Purpose of the Needs Assessment

Report
Issues and Selected findings: Assessment of
Prescription Drug Misuse by Youth in Boston
PFS2 Initiative
Boston Public Health Commission
Prepared by
J. Richard Woy, Ph.D.
JRW Associates
For panel presentation at
Statewide Substance Abuse Prevention Conference,
October 30, 2014
Outline of Presentation
- I. Background and purposes
- II. Challenges and attempted solutions
- III. Methods
- IV. Findings: Youth surveys
- V. Findings: Parent survey
- VI. Findings: Provider focus groups
- VII. Use of findings: PFS2 Boston program design
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I. Background and Purposes
Background:
• There currently is a three-year PFS2 Initiative underway in
Boston. Funded by BSAS and directed by the Boston
Public Health Commission (BPHC), the Initiative began in
late 2012 and is now late in its second year of
implementation.
• Most of Year 01 was devoted to needs/assets assessment,
development of the strategic plan and evaluation plan, and
establishment of baseline measures for the Initiative.
• The needs/assets assessment and issues associated with it
are the primary focus of this presentation.
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Background and Purposes (Continued)
Purposes:
• The needs/assets assessment was intended to: (1) provide
an empirical basis for development of the strategic plan
and evaluation plan; and (2) to establish baseline measures
against which to measure success of the Initiative.
• Purposes of this presentation are: (1) to explore challenges
encountered and our attempts at solutions; (2) to present
selected findings from the assessment; and (3) then how
we are using the findings for program development,
implementation, and evaluation.
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II. Challenges and Attempted Solutions
Challenges:
• Limited existing data on NMUPD by youth in Boston.
• No ready access to large representative samples of youth to
survey in Boston. (In particular, no access to survey youth
in Boston Public Schools)
• Scope and complexity of a major city.
– Large bureaucracies
– Many neighborhoods
– Many service sectors and providers
• Limited resources for assessment.
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Challenges and Attempted Solutions (Cont’d)
Attempted solutions:
• Collection and review of all existing recent data on
NMUPD by youth in Massachusetts and Boston.
• Use of “convenience samples” to survey youth and parents
of youth:
– Baseline surveys/youth: Focus groups with youth
– Baseline surveys/parents: Parent University, Boston Public
Schools
• Heavy reliance on qualitative methods, including: (1) focus
groups; and (2) key informant interviews.
• Design Team and BPHC resources/network.
• “Convergent” analysis.
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III. Methods
Data collection re NMUPD by youth in Boston:
• Survey of youth in focus groups (N=74)
• Survey of parents in Parent University (N=53)
• 11 focus groups with youth (N=101), including many
neighborhoods and types of settings (e.g., after school
programs; residential drug treatment programs; certain
public schools).
• 2 focus groups with service providers (N=21), one group
serving youth 12-17 years of age and one group serving
youth ages 18 to 25 years.
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Methods (Continued)
Data collection re NMUPD by youth in Boston:
• 10 key informant telephone interviews with experts and
opinion leaders re NMUPD by youth in Boston.
• Survey of healthcare providers attending a workshop
entitled “Prescribing Practices and Poly Drug Abuse”
(N=14).
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IV. Survey Findings: NMUPD by Youth
Data source
Percent high school students reporting NMUPD
Lifetime
Past 30-day
National, YRBS
21%
--
MA, Youth Health Risk
15%
6%
MA, MYTH
17%
7%
Boston, A-B SA TF
--
7%
Boston, DSAC
--
5%
Boston, PFS2
22%
4%
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Survey findings: NMUPD by Youth (Cont’d)
PFS2 survey: Additional observations
• Lifetime rates substantially higher than current rates.
• Reported rates very low in 12-14 year old range and then
increasing through high school years.
• Most who reported lifetime NMUPD reported misuse of
multiple types of drugs, including narcotics/opioids (75%),
Ritalin or Adderall (81%), and Other drugs (81%).
