,
2019
Regional Needs Assessment 2019
EPIDEMIOLOGICAL PROFILE, YOUTH SUBSTANCE USE AND MISUSE TRENDS, AND PREVENTION EFFORTS IN THE TEXAS GULF COAST REGION PREVENTION RESOURCE CENTER: REGION 6
Physical: 303 Jackson Hill St. www.councilonrecovery.org Main: 713-942-4100 Houston, TX 77007 www.prc6.org Fax: 713-526-8257 Mail: PO Box 2768 Toll-Free: 1-888-655-3328 Houston, TX 77252
PRC 6 RNA 2018
Table of Contents Executive Summary ...... v Key findings: ...... v Prevention Resource Centers ...... vii Our Purpose ...... vii How We Help the Community ...... viii Conceptual Framework...... ix Adolescence ...... ix Epidemiology ...... ix Socio-Ecological Model ...... ix Risk and Protective Factors ...... x Consumption Patterns ...... xii Consequences ...... xii Audience ...... xiii Introduction...... 1 Methodology ...... 3 Regional Profile and Demographics ...... 5 Population ...... 6 Age...... 6 Race, Ethnicity and Concentrations of Populations ...... 4 Limited English Proficiency ...... 7 Risk Factors ...... 9 Society Domain ...... 9 Per Capita Income ...... 10 Employment ...... 12 Household Composition ...... 13 Temporary Assistance for Needy Families (TANF) Recipients ...... 13 Supplemental Nutrition Assistance Program (SNAP) Recipients ...... 13 Children eligible for Free and Reduced Cost Lunch ...... 13 Uninsured Children ...... 14 Catastrophic Events: Hurricane Harvey ...... 24 Community Domain ...... 24
P a g e i | 157
PRC 6 RNA 2018
Child Homelessness ...... 24 Criminal Activity ...... 27 Drug Seizures and Drug Trafficking ...... 34 Availability ...... 36 School Domain ...... 38 Dropout Rates ...... 38 School Discipline and Alcohol and Drugs on School Property ...... 38 Family Domain ...... 45 Parental Approval of Consumption ...... 45 Peer Domain ...... 48 Cultural Norm and Youth Perceptions of Peer Consumption ...... 48 Perceived Access to Alcohol, Tobacco, Marijuana, and Prescription Drugs ...... 51 Social Hosting and Parties ...... 52 Individual Domain ...... 57 Mental Health ...... 57 Regional Consumption Patterns in Youth and Young Adults ...... 60 Alcohol ...... 60 Age of Initiation and Early Initiation ...... 60 Current use, Lifetime Use, and Current High-risk Use...... 61 Tobacco ...... 64 Age of Initiation and Early Initiation ...... 64 Current Use and Lifetime Use ...... 65 Marijuana ...... 67 Current Use, Lifetime Use, and Current High-risk Use ...... 68 Prescription Drugs ...... 71 Current Use and Lifetime Use ...... 71 College Student Consumption ...... 72 Special Topic: Opioids ...... 73 Consequences ...... 76 Mortality ...... 76 Overdose Deaths ...... 76 Drug and Alcohol Related Fatalities ...... 77
P a g e ii | 157
PRC 6 RNA 2018
Legal ...... 78 Substance Use, Driving Under the Influence, and Criminal Charges ...... 78 Hospitalization and Treatment ...... 83 Hospital Use Due to AOD ...... 83 Emergency Room Admissions due to Alcohol and Other Drugs ...... 85 Environmental Protective Factors ...... 86 Society Domain ...... 86 Counteradvertising ...... 87 Influencing Community Norms ...... 87 Community Domain ...... 94 Social Associations ...... 94 Community Partners and Community Coalitions ...... 95 Treatment/Intervention Providers ...... 96 School Domain ...... 96 Youth Prevention Programs ...... 96 Alcohol, Tobacco, and Other Drugs Education in School ...... 97 Alternative Peer Groups and Recovery High Schools ...... 98 Adolescent Recovery Oriented Systems of Care ...... 98 High School Completion and Graduation Rates ...... 99 Family Domain ...... 99 Communication between Parent and Child Regarding Alcohol, Tobacco, and other Drugs ...... 99 Parental Attitudes toward Alcohol and Drug Consumption ...... 101 Peer Domain ...... 104 Perception of Peer Consumption versus Actual Peer Consumption ...... 104 Individual Domain ...... 106 Life Skills Learned in Youth Prevention Programs ...... 106 Youth Perception of Risk and Harm of Alcohol, Tobacco, Marijuana, and Prescription Drugs ..... 106 Trends of Declining Substance Use ...... 108 Alcohol Statewide Longitudinal Trends ...... 108 Tobacco Statewide Longitudinal Trends ...... 109 Marijuana Statewide Longitudinal Trends ...... 110 Prescription Drugs Statewide Longitudinal Trends ...... 111
P a g e iii | 157
PRC 6 RNA 2018
Illicit Drugs Longitudinal Statewide Trends ...... 112 Region in Focus ...... 113 Gaps in Services ...... 113 Gaps in Data ...... 114 Appendix A ...... 118 References ...... 118 Appendix B ...... 124 Glossary of Terms ...... 124 Appendix c ...... 128 Texas Department of Public Safety, Houston Police Department Drug Seizures, June 2018-June 2019 ...... 128 Appendix D ...... 129 2019 PDMP Update ...... 129 Appendix E ...... 131 SAMHSA Behavioral Health Treatment Services Locator ...... 131 Appendix F ...... 134 HHSC-Funded Prevention Programs, Region 6, Fiscal Year 2019 ...... 134 Appendix G ...... 138 Suggested Citation ...... 138
P a g e iv | 157
PRC 6 RNA 2018
Executive Summary The Regional Needs Assessment (RNA) is a document created by the Prevention Resource Center (PRC) in Region 6 along with Evaluators from PRCs across the state of Texas and supported by The Council on Recovery and the Texas Health and Human Resources Commission (HHSC). The PRC 6 serves 13 counties in the Texas Gulf Coast Region.
This RNA was designed to aid PRCs, HHSC, and community stakeholders in long-term strategic prevention planning based on most current information relative to the unique needs of the diverse communities in the state of Texas. This document will present demographics, summaries of statistics, and prevalence rates relevant to risk and protective factors associated with substance use and misuse, as well as consumption patterns and consequences data. This RNA will also provide insight related to gaps in services and data availability challenges.
A team of regional evaluators has procured national, state, regional, and local data through partnerships and collaboration with diverse agencies in sectors such as law enforcement, public health, and education, among others. The data obtained through these partnerships have been synthesized and compiled into this comprehensive reference source. PRC 6 staff members recognize those collaborators who contributed to the creation of this RNA. Key findings: 1. As predicted, there were some indicators that showed the impact of Hurricane Harvey on Region 6 Gulf coast counties and this definitely deserves some discussion, here. The trends for indicators in the Society Domain section of Environmental Risk Factors in this needs assessment, particularly those that provide information on levels of dependence on public assistance, homelessness, and violent crime rates, which are conditions one might assume to typically follow such a catastrophic event. The data for the Supplemental Nutrition Assistance Program (SNAP) show a distinct increase for Region 6, overall, for calendar year 2017, with what seems to be a return to pre-Harvey levels, even back down to 2015 levels for 2018. It could also be possible that this kind of drop in number of SNAP recipients in 2018 is associated with the child homelessness or displacement issues that many residents faced, and continue to face, after Hurricane Harvey hit. The child homelessneness data begins to show the kind of impact Harvey had on individuals experiencing homelessness. Although there are only three data points for each county in Region 6 (data sets from Texas Education Agency, that include child homelessness data, only go as far back to the 2016-2017 school year), the data shows that homelessness rates more than doubled and even tripled for many counties, especially many of the coastal counties, in Region 6 during the school year that Harvey hit, compared to the previous year. Subsequently, many of the child homelessness rates seemingly returned to pre-Harvey rates for the 2018-2019 school year. In addition to coastal counties, Liberty County, positioned near the mouth of the Liberty River and experienced record rainfall during Harvey, appears to have experienced significant increases in several indicators, as well.
2. Region 6 currently has eight substance use prevention coalitions, all concentrated in coastal counties, which are definitely warranted. However, it seems that it is time to make a more
P a g e v | 157
PRC 6 RNA 2018
concerted effort in directing attention regarding substance use prevention out toward those non-coastal counties that seem to be suffering, especially where indicators of risk factors are concerned. Particularly notable during compilation of the current RNA, Liberty County seems to be in need of strong prevention efforts. As there are no state-funded community prevention coalitions in Liberty County, nor are there any state-funded Youth Prevention Programs in Liberty County, perhaps the community readiness for ushering both types of prevention of prevention efforts into the county is now at a level where successful implementation is a strong possibility. This is particularly important as the substance use treatment, mental health, health care center, and buprenorphine provider services (one provider of each in this county) are almost non-existent in this county.
3. Vaping and marijuana consumption continue to demand attention of prevention providers, as the data presented, here, along with the societal and cultural influences arising from the legalization of marijuana are, probably here to stay. The results of focus groups with adults and youth invoke concern regarding the increase in vaping, the ease with which vaping paraphernalia can be obtained (even in the mail) and concealed , and the use of vape pens to smoke marijuana concentrates in them with a pleasantly scent or no odor at all. Houston HIDTA found in their annual Drug Threat Assessment that vaping is showing a significant upward surge in adolescents, a finding that resonated with adolescent substance use professionals who participated in the aforementioned adult groups conducted by the PRC 6. HIDTA also reports that marijuana is the most trafficked and most frequently seized illicit drugs in Texas. Influence of increased marijuana availability, along with slight decrease on perception of harm measures, the threat of marijuana for teens is seen as marijuana concentrates (wax and oil) and high-grade/hydroponic marijuana are the top two emerging trends. Edibles incorporating the high doses of THC are being produced as candy and baked goods and poses yet another trend of which providers need to be aware, as youth have been found to consume such products in alarming quantities, and alarming because the high THC potencies in these products are causing individuals to overdose and require medical attention.
P a g e vi | 157
PRC 6 RNA 2018
Prevention Resource Centers Our Purpose Prevention Resource Centers (PRC) are a program funded by the Texas Health and Human Services Commission (HHSC) to provide data and information related to substance use and misuse prevention, and to support prevention collaboration efforts in the community. There is one PRC located in each of the eleven Texas Health Service Regions (see Figure 1) to provide support to prevention providers located in their region with substance use data, trainings, media activities, and regional workgroups. PRCs have four fundamental objectives related to the services they provide to partner agencies and the community in general: (1) collect data relevant to alcohol, tobacco, and other drug use among adolescents and adults and share findings with community partners (2) ensure sustainability of a Regional Epidemiological Workgroup focused on identifying strategies related to data collection, gaps in data, and prevention needs, (3) coordinate regional prevention trainings and conduct media awareness activities related to risks and consequences of ATOD use, and (4) conduct voluntary compliance checks and education on state tobacco laws to retailers.
Efforts carried out by PRCs are focused on the state’s three prevention priorities of underage drinking, use of marijuana and other cannabinoids, and prescription drug misuse.
Figure 1. Current areas serviced by Prevention Resource Centers in Texas
Region 1 Panhandle and South Plains Region 2 Northwest Texas Region 3 Dallas/Fort Worth Metroplex Region 4 Upper East Texas Region 5 Southeast Texas Region 6 Gulf Coast Region 7 Central Texas Region 8 Upper South Texas Region 9 West Texas Region 10 Upper Rio Grande Region 11 Rio Grande Valley/Lower South Texas
Regional PRCs are tasked with compiling and synthesizing data and disseminating findings to the community. Data collection strategies are organized around risk and protective factors, consumption data, and related consequences associated with substance use and misuse. PRCs engage in building collaborative partnerships with key community members who aid in securing access to information.
P a g e vii | 157
PRC 6 RNA 2018
How We Help the Community PRCs provide technical assistance and consultation to providers, community groups, and other stakeholders in identifying data and data resources related to substance use or other behavioral health indicators. PRCs work to promote and educate the community on substance use and misuse and associated consequences through various data products, media awareness activities, and an annual regional needs assessment. These resources and information provide stakeholders with knowledge and understanding of the local populations they serve, help guide programmatic decision making, and provide community awareness and education related to substance use and misuse. Additionally, the program provides a way to identify community strengths as well as gaps in services and areas of improvement.
P a g e viii | 157
PRC 6 RNA 2018
Conceptual Framework As one reads through this needs assessment, two guiding concepts will appear throughout the report: a focus on the youth population and the use of an empirical approach from a public health framework. For the purpose of strategic prevention planning related to drug and alcohol use among youth populations, this report is based on three main aspects: risk and protective factors, consumption patterns, and consequences of substance misuse and substance use disorders (SUDs). Adolescence The World Health Organization (WHO) identifies adolescence as a critical transition in the life span characterized by tremendous growth and change, second only to infancy. This period of mental and physical development poses a critical point of vulnerability where the use and misuse of substances, or other risky behaviors, can have long-lasting negative effects on future health and well-being. This focus of prevention efforts on adolescence is particularly important since about 90 percent of adults who are clinically diagnosed with SUDs, began misusing substances before the age of 18.
The information presented in this document is compiled from multiple data sources and will therefore consist of varying demographic subsets of age which generally define adolescence as ages 10 through 17-19. Some domains of youth data conclude with ages 17, 18 or 19, while others combine “adolescent” and “young adult” to conclude with age 21. Epidemiology The WHO describes epidemiology as the “study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems.” This definition provides the theoretical framework through which this assessment discusses the overall impact of substance use and misuse. Through this lens, epidemiology frames substance use and misuse as a preventable and treatable public health concern. The Substance Abuse and Mental Health Services Administration (SAMHSA) establishes epidemiology to identify and analyze community patterns of substance misuse as well as the contributing factors influencing this behavior. SAMHSA adopted an epidemiology-based framework on a national level while this needs assessment establishes this framework on a regional level. Socio-Ecological Model The Socio-Ecological Model (SEM) is a conceptual framework developed to better understand the multidimensional factors that influence health behavior and to categorize health intervention strategies.1 Intrapersonal factors are the internal characteristics of the individual of focus and include knowledge, skills, attitudes, and beliefs. Interpersonal factors include social norms and interactions with significant others, such as family, friends, and teachers. Organizational/institutional factors are social and physical factors that indirectly impact the individual of focus (e.g., zero tolerance school policies, classroom size, mandatory workplace drug testing). Finally, community/societal factors include neighborhood connectedness, collaboration between organizations, and policy.
1 McLeroy, KR, Bibeau, D, Steckler, A, Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education & Behavior, 15(4), 351-377.
P a g e ix | 157
PRC 6 RNA 2018
The SEM proposes that behavior is impacted by all levels of influence, from the intrapersonal to the societal, and that the effectiveness of health promotion programs is significantly enhanced through the coordination of interventions targeting multiple levels. For example, changes at the community level will create change in individuals and support of individuals in the population is essential for implementing environmental change. Risk and Protective Factors Researchers have examined the characteristics of effective prevention programs for more than 20 years. One component shared by effective programs is a focus on risk and protective factors that influence substance misuse among adolescents. Protective factors are characteristics that decrease an individual’s risk for a substance use disorder. Examples may include factors such as strong and positive family bonds, parental monitoring of children's activities, and access to mentoring. Risk factors are characteristics that increase the likelihood of substance use behaviors. Examples may include unstable home environments, parental use of alcohol or drugs, parental mental illnesses, poverty levels, and failure in school performance. The complicated nature of studying and addressing SUD prevention has yielded an involved model. Figures 2 and 3 features an adaptation from the chapter on prevention from the 2016 Oxford Handbook on Substance Use and Substance Use Disorders (2016) and includes risk factors and protective factors organized among the six domains of individual, peer, family, school, community, and society.2 This framework will serve as a guide for organizing and discussing risk factors and protective factors in this RNA.
Figure 2. Socio-ecological model for alcohol and other drug use
2 D’Amico, EJ, Chan Osilla, K, Stern, SA. Prevention and Intervention in the School Setting. In Sher, KJ, ed. The Oxford Handbook of Substance Use and Substance Use Disorders, Volume 2. New York, NY: Oxford University Press; 2016: 675-723.
P a g e x | 157
Figure 3. Socio-ecological model for alcohol and other drug use with examples of risk and protective factors
Adapted from: D’Amico, EJ, Osilla, KC. Prevention and intervention in the school setting. In: KJ Sher ed. The Oxford Handbook of Substance Use and Substance Use Disorders. Vol. 2.New York, NY: Oxford University Press; 2016:678.
Consumption Patterns For the purpose of this needs assessment, and in following with operational definitions typically included in widely used measures of substance consumption, such as the Texas School Survey of Drug and Alcohol Use (TSS) , the Texas Youth Risk Surveillance System (YRBSS) , and the National Survey on Drug Use and Health (NSDUH) , consumption patterns are generally operationalized into three categories: lifetime use (ever tried a substance, even once), school year use (past year use when surveying adults or youth outside of a school setting), and current use (use within the past 30 days). These three categories of consumption patterns are used in the TSS to elicit self-reports from adolescents on their use and misuse of tobacco, alcohol (underage drinking), marijuana, prescription drugs, and illicit drugs. The TSS, in turn, is used as the primary outcome measure in reporting on Texas youth substance use and misuse in this needs assessment.
Due to its overarching and historical hold on the United States, there exists a plethora of information on the evaluation of risk factors that contribute to Alcohol Use Disorder (AUD). According to SAMHSA, AUD is ranked as the most wide-reaching SUD in the United States, for people ages 12 and older, followed by Tobacco Use Disorder, Cannabis Use Disorder, Stimulant Use Disorder, Hallucinogen Use Disorder, and Opioid Use Disorder (presented in descending order by prevalence rates). When evaluating alcohol consumption patterns in adolescents, more descriptive information beyond the aforementioned three general consumption categories is often desired and can be tapped by adding specific quantifiers (i.e., per capita sales, frequency and trends of consumption, and definitions of binge drinking and heavy drinking), and qualifiers (i.e., consequential behaviors, drinking and driving, alcohol consumption during pregnancy) to the operationalization process. For example, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has created very specific guidelines that are widely used in the in quantitative measurement of alcohol consumption. These standards define binge drinking as the drinking behaviors that raise an individual’s Blood Alcohol Concentration (BAC) up to or above the level of .08gm%, which is typically five or more drinks for men and four or more drinks for women, within a two-hour time span. At-risk or heavy drinking, is defined as more than four drinks a day or 14 drinks per week for men and more than three drinks a day or seven drinks per week for women. “Benders” are considered two or more days of sustained heavy drinking. See Figure 4 for the NIAAA’s operational definitions of the standard drink. Consequences One of the hallmarks of SUDs is the continued use of a substance despite harmful or negative consequences. The types of consequences most commonly associated with SUDs, the most severe of SUDs being addiction, typically fall under the categories of health consequences, physical consequences, social consequences, and consequences for adolescents. The prevention of such consequences has received priority attention as Goal 2 (out of four goals) on the 2016-2020 NIDA Strategic Plan titled Develop new and improved strategies to prevent drug use and its consequences.
The consequences associated with SUDs tend to be developmentally, culturally, and contextually dependent and the measurement and conceptualization of such associations has proven to be quite difficult for various reasons, including the fact that consequences are not always caused or worsened by substance use or misuse. Therefore, caution should be taken in the interpretation of the data presented in this needs assessment. Caution in inferring relationships or direction of causality should be taken, also,
PRC 6 RNA 2018
because only secondary data is reported out and no sophisticated analytic procedures are involved once that secondary data is obtained by the PRCs and reported out in this needs assessment, which is intended to be used as a resource.
Figure 4. NIAAA (2004) rubric for operationalizing the standard drink by ounces and percent alcohol across beverage type3
Audience Potential consumers of this RNA include stakeholders from a variety of disciplines: substance use prevention and treatment providers; medical providers; school districts and higher education; substance use prevention community coalitions; city, county, and state leaders; and community members interested in increasing their knowledge of public health factors related to drug consumption. The information presented in this report aims to contribute to program planning, evidence-based decision making, and community education.
The executive summary found at the beginning of this report will provide highlights of the report for those seeking a brief overview. Since readers of this report will come from a variety of professional fields, each yielding specialized genres of professional terms and concepts related to substance use and misuse prevention, a glossary of key concepts can be found in Appendix B of this RNA, following Appendix A, which is the reference section. The core of the RNA focuses on risk factors, consumption patterns, consequences, and protective factors. Appendix G contains the suggested citation and acknowledgments for this document.
3 D’Amico, EJ, Chan Osilla, K, Stern, SA. Prevention and Intervention in the School Setting. In Sher, KJ, ed. The Oxford Handbook of Substance Use and Substance Use Disorders, Volume 2. New York, NY: Oxford University Press; 2016: 675-723.
P a g e xiii | 157
PRC 6 RNA 2019
Introduction The Texas Health and Human Services Commission (HHSC) administers approximately 225 school and community-based prevention programs across 72 different providers with federal funding from the Substance Abuse Prevention and Treatment Block Grant to prevent the use and consequences of alcohol, tobacco and other drugs (ATOD) among Texas youth and families. These programs provide evidence-based curricula and effective prevention strategies identified by SAMHSA’s Center for Substance Abuse Prevention (CSAP).
The Strategic Prevention Framework (SPF) provided by CSAP guides many prevention activities in Texas (see Figure 5). In 2004, Texas received a state incentive grant from CSAP to implement the Strategic Prevention Framework in close collaboration with local communities in order to tailor services to meet local needs for substance abuse prevention. This prevention framework provides a continuum of services that target the three classifications of prevention activities under the Institute of Medicine (IOM), which are universal, selective, and indicated.4
The Health and Human Services Commission Substance Abuse Services funds Prevention Resource Centers (PRCs) across the state of Texas. These centers are part of a larger network of youth prevention programs providing direct prevention education to youth in schools and the community, as well as community coalitions that focus on implementing effective environmental strategies. This network of substance abuse prevention services work to improve the welfare of Texans by discouraging and reducing substance use and misuse. Their work provides valuable resources to enhance and improve our state's prevention services aimed to address our state’s three prevention priorities to reduce: (1) underage drinking; (2) marijuana use; and (3) non-medical prescription drug abuse. These priorities are outlined in the Texas Behavioral Health Strategic Plan developed in 2012.
Our Audience
Readers of this document include stakeholders from a variety of disciplines such as substance use prevention and treatment providers; medical providers; school districts and higher education; substance use prevention community coalitions; city, county, and state leaders; and community members interested in increasing their knowledge of public health factors related to drug consumption. The information presented in this report aims to contribute to program planning, evidence-based decision making, and community education.
Purpose of This Report
This needs assessment reviews substance abuse data and related variables across the state that aid in substance abuse prevention decision making. The report is a product of the partnership between the regional Prevention Resource Centers and the Texas Department of State Health Services. The report seeks to address the substance abuse prevention data needs at the state, county and local levels. The assessment focuses on the state’s prevention priorities of alcohol (underage drinking), marijuana, and prescription drugs and other drug use among adolescents in Texas. This report explores drug
4 SAMHSA. Strategic Prevention Framework. https://www.samhsa.gov/capt/applying-strategic-prevention-framework. Last updated June 5, 2017.Accessed July 30, 2017.
P a g e 1 | 157
PRC 6 RNA 2019
consumption trends and consequences. Additionally, the report explores related risk and protective factors as identified by the Center for Substance Abuse Prevention (CSAP).
Figure 5. Strategic Prevention Framework (SPF)5
5Substance Abuse and Mental Health Services Administration. Strategic Prevention Framework. https://www.samhsa.gov/capt/applying- strategic-prevention-framework. Last updated June 5, 2017.Accessed July 30, 2017.
P a g e 2 | 157
PRC 6 RNA 2019
Methodology Purpose
This needs assessment is a review of data on substance misuse, substance use disorders, and related variables that will aid in substance misuse prevention decision making at the county, regional, and state level. In this needs assessment, the reader will find the following: primary focus on the state-delineated prevention priorities of alcohol (underage drinking), marijuana, prescription drugs, and other drug use among adolescents; exploration of drug consumption trends and consequences, particularly where adolescents are concerned; and an exploration of related risk and protective factors as operationalized by CSAP.
Specifically, this regional needs assessment can serve in the following capacities:
To determine patterns of substance use among adolescents and monitor changes in substance use trends over time; To identify gaps in data where critical substance misuse information is missing; To determine county-level differences and disparities; To identify substance use issues that are unique to specific communities; To provide a comprehensive resource tool for local providers to design relevant, data-driven prevention and intervention programs targeted to needs; To provide data to local providers to support their grant-writing activities and provide justification for funding requests; To assist policy-makers in program planning and policy decisions regarding substance misuse prevention, intervention, and treatment at the region and state level.
Process
The state evaluator and the regional evaluators collected primary and secondary data at the county, regional, and state levels between September 1, 2018 and May 30, 2019.
Between September and July the State Evaluator meet with Regional Evaluators via bi-weekly conference calls to discuss the criteria for processing and collecting data. The information is primarily gathered through established secondary sources including federal and state government agencies. In addition, region-specific data collected through local law enforcement, community coalitions, school districts and local-level governments are included to address the unique regional needs of the community. Additionally, qualitative data is collected through primary sources such as surveys and focus groups conducted with stakeholders and participants at the regional level.
Primary and secondary data sources are identified when developing the methodology behind this document. Readers can expect to find information from the American Community Survey, Texas Department of Public Safety, Texas School Survey of Drug and Alcohol Use, and the Community Commons, among others. Also, adults and youth in the region were selected as primary sources.
P a g e 3 | 157
PRC 6 RNA 2019
Qualitative Data Selection
During the year, focus groups, surveys and interviews are conducted by the Regional Evaluator to better understand what members of the communities believe their greatest need to be. The information collected by this research serves to identify avenues for further research and provide access to any quantitative data that each participant may have access to.
Focus Groups and Interviews
Participants for the focus groups are invited from a wide selection of professionals including law enforcement, health, community leaders, clergy, high school educators, town councils, state representatives, university professors, and local business owners. In these sessions, participants discuss their perceptions of how their communities are affected by alcohol, marijuana, and prescription drugs.
Interviews are conducted primarily with school officials and law enforcement officers. Participants are randomly selected by city and then approached to participate in an interview with the Regional Evaluator. Each participant is asked the following questions:
What problems do you see in your community? What is the greatest problem you see in your community? What hard evidence do you have to support this as the greatest problem? What services do you lack in your community?
For the 2018 calendar year, some of the above questions were operationalized into an informal survey that was completed by community members around Region 6. Many of the collective responses to the questions on that survey will be included in the aforementioned Qualitative Perspectives boxes, as well as responses obtained in focus groups and/or interviews.
Longitudinally Presented Data
In an attempt to capture a richer depiction of possible trends in the data presented in this needs assessment, data collection and reporting efforts consist of multi-year data where it is available from respective sources. Most longitudinal presentations of data in this needs assessment consist of (but are not limited to) the most recently-available data collected over three years in one-year intervals of data- collection, or the most recently-available data collected over three data-collection intervals of more than one year (e.g. data collection for the TSS is done in two-year intervals). Where possible, five year data presentations are included in hopes of revealing trends significant to many of the indicators included, here. Efforts are also made in presenting state-and national-level data with county-level data for comparison purposes. However, where it is the case that neither state-level nor national-level date are included in tables and figures, the assumption can be made by the reader that this data is not made available at the time of the data request. Such requests are made to numerous county, state, and national-level agencies in the development of this needs assessment.
P a g e 4 | 157
PRC 6 RNA 2019
Regional Profile and Demographics
The geographical scope of work for PRC Region 6 encompasses 13 counties (see Figure 6): Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, and Wharton.
Figure 6. Location and 13 counties of Region 6 in Texas
Source: Houston-Galveston Area Council
The Gulf Coast Region of Texas, also known as Health Service Region 6, encompasses thirteen counties across which geological and geographical landscapes are as varied as there are counties. The various terrains found in the state of Texas span costal-area beaches and wetlands, hill country positioned centrally in Texas, ever-increasing suburban master-plan communities that border large cities, sprawling refineries, and the urban concrete jungle of America’s fourth largest city. In fact, Houston is one of Texas’ three largest cities that fall into the top ten most populous cities in the United States (Dallas and San Antonio are the other two).6
6 The 200 largest cities in the United States by population 2019. World Population Review. http://worldpopulationreview.com/us-cities/. Accessed July 18, 2019.
P a g e 5 | 157
PRC 6 RNA 2019
The Port of Houston is the largest of 10 seaports located along Texas’ 367-mile coastline of the Gulf of Mexico. Texas’ 29 official ports of entry, including the Port of Houston, are well known as significant contributors to the diverse and growing Texas economy.7 Houston was even featured in a recent Los Angeles Times article that hails Houston as a “city whose stunning growth and high-volume immigration have turned it into the most racially and ethnically diverse major metropolis in the country, surpassing New York in 2010.”8
The thirteen counties of Texas Region 6 are home to almost 7.5 million people, with a little over 4.8 million people residing in Harris County, alone. About one quarter of Texas’ population resides in Region 6. Population The population across the counties of Region 6 include a wide range of urban and rural settings. At the county level, Tables 1 and 2 present general county-level population data regarding population density, age, race and ethnicity, and trends.9
Age According to the U.S. Surgeon General’s 2017 report on addiction, behavioral health problems such as substance use, violence, risky driving, mental health problems, and risky sexual activity are now the leading causes of death for those aged 15-24.10 As previously indicated in the Conceptual Framework section of this RNA, adolescence and young adulthood tend to be the stages in life where likelihood for the onset of substance use and misuse —including tobacco, alcohol, and illegal and prescription drugs— is significantly higher than in any other stage of life. Therefore, attention to populations in this age range is of great importance in efforts of preventing substance use and misuse in Region 6.
