related quality of life, both physical and mental, worsens with increases in the unemployment rate. Although the effect sizes are relatively small in magnitude for both outcomes, the impact is more pronounced for mental health. These results raise questions about the unexpected findings reported in earlier studies of a health-improving effect of economic downturns and suggest that the current worldwide economic recession may have some serious hidden costs. Background: Health-related quality of life refers to an individual's perceived physical and mental health and goes beyond the presence or absence of illnesses to encompass a multidimensional concept of well being. Previous research on the relationships between macroeconomic conditions and health status reveal improvements in physical health during economic downturns. However, few studies have examined whether mental health status improves or declines during tough economic times. Aims: The main objective of this paper is to provide new evidence on the impact of macroeconomic conditions on Health-related quality of life (HRQL), or functional health, by analyzing the physical and mental health summary scores of the 12-Item Short Form Health Survey (SF-12). Data: The analysis uses panel data from Waves 1 and 2 of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) for individuals 18-59 years (in Wave 1), for a final sample of 26,313 individuals. The NESARC collected and reported data on the SF-12 health scores, including a physical health score (PCS) for overall physical functioning, and a mental health score (MCS) for mental/psychological functioning. To analyze the impact of economic downturns on HRQL, the study matches the NESARC variables with data on state-level macroeconomic conditions. Methods: To estimate the effects of macroeconomic conditions on HRQL, this paper takes advantage of the longitudinal nature of the dataset and uses individual fixed-effect models to account for both individual and state-level heterogeneity. Although it is unlikely for individual omitted variables (e.g., individuals' preferences and attitudes) to be significantly correlated with the state unemployment rate, using longitudinal data allows for the estimation of a more fully specified model. Results: Findings consistently indicate that an increase in the average state unemployment rate worsens an individual's HRQL, suggesting that the loss of jobs and income and/or the economic distress associated with economic downturns have a detrimental effect on people's daily lives. Although the magnitudes of the changes are generally small, results show that mental health decreases more than physical health during tough economic times. Policy Implications: With the recent worldwide economic recession causing steep drops in the U.S. Gross Domestic Product along with double-digit unemployment rates, the implications of this study are disheartening. Besides macroeconomic policies to help stimulate the economy, government officials and policymakers should also consider social policies to help people cope with the recession and buffer the potential negative health impact, both mental and physical. Moreover, policymakers should keep in mind that the mental health effects might be greater and longer lasting.

Longitudinal Analysis of Changes in Illicit Drug Use and Health Services Utilization

Michael T. French et al. — Thu, 05 Jan 2012 06:50:53 PST

Objective. To analyze the relationships between illicit drug use and three types of health services utilization: emergency room utilization, hospitalization, and medical attention required due to injury(s). Data. Waves 1 and 2 (11,253 males and 13,059 females) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Study Design. We derive benchmark estimates by employing standard cross-sectional data models to pooled waves of NESARC data. To control for potential bias due to time-invariant unobserved individual heterogeneity, we reestimate the relationships with fixed-effects models. Principal Findings. The cross-sectional data models suggest that illicit drug use is positively and significantly related to health services utilization in almost all specifications. Conversely, the only significant (p<.05) relationships in the fixed-effects models are the odds of receiving medical attention for an injury and the number of injuries requiring medical attention for men, and the number of times hospitalized for men and women. Conclusions. Failing to control for time-invariant individual heterogeneity could lead to biased coefficients when estimating the effects of illicit drug use on health services utilization. Moreover, it is important to distinguish between types of drug user (casual versus heavy) and estimate gender-specific models.

