Regional Needs Assessment 2017

Transcription

1 2017 Regional Needs Assessment 2017 TRENDS OF SUBSTANCE MISUSE, SUBSTANCE USE DISORDERS, AND PREVENTION NEEDS IN YOUTH IN THE TEXAS GULF COAST REGION PREVENTION RESOURCE CENTER: REGION 6

2 Table of Contents Table of Contents Executive Summary...iii Prevention Resource Centers... v Conceptual Framework... vii Introduction... 1 Methodology... 3 Regional Profile and Demographics... 6 Population... 6 Socioeconomics Risk Factors Community Domain School Domain Family Domain Individual/Peer Domain Alcohol Marijuana Prescription Drugs Comparative Trends Special Topics Consequences...56 Mortality...56 Legal Consequences...59 Protective Factors Community Domain School Domain Family Domain Individual/Peer Domain Region in Focus Gaps in Services Gaps in Data Regional Successes P a g e i 114

3 Table of Contents Key Findings Summary of Region Compared to State Appendix A Glossary of Terms Appendix B List of Tables List of Figures Appendix C Region 6 Listing of Substance Abuse and Mental Health Treatment Centers Appendix D HHSC-Funded Prevention Programs, Region 6, Fiscal Year Appendix E Suggested Citation P a g e ii 114

4 Executive Summary 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 a summary of statistics relevant to risk and protective factors associated with substance misuse and substance use disorders (SUDs), 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 of 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 a comprehensive reference source, here. PRC 6 staff members recognize those collaborators who contributed to the creation of this RNA. Main key findings from this assessment include: 1. Partnership is key. For communities and counties with persistently high risk factors and incidences related to substance misuse and SUDs, as well as drug trafficking, but are not part of the Houston High Density Drug Trafficking Area (HIDTA) list of counties, there are criteria that can be investigated to determine satisfaction of the require criteria for inclusion in the Houston HIDTA. With this inclusion, comes valuable working relationships with the HIDTA division team members and heightened interest and attention on the part of the Drug Enforcement Agency (DEA) in coordinated prevention efforts. For Region 6 counties not on the Houston HIDTA list, that also have multiple community-level risk factors discussed in this RNA, might benefit from inquiring about their county jurisdiction s status with the DEA regarding inclusion in Houston HIDTA initiatives. 2. This RNA definitely provides justification for many counties that continuously show up in the demographic and risk factors data as ranking highest in prevalence of risk factors such as violent and property crime indices, single parent households, unemployment, death by suicide, and reliance on family assistance programs. Even without running sophisticated analyses, the rates per 100,000 population of the aforementioned risk factors demonstrate a dire need for prevention and treatment services and/or HHSC-funded prevention community coalitions for such counties. Table 27 provides a list of existing community partners and community coalitions. P a g e iii 114

5 Executive Summary 3. TSS consumption data corroborated with DEA findings in adolescents. Illicit drugs other than marijuana seemed to show much less interest from youth. Alcohol consumption is of highest prevalence in adolescents, compared to other substances. Even in the consumption data for alcohol, marijuana, and other drugs, an import finding to remember is that there is only a small percentage of youth who report their engagement in substance misuse and SUDs, so there is much to be said about the majority of youth who are not engaging in such at risk behaviors. In fact these students very well may be contributing in a positive manner to the protective factors of their cultural and social norms. Unfortunately, the TSS data cannot be aggregated and analyzed in a manner that yields valid region-specific data on changes in consumption behaviors over time. The state-level consumption data, however, are promising in showing declines in use of several substances, with the exception of an upward trend in some cases for the most recent TSS data collection wave in Accordingly, the investigation into variables that may have contributed to that upward turn are beyond the scope of this RNA. Regardless, many of the overall trends that occurred over the past five data collection waves (10 years) are still encouraging. P a g e iv 114

6 Prevention Resource Centers Prevention Resource Centers There are eleven regional Prevention Resource Centers (PRCs) servicing the state of Texas. Each PRC acts as the central data repository and substance abuse prevention training liaison for their region. Data collection efforts carried out by PRCs are focused on the state s prevention priorities of alcohol (underage drinking), marijuana, and prescription drug use, as well as other illicit drugs. Our Purpose Prevention Resource Centers have four fundamental objectives related to services provided to partner agencies and the community in general: (1) collect data relevant to alcohol, tobacco, and other drug (ATOD) use among adolescents and adults and share findings with community partners via the RNA, presentations, and data reports, (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) provide tobacco education to retailers to encourage compliance with state law and reduce sales to minors. What Evaluators Do Regional PRC Evaluators are primarily tasked with developing data collection strategies and tools, synthesizing and compiling 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 misuse and SUDs. Along with the Community Liaison and Tobacco Specialists, PRC Evaluators engage in building collaborative partnerships with key community members who aid in securing access to information. How We Help the Community PRCs provide technical assistance and consultation to providers, community groups and other stakeholders related to data collection activities for a data repository. PRCs also contribute to the increase in stakeholders knowledge and understanding of the populations they serve, improve programs, and make data-driven decisions. Additionally, the program provides a way to identify community strengths as well as gaps in services and areas of improvement. P a g e v 114