Texas’ youth population (under age 18) comprises 25.6 percent of the total population. Tables 1 and 2 illustrate county-level population projection totals and percentages for the age ranges of 0-17 and 18 and older, for 2017-2019. County-level changes in population, 2015-2019, are also included.
7 Hegar, G. Fiscal notes: Port of Houston. Texas Comptroller of Public Accounts. file:///C:/Users/mromain-harrott/Downloads/fn.pdf. Published April, 2017. Accessed July 30, 2017. 8 Coronado, G. How Houston has become the most diverse place in America. Los Angeles Times. http://www.latimes.com/nation/la-na- houston-diversity-2017-htmlstory.html. Published May 9, 2017. Accessed July 24, 2017. 9 Texas Department of State Health Services. Population Projections by Year. https://www.dshs.texas.gov/chs/popdat/downloads.shtm. Accessed June 6, 2019. 10 U.S. Department of Health and Human Services. Facing addiction in America: the surgeon general’s report on alcohol, drugs, and health. https://addiction.surgeongeneral.gov/. Published 2017. Accessed July 30, 2017.
P a g e 6 | 157
PRC 6 RNA 2019
Table 1. Region 6 county-level projected population total and population density: 2017-2019 and five-year change for 2015-201911 Population 2017 Population 2018 Population 2019 Change 2015-2019 Total Land Projected Density Projected Density Projected Density Projected Density County Area (Square Total Total Total Total Miles) Austin 646.5 33,876 52.4 34,766 53.8 35,640 55.1 3,402 5.2 Brazoria 1,357.8 378,766 279.0 389,066 286.5 399,681 294.4 40,826 30.1 Chambers 597.2 43,513 72.9 44,844 75.1 46,196 77.4 5,251 8.8 Colorado 960.3 22,151** 23.1** 22,327** 23.3** 22,506** 23.4** 721†† 0.7††
Fort Bend 861.8 786,948 913.1 819,681 951.1 853,649 990.5 129,545 150.3 Galveston 379** 321,627 848.6 325,997 860.2 330,504 872.0 17,624 46.5 Harris 1,704.9* 4,633,511* 2,717.8* 4,716,479* 2,766.4* 4,800,558* 2,815.7* 329,131† 193.0† Liberty 1,158.5 86,047 74.3 87,600 75.6 89,190 77.0 6,206 5.4 Matagorda 1,092.9 38,879 35.6 39,147 35.8 39,424 36.1 1,129 1.1 Montgomery 1,041.9 590,851 567.1 613,169 588.5 636,414 610.8 87,882 84.3 Walker 784.2 71,206 90.8 71,717 91.5 72,246 92.1 2,047 2.6 Waller 513.3 53,094 103.4 54,675 106.5 56,297 109.7 6,215 12.1 Wharton 1,086.2 42,702 39.3 42,884 39.5 43,069 39.7 737 0.7†† Region 6 12,184.3 7,103,171 583.0 7,262,352 596.0 7,425,374 609.4 630,716 51.7 Texas 261,250.0 28,797,290 110.2 29,366,479 112.4 29,948,091 114.6 2,252,807 8.6 *Highest projected population total, land area, and density per square mile. **Lowest projected population total, land area, and density per square mile. †Largest change in projected population total and population density. ††Smallest change in projected population total and population density.
11 Texas Department of State Health Services. Population Projections by Year. https://www.dshs.texas.gov/chs/popdat/downloads.shtm. Accessed June 6, 2019.
P a g e 1 | 157
PRC 6 RNA 2019
Figure 7. Region 6 county-level projected population totals five-year trends for 2015-201912
8000000
7000000
6000000
5000000
4000000
3000000 Projected Population Projected
2000000
1000000
0 2015 2016 2017 2018 2019
Year
Austin Brazoria Chambers Colorado Fort Bend
Galveston Harris Liberty Matagorda Montgomery
Walker Waller Wharton Region 6
12 Texas Department of State Health Services. Population Projections by Year. https://www.dshs.texas.gov/chs/popdat/downloads.shtm. Accessed June 6, 2019.
P a g e 2 | 157
PRC 6 RNA 2019
Table 2. Region 6 county-level projected population percentages for Ages 0-17, 18+: 2017-2019 and five-year change for 2015-201913 2017 2018 2019 2015-2019 Population Change Pop Total Age 0- Age 18+ Pop Total Age 0- Age Pop Total Age 0-17 Age 18+ Total Pop Age Age 18+ 17 17 18+ 0-17 Austin 33,876 23.4% 76.6% 34,766 23.2% 76.8% 35,640 23.0% 77.0% 3,402 -0.9% 0.9% Brazoria 378,766 26.9%* 73.1% 389,066 26.6%* 73.4% 399,681 26.3%* 73.7% 40,826 -0.9% 0.9% Chambers 43,513 25.6% 74.4% 44,844 25.1% 74.9% 46,196 24.6% 75.4% 5,251 -1.1% 1.9% Colorado 22,151 22.4% 77.6% 22,327 22.3% 77.7% 22,506 22.2% 77.8% 721 -0.5% 0.5% Fort Bend 786,948 26.8% 73.2% 819,681 26.2% 73.8% 853,649 25.6% 74.4% 129,545 -2.2% 2.2%† Galveston 321,627 24.4% 75.6% 325,997 24.2% 75.8% 330,504 24.0% 76.0% 17,624 -0.7% 0.7% Harris 4,633,511 26.4% 73.6% 4,716,479 26.1% 73.9% 4,800,558 25.9% 74.1% 329,131 -0.9% 0.9% Liberty 86,047 24.2% 75.8% 87,600 24.0% 76.0% 89,190 23.8% 76.2% 6,206 -0.7% 0.7% Matagorda 38,879 24.9% 75.1% 39,147 24.8% 75.2% 39,424 24.6% 75.4% 1,129 -0.6% 0.6% Montgomery 590,851 25.0% 75.0% 613,169 24.6% 75.4% 636,414 24.2% 75.8% 87,882 -1.6% 1.6% Walker 71,206 17.5%** 82.5%* 71,717 17.7%** 82.3%* 72,246 17.9%** 82.1%* 2,047 0.8% -0.8% Waller 53,094 24.4% 75.6% 54,675 24.3% 75.7% 56,297 24.2% 75.8% 6,215 -0.3% 0.3%†† Wharton 42,702 25.6% 74.4% 42,884 25.4% 74.6% 43,069 25.3% 74.7% 737 -0.6% 0.6% Region 6 7,103,171 26.1% 73.9% 7,262,352 25.8% 74.2% 7,425,374 25.5% 74.5% 630,716 -1.1% 1.1% Texas 28,797,290 26.0% 74.0% 29,366,479 25.8% 74.2% 29,948,091 25.6% 74.4% 2,252,807 -0.8% 0.8% Note. *Highest percentage of population in age range. **Lowest percentage of population in age range. †Largest change in percentage of population in age range. ††Smallest change in percentage of population in age range.
13 Texas Department of State Health Services. Population Projections by Year. https://www.dshs.texas.gov/chs/popdat/downloads.shtm. Accessed June 6, 2019. P a g e 3 | 157
PRC 6 RNA 2019
Race, Ethnicity and Concentrations of Populations As most RNAs of this type typically present the general demographics of the population on which and for which such assessments are prepared, so is the case, here, at least to the best extent possible. Figure 8 displays each county’s race and ethnicity proportions in relation to the total population and population density of the respective county.
Figure 8. Region 6 county-level population projections of race and ethnicity, 201914
Austin County Brazoria County Total: 35,640 Total: 399,681 Other, Density: 55.1 Other, Density: 294.4 39,955, 760, 2% 10% Anglo, 178,566, Hispanic, 45% 10,866, 30% Hispanic, 126,365, Anglo, 31% 20,568, Black, 58% 3,446, Black, 54,795, 14% 10%
Chambers County Colorado County Total: 46,196 Total: 22,506 Density: 77.4 Other, Density: 23.4 Other, 1,283, 3% 356, 2%
Hispanic, Hispanic, 11,862, 7,044, 31% 26%
Anglo, 12,207, Black, Anglo, 54% 3,693, 8% 29,358, Black, 63% 2,899, 13%
14 Texas Department of State Health Services. Population Projections by Year. https://www.dshs.texas.gov/chs/popdat/downloads.shtm. Accessed June 6, 2019.
P a g e 4 | 157
PRC 6 RNA 2019
Fort Bend County Galveston County Other, Total: 853,649 Total: 330,504 22,220, Density: 990.5 Density: 872.0 7% Anglo, Other, 252,790, 187,260, 30% 22% Hispanic, 86,305, 26%
Hispanic, Black, Anglo, 231,534, Black, 182,065, 181,365, 27% 40,614, 21% 55% 12%
Harris County Liberty County Total: 4,800,558 Other, Total: 89,190 Other, 447,668, Density: 2,815.7 Density: 77.0 2,258, 2% 9% Anglo, 1,271,891, 26% Hispanic, 21,096, 24%
Black, Hispanic, Anglo, 9,120, 10% 2,237,610, Black, 56,716, 47% 843,389, 64% 18%
Matagorda County Montgomery County Total: 39,424 Total: 636,414 Other, Density: 36.1 Other, Density: 610.8 29,884, 1,306, 3% 5% Hispanic, 177,438, 28% Anglo, Hispanic, 16,979, 16,878, 43% 43%
Anglo, Black, 400,948, 28,144, 63% Black, 4% 4,261, 11%
P a g e 5 | 157
PRC 6 RNA 2019
Walker County Waller County Total: 72,246 Total: 56,297 Density: 92.1 Other, Density: 109.7 Other, 2,663, 4% 1,185, 2%
Hispanic, 13,620, 19% Anglo, Hispanic, 22,600, 20,430, 40% 36% Anglo, 40,210, Black, 55% 15,753, 22% Black, 12,082, 22%
Wharton County Region 6 Total: 43,069 Total: 7,425,374 Other, Density: 39.7 Other, Density: 609.4 737,384, 586, 1% 10% Anglo, 2,502,925, Hispanic, Anglo, 34% 17,935, 18,727, 42% 43%
Hispanic, 2,978,983, 40% Black, Black, 1,206,082, 16% 5,821, 14%
Texas Other, Total: 29,948,091 2,100,489, Density: 114.6 7% Anglo, 11,871,540 , 40%
Hispanic, 12,568,914 , 42% Black, 3,407,148, 11%
P a g e 6 | 157
PRC 6 RNA 2019
Limited English Proficiency About 14 percent of the population in Texas has limited proficiency in English. Limited English Proficiency (LEP) is defined as speaking English less than very well.15 As of the 2017 projections for individuals older than four years of age, who identify themselves as speakers with LEP, Harris County has the largest population of speakers with LEP at 20.4 percent. Walker County has the smallest population of speakers with LEP at 5.7 percent.
Almost 17 percent of the population in Region 6 is comprised of speakers who have LEP. Statistically, it has been shown that this population is more likely to experience impoverishment and to be less educated compared to the English-proficient population in the United States. Such risk factors are known to be associated with substance use and misuse. Table 3 displays the five-year estimates for the percent of LEP population for each county in Region 6 and Texas.
15 U.S. Census Bureau. 2012-2016 American Community Survey 5-year estimates: Language Spoken at Home. American FactFinder - Results. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_S1601&prodType=table. Published October 5, 2010. Accessed April 22, 2019.
P a g e 7 | 157
PRC 6 RNA 2019
Table 3. Region 6 county-level population estimates of LEP speakers for 2015, 2016, 2017; including 2013-2017 five-year change in percentage of LEP speakers16 2015 2016 2017 2013-2017 Population Percent Population Percent Population Percent Change in > 5 Years Pop >5 > 5 Years Pop > 5 > 5 Years Pop > 5 Percent County LEP LEP LEP Pop > 5 LEP Austin 27,130 7.3% 27,323 8.0% 27,507 8.8% 1.4% Brazoria 307,400 7.9% 313,861 8.1% 321,296 7.9% 0.2% Chambers 34,716 9.6% 35,523 10.4% 36,540 8.6% 1% Colorado 19,553 4.9%** 19,490 6.1% 19,608 7.4% 1.6% Fort Bend 612,667 13.0% 635,642 12.9% 661,564 13.0% 0.1% Galveston 287,973 6.4% 293,874 6.7% 300,345 6.8% 0.3% Harris 4,013,836 20.4%* 4,086,726 20.3%* 4,175,737 20.4%* 0%†† Liberty 72,186 6.5% 73,248 6.9% 74,366 7.4% 1.5% Matagorda 34,007 13.0% 34,136 12.4% 34,158 9.6% (3%) Montgomery 467,817 8.1% 482,971 7.7% 498,539 7.8% (0.5%) Walker 66,283 5.7% 66,865 5.9%* 67,698 5.7%** 0.5% Waller 42,816 10.5% 43,897 11.6% 45,196 12.9% 4.3%† Wharton 38,448 8.9% 38,550 9.0% 38,601 8.7% (0.8%) Region 6 6,024,832 16.7% 6,152,106 16.6% 6,301,155 16.7% 0% Texas 24,587,309 14.2% 24,985,749 14.1% 25,437,762 14.1% (0.1%) *Highest percentage of limited English proficient speakers. **Lowest percentage of limited English proficient speakers. †Largest percent change in limited English proficient speakers. ††Smallest percent change in limited English proficient speakers
16 U.S. Census Bureau. 2012-2016 American Community Survey 5-year estimates: Language Spoken at Home. American FactFinder - Results. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_S1601&prodType=table. Published October 5, 2010. Accessed April 22, 2019.
P a g e 8 | 157
PRC 6 RNA 2019
Risk Factors In following with the framework presented in Figure 2. Risk and protective factors for alcohol and other drug use that was introduced on p. xii, risk factors will be discussed within the context of the domains of Society, Community, School, Family, Peer, and Individual.
Adapted from: D’Amico, EJ, Osilla, KC. Prevention and intervention in the school setting. In: KJ Sher ed. The Oxford Handbook of Substance Use and Substance Use Disorders. Vol. 2.New York, NY: Oxford University Press; 2016:678.
Society Domain There are many societal factors associated with the use and misuse of substances, such as poverty, unemployment, discrimination, and unhealthy media messages promoting the use of substances. The Surgeon General’s recent report on addiction specifically cites predictors of future substance use and misuse consist of and often relate to physiological changes that occur over the course of development or to factors in a person’s environment, such as transitions, parental divorce, and particularly, low parental socioeconomic status. Although low socioeconomic status, among other risk factors, has been found to have consistent effects across (and regardless of) gender and culture, it cannot be denied that low income and disadvantaged populations experience greater exposure to environmental risk factors and less exposure to protective factors than other populations in which parents’ socioeconomic status is higher. 17
17 U.S. Department of Health and Human Services. Facing addiction in America: the surgeon general’s report on alcohol, drugs, and health. https://addiction.surgeongeneral.gov/. 2017. Accessed July 30, 2017.
P a g e 9 | 157
PRC 6 RNA 2019
Per Capita Income Since socioeconomic status is an important variable in addressing the potential for youth in developing issues with substance use and misuse, evaluating per capita income in relation to the 2019 Federal Poverty Level Guidelines reveals that many of the Region 6 counties’ per capita income amounts fall below, at, or right above the federal poverty level guideline for a family of four ($24,600). Of course, as per capita income is basically the county average, it is important to keep in mind that for every income above the poverty level, there is an income below the poverty level. The Federal Poverty Level for 2019 is contingent upon the number of persons in a household. Figure 9 shows the 2018 Federal Poverty Level guidelines for the 48 border states and Washington D.C. according to the number of persons per household. 18 Table 5 shows the per capita income for each county in Region 6.
Figure 9. Federal Poverty Level: 201919
$50,000 $43,430 $39,010 $40,000 $34,590 $30,170 $30,000 $25,750 $21,330 $20,000 $16,910 $12,490
Amount in Dollars in Amount $10,000
$0 1 2 3 4 5 6 7 8 Persons per Household
As it can be seen in Table 4, Fort Bend County has had the highest per capita income out of the 13 counties, with per capita income topping out at $38,382 for Fort Bend in 2017. Walker County had the lowest per capita income for 2017 at $17,194. The county with the highest five-year change between 2013 and 2017 was Montgomery County, with an increase of $5,101. Matagorda County saw the lowest amount of change with a decrease in per capita income of $95.
18 U.S. Department of Health and Human Services. Federal poverty level guidelines. https://aspe.hhs.gov/poverty-guidelines. Accessed June 18, 2019. 19 U.S. Department of Health and Human Services. Federal poverty level guidelines. https://aspe.hhs.gov/poverty-guidelines. Accessed June 18, 2019.
P a g e 10 | 157
PRC 6 RNA 2019
Table 4. Region 6 county-level per capita income: 2013-201720 County 2013 2014 2015 2016 2017 2013-2017 Change Austin $25,884 $27,490 $27,658 $28,351 $30,101 $4,217 Brazoria $29,081 $30,134 $30,634 $31,180 $32,343 $3,262 Chambers $30,140 $30,102 $30,572 $29,729 $31,412 $1,272 Colorado $24,348 $24,112 $25,578 $26,161 $26,689 $2,341 Fort Bend $34,084* $35,024* $35,962* $37,134* $38,382* $4,298 Galveston $30,926 $31,030 $31,585 $32,756 $33,870 $2,944 Harris $27,899 $28,454 $29,047 $29,850 $30,856 $2,957 Liberty $19,740 $20,370 $21,194 $22,065 $22,153 $2,413 Matagorda $23,389 $22,072 $21,693 $22,939 $23,294 ($95)†† Montgomery $32,911 $33,455 $34,215 $35,912 $38,012 $5,101† Walker $16,330** $16,571** $16,135** $16,419** $17,194** $864 Waller $22,412 $22,645 $22,849 $23,338 $23,888 $1,476 Wharton $20,310 $20,782 $21,581 $23,245 $25,867 $5,557 Texas $26,019 $26,513 $26,999 $27,828 $28,985 $2,966 United States $28,155 $28,555 $28,930 $29,829 $31,177 $3,022 * Highest per capita income. ** Lowest per capita income. †Largest change in per capita income. ††Smallest change in per capita income
20US Census Bureau American Fact Finder. Per capita income in the last 12 months (in corresponding years' inflation-adjusted dollars) for 2013- 2017. https://factfinder.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t#none. Accessed July 10, 2019.
P a g e 11 | 157
PRC 6 RNA 2019
Employment Employment data are relevant to prevention because unemployment creates instability and reduces access to health insurance, health services, healthy foods, and other necessities that contribute to health status. 21 In Table 5, the most recently-available unemployment data for each of the 13 counties in Region 6 can be seen for 2016, 2017, and 2018. 22 As of 2018, Colorado County has the lowest unemployment rate (3.3%) in the Gulf Coast Region, where Matagorda County the highest unemployment rates (6.1%) in the region. Matagorda County also had the largest five-year change in unemployment rate, dropping by 1.7%, 2014-2018. Chambers had the smallest five-year change in employment rate, dropping .4%, 2014-2018.
Table 5. Region 6 county-level labor force totals and percent unemployment 2016, 2017, 2018; showing change in labor force total and percent unemployment 2014-201823 2016 2017 2018 2014-2018 Change Labor % Labor % Labor % Labor % County Force Total Unemp Force Total Unemp Force Total Unemp Force Total Unemp Austin 14,128 5.3% 13,997 4.3% 14,015 3.6% -121 -1.2% Brazoria 168,419 5.2% 171,954 5.3% 175,989 4.5% 9,277 -0.6% Chambers 17,991 6.1% 18,511 6.5% 19,157 5.4% 1,314 -0.4%†† Colorado 9,758 4.8%* 10,080 3.8%* 9,680 3.3%** -597 -1.1% Fort Bend 359,594 5% 369,788 4.6% 382,102 4% 35,034 -0.5% Galveston 158,813 5.3% 161,703 5.2% 164,757 4.6% 7,128 -1% Harris 2,255,093 5.3% 2,268,944 5.0% 2,304,397 4.4% 74,245 -0.6% Liberty 31,191 7.6%** 31,713 7.1% 32,303 5.8% 1,321 -1.4% Matagorda 16,833 7.4% 16,930 7.2%** 16,912 6.1%* 232 -1.7%† Montgomery 260,658 4.9% 267,342 4.3% 275,152 3.8% 21,318 -0.6% Walker 23,663 5.3% 23,625 4.6% 23,970 4.2% 814 -1.2% Waller 21,841 5.7% 22,201 4.9% 22,763 4.3% 1,443 -0.8% Wharton 21,009 5% 21,054 4.5% 21,416 3.7% -158 -1% Region 6 3,364,467 5.3% 3,397,842 5% 3,462,613 4.3% 151,250 -0.7% Texas 13,317,197 4.6% 13,531,442 4.3% 13,839,910 3.9% 815,193 2.9% Note. Unemp = Unemployed. * Highest unemployment rate. ** Lowest unemployment rate. †Largest change in unemployment rate. ††Smallest change in unemployment rate
21 U.S. Department of Health and Human Services. Facing addiction in America: the surgeon general’s report on alcohol, drugs, and health. https://addiction.surgeongeneral.gov/. Accessed July 30, 2017. 22 U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics Information and Analysis. Labor Force Data by County, 2018 Annual Averages. 2018. https://www.bls.gov/lau/#tables. Accessed June 28, 2019. 23 U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics Information and Analysis. Labor Force Data by County, 2018 Annual Averages. 2018. https://www.bls.gov/lau/#tables. Accessed June 28, 2019.
P a g e 12 | 157
PRC 6 RNA 2019
Household Composition Household composition can also provide insight into potential risk and protective factors related to substance use and misuse prevention. Children in households with only one adult are statistically at greater risk for adverse health outcomes, including behavioral health outcomes such as substance use and misuse. As indicated in Table 6, there exists an 18 percent range between the lowest and highest percentages of single-parent households among the 13 counties in Region 6, with the most recent data (2013-2017 population estimates) showing Matagorda County as holding the largest percentage of such households (39%) and Fort Bend County holding the smallest percentage (21%).24
Temporary Assistance for Needy Families (TANF) Recipients The state of Texas provides a program called Temporary Assistance to Needy Families (TANF) to under- employed and newly unemployed parents of children under age 19. TANF provides a stipend and Medicaid benefits. The percentage of households in Texas that receive public assistance income of this type varies significantly from county to county with the latest available data (2018) identifying Fort Bend County with the lowest TANF recipient rate of 50.1 per 100,000 and Liberty county with the highest rates of TANF recipients at 148.4 per 100,000 (see Table 7) .2526 Figure 10 illustrates the five-year trends of TANF recipients per 100,000 population for all 13 counties in Region 6, 2014-2018.
Supplemental Nutrition Assistance Program (SNAP) Recipients Another estimate of instability in the provision of basic needs for children is the estimated percentage of households receiving the Supplemental Nutrition Assistance Program (SNAP) benefit (see Table 9). According to the most recently available data (2018), Fort Bend is the county with the lowest rate of SNAP recipients at 6,620.1 per 100,000 population. The Region 6 county that ranks highest in SNAP recipients is Liberty County at 15,230 per 100,000 population. Liberty County had the largest change in rate of SNAP recipients, increasing by 2,333.4 per 100,000 population on the 2014-2018 five-year period of time, and Matagorda County saw the least amount of change at 37.3 SNAP recipients per 100,000 population. Austin County was the only county to see a drop in SNAP recipients per 100,000 population at -82.7 during 2014-2018 (see Table 8). Figure 11 illustrates the five-year trends of SNAP recipients per 100,000 population for all 13 counties in Region 6, 2014-2018.
Children eligible for Free and Reduced Cost Lunch Waller had highest percentage of children who were eligible for free and reduced cost lunch at 73.5 percent in 2017, where Chambers County had the lowest percentage of children who were eligible for free and reduced cost lunch at 30.7 percent. Walker County saw the largest five-year change in percent of children eligible for free and reduced-cost lunch, and Austin saw the smallest, for 2013 through 2017 (see Table 9). Figure 12 illustrates five-year trends for county-level percentages for children eligible for
24 County Health Rankings & Roadmaps. Children in single-parent households. http://www.countyhealthrankings.org/app/texas/2019/measure/factors/82/data. Accessed May 15, 2019.. 25 Temporary Assistance for Needy Families. Texas Health and Human Services Commission. https://hhs.texas.gov/about-hhs/records- statistics/data-statistics/data/statistics/temporary-assistance-needy-familites-tanf-statistics. Accessed June 29, 2019. 26Texas Department of State Health Services. Population estimates broken down by age, sex, and race/ethnicity. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk. Accessed July 1, 2019.
P a g e 13 | 157
PRC 6 RNA 2019
free and reduced-cost lunch, 2013-2017. Income eligibility guidelines for free and reduced-cost lunch programs can be found at https://www.fns.usda.gov/cnp/fr-032019.27
Uninsured Children Uninsured children are significantly more likely than insured children to not have a regular physician and to not receive medical care due to expense, particularly where mental health is concerned.28 In Region 6, the county with the lowest percentage of uninsured children as of 2016 was Fort Bend County at 7 percent. The counties with the highest percentage of uninsured children were Colorado County at 14 percent (see Table 10 and Figure 13).
27 United States Department of Agriculture Food and Nutrition Service. Child Nutrition Programs – Income Eligibility Guideline – (July 1, 2019 – June 30, 2020). Last published March 20, 2020. https://www.fns.usda.gov/cnp/fr-032019. Accessed July 20, 2019. 28 Stevens, J., Harman, J.S., & Kelleher, J.K. Race/ethnicity and insurance status as factors associated with ADHD treatment patterns. Journal of Child and Adolescent Psychopharmacology. 2005; 15 (1) 88-96.
P a g e 14 | 157
PRC 6 RNA 2019
Table 6. Region 6 county-level totals and percentages of children from single-parent households, five year estimates: 2011-2015, 2012-2016, 2013-201729 2011-2015 Estimates 2012-2016 Estimates 2013-2017 Estimates All Total from Percent All Total Percent All Total Percent County Children SPHH From SPHH Children from SPHH from SPHH Children from SPHH from SPHH Austin 7,104 1,724 24% 7,090 2,058 29% 7,049 1,730 25% Brazoria 88,979 24,493 28% 90,273 22,851 25% 92,121 22,261 24% Chambers 10,352 2,059 20%** 10,582 1,826 17%** 10,987 2,684 24% Colorado 4,804 1321 27% 4,805 1,405 29% 4,883 1,615 33% Fort Bend 18,5525 4,1533 22% 191,137 42,833 22% 198,114 42,201 21%** Galveston 75,307 21,967 29% 76,665 23,486 31% 78,244 24,142 31% Harris 1,181,303 422,703 36% 1,198,261 434,302 36% 1,215,781 438,387 36% Liberty 19,208 5,222 27% 19,701 5,196 26% 20,255 5,888 29% Matagorda 9,401 3,692 39% 9,575 3,983 42%* 9,547 3,754 39%* Montgomery 135,041 32,671 24% 138,361 32,957 24% 141,987 33,822 24% Walker 10,649 3,677 35% 10,543 3,156 30% 10,598 3,303 31% Waller 10,759 3,197 30% 11,073 3,412 31% 11,526 3,509 30% Wharton 10,663 4,244 40%* 10,663 3,916 37% 10,725 4,063 38% 1,749,095 568,503 33% 1,778,729 581,381 33% 1,811,817 587,359 32% Region 6
Texas 7,003,149 2,331,521 33% 7,076,774 2,358,262 33% 7,157,337 2,358,861 33% Note. SPHH = Single Parent Households. *Highest percent of children from single-parent households. **Lowest percent of children from single-parent households.
29 County Health Rankings & Roadmaps. Children in single-parent households. http://www.countyhealthrankings.org/app/texas/2019/measure/factors/82/data. Accessed May 15, 2019.
