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PowerPoint Poster Example - University of Texas at Austin

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Differences in Characteristics of Heroin Inhalers and Injectors
at Admission to Treatment
J. C. Maxwell, R. T. Spence, & T. M. Bohman
UT Center for Social Work Research
Introduction
 Purpose: to understand why heroin inhalers (“snorters”) in Texas enter treatment
sooner than injectors.
 This study extends earlier findings by comparing the characteristics of heroin
injectors versus inhalers at their first admission to publicly-funded treatment using
CODAP/TEDS data.
 This study will build on earlier studies, but looks at differences in patterns of
heroin use in a much larger sample characterized both by its race/ethnic diversity
and by the use of black tar heroin, a type of heroin primarily seen only in the
western United States and Mexico.
 This project has three phases:
1) analysis of CODAP/TEDS data on clients who had a primary problem with
heroin;
2) in-depth interviews with heroin users in public and private programs; and
3) interviews and focus groups with heroin inhalers and injectors who are not in
treatment.
 This poster reports on the first phase only.
Sample
 9,732 unduplicated adults who were first admissions to TCADA-funded residential,
outpatient drug-free, or outpatient methadone treatment programs between
January 1, 1997 and December 31, 2001.
 Clients had a primary problem with either inhaled or injected heroin which they
had used in the month prior to admission.
 While they were first admissions to TCADA programs, 64% had been treated
previously in non-TCADA-funded programs.
 92.5% were injectors and 7.5% were inhalers.
 Mean age at admission was 35.8 years (SD 10.6). Age of first use of heroin was
22.9 years (SD 8.0).
 The mean lag between first use and admission to TCADA-funded treatment was
13.5 years (SD 10.8).
 69% were male; 49% were Hispanic, 40% were Anglo, and 12% were African
American.
 Average annual legal income was $5,522; 17% were employed and education
level was 11.1 years.
 75% lived with their families, 28% were married or co-habiting with a partner, 11%
were homeless, and 30% were involved with the criminal justice or legal system.
 33% reported a secondary problem with powder cocaine, 12% with alcohol, 7%
with marijuana, and 4% with crack cocaine; 38% reported no problems with other
drugs.
Results
C o m p a ris o n s o f H e ro in In je c to rs a n d In h a le rs o n D e m o g ra p h ic ,
C rim in a l J u s tic e S ta tu s , T re a tm e n t, D ru g U s e , a n d S u b s ta n c e
A b u s e Im p a irm e n t C h a ra c te ris tic s
D e m o g ra p h ic s
A g e at A d m issio n
A g e of F irst U se
L a g — F irst U se to E n try to
T re a tm e n t (Y e a rs)
In je c tors
3 6 .0
2 2 .8
S .E .
0 .4 8 2
0 .1 8 8
In h a le rs
3 1 .0
2 3 .5
S .E .
0 .6 1 4
0 .3 4 7
P r> |t]
< .0 0 0 1
< .0 0 0 1
1 3 .8
0 .4 6 3
8 .1
0 .6 0 4
< .0 0 0 1
P e rc e n t
In je c tors
7 0 .0
4 0 .7
4 9 .6
9 .7
7 4 .9
1 1 .4
1 .5 8
3 2 .1
1 1 .0
1 6 .9
$ 5 ,4 2 6
P e rc e n t
In h a le rs
6 1 .7
2 9 .2
3 4 .5
3 6 .2
8 0 .6
5 .0
2 .1 8
4 3 .3
1 1 .3
2 3 .3
$ 6 ,6 9 4
O dds
R a tio *
.8 1
.4 3
1 .1 5
2 .8 2
1 .2 3
.6 1
1 .7 2
1 .6 1
1 .1 4
1 .2 3
1 .2 3
C o n fid e n c e
L im its
0 .7 0 -0.9 4
0 .3 1 -0.6 1
0 .9 4 -1.4 0
1 .8 3 -4.3 3
1 .0 1 -1.5 1
0 .5 0 -0.7 3
1 .0 9 -2.7 2
1 .3 1 -1.9 8
0 .8 7 -1.4 9
1 .0 3 -1.4 7
0 .9 9 -1.5 3
% M a le
.0 0 6 8
% A n g lo
< .0 0 0 1
% H ispa n ic
.1 7 1 6
% A frica n A m erican
< .0 0 0 1
% L ive w ith F a m ily
.0 4 3 0
% H o m e le ss
< .0 0 0 1
% P re g na n t
.0 2 0 6
