Drug Use in Metropolitan America

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Edited by: Robert M. Bray

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    List of Tables

    • Table 2.1 Unweighted Numbers of Respondents for Each DC*MADS Population, by Demographic Characteristics 23
    • Table 2.2 Demographic Characteristics of DC*MADS Populations 31
    • Table 2.3 Comparison of Questionnaire Sections for DC*MADS Populations 36
    • Table 2.4 Survey Response Data and Performance Rates for DC*MADS Populations 44
    • Table 3.1 Prevalence of Past Month Alcohol and Illicit Drug Use and Past Year Dependence and Treatment for 25 Metropolitan Statistical Areas 60
    • Table 3.2 Prevalence of Illicit Drug, Alcohol, and Tobacco Use in the DC MSA Household Population 66
    • Table 3.3 Prevalence of Illicit Drug, Alcohol, and Tobacco Use in the DC MSA Household Population, Large Metropolitan Areas, and the Total U.S. Household Population 68
    • Table 3.4 Prevalence of Illicit Drug, Alcohol, and Tobacco Use in the Past Year and Past Month in the DC MSA Household Population, by Location 70
    • Table 3.5 Prevalence of Illicit Drug, Alcohol, and Tobacco Use in the Past Year and Past Month in the DC MSA Household Population, by Socioeconomic Status of Area 71
    • Table 3.6 Prevalence of Illicit Drug Use in the Past Year and Past Month in the DC MSA Household Population, by Demographic Characteristics 72
    • Table 3.7 Prevalence of Illicit Drug and Alcohol Use During the Past Year for DC*MADS Populations 74
    • Table 4.1 Demographic Characteristics of the DC MSA Homeless and Transient Population, by Sample Location 90
    • Table 4.2 Any Illicit Drug Use and Heavy Alcohol Use in the Past Month, by Demographic Characteristics 97
    • Table 4.3 Patterns of Service Utilization, by Type of Drug User 102
    • Table 5.1 Characteristics of the Institutionalized Population, by Type of Institution 134
    • Table 5.2 Use of Any Illicit Drug During the Past Year, During the Past Month, and While Institutionalized, by Demographic Characteristics 141
    • Table 5.3 Past Year Use of Illicit Drugs and Alcohol, by Type of Institution 143
    • Table 5.4 Drug- and Alcohol-Related Problems During the Past Year, by Preinstitutionalized Drug Use Typology 149
    • Table 5.5 Substance Abuse Treatment Among Institutionalized Drug and Alcohol Users, by Drug Use Typology 150
    • Table 5.6 Lifetime and Past Year Services for Primary Care Problems and Insurance Coverage, by Preinstitutionalized Drug Use Typology 153
    • Table 6.1 Percentage of Convicted Adult Offenders Sentenced to Incarceration in the DC MSA and Reporting Illicit Drug Use, by Personal Characteristics and Time Period 171
    • Table 6.2 Frequency of Use of Illicit Drugs and Alcohol by Convicted Adults Sentenced to Incarceration in the DC MSA Before and After Arrest, by Incarceration Status 1 Month After Arrest and Type of Drug 172
    • Table 6.3 Percentage of Convicted Incarcerated Juvenile Offenders From the DC MSA Reporting Illicit Drug Use, by Characteristics and Time Period 175
    • Table 6.4 Frequency of Use by Convicted Incarcerated Juvenile Offenders From the DC MSA of Illicit Drugs and Alcohol Before and After Arrest, by Incarceration Status 1 Month After Arrest and Type of Drug 176
    • Table 6.5 Percentage of Offenders Committing a Crime at Least Once in the Previous 3 Years, by Type of Offender and Type of Crime 178
    • Table 6.6 Percentage of Most Recent Predatory Crimes Committed by Offenders in the DC MSA and That Were Preceded by Drug Use, by Type of Drug, Type of Offender, and Type of Predatory Crime 181
    • Table 6.7 Self-Reported Motivation Associated With Most Recent Predatory Crime Committed Since 1988 Among Offenders in the DC MSA, by Type of Offender and Type of Predatory Crime 183
    • Table 6.8 Frequency of Drug-Trafficking Activities, by Type of Offender and Type of Activity 187
    • Table 7.1 Past Month Use of Any Illicit Drug, by Demographic Characteristics and Treatment Modality 207
    • Table 7.2 Past Year Patterns of Drug Use, by Treatment Modality 210
    • Table 7.3 Primary Care Problems, Insurance Coverage, and Medical Treatment, by Treatment Modality 217
    • Table 7.4 Illegal Activities and Arrests for Criminal Offenses in the Lifetime, by Treatment Modality 220
    • Table 8.1 Prevalence of Any Illicit Drug Use, by Demographic Characteristics and Period of Use, for DC Women Delivering Livebirths in DC Hospitals 247
    • Table 8.2 Drug Use Patterns During Pregnancy, by Infant Birthweight, Gestational Age, and Prenatal Care, for DC Women Delivering Livebirths in DC Hospitals 251
    • Table 8.3 Adjusted Odds Ratios of Infant Birthweight Categories for Substance Use During Pregnancy Among DC Women Delivering Livebirths in DC Hospitals 253
    • Table 9.1 Percentages and Estimated Numbers of People in the DC MSA Composite Population 276
    • Table 9.2 Prevalence of Any Illicit Drug Use in the Past Year for Household, Homeless, Institutionalized, and Composite Populations, by Demographic Characteristics 284