• Risk of harm: Respondents rated heroin very risky,
prescription narcotics and other prescription drugs
moderately risky, and marijuana least risky.
• Access: Respondents rated alcohol fairly easy to obtain
and prescription drugs and marijuana only fairly difficult.
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V. Findings: PFS2 Parent Survey
Percent
parents
Survey item
60%
Reported storing prescription drugs in a secure location.
60%
Reported periodically disposing of outdated prescription drugs.
85%
Reported it is be wrong for their children to misuse prescription drugs.
80%
Reported they and their children hold the same feelings about NMUPD.
89%
Reported that their children know what their parents think about drugs
and NMUPD.
100%
Reported that they had talked with their children about drugs/NMUPD.
100%
Reported it was easy to talk with their children about drugs/NMUPD
100%
Reported it was very important to give children information about the
dangers of drugs/NMUPD.
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Findings: PFS2 Parent Survey (Cont’d)
Additional observations:
• Youth substance use: Reported use rates in this sample
were less than half the rates reported by youth themselves.
• Text responses: While parents reported that it was easy to
talk to their children about drugs and that they had done so,
in written responses to open-ended questions they also
identified a number of challenges in this area as well as
suggesting a number of types of information that might be
helpful to them as parents in their efforts to protect their
children from the dangers of drugs and NMUPD.
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VI. Findings: Focus Groups with Providers
Scope, characteristics, and seriousness:
• Youth NMUPD a serious problem in Boston.
• Problem is trending up and moving lower in age.
• Involves multiple drugs in addition to opioids.
• Involves both genders and many racial/ethnic groups.
• Tends to start with experimentation at home and with peers
and often is a gateway to other street drugs.
• May be more frequent among drug users under 25 years
than among older drug users.
• May sometimes be part of larger pattern of trauma/abuse.
• May be a different pattern among college students.
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Findings: Provider Focus Groups (Cont’d)
Key risk factors:
• Easy access to prescription drugs from parents, friends,
and doctors’ prescriptions, as well as illegally.
• Youth and society as a whole tend to view prescription
drugs as acceptable and safe, unlike use of street drugs.
• Insufficient knowledge and awareness of the dangers of
NMUPD.
• Peer pressure.
• Trauma and/or neglect in childhood.
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Findings: Provider Focus Groups (Cont’d)
Suggested solutions:
• Educate youth regarding risks/dangers of NMUPD before
they start using, e.g. reverse perception that prescription
drugs are acceptable and safe.
• Educate/involve parents re risks/dangers of NMUPD and
how to reduce access to prescription drugs at home.
• Educate/involve providers, especially doctors and dentists
around reducing over-prescribing and adherence to best
practices re prescription of drugs.
• Create universal drug prescription data base.
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VII. Use of Findings in Program Design
and Implementation
PFS2 Boston program design, based on the above findings:
• Goal: Reduce the number of youth ages 12 to 17 years in
Boston who initiate NMUPD.
• Primary intervening variables/risk factors: (1) low
perception of risk/harm; and (2) easy access to PD’s.
• Other intervening variables: (1) extent of peer approval of
NMUPD; (2) extent of parental/caregiver and prescriber
approval/disapproval of NMUPD.
• Target groups: (1) Youth; (2) Parents; and (3) Providers.
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Use of Findings (Cont’d)
PFS2 Boston program design, based on the above findings:
• Strategies/Youth: City-wide awareness projects and local
neighborhood education efforts targeting youth to address
perception of risk/harm issue.
• Strategies/Parents: Through BPS Parent University,
provide education and try to mobilize parents on
perception of risk/harm issue and ways to reduce access at
home.
• Strategies/Providers: Through collaboration with BU
Scope of Pain project, provide education and try to
mobilize health care providers to address access issue.
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For additional information
For additional information, contact:
J. Richard Woy
JRW Associates
O: 617-731-9852
Email: [email protected]
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