Gender, Pregnancy, and Treatment Completion by Criminal Justice Referral Status
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Gender, Pregnancy, and Treatment Completion by Criminal Justice Referral Status Mishka Terplan MD MPH 1 , Meg Palisoul 2 , Steve Lui Msc 3 , Catherine Friedman MD 4 1 University of Maryland School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Baltimore, MD, USA

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Pregnant women who enter drug treatment from the criminal justice system

Gender, Pregnancy, and Treatment Completion by Criminal Justice Referral Status

Mishka Terplan MD MPH1, Meg Palisoul2, Steve LuiMsc3, Catherine Friedman MD4

1 University of Maryland School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Baltimore, MD, USA

2 University of Maryland School of Medicine, Baltimore, MD, USA

3 University of Huddersfield, Department of Nursing and Health Studies, Centre for Health and Social Care, Yorkshire, UK

4 University of Pittsburgh Medical Center, Department of Psychiatry, Pittsburgh, PA, USA

Abstract

Results

Background

Court-mandated drug treatment has become more common in the United States over the last decades. However its effectiveness has not been investigated nationally in terms of gender and pregnancy status.

Methods

We used the 2006 Treatment Episode Data Set. The primary outcome was treatment completion including transfers to further care. The primary exposure was criminal justice referrals. Demographic and treatment characteristics were compared with chi-squared and t-tests. Confounding was assessed via a backwards elimination method using change-in-estimate criteria. Logistic regression models were stratified by gender and pregnancy. Results are reported as Odds Ratios (OR) with 95% confidence intervals (CI).

Results

Of the 1.5 million treatment admissions, 38% of men, 29% of women, and 35% of pregnant women entered treatment from the criminal justice system. Overall pregnant women were younger, with lower educational achievement and employment, less likely to use alcohol, and more likely to use methamphetamines. Pregnant women were less likely to complete treatment (55%) than non-pregnant women (57%) or men (61%). After controlling for confounders, the subset of pregnant women (OR 1.37 [1.29, 1.46]) and non-pregnant women (1.25 [1.23, 1.26]) who entered treatment via the criminal justice system had a higher odds of treatment completion than men (0.95 [95% CI: 0.94, 0.96]).

Conclusion

Criminal justice referral appears to be an important effect measure modifier in drug treatment completion. The reasons why pregnant women especially do better in this context needs to be further explored.

Criminal Justice Treatment Referrals

Odds of Treatment Completion by Criminal Justice Referral (95% CI)

Introduction

Court-mandated drug treatment has become more common in the United States over the last decades.

However its effectiveness has not been investigated nationally in terms of gender and pregnancy status.

Methods

Data:

Treatment Episode Data Set – Discharges (TEDS-D), 2006. TEDS-D is a national-level data set that captures all admissions to drug treatment centers that receive federal funding in the United States. TEDS-D captures approximately 87% of all treatment admissions in the US.

Variable Definition:

Criminal Justice Referral – any referral originating from state/federal court, formal adjudication, probation/parole, DUI/DWI, or diversionary program.

Treatment completion – created from the reason for discharge. Completion = completion or transfer to another treatment facility.

Statistical Analysis (STATA v 11.0)

•       Bivariate – Pearson Chi square•       Continuous – t- tests and ANOVA•       Modeling – Logistic Regression (confounding assessed via a backwards elimination method using change-in-estimate criteria)

† More than 25% missing; p-value <0.01 for all comparisons

Conclusions

Pregnant women who enter drug treatment from the criminal justice system:

Start using at an earlier age

>50% have recently used alcohol

>50% leave treatment AMA

The odds of treatment completion among pregnant women are

Greater for white patients

Poorer for residential versus ambulatory treatment

Greater for alcohol versus any other substance

Worse among initial treatment admissions

Summary

Implications

Of the 1.5 million treatment admissions, 38% of men, 29% of women, and 35% of pregnant women entered treatment from the criminal justice system.

Overall pregnant women were younger, with lower educational achievement and employment, less likely to use alcohol, and more likely to use methamphetamines. They also had more IDU and a greater proportion of Medicare health insurance.

Pregnant women were less likely to complete treatment (55%) than non-pregnant women (57%) or men (61%).

Pregnant women who enter drug treatment from the criminal justice system are an important sub-group of pregnant women with a unique set of needs.

Their poor treatment completion and high rates of alcohol consumption are concerning.

Better retention in treatment for this population is critical.

p-value <0.01 for all comparisons


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