    List of Figures

    • Figure 2.1 District of Columbia Metropolitan Statistical Area (DC MSA) 20
    • Figure 3.1 Prevalence of Illicit Drug, Alcohol, and Tobacco Use in the DC MSA Household Population 65
    • Figure 4.1 Classification of DC MSA Homeless and Transient Population Into McKinney Act Groups, by Location 92
    • Figure 4.2 Prevalence of Illicit Drug, Alcohol, and Needle Use in the DC MSA Homeless and Transient Population 95
    • Figure 4.3 Prevalence of Co-Occurring Problems, by Type of Drug User 100
    • Figure 5.1 Prevalence of Illicit Drug and Alcohol Use in the DC MSA Institutionalized Population 138
    • Figure 5.2 Drug Use Typology 146
    • Figure 6.1 Prevalence of Illicit Drug and Alcohol Use Among DC MSA Convicted Adult Offenders Sentenced to Incarceration 169
    • Figure 6.2 Prevalence of Illicit Drug and Alcohol Use Among DC MSA Convicted Incarcerated Juvenile Offenders 174
    • Figure 7.1 Prevalence of Past Year Illicit Drug and Alcohol Use Among DC MSA Drug Treatment Clients 202
    • Figure 7.2 Prevalence of Past Month Illicit Drug and Alcohol Use Among DC MSA Drug Treatment Clients 203
    • Figure 8.1 Demographic Characteristics and Parity Among DC Women Delivering Livebirths in DC Hospitals 242
    • Figure 8.2 Frequency, Source, and Timing of Prenatal Care Services Received During Pregnancy Among DC Women Delivering Livebirths in DC Hospitals 243
    • Figure 8.3 Prevalence of Illicit Drug, Alcohol, and Cigarette Use Among DC Women Delivering Livebirths in DC Hospitals 245
    • Figure 9.1 Overlap of Sampling Frames for the DC MSA Household, Homeless and Transient, and Institutionalized Populations 275
    • Figure 9.2 Prevalence of Past Year Illicit Drug Use in the DC MSA Household, Homeless and Transient, Institutionalized, and Composite Populations 277
    • Figure 9.3 Number of Past Year Illicit Drug and Needle Users in the DC MSA Household and Composite Populations 281
    • Figure 9.4 Estimated Numbers of Past Year Crack Cocaine, Heroin, and Needle Users in the DC MSA Composite Population 287
    • Figure 9.5 Prevalence of Lifetime Needle Sharing in the DC MSA Household, Homeless and Transient, Institutionalized, and Composite Populations 289

    Acknowledgments

    Many individuals, groups, and organizations made valuable contributions to the conceptualization, design, implementation, and conduct of the Washington, DC, Metropolitan Area Drug Study (DC*MADS). The magnitude of these efforts was much greater than that required for other significant research investigations because of the large number of studies in the project and their many complexities and challenges. We are grateful to all who gave of their time and energy to make the project succeed, but page limitations permit us to cite only some of the major contributors to this effort.