Alcohol Use and Popularity: Social Payoffs from Conforming to Peers' Behavior

Michael T. French et al. — Thu, 05 Jan 2012 06:47:07 PST

Although many economic analyses of adolescents have examined the costs of risky behaviors, few have investigated the gains that young people derive from such actions, particularly in terms of social payoffs for complying with peer behavior. This paper studies the relationship between adolescents' use of alcohol (relative to that of their peers) and popularity at school. We use data from the National Longitudinal Study of Adolescent Health, a rich and nationally representative survey with detailed information on social networks. Our findings suggest that adolescents are socially rewarded for conforming to their peers' alcohol use and penalized (to a lesser degree) for increasing their consumption above that of their peers. Male adolescents are rewarded for keeping up with their peers' drinking and for getting drunk. Female adolescents are rewarded for drinking per se, but not necessarily for keeping up with their peers. The results offer new information on peer influence and have implications for substance abuse interventions at school and in the community.

The Economic Costs of Quarterly Monitoring and Recovery Management Checkups for Adults with Chronic Substance Use Disorders

Michael T. French et al. — Thu, 05 Jan 2012 06:34:44 PST

Recovery management checkups (RMCs) for clients with substance use disorders reduce the time from relapse to treatment reentry, increase treatment retention, and improve long-term outcomes. The objectives of this article are to calculate and compare the economic costs of providing outcome monitoring (OM) only with those of providing OM + RMC to help understand the feasibility of disseminating this model more widely. We estimate the total and incremental costs of OM and OM + RMC using data from a recently completed randomized controlled trial with adult chronic substance users (N = 446). Adding RMC to OM increased total intervention costs by about 50% per person per year ($707 to $1,283) and quarter ($177 to $321). It cost an average of $834 to identify a person in relapse and $2,699 to identify, link, and retain them in treatment. The increased costs of RMC are modest relative to the substantial societal costs of chronic substance users returning to regular use, crime, and other risk behaviors.

Beauty and the Labor Market: Accounting for the Additional Effects of Personality and Grooming

Michael T. French et al. — Wed, 04 Jan 2012 12:10:30 PST

This paper examines the influence of three non-cognitive personal traits — beauty, personality, and grooming — on the labor market earnings of young adults. It extends the analyses of Hamermesh and Biddle [1994, American Economic Review 84(5): 1174–1194] and others who focus primarily on the effects of beauty on labor market earnings. We find that personality and grooming significantly affect wages, and their inclusion in a model of wage determination reduces somewhat the effects of beauty. We also find some evidence of employer discrimination based on these traits in the setting of wages.

Does Drug Abuse Treatment Affect Employment and Earnings of Clients?

Michael T. French et al. — Thu, 01 Sep 2011 11:16:43 PDT

Drug abuse treatment is an effective way to reduce drug use. Treatment is also intended to promote other positive outcomes such as reduced criminal activity, employment and higher earnings. This study examines the impact of drug abuse treatment on the followup labor market experiences of clients. We conduct a descriptive analysis of labor force status, work effort and earnings one year prior to admission, at admission and one year following discharge. The analysis is performed with data from the Treatment Outcome Prospective Study (TOPS). TOPS is a large scale longitudinal study of over 11,000 individuals admitted to 41 federally funded treatment centers from 1979 to 1981. Results indicate that a greater percentage of clients are employed one year following discharge than at admission, but less than at one year prior to admission. Average annual, weekly and hourly earnings increased by 16%, 6% and 8% from the year prior to admission to the year following discharge. The results from this study have important policy implications for public and private treatment strategies.

A research agenda for economic evaluation of substance abuse services

Michael T. French et al. — Thu, 01 Sep 2011 10:49:27 PDT

Economic analyses of substance abuse interventions play a critical role in informing the decision makers involved in funding these programs. Despite the emergence of new and more effective interventions, the adoption of costlier services still demands justification based on economic evidence. Updated and more rigorous economic information allows patients, health care professionals, insurance companies, policymakers, and others to allocate scarce resources more efficiently. To prepare for the next wave of addiction health services research, this article presents background information on the economics of addiction health services, reviews recent empirical and methodological contributions, and provides 15 research recommendations.