P a g e 15 | 157
PRC 6 RNA 2019
Table 7. Region 6 county-level Temporary Assistance to Needy Families (TANF) recipients per 100,000: 2016, 2017, 2018; five-year change in rate per 100,000 for 2014-20183031 2016 2017 2018 2014-2018 TANF Rate per TANF Rate per TANF Rate per Change in Rate County Population Recipients 100,000 Population Recipients 100,000 Population Recipients 100,000 per 100,000 Austin 33,048 33 99.9 33,876 41 121.0 34,766 38 109.3 -78.4 Brazoria 368,706 237 64.3** 378,766 227 59.9** 389,066 207 53.2 -19.2 Chambers 42,211 34 80.5 43,513 32 73.5 44,844 26 58.0 -60.8 Colorado 21,978 18 81.9 22,151 27 121.9 22,327 20 89.6 -44.6 Fort Bend 754,968 506 67.0 786,948 496 63.0 819,681 411 50.1** -36.9 Galveston 317,213 417 131.5 321,627 482 149.9 325,997 424 130.1 -55.7 Harris 4,551,437 6,284 138.1 4,633,511 6,722 145.1 4,716,479 5,953 126.2 -57.9 Liberty 84,504 143 169.2 86,047 148 172.0* 87,600 130 148.4* -144.9† Matagorda 38,581 48 124.4 38,879 49 126.0 39,147 43 109.8 4.5†† Montgomery 569,235 406 71.3 590,851 474 80.2 613,169 401 65.4 -14.8 Walker 70,694 79 111.7 71,206 71 99.7 71,717 78 108.8 -64.6 Waller 51,530 66 128.1 53,094 64 120.5 54,675 65 118.9 -47.7 Wharton 42,519 192 451.6* 42,702 58 135.8 42,884 45 104.9 -35.1 Region 6 6,946,624 8,463 121.8 7,103,171 8,891 125.2 7,262,352 7,841 108.0 -51.7 Texas 28,240,245 62,228 220.4 28,797,290 60,310 121.0 29,366,479 53,095 180.8 -103.4 Note. Rate per 100,000 was calculated using population estimates from Texas Department of State Health Services. * Highest unemployment rate. ** Lowest unemployment rate. †Largest change in unemployment rate. ††Smallest change in unemployment rate
30 Temporary Assistance for Needy Families. Texas Health and Human Services Commission. https://hhs.texas.gov/about-hhs/records-statistics/data-statistics/data/statistics/temporary-assistance- needy-familites-tanf-statistics. Accessed June 29, 2019. 31Texas Department of State Health Services. Population estimates broken down by age, sex, and race/ethnicity. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk. Accessed July 1, 2019. P a g e 16 | 157
PRC 6 RNA 2019
Figure 10. Region 6 county-level five-year trends in TANF recipients per 100,000 population: 2014, 2015, 2016, 2017, 2018
500.0
450.0
400.0
350.0
300.0
250.0
200.0
150.0
TANF TANF Recipientsper 100,000 100.0
50.0
- 2014 2015 2016 2017 2018
Year Austin Brazoria Chambers Colorado Fort Bend Galveston Harris Liberty Matagorda Montgomery Walker Waller Wharton Region 6 Texas
P a g e 17 | 157
PRC 6 RNA 2019
Table 8. Region 6 county-level Supplemental Nutrition Assistance Program (SNAP) recipients per 100,000: 2016, 2017, 2018; change in rate per 100,000 for 2014-201832 2016 2017 2018 2014-2018 SNAP Rate per SNAP Rate per SNAP Rate per Change in Rate County Population Recipients 100,000 Population Recipients 100,000 Population Recipients 100,000 per 100,000 Austin 33,048 3,080 10,392.4 33,876 3,226 10,830.6 34,766 2,890 8,312.7 -82.67 Brazoria 368,706 31,004 8,762.5 378,766 35,594 9,820.2 389,066 32,298 8,301.4 334.94 Chambers 42,211 3,162 7,849.5 43,513 3,832 9,246.9 44,844 3,308 7,376.7 599.98 Colorado 21,978 2,423 11,523.3 22,151 2,725 12,834.4 22,327 2,340 10,480.6 435.23 Fort Bend 754,968 52,380 7,059.7** 786,948 56,793 7,425.6** 819,681 54,264 6,620.1** 258.47 Galveston 317,213 37,844 11,492 321,627 39,646 11,833.4 325,997 37,721 11,571.0 947.82 Harris 4,551,437 672,219 14,559.5 4,633,511 712,352 15,309.6 4,716,479 653,450 13,854.6 971.26 Liberty 84,504 12,990 15,962.7 86,047 13,820 16,519.6 87,600 13,342 15,230.6 * 2,333.43† Matagorda 38,581 6,001 16,167.8* 38,879 6,759 18,346.9* 39,147 5,843 14,925.8 37.28†† Montgomery 569,235 44,991 8,113.5 590,851 47,574 8,332.7 613,169 45,244 7,378.7 295.76 Walker 70,694 6,870 9,581.5 71,206 7,907 10,944.7 71,717 6,760 9,425.9 808.69 Waller 51,530 6,382 12,749.2 53,094 6,265 12,210.8 54,675 6,009 10,990.4 39.05 Wharton 42,519 6,495 15,600.2 42,702 6,475 15,428.4 42,884 6,078 14,173.1 748.31 Region 6 6,946,624 885,840 12,710.3 7,103,171 942,967 13,347.6 7,262,352 869546 11,973.3 707.02 Texas 28,240,245 3,867,476 13,859.5 28,797,290 3,943,512 13,932.4 29,366,479 3,725,683 12,686.9 -158.81 Note. Rate per 100,000 was calculated using population estimates from Texas Department of State Health services. 33 * Highest unemployment rate. ** Lowest unemployment rate. †Largest change in unemployment rate. ††Smallest change in unemployment rate
32 Supplemental Nutritional Assistance Program (SNAP) Statistics. Texas Heath and Human Services Commission. https://hhs.texas.gov/about-hhs/records-statistics/data-statistics/supplemental- nutritional-assistance-program-snap-statistics. Accessed May 10, 2019. 33Texas Department of State Health Services. Population estimates broken down by age, sex, and race/ethniciry. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk. Accessed July 1, 2019. P a g e 18 | 157
PRC 6 RNA 2019
Figure 11. Region 6 county-level five-year trends in SNAP recipients per 100,000 population: 2014, 2015, 2016, 2017, 2018
20000.0
18000.0
16000.0
14000.0
12000.0
10000.0
8000.0
6000.0 SNAP Recipients per 100,000 per Recipients SNAP
4000.0
2000.0
0.0 2014 2015 2016 2017 2018 Year
Austin Brazoria Chambers Colorado Fort Bend Galveston Harris Liberty Matagorda Montgomery Walker Waller Wharton Region 6 Texas
P a g e 19 | 157
PRC 6 RNA 2019
Table 9. Region 6 county-level percentages of children eligible for free or reduced cost lunch: 2015, 2016, 2017; five-year change in percent eligible 2013-20173435 2015 2016 2017 2013-2017 Total Total % Total Total % Total Total % Change in County Children Eligible Eligible Children Eligible Eligible Children Eligible Eligible % Eligible Austin 5,441 2,854 52.5% 5,531 2,798 50.6% 5,587 3,009 53.9% 0.0%†† Brazoria 66,670 29,822 44.7% 68,619 30,588 44.6% 70,609 31,822 45.1% -0.8% Chambers 8,279 2,696 32.6% 8,507 2,711 31.9% 8,723 2,676 30.7%** -4.3% Colorado 3,501 2,240 64.0% 3,524 2,181 61.9% 3,517 2,267 64.5% 0.7% Fort Bend 145,172 46,264 31.9%** 150,180 46,084 30.7%** 156,082 50,785 32.5% -3.2% Galveston 60,689 26,900 44.3% 61,977 27,954 45.1% 62,379 27,967 44.8% -0.6% Harris 877,095 563,388 64.2% 887,304 576,417 65.0% 895,352 584,079 65.2% -1.2% Liberty 15,097 9,350 61.9% 15,648 9,656 61.7% 16,331 10,645 65.2% 2.8% Matagorda 7,121 4,694 65.9% 7,261 4,706 64.8% 7,264 4,727 65.1% -5.5% Montgomery 101,579 41,515 40.9% 105,359 42,569 40.4% 108,165 44,445 41.1% -0.7% Walker 8,073 4,682 58.0% 8,388 4,856 57.9% 8,751 4,980 56.9% -6.4%† Waller 6,158 4,465 72.5%* 6,474 4,759 73.5%* 6,649 4,885 73.5%* -2.7% Wharton 8,405 5,309 63.2% 8,447 5,620 66.5% 8,510 5,546 65.2% 0.9% Region 6 1,313,280 744,179 56.7% 1,337,219 760,899 56.9% 1,357,919 777,833 57.3% -1.7% Texas 5,233,736 3,058,606 58.4% 5,300,635 3,107,545 58.6% 5,360,756 3,132,073 58.4% -1.8% Note. *Highest percentage of children eligible for free or reduced-cost lunch. **Lowest percentage of children eligible for free or reduced cost lunch. †Largest change in percentage of children eligible for free and reduced-cost lunch. ††Smallest change in percentage of children eligible for free and reduced-cost lunch.
34 County Health Rankings and Roadmaps. Texas Data. 2018. http://www.countyhealthrankings.org/app/texas//compare/snapshot.Accessed June 18, 2018. 35 U.S. Department of Education, National Center for Education Statistics, Common Core of Data (CCD), "Local Education Agency (School District) Universe Survey Membership Data", 2015-16 v.1a; "Public Elementary/Secondary School Universe Survey", 2011-12 v.1a, 2012-13 v.2a, 2013-14 v.2a; "Public Elementary/Secondary School Universe Survey Free Lunch Data", 2015-16 v.1a; "Public Elementary/Secondary School Universe Survey Membership Data", 2015-16 v.1a.
P a g e 20 | 157
PRC 6 RNA 2019
Figure 10. Region 6 county-level five-year trends of percentages of children eligible for free and reduce-cost lunch: 2013, 2014, 2015, 2016, 2017
80.0%
70.0%
cost Lunch cost 60.0% -
50.0%
40.0%
30.0%
20.0%
10.0% Percentage Eligible for Free and Reduced and Free for Eligible Percentage
0.0% 2013 2014 2015 2016 2017 Year
Austin Brazoria Chambers Colorado Fort Bend Galveston Harris Liberty Matagorda Montgomery Walker Waller Wharton Region 6 Texas
P a g e 21 | 157
PRC 6 RNA 2019
Table 10. Region 6 county-level counts and percentages for uninsured children: 2014, 2015, 2016; five-year change in percent uninsured, 2012- 2016 2014 2015 2016 2012-2016 Total Total % Total Total % Total Total % Change in County Children Unins Unins Children Unins Unins Children Unins Unins % Unins Austin 7,154 1,025 14% 7,231 964 13%* 7,545 810 11% -5%† Brazoria 92,812 9,468 10% 94,570 9,507 10% 98,662 8,546 9% -3% Chambers 10,765 1,414 13% 11,052 1,171 10% 11,683 1,164 10% -1%†† Colorado 4,800 725 15%* 4,834 619 12% 5,046 681 14%* -4% Fort Bend 198,356 17,529 9%** 205,323 14,884 7%** 216,084 14,425 7%** -4% Galveston 79,267 8,050 10% 81,040 7,044 9% 84,497 7,268 9% -1%†† Harris 1,225,268 153,466 12% 1,239,281 133,445 11% 1,279,559 135,569 11% -3% Liberty 20,073 2,692 13% 20,835 2,275 11% 21652 2,450 11% -4% Matagorda 9,376 1,170 12% 9,483 1,101 11% 9,829 1,061 11% -3% Montgomery 143,528 14,982 10% 147,950 12,761 9% 154,979 15,133 10% -2% Walker 11,029 1,463 13% 11,009 1,121 10% 11,213 1,183 11% -3% Waller 11,726 1,726 15%* 12,078 1,625 13%* 12,492 1,678 13% -3% Wharton 10,745 1,407 13% 10,809 1,458 13%* 11,177 1,379 12% -4% Region 6 1,824,899 215,117 12% 1,855,495 187,975 10% 1,924,418 191,347 10% Texas 7,224,377 857,022 12% 7,300,000 747,567 10% 7,559,241 735,079 10% -3% Note. *Highest percentage of uninsured children. **Lowest percentage of uninsured children. †Largest five-year change in percent uninsured. ††Smallest five-year change in percent uninsured.
P a g e 22 | 157
PRC 6 RNA 2019
Figure 13. Region 6 county-level five-year trends of percentages of uninsured children: 2012, 2013, 2014, 2015, 2016 100%
90%
80%
70%
60%
50%
40%
30% Percent Uninsured Children Uninsured Percent 20%
10%
0% 2012 2013 2014 2015 2016 Year
Austin Brazoria Chambers Colorado Fort Bend Galveston Harris Liberty Matagorda Montgomery Walker Waller Wharton Region 6 Texas
P a g e 23 | 157
PRC 6 RNA 2019
Catastrophic Events: Hurricane Harvey Parts of Region 6 were devastated in late August and early September of 2017 by Hurricane Harvey. Catastrophic rain-induced flooding in southeast Texas and the Houston metropolitan area resulted in $125 billion dollars in damages. Harvey impacted the region in ways that are just beginning to evidence themselves through possible disruptions in what would have otherwise been already predicted trajectories or trends in data. Hurricane Harvey rivalled only Hurricane Katrina in 2005 as the second costliest hurricanes or natural disasters in US history. Hurricane Harvey forced 39,000 people out of their homes and into shelters, damaged 204,000 homes, and 738,000 people registered for assistance with the Federal Emergency Management Administration.36 3738 Community Domain Child Homelessness There is an increased risk for substance use and misuse in children who experience homelessness or transient situations. Research indicates that a homeless child is 60 percent more likely to use drugs in his or her lifetime, compared with a child who does not experience homelessness.39 Many children who experience homelessness, also experience chronic absenteeism and increased school mobility which contributes to disruptions in learning, lower school achievement, and an increased risk of dropping out of school. These students also face significant gaps in high school graduation compared to their peers who do not experience homelessness.
In 2018, individuals under the age of 18 made up 20.2 percent (111,592) of the national homeless population and individuals in the age range of 18-24 made up 8.7 percent (48,319) of the national homeless population.40 In Region 6 during the 2019 school year, 19,721 students were identified as homeless in public schools. As Table 11 shows, Region 6 saw a significant increase of over 25,000 students identified as experiencing homeless over the course of the 2017-2018 school year,41 which occurred at the beginning of the school year during which Hurricane Harvey devastated several counties in the Region 6 area. The number of students experiencing homelessness dropped back down over 25,000 students to 19,721 students experiencing homelessness during the 2018-2019 school year. Figure 14 illustrates the Region 6 county-level trends in percentage of enrolled students experiencing homelessness for 2016-2017, 2017-2018, and 2018-2019. Figure 15 illustrates the Region 6 county-level
36 Hunn, D, Dempsey, M, Zaveri, M. Harvey’s floods: most homes damaged by Harvey were outside flood plain, data show. Houston Chronicle. March 30, 2018. https://www.houstonchronicle.com/news/article/In-Harvey-s-deluge-most-damaged-homes-were-12794820.php. Accessed July 19, 2019. 37 Amadeo, K. Hurricane Harvey facts, damage and costs: what made Harvey so devastating? The Balance. Updated June 25, 2019. https://www.thebalance.com/hurricane-harvey-facts-damage-costs-4150087. Accessed July 19, 2019. 38 Moravec, ER. Texas officials: Hurricane Harvey death toll at 82, ‘mass casualties have absolutely not happened.’ September 14, 2017. https://www.washingtonpost.com/national/texas-officials-hurricane-harvey-death-toll-at-82-mass-casualties-have-absolutely-not- happened/2017/09/14/bff3ffea-9975-11e7-87fc-c3f7ee4035c9_story.html?utm_term=.6b808589cd3b. Accessed July 19, 2019. 39 Embleton L, Mwangi A, Vreeman R, Ayuku D, Braitstein P. The epidemiology of substance use among street children in resource- constrained settings: a systematic review and meta-analysis. Journal of Addiction. 2013. 40 U.S. Department of Housing and Urban Development, Office of Community Planning and Development. The 2018 Annual Homeless Assessment Report (AHAR) to Congress https://files.hudexchange.info/resources/documents/2018-AHAR-Part-1.pdf, Published December, 2018. Accessed July 19, 2019.
P a g e 24 | 157
PRC 6 RNA 2019
trends in student enrollment totals for 2014-2015, 2015-2016, 2016-2017, 2017-2018, and 2018-2019 school years.
Table 11. Region 6 county-level child homelessness and year-end enrollment rates: 2017, 2018, 201942 2017 2018 2019 Enroll- Home- % Enroll- Home- % Enroll- Home- % ment less Home- ment less Home- ment less Home- less less less
Austin 5,885 30 0.5% 5,,900 37 0.6% 5,868 30 0.5% Brazoria 70,609 1,530 2.2% 71,766 3,113 4.3% 72,707 1,303 1.8% Chambers 8,055 80 1.0% 8,247 478 5.8% 8,568 89 1.0% Colorado 3,558 82 2.3% 3,577 139 3.9% 3,609 70 1.9% Fort Bend 111,695 1,103 1.0% 114,256 2,112 1.8% 116,417 1,082 0.9% Galveston 82,828 2,067† 2.5% 83,071 6,619 8.0% 83,109 1,971† 2.4% Harris 909,547 11,717 1.3% 911,170 28,520 3.1% 895,755 13,203 1.5% Liberty 16,259 538 3.3% 16,961 1,604 9.5% 18,124 593 3.3% Matagorda 7,264 75 1.0% 7,150 75 1.0% 7255 82 1.1% Montgomery 10,7257 623 0.6% 110,164 1,642 1.5% 112,348 693 0.6% Walker 8,373 255 3.0% 9,587 378 3.9% 10,360 288 2.8% Waller 10,872 257 2.4% 11,172 229 2.0% 11,,359 167 1.5% Wharton 8,510 77 0.9% 8,369 396 4.7% 8,319 150 1.8% Region 6 135,0712 18,434 1.4% 1361,390 45,342 3.3% 1353,798 19,721 1.5% †Number of homeless students is actually 1-10 students more than represented, here, and are not included due to masked values
42Texas Education Agency. County-level homelessness and year-end enrollment rates. 2017, 2018, 2019. https://rptsvr1.tea.texas.gov/adhocrpt/adspr.html. Accessed July, 2019.
P a g e 25 | 157
PRC 6 RNA 2019
Figure 14. Region 6 county-level percentages of enrolled students experiencing homelessness: TEA, 2016-2017, 2017-2018, 2018-2019
10.0% 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0%
2.0% Homelessness 1.0% 0.0% 2016-2017 2017-2018 2018-2019 Percent of StudentsExperiencing School Year
Austin Brazoria Chambers Colorado Fort Bend Galveston Harris Liberty Matagorda Montgomery Walker Waller Wharton Region 6
Figure 15. Region 6 county-level school enrollment totals: TEA, 2014-2015, 2015-2016, 2016-2017, 2017- 2018, 2018-2019
1000000 900000 800000 700000 600000 500000 400000 300000 200000 100000 StudentEnrollment Totals 0 2015 2016 2017 2018 2019 School Year
Austin Brazoria Chambers Colorado Fort Bend Galveston Harris Liberty Matagorda Montgomery Walker Waller Wharton
P a g e 26 | 157
PRC 6 RNA 2019
Criminal Activity There are several risk factors associated with future development of substance use and misuse within the community domain that can be linked to criminal activity. In the state of Texas, the Department of Public Safety operationalizes criminal activity into two categories or indices: Property Crime Index and Violent Crime Index. The Property Crime Index is used to track and categorize the crimes of burglary, larceny, and auto theft. The Violent Crime Index is used to track and categorize the crimes of murder, rape, robbery, and assault.43 Tables 12-15 display totals and rates of offences per 100,000 population for Property Crime Index and Violent Crime Index, as well as subcategories for each, for each county in Region 6. As of 2018, Harris County ranked highest in the number of property crimes at a rate of 3,141.2.4 offences per 100,000 population, where Austin County ranked lowest at a rate of 825.8 property crime offences per 100,000 population. Liberty County saw the largest five-year change in rate of property crime with a drop of 1,259.5 offences per 100,000 population. Matagorda County showed the smallest amount of five-year change with a drop of 26.9 property crime offences per 100,000 population. Also, as of 2018, Harris County ranked highest in violent crimes at a rate of 740.5 offences per 100,000 population. Colorado County ranked lowest in violent crimes at a rate of 159.7 offences per 100,000 population. Wharton County saw the largest five-year change in Violent Crime Index, rising 124.2 offences per 100,000 population. Galveston County saw the smallest five-year change in Violent Crime Index with an increase in 10.9 offences per 100,000 population. See Tables 13 and 15 for more detailed breakdowns of rates by crime subcategories. See Figures 15 and 16 for five-year trends in offences per 100,000 for Property Crime Index and Violent Crime Index.
43 Texas Department of Public Safety. Texas crime report for 2016, 2017, 2018. http://www.dps.texas.gov/crimereports/13/citCh2.pdf. Accessed July 10, 2019.
P a g e 27 | 157
PRC 6 RNA 2019
Table 12. Region 6 county-level Property Crime Index per 100,000: 2016, 2017, 2018, and five-year change in rate per 100,000 2014-2018 44 2016 2017 2018 2014- 2018 Change Total Rate per Total Rate per Total Rate per County Population Offenses 100,000 Population Offenses 100,000 Population Offenses 100,000 Austin 29,718 406 1,366.1 29,963 324 1,081.3 29,912 247 825.8** -755.1 Brazoria 358,003 5,813 1,623.7 367,132 5,405 1,472.2 373,587 5,405 1,446.8 -299.4 Chambers 35,244 846 2,400.4 36,489 718 1,967.7 37,983 649 1,708.7 -719.6 Colorado 20,806 226 1,086.2** 21,020 205 975.3** 21,225 200 942.3 -265 Fort Bend 702,338 9,190 1,308.5 728,805 8,416 1,154.9 752,245 8,212 1,091.7 -299.6 Galveston 340,859 8,839 2,593.2 349,112 8,380 2,400.4 354,271 7,795 2,200.3 -633 Harris 4,646,498 162,877 3,505.4* 4,702,468 154,912 3,294.3* 4,753,437 149,315 3,141.2* -683.8 Liberty 80,209 1,699 2,118.2 25,306 686 2,710.9 84,637 1,428 1,687.2 -1,259.5† Matagorda 36,674 1,228 3,348.4 37,230 1,002 2,691.4 36,756 1,104 3,003.6 -26.9†† Montgomery 547,297 7,942 1,451.2 567,199 6,823 1,202.9 580,733 7,680 1,322.5 -300.3 Walker 70,997 1,019 1,435.2 71,970 877 1,218.5 72,631 873 1,202 -656.4 Waller 48,644 680 1,398 50,195 663 1,320.9 51,297 779 1,518.6 -278.5 Wharton 41,398 1,094 2,642.6 41,762 911 2,181.5 41,950 723 1,723.5 -252.9 Region 6 6,958,685 201,859 2,900.8 7,028,651 189,322 2,693.6 7,190,664 184,410 2,564.6 Texas 27,821,692 765,537 2,751.6 28,304,596 718,844 2,539.7 28,586,648 675,049 2,361.4 -626.6 *Highest rate of property crime offences per 100,000 population. **Lowest rate of property crime offences per 100,000 population. †Highest five-year change in offences per 100,000 population. ††Lowest five-year change in offences per 100,000 population
44Texas Department of Public Safety. Texas crime report for 2016, 2017, 2018. http://www.dps.texas.gov/crimereports/13/citCh2.pdf. Accessed June 30, 2019. P a g e 28 | 157
PRC 6 RNA 2019
Figure 16. Region 6 county-level five-year trends in Property Crime Index: 2014, 2015, 2016, 2017, 201845
4500.0
4000.0
3500.0
3000.0
2500.0
2000.0
1500.0
1000.0 Offences per 100,000 Population per100,000 Offences 500.0
0.0 2014 2015 2016 2017 2018 Year Austin Brazoria Chambers Colorado Fort Bend Galveston Harris Liberty Matagorda Montgomery Walker Waller Wharton
45 Texas Department of Public Safety. Texas crime report for 2016, 2017, 2018. http://www.dps.texas.gov/crimereports/13/citCh2.pdf. Accessed June 30, 2019. P a g e 29 | 157
PRC 6 RNA 2019
Table 13. Region 6 county-level Property Crime Index, subcategories of burglary, grand larceny, and auto theft per 100,000: 201846 Burglary Grand Larceny Auto Theft Rate per Rate per Rate per County Total Population Offenses 100,000 Offenses 100,000 Offenses 100,000 Austin 29,912 82 274.1 136 454.7** 29 9.7** Brazoria 373,587 798 213.6 4,227 1,131.5 380 101.7 Chambers 37,983 124 326.5 514 1,353.2 11 29 Colorado 21,225 37 174.3 135 636.0 28 131.9 Fort Bend 752,245 1,142 151.8** 6,594 876.6 476 63.3 Galveston 354,271 1,250 352.8 5,851 1,651.6 694 195.9 Harris 4,753,437 25,544 537.4 104,532 2,199.1* 19,239 404.7* Liberty 84,637 333 393.4 923 1,090.5 172 203.2 Matagorda 36,756 264 718.3* 794 2,160.2 46 125.1 Montgomery 580,733 1,342 231.1 5,644 971.9 694 119.5 Walker 72,631 181 249.2 622 856.4 70 96.4 Waller 51,297 175 341.2 563 1,097.5 41 79.9 Wharton 41,950 161 383.8 524 1,249.1 38 90.6 Region 6 7,190,664 31,433 437.1 131,059 1,822.6 21,918 304.8 Texas 28,586,648 116,869 408.8 489,467 1,712.2 675,049 2,361.4 *Highest rate of property crime offences per 100,000 population. **Lowest rate of property crime offences per 100,000 population. †Highest five-year change in offences per 100,000 population. ††Lowest five-year change in offences per 100,000 population.
46 Texas Department of Public Safety. Texas crime report for 2016, 2017, 2018. http://www.dps.texas.gov/crimereports/13/citCh2.pdf. Accessed June 30, 2019. P a g e 30 | 157
PRC 6 RNA 2019
Table 14. Region 6 county-level Violent Crime Index per 100,000: 2016, 2017, 2018 47 2016 2017 2018 2014-2018 change Total Rate per Total Rate per Total Rate per County Population Offenses 100,000 Population Offenses 100,000 Population Offenses 100,000 Austin 29,718 60 201.9 29,963 49 163.5 29,912 46 153.8 -120.9 Brazoria 358,003 666 186 367,132 636 173.2 373,587 614 164.4 -12.1 Chambers 35,244 149 422.8 36,489 104 285.0 37,983 61 160.6 -109.5 Colorado 20,806 53 254.7 21,020 61 290.2 21,225 24 113.1** -73.7 Fort Bend 702,338 1,248 177.7 728,805 1,400 192.1 752,245 1,456 193.6 -27.5 Galveston 340,859 1,005 294.9 349,112 939 269.0 354,271 993 280.3 +10.9†† Harris 4,646,498 34,814 749.3** 4,702,468 36,511 776.4** 4,753,437 35,200 740.5* +15.4 Liberty 80,209 306 381.5 25,306 135 533.5 84,637 271 320.2 -118.4 Matagorda 36,674 135 368.2 37,230 175 470.1 36,756 159 432.6 +106.8 Montgomery 547,297 874 159.7* 567,199 871 153.6* 580,733 1,163 200.3 +28.6 Walker 70,997 265 373.3 71,970 233 323.8 72,631 202 278.1 +101.9 Waller 48,644 162 333 50,195 155 308.9 51,297 203 395.7 -35 Wharton 41,398 173 418 41,762 169 404.7 41,950 141 336.1 +124.2† Region 6 6,821,555 38,230 560.4 7,028,651 41438 589.6 7,190,664 405,33 563.7 Texas 27,821,692 120,652 433.7 28,304,596 123,211 435.3 28,586,648 118,645 415.0 -10.8 *Highest rate of property crime offences per 100,000 population. **Lowest rate of property crime offences per 100,000 population. †Highest five-year change in offences per 100,000 population. ††Lowest five-year change in offences per 100,000 population.
47 Texas Department of Public Safety. Texas crime report for 2016, 2017, 2018. http://www.dps.texas.gov/crimereports/13/citCh2.pdf. Accessed June 30, 2019. P a g e 31 | 157
PRC 6 RNA 2019
Figure 16. Region 6 county-level five-year trends in Violent Crime Index: 2014, 2015, 2016, 2017, 2018
900
800
700
600
500
400
300 Offences Offences per 100,000Population
200
100
0 2014 2015 2016 2017 2018 Year
Austin Brazoria Chambers Colorado Fort Bend Galveston Harris Liberty Matagorda Montgomery Walker Waller Wharton
P a g e 32 | 157
PRC 6 RNA 2019
Table 15. Region 6 county-level Violent Crime Index, subcategories of murder, rape, robbery, and assault per 100,000: 201848 Murder 2018 Rape 2018 Robbery 2018 Assault 2018 Total Rate per Rate per Rate per Rate per County Population Offenses 100,000 Offenses 100,000 Offenses 100,000 Offenses 100,000 Austin 29,912 0 0* 11 67.5 3 10.0 32 107 Brazoria 373,587 4 1.1 129 34.5 107 28.6 374 100.1 Chambers 37,983 3 7.9 4 10.5* 10 26.3 44 115.8 Colorado 21,225 0 0* 5 23.6 2 9.4* 17 80.1* Fort Bend 752,245 14 1.9 216 28.7 285 37.9 941 125.1 Galveston 354,271 25 7.1 234 66.1 225 63.5 509 143.7 Harris 4,753,437 378 8 2,224 46.8 11,558 243.2** 21,040 442.6** Liberty 84,637 2 2.4 53 62.6 24 28.4 192 226.9 Matagorda 36,756 5 13.6* 21 57.1 22 59.9 111 302 Montgomery 580,733 14 2.4 188 32.4 197 33.9 764 131.6 Walker 72,631 1 1.4 37 50.9 20 27.5 144 198.3 Waller 51,297 1 1.9 53 103.3* 21 40.9 128 249.5 Wharton 41,950 3 7.2 17 40.5 8 19.1 113 269.4 Region 6 7,148,714 447 6.3 3,175 44.4 12,474 174.5 24296 339.9 Texas 28,586,648 1,324 4.6 14,866 52.0 28,272 99 74183 259.5 *Lowest rate per 100,000 population **Highest rate per 100,000 population
48Texas Department of Public Safety. Texas crime report for 2016. http://www.dps.texas.gov/crimereports/13/citCh2.pdf. Accessed June 30, 2019. P a g e 33 | 157
PRC 6 RNA 2019
Drug Seizures and Drug Trafficking The Houston High Intensity Drug Trafficking Area (HIDTA) division of the Drug Enforcement Agency (DEA), within Region 6, provides a very important source of information regarding drug trafficking and money laundering organizations in the Houston HIDTA. Figure 17 highlights the 17 counties in the Houston HIDTA region: Aransas, Austin, Brazoria, Brooks, Fort Bend, Galveston, Harris, Jefferson, Jim Wells, Kennedy, Kleberg, Liberty, Montgomery, Nueces, Refugio, Walker, and Victoria. The Region 6 counties involved in the Houston HIDTA are Austin, Brazoria, Fort Bend, Galveston, Harris, Liberty, Montgomery, and Walker Counties.