    DC*MADS was sponsored by the National Institute on Drug Abuse (NIDA), Division of Epidemiology and Prevention Research (DEPR), and funded under Contract No. 271-89-8340. Elizabeth Y. Lambert, M.Sc., served as the NIDA project officer and provided oversight and guidance to all aspects of the work, including the review and technical editing of the final study reports. Zili Sloboda, Sc.D., and Ann Blanken of DEPR offered administrative support, and Lana Harrison, Ph.D., Arthur Hughes, James Colliver, Ph.D., and Lulu Beatty, Ph.D., provided helpful technical reviews and critiques of the final reports (see “Appendix I: DC*MADS Technical Reports,” 1998, available on the Sage Publications World Wide Web site at

    and on the Research Triangle Institute World Wide Web site at:

    Although NIDA provided funding for the project, the views, opinions, and findings presented in this book are solely those of the authors and should not be construed as official NIDA position or policy.

    The research team for DC*MADS included staff from Research Triangle Institute (RTI), as the prime contractor, and Westat, Inc. (the subcontractor). These two firms conducted most of the research; however, expertise and assistance were provided by other outstanding companies in the DC area, including Birch and Davis, Inc.; Johnson, Bassin, and Shaw, Inc.; and Tiger Research, as well as by independent advisors and consultants. Credit also should be given to all those who contributed to the success of the DC*MADS project by developing questionnaires, constructing sampling frames, coordinating data collection activities, tabulating data, completing various data processing tasks, preparing codebooks, and editing and keying manuscripts for the technical reports and this book.

    At RTI, Susan L. Bailey, Ph.D., served as assistant project director and study leader; Judith T. Lessler, Ph.D., provided overall guidance on sampling issues and methods for combining data across populations; Jutta Thornberry coordinated questionnaire development to ensure comparability among the studies as well as leading RTI data collection efforts; Mary Anne Ardini and Tabitha Hendershot managed day-to-day data collection activities; and George H. Dunteman, Ph.D., provided analytical consultation for several of the final reports. Data editing and processing were handled by a dedicated staff of editors, coders, and data entry keyers under the direction of R. Jo Saraphis and Karen S. Woodell. Donald R. Akin, Ronaldo Iachan, Ph.D., and Sara C. Wheeless, Ph.D., constructed weights for the study samples. Lisa E. Packer, Gayle S. Bieler, Emelita de Leon-Wong, Ph.D., Donna D. Medeirus, and the late Teresa D. Crotts provided programming and analytical support. Richard S. Straw provided copyediting and proofreading assistance, and Teresa F. Gurley, Brenda K. Porter, Catherine A. Boykin, and Linda B. Fonville typed the reports. Teresa Gurley and Richard Straw, respectively, also did the typing, copyediting, and proofreading of the manuscript for this book. A positive and supportive working environment for the preparation of this book was provided by the Center for Social Research and Policy Analysis, under the direction of J. Valley Rachal; the Health and Social Policy Division, under the direction of George C. Theologus, Ph.D.; the Statistics, Health, and Social Policy Unit under the direction of Richard A. Kulka, Ph.D.; and RTI's corporate management, under the direction of F. Thomas Wooten, Ph.D., and Alvin M. Cruze, Ph.D.

    At Westat, Inc., Veronica Nieva, Ph.D., served as associate study leader and provided corporate liaison; Mary McCall, M.S., worked tirelessly to obtain the cooperation and participation of DC hospitals; Paul Brounstein, Ph.D., provided invaluable assistance in developing the study design, making arrangements with local agencies, and assisting in the data analysis for the studies of criminal and juvenile offenders; James Bethel, Ph.D., and David Marker, Ph.D., developed the sample designs and computed the final weights; and Nadine Rubenstein and Tracy Flaherty coordinated questionnaire development, study procedures, and data collection efforts. Programming at Westat was performed by Sandra Baker, Portia DePhillips, and Camille Clifford. Data editing was supervised by Maura Gost, and the manuscripts and reports were edited by Carol Benson and Barbara Brickman.