% M in o r C h ild ren in H o m e
< .0 0 0 1
Y e a rs o f E d ucatio n
.3 5 8 6
% E m p lo ye d a t A dm ission
.0 2 5 3
Y e a rly In co m e
.0 6 1 0
C rim in a l J u s tic e S ta tu s
% In vo lve d C rim in a l Ju stice 3 0 .7
2 5 .6
.6 9
< .0 0 0 1
0 .5 9 -0.8 0
L e g a l S yste m
% o n P ro b atio n
1 0 .8
1 1 .1
.9 5
.7 4 9 8
0 .6 9 -1.3 1
% o n P a ro le
1 3 .5
6 .3
.3 6
< .0 0 0 1
0 .2 6 -0.4 9
T re a tm e n t
% F irst T C A D A T rea tm e n t
3 5 .2
4 9 .3
1 .9 1
< .0 0 0 1
1 .6 8 -2.1 8
% A d m itte d to M e tha d o n e
2 9 .0
3 7 .7
0 .9 4
.3 3 4 2
0 .8 4 -1.0 6
S e c o n d a ry D ru g P ro b le m
% None
3 8 .2
2 9 .9
1 .2 4
.0 8 8 6
0 .9 7 -1.5 8
% A lco ho l
12. 2
1 0 .4
1 .0 4
.6 8 3 8
0 .8 6 -1.2 5
% P o w d e r C o ca in e
3 3 .3
3 1 .5
.5 1
< .0 0 0 1
0 .3 6 -0.7 1
% C ra ck C oca in e
4 .0
8 .7
2 .1 9
< .0 0 0 1
1 .8 2 -2.6 3
% M a riju a n a
6 .1
1 4 .3
2 .2 1
< .0 0 0 1
1 .7 3 -2.8 2
S u b s ta n c e A b u s e Im p a irm e n t (% w ith 0 D a ys o f P ro b lem s in L a s t M o n th )
S ickn e ss/H e a lth P ro b le m s
6 2 .8
7 0 .6
.6 8
.0 5 9 8
0 .4 6 -1.0 2
E m p lo ym e n t P ro b lem s
3 5 .7
4 5 .3
.6 6
.0 2 5 7
0 .4 6 -0.9 5
F a m ily/M a rita l P ro ble m s
4 3 .3
4 6 .7
.8 1
.2 1 1 0
0 .5 9 -1.1 2
P e e r/S ocia l P ro blem s
6 1 .3
6 3 .1
.8 8
.5 1 9 8
0 .6 0 -1.2 9
P sych o lo g ica l P ro b le m s
4 1 .8
4 5 .2
.8 4
.2 7 4 1
0 .6 1 -1.1 5
D ru g /A lco h o l P ro b le m s
1 4 .0
1 4 .8
.8 7
.5 8 7 8
0 .5 2 -1.4 5
M u ltiva ria te P re d ic tio n o f H e ro in In h a le r ve rs u s In je c to r
S ta tu s fro m D e m o g ra p h ic , C rim in a l J u s tic e S ta tu s ,
T re a tm e n t, D ru g U s e , S e c o n d D ru g P ro b le m s a n d
S u b s ta n c e A b u s e Im p a irm e n t C h a ra c te ris tic s
O dds
R a tio
L o g is tic R e g re s s io n M o d e l
E s tim ate
P r> |Z |
D e m o g ra p h ic s
M a le ve rsu s F e m a le
-0 .1 0
0 .4 3
0 .9 1
A frica n A m e rica n ve rsus A n g lo
2 .5 1
0 .0 0
1 2 .3 2
H isp a n ic ve rsu s A ng lo
0 .5 5
0 .0 0
1 .7 4
A g e at A d m issio n
-0 .1 0
0 .0 0
0 .9 1
A g e of F irst U se
0 .0 6
0 .0 0
1 .0 6
L ive w ith F a m ily
-0 .0 9
0 .6 4
0 .9 1
H o m e le ss
-0 .2 6
0 .1 8
0 .7 7
P re g n a n t
0 .1 3
0 .6 7
1 .1 4
M in o r C h ild re n in H o m e
0 .3 1
0 .0 2
1 .3 6
Y e a rs o f E d ucatio n
0 .0 5
0 .5 2
1 .0 5
E m p lo ye d a t A d m issio n
0 .2 0
0 .1 0
1 .2 2
Y e a rly In co m e
0 .1 1
0 .0 2
1 .1 1
C rim in a l J u s tic e S ta tu s
C rim in a l Ju stice /L eg a l In vo lve m e n t
0 .0 0
0 .9 9
1 .0 0
O n P ro ba tio n
-0 .2 6
0 .6 2
0 .7 7
O n P a role
-0 .8 2
0 .0 9
0 .4 4
T re a tm e n t
F irst T C A D A T re atm e n t
0 .3 9
0 .0 0
1 .4 7
A d m itted to M eth a do n e
0 .2 3
0 .5 7
1 .2 6
S e c o n d D ru g P rob le m
None
0 .1 7
0 .4 2
1 .1 8
A lco h o l
0 .3 7
0 .2 0
1 .4 5
P o w d e r C o ca in e
-0 .5 1
0 .1 3
0 .6 0
C ra ck C o ca in e
0 .6 5
0 .0 1
1 .9 1
M a riju a n a
0 .5 9
0 .0 8
1 .8 0
S u b s ta n c e A b u s e Im p a irm e n t (% w ith 0 D a ys o f P ro b lem s in L a s t
M o n th )
S ickn e ss/H e a lth P ro b le m s
-0 .1 9
0 .0 6
0 .8 3
E m p lo ym e n t P ro b lem s
-0 .0 1
0 .8 5
0 .9 9
F a m ily/M a rita l P ro ble m s
0 .0 6
0 .5 6
1 .0 6
P e e r/S ocia l P ro ble m s in
-0 .0 7
0 .5 8
0 .9 3
P sych o lo g ica l P ro b le m s
0 .0 0
0 .9 5
1 .0 0
D ru g /A lco h o l P ro b le m s
-0 .0 4
0 .6 4
0 .9 6
*O d d s ratio s gre a te r tha n 1 in d ica te inh a le rs a re m o re like ly to ha ve th is cha ra cte ristic p re se n t w h ile
o d d s ratio s le ss th an 1 in d ica te in ha le rs a re le s s like ly to ha ve th is ch a ra cte ristic p re se nt