Figure 17. Houston HIDTA designated counties
Adapted from Houston Investigative Support Center. 2018 Houston High Intensity Drug Trafficking Area (HIDTA) Threat Assessment. Office of National Drug Control Policy. 2018; p. 6.
P a g e 34 | 157
PRC 6 RNA 2019
According to the 2019 Houston HIDTA Drug Threat Assessment, more cocaine is seized than any other drug type with the exception of marijuana in this region. Marijuana is being transported into the Houston HIDTA by way of the US postal system or driven across state lines from states in which marijuana is legal, indoor hydroponic marijuana grow operations, which are many and typically run by Asian criminal groups and individuals, and outdoor grow operations thought to be run by Mexican nationals who possibly have links to Mexican cartels. Houston HIDTA’s highway systems rank highest in methods of transport in. Other methods for transport into the region include backroad routes, maritime passage along the Intercostal Waterway, and the region’s large commercial airports.49 Figure 18 displays a map of hydroponic marijuana grow houses in the Houston area, just some of the locations seized as a result of an eight-year investigation, called Operation Greenhouse Effect, into a large Asian drug trafficking organization.
Figure 18. Map of hydroponic marijuana grow houses seized as a result of Operation Greenhouse Effect
Adapted from Houston Investigative Support Center. 2018 Houston High Intensity Drug Trafficking Area (HIDTA) Threat Assessment. Office of National Drug Control Policy. 2018.
49 Houston Investigative Support center. 2018 Houston High Intensity Drug Trafficking Area (HIDTA) Threat Assessment. Office of National Drug Control Policy. 2018.
P a g e 35 | 157
PRC 6 RNA 2019
One of this year’s more concerning HIDTA drug seizures was one involving a 100 pounds of methamphetamine. However, the 170 grams of a gray compressed powder, which turned out to be the the dangerous synthetic opioids fentanyl and carfentanil, was also confiscated during that seizure. The Houston Investigative Support Center in Houston indicates in a bulletin published for officer safety purposes, that this is the first seizure of its kind by the agency, although similar seizures have been identified by intelligence in other states and on the street. This mixture of these illicit and incredibly lethal substances have been referred to as “Gray Death” due to its concrete-like appearance.50
If one’s goal is to follow drug seizure data from a more local perspective, Texas Department of Public Safety (TxDPS) keeps an online current repository of every local law enforcement agency’s drug seizures for each county. Reporting on the actual seizure data for each law enforcement agency for each county in Region 6 is outside the scope of this RNA due to its extensive nature – Harris county, alone, has 44 law enforcement agencies for which separate drug seizure reports are updated on a monthly basis by the Texas DPS. This data and downloadable reports for each law enforcement agency are available at https://txucr.nibrs.com/Report/DrugSeized. A printout of drug seizure data for Houston Police Department is included in Appendix E as an example.51
Availability Alcohol Retail Licenses and Sales Violations High availability has been defined as the “high number of alcohol outlets in a defined geographical area or per a sector of the population.”52 Since the purchase of alcohol is legal for persons over the age of 20 in Texas, and most individuals with SUDs indicate that their addiction began during their adolescent or young adult years, it is important to address accessibility of alcohol by looking at the number of alcohol retailers holding active current permits in each county, as well as the density of such permits per square mile in each county. Table 16 displays the variable of active current permit and density of permit for each county in Region 6. Totals of active current alcohol retailer permits range from 94 permits in Colorado County to 10,804 permits in Harris County. The permit density per square mile ranges from .1 permit per square mile for Colorado and Wharton Counties, to 6.4 permits per square mile in Harris County.
50 Houston Investigative Support center. 2018 Houston High Intensity Drug Trafficking Area (HIDTA) Threat Assessment. Office of National Drug Control Policy. 2018. 51Texas Department of Public Safety Crime in Texas Online. Drugs seized reports. https://txucr.nibrs.com/Report/DrugSeized. Accessed July 25, 2017. 52 U.S. Department of Health and Human Services. Facing addiction in America: the surgeon general’s report on alcohol, drugs, and health. https://addiction.surgeongeneral.gov/. Published 2017. Accessed July 30, 2017.
P a g e 36 | 157
PRC 6 RNA 2019
Table 16. Region 6 county-level counts of active alcohol sales permits and permit density per square mile: 201953
License Status - Total Land Area Permit Density County Current (Square Miles) (per Square Mile) Austin 106 646.49 .2 Brazoria 647 1,357.81 .5 Chambers 129 597.15 .2 Colorado 94 960.29 .1** Fort Bend 1,105 861.84 1.3 Galveston 1,045 378.95 2.8 Harris 10,804 1,704.86 6.4* Liberty 174 1,158.45 .2 Matagorda 159 1,092.90 .2 Montgomery 1,174 1,041.92 1.1 Walker 129 784.19 .2 Waller 125 513.34 .2 Wharton 144 1,086.15 .1** Region 6 15,835 12,184.31 1.3 Texas 58,139 261,250.0 4.5 *Highest permit density per square mile **Lowest permit density per square mile
53 Texas Alcoholic Beverage Commission. https://www.tabc.texas.gov/PublicInquiry/RosterSummary.aspx. Accessed April 4, 2019.
P a g e 37 | 157
PRC 6 RNA 2019
School Domain Dropout Rates In Chapter 3 of the U.S. Surgeon General’s (2017) report on addiction, risk factors that occur in the school domain are listed and defined. Academic failure, particularly that which begins occurring in late elementary school, as well as lack of commitment to school, have been linked to school dropout rates, which in turn, may increase risk for the development of substance use and misuse problems and vice versa.54 High school and college completion, or the lack thereof, play a key role in income inequality in Region 6. In the Gulf Coast, specifically, local jobs requiring a bachelor’s degree pay on average $28 dollars more per hour than other regional jobs.55 Table 17 displays dropout rates for each county in Region 6, for 2015, 2016, and 2017.56 As of 2017, Walker County had the highest high school dropout rate at 11.2 percent and Chambers County had the lowest high school dropout rate at .8 percent.
School Discipline and Alcohol and Drugs on School Property In the Surgeon General’s report on addiction, the lack of commitment to school is described as a breakdown in the student’s ability to see his or her role as meaningful and rewarding. Table 18 shows county-level school expulsion and suspension counts for 2016, 2017, and 2018 in Region 6.
Two indicators on the TSS provide some insight into the possible behaviors associated with such a lack of investment or commitment to school. The first indicator consists of questions that elicit self-reports of conduct problems and absenteeism in students who identify as users and non-users of alcohol and marijuana (see Table 1957. The second indicator, alcohol and drugs on school property, can be inferred from students’ self-reports regarding the number of days they attended classes while drunk on alcohol, high from marijuana use, or high from some other drug (see Figures 19-22 for 2016 and 2018 comparison).58 Table 20 displays county-level school alcohol and drug violation data, as well, for the 2016-2017 school year.
54 U.S. Department of Health and Human Services. Facing addiction in America: the surgeon general’s report on alcohol, drugs, and health. https://addiction.surgeongeneral.gov/. Published 2017. Accessed July 30, 2017. 55 Texas Comptroller of Public Accounts. Regional Snapshot: Gulf Coast Region. https://comptroller.texas.gov/economy/docs/regions/region- 5.pdf. Published 2015. Accessed July 30, 2017. 56Texas Education Agency. Completion, Graduation, and Dropouts. https://tea.texas.gov/acctres/dropcomp/years.html.. Published December 14, 2017. Accessed April 24, 2018. 57 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report. Accessed July 25, 2019. 58 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 38 | 157
PRC 6 RNA 2019
Table 17. Region 6 county-level dropout rates: 2015, 2016, 201759 2015 2016 2017 Graduate Drop Graduate Drop Out Graduate Drop % Out % % % % Out % Austin 95.7% 3.3% 94.1% 4.7% 96.8% 1.8% Brazoria 93.2% 2.8% 93.7% 2.2% 93.8% 2.2% Chambers 98.2% 0.2%** 98.4% 0.2%** 97.7% 0.8%** Colorado 92.6% 3% 85.9% 6.7% 80.2% 7.5% Fort Bend 93.2% 3.4% 92.9% 3.8% 93.6% 3.4% Galveston 91.9% 4% 91.7% 3.9% 92.3% 3.8% Harris 87% 7.8% 86.7% 8% 87.2% 7.8% Liberty 90.8% 5.5% 91.6% 5.6% 91.2% 5.4% Matagorda 92.9% 5.6% 91.6% 4.7% 92.7% 4.1% Montgomery 92.4% 3.6% 91.5% 3.8% 92.8% 3.3% Walker 79.3% 7.9%* 77.1% 10.3%* 76.7% 11.2%* Waller 94.2% 2.9% 94.7% 2.4% 95.1% 2.6% Wharton 95.0% 3.1% 96.3% 1.7% 96.0% 2.2% Region 6 88.9% 6.3% 88.5% 6.5% 89.1% 6.3% Texas 93.7% 6.3% 93.8% 6.2% 82.8% .3%, 1.9%, 1.4%† Note. Graduate % only includes information on graduates, continued education programs, and those students holding General Education Diplomas (GED). * Highest dropout rate. **Lowest dropout rate.†TEA reported 2017 dropout data by the grade ranges of Grades 7-8, Grades 9-12, and Grades 7-12
59Texas Education Agency. Completion, graduation, and dropout rates. Texas Education Agency. https://tea.texas.gov/acctres/dropcomp/years.html. Published December 14, 2017. Accessed April 8, 2018 and April 11, 2019.
P a g e 39 | 157
PRC 6 RNA 2019
Table 18. Region 6 county-level school expulsion and suspension counts: 2016, 2017, 201860 2016 2017 2018 Year-End Expulsion Suspension Year-End Expulsion Suspension Year-End Expulsion Suspension Enrollment Count Count Enrollment Count Count Enrollment Count Count Austin 6,265 0 2,443 6,289 -- 2,456 6,247 -- 2,099 Brazoria 71,862 77 18,717 74,124 80 18,254 75,190 83 18,215 Chambers 8,260 -- 1,767 8,528 0 1,569 8,723 -- 1,670 Colorado 3,861* -- 1,391 3,977* -- 1,563 3,927 0 1,242 Fort Bend 114,787 52 19,053 117,345 38 20,326 119,428 40 19,046 Galveston 86,367 66 30,960 86,750 87 32,237 86,751 94 30,233 Harris 938,217** 612 331,374 947,982** 580 325,538 944,967 539 281,383 Liberty 17,001 -- 8,672 17,937 17 7,152 18,606 -- 8,143 Matagorda 7,808 -- 5,179 7,786 -- 4,895 7,639 -- 4,043 Montgomery 110,511 199 28,053 113,495 190 28,224 116,132 208 26,802 Walker 9,067 -- 3,755 9,562 -- 3,966 11,132 -- 4,237 Waller 11,314 -- 4,437 11,620 20 4,290 11,839 -- 3,655 Wharton 8,849 -- 4,212 8,936 -- 4,788 8,702 0 4,096 Region 6 1,394,169 460,013 1,414,331 455,258 1,419,283 404,864 Note. Suspension Count = In-School Suspension and Out-of-School Suspension Counts Combined. No highest and lowest count indicated for Expulsion Counts due to masked or unreported data. -- = masked or unreported data are done so in accordance with TEA procedures.61 *Lowest count **Highest count
60 Texas Education Agency. Year-end enrollment, homelessness enrollment, expulsions, in-school suspensions, and out-of-school suspensions. 2017. Report generated July 5, 2018. 61 Texas Education Agency. 2017 Explanation of Masking Rules. https://rptsvr1.tea.texas.gov/perfreport/account/2017/masking.html. Accessed July 12, 2019. P a g e 40 | 157
PRC 6 RNA 2019
Table 19. Region 5/6 and Texas comparisons of conduct problems at and absences from school, Grades 7-12: TSS, 201862 Average number of days Average number of days conduct problems reported absent Students Region 5/6 Texas Region 5/6 Texas Non-alcohol users 0.9 .8 3.1 3.3 Alcohol users 2.6 2.3 4.4 4.3 Non-marijuana users 1.2 1.0 3.5 3.5 Marijuana users 3.9 3.4 4.5 4.5
Figure 19. Region 5/6 and Texas trends in conduct problems reported, Grades 7-12: TSS, 2014, 2016, 2018
5 4.5 4 3.5 3 2.5 2 1.5
Problems 1 0.5 0 2014 2016 2018
Average Average Number of Conduct Year
Region 5/6 Non-Alcohol Users Texas Non-Alcohol Users Region 5/6 Alcohol Users Texas Alcohol Users Region 5/6 Non-MJ Users Texas Non-MJ Users Region 5/6 MJ Users Texas MJ Users
6262 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2019.
P a g e 41 | 157
PRC 6 RNA 2019
Figure 20. Regions 5 and 6 and Texas report of class attendance while drunk or high, Grades 7-12:TSS, 201663 10.0% 9.0% 8.0% 7.0% Region 5/6 2016 6.0% Texas 2016 5.0% 4.0% 3.6% 3.0% 3.1% 3.0% 2.9% 1.9% 1.4% 1.7% Percent Percent responses 2.0% 1.6% 0.6% 1.0% 1.2% 0.6% 1.0% 0.6% 0.5% 0.4% 0.6% 0.6%0.6% 0.0%
Since school began in the fall, on how many days (if any) have you attended class while drunk on alcohol, high from marijuana use, or high from use of some other drug?
Figure 21. Regions 5 and 6 and Texas report of class attendance while drunk or high, Grades 7-12:TSS, 201864
10.0% 9.0% 8.0% Region 5/6 2018 7.0% 6.0% Texas 2018 5.0% 4.5% 4.1% 4.0% 3.3% 2.9% 3.0% 1.9% Percent Percent responses 1.8% 2.1% 2.0% 1.5% 1.7% 1.3% 0.5% 1.0% 0.7% 0.5%0.4%0.4% 0.7% 0.5%0.6% 0.0%
Since school began in the fall, on how many days (if any) have you attended class while drunk on alcohol, high from marijuana use, or high from use of some other drug?
63 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016 HHSC Region 5 and 6 Report. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2018. 64 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016 HHSC Region 5 and 6 Report. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2018.
P a g e 42 | 157
PRC 6 RNA 2019
Figure 22. Regions 5 and 6 and Texas percentage of students reporting attending class while drunk on alcohol, high from marijuana use, or high from use of some other drug, Grades 7-12; TSS 2014, 2016, 201865
9.00% 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00%
Percent of StudentResponses 0.00% 2014 2016 2018 Year
Alcohol Region 5/6 Alcohol Texas Marijuana Region 5/6 Marijuana Texas Other Drug Region 5/6 Other Drug Texas
Table 20. Region 6 county-level school alcohol and controlled substance violation data: 2016-201766
65 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2019. 66Texas Education Agency. County-level alcohol and controlled substance violation data, 2016-2017. http://tea.texas.gov . Report generated July 17, 2018.
P a g e 43 | 157
PRC 6 RNA 2019
Alcohol Violation Controlled Substance Violation Student Count Incident Count Student Count Incident Count Austin 0 0 16 12 Brazoria 68 39 211 190 Chambers ------Colorado ------Fort Bend 72 62 392 379 Galveston -- -- 370 354 Harris 488 338 3,819 3,439 Liberty 36 21 98 74 Matagorda -- -- 26 24 Montgomery 143 90 387 344 Walker -- -- 28 28 Waller -- 22 -- -- Wharton -- -- 33 31 Note. -- = Masked or missing data.
P a g e 44 | 157
PRC 6 RNA 2019
Family Domain Parental Approval of Consumption One of the strongest predictors of substance use and misuse in youth is favorable parental attitudes to drug use and approval of drinking and drug use. Figures 23-28 display the breakdown of students’ perceptions of their parents’ approval of consuming alcohol, marijuana, and tobacco products, comparing the distribution of responses in 2018 with those in 2016 TSS data collection wave.67
Figure 23. Region 5/6 and Texas students’ perceptions of parental attitudes toward consumption of alcohol, Grades 7-12: TSS, 201668 100.0% 80.0% Region 5/6 2016 61.4% 64.9% 60.0% Texas 2016 40.0% 13.4%13.7% 12.0% 20.0% 10.7% 4.0% 8.0%6.3% 3.3% 1.2% 1.1% Percent Percent responses 0.0% Strongly Mildly Neither Mildly Strongly Do Not Disapprove Disapprove Approve Approve Know How do your parents feel about kids your age drinking …
Figure 24. Region 5/6 and Texas students’ perceptions of parental attitudes toward consumption of alcohol, Grades 7-12: TSS, 201869
100.0% 90.0% 80.0% Region 5/6 2018 70.0% 60.5%62.0% 60.0% Texas 2018 50.0% 40.0% 30.0% 14.6% 13.8% 20.0% 14.4% 12.3% 6.5% Percent Percent responses 4.0%3.9% 6.2% 10.0% 1.0% 1.0% 0.0% Strongly Mildly Neither Mildly Strongly Do Not Disapprove Disapprove Approve Approve Know How do your parents feel about kids your age drinking alcohol?
67 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report. Accessed July 25, 2019. 68 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report. Accessed July 25, 2019. 69 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report. Accessed July 25, 2019.
P a g e 45 | 157
PRC 6 RNA 2019
Figure 25. Region 5/6 and Texas comparisons of students’ perceptions of parental attitudes toward use of tobacco, Grades 7-12: TSS, 201670
100.0% 90.0% 78.4% 80.0% 75.8% Region 5/6 2016 70.0% 60.0% Texas 2016 50.0% 40.0% 30.0%
Percent Percent responses 20.0% 7.5% 6.5% 8.1%6.5% 10.0% 7.4% 5.9% 1.1%1.0% 0.9% 0.8% 0.0% Strongly Mildly Neither Mildly Strongly Do Not Disapprove Disapprove Approve Approve Know How do your parents feel about kids your age using tobacco?
Figure 26. Region 5/6 and Texas comparisons of students’ perceptions of parental attitudes toward use of tobacco, Grades 7-12: TSS, 201871
100.0% 90.0% 78.9%78.3% 80.0% Region 5/6 2018 70.0% 60.0% Texas 2018 50.0% 40.0% 30.0%
Percent Percent responses 20.0% 7.0% 6.1% 6.8% 10.0% 7.5% 5.9% 0.7%0.9% 0.6% 0.6% 0.6% 0.0% Strongly Mildly Neither Mildly Strongly Do Not Disapprove Disapprove Approve Approve Know How do your parents feel about kids your age using tobacco?
70 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 71 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 46 | 157
PRC 6 RNA 2019
Figure 27. Region 5/6 and Texas comparisons of students’ perceptions of parental attitudes toward use of marijuana, Grades 7-12: TSS, 201672
100.0% 90.0% 78.1%79.0% 80.0% Region 5/6 2016 70.0% 60.0% Texas 2016 50.0% 40.0% 30.0%
Percent Percent responses 20.0% 5.4% 7.6%6.2% 10.0% 5.8%6.1% 5.9% 1.3%1.4% 1.8% 1.5% 0.0% Strongly Mildly Neither Mildly Strongly Do Not DisapproveDisapprove Approve Approve Know How do your parents feel about kids your age using marijuana?
Figure 28. Region 5/6 and Texas comparisons of students’ perceptions of parental attitudes toward use of marijuana, Grades 7-12: TSS, 201873
100.0% 90.0% 80.0% 76.2%76.5% Region 5/6 2018 70.0% 60.0% Texas 2018 50.0% 40.0% 30.0%
Percent Percent responses 20.0% 7.2% 7.4% 6.3%6.5% 10.0% 6.1% 7.0% 1.8%1.9% 1.1% 1.3% 0.0% Strongly Mildly Neither Mildly Strongly Do Not Disapprove Disapprove Approve Approve Know
How do your parents feel about kids your age using marijuana?
72 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 73 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 47 | 157
PRC 6 RNA 2019
Peer Domain Cultural Norm and Youth Perceptions of Peer Consumption When evaluating the risk factors that contribute to certain risky behaviors (in this case, substance misuse behaviors), there are many factors external to an individual that can increase the likelihood that individual would engage in those risky behaviors, one of those risk factors being cultural or social norm. Although many risk factors impose a predisposition to substance use and misuse, perceptions of one’s peers’ engagement in such risky behaviors can be quite influential on that individual’s inclination to do the same. Figures 29-34 display students’ perceptions of how many of their close friends use alcohol, tobacco, and marijuana for 2016 and 2018 for comparison of distribution of responses.74
Figure 29. Regions 5/6 and Texas, perception of peer consumption of alcohol, Grades 7-12: TSS, 201675
100.0% Region 5/6 2016 80.0% Texas 2016 60.0% 47.7%49.5% 40.0% 23.2% 23.3% 20.0% 13.7%13.8% 11.5%10.3%
4.0%3.1% Percent Responses 0.0% None Few Some Most All How many of your close friends use alcohol ? Figure 30. Regions 5/6 and Texas, perception of peer consumption of alcohol, Grades 7-12: TSS, 201876 100.0% Region 5/6 2018 80.0% Texas 2018 60.0% 48.6%48.4% 40.0% 24.2%23.8% 20.0% 13.5%14.0% 10.4%10.5% 3.3%
Percent Responses 3.2% 0.0% None Few Some Most All
How many of your close friends use alcohol ?
74 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 75 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 76 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016 HHSC Region 5 and 6 Report. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2018.
P a g e 48 | 157
PRC 6 RNA 2019
Figure 31. Regions 5/6 and Texas, perception of peer consumption of tobacco, Grades 7-12: TSS, 201677
100.0% 90.0% Region 5/6 2016 80.0% 68.4% Texas 2016 70.0% 66.0% 60.0% 50.0% 40.0% 30.0% 20.2%19.1%
Percent Responses 20.0% 7.8% 10.0% 8.4% 4.2% 3.7% 1.2%1.0% 0.0% None Few Some Most All
How many of your close friends use tobacco ?
Figure 32. Regions 5/6 and Texas, perception of peer consumption of tobacco, Grades 7-12: TSS, 201878
100.0% 90.0% Region 5/6 2018 80.0% 70.8%70.1% 70.0% Texas 2018 60.0% 50.0% 40.0% 30.0%
Percent Responses 20.0% 18.2%18.1% 7.3% 10.0% 7.2% 3.1% 3.6% 0.7%0.9% 0.0% None Few Some Most All
How many of your close friends use tobacco?
77 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 78 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016 HHSC Region 5 and 6 Report. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2018.
P a g e 49 | 157
PRC 6 RNA 2019
Figure 33. Regions 5/6 and Texas, perception of peer consumption of marijuana, Grades 7-12: TSS, 201679
100.0% 90.0% 80.0% 70.0% Region 5/6 2016 58.8% 58.6% 60.0% Texas 2016 50.0% 40.0% 30.0% 20.0% 19.0% Percent Responses 20.0% 10.9% 10.6% 8.5% 10.0% 7.6% 2.9% 3.0% 0.0% None Few Some Most All
How many of your close friends use marijuana?
Figure 34. Regions 5/6 and Texas, perception of peer consumption of marijuana, Grades 7-12: TSS, 201880
100.0% 90.0% 80.0% 70.0% Region 5/6 2018 60.0% 56.1%56.9% Texas 2018 50.0% 40.0% 30.0% 18.9%
Percent Responses 19.4% 20.0% 11.6%11.2% 10.0%9.5% 10.0% 3.4%3.0% 0.0% None Few Some Most All
How many of your close friends use marijuana?
79 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 80 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 50 | 157
PRC 6 RNA 2019
Perceived Access to Alcohol, Tobacco, Marijuana, and Prescription Drugs SAMHSA specifically cites norms and laws favorable to substance use as a key risk factor for potential substance use and misuse. Figures 35-36 displays adolescents’ perceptions of how easy it is for them to obtain alcohol, tobacco, and marijuana, again, providing data from 2016 and 2018 TSS data waves for comparisons of distribution in responses.
Figure 35. Region 5/6 and Texas comparisons, perceived accessibility to alcohol, tobacco, and marijuana, Grades 7-12: 201681
100% 90% Somewhat/Very 33.3% Easy 80% 36.1% 34.8% 32.2% 46.8% 46.9% Very/Somewhat 70% Difficult 60% 16.0% 14.4% 17.2% 17.1% Impossible 50% 15.… 17.2% Never 40% 20.3% 21.8% 22.8% 24.1% 30% 13.4% 14.5% 20% 29.1% 28.9% 10% 24.… 21.4% 26.2% 25.4%
0% % Responses of Responses Ease Category % per Alcohol, Alcohol, Tobacco, Tobacco, Marijuana,Marijuana, Region 5/6 Texas Region 5/6 Texas Region 5/6 Texas
If you wanted some, how easy would it be to get alcohol? tobacco? marijuana? Figure 36. Region 5/6 and Texas comparisons, perceived accessibility to alcohol, tobacco, and marijuana, Grades 7-12: 201882
100% Very/Somewhat Easy 35.0% 90% Very/Somewhat Difficult 33.5% 80% 46.9% 34.1% 33.9% 46.8% Impossible 70% Never 60% 14.5% 16.4% 15.1% 16.8% 50% 15.… 16.6% 40% 19.4% 19.3% 20.4% 24.1% 30% 13.1% 13.1% 20% 32.0% 30.3% 29.5% 10% 24.… 23.5% 28.8%
% Responses of Responses Ease Category % per 0% Alcohol, Alcohol, Tobacco, Tobacco, Marijuana,Marijuana, Region 5/6 Texas Region 5/6 Texas Region 5/6 Texas If you wanted some, how easy would it be to get alcohol? tobacco? marijuana?
81 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 82 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 51 | 157
PRC 6 RNA 2019
Social Hosting and Parties Figures 37 and 38 show percentage of adolescents, questioned about their sources for obtaining alcohol, who indicated they get alcohol from several sources, including home and parties. Less than 10 percent of adolescents report getting alcohol from the store, according to the TSS for 2016 and 2018. The topic of social hosting is a persistent concern, and understandably so as Figures 39 and 40 display students’ perceived availability of alcohol at parties they have reported attending. Figures 40 and 41 displays students’ perceived availability of marijuana and/or other drugs at parties they have reported attending. Figure 43 displays sources from which adolescents most frequently obtain prescription pain relievers, ages 12-17, as reported in the National Survey on Drug Use and Health for 2017 where 57 percent of youth ages 12-17 report getting prescription pain relievers from friends or family.83
83 Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD. 2018. https://www.samhsa.gov/data/sites/default/files/cbhsq- reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.pdf. Accessed July 21, 2019.
P a g e 52 | 157
PRC 6 RNA 2019
Figure 37. Regions 5/6 and Texas, accessible sources of alcoholic beverages, Grades 7-12: 2016 84
100.0% 90.0% 80.0% Region 5/6 2016 70.0% Texas 2016 60.0% 50.0% 40.0% 30.6% 30.0% 24.3% 22.4% 26.0%24.2% 27.8%
Percent Percent Responses 17.3% 20.0% 15.8% 9.1% 7.8% 10.0% 0.0% Home Friends Store Parties Other How often, if ever, do you get alcoholic beverages from home? friends? store? parties? other?
Figure 38. Regions 5/6 and Texas, accessible sources of alcoholic beverages, Grades 7-12: 201885
100.0% 90.0% 80.0% Region 5/6 2018 70.0% Texas 2018 60.0% 50.0% 40.0% 27.0% 28.5% 30.0% 24.0% 24.2% 24.3% 27.4%
Percent Percent Responses 20.0% 15.0% 15.1% 8.0% 8.0% 10.0% 0.0% Home Friends Store Parties Other How often, if ever, do you get alcoholic beverages from home? friends? store? parties? other?
84 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 85 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 53 | 157
PRC 6 RNA 2019
Figure 39. Regions 5/6 and Texas, reports of presence of alcohol at parties, Grades 7-12: TSS, 201686 100.0% 90.0% 80.0% 70.0% Region 5/6 2016
60.0% Texas 2016 49.1% 51.0% 50.0% 40.0% 30.0% 17.9%
Percent Responses 17.7% 20.0% 10.9% 7.9% 8.1% 10.3% 10.0% 7.5% 6.3% 5.4% 7.9% 0.0% Never Seldom Half Time Most Time Always Did not Know/Attend
Thinking of the parties you attended this school year, how often was alcohol used?
Figure 40. Regions 5/6 and Texas, reports of presence of alcohol at parties, Grades 7-12: TSS, 201887
100.0% 90.0% 80.0% 70.0% Region 5/6 2018 60.0% 49.5% 50.3% 50.0% Texas 2018 40.0% 30.0% 17.2% 20.0% 18.1% Percent Responses 8.0% 8.9% 8.4% 10.4% 10.4% 10.0% 7.3% 6.4% 5.5% 0.0% Never Seldom Half Time Most Time Always Did not Know/Attend
Thinking of the parties you attended this school year, how often was alcohol used?
86 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 87 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 54 | 157
PRC 6 RNA 2019
Figure 41. Regions 5/ 6 and Texas, reports of presence of marijuana and/or other drugs at parties, Grades 7-12: TSS, 201688 100.0% 90.0% 80.0% 70.0% Region 5/6 60.9%60.9% 2016 60.0% Texas 2016 50.0% 40.0% 30.0%
Percent Responses 17.8% 17.8% 20.0% 6.4% 5.4% 5.9% 10.0% 5.8% 4.5% 4.2% 5.2% 5.3% 0.0% Never Seldom Half Time Most Time Always Did not Know/Attend
Thinking of the parties you attended this school year, how often was marijuana and/or other drugs used?