    Others with key roles in the conduct of DC*MADS include Mitchel S. Ratner, Ph.D., of Tiger Research (initially with Birch and Davis, Inc.), who led the Adverse Effects of Drug Abuse Study, and Gail Bassin of Johnson, Bassin, and Shaw, Inc., who made important contributions to the Area Opinion Leaders Study. George C. McFarland was pivotal as a liaison to the community, and without him, gaining community support and cooperation would have been much more difficult. The DC*MADS 17-person Advisory Group (see “Appendix H: Members of the DC*MADS Advisory Group,” 1998, available on the World Wide Web) provided substantive input on the research, including its multifaceted conceptual issues and processes of implementation. Several of the studies relied on special advisory groups (see final reports, Appendix I, 1998) or consultants, who were instrumental in sorting through sensitive issues and procedures.

    Finally, we are indebted to those who contributed directly to the preparation of this book. Peter Labella, the Sage acquiring editor, has provided encouragement and guidance throughout the preparation of this book to expedite its publication, and Diana E. Axelsen, the Sage production editor, has directed the task of converting manuscript pages into final finished copy. Professional development awards from RTI were made to Dr. Bray to help support the preparation of the overall manuscript and to Dr. Dennis to help support preparation of Chapter 4. Amy A. Vincus helped draft some of the appendix materials available on the Sage Publications World Wide Web site at http://www.sagepub.com and prepared tables for several chapters. Richard S. Straw ably coordinated preparation of the manuscript, including copyediting and checking the numerous details necessary to produce the book.

    We would be remiss if we neglected to thank the many dedicated professionals and staff of the participating institutions (including shelters, food kitchens, clinics, hospitals, jails, and prisons) for providing support and assistance in reaching the study participants and persons in local, state, and federal government agencies. Most of all, we owe a debt of gratitude to the men, women, and children who participated in the project and were willing to share personal and sensitive information about their lives—without them, this book, and the knowledge and insights it attempts to impart, would not have been possible.

    Robert M.Bray Research Triangle Institute
    Mary EllenMarsden Brandeis University
  • About the Authors

    Robert M. Bray, Ph.D., a senior research psychologist, is a principal investigator and project director at Research Triangle Institute with nearly 20 years of experience directing and analyzing complex surveys. His recent work has focused on the epidemiology of substance use and other health behaviors in civilian and military populations. For DC*MADS, he was overall project director, study leader for the Household and Nonhousehold Populations Study (see Chapters 3 and 9 of this book), and co-study leader for the Drug Use and Pregnancy Study (see Chapter 8). He also directed the 1982, 1985, 1988, 1992, and 1995 Worldwide Surveys of Substance Use and Health Behaviors Among U.S. Military Personnel; was coordinator of analytic reports for the 1988 and 1990 National Household Surveys on Drug Abuse; and conducted comparative analyses of military and civilian rates of substance use. He is currently directing a series of studies of various populations in several states assessing the need for substance abuse treatment services, including studies of household populations, homeless people, adolescents, students attending school, arrestees, and Native Americans. He also is principal investigator of two studies examining the health status, behaviors, and performance of military women and men. He has coauthored several chapters for other books, has published articles in a variety of journals, and is coeditor of The Psychology of the Courtroom. Dr. Bray is an ad hoc journal and grant reviewer and served on the Committee on Drug Use in the Workplace for the National Research Council, Institute of Medicine. He received his doctorate in social psychology from the University of Illinois, Urbana-Champaign.

    David Cantor, Ph.D., is a senior research associate with Westat, Inc., in Rockville, Maryland. He is currently conducting research on violence in schools, assisting in the design of a household survey to monitor the impact of recent changes in federal law to reform welfare (as well as other government programs), and designing a survey to measure the impact of federal medical savings accounts. For DC*MADS, he was study leader for the Adult Criminal Offenders Study and for the Juvenile Offenders Study (see Chapter 6 of this book). He also was a principal analyst and author for the Institutionalized Study. His research interests include the causes and consequences of predatory victimization, the relationship between drugs and crime, and methodological issues related to monitoring social issues and problems. He has a master's degree in applied and mathematical statistics and a doctorate in sociology from the University of Illinois, Urbana-Champaign.

