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Biomedical subjects

G A Zarkin

Publications and source records attributed to G A Zarkin.

At least 19 recordsLinked to original sources
PubMed2001

The joint demand for cigarettes and marijuana: evidence from the National Household Surveys on Drug Abuse.

Recent studies have shown that efforts to curb youths' alcohol use, such as increasing the price of alcohol or limiting youths' access, have succeeded but may have had the unintended consequence of increasing marijuana use. This possibility is troubling in light of the doubling of teen marijuana use from 1990 to 1997. What impact will recent increases in cigarette prices have on the demand for other substances, such as marijuana? To better understand how the demand for marijuana and tobacco responds to changes in the policies and prices that affect their use, we explore the National Household Survey on Drug Abuse (NHSDA) from 1990 to 1996. We find evidence that both higher fines for marijuana possession and increased probability of arrest decrease the probability that a young adult will use marijuana. We also find that higher cigarette taxes appear to decrease the intensity of marijuana use and may have a modest negative effect on the probability of use among males.

Adolescent↗
PubMed2001

The effect of an enhanced employee assistance program (EAP) intervention on EAP utilization.

OBJECTIVE: An enhanced employee assistance program (EAP) intervention was developed that delivers comprehensive EAP outreach services to all employees who may have alcohol-related and other workplace problems; standard EAP materials traditionally targeted at white men were enhanced to include women and minorities. This study evaluates whether the enhanced EAP intervention increased EAP utilization. METHOD: The enhanced EAP intervention was developed at a large community-based not-for-profit EAP located in Rockford, Illinois. Two primary worksites and 16 other newly contracted worksites received the enhanced EAP intervention and served as intervention sites; the 107 other worksites serviced by the EAP were used as comparison sites. We used time series data from 1991 to 1998 and included repeated measures on each firm's quarterly EAP utilization. RESULTS: The enhanced EAP intervention increased the mean number of women and minority cases per worksite by 58%, white male cases by 45% and total EAP cases by 53%. CONCLUSIONS: This study shows that, for a modest cost, the enhanced EAP intervention successfully increased utilization of EAP by all employees, especially utilization by women and minority employees. It also shows that traditional EAP services and outreach materials can be made more appealing to women and minorities without adversely affecting their utilization by white men.

Alcoholism↗
PubMed2001

The cost and cost-effectiveness of an enhanced intervention for people with substance abuse problems at risk for HIV.

OBJECTIVE: To estimate the costs, effectiveness, and cost-effectiveness of prevention interventions for out-of-treatment substance abusers at risk for HIV. This is the first cost-effectiveness study of an AIDS intervention that focuses on drug use as an outcome. STUDY DESIGN: We examined data from the North Carolina Cooperative Agreement site (NC CoOp). All individuals in the study were given the revised NIDA standard intervention and randomly assigned to either a longer, more personalized enhanced intervention or no additional intervention. We estimated the cost of each intervention and, using simple means analysis and multiple regression models, estimated the incremental effectiveness of the enhanced intervention relative to the standard intervention. Finally, we computed cost-effectiveness ratios for several drug use outcomes and compared them to a "back-of-the-envelope" estimate of the benefit of reducing drug use. PRINCIPAL FINDINGS: The estimated cost of implementing the standard intervention is $187.52, and the additional cost of the enhanced intervention is $124.17. Cost-effectiveness ratios range from $35.68 to $139.52 per reduced day of drug use, which are less than an estimate of the benefit per reduced drug day. CONCLUSIONS: The additional cost of implementing the enhanced intervention is relatively small and compares favorably to a rough estimate of the benefits of reduced days of drug use. Thus, the enhanced intervention should be considered an important additional component of an AIDS prevention strategy for out-of-treatment substance abusers.

AIDS Serodiagnosis↗
PubMed2000

The relationship between marijuana initiation and dropping out of high school.