Demographics of Injectors & Inhalers at
Admission to Treatment
Analysis
40
 Statistical models included a generalized linear model with the outcome
modeled as a binomial and multinomial distribution and a hierarchical linear
model for continuous outcomes.
 The Generalized Estimating Equation (GEE) model was used to account for the
variation in heroin user characteristics due to treatment program.
 All analyses were conducted using SAS v8.
P r> |Z |
Discussion
Injectors
Inhalers
80%
Limitations/Further Study
 The findings from this first phase of the study are limited by the variables collected in
CODAP/TEDS and they cannot be generalized to all heroin users in treatment in
Texas since only 9 of the 69 methadone programs in the state report CODAP/TEDS
data. Collecting comparable data on clients in private programs is part of Phase 2 of
this research study.
 Phase 2 will be in-depth face-to-face interviews with heroin users to determine
reasons for shifting or not shifting to needles. Data will be collected on patterns of
use of other drugs, attitudes towards needle use (fear of needles or “needle
fixation”), prior sexual and physical abuse, mental and physical status, childhood and
family history, criminal history, and reasons for remaining an inhaler or for shifting to
injection.
 Phase 3 will be interviews and focus groups with heroin users who have never been
in treatment.
Demographics of Injectors & Inhalers at
Admission to Treatment
Demographics of Injectors & Inhalers at
Admission to Treatment
70%
35
Injectors
30
60%
25
50%
20
40%
Injectors
90%
Inhalers
Inhalers
80%
70%
60%
50%
15
30%
10
20%
40%
30%
Acknowledgements
20%
5




 Consistent with other studies, we found that there are significant differences
between injectors and inhalers at admission to treatment. Inhalers are younger,
more likely to have used heroin for fewer years, to be first admissions to
treatment, to have children in the home, and to have higher annual incomes.
 Texas injectors and inhalers reported no difference in number of days that heroin
was used in the month prior to admission. We would speculate that some of the
inhalers had reached a level of dependence where their habits could no longer be
maintained through daily inhaling and that faced with the need to shift to injecting,
they had, instead, chosen to enter treatment.
 Our study found that there were very large differences by race/ethnicity, with
African Americans in the sample being much more likely to be inhalers than
injectors. This finding is not well understood and will be the focus of additional
study.
 While the bivariate analysis showed that injectors were more likely to have
problems with the legal system and to be on parole, which would be a reflection
of their longer crime careers, these patterns were not significant in the
multivariate prediction model, which controlled for age.
 Having minor children in the household was a significant predictor of being an
inhaler.
 Only higher income was a significant economic predictor of inhaling when age,
gender, and race/ethnicity were controlled. However, findings about the economic
status may be confounded because TCADA programs give priority to povertylevel clients.
10%
10%
Funding from NIDA (R21 DA014744)
Cooperating treatment providers and study participants
Accepted for publication in Substance Use and Misuse.
Contact Jane Maxwell
512 232-0610
jcmaxwell@mail.utexas.edu
0
0%
Admission Age*
Age 1st Use*
Lag*
# Days Used
*p <0.05
0%
Male*
Anglo*
Hispanic
Black*
Live with Family*
*p <0.05
*p <0.05
Homeless*
Pregnant*
Kids at Home*
Employed*
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