Efficacy and cost-effectiveness of subsidized ridesharing as a drunk driving intervention in Columbus, OH

BACKGROUND

No economic evaluations exist of free or subsidized ridesharing services designed to reduce impaired driving.

OBJECTIVES

To evaluate the effects and economics of a 17-weekend program that provided rideshare coupons good for free one-way or round trips to/from the hospitality zones in Columbus, Ohio, coupled with a modest increase in enforcement and a media campaign that used messaging about enforcement to promote usage.

METHODS

Web surveys of riders and intercept surveys of foot traffic in the hospitality zones yielded data on the reduction in driving after drinking and the change in alcohol consumption associated with coupon use. We estimated crash changes from trip data using national studies, then confirmed with an ARIMA analysis of monthly police crash reports. Costs and output data came from program and rideshare company records.

RESULTS

70.8% of 19,649 responding coupon redeemers said coupon use reduced the chance they would drive after drinking. An estimated 1 in 4,310 drink-driving trips results in an alcohol-attributable crash, so the coupons prevented an estimated 3.2 crashes. Consistent with that minimal change, the ARIMA analysis did not detect a drunk-driving crash reduction. Self-reports indicated alcohol consumption rose by an average of 0.4 drinks per coupon redeemer, possibly with an equal rise among people who rode with the redeemer. The program cost almost $650,000 and saved an estimated 1.8 years of healthy life. Across a range of discount rates and values for a year of healthy life, it cost $366,000 to $791,000 per year of healthy life saved. Its estimated benefit-cost ratio was between 0.31 and 0.59, meaning it cost far more than it saved.

CONCLUSIONS

Ridesharing, coupled with a media campaign and increased enforcement, was not a cost-effective drunk-driving intervention. Although it reduced drink-driving crashes and saved years of healthy life, those savings were modest and expensive. Moreover, the self-reported increase in participant drinking imposed countervailing risks. Even sensitivity analyses that potentially overestimate the benefits and underestimate the costs indicate a significant imbalance between program costs and savings. Any funding devoted to ridesharing would divert scarce resources from interventions with benefit-cost ratios above 1. Thus, our evaluation suggests that governments should not devote energy or resources to ridesharing programs if their primary objective is to reduce drink-driving or harmful alcohol use.

Gender differences in Afghan drug-abuse treatment: an assessment of treatment entry characteristics, dropout, and outcomes

OBJECTIVE

The current study examines gender differences in drug-abuse treatment (DAT) entry, dropout, and outcomes in seven DAT centers in Afghanistan. This is the first study to examine gender differences in DAT programming in Afghanistan.

DESIGN

A prospective cohort design of 504 women and men in seven DAT centers in Afghanistan was used in this study and the analyses examined whether gender differences exist for patients (1) at treatment entry, (2) at treatment dropout, and (3) for treatment outcomes.

RESULTS

Gender differences were found at baseline for patient characteristics, drug use, crime, and social and occupational functioning. Results showed a trend that women remained in treatment longer than men. Looking at gender differences in treatment success, results showed greater reductions in drug use and crime, and greater social functioning among women.

CONCLUSION

Results provide preliminary evidence for potential treatment success of women-tailored DAT programming in Afghanistan. Results also indicate that DAT appears to be successful among Afghan men; however, lower positive outcomes for men when compared to women suggest that more efforts should focus on tailoring DAT programming to the specific needs of Afghan men as well. Study limitations are addressed, and important policy implications are discussed.

Examining human rights and mental health among women in drug abuse treatment centers in Afghanistan

Denial of human rights, gender disparities, and living in a war zone can be associated with severe depression and poor social functioning, especially for female drug abusers. This study of Afghan women in drug abuse treatment (DAT) centers assesses (a) the extent to which these women have experienced human rights violations and mental health problems prior to entering the DAT centers, and (b) whether there are specific risk factors for human rights violations among this population. A total of 176 in-person interviews were conducted with female patients admitted to three drug abuse treatment centers in Afghanistan in 2010. Nearly all women (91%) reported limitations with social functioning. Further, 41% of the women indicated they had suicide ideation and 27% of the women had attempted suicide at least once 30 days prior to entering the DAT centers due to feelings of sadness or hopelessness. Half of the women (50%) experienced at least one human rights violation in the past year prior to entering the DAT centers. Risk factors for human rights violations among this population include marital status, ethnicity, literacy, employment status, entering treatment based on one’s own desire, limited social functioning, and suicide attempts. Conclusions stemming from the results are discussed.