7 Prevention Resource Centers Our Regions Figure 1. Current areas serviced by Prevention Resource Centers in Texas Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 7 Region 8 Region 9 Region 10 Region 11 Panhandle and South Plains Northwest Texas Dallas/Fort Worth Metroplex Upper East Texas Southeast Texas Gulf Coast Central Texas Upper South Texas West Texas Upper Rio Grande Rio Grande Valley/Lower South Texas P a g e vi 114

8 Conceptual Framework Conceptual Framework As one reads through this RNA, two guiding concepts will appear throughout: 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 RNA is based on three main aspects: risk and protective factors, consumption patterns, and consequences of substance misuse and SUDs. Adolescence According to the National Institute on Drug Abuse (NIDA), there is a higher likelihood for people to begin misusing drugs including tobacco, alcohol, and illegal and prescription drugs during adolescence and young adulthood. The teenage years are a critical period of vulnerability to SUDs given that the brain is still developing and some brain areas are less mature than others. The Texas Health and Human Services Commission (HHSC) posits a traditional definition of adolescence as ages (Texas Administrative Code 441, rule 25). However, The World Health Organization (WHO) and American Psychological Association (APA) both define adolescence as the period of age from The WHO identifies adolescence as the period in human growth and development that represents one of the critical transitions in the life span and is characterized by a tremendous pace in growth and change that is second only to that of infancy. Behavior patterns that are established during this process, such as drug use or nonuse and sexual risk taking or protection, can have long-lasting positive and negative effects on future health and well-being. The information presented in this needs assessment document is comprised of county, regional, and state data, which generally define adolescence as ages 10 through The data reviewed here has been mined from multiple sources and will therefore consist of varying demographic subsets of age. 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 As established by the Substance Abuse and Mental Health Services Administration (SAMHSA), epidemiology helps prevention professionals identify and analyze community patterns of substance misuse and the various factors that influence behavior. Epidemiology, or the study of what is of the people, provides the theoretical underpinnings through which the impact of substance misuse and SUDs, on the public at large, is addressed for the purpose of this RNA. Epidemiology frames drug and alcohol use as a public health concern that is both preventable and treatable. According to the WHO, Epidemiology is 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. SAMHSA adopted an epidemiology-based framework for the purpose of surveying and monitoring systems which currently provide indicators regarding the misuse and SUDs of drugs and alcohol on a national level. Ultimately, WHO, SAMHSA, and several other organizations are endeavoring to create an P a g e vii 114

9 Conceptual Framework ongoing systematic infrastructure (such as a repository) that will enable effective analysis and strategic planning for the nation s disease burden, while identifying demographic indicators of risk and evaluating appropriate policy implementation for prevention and treatment. Risk and Protective Factors Traditionally, the prevalent belief regarding the causes of addiction was rooted in the notion that the physical properties of drugs and alcohol were the primary determinants of addiction. However, there now exists a large body of literature documenting the paramount impact of environmental and biological attributes on the potential for the development of SUDs (the most severe of which is addiction). Accordingly, more than 20 years of research has examined the characteristics of effective prevention programs. 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, such as: strong and positive family bonds, parental monitoring of children's activities and peers, and clear rules of conduct that are consistently enforced within the family. Risk factors increase the likelihood of substance abuse problems, such as chaotic home environments, history of parental abuse of substances or mental illnesses, poverty levels, and failure in school performance. Risk and protective factors are classified under four main domains: community, school, family, and individual/peers. Figure 2 illustrates the organization of the risk and protective factors according to the four aforementioned domains. P a g e viii 114