Price Elasticity of Demand for Malt Liquor Beer: Findings from a Pilot Study

Michael T. French et al. — Thu, 01 Sep 2011 10:29:41 PDT

Our objective is to estimate the relative price elasticity of demand for malt liquor beer (MLB), regular beer, hard liquor, and a combined group of all other alcoholic beverages. Three hundred and twenty-nine alcohol consumers (mostly male) in South-Central Los Angeles answered a series of questions pertaining to expected consumption responses to hypothetical price increases. We found that based on a 10% price increase, the mean price elasticity of demand (% change in quantity demanded / % change in price) was -0.79 for MLB drinkers, -1.14 for regular beer drinkers, -1.11 for hard liquor drinkers, and -1.69 for the combined group of all other drinkers. Logistic regression analysis revealed that the personal characteristics significantly related to being a MLB drinker were older age, not working, being homeless, and a daily drinker. Daily (or nearly daily) drinkers were more likely to be married, earning lower incomes, and hard liquor drinkers. This study is the first to investigate the price elasticity of demand for MLB drinkers and other heavy alcohol consumers in poor urban neighborhoods of the US. Future research can use the methods from this pilot study to more rigorously examine and compare the price sensitivity among heavy drinking groups.

Does having a dysfunctional personality hurt your career? Axis II personality disorders and labor market outcomes

Michael T. French et al. — Thu, 25 Aug 2011 06:06:01 PDT

Despite recent interest in how psychiatric disorders affect work outcomes, little is known about the role of personality disorders (PDs), which are poorly understood yet prevalent (15%) and impairing. We used nationally representative data for 12,457 men and 16,061 women to examine associations of PDs with any employment, full-time employment, chronic unemployment, being ﬁred or laid off, and having trouble with a boss or co-worker. Antisocial, paranoid, and obsessivecompulsive PDs demonstrated the broadest patterns of associations with adverse outcomes. Findings suggest that PDs may have implications for the productivity of co-workers as well as that of the disordered employees themselves.

Cost Estimation When Time and Resources are Limited: The Brief DATCAP

Michael T. French et al. — Mon, 01 Aug 2011 07:42:19 PDT

The Drug Abuse Treatment Cost Analysis Program (DATCAP) was designed in the early 1990s as a research guide to collect and analyze financial data from addiction treatment programs. The addiction research community could clearly benefit from a version of the DATCAP that reduced the time and effort required for its administration without compromising the integrity of its cost estimates. This paper introduces the Brief DATCAP and presents some preliminary findings. Initial feedback from respondents suggests that the Brief DATCAP is understandable, and easier and quicker to complete than the DATCAP. More importantly, preliminary results indicate that cost estimates from the Brief DATCAP differ from those of the longer DATCAP by less than 2%. These results have important research and policy implications because a shorter yet reasonably accurate cost instrument will enhance the feasibility and precision of future economic evaluations of addiction interventions.

Out of Touch or on the Money: Do the Clinical Objectives of Addiction Treatment Coincide with Economic Evaluation Results?

Michael T. French et al. — Mon, 01 Aug 2011 07:10:35 PDT

Previous economic studies have examined the association between substance abuse treatment and reduced costs to society, but it remains uncertain whether the economic measures used in cost and benefit-cost analyses of treatment programs correspond in direction and magnitude with clinical outcomes. In response to this uncertainty, the present study analyzed a longitudinal data set of addiction treatment clients to determine the statistical agreement between clinical and economic outcomes over time. Data were collected from 1,326 clients in the Chicago cohort of the Persistent Effects of Treatment Study. These individuals were interviewed at baseline as well as at 6-, 24-, 36-, and 48-month followup periods (91.6% followup). Correlations between clinical and economic measures were generally small (ρ of 0.1 to 0.3) and often became non-significant once we controlled for baseline severity. The results demonstrate that although some associations exist, outcomes should be evaluated along both clinical and economic dimensions.