Figure 42. Regions 5/ 6 and Texas, reports of presence of marijuana and/or other drugs at parties, Grades 7-12: TSS, 201889 100.0% 90.0% 80.0% 70.0% Region 5/6 59.3% 59.7% 2018 60.0% Texas 2018 50.0% 40.0% 30.0% 17.4% 18.3%
Percent Responses 20.0% 6.0% 5.9% 6.1% 10.0% 5.6% 4.8% 4.3% 6.4% 6.1% 0.0% Never Seldom Half Time Most Time Always Did not Know/Attend
Thinking of the parties you attended this school year, how often was marijuana and/or other drugs used?
88 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 89 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 55 | 157
PRC 6 RNA 2019
Figure 43. National, youth reports of where they obtain prescription drugs not prescribed to them, Ages 12-17: NSDUH, 201790
Stole from Doctor's Some Other Way Office, Clinic, or 6% Pharmacy 2%
Prescriptions from More than One Doctor 2% From Friend or Relative for Free 38% Prescription from One Doctor 28%
Bought from Drug Dealer or other Bought from Friend Stranger Stole from Friend or or Relative 5% Relative 12% 7%
90 Substance Abuse and Mental Health Services Administration. Results from the 2016 National Survey on Drug Use and Health: detailed tables. https://www.samhsa.gov/samhsa-data-outcomes-quality/major-data-collections/reports-detailed-tables-2016-NSDUH. Published September 7, 2017. Accessed July 15, 2018.
P a g e 56 | 157
PRC 6 RNA 2019
Individual Domain Mental Health According to the World Health Organization, half of all mental health conditions start by 14 years of age. Yet, most cases go undetected and, therefore, untreated.
Suicide As of 2017, the CDC has identified suicide as the third leading cause of death for youth aged 10-14 and the second leading cause of death for youth ages 15-19, in the US.91 Suicide is the leading cause of death in individuals with SUDs and comorbidity of mental illness and SUDs increase the risk of suicide even further. Table 21 displays the deaths by suicide rates for Region 6 by county for 1999-2017. Austin County had the highest death by suicide rate at 18.1 per 100,000 population. Fort Bend County had the lowest rate of death by suicide at 8.4.92
Table 21. Region 6 county-level incidents of death by suicide per 100,000: 1999-2017 Population Deaths Age-adjusted
Death Rate Austin 516812 95 18.1* Brazoria 5663905 701 12.6 Chambers 620552 79 13.5 Colorado 392484 51 12.8 Fort Bend 10293364 819 8.4** Galveston 5457738 775 14.2 Harris 75396806 7540 10.4 Liberty 1226010 180 14.6 Matagorda 1433296 210 14.8 Montgomery 703980 86 12 Walker 8062463 1153 14.5 Waller 1262702 188 14.7 Wharton 778058 104 13.9 Region 6 112590601 12065 10.7† Texas 461846329 51622 11.4 †Crude rate. *Highest age-adjusted death rate. **Lowest age-adjusted death rate.
91 Centers for Disease Control and Prevention. Web-Based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: National Center for Injury Prevention and Control. Available online: http://www.cdc.gov/injury/wisqars/index.html. 92 Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2017 on CDC WONDER Online Database, released December, 2018. Data are from the Multiple Cause of Death Files, 1999-2017, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Jun 18, 2019.
P a g e 57 | 157
PRC 6 RNA 2019
Depression Figures 44 and 45 help illustrate the magnitude of depression for adults and youth in the US and in Texas. Table provides youth treatment data at the county level for Region 6.
Figure 44. US and Texas depression in adults: BFFRSS 2011-201793
25 20 15 10 5
100,000 0 2011 2012 2013 2014 2015 2016 2017 Texas 16.6 15.5 16 14.6 16.1 12.5 16.7 U.S. 17.5 18 18.7 19 19 17.4 20.5
Adults Reporting Deepression Reporting Adults Deepression per Year
Texas U.S.
Figure 45. US Major Depressive Episode (MDE) and MDE with Severe Impairment in the past year among youths ages 12-17: percentages, 2004-201794
93 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2015. https://www.cdc.gov/brfss/brfssprevalence/. Accessed Mar 13, 2019. 94 Center for Behavioral Health Statistics and Quality. (2018). 2017 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration, Rockville, MD. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq- reports/NSDUHFFR2017/NSDUHFFR2017.pdf. Accessed July 22, 2019.
P a g e 58 | 157
PRC 6 RNA 2019
Table 22. Region 6 county-level youth mental health and substance use treatment: HHSC, 2016-201795
2016 2017 Type of Diagnosis Primary Diagnosis Type of Diagnosis Primary Diagnosis County ACAU MH Dual Other/ ACAU MH Dual Other/ Only MH Not MH SU Only MH Not MH SU Austin 85 82 * 71 14 85 84 * 59 26 Brazoria 272 257 15 229 42 * 247 241 * 208 39 Chambers 23 22 * 22 * 38 36 * 33 * Colorado 103 101 * 92 11 123 120 * 101 22 Fort Bend 756 741 15 608 147 * 874 861 13 656 218 * Galveston 402 383 19 323 78 * 329 314 15 283 45 * Harris 4,854 4,404 450 4,762 87 * 5,431 4,946 485 5,331 91 * Liberty 143 140 * 139 * 165 160 * 156 * Matagorda 181 178 * 147 34 160 160 124 36 Montgomery 1,054 1,005 49 983 69 * 1,241 1,193 48 1,176 63 * Walker 121 117 * 120 * 128 123 * 126 * Waller 127 123 * 114 13 119 115 * 101 18 Wharton 174 170 * 156 17 * 165 162 * 147 18 Region 6 8,295 7,723 572 7,766 9,105 8,515 590 8,501 Note. *Suppressed data due to age of clients. ACAU = Active Authorizations. MH = Mental Health. Dual = Dual Diagnoses.
95 Texas Health and Human Services Commission, Intellectual and Developmental Disability/Behavioral Health Services, Office of Decision Support. (2019). Clinical Management for Behavioral Health Services Data Warehouse (CMBHS), 2014 to 2018 Youth Mental Health and Substance Use Treatment. P a g e 59 | 157
PRC 6 RNA 2019
Regional Consumption Patterns in Youth and Young Adults
Alcohol Age of Initiation and Early Initiation Age of initiation, particularly early age of initiation to a substance, is a highly significant risk factor for developing substance use and misuse issues later in life. In fact, as it was mentioned in the front matter of this RNA, about 90 percent of individuals who develop substance use disorders, first tried a substance before the age of 18. Figure 46 illustrates the average age of initiation of alcohol use, as reported by the grade-level participants in the 2014 and 2018 administration of the TSS. Figure 47 illustrates the early imitation (age of initiation before the age of 13 years old) for the adolescent participants in the 2014 and 2018 administration of the TSS, as well as the 9th through 12th graders who participated in the 2017 administration of the Youth Behavioral Risk Surveillance System (YRBSS) Texas sample.9697
Figure 46. Region 5/6 age of initiation of alcohol: TSS Grades 7-12, 2014, 201898 16
15
14
13
12
11 Age of First Use Alcohol of Use AgeFirst of
10 2014 2018 7th Graders 10.7 10.6 8th Graders 11.2 11.2 9th Graders 12.2 12.2 10th Graders 13.1 13.1 11th Graders 13.9 13.7 12th Graders 14.7 14.9
96 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report. Accessed July 25, 2019. 97 Center for Disease Control and Prevention. High School Youth Risk Behavior Surveillance System (YRBSS). 2017. http://healthdata.dshs.texas.gov/HealthRisks/YRBS. Accessed July 25, 2018. 98 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report. Accessed July 25, 2019.
P a g e 60 | 157
PRC 6 RNA 2019
Figure 47. Region 5 and 6 early initiation to alcohol, under the age of 13: TSS, grades 7-12, 2014, 2018; YRBSS, grades 9-12, 201799100101
100.0%
90.0%
80.0%
70.0%
60.0%
50.0% 40.7% 38.0% 39.7% 40.0% 35.3%
30.0%
20.0% 17.0%
10.0% Percentage of Initiates Under Years 13 0.0% TSS, Grades 7-12, 2014 YRBS, Grades 9-12, 2017 TSS, Grades 7-12, 2018
Region 5/6 Texas
Current use, Lifetime Use, and Current High-risk Use Figure 48 displays the percentages of current use and lifetime use, as reported by the youth who completed the TSS for 2014, 2016, and 2018 in Region 5/6. Figures 49 and 50 provide a more detailed look at high-risk alcohol consumption by eliciting youths’ responses about consuming five or more drinks in a two hour period and how many days (times) they did so during the course of the past 30 days.
99 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report. Accessed July 25, 2019. 100 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Texas State Report. https://www.texasschoolsurvey.org/Report. Accessed July 25, 2019. 101 Center for Disease Control and Prevention. High School Youth Risk Behavior Surveillance System (YRBSS). 2017. http://healthdata.dshs.texas.gov/HealthRisks/YRBS. Accessed July 25, 2018.
P a g e 61 | 157
PRC 6 RNA 2019
Figure 48. Region 5/6 and Texas comparisons of indicators of current use and lifetime use of alcohol: TSS Grades 7-12, 2014, 2016, 2018102103
100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0%
PercentResponses 20.0% 10.0% 0.0% 2014 2016 2018 Current Use 5/6 21.9% 31.7% 30.4% Lifetime Use 5/6 51.9% 56.7% 52.1% Current Use Texas 21.2% 28.6% 29.0% Lifetime Use Texas 50.5% 53.0% 51.5%
102 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 103 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Texas State Report. https://www.texasschoolsurvey.org/Report. Accessed July 25, 2019.
P a g e 62 | 157
PRC 6 RNA 2019
Figure 49. Region 5/6 and Texas comparisons of high-risk alcohol consumption behaviors, Grades 7-12: TSS, 2016104105
10.0% 9.0% 8.0% Region 5/6 7.0% Texas 6.0% 5.0% 5.0% 4.3% 4.0% 2.9% 2.6% 2.4% 3.0% 2.2% 1.8% 2.0% 1.5% Percent Percent responses 0.8%0.8% 1.0% 0.0% One Day Two Days 3-5 Days 6-9 Days 10+ During the past 30 days, on how many days have you had five or more drinks of alcohol in a two hour period?
Figure 50. Region 5/6 and Texas comparisons of high-risk alcohol consumption behaviors, Grades 7-12: TSS, 2018106107
10.0% 9.0% 8.0% Region 5/6 7.0% Texas 6.0% 5.0% 4.3% 4.4% 4.0% 3.1% 2.7% 3.0% 2.5% 2.4% 1.7% 1.5% Percent Percent responses 2.0% 0.7% 0.9% 1.0% 0.0% One Day Two Days 3-5 Days 6-9 Days 10+ During the past 30 days, on how many days have you had five or more drinks of alcohol in a two hour period?
104 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report. Accessed July 25, 2019. 105 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Texas State Report. https://www.texasschoolsurvey.org/Report. Accessed July 25, 2019. 106 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report. Accessed July 25, 2019. 107 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Texas State Report. https://www.texasschoolsurvey.org/Report. Accessed July 25, 2019.
P a g e 63 | 157
PRC 6 RNA 2019
Tobacco Age of Initiation and Early Initiation Figure 51 illustrates the average age of initiation of tobacco use, as reported by the grade-level participants in the 2014 and 2018 administration of the TSS. Figure 52 illustrates the early initiation (age of initiation before the age of 13 years old) for the adolescent participants in the 2014 and 2018 administration of the TSS, as well as the 9th through 12th graders who participated in the 2017 administration of the Youth Behavioral Risk Surveillance System (YRBSS) Texas sample.108109
Figure 51: Region 5/6 age of initiation of tobacco: TSS Grades 7-12, 2014, 2018110
16 15 14 13 12 11 10
Age of First Use of Tobacco of Use First of Age 2014 2018 7th Graders 11 10.9 8th Graders 11.2 11.3 9th Graders 12.4 12.3 10th Graders 13 13.1 11th Graders 14 13.7 12th Graders 14.9 15.1
108 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 109 Center for Disease Control and Prevention. High School Youth Risk Behavior Surveillance System (YRBSS). 2017. http://healthdata.dshs.texas.gov/HealthRisks/YRBS. Accessed July 25, 2018. 110 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 64 | 157
PRC 6 RNA 2019
Figure 52. Region 5 and 6 early initiation to tobacco, under the age of 13: TSS, grades 7-12, 2014, 2018; YRBSS, grades 9-12, 2017111112113
100.0%
90.0%
80.0%
70.0%
60.0%
50.0% 36.3% 37.7% 40.0% 33.7% 31.0% 30.0%
20.0% 11.9% 10.0%
0.0% TSS, Grades 7-12, 2014 YRBS, Grades 9-12, 2017 TSS, Grades 7-12, 2018
Region 5/6 Texas
Current Use and Lifetime Use Of those students who have reported using tobacco during the 2014, 2016, and 2018 TSS data collection, Figure 53 displays the percentages of current use and lifetime use, as reported by the students, as well as the three-year trend in current use and lifetime use. The percentages for current use more than doubled In Region 5/6 and almost doubled at the state level between 2014 and 2016. The percentages for lifetime use increased at the Region 5/6 level by at least 25 percent and by at least 30 percent at the state level. The data for 2018 show a leveling off with percentages holding steady within one or two percentage points. Figure 54 illustrates the role that electronic vaping products are playing in the increase in tobacco consumption rates. 114
111 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 112 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Texas State Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 113 Center for Disease Control and Prevention. High School Youth Risk Behavior Surveillance System (YRBSS). 2017. http://healthdata.dshs.texas.gov/HealthRisks/YRBS. Accessed July 25, 2018. 114 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report. Accessed July 25, 2019.
P a g e 65 | 157
PRC 6 RNA 2019
Figure 53. Region 5/6 and Texas comparisons of indicators of current use and lifetime use of tobacco: TSS Grades 7-12, 2014, 2016, 2018115 116 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% PercentResponses 0.0% 2014 2016 2018 Current Use 5/6 7.0% 15.6% 16.7% Lifetime Use 5/6 20.4% 32.7% 31.1% Current Use Texas 8.4% 14.5% 16.3% Lifetime Use Texas 22.4% 30.5% 30.3%
115Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 116 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Texas State Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 66 | 157
PRC 6 RNA 2019
Figure 54. Region 5/6 indicators of current use and lifetime use of any tobacco product compared to subgroups tobacco/nicotine delivery method: Grades 7-12: 2016, 2018117
100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0%
Percent Percent Responses 20.0% 10.0% 0.0% 2016 2018 Cigarettes Current Use Region 6 5.1% 3.0% Cigarettes Lifetime Use 16.6% 12.3% Smokeless Tobacco Current Use 3.1% 2.5% Smokeless Tobacco Lifetime Use 8.4% 7.2% Electronic Vape Current Use 9.2% 12.7% Electronic Vape Lifetime Use 13.3% 26.9% Any Tobacco Current Use 15.6% 16.7% Any Tobacco Lifetime 32.7% 31.1%
Marijuana Age of Initiation and Early Initiation
Figure 55 illustrates the average age of initiation of marijuana use, as reported by the grade-level participants in the 2014 and 2018 administration of the TSS. Figure illustrates the early initiation (age of initiation before the age of 13 years old) for the adolescent participants in the 2014 and 2018 administration of the TSS, as well as the 9th through 12th graders who participated in the 2017 administration of the Youth Behavioral Risk Surveillance System (YRBSS) Texas sample.
117 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 67 | 157
PRC 6 RNA 2019
Figure 55. Region 5/6 age of initiation of marijuana: TSS Grades 7-12, 2014, 2018118
16 15 14 13 12 11 10 2014 2018 7th Graders 11.6 11.5 8th Graders 12.5 12.2
9th Graders 12.9 13.2 Age of First Use of Marijuana of Use First of Age 10th Graders 13.7 13.8 11th Graders 14.4 14.3 12th Graders 15 15.3
Figure 56. Region 5 and 6 early initiation to tobacco, under the age of 13: TSS, grades 7-12, 2014, 2018; YRBSS, grades 9-12, 2017119120121
100.0%
80.0%
60.0% 36.3% 37.7% 40.0% 33.7% 31.0%
20.0% 11.9%
0.0% TSS, Grades 7-12, 2014 YRBS, Grades 9-12, 2017 TSS, Grades 7-12, 2018
Region 5/6 Texas
Current Use, Lifetime Use, and Current High-risk Use
118 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 119 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 120 Center for Disease Control and Prevention. High School Youth Risk Behavior Surveillance System (YRBSS). 2017. http://healthdata.dshs.texas.gov/HealthRisks/YRBS. Accessed July 25, 2018. 121 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Texas State Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 68 | 157
PRC 6 RNA 2019
Of those students who have reported using marijuana during the 2014, 2016, and 2018 TSS data collection, Figure 57 displays the percentages of current use and lifetime use, as reported by the students, as well as the three-year trend in current use and lifetime use. The data for all four categories demonstrated slight increases in percentages between 2016 and 2018, no more than one or two percentage points among current use and lifetime use at the Region 6 and state level. Prior, and up to the 2016 data collection wave, current use (past 30 days) percentages for Region 6 and Texas showed a slight decline between 2014 and 2016, where the lifetime consumption patterns for Region 6 and Texas showed a slight increase. Figures 58 and 59 present comparison data for 2016 and 2018 for high-risk marijuana consumption behaviors. Here, it is recommended that the reader pay close attention how the distribution of youths’ responses, as depicted in the bar graphs, change from one year to the other.
Figure 57. Region 5/6 and Texas comparisons of indicators of current use and lifetime use of marijuana: TSS Grades 7-12, 2014, 2016, 2018122123
100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0%
30.0% PercentResponses 20.0% 10.0% 0.0% 2014 2016 2018 Current Use Region 5/6 9.5% 12.3% 14.3% Lifetime Use Region 5/6 23.9% 21.5% 22.8% Current Use Texas 9.1% 12.2% 13.6% Lifetime Use Texas 23.2% 21.0% 22.1%
122 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 123 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Texas State Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 69 | 157
PRC 6 RNA 2019
Figure 58. Regions 5 and 6 and Texas comparisons of high-risk marijuana consumption behaviors, Grades 7-12: TSS, 2016124125
10.00% 9.00% 8.00% Region 5/6 2016 7.00% 6.00% Texas 2016 5.00% 4.1% 3.70% 3.9% 3.9% 3.8% 4.00% 3.5% 2.8% 2.9% 3.00% 1.7%1.9% 1.6% Percent Percent responses 2.00% 1.4% 1.00% 0.00% Less than About About Several Several Every Day Once a Once a Once a Times a Times a Year Year Month Month Week How often do you normally use marijuana? (79.2%, 82.4% Never Used)
Figure 59. Regions 5 and 6 and Texas comparisons of high-risk marijuana consumption behaviors, Grades 7-12: TSS, 2018
10.0% 9.0% 8.0% Region 5/6 2018 7.0% 6.0% Texas 2018 5.0% 4.1% 4.1% 4.1% 3.8% 3.8% 3.6% 4.0% 3.7% 3.2% 3.0% 2.1%2.2% 1.6%1.7% Percent Percent responses 2.0% 1.0% 0.0% Less than About About Several Several Every Day Once a Once a Once a Times a Times a Year Year Month Month Week How often do you normally use marijuana? (80.6%, 81.4% Never Used)
124 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 125 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC State of Texas Report. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 70 | 157
PRC 6 RNA 2019
Prescription Drugs Current Use and Lifetime Use Of those students who reported using prescription medications not prescribed to them, with the intent of getting high, Figure 60 displays the percentages of current use and lifetime use, as reported by those students. In Region 5/6 and Texas, the current use consumption rates have declined by three or four percentage points and the lifetime consumption rates have either stayed the same or are less that one percentage point in difference.
Figure 60. Region 5/6 and Texas comparisons of indicators of current use and lifetime use of prescription drugs, Grades 7-12: TSS, 2016, 2018126127
100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0%
Percent Responses Percent 20.0% 10.0% 0.0% 2016 2018 Current Use Region 5/6 11.6% 7.5% Lifetime Use Region 5/6 20.0% 19.7% Current Use Texas 10.3% 7.1% Lifetime Use Texas 18.5% 18.5%
126 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Reports. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 127 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Texas State Reports. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 71 | 157
PRC 6 RNA 2019
College Student Consumption
Figure 61. Region 5/6 and Texas comparisons of indicators of current use and lifetime use of alcohol: CSS, ages 18-242013, 2015, 2017
Figure 62. Region 5/6 and Texas comparisons of indicators of current use and lifetime use of tobacco: CSS, ages 18-24, 2013, 2015, 2017128
100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% Percent Percent Responses 10.0% How recently, if ever, have you used tobacco? 0.0% 2013 2015 2017 Current Use (past 30 days) 22.1% 25.7% 18.2% Lifetime Use 47.6% 55.0% 46.5%
128 M.P. Trey Marchbanks III, PhD. Texas College Survey. Public Policy Research Institute (PPRI). https://texascollegesurvey.org. Published August 2017. Accessed March 27, 2019.
P a g e 72 | 157
PRC 6 RNA 2019
Figure 63. Region 5/6 and Texas comparisons of indicators of current use and lifetime use of marijuana: CSS, ages 18-24, 2013, 2015, 2017
Special Topic: Opioids
For the past three CSS data collection waves (2013, 2015, 2017) the percent of young adults in Texas who completed the survey barely surpassed one percent, if even that (lifetime use: 1.2%, 1.2%, .8%, respectively; current use: .2%, .1%, 0%, respectively), in reporting their use of heroin. The TSS reporting of heroin consumption rates for 2018 for youth aged 12-17 also does not reveal any rates that even meet 1%, therefore not receiving a lot of attention in this instance of consumption reporting. However, due to the lethal and immediate overdose potential of opioids, including heroin, fentanyl, carfentenil, as well as prescription opioids, the topic of opioids definitely deserves mention, here. As can be seen in Figure 64, accidental poisoning deaths due to opioids was highest in individuals aged 25-34, and fifth highest in individuals aged 15-24, in Texas as of 2015.129
129 Texas Health Data Center for Health Statistics. Texas Summary Statistics, 2015, Accidental Poisoning Deaths where opioids were involved. Texas Health and Human Services: Texas Department of State Health Services. http://healthdata.dshs.texas.gov/Opioids/Deaths, Accessed July 27, 2019.
P a g e 73 | 157
PRC 6 RNA 2019
Figure 64. Accidental poisoning deaths due to opioids in Texas: 2015
According to the US Department of Health and Human Services, 130+ people die every day in the US from an opioid-related drug overdose.130 It is important that awareness is raised and that vigilance in staying informed about the almost immediate lethal consequences of consuming opioid substances remains a high priority. Not only has some of the heroin found on the street been cut with the deadly synthetic opioid analogues of fentanyl and carfentanil, it has been found that drug dealers are mixing fentanyl with methamphetamines, cocaine, and other more common street drugs that are more popular and of which perception of harm is generally much lower than heroin.
Figure 65 is a picture of three vials, each containing the amount of heroin, fentanyl, and carfentanil needed to kill an average adult.131 The use of heroin, alone, can potentially be deadly, and has been especially deadly for those who have attempted to recover from Opioid Use Disorder (OUD) who have relapsed after going through the detoxification process and tried to inject the same amount that they were using when they began the detoxification process while in treatment. The concern, here, is that consumers are unknowingly consuming these substances as they are combined with a substance that the consumer thinks they have purchased. The seizures of these substances by Houston Investigative Support Center were discussed in an earlier section of this needs assessment, when agents seized a combination of fentanyl and carfentanil, known as “gray death’ on the street, amid a large-scale methamphetamine conversion laboratory seizure. In the Houston area, fentanyl and/or carfentanil have been found in cocaine and marijuana sold on the street in other states and Houston HIDTA officials are prepared for its entry into the Houston HIDTA counties.132
130 US Department of Health and Human Services. The opioid epidemic by the numbers. US Department of Health and Human Services. https://www.hhs.gov/opioids/about-the-epidemic/index.html. Accessed July 27, 2019. 131 Indiana Department of Homeland Security. Carfentanil safety for responders. Indiana Department of Homeland Security. https://www.in.gov/dhs/files/Carfentanil%20Fact%20Sheet.pdf. Accessed July 27, 2019. 132 Houston Investigative Support center. 2018 Houston High Intensity Drug Trafficking Area (HIDTA) Threat Assessment. Office of National Drug Control Policy. 2018.
P a g e 74 | 157
PRC 6 RNA 2019
133Figure 65. A visual of the dose of heroin, fentanyl and carfentanil needed to kill an average adult.
Adapted from: Indiana Department of Homeland Security. Carfentanil safety for responders. Indiana Department of Homeland Security. https://www.in.gov/dhs/files/Carfentanil%20Fact%20Sheet.pdf. Accessed July 27, 2019.
133 Indiana Department of Homeland Security. Carfentanil safety for responders. Indiana Department of Homeland Security. https://www.in.gov/dhs/files/Carfentanil%20Fact%20Sheet.pdf. Accessed July 27, 2019.
P a g e 75 | 157
PRC 6 RNA 2019
Consequences
Mortality Overdose Deaths Table 22 shows the counts and rates of drug- and alcohol-induced deaths by county in Region 6, 1999- 2017. In just about every county (with the exception of Austin county), the number of drug induced deaths outweighed the number of alcohol-induced deaths. In the last column, which displays the total count of all substance-induced deaths (drug- and alcohol-induced), Galveston County had the highest substance- induced death rates at 22 per 100,000 population. Fort Bend County had the lowest substance-induced death rate at 7.3 deaths per 100,000 population.
Table 22. Region 6 county-level drug and alcohol-induced deaths per 100,000: 1999-2017134 Drugs- and Drug-Induced Alcohol-Induced Alcohol-Induced Deaths Deaths Deaths Combined Rate per Rate per Rate per County Total Pop Count 100,000 Count 100,000 Count 100,000 Austin 516812 28 5.6 34 5.9 62 11.5 Brazoria 5663905 569 9.9 260 4.5 829 14.4 Chambers 620552 83 13.3 21 3.1 104 16.4 Colorado 392484 25 7 19 4.8 44 11.8 Fort Bend 10293364 469 4.6** 278 2.7** 747 7.3** Galveston 5457738 835 15 415 6.9* 1250 22* Harris 75396806 7520 10.1 4454 6.3 11974 16.4 Liberty 1433296 229 15.9* 76 5 305 20.9 Matagorda 703980 58 8.8 45 6.2 103 15 Montgomery 8062463 1005 12.4 441 5.2 1446 17.6 Walker 1262702 78 6 41 3.4 119 9.4 Waller 778058 67 9.4 48 6.4 115 15.8 Wharton 516812 46 6.3 45 5.1 91 11.4 Texas 461846329 43320 9.5 29094 6.5 72414 11.5 Note. -- = Suppressed or unreliable data **Lowest combined drug- and alcohol-induced deaths per 100,000 *Highest combined drug- and alcohol-induced deaths per 100,000
134 CDC Wonder. Drug- and Alcohol-Induced Deaths. https://wonder.cdc.gov/wonder/help/mcd.html. Accessed July 30, 2019.
P a g e 76 | 157
PRC 6 RNA 2019
Drug and Alcohol Related Fatalities
Table 23 displays DUI related fatalities by county for 2014, 2015, and 2016. As of 2016, the highest count for total fatalities was in Harris County. 135
Table 23. Region 6 county-level DUI alcohol related fatalities: 2014, 2015, and 2016136 2016 2017 2018 Driver Total Driver Total Driver Total County Fatalities Fatalities Fatalities Fatalities Fatalities Fatalities Austin 0 0 1 1 1 1 Brazoria 10 19 17 16 6 7 Chambers 1 2 0 0 2 5 Colorado 0 0 1 1 1 1 Fort Bend 7 12 8 5 7 8 Galveston 9 14 16 11 11 15 Harris 100 159 156 101 81 121 Liberty 2 5 2 4 2 3 Matagorda 2 3 3 2 1 1 Montgomery 14 21 21 17 13 17 Walker 4 7 6 5 3 4 Waller 1 1 9 3 3 3 Wharton 1 2 15 1 1 1 Region 6 151 245 255 167 132 187 Texas 638 987 693 1,046 618 940
135 Texas Department of Transportation. Report for DUI Driver Fatalities and DUI Total Fatalities, 2016, 2017, 2018. http://www.txdot.gov/government/enforcement/annual-summary.html. Accessed July 30, 2019. 136 Texas Department of Transportation. Report for DUI Driver Fatalities and DUI Total Fatalities, 2016, 2017, 2018. http://www.txdot.gov/government/enforcement/annual-summary.html. Accessed July 30, 2019.
P a g e 77 | 157
PRC 6 RNA 2019
Legal Substance Use, Driving Under the Influence, and Criminal Charges Many of the legal consequences associated with alcohol and drugs start with offences of drinking and then getting behind the wheel of a car and driving. Accordingly, the TSS has provided some insight into the percentages of students who report driving while drunk or high on drugs (see Figures 66 and 67). Table 25 displays offences of record for counties in Region 6.
Figure 66. Region 5/6 and Texas comparisons of students’ self-reports of driving while under the influence of alcohol, Grades 9-12: TSS, 2016137
100.0% 95.5% 95.6% 90.0% Region 5/6 Texas 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% Percent Percent responses 3.6% 10.0% 3.5% 0.4% 0.4% 0.5% 0.4% 0.0% None 1-3 Times 4-9 Times 10+ Times During the past 12 months, how many times (if any) have you driven a car when you have had a good bit to drink?