10 Conceptual Framework Figure 2. Organization of risk and protective factors by four domains: community, school, family, and individual and peers Consumption Patterns and Consequences Consequences and consumption patterns share a complex relationship; they are deeply intertwined and often occur in the context of other factors such as lifestyle, culture, or education level. It is a challenging task to determine if consumption of alcohol and other drugs has led to a particular consequence, or if a seemingly apparent consequence has resulted due to consumption of a substance. This RNA examines rates of consumption among adolescents and related consequences in the context of their cyclical relationship; it is not the intention of this RNA to infer causality between consumption patterns and consequences. Such inferences can only be made with the application of sophisticated analytic procedures which are outside the scope of this study. Consumption Patterns Defined For the purpose of this RNA, consumption is defined as the use and high-risk use of alcohol, tobacco, and illicit drugs, and includes patterns of use of alcohol, tobacco, and illicit drugs, focusing on regular or typical use, and high-risk use of such substances. Some examples of operationalizing alcohol consumption factors include evaluating consumption in terms of frequency, behaviors, and trends, such P a g e ix 114

11 Conceptual Framework as current binge drinking, heavy drinking, drinking and driving, alcohol consumption during pregnancy, and per capita sales. Operationalization of consumption can also include other descriptors, such as standardization of substance unit, duration of use, route of administration, and intensity of use (e.g., descriptors of illicit drug consumption may include such criteria as intravenous use and needle sharing). Understanding the measurement of the substance consumed plays a vital role in consumption rates. With alcohol, for instance, beverages are available in various sizes and by volume of alcohol. Variation occurs between beer, wine and distilled spirits. Accordingly, the percentage of pure alcohol may vary among the different categories of alcoholic beverages (see Figure 3). Obviously, a unit of alcohol must be standardized in order to derive meaningful and accurate relationships between consumption patterns and consequences. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines the drink as half an ounce of alcohol, or 12 ounces of beer, a 5 ounce glass of wine, or 1.5 ounce shot of distilled spirits. With regard to intake, the NIAAA has also established a rubric for operationalizing alcohol consumption into units of measurement across beverage types. Binge drinking has historically been operationalized as more than five drinks within a conclusive episode of drinking. The NIAAA (2004) defines it further 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 for women, within a two hour time span. Risky drinking, on the other hand, is predicated by a lower BAC over longer spans of time, while benders are considered two or more days of sustained heavy drinking. Figure 3. NIAAA (2004) rubric for operationalizing alcohol consumption into unit of measurement across beverage type Source: What is a standard Drink? National Institute for Alcohol Abuse and Alcoholism Accessed July 30, P a g e x 114

12 Conceptual Framework Consequences For the purpose of the RNA, consequences are defined as adverse social, health, and safety problems or outcomes associated with the use of alcohol and other drugs. Consequences include events such as mortality, morbidity, violence, crime, health problems, academic failure, and other undesired events for which alcohol and/or drugs are clearly and consistently involved. Although a specific substance may not be the single cause of a consequence, measureable evidence must support a link to alcohol and/or drugs as a contributing factor to the consequence. The WHO estimates alcohol use as the world s third leading risk factor for loss of healthy life, and that the world disease burden attributed to alcohol is greater than that for tobacco and illicit drugs. In addition, stakeholders and policymakers have a vested interest in the monetary costs associated with substance-related consequences. County-, regional-, and state-level data related to consequences of alcohol and other drug use are summarized in later sections of this RNA. Audience Potential readers of this document 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 RNA aims to contribute to program planning, evidence-based decision making, and community education. The executive summary found at the beginning of this RNA provides highlights for those seeking a brief overview. Since readers of this RNA will come from a variety of professional fields, each yielding specialized genres of professional terms and concepts related to substance misuse and SUD prevention, a glossary of key concepts can be found in Appendix A of this RNA. The core of the RNA focuses on risk factors, consumption patterns, consequences, and protective factors. A list of tables and figures can be found in Appendix B. P a g e xi 114

13 Introduction Introduction The State Health and Human Services Commission (HHSC), along with the Substance Abuse and Mental Health Services Administration (SAMHSA), funds approximately 188 school and community-based programs statewide to prevent the use and consequences of alcohol, tobacco and other drugs (ATODs) among Texas youth and families. These programs provide effective evidence-based prevention interventions, which are formally identified by SAMHSA s Center for Substance Abuse Prevention (CSAP) as such. The Strategic Prevention Framework (SPF) provided by CSAP guides many prevention activities in Texas (see Figure 4). In 2004, Texas received a state incentive grant from CSAP to implement the SPF in close collaboration with local communities in order to tailor services appropriate to communities needs for substance misuse and substance use disorders (SUD) prevention. This prevention framework provides a continuum of services that are developed and organized according to the three classifications of prevention activities under the Institute of Medicine (IOM): universal, selective, and indicated. More will be discussed about the three classifications in the Protective Factors section of this Regional Needs Assessment (RNA). Figure 4. Strategic Prevention Framework (SPF) Source: Strategic Prevention Framework. SAMHSA. Last updated June 5, 2017.Accessed July 30, 2017 P a g e 1 114