Cost-Effectiveness Analysis (CEA) of Four Interventions for Adolescents with a Substance Use Disorder

Michael T. French et al. — Thu, 28 Jul 2011 09:35:50 PDT

Alcohol, tobacco, and illicit drug use among adolescents in the U.S. continues to be a serious public health challenge. A variety of outpatient treatments for adolescent substance use disorders have been developed and evaluated. Although no specific treatment modality is effective in all settings, a number of promising adolescent interventions have emerged. As policy makers try to prioritize which programs to fund with limited public resources, the need for systematic economic evaluations of these programs is critical. The present study attempted a cost-effectiveness analysis (CEA) of four interventions, including family-based, individual, and group cognitive behavioral approaches, for adolescents with a substance use disorder. The results indicated that treatment costs varied substantially across the four interventions. Moreover, family therapy showed significantly better substance use outcome compared to group treatment at the 4-month assessment, but group treatment was similar to the other interventions for substance use outcome at the 7-month assessment and for delinquency outcome at both the 4-month and 7-month assessments. These findings over a relatively short follow-up period suggest that the least expensive intervention (group) was the most cost effective. However, this study encountered numerous data and methodological challenges in trying to supplement a completed clinical trial with an economic evaluation. These challenges are explained and recommendations are proposed to guide future economic evaluations in this area.

“Does America Spend Enough on Addiction Treatment?: Results from Public Opinion Surveys

Michael T. French et al. — Thu, 28 Jul 2011 09:26:20 PDT

Addiction treatment is often misunderstood and underappreciated in the United States. Although a large body of literature clearly demonstrates the clinical and economic benefits of addiction treatment for many clients and in most settings, the general public has a somewhat ambivalent attitude toward treatment expansion and taxpayer financing. A potential reason for this disconnect between economic evidence and public opinion is a weak identification with the need for, or the success of, addiction treatment for those individuals without a substance abuse problem themselves or in members of their family. Alternatively, addiction treatment stakeholders may be delivering an ineffective or misdirected message about the social value of this industry. This article explores these and other potential explanations for the paradoxically low placement of the addiction treatment industry among other socially important institutions in the United States. Although none of the explanations advanced in this article has been scientifically tested or verified, it is hoped that the historical inquiry and information provided herein will offer practical strategies for the stability and growth of the addiction treatment industry.

Alcohol Consumption, Risk of Injury, and High-Cost Medical Care

Michael T. French et al. — Thu, 28 Jul 2011 09:15:52 PDT

This study examined the effect of alcohol use on the probabilities of injury, inpatient hospital stay, and emergency department visit. Data were obtained from a sample of adults (N=1219) recruited from a Northern California county. Alcohol use measures included number of drinks, heavy drinking days, and an indicator variable for problem drinking. Models were estimated for men and women separately while controlling for confounders. Results indicate that most alcohol use measures were not significantly related to injury probability or medical care utilization. Among the exceptions, problem drinking was a significant positive predictor of any emergency department visit for both sexes. When drinkers during the past year were divided into light, moderate, and heavy drinking groups and compared to lifetime abstainers, all male drinkers had a higher probability of injury, and light and moderate female drinkers had a lower probability of an emergency department visit.

“Effects of Physical Attractiveness, Personality, and Grooming on Academic Performance in High School

Michael T. French et al. — Mon, 25 Jul 2011 09:09:37 PDT

Using data from the National Longitudinal Study of Adolescent Health (Add Health), we investigate whether certain aspects of personal appearance (i.e., physical attractiveness, personality, and grooming) affect a student's cumulative grade point average (GPA) in high school. When physical attractiveness is entered into the model as the only measure of personal appearance (as has been done in previous studies), it has a positive and statistically significant impact on GPA for female students and a positive yet not statistically significant effect for male students. Including personality and grooming, the effect of physical attractiveness turns negative for both groups, but is only statistically significant for males. For male and female students, being very well groomed is associated with a statistically significant GPA premium. While grooming has the largest effect on GPA for male students, having a very attractive personality is most important for female students. Numerous sensitivity analyses support the core results for grooming and personality. Possible explanations for these findings include teacher discrimination, differences in student objectives, and rational resource allocation decisions.