The prevalence of marijuana use among young people has risen rapidly in recent years, causing concern over the potential impact on academic performance of such use. While recent studies have examined the effect of alcohol use on educational attainment, they have largely ignored the potential negative effects of other substances, such as marijuana. This paper examines whether the relationship between the initiation of marijuana use and the decision to drop out of high school varies with the age of dropout or with multiple substance use. Data are from a longitudinal survey of 1392 adolescents aged 16-18 years. The results suggest that marijuana initiation is positively related to dropping out of high school. Although the magnitude and significance of this relationship varies with age of dropout and with other substances used, it is concluded that the effect of marijuana initiation on the probability of subsequent high school dropout is relatively stable, with marijuana users' odds of dropping out being about 2.3 times that of non-users. Implications of these conclusions are considered for both policy makers and researchers.

Adolescent↗
PubMed2000

Are QALYs an appropriate measure for valuing morbidity in acute diseases?

In this paper, we examine the problems associated with using quality adjusted life years (QALYs) as the measure of effectiveness to evaluate interventions for acute conditions. We illustrate the way in which using commonly accepted benchmarks for costs per QALY, in order to adopt interventions for acute conditions, might result in decisions that are not consistent with maximizing net societal benefit. We suggest that an alternate methodology, such as willingness to pay, may be more appropriate to make allocation decisions for acute conditions.

Acute Disease↗
PubMed2000

Estimating the willingness to pay for drug abuse treatment: a pilot study.

Previous economic studies of the benefits of drug treatment have limited their estimation to tangible benefits, and thus have underestimated the benefits of drug treatment. The willingness-to-pay (WTP) approach is a more encompassing benefit valuation method that captures both tangible and intangible benefits and accords with valuation concepts used by economists. In this study, we report the results of a pilot study in which we used the contingent valuation (CV) method to value drug treatment. We conducted mall intercept surveys in two communities: the Triad area in North Carolina and Brooklyn, New York. We estimated WTP models for two different drug treatment programs: a program for all drug users and a program specifically targeted to women drug users. We modeled respondents' WTP for drug treatment as a function of their demographics and to responses from attitudinal/experience questions. The mean WTP for both types of drug treatment programs was estimated to be approximately $37 per respondent. Finally, we demonstrated how the results of the CV method may be used in a benefit-cost analysis of drug treatment.

Adult↗
PubMed2000

Symptoms of dependence, multiple substance use, and labor market outcomes.

The prevalence and costs of alcohol and drug disorders pose a serious social concern for policymakers. In this paper, we use data from the National Household Surveys on Drug Abuse (NHSDA) to estimate simple descriptive statistics and analysis of variance (ANOVA) models of the relationship between symptoms of dependence and labor market outcomes for alcohol, cigarettes, marijuana, and other illicit drugs. For men, we find that substance use with symptoms of dependence is associated with both lower employment rates and fewer hours of work. For women, we find that substance use with symptoms of dependence is associated with lower employment rates, but we find no consistent evidence of a relationship between symptoms of dependence and the number of hours worked. Finally, all of our point estimates are smaller in magnitude when we control for multiple substance use, suggesting that comorbidities play a critical role in the relationship between substance use and labor market outcomes. Our results suggest that policymakers and researchers should consider the full spectrum of substance use and dependence rather than focusing on the simple use of a single substance.

Adolescent↗
PubMed2000

The effect of Employee Assistance Programs use on healthcare utilization.

OBJECTIVE: To estimate the effect of Employee Assistance Program (EAP) use on healthcare utilization as measured by health claims. DATA SOURCES: A unique data set that combines individual-level information on EAP utilization, demographic information, and health insurance claims from 1991 to 1995 for all employees of a large midwestern employer. STUDY DESIGN: Using "fixed-effect" econometric models that control for unobserved differences between individuals' propensities to use healthcare resources and the EAP, we perform our analyses in two steps. First, for those employees who visited the EAP, we test whether post-EAP claims differ from pre-EAP claims. Second, we combine claims data of individuals who went to an EAP with those of individuals who did not use an EAP to test whether differences in utilization exist between EAP users and nonusers. DATA COLLECTION METHODS: From the EAP we obtained the date of first EAP contact for all employees who used the service, and from the company's human resources department we obtained limited demographic data on all employees. We obtained healthcare utilization claims data on all employees and their dependents from the company's two healthcare plans: a fee-for-service (FFS) plan and a health maintenance organization (HMO) plan. PRINCIPAL FINDINGS: We found that going to an EAP substantially increases both the probability of an alcohol, drug abuse, or mental health (ADM) claim and the number of ADM claims in the same quarter as EAP contact. The increased probability of an ADM claim persists for approximately 11 quarters after the initial contact, while the increased ADM charges persist for approximately six quarters after the initial EAP contact. CONCLUSIONS: Our results strongly suggest that the EAP is able to identify behavioral and other health problems that may affect workplace performance and prompt EAP users to access ADM and other healthcare. Consistent with the stated goals of many EAPs, including the one examined in this study, this process should improve individuals' health, family functioning, and workplace performance.