14 Introduction The Texas HHSC 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 providers works to improve the welfare of Texans by discouraging and reducing substance misuse and SUDs. Their work provides valuable resources to enhance and improve our state's prevention services aimed at addressing our state s three prevention priorities of reducing: (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 The geographical scope of work for PRC Region 6 encompasses the 13 counties that comprise this healthcare region. Figure 5 highlights the southeast location of Region 6 in the state of Texas, as well as the 13 counties that make up Region 6: Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, Wharton. Figure 5. Location and 13 counties of Region 6 in Texas Source: Houston-Galveston Area Council P a g e 2 114

15 Methodology Methodology Purpose This RNA is a review of data on substance misuse, SUDs, and related variables across Region 6 that will aid in substance misuse prevention decision making. A product of the partnership between the Region 6 PRC and the Texas HHSC, this RNA was written in an effort to identify substance misuse, substance use disorder, and prevention data needs at the county, regional, and state levels. In this RNA, 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 RNA 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 information regarding substance misuse and SUDs is missing; To determine county-level differences and disparities within Region 6; To identify substance use issues that are unique to specific communities in Region 6; 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 the prevention, intervention, and treatment of substance misuse and SUDs in Region 6, as well as the state of Texas. Process The state evaluator and the regional evaluators collected copious amounts of data at the county, regional, and state levels between September 1, 2016 and June 30, Between September 2016 and July 2017, the state evaluator met with regional evaluators via bi-weekly conference calls to discuss the criteria for processing and collecting data. The information was 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. Data sources were identified when developing the methodology for this RNA. Readers can expect to find information from agencies such as the American Community Survey, Texas Department P a g e 3 114

16 Methodology of Public Safety (DPS), Texas School Survey of Drug and Alcohol Use, and the Community Commons, among others. Data Selection Relevant data elements were determined and reliable data sources were identified through a collaborative process among the team of regional evaluators and with support from resources provided by the Southwest Regional Center for Applied Prevention Technologies (CAPT). For the purpose of this RNA, the Regional Evaluators and the Statewide Prevention Evaluator chose secondary data sources as the main resource for this document based on the following criteria. Relevance: The data source provides an appropriate measure of substance use consumption, consequence, and related risk and protective factors. Timeliness: Our attempt is to provide the most recent data available (within the last five years); older data may be provided for comparison purposes. Methodologically sound: Data that used well-documented methodology with valid and reliable data collection tools. Representative: We chose data that most accurately reflects the target population at the county regional, and (where appropriate and available) state and national levels. Accuracy: Data is an accurate measure of the associated indicator. Texas School Survey (TSS) Adolescents responses to several questions on the Texas School Survey (TSS) were used as indicators of variables such as consumption, accessibility, perception of harm, perception of peers use and parents attitudes about alcohol and drug use, as well as the documentation of alcohol and drug use trends over time, for the purpose of this RNA. The TSS is typically administered to adolescents in grades 7-12 who attend schools across the state of Texas that have been selected specifically for participation in completing the TSS at two-year intervals. Ideally, the goal of the TSS developers and researchers is to have at least 14 participating schools per region, which have been selected based on specific demographic and randomization criteria, in order to produce reliable and valid data at the level of each individual region across Texas. Unfortunately, the attainment of participation from at least 14 campuses at the regional level can prove to be a difficult task as participation is voluntary on the part of each campus and not mandated. In the case of such an event, the data of each region where the criterion of 14 participating campuses was not met were combined with another neighboring region where the same criterion was not met. Accordingly, as the criterion of 14 participating campuses for Region 6 was not met for the 2014 and 2016 TSS data collection waves, the TSS data for Region 6 was combined with the data of two neighboring regions (Region 5 and Region 8), each combination to be evaluated as one data set (e.g., the combination of Region 6 and Region 5 data yields one data set and the combination of Region 6 and Region 8 yields a separate dataset). Because the combined dataset of Regions 5 and 6 were used for reporting purposes in the collection of TSS data in 2014, the same combination of datasets will be used for the purpose of this RNA. P a g e 4 114

17 Methodology Longitudinally Presented Data In an attempt to capture a deeper richness regarding possible trends in the data presented in this RNA, data collection and reporting efforts consist of multi-year data where it was available. Most longitudinal presentations of data in this document 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). Efforts were 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 data are included in tables and figures, the assumption can be made by the reader that this data was not made available at the time of the data request. Such requests were made to numerous county-, state-, and national-level agencies in the development of this RNA. P a g e 5 114