Figure 67. Region 5/6 and Texas comparisons of students’ self-reports of driving while under the influence of drugs, Grades 7-12: TSS, 2018138
95.0% 100.0% 94.0% Region 5/6 90.0% Texas 80.0% 70.0% 60.0% 50.0% 40.0% 30.0%
Percent Percent responses 20.0% 10.0% 3.4% 3.6% 0.4% 0.8% 0.5% 1.5% 0.0% None 1-3 Times 4-9 Times 10+ Times During the past 12 months, how many times (if any) have you driven a car when you have felt high from drugs?
137 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016, 2018 HHSC Region 5 and 6 Reports. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2018. 138 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016, 2018 HHSC Texas State Reports. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2018.
P a g e 78 | 157
PRC 6 RNA 2019
Table 24. Region 6 county-level counts of offenses of record: 2016, 2017, and 2018139 2016 2017 2018 Drug- Drug- Drug- Drug- Drug- Drug- Drug- Drug- Drug- County Delivery Possession Other DWI Delivery Possession Other DWI Delivery Possession Other DWI Austin 0** 13** 0 4** 6** 21 0 2** 5 12** 1 4** Brazoria 58 167 13* 116 49 187 7* 107 56 196 4* 78 Chambers 10 19 0 7 11 29 0 10 8 24 0 11 Colorado 8 23 0 5 12 21 0 6 8 33 0 8 Fort Bend 85 56 0 24 75 70 0 36 74 67 0 40 Galveston 94 162 1 83 95 170 0 95 92 161 0 77 Harris 1,379* 1,981* 1 666* 1,328* 1,728* 1 667* 1,169 1,411* 0 580* Liberty 44 106 0 35 51 96 0 35 61 102 0 29 Matagorda 29 19 0 7 22 20 0 5 18 25 0 5 Montgomery 231 220 1 284 242 236 0 273 254 258 0 290 Walker 14 23 0 12 16 21 0 10 18 19 0 12 Waller 13 18 0 7 12 21 0 5 8 27 0 6 Wharton 15 24 0 13 14 19* 0 13 15 22 1 7 Region 6 1,980 2,831 16 1,263 1,933 2,639 8 1,264 1,786 2,357 6 1,147 Texas 9,686 13,841 31 7,044 9,686 13,917 28 6,643 9,825 14,116 22 6,031 *Highest count of offenses. **Lowest count of offenses.
139 Texas Department of Criminal Justice. Texas Incarcerations, Drug and Alcohol Offenders on Hand, 2016-2018. Report generated July 1, 2019. P a g e 79 | 157
PRC 6 RNA 2019
The next three tables provide juvenile justice data on juvenile offences in Region 6 for 2015, 2016, and 2017 as reported out by the Texas Juvenile Justice Department (TJJD) (see Tables 25-27 ).140
Table 25. Region 6 county level categorical data on juvenile referrals and offences, TJJD: 2015 2015 Juvenile Violent Other Misd. Other Total Referral County Population Felony Felony A & B VOP Status CINS Referrals Rate/1,000 Austin 2,987 3 3 36 4 1 7 54 18 Brazoria 36,958 65 87 524 346 68 19 1,109 30 Chambers 4,432 2 5 12 0 0 0 19 4 Colorado 1,908 1 9 14 6 0 1 31 16 Fort Bend 80,416 88 156 657 235 71 10 1,217 15 Galveston 30,131 96 131 593 340 3 16 1,179 39 Harris 451,296 831 1,362 4,754 1,193 244 160 8,544 19 Liberty 7,825 12 12 30 3 0 0 57 7 Matagorda 3,703 9 12 55 8 20 6 110 30 Montgomery 55,659 146 164 515 218 64 6 1,113 20 Walker 4,203 9 9 53 8 11 2 92 22 Waller 4,455 3 6 11 0 0 1 21 5 Wharton 4,433 13 22 54 11 0 0 100 23 Region 6 688,406 1,278 1,978 7,308 2,372 482 228 13,646 20 Note. Misd. A & B = Misdemeanor A & B. VOP = Violation of Parole. Status = offense committed by a juvenile that would otherwise not be considered an offense if committed (engaged in) by an adult; also considered as Conduct In Need of Supervision. CINS = Conduct In Need of Supervision.
140 Texas Juvenile Justice Department. The State of Juvenile Probation Activity in Texas. Website. Published November 2018, October 2017, October 2016. www.tjjd.texas.gov. Accessed April 1, 2019.
P a g e 80 | 157
PRC 6 RNA 2019
Table 26. Region 6 county level categorical data on juvenile referrals and offences, TJJD: 2016141 2016 County Juvenile Violent Other Misd. VOP Status Other Total Referral Population Felony Felony A & B CINS Referrals Rate/1,000 Austin 2,945 2 5 33 2 1 1 44 15 Brazoria 37,749 83 114 475 264 67 14 1,017 27 Chambers 4,444 4 3 7 0 0 0 14 3 Colorado 1,893 4 3 13 1 0 0 21 11 Fort Bend 81,724 99 148 571 178 48 4 1,048 13 Galveston 30,046 58 117 555 299 5 6 1,040 35 Harris 455,812 822 1,196 4,406 1,076 225 118 7,843 17 Liberty 7,815 9 4 48 0 0 0 61 8 Matagorda 3,685 17 25 44 7 0 6 99 27 Montgomery 56,515 103 152 475 166 50 1 947 17 Walker 4,257 10 9 45 6 0 0 70 16 Waller 4,547 4 7 27 0 0 0 38 8 Wharton 4,473 6 18 48 15 0 0 87 19 Region 6 695,905 1,221 1,801 6,747 2,014 396 150 12,329 18 Note. Misd. A & B = Misdemeanor A & B. VOP = Violation of Parole. Status = offense committed by a juvenile that would otherwise not be considered an offense if committed (engaged in) by an adult; also considered as Conduct In Need of Supervision. CINS = Conduct In Need of Supervision.
141 Texas Juvenile Justice Department. The State of Juvenile Probation Activity in Texas. Website. Published November 2018, October 2017, October 2016. www.tjjd.texas.gov. Accessed April 1, 2019.
P a g e 81 | 157
PRC 6 RNA 2019
Table 27. Region 6 county level categorical data on juvenile referrals and offences, TJJD: 2017142 2017 Juvenile Violent Other Misd. Other Total Referral County Population Felony Felony A & B VOP Status CINS Referrals Rate/1,000 Austin 2,933 3 13 20 1 7 4 48 16 Brazoria 38,358 75 116 415 247 59 13 925 24 Chambers 4,380 4 8 7 0 0 0 19 4 Colorado 1,880 3 10 14 5 0 0 32 17 Fort Bend 82,589 119 117 553 174 40 3 1,006 12 Galveston 30,081 56 110 485 257 8 42 958 32 Harris 459,007 774 1,094 4,077 1,111 160 114 7,330 16 Liberty 7,846 20 18 71 1 0 1 111 14 Matagorda 3,681 14 18 31 8 0 1 72 20 Montgomery 57,079 137 161 477 210 84 6 1,075 19 Walker 4,324 13 15 45 3 0 0 76 18 Waller 4,677 4 4 11 0 0 0 19 4 Wharton 4,445 9 14 51 13 0 0 87 20 Region 6 701,280 1,231 1,698 6,257 2,030 358 184 11,758 17 Note. Misd. A & B = Misdemeanor A & B. VOP = Violation of Parole. Status = offense commited by a juvenile that would otherwise not be considered an offense if committed (engaged in) by an adult; also considered as Conduct In Need of Supervision. CINS = Conduct In Need of Supervision.
142 Texas Juvenile Justice Department. The State of Juvenile Probation Activity in Texas. Website. Published November 2018, October 2017, October 2016. www.tjjd.texas.gov. Accessed April 1, 2019.
P a g e 82 | 157
PRC 6 RNA 2019
Hospitalization and Treatment Hospital Use Due to AOD
As can be seen in Figure 68, marijuana is the primary substance of use in youth aged 12-17, as evidenced from state funded treatment
Figure 68. Texas Treatment Episodes Data: Primary substance use at admission among discharges aged 12-17 by substance, Ages 12-17: 2017143 Stimulants Other Alcohol 4% 4% 3% Opiates Cocaine 1% 1%
Marijuana/hashish 87%
143 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2017. Admissions to and Discharges from Publicly-Funded Substance Use Treatment. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2019. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/TEDS-2017.pdf. Accessed July 23, 2019.
P a g e 83 | 157
PRC 6 RNA 2019
Table 28. Region 6 county-level counts of exposures for which the reason was intentional abuse: 2010- 2017144 County 2010 2011 2012 2013 2014 2015 2016 2017 Austin -- 5 -- -- 6 ------Brazoria 39 50 37 30 34 39 25 26 Chambers 5 -- 6 ------5 Colorado ------0 -- -- 6 -- Fort Bend 70 74 65 57 64 74 54 47 Galveston 48 59 44 50 38 45 35 31 Harris 569 654 656 487 421 467 344 374 Liberty 23 24 19 11 11 10 9 8 Matagorda 6 -- 7 7 -- 9 -- 10 Montgomery 81 69 74 66 57 59 49 46 Walker 10 7 8 5 10 15 7 14 Waller -- -- 19 -- 0 -- 0 0 Wharton 5 6 8 -- 5 6 6 9 Region 6 856 948 943 713 646 724 535 570 Texas 4,292 4,358 3,918 3,431 3,273 3,250 2,975 2,759 Note. -- = Missing data or suppressed data.
Table 29. Region 6 opioid related exposures by opioid category: 2013-2017145 Region 6 Opioid Category 2013 2014 2015 2016 2017 All Opioids 1141 1137 1033 963 961 Commonly Prescribed Opioids 896 869 720 678 676 Heroin 21 14 16 28 25 Other/Unspecified Opioids 5 13 8 9 13 Synthetic Opioids 251 270 321 279 287
144 Southeast Texas Poison Center. Exposures reported to the Texas Poison Center Network during January 2000-June 2018 where the exposure reason was intentional abuse. Report generated on July 3, 2018. 145 Texas Department of State Health Services, Texas Health Data, Texas Poison Center Network (TPCN), http://healthdata.dshs.texas.gov/Opioids/PoisonCenter. Accessed January 2019.
P a g e 84 | 157
PRC 6 RNA 2019
Emergency Room Admissions due to Alcohol and Other Drugs
Table 30.Region 6 county-level counts of EMS runs with primary symptom of overdose from alcohol or drugs: 2010-2014, 2016146 County 2010 2011 2012 2013 2014 2016 Austin 13 19 18 6 21 7 Brazoria 404 433 397 242 389 185 Chambers 6 -- 5 ------Colorado 23 21 24 10 7 6 Fort Bend 222 162 211 297 490 208 Galveston 216 256 296 272 328 210 Harris 1636 1511 1648 1318 1116 1111 Liberty 45 54 105 55 27 6 Matagorda 65 ------294 Montgomery 463 680 740 261 157 95 Walker 10 21 17 86 84 59 Waller 13 40 20 -- 12 20 Wharton 5 32 19 22 22 10 Region 6 3121 3229 3500 2569 2653 2211 Note. -- = Missing data or suppressed data. Texas EMS and Trauma Registries did not report 2015 data.
146 Texas Department of State Health Services. Texas EMS and Trauma Registries Portal. http://www.dshs.texas.gov/injury/. Accessed July 3, 2018.
P a g e 85 | 157
PRC 6 RNA 2019
Environmental Protective Factors Much of the information provided up until this point in this RNA, such as the risk factors, consumption, and consequences data, seem to paint a grim picture for parts of Region 6. However, the inclusion of this information is important and necessary in order to make educated decisions about the allocation of resources in order to make the highest impact for those areas most in need. Hopefully, this section on Protective Factors will highlight the great strides that have been made through prevention efforts in FY 2019. Once again, in following with the framework presented in the Socio-Ecological Model for Alcohol and Other Drug Use that was introduced on p. xii, protective factors will be discussed within the context of the domains of Society, Community, School, Family, Peer, and Individual.
Adapted from: D’Amico, EJ, Osilla, KC. Prevention and intervention in the school setting. In: KJ Sher ed. The Oxford Handbook of Substance Use and Substance Use Disorders. Vol. 2.New York, NY: Oxford University Press; 2016:678.
Society Domain In their chapter in the Oxford Handbook of Substance Use and Substance Use Disorders on the policies and programs regulating impaired driving, Voas and Fell discuss some of the most successful efforts in this arena which include many that fall under the Society Domain of Protective Factors. Some of these efforts include minimum drinking age laws, limiting alcohol availability, laws against serving obviously
P a g e 86 | 157
PRC 6 RNA 2019
intoxicated persons, and alcohol excise taxes.147 However, some of the evidence-based environmental strategies that are funded for and implemented by the HHSC-funded prevention coalitions in Region 6 also fall under the Society Domain of Protective Factors as described by Voas and Fell, as many of the coalitions are involved in implementing strategies such as counteradvertising, influencing community norms, and promoting citizen activism, and the implementation of these strategies has been very evident among Region 6 prevention coalitions during the FY2018.148
Counteradvertising PRC6 and all of the state-funded substance abuse prevention coalitions are constantly involved in media literacy projects throughout the year. During the FY2019, PRC6 has extended HHSC-sponsored, Drug Free Texas, SAMHSA, CDC, Get Smart Smart About Drugs, media literacy messages on alcohol, drugs, and tobacco use through social media outlets such as Facebook and maintenance of coalition websites. The PRC6 develops, posts, and disseminates fact sheets with the latest TSS consumption data on each of the four priority substances, as well (visit www.prc6.org). The extensive nature of the data included in this current RNA 2019, particularly the presentation of five-year trends for the first time since the completion of RNAs has become a contract requirement for PRCs with HHSC, has provided a plethora of new information on which the public would benefit from awareness and education.
Even just the “sober curious” movement across the US demonstrates the movement of the desire of the general population in a direction more consistent with, simply put, a healthier lifestyle. The sober curious movement has garnered attention from mainstay media outlets, such as the Today Show, Good Morning America, CNN, the New York Times, originating from a recently published book by Ruby Warrington titled, Sober Curious,149 and touting media headlines such as: The Rise of the Sober Curious: Having it all, Without Alcohol; They’re Young, They’re Fun, and They’re Alcohol Free; The New Sobriety; “Sober Curious” or Literally Dying: When Saving Your Life Becomes Trendy. The term, “mocktail,”which is basically a non-alcoholic beverage, has become quite a popular item on the menus of many restaurants and bars.
Influencing Community Norms Bi-annual prescription drug take-back efforts are a mainstay across the United States and are orchestrated through partnerships between the Drug Enforcement Agency (DEA) and countless coalitions, agencies, businesses, and law enforcement across the country. These concerted efforts prevent youth substance use and misuse by reducing the amount of prescription drugs available from family and friends’ medicine cabinets, which is important since about 58 percent of youth ages 12-17 reported getting drugs not prescribed to them from a friend or family member.150 Hundreds of thousands of pounds of unused, expired, and unwanted prescription drugs are collected on a bi-annual
147 Voas, RB, Fell, JC. Programs and policies designed to reduce impaired driving. In: KJ Sher ed. The Oxford Handbook of Substance Use and Substance Use Disorders. Vol. 2.New York, NY: Oxford University Press; 2016:621-674. 148 Voas, RB, Fell, JC. Programs and policies designed to reduce impaired driving. In: KJ Sher ed. The Oxford Handbook of Substance Use and Substance Use Disorders. Vol. 2.New York, NY: Oxford University Press; 2016:621-674. 149 Warrington, R. Sober Curious: The Blissful Sleep, Greater Focus, Limitles Presence, and Deep Connection Awaiting Us All on the Other Side of Alcohol. New York, NY: HarperCollins Publishers, 2018. 150 Substance Abuse and Mental Health Services Administration. Results from the 2016 National Survey on Drug Use and Health: detailed tables. https://www.samhsa.gov/samhsa-data-outcomes-quality/major-data-collections/reports-detailed-tables-2016-NSDUH. Published September 7, 2017. Accessed July 15, 2018.
P a g e 87 | 157
PRC 6 RNA 2019
basis at community drug takeback events. In fact, National Prescription Drug Take-Back Day has become an annual event through which coalition leaders, law enforcement agencies, and community partners work together in partnerships to ensure widespread success for this event, and also, to provide permanent drop-boxes at police stations, sheriffs’ departments, and certain pharmacies.151
The American Medical Association has commissioned an Opioid Task Force that publishes an annual progress report on the number of physicians each state has registered in its Prescription Drug Monitoring Program (PDMP), as well as percent increase in the number of queries submitted to the PDMP by physicians. Opioid prescriptions are decreasing nationwide as opioid prescription data between 2013 and 2016 show negative correlations with the increased effectiveness of PDMPs, which is good.152 As lack of use has been cited as a major barrier to physicians effectively using PDMPs, Figure 69 shows the percent increase of physicians’ queries in their respective states’ PDMPs. For the most part, each state shows at least a minimal percent increase in the number of physician queries made in the PDMP system. For some states, the percent increase in queries from 2016 year to 2017 might even be deemed as astronomical, increasing by more than 2,000 percent. For example, North Carolina saw an increase of physician queries of 2,054 percent. Texas physicians demonstrated a 283 percent increase in queries in the PDMP system from 2016 to 2017.
Figure 69. Percent increase in physicians’ Prescription Drug Monitoring Program queries from 2016 to 2017153
Note. States for which there were missing data (CO, CT, DC, HI, IN, IA, ME, MD, MA, MO, MT, NE, UT) or a decrease in physicians’ queries (OK,-8.1%; NH, -88.7%) were not included in this analysis.
151 To find prescription drug drop-off locations near you, or to list your agency’s drop-box, see RxDrugDropBox.org. 152 American Medical Association Opioid Task Force. Physicians’ progress to reverse the nation’s opioid epidemic. American Medical Association Opioid Task Force Progress Report 2018. American Medical Association. 2018. https://www.end-opioid-epidemic.org/wp- content/uploads/2018/05/AMA2018-OpioidReport-FINAL-updated.pdf. Accessed July 25, 2018. 153 American Medical Association Opioid Task Force. Physicians’ progress to reverse the nation’s opioid epidemic. American Medical Association Opioid Task Force Progress Report 2018. American Medical Association. 2018. https://www.end-opioid-epidemic.org/wp- content/uploads/2018/05/AMA2018-OpioidReport-FINAL-updated.pdf. Accessed July 25, 2018.
P a g e 88 | 157
PRC 6 RNA 2019
Figures 70 and 71 illustrate data from the aforementioned Opioid Task Force’s 2019 progress report. This progress report includes five-year increases in the number of physicians registered in their states’ PDMP, as well as five-year increases in physicians’ queries into the PDMP. The drastic increase in registrations and queries into the PDMPs represents a comprehensive success in moving the needle on community and societal norms in that it seems these PDMP efforts are becoming the norm, particularly within the pharmacological and medical fields. The physician registrations and queries in the Texas PDMP are presented below.154
Figure 70. Texas physicians’ registrations into the Texas PDMP: five-year trend, 2014-2018
100,000 92,232 90,000 80,000 70,000 60,000 57,446 50,000 44,633 40,000 32,685 27,205 30,000 20,000 10,000 0 2014 2015 2016 2017 2018
Texas PDMP Registrants Linear (Texas PDMP Registrants)
154 American Medical Association Opioid Task Force. Physicians’ progress to reverse the nation’s opioid epidemic. American Medical Association Opioid Task Force Progress Report 2019 American Medical Association. 2019. https://www.ama-assn.org/system/files/2019-06/opioid-task-force- progress-report.pdf. Accessed July 25, 2019.
P a g e 89 | 157
PRC 6 RNA 2019
Figure 71. Texas physicians’ queries into the Texas PDMP, five-year trend: 2014-2018155 9,000,000 8,143,304 8,000,000
7,000,000
6,000,000
5,000,000 4,163,058 4,000,000
3,000,000
2,000,000 1,130,400 867,879 1,086,373 1,000,000
0 2014 2015 2016 2017 2018 -1,000,000
Texas PDMP Queries Linear (Texas PDMP Queries)
155 American Medical Association Opioid Task Force. Physicians’ progress to reverse the nation’s opioid epidemic. American Medical Association Opioid Task Force Progress Report 2019 American Medical Association. 2019. https://www.ama-assn.org/system/files/2019-06/opioid-task- force-progress-report.pdf. Accessed July 25, 2019.
P a g e 90 | 157
PRC 6 RNA 2019
The inclusion of dispensation of scheduled controlled substances further contributes to the growing expectational norms for prescribing practices that the use of PDMPs is encouraging. Figures 72 -75 present the total dispensation data for DEA scheduled controlled substances, submitted to the PDMP by pharmacies located in Texas. 156
Figure 72. Region 6 county-level dispensation data for DEA scheduled controlled substances, all 13 counties: 2017-2018
2500000
2000000
1500000
1000000
500000
0
Sch 2 2017 Sch 2 2018 Sch 3 2017 Sch 3 2018 Sch 4 2017 Sch 4 2018 Sch 5 2017 Sch 5 2018
Note. Sch = Schedule.
156 Texas State Board of Pharmacy. Total dispensation data submitted to the Prescription Monitoring Program by Texas licensed pharmacies. 2017-2018. www.pharmacy.texas.gov. Accessed July 27, 2019.
P a g e 91 | 157
PRC 6 RNA 2019
Figure 73. Region 6 county-level dispensation data for DEA scheduled controlled substances, Harris County with highest dispensations: 2017-2018157
2500000
2000000
1500000
1000000
500000
0 Harris
Sch 2 2017 Sch 2 2018 Sch 3 2017 Sch 3 2018 Sch 4 2017 Sch 4 2018 Sch 5 2017 Sch 5 2018
Note. Sch = Schedule.
Figure 74. Region 6 county-level dispensation data for DEA scheduled controlled substances, Fort Bend, Montgomery, Brazoria, and Galveston Counties with second, third, fourth, and fifth highest dispensations, respectively: 2017-2018
500000 450000 400000 350000 300000 250000 200000 150000 100000 50000 0 Brazoria Fort Bend Galveston Montgomery
Sch 2 2017 Sch 2 2018 Sch 3 2017 Sch 3 2018 Sch 4 2017 Sch 4 2018 Sch 5 2017 Sch 5 2018
Note. Sch = Schedule.
157 Texas State Board of Pharmacy. Total dispensation data submitted to the Prescription Monitoring Program by Texas licensed pharmacies. 2017-2018. www.pharmacy.texas.gov. Accessed July 27, 2019.
P a g e 92 | 157
PRC 6 RNA 2019
Figure 75. Region 6 county-level dispensation data for DEA scheduled controlled substances, remaining eight counties: 2017-2018158
70000
60000
50000
40000
30000
20000
10000
0
Sch 2 2017 Sch 2 2018 Sch 3 2017 Sch 3 2018 Sch 4 2017 Sch 4 2018 Sch 5 2017 Sch 5 2018
Note. Sch = Schedule.
158 Texas State Board of Pharmacy. Total dispensation data submitted to the Prescription Monitoring Program by Texas licensed pharmacies. 2017-2018. www.pharmacy.texas.gov. Accessed July 27, 2019.
P a g e 93 | 157
PRC 6 RNA 2019
Community Domain
Social Associations Addiction, the most severe form of SUD, is widely known as an incredibly isolating disease. Therefore, ensuring that decreased opportunities of isolation are countered through activities and events that promote connectedness to others, is important to preventing the development of SUDs. Social associations is a measure of family support, involvement in community life, social network, social trust, volunteering and membership in organizations, which are behaviors associated with decreased isolation. Social associations include membership associations in a county, such as civic organizations, bowling centers, golf clubs, fitness centers, sports organizations, religious organizations, political organizations, labor organizations, business organizations, and professional organizations. The calculation of social association rates takes the total number of membership associations in a county, divides that number by the total population of that county, and then multiplies by 100,000 for a rate per 100,000 population. Table 31, below, shows county-level social associations for 2017, 2018, and 2019.159
Table 31. Region 6 county-level totals and rates per 100,000 population for social associations: 2017, 2018, 2019
Social Associations 2017 Social Associations 2018 Social Associations 2019 Total Rate per Total Rate per Total Rate per County 100,000 100,000 100,000 Austin 36 1.2 38 1.3 36 1.2 Brazoria 235 0.7 241 0.7 239 0.7 Chambers 25 0.7 25 0.6 27 0.7 Colorado 36 1.7 35 1.7 35 1.7 Fort Bend 325 0.5 351 0.5 370 0.5 Galveston 243 0.8 242 0.8 243 0.7 Harris 2402 0.5 2443 0.5 2460 0.5 Liberty 74 1.0 75 0.9 77 0.9 Matagorda 56 1.5 58 1.6 54 1.5 Montgomery 306 0.6 325 0.6 333 0.6 Walker 46 0.7 49 0.7 47 0.7 Waller 31 0.7 32 0.7 34 0.7 Wharton 71 1.7 70 1.7 68 1.6 Region 6 3886 12.3 3984 12.3 4023 12 Texas 20814 0.8 20998 0.8 21256 0.8
159 University of Wisconsin Population Health Institute. 2017 County Health Rankings Texas Data. http://www.countyhealthrankings.org/app/texas/2019/downloads. Accessed May 28, 2019.
P a g e 94 | 157
PRC 6 RNA 2019
Community Partners and Community Coalitions In order for prevention efforts against substance use and misuse to be effective with youth, there are protective factors within the community domain that can be fortified through actions such as the provision of positive opportunities for social involvement, recognition of youth for positive behaviors, and reinforcement and fostering of standard for behaviors.160 Well supported scientific evidence shows that communities are an important organizing force for bringing effective evidence-based interventions to scale. Accordingly, the Gulf Coast Region is home to several robust community coalitions for prevention of substance use and misuse in youth. Coalitions work in partnership with many organizations in order to educate the public, schools, law enforcement, parents, and teens about the risks of youth substance misuse, as well as the benefits of healthy alternatives (see Table 32 for a listing of community partners and community coalitions in Region 6).
Table 32. Region 6 PRC community partners and community coalitions FY2019:
Archway Academy Facing Addiction/NCADD League City Bay Area Alliance for Youth and Families Communities Project Bay Area Council on Drugs and Alcohol Lee College Allied Health Division Southeast Harris County Community Prevention Lee College Student Affairs Office Coalition/BACODA Lovett Center Baker Institute for Public Policy at Rice University Mothers Against Drunk Driving Brazoria County Community Prevention Maximus Texas Health Steps Outreach Coalition Menninger Clinic Coalition for Behavioral Health Mercy Street Cypress-Fairbanks Independent School District One Recovery Substance Use Intervention Program Pasadena County Community Prevention Commissioner's Office Pct. 2 Coalition/BACODA Communities In Schools - Baytown Phoenix House Communities In Schools - Harris County North Harris County Substance Abuse Deer Park Police Prevention Coalition Council on Substance Abuse Prevention Recovery Support Strategies Galveston County Mutual Assistance Partnership Santa Maria Hostel Harris County Labs UTMB Health Resource Center Harris County Youth Services SEARCH Houston Emergency Response Opioid Serenity Light Engagement System TABC Houston Forensic Science Center Take Action Recovery Houston High Intensity Drug Trafficking Area Texas FRIDAY Program The Refuge Houston Recovery Center The Source for Women Nancy Ojeda La Porte Councilwoman Vest Counseling
160 U.S. Department of Health and Human Services. Facing addiction in America: the surgeon general’s report on alcohol, drugs, and health. https://addiction.surgeongeneral.gov/. Published 2017. Accessed July 30, 2017.
P a g e 95 | 157
PRC 6 RNA 2019
Treatment/Intervention Providers The Recovery Oriented Systems of Care (ROSC) community, particularly of the Greater Houston Area, rivals that of very few other recovery communities in the United States. The Houston Recovery Initiative (HRI) ROSC meetings are held the third Friday of every month and yield a significant monthly gathering of service providers from all across the Gulf Coast Region 6 area. These meetings have brought in attendees and speakers from the Houston Mayors Office, as well as from around the state of Texas and the country. The Houston ROSC is officially titled the Houston Recovery Community
In past publications of RNAs for PRC 6, an appendix containing a list of treatment providers in all of Region 6 was procured from the SAMHSA online Behavioral Health Treatment Services Locator (https://findtreatment.samhsa.gov/). For the current RNA, and due to the limited page space that has daunted the ability to include all information specific to the selection of available parameters in past years, Appendix now contains a tip sheet for navigating the website and setting parameters for individual searches. Some parameters might be age groups served, acceptance of insurance/ Medicaid, and whether the provider provides Mental Health services, Substance Use services, and/or Medication Assisted Treatment and Recovery (MAT/MAR). School Domain Essentially, some of the most important protective factors in the School Domain are the provision of ample prosocial opportunities, positive instructional climate, clear standards set for behavior, and healthy attitudes and beliefs taught in a caring and compassionate way.161
Youth Prevention Programs There are three types of youth prevention programs: universal prevention interventions (YPU), selective interventions (YPS), and indicated interventions (YPI). School-level YPU interventions are designed to address social and emotional competencies in the overall and have the greatest overall impact on reducing substance use and misuse compared to more individually-focused interventions. In many cases, an entire population of students on a school campus might be enrolled in a universal intervention program and many universal programs are designed to be implemented with elementary populations, as well as adolescent populations. The far-reaching nature of universal intervention programs is what gives these programs results that yield more bang for the buck, so to speak.162
Selective youth prevention interventions (YPS) are designed for youth who come to the table already at increased risk of developing substance misuse problems. Although more limited in their reach, compared to population-based interventions, YPS programs and services are purposefully designed for a specific high-risk group with the goal of reducing identified risk factors, increasing protective factors, or both. YPS programs do have some advantages over universal intervention programs in that greater levels of resources and efforts are allocated to individuals who are at high risk for developing behavioral health difficulties.