Alcoholism↗
PubMed1999

Cost of employee assistance programs: comparison of national estimates from 1993 and 1995.

The cost and financing of mental health services is gaining increasing importance with the spread of managed care and cost-cutting measures throughout the health care system. The delivery of mental health services through structured employee assistance programs (EAPs) could be undermined by revised health insurance contracts and cutbacks in employer-provided benefits at the workplace. This study uses two recently completed national surveys of EAPs to estimate the costs of providing EAP services during 1993 and 1995. EAP costs are determined by program type, worksite size, industry, and region. In addition, information on program services is reported to determine the most common types and categories of services and whether service delivery changes have occurred between 1993 and 1995. The results of this study will be useful to EAP managers, mental health administrators, and mental health services researchers who are interested in the delivery and costs of EAP services.

Cost Control↗
PubMed1999

Are health states "timeless"? The case of the standard gamble method.

The standard gamble method, as currently recommended for use in health care program evaluation, provides an individual's preference score or "utility weight" for living in a given health state for the rest of the individual's life. Many researchers interpret this value as a time-independent or "timeless" one and order health states on a scale of zero (death) to one (full health), regardless of the time spent in the health state. This article examines whether preference scores for a severe pain health state are "timeless," or in other words whether the utility independence assumption is satisfied. Our study results suggest that for the majority of respondents, the preference scores are not independent of time.

Aged↗
PubMed1998

The differential effects of alcohol consumption and dependence on adverse alcohol-related consequences: implications for the workforce.

Previous literature has supported the hypothesis that high rates of alcohol consumption are associated with adverse social consequences and that dependence on alcohol has an effect on that relationship. The purpose of this paper is to further specify the alcohol consumption-adverse consequences linkage by developing and estimating a latent variable model that incorporates the mediating effects of loss of control over alcohol consumption. This model is applied to measures for three alcohol-related constructs--consumption, loss of control and adverse consequences--incorporated in the 1991 National Household Survey on Drug Abuse, for members of the primary workforce in the US. The research suggests that workplace decision makers attempting to minimize the adverse workplace consequences of alcohol abuse should implement procedures that assess and respond to alcohol dependency rather than relying exclusively on detection of and intervention with alcohol consumption per se.

Adult↗
PubMed1998

Alcohol use and wages: new results from the National Household Survey on Drug Abuse.

A recent study published in the Journal of Health Economics by French and Zarkin [French, M.T., Zarkin, G.A., 1995. Is moderate alcohol use related to wages? Evidence from four worksites, Journal of Health Economics 14, 319-344] found evidence of a positive, inverse-U-shaped relationship between wages and alcohol consumption for individuals at four worksites. In this paper, we attempted to replicate French and Zarkin's findings using a combined sample of prime-age workers from the 1991 and 1992 National Household Surveys on Drug Abuse (NHSDA). Whereas French and Zarkin found that individuals who consume approximately 1.5 to 2.5 drinks per day have higher wages than non-drinkers and heavy drinkers, we found no evidence of a turning point at this consumption level for either men or women. Our results do suggest that men who use alcohol have approximately 7% higher wages than men who do not drink, and this apparent wage premium is approximately the same over a wide range of alcohol consumption. For women, the estimated alcohol use premium is approximately half as large as for men and is statistically insignificant.

Adult↗
PubMed1998

Valuing outcomes in health care: a comparison of willingness to pay and quality-adjusted life-years.