A community prevention model to prevent children from inhaling and ingesting harmful legal products

Children's misuse of harmful legal products (HLPs), including inhaling or ingesting everyday household products, prescription drugs, and over-the-counter drugs, constitutes a serious health problem for American society. This article presents a community prevention model (CPM) focusing on this problem among pre and early adolescents. The model, consisting of a community mobilization strategy and environmental strategies targeting homes, schools, and retail outlets, is designed to increase community readiness and reduce the availability of HLPs, which is hypothesized to reduce HLPs use among children. The CPM is being tested in Alaskan rural communities as part of an inprogress eight-year National Institute on Drug Abuse randomized-controlled trial. This paper presents the CPM conceptual framework, describes the model, and highlights community participation, challenges, and lessons learned from implementation of the model over a 21-month period.

The prevention delivery system: organizational context and use of comprehensive programming frameworks

The purpose of this exploratory study is to investigate organizational-level mechanisms in the Prevention Delivery System (PDS) and their influence on implementing comprehensive programming frameworks (e.g., Communities that Care-CtC) as the innovation. The PDS is part of the Interactive Systems Framework for Dissemination and Implementation (ISF) and describes key characteristics of innovation implementation and dissemination. The study addresses two research questions: (1) What types of organizational characteristics are related to successful use of each of the programming processes (i.e., planning, implementation, evaluation, and sustainability) that are part of comprehensive programming frameworks?; and (2) What are the similarities and differences in the organizational patterns correlated with use of each of the programming processes? Surveys, interview data, and other documents designed to assess organizational characteristics and extent of use of a comprehensive programming framework over time, were collected from 8 Community boards and 23 provider agencies. These organizations were responsible for planning and delivering substance abuse prevention services as part of a statewide initiative in Ohio. Data were analyzed using Spearman rho (and rank-biserial) correlations, with an emphasis on effect sizes. Results indicated that leadership, shared vision, process advocates, and technical assistance were common correlates of use across programming processes. However, the role played by these organizational variables differed for each programming process, pointing to complex interactions of the organizational infrastructure with other variables (i.e., characteristics of the innovation itself and external macro-level factors). This exploratory study provides preliminary data on the organizational-level mechanisms of the PDS and the complexity of their relationships with the other Systems in the Interactive Systems Framework.

Individual and contextual predictors of inhalant use among 8th graders: a multilevel analysis

Few studies of inhalant use have examined a large number of predictors at the individual level, including risk and protective factors and delinquent behavior, while also taking into account contextual variables (such as school size and poverty rates). This exploratory study uses 8th grade data from a large-scale survey of students in Kentucky to examine individual and contextual predictors of prevalence of inhalant use, and compares the predictors of inhalant use with factors predicting the use of marijuana and other drug use. Hierarchical Generalized Linear Modeling results using a logit link function suggest that the relationships between inhalant use and some of these factors are different than the relationships between the factors and both marijuana and other drug use. Implications for prevention of inhalant use are discussed.

A community prevention intervention to reduce youth from inhaling and ingesting harmful legal products

Youth use of harmful legal products, including inhaling or ingesting everyday household products, prescription drugs, and over-the-counter drugs, constitutes a growing health problem for American society. As such, a single targeted approach to preventing such a drug problem in a community is unlikely to be sufficient to reduce use and abuse at the youth population level. Therefore, the primary focus of this article is on an innovative, comprehensive, community-based prevention intervention. The intervention described here is based upon prior research that has a potential of preventing youth use of alcohol and other legal products. It builds upon three evidence-based prevention interventions from the substance abuse field: community mobilization, environmental strategies, and school-based prevention education intervention. The results of a feasibility project are presented and the description of a planned efficacy trial is discussed.