161 D’Amico, EJ, Osilla, KC. Prevention and intervention in the school setting. In: KJ Sher ed. The Oxford Handbook of Substance Use and Substance Use Disorders. Vol. 2.New York, NY: Oxford University Press; 2016:675-723. 162 Source: U.S. Department of Health and Human Services. Facing addiction in America: the surgeon general’s report on alcohol, drugs, and health. https://addiction.surgeongeneral.gov/. Published 2017. Accessed July 30, 2017.
P a g e 96 | 157
PRC 6 RNA 2019
Indicated youth prevention interventions are designed for those youth who are identified as already being involved in risky behavior. As many of the TSS data points for 2018 have shown, the percentages of students already involved in such risky behavior are quite small. However, it is this population of youth who require the most intensive and individualized prevention interventions and resources available. Given the likelihood of developing SUDs without intensive intervention, which imposes a much larger financial burden than the higher cost of the YPI intervention (in comparison with YPUs and YPSs), the benefits of the YPI for this population of youth far outweigh any negatives associated with such a cost. See Appendix H for a listing of youth prevent programs in Region 6 for FY2018.
Alcohol, Tobacco, and Other Drugs Education in School The next two tables present indicators from the TSS regarding how information about alcohol and drugs is given to students, as well as who students would seek help from should they find themselves in having substance misuse or substance use disorder problems. Table 32 displays the school-based individuals or departments from which students report receiving information on alcohol and other drugs at school, as per the TSS. Other than Any School Source, Assembly Program and School Health classes were the highest reported source from which students reported getting information about alcohol and drugs, which was 32 percent and 30.1 percent, respectively, of students in Region 5/6 who filled out the TSS.
Table 32. Region 5/6 and Texas comparisons of student reports on sources from which they received information on alcohol and drugs, Grades 7-12: TSS, 2016, 2018 Since school began in the Fall, have you gotten any information on drugs or alcohol from the following? 2016 2018 School Personnel Region 5/6 Texas Region 5/6 Texas School Health 44.7% 43.9% 30.1% 40.1% Assembly Program 34.9% 44.7% 32.0% 40.5% Guidance Counselor 21.3% 27.9% 19.3% 26.7% School Nurse 14.3% 17.2% 12.1% 16.7% Science or Social Studies Class 23.0% 27.3% 22.0% 26.5% Student Group or Club 13.4% 14.4% 11.2% 14.6% Invited Guest 22.2% 31.6% 18.8% 27.6% Another Source at School 26.0% 28.9% 24.9% 28.6% Any School Source 63.2% 68.9% 55.5% 64.7% No Prevention Education on Drugs 36.8% 31.1% -- -- or Alcohol Note. -- = No data.
P a g e 97 | 157
PRC 6 RNA 2019
Alternative Peer Groups and Recovery High Schools The Alternative Peer Group (APG) has emerged as a comprehensive model for recovery from SUDs in adolescents, and has a rich history in Region 6, particularly the Houston area.163 Research has shown that peers can have as much, or even more, of a positive influence on successful recovery as a negative impact on substance misuse. 164 The use of the APG model is particularly important when considering the environment and organizational structure within many sober or recovery schools, the students of which tend to support and engage one another in positive emotional, informational, and affiliational ways. This positive peer support tends to be integral in recovery schools that are based on the APG model, and provides a means through which students can celebrate their journey of recovery alongside peers who are also in recovery. Such positive peer pressure, as well as the high expectations of the school culture that foster empathy and encouragement toward recovery and sobriety, has been shown to positively impact the recovery journeys of many youth.165
Adolescent Recovery Oriented Systems of Care The Adolescent Recovery Oriented Systems of Care (AROSC) subcommittee of the Houston Recovery Initiative Recovery Oriented Systems of Care (HRI/ROSC) is one example of the organization of various agencies in Region 6 that provide positive recovery-centered events for adolescents and their families. The mission statement of the AROSC is as follows: The mission of the AROSC is to come together as a team to fulfill the vision of promoting pathways to recovery for our children, families, and community. The Houston AROSC works closely with Fortis Academy, the first public recovery high school in Houston, is gearing up for its second annual Recovery in the Park event soon to come in September,2019, and dedicates its organizational efforts to ensuring best practices for youth and their families who are seeking treatment and recovery services. The important take-away from these efforts, particularly for the participating youth, is the positive peer pressure culture of recovery and facilitation of multiple opportunities to experience and engage in effective and adaptive life skills, untainted by addictive substances.
163 Collier, C., Hilliker, R., & Onwuegbuzie, A. Alternative peer group: a model for youth recovery. Journal of Groups in Addiction and Recovery. 2014; v. 9 (1). 164 Center for Substance Abuse Treatment. What are peer recovery support services?: Recovery Community Services Program; Rockville, MD: 2009. http://store.samhsa.gov/shin/content//SMA09-4454/.pdf, Accessed July 30, 2017. 165 Karakos, H. Positive peer support or negative peer influence? The role of peers among adolescents in recovery high schools. Peabody Journal of Education. January 1, 2014; 89(2): 214-228. Doi: 10.1080/0161956X.2014.897094.
P a g e 98 | 157
PRC 6 RNA 2019
High School Completion and Graduation Rates
Table 33. Region 6 county-level graduation and dropout rates: 2014, 2015, 2016, 2017166 2014 2015 2016 2017 Graduate % Graduate % Graduate % Graduate % Austin 95.7% 95.7% 96.8% 94.1% Brazoria 92.8% 93.2% 93.8% 93.7% Chambers 99%* 98.2%* 97.7%* 98.4%* Colorado 93.3% 92.6% 80.2% 85.9% Fort Bend 92.1% 93.2% 93.6% 92.9% Galveston 91.4% 91.9% 92.3% 91.7% Harris 86.3% 87% 87.2% 86.7% Liberty 92% 90.8% 91.2% 91.6% Matagorda 92.5% 92.9% 92.7% 91.6% Montgomery 91.4% 92.4% 92.8% 91.5% Walker 74.9%** 79.3%** 76.7%** 77.1%* Waller 95.8% 94.2% 95.1% 94.7% Wharton 95.6% 95.0% 96.0% 96.3% Region 6 91.8% 88.9% 89.1% 88.5% Texas 93.4% 93.7% 82.8% 93.8% Note. Graduate % only includes information on graduates, continued education programs, and those students holding General Education Diplomas (GED). *Highest graduation rate. **Lowest graduation rate.
Family Domain The protective factors discussed below are clear indicators of what one might expect in the Family Domain of youth where there are positive attachments, healthy attitudes and beliefs and clear standards for behavior, high parental expectations, a sense of basic trust, and positive family dynamics.
Communication between Parent and Child Regarding Alcohol, Tobacco, and other Drugs As can be seen in Figures 76 and 77, the highest percentage of student reports indicating to whom they would go for help if they were having difficulties with drugs or alcohol, 68 percent (the highest percentage of all choices provided) indicated they would go to their parents.
166 Texas Education Agency. Completion, graduation, and dropout rates. Texas Education Agency. https://tea.texas.gov/acctres/dropcomp/years.html. Published December 14, 2017. Accessed April 8, 2018 and April 11, 2019.
P a g e 99 | 157
PRC 6 RNA 2019
Figure 76. Region 5/6 and Texas comparisons of student reports of individuals to whom they would reach out for help if they had a drug or alcohol problem TSS, Grades 7-12: 2016.167
100.0% 90.0% Region 5/6 Texas 80.0% 70.7% 68.2% 64.2% 70.0% 62.8% 62.1% 56.2% 61.4% 60.0% 54.8% 50.0% 42.9% 38.2% 40.3% 39.4% 40.9% 40.0% 39.2% 30.0% 22.6% 24.0%
Percent Percent responses 20.0% 10.0% 0.0% School School Another Parents Program or Medical Friends Another Counselor Nurse Adult in Counselor Doctor Adult School Outside School If you had a drug or alcohol problem and needed help, who would you go to?
Figure 77. Region 5/6 and Texas comparisons of student reports of individuals to whom they would reach out for help if they had a drug or alcohol problem TSS, Grades 7-12: 2018168
100.0% 90.0% Region 5/6 Texas 80.0% 70.6% 67.1% 63.5% 70.0% 58.2%61.7% 59.9% 56.5% 58.8% 60.0% 50.0% 40.1% 39.4% 43.0% 40.8% 40.0% 36.3% 37.3% 30.0% 21.4% 24.2%
Percent Percent responses 20.0% 10.0% 0.0% School School Another Parents Program or Medical Friends Another Counselor Nurse Adult in Counselor Doctor Adult School Outside School If you had a drug or alcohol problem and needed help, who would you go to?
167 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016 HHSC Region 5 and 6 Report. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2018. 168 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016 HHSC Region 5 and 6 Report. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2018.
P a g e 100 | 157
PRC 6 RNA 2019
Parental Attitudes toward Alcohol and Drug Consumption Just as favorable parental attitudes toward substance consumption is a risk factor for youths’ use and misuse of substances, so too are parents’ negative attitudes toward substance use and misuse a protective factor from such behaviors. Furthermore, parental involvement with adolescent children, which is also a protective factor, includes providing clear expectations of behavior. Figures 78-81 display students’ perceptions of parental attitudes toward alcohol and drug use.
Figure 78. Region 5/6 and Texas comparisons of students’ perceptions of parental attitudes toward consumption of alcohol, Grades 7-12: TSS, 2016169 100.0% 90.0% 80.0% 64.9% 70.0% 61.4% Region 5/6 Texas 60.0% 50.0% 40.0% 30.0% 13.4%13.7% 12.0% 20.0% 10.7% 8.0%6.3%
Percent Percent responses 4.0%3.3% 10.0% 1.2% 1.1% 0.0% Strongly Mildly Neither Mildly Approve Strongly Do Not Know Disapprove Disapprove Approve How do your parents feel about kids your age drinking alcohol?
Figure 79. Region 5/6 and Texas comparisons of students’ perceptions of parental attitudes toward consumption of alcohol, Grades 7-12: TSS, 2018170
100.0% 90.0% 80.0% 70.0% 60.5% 62.0% Region 5/6 Texas 60.0% 50.0% 40.0% 30.0% 13.8% 20.0% 14.6%14.4% 12.3% 4.0%3.9% 6.2%6.5% Percent Percent responses 10.0% 1.0% 1.0% 0.0% Strongly Mildly Neither Mildly Approve Strongly Do Not Know Disapprove Disapprove Approve How do your parents feel about kids your age drinking alcohol?
169 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016 HHSC Region 5 and 6 Report. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2018. 170 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016 HHSC Region 5 and 6 Report. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2018.
P a g e 101 | 157
PRC 6 RNA 2019
Figure 80. Region 5/6 and Texas comparisons of students’ perceptions of parental attitudes toward consumption of tobacco, Grades 7-12: TSS, 2016171
100.0% 90.0% 78.4% 80.0% 75.8% 70.0% Region 5/6 2016 Texas 2016 60.0% 50.0% 40.0% 30.0%
Percent Percent responses 20.0% 7.5% 7.4% 6.5% 8.1%6.5% 10.0% 5.9% 1.1%1.0% 0.9% 0.8% 0.0% Strongly Mildly Neither Mildly Approve Strongly Do Not Know Disapprove Disapprove Approve
How do your parents feel about kids your age using tobacco?
Figure 81. Region 5/6 and Texas comparisons of students’ perceptions of parental attitudes toward consumption of tobacco, Grades 7-12: TSS, 2018172 100.0% 90.0% 78.9% 78.3% 80.0% 70.0% Region 5/6 2018 Texas 2018 60.0% 50.0% 40.0% 30.0%
Percent Percent responses 20.0% 7.0% 7.5% 6.1% 6.8%6.8% 10.0% 5.9% 0.7%0.9% 0.6% 0.6% 0.0% Strongly Mildly Neither Mildly Approve Strongly Do Not Know Disapprove Disapprove Approve
How do your parents feel about kids your age using tobacco?
171 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016 HHSC Region 5 and 6 Report. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2018. 172 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016 HHSC Region 5 and 6 Report. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2018.
P a g e 102 | 157
PRC 6 RNA 2019
Figure 82. Region 5/6 and Texas comparisons of students’ perceptions of parental attitudes toward use of marijuana, Grades 7-12: TSS, 2016173
100.0% 90.0% 78.1% 79.0% 80.0% 70.0% Region 5/6 2016 Texas 2016 60.0% 50.0% 40.0% 30.0%
Percent Percent responses 20.0% 5.8% 6.1% 5.4%5.9% 7.6%6.2% 10.0% 1.3%1.4% 1.8% 1.5% 0.0% Strongly Mildly Neither Mildly Approve Strongly Do Not Know Disapprove Disapprove Approve How do your parents feel about kids your age using marijuana?
Figure 83. Region 5/6 and Texas comparisons of students’ perceptions of parental attitudes toward use of marijuana, Grades 7-12: TSS, 2018174 100.0% 90.0% 80.0% 76.2% 76.5% 70.0% Region 5/6 2018 Texas 2018 60.0% 50.0% 40.0% 30.0%
Percent Percent responses 20.0% 7.2% 7.4% 6.3%6.5% 10.0% 6.8% 7.0% 1.8%1.9% 1.8% 1.3% 0.0% Strongly Mildly Neither Mildly Approve Strongly Do Not Know Disapprove Disapprove Approve
How do your parents feel about kids your age using marijuana?
173 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016 HHSC Region 5 and 6 Report. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2018. 174 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016 HHSC Region 5 and 6 Report. http://www.texasschoolsurvey.org/Documents/Reports/Region/16Region5-6.pdf. Accessed July 25, 2018.
P a g e 103 | 157
PRC 6 RNA 2019
Peer Domain Some of the protective factors that are particularly important at the Peer Domain would have much to do with facilitating environments where youth are positively involved with peers, where they are not easily influenced by the negative behaviors of their peers, and involved in organized activities. 175
Perception of Peer Consumption versus Actual Peer Consumption One important contradiction between perception of peer consumption and actual consumption data is that youth tend to perceive that their friends are using or misusing substances at quite a higher level than what youth, in general, actually report using. Figures 84-86 demonstrate this phenomenon for alcohol, marijuana, and tobacco as perception of peer consumption and actual consumption was measured on the TSS.
Figure 84. Regions 5/6 and Texas youth perception of peer consumption versus actual consumption of alcohol, Grades 7-12: TSS, 2018176
175 D’Amico, EJ, Osilla, KC. Prevention and intervention in the school setting. In: KJ Sher ed. The Oxford Handbook of Substance Use and Substance Use Disorders. Vol. 2.New York, NY: Oxford University Press; 2016:675-723. 176 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Texas State Reports. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 104 | 157
PRC 6 RNA 2019
Figure 85. Regions 5/6 and Texas youth perception of peer consumption versus actual consumption of marijuana, Grades 7-12: TSS, 2018177
Figure 86. Regions 5/6 and Texas youth perception of peer consumption versus actual consumption of tobacco, Grades 7-12: TSS, 2018178
177 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 Region 5/6 Texas Reports. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 178 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Texas State Reports. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 105 | 157
PRC 6 RNA 2019
Individual Domain Life Skills Learned in Youth Prevention Programs According to epidemiological investigations on the protective factors in reducing risky behaviors in youth, the social, emotional, behavioral, cognitive, and moral competence in the individual is key. Therefore the evidence based interventions that are approved for use with youth in prevention programs focus on building skills of increased self-efficacy, spirituality, resiliency, and good decision making in these youth. Additionally, Chapter 3 of the U.S. Surgeon General’s report on addiction specifically discusses the step-by-step process for improving the dissemination and implementation of evidence- based interventions and programs that focus on strengthening all the aforementioned individually- geared skills.
Youth Perception of Risk and Harm of Alcohol, Tobacco, Marijuana, and Prescription Drugs High perception of risk or negative feelings towards alcohol or drug use is a major protective factor against substance use and misuse, which was also captured with students’ responses to questions about perception of harm on the TSS. Figure 87 and Figure 88 for 2016 and 2018, respectively, illustrates students’ perception of harm in response to questions about alcohol, tobacco, marijuana, and prescription drugs, which are actually high.
P a g e 106 | 157
PRC 6 RNA 2019
Figure 87. Region 5/6 and Texas, perceived risk of harm from alcohol, tobacco, marijuana, and prescription drugs, Grades 7-12: TSS, 2016179 100.0% 85.8% 88.2% 82.4% 87.6% 90.0%81.3% 84.0% 71.6% 80.0% 71.5% Region 5/6 70.0% Texas 60.0% 50.0% 40.0% 24.2% 30.0% 14.8% 24.4% 6.5% 20.0% 14.2% 11.3% Percent Percent Responses 3.9% 9.9% 5.8% 6.3% 10.0% 3.3% 4.6%4.3% 4.5%3.9% 5.4% 0.0%
How dangerous do you think it is for kids your age to use...?
Figure 88. Region 5/6 and Texas, perceived risk of harm from alcohol, tobacco, marijuana, and prescription drugs, Grades 7-12: TSS, 2o18180
100.0% 84.9% 88.2% 90.0% 78.9% 84.3% 87.3% 77.0% 80.0% 69.7% Region 5/6 68.2% 70.0% Texas 60.0% 50.0% 40.0% 26.3% 30.0% 18.2% 25.6% 7.7% 16.9%
Percent Percent Responses 20.0% 10.0% 9.9% 5.6% 5.0% 6.8% 10.0% 0.0%4.1% 5.7%5.1% 4.7% 4.9% 0.0%
How dangerous do you think it is for kids your age to use...?
179 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5/6 Reports. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 180 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Texas State Reports. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 107 | 157
PRC 6 RNA 2019
Trends of Declining Substance Use
Alcohol Statewide Longitudinal Trends181182
Figure 89.Texas trends in adolescents’ alcohol consumption: TSS, Grades 7-12, 2002, 2004, 2006, 2008, 2010, 2012, 2014, 2016, 2018; YRBS, Grades 9-12, 2001, 2005, 2007, 2009, 2011, 2013, 2017
100 90 80 70 60 50 40 30 20
PercentResponses 10 0
Year TSS, Current Use, Grade 7-12 TSS, Lifetime Use, Grades 7-12 YRBS, Current Use, Grades 9-12 YRBS, Lifetime Use, Grades 9-12 Figure 90. Texas trends in adolescents’ alcohol consumption, Grades 9-12: YRBS, 2001, 2005, 2007, 2009, 2011, 2013, 2017
100 80
60 Current Use 40 Lifetime Use 20 Binge Drinking Extreme Binge Drinking PERCENT RESPONSES PERCENT 0 2001 2005 2007 2009 2011 2013 2017 YEAR
181 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2002, 2004, 2006, 2008, 2010, 2012, 2014, 2016, 2018. HHSC Texas State Reports. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 182 Center for Disease Control and Prevention. High School Youth Risk Behavior Surveillance System (YRBSS). 2001, 2005, 2007, 2009, 2011, 2013, 2017. http://healthdata.dshs.texas.gov/HealthRisks/YRBS. Accessed July 25, 2018.
P a g e 108 | 157
PRC 6 RNA 2019
Tobacco Statewide Longitudinal Trends183
Figure 91. Texas trends in adolescents’ tobacco consumption: TSS, Grades 7-12, 2008, 2010, 2012, 2014, 2016, 2018
100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 2008 2010 2012 2014 2016 2018 Any TobaccoCurrent Use Any Tobacco Lifetime Use E-Vape Current Use E-Vape Lifetime Use
183 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2008, 2010, 2012, 2014, 2016, 2018 HHSC Texas State Reports. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 109 | 157
PRC 6 RNA 2019
Marijuana Statewide Longitudinal Trends184185
Figure 92. Texas trends in adolescents’ marijuana consumption: TSS, Grades 7-12, 2002, 2004, 2006, 2008, 2010, 2012, 2014, 2016, 2018; YRBS, Grades 9-12, 2001, 2005, 2007, 2009, 2011, 2013, 2017
100 90 80 70 60 50 40
30 Percent Responses Percent 20 10 0
TSS, Current Use, Grade 7-12 TSS, Lifetime Use, Grades 7-12 YRBS, Current Use, Grades 9-12 YRBS, Lifetime Use, Grades 9-12
184 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2002, 2004, 2006, 2008, 2010, 2012, 2014, 2016, 2018 HHSC Texas State Reports. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019. 185 Center for Disease Control and Prevention. High School Youth Risk Behavior Surveillance System (YRBSS). 2001, 2005, 2007, 2009, 2011, 2013, 2017. http://healthdata.dshs.texas.gov/HealthRisks/YRBS. Accessed July 25, 2018.
P a g e 110 | 157
PRC 6 RNA 2019
Prescription Drugs Statewide Longitudinal Trends186
Figure 93. Texas trends in adolescents’ prescription drug consumption: TSS, 2008, 2010, 2012, 2014, 2016, 2018 100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0% 2008 2010 2012 2014 2016 2018 TSS Prescriptions Current TSS Prescriptions Lifetime
186 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2002, 2004, 2006, 2008, 2010, 2012, 2014, 2016, 2018 HHSC Texas State Reports. https://www.texasschoolsurvey.org/Report Accessed July 25, 2019.
P a g e 111 | 157
PRC 6 RNA 2019
Illicit Drugs Longitudinal Statewide Trends187188
Figure 94. Texas trends in adolescents’ consumption of any illicit drug: TSS, Grades 7-12, 2008, 2010, 2012, 2014, 2016, 2018
100 90 80 70 60 50 40 30 20 10 0 2008 2010 2012 2014 2016 2018
TSS Illicit Current Use TSS Illicit Lifetime Use
Figure 95. Texas trends in adolescents’ life time use of substances, Grades 9-12: YRBS, 2001, 2005, 2007, 2009, 2011, 2013, 2017
100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 2001 2005 2007 2009 2011 2013 2017
Year Percent of Time Life Use
Alcohol Marijuana Inhalants Cocaine
187 Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2002, 2004, 2006, 2008, 2010, 2012, 2014, 2016, 2018 HHSC Texas State Reports. https://www.texasschoolsurvey.org/Report . Accessed July 25, 2019. 188 Center for Disease Control and Prevention. High School Youth Risk Behavior Surveillance System (YRBSS). 2001, 2005, 2007, 2009, 2011, 2013, 2017. http://healthdata.dshs.texas.gov/HealthRisks/YRBS. Accessed July 25, 2018.
P a g e 112 | 157
PRC 6 RNA 2019
Region in Focus Gaps in Services In past years’ RNAs, the lack of services in the more rural counties of Region 6 has been noted as a service gap of concern. Obviously, concern for all of the coastal counties impacted by Hurricane Harvey is a priority, and the rural counties with very limited access to mental health and substance use treatment services are also a priority (many overlapping with each other), Liberty County is a county that keeps garnering attention with data alluding to the presence of many risk factors for substance use and misuse. Additionally, when entered into SAMHSA’s online Behavioral Health Treatment Services Locator, the system produces only the search results of one Substance Use Treatment provider, one Mental Health Services provider, one Health Care Center, and one Buprenorphine Physician in Liberty County. Also, on the prevention side, Liberty County does not appear to have any state-funded youth prevention programs, nor does it have a substance use community coalition. With the upcoming grant cycle, Liberty County is definitely in need of services, and appears to have more than enough data to support public funding directed to prevention and treatment efforts.
At the state and national level, Texas is still lagging in efforts to end the opioid epidemic in our county, compared to other states. The American Medical Association Opioid Task Force highlights the states that are leading these efforts in their current progress report for 2019 and, unfortunately, Texas is not one of the highlighted states (see Figure 96). 189
Figure 96. American Medical Association Opioid Task Force map highlighting leading states’ actions toward ending the opioid epidemic: 2019
189 American Medical Association Opioid Task Force. Physicians’ progress to reverse the nation’s opioid epidemic. American Medical Association Opioid Task Force Progress Report 2019. American Medical Association. 2019. https://www.ama-assn.org/system/files/2019- 06/opioid-task-force-progress-report.pdf. Accessed July 25, 2019.
P a g e 113 | 157
PRC 6 RNA 2019
Adapted from: American Medical Association Opioid Task Force. Physicians’ progress to reverse the nation’s opioid epidemic. American Medical Association Opioid Task Force Progress Report 2019. American Medical Association. 2019. https://www.ama-assn.org/system/files/2019-06/opioid-task-force-progress- report.pdf. Accessed July 25, 2019.
Gaps in Data One of the most notable gaps, pertaining to the procurement of data for the current RNA 2019 was the lack in congruency of presentation of data in the TSS reports for 2018 in comparison with previous years’ reports. In the 2016 administration of the TSS, the questions on age of initiation was omitted, much to the dismay of many prevention providers in Region 6 (as well as all over the state of Texas), as age of initiation is highly associated future substance misuse and development of substance use disorders. However, in including the questions on age of initiation in the 2018 administration of the TSS, the reporting out of the respective data was not consistent with how this particular piece of data was reported out in 2014, 2008, and 2006. This lack of consistency seems quite counterintuitive for region- level prevention providers who are supposed to be able to derive meaning from possible region-level trends in data for the purpose of securing funding as well as providing appropriate services specific to their communities and region. With this said, the Public Policy Research Institute (PPRI), which is contracted with HHSC in the development, administration, and analysis of the TSS, always indicates that caution should be taken in interpreting the data from the TSS, particularly the interpretation of causal relationships, due to the fact that the TSS research methodology is more epidemiological in nature and, appropriately, does incorporate experimental research methodology needed in order to conclude causal relationships. Two efforts that are, however, required of PRCs across the state of Texas are to liaise with
P a g e 114 | 157
PRC 6 RNA 2019
schools in promoting the bi-annual administration of the TSS for the purpose of the HHSC/PPRI contract, and to assist regional constituents in interpreting the TSS data presented in the annual publication of the RNA. However, if the data (particularly that elicited for age of initiation before and after 2016) is taken at face value in say, the simple attempt to chronologically chart said data, the resulting graph would be incorrect. In the preparation of the current RNA 2019, and upon request, a step-by-step set of instructions was received from personnel at PPRI in order to equate the 2018 data with that of 2014 and earlier so that a correct display could be charted for the purpose of including it in the current RNA 2019. The fact that this inconsistent presentation of data is widely available to the public is concerning and the reports on the TSS website should be corrected.
Another gap in data is evident in the delay in reporting protocols, or even just the ceasing of reporting by some agencies, such as death by suicide rates from DSHS and EMS data by the Texas EMS and Trauma Registries Portal. The data is very out of date on these official reporting sites. For example, the HHSC’s Health Dashboard only presents suicide data up through 2015, yet the news stories and articles in the media and recent CDC reports on increasing suicide rates, particularly in adolescents and young adults with death by suicide as the second highest cause of death in these populations, are prolific as of late. The lack in consistency of accidental poisoning deaths from opioids is also another gap in reporting of data. The timely release of the types of data reports alluded to in this paragraph are especially important for Gulf Coast Region 6 reporting as this area has undergone a significantly catastrophic event in recent years. Hurricane Harvey devastated the region in late August and early September of 2017. Recent child homelessness data from TEA and public assistance data as seen with the jump in SNAP recipients (as well as other indicators) between 2017 and 2018 are just beginning to illustrate, empirically, how much Harvey disrupted the region. Corroborating evidence of just how devastating Hurricane Harvey was, and continues to be, on this area is still yet to be seen.
One indicator that is one of the most important predictors of academic success in the educational literature, which is reading on grade level by the end of third grade, has not been included in the academic achievement section of this RNA, but it should, especially since the overall goal is prevention, here. The Surgeon General’s 2017 report on addiction included a chapter on prevention, in which school failure beginning as soon as fourth grade (but several decades of educational research tells us even younger190) is cited as a significant risk factor. Yet, most epidemiological investigations into substance use prevention often only include indicators like graduation and dropout rates, educational attainment, and college admissions. The inclusion of STAAR reading scores for each county, for the end of third grade, could add yet an even deeper understanding of the academic achievement prevention and risk factors involved in substance use.
190 Report of the National Reading Panel: Teaching Children to Read: an Evidence-Based Assessment of the Scientific Research Literature on Reading and Its Implications for Reading Instruction: Reports of the Subgroups. Washington, D.C.: National Institute of Child Health and Human Development, National Institutes of Health, 2000. https://www.nichd.nih.gov/sites/default/files/publications/pubs/nrp/Documents/report.pdf
P a g e 115 | 157
PRC 6 RNA 2019
Conclusion Key Findings
1. As predicted, there were some indicators that showed the impact of Hurricane Harvey on Region 6 Gulf coast counties and this definitely deserves some discussion, here. The trends for indicators in the Society Domain section of Environmental Risk Factors in this needs assessment, particularly those that provide information on levels of dependence on public assistance, homelessness, and violent crime rates, which are conditions one might assume to typically follow such a catastrophic event. The data for the Supplemental Nutrition Assistance Program (SNAP) show a distinct increase for Region 6, overall, for calendar year 2017, with what seems to be a return to pre-Harvey levels, even back down to 2015 levels for 2018. It could also be possible that this kind of drop in number of SNAP recipients in 2018 is associated with the child homelessness or displacement issues that many residents faced, and continue to face, after Hurricane Harvey hit. The child homelessneness data begins to show the kind of impact Harvey had on individuals experiencing homelessness. Although there are only three data points for each county in Region 6 (data sets from Texas Education Agency, that include child homelessness data, only go as far back to the 2016-2017 school year), the data shows that homelessness rates more than doubled and even tripled for many counties, especially many of the coastal counties, in Region 6 during the school year that Harvey hit, compared to the previous year. Subsequently, many of the child homelessness rates seemingly returned to pre-Harvey rates for the 2018-2019 school year. In addition to coastal counties, Liberty County, positioned near the mouth of the Liberty River and experienced record rainfall during Harvey, appears to have experienced significant increases in several indicators, as well.