The Health Effects of Parental Problem Drinking on Adult Children

Michael T. French et al. — Mon, 25 Jul 2011 08:27:08 PDT

BACKGROUND: Much of the research on adult children of alcoholics has focused on the transmission of drinking patterns from parents to their children and the development of alcohol-related problems. Less is known about how exposure to parental problem drinking affects children as they progress into adulthood in terms of other mental health outcomes. This is crucial information, in part because the average age of onset for depression and other mental health disorders is during late adolescence or young adulthood. AIMS: The objective of this study was to rigorously assess the long-term impacts of parental problem drinking on adult children's mental and self-perceived overall health. The study improves on previous literature by analyzing a range of mental health markers and other predictors of morbidity, by focusing on a period of adulthood that only a limited number of studies have examined, and by using data from a highly regarded and nationally representative panel study. DATA: The analysis used data from the NLSY79, a nationally representative sample of 12,686 men and women. The NLSY79 collected detailed information about personal and family characteristics, including alcohol and other substance use, for a cohort of individuals who were between the ages of 14 and 22 when first surveyed in 1979. The survey was re-administered each year through 1994 and on a biennial basis since then. The dataset provides information on parental drinking and identifies problematic drinking behaviors both among mothers and fathers. Beginning with the 1998 survey, an extensive health module was administered to respondents over 40 years of age to provide a baseline health profile of the respondents before retirement. It includes a set of measures that assess the mental, physical, and behavioral health of the respondents when they reached the age of 40. METHODS: Estimation was conducted using propensity score matching (PSM) methods. Through the use of PSM methods, we control for a rich set of observed demographic, household, geographic, and economic characteristics, as well as unobserved features correlated with these variables, that predispose a parent to drink problematically, thereby reducing the possibility of estimation bias. In addition, PSM is superior to traditional multivariate regression in that it allows for the possibility of non-linear effects and the comparison of treatment and control individuals with similar characteristics. RESULTS: The results indicate that parental problem drinking is associated with significant mental health consequences for children that persist far into adulthood. Adult respondents with a problem-drinking father were more likely to have been diagnosed with mental health problems relative to other respondents, while those with a problem-drinking mother had poorer self-perceived health and mental health (SF-12) scores. Respondents with a problem-drinking mother were also more likely to have ever been diagnosed with a mental health problem. Outcomes were worse for daughters of problem drinkers than for sons. POLICY IMPLICATIONS: These long-lasting consequences of parental problem drinking on adult children's mental health should be considered when designing and financing interventions targeting problem drinkers and their families.

That Instrument is Lousy! In Search of Agreement When Using Instrumental Variables Estimation in Substance Use Research

Michael T. French et al. — Mon, 25 Jul 2011 08:20:29 PDT

The primary statistical challenge that must be addressed when using cross-sectional data to estimate the consequences of consuming addictive substances is the likely endogeneity of substance use. While economists are in agreement on the need to consider potential endogeneity bias and the value of instrumental variables estimation, the selection of credible instruments is a topic of heated debate in the field. Rather than attempt to resolve this debate, our paper highlights the diversity of judgments about what constitutes appropriate instruments for substance use based on a comprehensive review of the economics literature since 1990. We then offer recommendations related to the selection of reliable instruments in future studies.

Economic Evaluation of Adolescent Addiction Programs: Methodologic Challenges and Recommendations

Michael T. French et al. — Mon, 25 Jul 2011 08:11:59 PDT

This article identifies and describes several methodologic challenges encountered in economic evaluations of substance abuse interventions for adolescents. Topics include study design, the choice of perspective, the estimation of costs and outcomes, and the generalizability of results. Recommendations are offered for confronting these challenges using examples from research on adolescent substance abuse and dependency/addiction.