Quality-adjusted life-years (QALYs) and willingness to pay (WTP) are two preference-based measures of health-related outcomes. In this article, we compare these two measures in eliciting individuals' preferences for health outcomes associated with shingles. To collect the necessary preference data, we administered computer-interactive interviews to a sample of 65- to 70-year-olds. We found no significant correlation between QALYs and WTP across individuals. We discuss our findings and argue that our results raise questions about whether QALYs and WTP are equivalent preference-based measures of health outcomes.

Aged↗
PubMed1997

The cost-effectiveness of ibutilide versus electrical cardioversion in the conversion of atrial fibrillation and flutter to normal rhythm.

Atrial fibrillation and atrial flutter are cardiac rhythm disorders that are often symptomatic and may interfere with the heart's function, limiting its effectiveness. These arrhythmias are responsible for a large number of hospitalizations at a significant cost to the healthcare system. Electrical cardioversion (EC) is the most common nonpharmacologic intervention used to convert atrial fibrillation and atrial flutter to normal rhythm. Electrical cardioversion is highly successful in converting patients to normal rhythm; however, it is more traumatic and resource intensive than pharmacologic treatment. Recently, a new rapid-acting drug, ibutilide, was approved for the conversion of atrial fibrillation and atrial flutter. Ibutilide is administered through intravenous infusion and does not require anesthetization of the patient, as is required for EC. A decision-tree model was developed to estimate the cost-effectiveness of ibutilide therapy compared with EC therapy. Clinical outcomes were based on a phase III trial of ibutilide, and resource use was based on the literature and physician clinical judgment. A stepped conversion regimen of first-line ibutilide followed by EC for patients who fail to convert is less expensive and has a higher conversion rate than first-line EC. Sensitivity analysis shows that our results are robust to changes in cost and effectiveness estimates.

Anti-Arrhythmia Agents↗
PubMed1996

Latent variable models of alcohol-related constructs.

This study examines the improvement in validity coefficients and structural relationships derived from formally modeling latent variables of adverse alcohol-related constructs. Results of a confirmatory factor analysis of responses from 8,755 participants in the 1988 National Household Survey of Drug Abuse support a three-factor model of alcohol abuse, dependence, and adverse consequences. A comparison of construct intercorrelations shows latent variables to be superior to measurement approaches using unweighted sums, quantity x frequency calculation, and single-item measurement.

Adolescent↗
PubMed1996

Analysis of prevention program effectiveness with clustered data using generalized estimating equations.

Experimental studies of prevention programs often randomize clusters of individuals rather than individuals to treatment conditions. When the correlation among individuals within clusters is not accounted for in statistical analysis, the standard errors are biased, potentially resulting in misleading conclusions about the significance of treatment effects. This study demonstrates the generalized estimating equations (GEE) method, focusing specifically on the GEE-independent method, to control for within-cluster correlation in regression models with either continuous or binary outcomes. The GEE-independent method yields consistent and robust variance estimates. Data from project DARE, a youth substance abuse prevention program, are used for illustration.

Adolescent↗
PubMed1996

Aiding troubled employees: the prevalence, cost, and characteristics of employee assistance programs in the United States.

OBJECTIVES: Employee assistance programs (EAPs) are job-based programs designed to identify and assist troubled employees. This study determines the prevalence, cost, and characteristics of these programs in the United States by worksite size, industry, and census region. METHODS: A stratified national probability sample of more than 6400 private, nonagricultural US worksites with 50 or more full-time employees was contacted with a computer-assisted telephone interviewing protocol. More than 3200 worksites responded and were eligible, with a response rate of 90%. RESULTS: Approximately 33% of all private, nonagricultural worksites with 50 or more full-time employees currently offer EAP services to their employees, an 8.9% increase over 1985. These programs are more likely to be found in larger worksites and in the communications/utilities/transportation industries. The most popular model is an external provider, and the median annual cost per eligible employee for internal and external programs was $21.83 and $18.09, respectively. CONCLUSIONS: EAPs are becoming a more prevalent point of access to health care for workers with personal problems such as substance abuse, family problems, or emotional distress.

Adult↗