2. Region 6 currently has eight substance use prevention coalitions, all concentrated in coastal counties, which are definitely warranted. However, it seems that it is time to make a more concerted effort in directing attention regarding substance use prevention out toward those non-coastal counties that seem to be suffering, especially where indicators of risk factors are concerned. Particularly notable during compilation of the current RNA, Liberty County seems to be in need of strong prevention efforts. As there are no state-funded community prevention coalitions in Liberty County, nor are there any state-funded Youth Prevention Programs in Liberty County, perhaps the community readiness for ushering both types of prevention of prevention efforts into the county is now at a level where successful implementation is a strong possibility. This is particularly important as the substance use treatment, mental health, health care center, and buprenorphine provider services (one provider of each in this county) are almost non-existent in this county.
3. Vaping and marijuana consumption continue to demand attention of prevention providers, as the data presented, here, along with the societal and cultural influences arising from the legalization of marijuana are, probably here to stay. The results of focus groups with adults and youth invoke concern regarding the increase in vaping, the ease with which vaping
P a g e 116 | 157
PRC 6 RNA 2019
paraphernalia can be obtained (even in the mail) and concealed , and the use of vape pens to smoke marijuana concentrates in them with a pleasantly scent or no odor at all. Houston HIDTA found in their annual Drug Threat Assessment that vaping is showing a significant upward surge in adolescents, a finding that resonated with adolescent substance use professionals who participated in the aforementioned adult groups conducted by the PRC 6. HIDTA also reports that marijuana is the most trafficked and most frequently seized illicit drugs in Texas. Influence of increased marijuana availability, along with slight decrease on perception of harm measures, the threat of marijuana for teens is seen as marijuana concentrates (wax and oil) and high-grade/hydroponic marijuana are the top two emerging trends. Edibles incorporating the high doses of THC are being produced as candy and baked goods and poses yet another trend of which providers need to be aware, as youth have been found to consume such products in alarming quantities, and alarming because the high THC potencies in these products are causing individuals to overdose and require medical attention.
P a g e 117 | 157
PRC 6 RNA 2019
Appendix A References 1. McLeroy, KR, Bibeau, D, Steckler, A, Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education & Behavior, 15(4), 351-377.
2. D’Amico, EJ, Chan Osilla, K, Stern, SA. Prevention and Intervention in the School Setting. In Sher, KJ, ed. The Oxford Handbook of Substance Use and Substance Use Disorders, Volume 2. New York, NY: Oxford University Press; 2016: 675-723.
3. National Institute for Alcohol Abuse and Alcoholism. What is a “standard” drink? https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/What-counts-as-a- drink/Whats-A-Standard-Drink.aspx. Accessed May 24, 2018.
4. 1Substance Abuse and Mental Health Services Administration. Strategic Prevention Framework. https://www.samhsa.gov/capt/applying-strategic-prevention-framework. Last updated June 5, 2017.Accessed July 30, 2017.
5. The 200 largest cities in the United States by population 2019. World Population Review. http://worldpopulationreview.com/us-cities/. Accessed July 18, 2019.
6. Hegar, G. Fiscal notes: Port of Houston. Texas Comptroller of Public Accounts. file:///C:/Users/mromain-harrott/Downloads/fn.pdf. Published April, 2017. Accessed July 30, 2017.
7. Coronado, G. How Houston has become the most diverse place in America. Los Angeles Times. http://www.latimes.com/nation/la-na-houston-diversity-2017-htmlstory.html. Published May 9, 2017. Accessed July 24, 2017.
8. Texas Department of State Health Services. Population Projections by Year. https://www.dshs.texas.gov/chs/popdat/downloads.shtm. Accessed June 6, 2019.
9. U.S. Department of Health and Human Services. Facing addiction in America: the surgeon general’s report on alcohol, drugs, and health. https://addiction.surgeongeneral.gov/. Published 2017. Accessed July 30, 2017.
10. U.S. Census Bureau. 2012-2016 American Community Survey 5-year estimates: Language Spoken at Home. American FactFinder - Results. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_S 1601&prodType=table. Published October 5, 2010. Accessed April 22, 2019. U.S. Census Bureau. 2012-2016 American Community Survey 5-year estimates: Language Spoken at Home. American FactFinder Results. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_5YR_S 1601&prodType=table. Published October 5, 2010. Accessed April 22, 2019.
11. U.S. Department of Health and Human Services. Federal poverty level guidelines. https://aspe.hhs.gov/poverty-guidelines. Accessed June 18, 2019.
P a g e 118 | 157
PRC 6 RNA 2019
12. US Census Bureau American Fact Finder. Per capita income in the last 12 months (in corresponding years' inflation-adjusted dollars) for 2013-2017. https://factfinder.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t#none. Accessed July 10, 2019.
13. U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics Information and Analysis. Labor Force Data by County, 2018 Annual Averages. 2018. https://www.bls.gov/lau/#tables. Accessed June 28, 2019.
14. County Health Rankings & Roadmaps. Children in single-parent households. http://www.countyhealthrankings.org/app/texas/2019/measure/factors/82/data. Accessed May 15, 2019.
15. Supplemental Nutritional Assistance Program (SNAP) Statistics. Texas Heath and Human Services Commission. https://hhs.texas.gov/about-hhs/records-statistics/data-statistics/supplemental- nutritional-assistance-program-snap-statistics. Accessed May 10, 2019.
16. County Health Rankings and Roadmaps. Texas Data. 2018. http://www.countyhealthrankings.org/app/texas//compare/snapshot.Accessed June 18, 2018.
17. U.S. Department of Education, National Center for Education Statistics, Common Core of Data (CCD), "Local Education Agency (School District) Universe Survey Membership Data", 2015-16 v.1a; "Public Elementary/Secondary School Universe Survey", 2011-12 v.1a, 2012-13 v.2a, 2013-14 v.2a; "Public Elementary/Secondary School Universe Survey Free Lunch Data", 2015-16 v.1a; "Public Elementary/Secondary School Universe Survey Membership Data", 2015-16 v.1a.
18. U.S. Census Bureau. 2008-2016 Small Area Health Insurance Estimates (SAHIE) Using the American Community Survey (ACS). Model-Based SAHIE Estimates for Counties and States: 2016. https://www.census.gov/data/datasets/time-series/demo/sahie/estimates-acs.html. Accessed June 28, 2018.
19. Hunn, D, Dempsey, M, Zaveri, M. Harvey’s floods: most homes damaged by Harvey were outside flood plain, data show. Houston Chronicle. March 30, 2018. https://www.houstonchronicle.com/news/article/In-Harvey-s-deluge-most-damaged-homes-were- 12794820.php. Accessed July 19, 2019.
20. Amadeo, K. Hurricane Harvey facts, damage and costs: what made Harvey so devastating? The Balance. Updated June 25, 2019. https://www.thebalance.com/hurricane-harvey-facts-damage- costs-4150087. Accessed July 19, 2019.
21. Moravec, ER. Texas officials: Hurricane Harvey death toll at 82, ‘mass casualties have absolutely not happened.’ September 14, 2017. https://www.washingtonpost.com/national/texas-officials- hurricane-harvey-death-toll-at-82-mass-casualties-have-absolutely-not- happened/2017/09/14/bff3ffea-9975-11e7-87fc- c3f7ee4035c9_story.html?utm_term=.6b808589cd3b. Accessed July 19, 2019.
P a g e 119 | 157
PRC 6 RNA 2019
22. Embleton L, Mwangi A, Vreeman R, Ayuku D, Braitstein P. The epidemiology of substance use among street children in resource-constrained settings: a systematic review and meta-analysis. Journal of Addiction. 2013.
23. U.S. Department of Housing and Urban Development, Office of Community Planning and Development. The 2018 Annual Homeless Assessment Report (AHAR) to Congress https://files.hudexchange.info/resources/documents/2018-AHAR-Part-1.pdf, Published December, 2018. Accessed July 19, 2019.
24. Texas Education Agency. County-level homelessness and year-end enrollment rates. 2017, 2018, 2019. https://rptsvr1.tea.texas.gov/adhocrpt/adspr.html. Accessed July, 2019
25. Texas Department of Public Safety. Texas crime report for 2016, 2017, 2018. http://www.dps.texas.gov/crimereports/13/citCh2.pdf. Accessed July 10, 2019.
26. Houston Investigative Support center. 2018 Houston High Intensity Drug Trafficking Area (HIDTA) Threat Assessment. Office of National Drug Control Policy. 2018.
27. Texas Department of Public Safety Crime in Texas Online. Drugs seized reports. https://txucr.nibrs.com/Report/DrugSeized. Accessed July 25, 2017.
28. Texas Alcoholic Beverage Commission. https://www.tabc.texas.gov/PublicInquiry/RosterSummary.aspx. Accessed April 4, 2019
29. Texas Comptroller of Public Accounts. Regional Snapshot: Gulf Coast Region. https://comptroller.texas.gov/economy/docs/regions/region-5.pdf. Published 2015. Accessed July 30, 2017.
30. Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2014, 2016, 2018 HHSC Region 5 and 6 Report. https://www.texasschoolsurvey.org/Report. Accessed July 25, 2019.of Public Accounts. Regional Snapshot: Gulf Coast Region. https://comptroller.texas.gov/economy/docs/regions/region-5.pdf. Published 2015. Accessed July 30, 2017.
31. Texas Education Agency. Completion, Graduation, and Dropouts. https://tea.texas.gov/acctres/dropcomp/years.html. Published December 14, 2017. Accessed April 24, 2018.
32. Texas Education Agency. County-level alcohol and controlled substance violation data, 2016-2017. http://tea.texas.gov . Report generated July 17, 2018.
33. Texas Department of State Health Services. 2001 - 2017 High School Youth Risk Behavior Survey Data. http://healthdata.dshs.texas.gov/HealthRisks/YRBS/. Accessed on April 27, 2018.
34. Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD. 2018. https://www.samhsa.gov/data/sites/default/files/cbhsq- reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.pdf. Accessed July 21, 2019.
P a g e 120 | 157
PRC 6 RNA 2019
35. Substance Abuse and Mental Health Services Administration. Results from the 2016 National Survey on Drug Use and Health: detailed tables. https://www.samhsa.gov/samhsa-data-outcomes- quality/major-data-collections/reports-detailed-tables-2016-NSDUH. Published September 7, 2017. Accessed July 15, 2018.
36. Centers for Disease Control and Prevention. Web-Based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: National Center for Injury Prevention and Control. Available online: http://www.cdc.gov/injury/wisqars/index.html
37. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2017 on CDC WONDER Online Database, released December, 2018. Data are from the Multiple Cause of Death Files, 1999-2017, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. http://wonder.cdc.gov/ucd- icd10.html. Accessed June 28, 2019.
38. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2015. https://www.cdc.gov/brfss/brfssprevalence/. Accessed Mar 13, 2019.
39. Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration, Rockville, MD. 2018. https://www.samhsa.gov/data/sites/default/files/cbhsq- reports/NSDUHFFR2017/NSDUHFFR2017.pdf. Accessed July 22, 2019.
40. Center for Disease Control and Prevention. High School Youth Risk Behavior Surveillance System (YRBSS). 2017. http://healthdata.dshs.texas.gov/HealthRisks/YRBS. Accessed July 25, 2018.
41. M.P. Trey Marchbanks III, PhD. Texas College Survey. Public Policy Research Institute (PPRI). https://texascollegesurvey.org. Published August 2017. Accessed March 27, 2019.
42. Texas Health Data Center for Health Statistics. Texas Summary Statistics, 2015, Accidental Poisoning Deaths where opioids were involved. Texas Health and Human Services: Texas Department of State Health Services. http://healthdata.dshs.texas.gov/Opioids/Deaths, Accessed July 27, 2019.
43. US Department of Health and Human Services. The opioid epidemic by the numbers. US Department of Health and Human Services. https://www.hhs.gov/opioids/about-the- epidemic/index.html. Accessed July 27, 2019.
44. Indiana Department of Homeland Security. Carfentanil safety for responders. Indiana Department of Homeland Security. https://www.in.gov/dhs/files/Carfentanil%20Fact%20Sheet.pdf. Accessed July 27, 2019.
45. Houston Investigative Support center. 2018 Houston High Intensity Drug Trafficking Area (HIDTA) Threat Assessment. Office of National Drug Control Policy. 2018.
P a g e 121 | 157
PRC 6 RNA 2019
46. CDC Wonder. Drug- and Alcohol-Induced Deaths. https://wonder.cdc.gov/wonder/help/mcd.html. Accessed July 30, 2019.
47. Texas Department of Transportation. Report for DUI Driver Fatalities and DUI Total Fatalities, 2016, 2017, 2018. http://www.txdot.gov/government/enforcement/annual-summary.html. Accessed July 30, 2019
48. Texas Department of Criminal Justice. Texas Incarcerations, Drug and Alcohol Offenders on Hand, 2016-2018. Report generated July 1, 2019.
49. Texas Juvenile Justice Department. The State of Juvenile Probation Activity in Texas. Website. Published November 2018, October 2017, October 2016. www.tjjd.texas.gov. Accessed April 1, 2019.
50. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2017. Admissions to and Discharges from Publicly-Funded Substance Use Treatment. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2019. https://www.samhsa.gov/data/sites/default/files/cbhsq- reports/TEDS-2017.pdf. Accessed July 23, 2019.
51. Southeast Texas Poison Center. Exposures reported to the Texas Poison Center Network during January 2000-June 2018 where the exposure reason was intentional abuse. Report generated on July 3, 2018.
52. Texas Department of State Health Services, Texas Health Data, Texas Poison Center Network (TPCN), http://healthdata.dshs.texas.gov/Opioids/PoisonCenter. Accessed January 2019.
53. Texas Department of State Health Services. Texas EMS and Trauma Registries Portal. http://www.dshs.texas.gov/injury/. Accessed July 3, 2018.
54. Voas, RB, Fell, JC. Programs and policies designed to reduce impaired driving. In: KJ Sher ed. The Oxford Handbook of Substance Use and Substance Use Disorders. Vol. 2.New York, NY: Oxford University Press; 2016:621-674.
55. Warrington, R. Sober Curious: The Blissful Sleep, Greater Focus, Limitless Presence, and Deep Connection Awaiting Us All on the Other Side of Alcohol. New York, NY: HarperCollins Publishers, 2018.
56. Substance Abuse and Mental Health Services Administration. Results from the 2016 National Survey on Drug Use and Health: detailed tables. https://www.samhsa.gov/samhsa-data-outcomes- quality/major-data-collections/reports-detailed-tables-2016-NSDUH. Published September 7, 2017. Accessed July 15, 2018.
57. American Medical Association Opioid Task Force. Physicians’ progress to reverse the nation’s opioid epidemic. American Medical Association Opioid Task Force Progress Report 2018. American Medical Association. 2018. https://www.end-opioid-epidemic.org/wp- content/uploads/2018/05/AMA2018-OpioidReport-FINAL-updated.pdf. Accessed July 25, 2018.
P a g e 122 | 157
PRC 6 RNA 2019
58. Texas State Board of Pharmacy. Total dispensation data submitted to the Prescription Monitoring Program by Texas licensed pharmacies. 2017-2018. www.pharmacy.texas.gov. Accessed July 27, 2019.
P a g e 123 | 157
PRC 6 RNA 2019
Appendix B
Glossary of Terms ACS American Community Survey Adolescent An individual between the ages of 12 and 17 years (SAMHSA) APA American Psychological Association ATOD Alcohol, tobacco, and other drugs BAC Blood Alcohol Concentration BLS U.S. Bureau of Labor Statistics BRFSS Behavioral Risk Factor Surveillance System CAPT Southwest Regional Center for Applied Prevention Technologies CBD Cannabinoid CBP U.S. Customs and Border Protection CDC Centers for Disease Control and Prevention CHR County Health Rankings CSAP SAMHSA's Center for Substance Abuse Prevention Current Use Misuse of a substance in the 30 days before participation in survey DEA Drug Enforcement Agency EBP Resource Center SAMHSA’s online Evidence-Based Practices Resource center providing communities, clinicians, policy-makers and others in the field with the information and tools they need to incorporate evidence-based practices into their communities or clinical settings. The Resource Center contains a collection of scientifically-based resources for a broad range of audiences, including Treatment Improvement Protocols, toolkits, resource guides, clinical practice guidelines, and other science-based resources, including prevention resources. Epidemiology Epidemiology is concerned with the distribution and determinants of health and diseases, sickness, injuries, disabilities, and death in populations Evaluation Systematic application of scientific and statistical procedures for measuring program conceptualization, design, implementation, and utility; making comparisons based on these measurements; and the use of the resulting information to optimize program outcomes. EWG Epidemiological Work Group
P a g e 124 | 157
PRC 6 RNA 2019
FBI UCR Federal Bureau-Investigation Uniform Crime Reporting HHSC Health and Human Services Commission HIDTA High Intensity Drug Trafficking Area Incidence Incidence refers to the occurrence of new cases of disease or injury in a population over a specified period of time. (CDC) IOM Institute of Medicine Lifetime Use Any misuse of a substance, even just once, in one’s lifetime NCES National Center for Education Statistics TJJD Texas Juvenile Justice Department NCLB No Child Left Behind NIDA National Institute on Drug Abuse OCA Texas Office of Court Administration PDAP Palmer Substance Abuse Program PDMP Prescription Drug Monitoring Program PPRI Public Policy Research Institute PRC Prevention Resource Center Prevalence Prevalence is the proportion of persons in a population who have a particular disease or attribute at a specified point in time or over a specified period of time. Prevalence differs from incidence in that prevalence includes all cases, both new and preexisting, in the population at the specified time, whereas incidence is limited to new cases only. (CDC) Protective Factor Protective factors are characteristics associated with a lower likelihood of negative outcomes or that reduce a risk factor’s impact. Protective factors may be seen as positive countering events. (SAMHSA) Risk Factor Risk factors are characteristics at the biological, psychological, family, community, or cultural level that precede and are associated with a higher likelihood of negative outcomes. (SAMHSA) RNA Regional Needs Assessment SAMHSA Substance Abuse and Mental Health Services Administration SNAP Supplemental Nutrition Assistance Program
P a g e 125 | 157
PRC 6 RNA 2019
SPF Strategic Prevention Framework. SAMHSA’s SPF is a planning process for preventing substance use and misuse. The five steps and two guiding principles of the SPF offer prevention professionals a comprehensive process for addressing the substance misuse and related behavioral health problems facing their communities. (SAMHSA) Substance Misuse The use of a substance for a purpose not consistent with legal or medical guidelines. This term often describes the use of a prescription drug in a way that varies from the medical direction, such as taking more than the prescribed amount of a drug or using someone else's prescribed drug for medical or recreational use.
Substance Use The consumption of low and/or infrequent doses of alcohol and other drugs such that damaging consequences may be rare or minor. Substance use might include an occasional glass of wine or beer with dinner, or the legal use of prescription medication as directed by a doctor to relieve pain or to treat a behavioral health disorder. SUD Substance Use Disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), no longer uses the terms substance abuse and substance dependence, rather it refers to substance use disorders, which are defined as mild, moderate, or severe to indicate the level of severity, which is determined by the number of diagnostic criteria met by an individual. Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. According to the DSM-5, a diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria. Disorders include: Alcohol Use Disorder (AUD), Tobacco Use Disorder, Cannabis Use Disorder, Stimulant Use Disorder, Hallucinogen Use Disorder, and Opioid Use Disorder. (SAMHSA) TANF Temporary Assistance for Needy Families TDC Texas Demographic Center TEA Texas Education Agency TJJD Texas Juvenile Justice Department TPII Texas Prevention Impact Index TSDC Texas State Data Center TSS Texas School Survey
P a g e 126 | 157
PRC 6 RNA 2019
TxDOT Texas Department of Transportation TxDPS Texas Department of Public Safety USCB U.S. Census Bureau WHO World Health Organization YRBSS Youth Risk Behavior Surveillance System
P a g e 127 | 157
PRC 6 RNA 2019
Appendix c Texas Department of Public Safety, Houston Police Department Drug Seizures, June 2018-June 2019
P a g e 128 | 157
PRC 6 RNA 2019
Appendix D 2019 PDMP Update
P a g e 129 | 157
PRC 6 RNA 2019
P a g e 130 | 157
PRC 6 RNA 2019
Appendix E SAMHSA Behavioral Health Treatment Services Locator https://findtreatment.samhsa.gov/
P a g e 131 | 157
PRC 6 RNA 2019
P a g e 132 | 157
PRC 6 RNA 2019
P a g e 133 | 157
PRC 6 RNA 2019
Appendix F HHSC-Funded Prevention Programs, Region 6, Fiscal Year 2019 This table provides detail about the school district, campus, and type of regional prevention programs. YPU: Youth Prevention-Universal. Curriculum designed for all students. YPS: Youth Prevention-Selected. Curriculum designed for students selected to receive preventative information based on risk factors. YPI: Youth Prevention-Indicated. Curriculum designed for students who have an indicated high risk for substance abuse. District Campus Program Aldine ISD Aldine Middle School YPS YPU Aldine ISD Compass Aldine Education Center YPI Aldine ISD Conley Elementary School YPS Aldine ISD Escamilla Elementary School YPU Aldine ISD Gray Elementary School YPS Aldine ISD Jones Middle School YPU Aldine ISD MacArthur 9th Grade Center YPU Aldine ISD Plummer Middle School YPU Aldine ISD Smith Academy YPU Aldine ISD Spence Elementary School YPU Aldine ISD Stovall Middle School YPS Aldine ISD Teague Middle School YPU Aldine ISD Thompson Elementary School YPS Aldine ISD Victory Early College High School YPU Alief ISD Alexander Elementary School YPU Alief ISD Alief Middle School YPI Alief ISD Budewig Intermediate School YPS YPU Alief ISD Bush Elementary School YPU Alief ISD Klentzman Intermediate School YPS YPU Alief ISD Mata Intermediate School YPI YPS Alief ISD O’Donnell Middle School YPS Alief ISD Olle Middle School YPI YPS Alief ISD Youngblood Intermediate School YPS Alvin ISD ADAPT Alternative Program YPS Channelview ISD Crenshaw Elementary School YPU Channelview ISD DeZavala Elementary School YPU Channelview ISD Schochler Elementary School YPU Charter KIPP Connect Middle School YPS Charter KIPP Generation Collegiate YPI Charter KIPP Zenith Academy YPU Charter Varnett Public School-Northeast YPS YPU Charter Varnett Public School-Southeast YPU Charter YES Prep-Hoffman Middle School YPU Charter YES Prep-Northside Middle School YPU Clear Creek ISD Clear View High School YPS
P a g e 134 | 157
PRC 6 RNA 2019
Cleveland ISD Cleveland Middle School YPS Cleveland ISD Eastside Elementary School YPS Cleveland ISD Northside Elementary School YPS Cleveland ISD Southside Primary School YPS Community Org BBRC Burnett Bayland Reception Center YPI Community Org Salvation Army Boys and Girls Club YPS Community Org Spring Branch Boys and Girls Club YPS Community Org Wesley Community Center YPS Conroe ISD Armstrong Elementary School YPS Conroe ISD Grangerland Intermediate School YPS Conroe ISD Hailey Elementary School YPS Dickinson ISD Dickinson Continuation Center (HS Students) YPS Dickinson ISD Dickinson High School YPS Dickinson ISD Hughes Elementary School YPS Dickinson ISD Juvenile Justice Center Levels 4 and 5 YPS Fort Bend ISD Austin High School YPI Fort Bend ISD Blue Ridge Elementary School YPU Fort Bend ISD Burton Elementary School YPU Fort Bend ISD Crockett Middle School YPS Fort Bend ISD Ferndell Henry Community for Learning YPI Fort Bend ISD Goodman Elementary School YPU Fort Bend ISD Heritage Rose Elementary School YPU Fort Bend ISD Hodges Bend Middle School YPS Fort Bend ISD Lake Olympia Middle School YPI Fort Bend ISD Lakeview Elementary School YPU Fort Bend ISD McAuliffe Middle School YPS Fort Bend ISD Mission Glen Elementary School YPU Fort Bend ISD Mission West Elementary School YPU Fort Bend ISD Missouri City Middle School YPS Fort Bend ISD Quail Valley Middle School YPS Fort Bend ISD Ridgegate Elementary School YPU Fort Bend ISD Ridgemont Elementary School YPU Fort Bend ISD Ridge Point High School YPI Fort Bend ISD Seguin Elementary School YPU Fort Bend ISD Sugar Land Middle School YPS Fort Bend ISD Townewest Elementary School YPU Fort Bend ISD Willowridge High School YPI Galena Park ISD Cimmaron Elementary School YPU Galena Park ISD Cunningham Middle School YPI YPS Galena Park ISD Galena Park High School YPI YPS Galena Park ISD Galena Park Middle School YPS Galena Park ISD Green Valley Elementary School YPU Galena Park ISD Northshore Sr. High School 9th Grade Center YPI YPS Galena Park ISD Northshore Sr. High School 10th-12th Grade YPI YPS Harris County Juvenile JJAEP Excel Academy YPI Probation Department
P a g e 135 | 157
PRC 6 RNA 2019
Houston ISD Atherton Elementary School YPU Houston ISD Austin High School YPI Houston ISD Barrick Elementary School YPU Houston ISD Bellaire High School YPI Houston ISD Booker T. Washington High School YPI YPS YPU Houston ISD Bruce Elementary School YPU Houston ISD Coop Elementary School YPS Houston ISD Crockett Elementary School YPS Houston ISD Eastwood Academy YPI Houston ISD Field Elementary School YPS Houston ISD Fleming Middle School YPU Houston ISD Foster Elementary School YPU Houston ISD Garden Oaks Montessori YPS Houston ISD Gregg Elementary School YPU Houston ISD James D. Burrus Elementary School YPS Houston ISD Kennedy Elementary School YPU Houston ISD Looscan Elementary School YPS Houston ISD M.C. Williams Middle School YPI YPS Houston ISD Mandarin Immersion Magnet School YPU Houston ISD McNamara Elementary School YPU Houston ISD Navarro Middle School YPI Houston ISD Oates Elementary School YPU Houston ISD Patrick Henry Middle School YPS YPU Houston ISD Peterson Elementary School YPU Houston ISD Sam Houston Math, Science, and Technology Center YPI YPU High School Houston ISD Stevens Elementary School YPU Houston ISD T.H. Rogers School YPU Houston ISD Tanglewood Middle School YPI Houston ISD West Briar Middle School YPU Houston ISD Westside High School YPI Houston ISD Whittier Elementary School YPU Klein ISD Schindewolf Intermediate School YPS Lamar CISD Alternative Learning Center YPI Lamar CISD Briscoe Junior High School YPI Lamar CISD Foster High School YPI Lamar CISD Fulshear High School YPI Lamar CISD George Junior High School YPI Lamar CISD George Ranch High School YPI Lamar CISD Lamar Junior High School YPI Lamar CISD Leaman Junior High School YPI Lamar CISD Navarro Middle School YPS Lamar CISD Pink Elementary School YPU Lamar CISD Reading Junior High School YPI Lamar CISD Terry High School YPI Lamar CISD Travis Elementary School YPU
P a g e 136 | 157
PRC 6 RNA 2019
Lamar CISD Wessendorf Middle School YPS Liberty ISD Liberty Elementary School YPS New Waverly ISD New Waverly Intermediate School YPS Pearland ISD Robert Turner College and Career High School YPS Private St. Pius X High School YPS Sante Fe ISD Coastal Alternative Program YPS Splendora ISD Peach Creek Elementary School YPS Spring ISD Burchett Elementary School YPU Spring ISD Donna C. Lewis Elementary School YPS Spring Branch ISD Buffalo Creek Elementary School YPS Spring Branch ISD Edgewood Elementary School YPS YPU Stafford MSD Stafford SEAC YPI Texas City ISD Texas City DAEP YPS Texas City ISD Texas City Early Childhood YPS
P a g e 137 | 157
PRC 6 RNA 2019
Appendix G Suggested Citation
Please use thie suggested citation information below:
Prevention Resource Center 6. Regional Needs Assessment 2019: Epidemiological Profile, Youth Substance Use and Misuse Trends, and Prevention Efforts in the Texas Gulf Coast Region. Houston, TX: The Council on Recovery; July, 2019. www.prc6.org/data.
Author
Melissa Romain-Harrott, Ph.D., Regional Evaluator, Prevention Resource Center 6
Acknowledgements
Thank you to the dynamic coalition leaders and community partners of Region 6 who tirelessly make it their business to build capacity for evidence-based prevention, treatment, and recovery services across the Gulf Coast Region. Special thanks to Julia Scott, Substance Abuse Prevention Evaluator with HHSC, Cynthia Sequeiros, Director of Prevention Resources and Services with The Council on Recovery, and Whitney Weathersby, PRC 6 Community Liaison, also with The Council on Recovery, for support through the data collection and assessment process. Lastly, thank you to Mary Beck, CSO of The Council on Recovery, for supporting the PRC6’s growth into a regionally-recognized source of data and evidence-based prevention support.
P a g e 138 | 157