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Monthly updates to Congress on RAND's work in health policy


Substance Use Among Middle-Schoolers: Understanding Racial and Ethnic Variation

young girl with cigarette and wineglass

Hispanic middle school students may be more likely to smoke tobacco, drink alcohol, or use marijuana than their peers from other ethnic groups, while Asian students may be least likely, according to a recent RAND study. A team of RAND researchers led by Elizabeth D'Amico and Regina Shih gathered data from 5,500 seventh- and eighth-graders at 16 California middle schools. The team found that, overall, 22 percent of students interviewed reported ever using alcohol, 10 percent reported using tobacco, and 7 percent reported marijuana use. For each substance, the odds of substance use were highest among Hispanic students and lowest among Asians, whereas Caucasian and African American students fell somewhere in between.

The RAND team wanted to understand these ethnic differences and so they further examined personal, family and school factors that may influence the middle schoolers' likelihood of substance use. They found that these factors also varied by race and ethnicity. Among Hispanic youth, personal factors were linked to risk of substance use—including youths' lack of confidence in their ability to resist peer pressure and beliefs that substance use had fewer negative consequences. In contrast, Asian youths' relatively low rates of substance use were explained by personal, family, and school factors. Asian youths who felt more confident in their ability to resist peer pressure, who expressed respect for their parents, and who perceived lower rates of substance use among their school peers were less likely to report substance use.

The findings point to important issues that could be addressed in school substance-use prevention programs. For example, interventions could improve youths' ability to resist peer pressure, which might be especially valuable for Hispanic youths. Interventions can also encourage positive parent-child communication and boost kids' sense of responsibility to their parents, which might help maintain Asian youths' lower rates of substance use. The researchers caution that they are not suggesting that such targeted efforts be offered only to students of certain ethnicities, but that such efforts should be widely applied in prevention programs to help the broadest range of youth possible.

READ THE RESEARCH BRIEF: The Influence of Personal, Family, and School Factors on Early Adolescent Substance Use

Which Physician Characteristics Predict Quality of Care?

female doctor

In choosing a doctor, Americans are often encouraged to select based on publicly available information, such as a doctor's board certification, educational background, or history of paying malpractice claims. But do these characteristics identify physicians who deliver the highest quality care? A team of researchers from RAND and the University of Pittsburgh studied the relationship between physician characteristics and quality of care. They examined the care delivered by about 10,000 Massachusetts physicians to more than 1.3 million adults during 2004 and 2005. Using data from insurance claims, researchers evaluated the quality of care provided for 22 common medical problems such as diabetes and heart disease.

Researchers found that the physicians studied provided on average about 63 percent of recommended care. Average performance varied by condition, ranging from 31 percent for cataract care to 68 percent for care of congestive heart failure. Only three physician characteristics were associated with better quality: being female, being board certified, and graduating from a medical school in the United States. Furthermore, the difference in quality between the average physician with the best combination of characteristics (female, board-certified, domestically educated) and the average physician with the worst combination (male, noncertified and internationally educated) was small: only 6 percentage points. Even among physicians with the best combination of characteristics, quality was uneven, ranging from 49 to 75 percent of recommended care. Strikingly, the analysis found that a physician's past payment of malpractice claims was not significantly related to quality.

These findings provide little evidence to suggest that a patient would consistently receive higher quality care by switching to a physician with the combination of characteristics identified as associated with high-quality care. The researchers conclude that the public would benefit from access to better data on physician performance.

READ MORE: Information Patients Use to Choose Physicians Not Always Good Predictors of Quality


Elizabeth D'Amico

Elizabeth D'Amico

Elizabeth D'Amico is a senior behavioral scientist at RAND and a licensed clinical psychologist. She is nationally recognized for her work developing, implementing, and evaluating interventions for adolescents that target alcohol and drug use. She currently has three studies in the field that evaluate interventions with youth and two that evaluate interventions with young adults.

Read more about Elizabeth D'Amico »

Regina Shih

Regina Shih

Regina Shih is a psychiatric epidemiologist at RAND. Shih's research focuses on the social and environmental determinants of mental disorders, substance use, cognitive dysfunction, and cardiovascular disease. Her research also seeks to clarify the causal pathways underlying racial/ethnic disparities in physical and mental health outcomes. She has previously published on the health effects of environmental exposure to lead, ambient air pollution, neighborhood socioeconomic status and neighborhood racial/ethnic segregation.

Read more about Regina Shih »


Lindsey Kozberg
Vice President, Office of External Affairs

Shirley Ruhe
Director, Office of Congressional Relations

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