    Michael L. Dennis, Ph.D., is a senior research psychologist at Chestnut Health Systems and director of its Drug Outcome Monitoring System. His recent work has focused on developing a biopsychosocial model of outcome monitoring for people with chronic substance use disorders, a group that moves in and out of the treatment system and has a variety of problems. During the past 10 years, he has worked as a principal investigator, evaluator, and methodologist for more than a dozen studies. These have addressed a variety of substantive issues (e.g., homelessness, vocational/ancillary services, case management, counselor training) and methodological challenges (e.g., randomized field experiments, time series, scale development, outcome monitoring). For DC*MADS, Dr. Dennis was the study leader for the Homeless and Transient Population Study (see Chapter 4 of this book). At the time of the study, he was at Research Triangle Institute. He also has served as an evaluator, consultant, and/or reviewer on work related to homelessness that has been done by the (former) Alcohol, Drug Abuse, and Mental Health Administration; Bureau of Health Care Delivery Assistance; Fannie Mae (Federal National Mortgage Association); Interagency Council on Homelessness; U.S. Department of Housing and Urban Development; National Institute on Alcohol Abuse and Alcoholism; National Institute on Drug Abuse; National Institute of Mental Health; North Carolina Interagency Council on Homeless Assistance Programs; and the Urban Institute. He has completed more than 75 major publications or technical reports and averaged four to six professional presentations per year. He received his psychology doctorate at Northwestern University, where he specialized in methodology and evaluation research.

    Patrick M. Flynn, Ph.D., a senior research psychologist, is currently a principal investigator and project director with the National Development and Research Institutes, Inc. He was the project director for the National Institute on Drug Abuse's (NIDA's) Cocaine Treatment Outcome Study, project codirector of the Drug Abuse Treatment Outcome Study, and project leader and task leader on a half dozen other important NIDA-funded research projects. For DC*MADS, he was study leader for the Current Treatment Client Characteristics Study (described in Chapter 7 of this book). He is currently the coprincipal investigator of NIDA's Cooperative Drug Abuse Treatment Outcome Study Coordinating Center. Early in his career, he was a counselor in a therapeutic community for drug abusers and was a program researcher on NIDA's Treatment Outcome Prospective Study (TOPS). He also has served in upper-level management positions in higher education and has held several academic positions, including tenured associate professor, college vice president, and dean of academic affairs. His research interests, in addition to substance abuse issues, include comorbid disorders, particularly personality disorders, psychological testing, and treatment improvement. He has authored or coauthored several book chapters and numerous journal publications, including those appearing in the American Journal of Drug and Alcohol Abuse, American Journal of Epidemiology, Journal of Addictive Diseases, Journal of Clinical Psychology, Journal of Personality Assessment, Journal of Personality Disorders, and Journal of Substance Abuse Treatment. He received his Ph.D. from the University of Miami, Coral Gables, Florida.

    Gregory H. Gaertner, Ph.D., is a vice president and managing director at the Gallup Organization's Government and Education Division. At the time that the DC*MADS research was conducted, he was employed at Westat, Inc. He oversaw Westat's participation in DC*MADS, which included studies of drug use among the institutionalized population, adult criminal offenders, juvenile offenders, school dropouts, elementary and secondary school students, and college-age young adults. Dr. Gaertner directed the Institutionalized Study described in Chapter 5 of this book. He is currently involved in multiple state-based assessments of the need for drug treatment funded by the Center for Substance Abuse Treatment. These assessments include studies of the incidence and prevalence of drug use and the need for treatment in household populations, and among homeless people, pregnant women, adolescents, criminal offenders, and Native Americans. He has taught research methods on the faculties of Case Western Reserve University and Bucknell University. He has written extensively on organizational change in the Academy of Management Review, Decision Sciences, the Academy of Management Journal, Public Administration Review, Human Relations, and other journals, as well as in various book chapters. He received his doctorate from the University of Chicago.

    Ronaldo Iachan, Ph.D., is a statistical consultant and serves as a statistical editor for the Journal of the American Medical Association with expertise in sample survey design and analysis. He was a research statistician with the Research Triangle Institute from 1985 to 1996, providing statistical task leadership for a variety of health, social, environmental, and economic studies. These included a national study of runaway and homeless youth and studies of HIV risk among the same population, state needs assessments of substance abuse treatment and prevention, living standards studies in several Central Asian republics, and evaluations of several educational programs. For DC*MADS, he led sampling and weighting activities for the Homeless and Transient Population Study and assisted with data analysis for the Adverse Effects of Drug Abuse Study. Dr. Iachan was an assistant professor at Iowa State University from 1981 to 1985, teaching graduate courses in sampling theory. He also taught statistics at the University of Wisconsin-Madison and at Duke University. His research also has extended to other areas of social statistics, including measures of agreement, spatial statistics, and robust statistics. He has published articles in a variety of peer-reviewed journals, including the Journal of the American Statistical Association, Biometrics, International Statistical Review, Psychometrics, Educational and Psychological Measurement, Journal of Official Statistics, and Survey Methodology. He received his doctorate and his master's degree in statistics from the University of California, Berkeley and his B.S. degrees in mathematics and systems engineering from PUC, Rio de Janeiro.

    Linda J. Keil, Ph.D., is a social psychologist employed by the Gallup Organization as a vice president and senior study director in the Government and Education Division. Over the past 12 years, her research has focused on hard-to-reach populations, including those described in Chapter 5 of this book. Other studies she has directed include a study of drug use among school dropouts, an evaluation of intervention programs for high-risk youth, an evaluation of the Job Corps' HIV policy, and a study of probation experiences among convicted drug felons. She received her graduate training at the University of California, Santa Barbara.

    Larry A. Kroutil, M.P.H., is a research analyst at Research Triangle Institute. His current research interests and activities involve estimating the prevalence and correlates of substance use among a variety of populations, assessing problems associated with substance use, and assessing the need for substance abuse treatment services among various populations. For the DC*MADS project, he worked primarily on the Household and Nonhousehold Populations Study (see Chapters 3 and 9), the Current Treatment Client Characteristics Study (see Chapter 7), and the Drug Use and Pregnancy Study (see Chapter 8). He recently has been lead author or coauthor of a series of papers and technical reports assessing the prevalence and trends in substance use among military and civilian populations. He received a Master of Public Health degree in health education in 1987 from the University of North Carolina at Chapel Hill.

    James W. Luckey, Ph.D., is a senior research psychologist at Research Triangle Institute. During the past decade, he has led or played a major role in more than a dozen substance abuse projects funded by the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the Center for Substance Abuse Treatment. Current projects he is leading include assessing the viability and value of an outcomes monitoring system for narcotic addiction treatment programs, studying alcohol treatment outcomes under managed care, and examining treatment needs for North Carolina. He is interested in research that can be applied directly to improving substance abuse treatment systems and enjoys studies that involve collaboration among providers, policymakers, and researchers. For DC*MADS, he was analytic leader for the Current Treatment Client Characteristics Study described in Chapter 7 of this book. Prior to coming to RTI, Dr. Luckey was on the faculty at the School of Public Health, University of North Carolina, for 10 years, and he is currently an adjunct associate professor there. He has served as a reviewer for several journals and on NIH grant review panels. He has authored and coauthored several book chapters and numerous journal publications, including articles for the Journal of Substance Abuse Treatment, American Journal of Drug and Alcohol Abuse, Journal of Addictive Diseases, Journal of Maintenance in the Addictions, American Journal of Public Health,International Journal of the Addictions, Evaluation and Program Planning, and Journal of Personality Disorders. He received his doctorate from the University of Nebraska–Lincoln.

    Mary Ellen Marsden, Ph.D., is Associate Research Professor at the Institute for Health Policy at Brandeis University and was formerly a senior research sociologist with Research Triangle Institute. Her research has focused on the study of substance use epidemiology, treatment effectiveness, and policy issues. For DC*MADS, she was costudy leader for the Household and Nonhousehold Populations Study (see Chapter 3 of this book). Dr. Marsden is currently study director for the treatment outcomes component of the Alcohol and Drug Services Study and coordinator of substance abuse sites for the Coordinating Center for Managed Care and Vulnerable Populations. She is principal investigator for a study to improve outcomes monitoring for the Massachusetts substance abuse treatment system and coprincipal investigator for a study of the health and performance of military women and a study of the effectiveness of prison-based substance abuse treatment. She was a lead author of Drug Abuse Treatment: A National Study of Effectiveness, the book summarizing the results of the Treatment Outcome Prospective Study, and author of several reports from the National Household Survey on Drug Abuse. She received her doctorate in sociology from the University of Chicago.

    Jutta Thornberry is a senior survey specialist for the Research Triangle Institute. She has 28 years of experience in developing data collection methodologies and in supervising data collection activities for various research projects. Prior to joining RTI in 1986, she was the head of field operations for the Survey Research Laboratory at the University of Illinois. Currently, she is project director for the Sources of Mediators of Alzheimer's Caregiver Stress study, which is being conducted for the University of Maryland. She also is coprincipal investigator for the NIH-DC Initiative to Reduce Infant Mortality in the District of Columbia and serves as the project director for one of the six DC Initiative protocols, titled Lack of Age-Appropriate Immunization Among Infants and Children Born in DC. Ms. Thornberry specializes in designing methodologies and managing studies utilizing computer-assisted interviewing, especially on studies involving sensitive topics and behaviors, and with nontraditional populations. She served as the Washington, DC, area coordinator for DC*MADS and helped provide comparability for the core modules for the study questionnaires. She functioned as the data collection manager for the Homeless and Transient Population Study (see Chapter 4 of this book), the Drug Use and Pregnancy Study (see Chapter 8), the Current Treatment Client Characteristics Study (see Chapter 7), and the Young Adults Study. She received a B.A. in sociology from the University of Illinois at Urbana.

    Amy A. Vincus, M.P.H., is a research analyst at Research Triangle Institute. Her current research interests and activities include developing instruments to assess the relationships between psychosocial constructs and substance abuse, studying military women's health, and evaluating the effects of community-level substance abuse prevention. She recently coauthored a methodological paper on implementing a lay health adviser program. For DC*MADS, she served as this book's manuscript coordinator. She received a Master of Public Health degree in health behavior and health education in 1995 from the University of North Carolina at Chapel Hill.

    Wendy A. Visscher, M.P.H., Ph.D., is a senior research epidemiologist and the director of the Epidemiology and Medical Studies Program at the Research Triangle Institute. She has a broad range of research experience and is expert in the design and conduct of epidemiologic surveys, case-control studies, and cohort studies. She is experienced with all modes of data collection, including record abstraction, mail surveys, household screening and interviewing, telephone interviewing, biological specimen collection, and clinical interviews and exams. She currently leads several research studies and chairs one of RTI's human subjects committees. For DC*MADS, she was costudy leader for the Drug Use and Pregnancy Study described in Chapter 8 of this book. She has contributed to a variety of health-related studies at RTI. She currently serves as project director for Project DIRECT (Diabetes Intervention Reaching and Educating Communities Together), a community intervention study designed to reduce the risk of diabetes and its complications in African Americans. She also directs the Plastic Surgery Outcomes Study, a patient outcomes study designed to determine psychological and quality of life measures associated with the removal of silicone and saline breast implants. Her other research areas include reproductive outcomes, radiation, cancer, drug abuse, mental health, and HIV/AIDS. She has presented research findings at professional conferences and has been published in the American Journal of Public Health, the Journal of the National Cancer Institute, and Spine. She received her graduate training at the University of Minnesota.

    Sara C. Wheeless, Ph.D., is a senior research statistician at the Research Triangle Institute with more than 17 years of experience in the analysis of data from complex sample surveys. She also has expertise in the design and selection of probability samples and in using Kuhn-Tucker theory for optimum sample allocation and sample size determination. She has directed the statistical analysis on numerous projects involving item imputations using weighted and unweighted hot deck techniques, weight construction using multiplicity and poststratification adjustments, and specification of variable recodes and analysis file construction. She has used or directed the use of SUDAAN, RTI's software for the analysis of data from complex sample surveys, on numerous large data sets for producing descriptive analysis, multivariate modeling using linear and logistic regression, and standardized comparisons. For DC*MADS, Dr. Wheeless was responsible for sample design, weight construction, and analysis for the Current Treatment Client Characteristics Study (see Chapter 7) and was the statistical analyst for the Drug Use and Pregnancy Study (see Chapter 8). In addition, she constructed the weights for combining data from the household, institutionalized, and homeless populations (see Chapter 9) and provided consultation on analyses and codebook development for several other studies within the DC*MADS project. She received her doctorate in statistics from North Carolina State University.


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