18 Regional Profile and Demographics Regional Profile and Demographics The Gulf Coast Region of Texas, also known as healthcare 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). The Port of Houston is the largest of 10 seaports located along Texas 367-mile coastline of the Gulf of Mexico and Texas 29 official ports of entry, including the Port of Houston, are well known as significant contributors to the diverse and growing Texas economy 1. 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 The thirteen counties of Texas Region 6 are home to more than 6.5 million people, with a little over 4.3 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 through 3 present general county-level population data regarding population density, age, race and ethnicity. Age According to the U.S. Surgeon General s recent 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 As previously indicated in the Conceptual Framework section of this document, adolescence and young adulthood tend to be the stages in life where likelihood for the onset of substance misuse and SUDs including tobacco, alcohol, and illegal and 1 Hegar, G. Fiscal notes: Port of Houston. Texas Comptroller of Public Accounts. file:///c:/users/mromainharrott/downloads/fn.pdf. Published April, Accessed July 30, Coronado, G. How Houston has become the most diverse place in America. Los Angeles Times. Published May 9, Accessed July 24, P a g e 6 114

19 Regional Profile and Demographics 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 misuse and SUDs, the most severe of which is addiction, in our region. Texas population is significantly younger than the population of the United States as whole. Texas youth population (under age 18) comprises 26.7% of the total population, compared to 23.3% nationwide 3 Tables 2 and 3 illustrate county-level population totals and percentages for several set age ranges representing all life stages from birth to death. Table 1. Region 6 county-level total population and population density estimates: County Total Population Total Land Area (Square Miles) Population Density (Per Square Mile) Austin 28, Brazoria 331,741 1, Chambers 37, Colorado 20, * Fort Bend 658, Galveston 308, Harris 4,356,362 1, ,555.27** Liberty 77,486 1, Matagorda 36,598 1, Montgomery 502,586 1, Walker 69, Waller 45, Wharton 41,264 1, Region 6 6,514,602 12, Texas 26,538, , US 316,515,021 3,532, * Lowest population density per square mile: Colorado County **Highest population density per square mile: Harris County Source: US Census Bureau, American Community Survey. 5-Year Population Totals and Density Estimates by Regions and Counties Accessed May 31, Texas State Data Center, 2015 Population Projections, and U.S. Census Bureau, 2014 Annual Estimates of Population. Accessed July 30, P a g e 7 114

20 Regional Profile and Demographics Table 2. Region 6 county-level population estimates and percentages by age category, Age 0-34: Age 0-4 Age 5-17 Age Age Total % Total % Total % Total % Austin 1, % 5, , , Brazoria 24, , , , Chambers 2, , , , Colorado 1, , , , Fort Bend 45, , , , Galveston 20, , , , Harris 342, , , , Liberty 5, , , , Matagorda 2, , , , Montgomery 34, , , , Walker 3, , , , Waller 3, , , , Wharton 2, , , , Region 6 489, ,272, , , Texas 1,951, ,107, ,714, ,840, US 19,912, ,771, ,368, ,881, Source: US Census Bureau, American Community Survey. 5-Year Population Totals and Density Estimates by Regions and Counties Retrieved on 05/31/2017 from: P a g e 8 114

21 Regional Profile and Demographics Table 3. Region 6 county-level population estimates and percentages by age category, Ages : Age Age Age Age 65+ Total % Total % Total % Total % Austin 3, , , , Brazoria 48, , , , Chambers 5, , , , Colorado 2, , , , Fort Bend 101, , , ,998 9 Galveston 40, , , , Harris 624, , , , Liberty 10, , , , Matagorda 4, , , , Montgomery 69, , , , Walker 9, , , , Waller 4, , , , Wharton 4, , , , Region 6 928, , , , Texas 3,602, ,465, ,888, ,968, US 40,651, ,895, ,417, ,615, Source: US Census Bureau, American Community Survey. 5-Year Population Totals and Density Estimates by Regions and Counties Accessed May 31, P a g e 9 114

22 Regional Profile and Demographics 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. Figure 6 displays each county s race and ethnicity proportions in relation to the total population and population density of the respective county. Tables 4-6 display the race and ethnicity percentages for all 13 counties. Figure 6. Region 6 county-level population estimate totals and percentages by race and ethnicity, Austin County: Total Population, 28,886; Population Density, 4.68 Native American,, 7, 0% Asian, 0, 0% Black, 2,553, 9% Native Hawaiian, 0, 0% Race Other, 998, 3% Multiple, 845, 3% Ethnicity Hispanic or Latino, 7,327, 25% White, 24,483, 85% Non- Hispanic, 21,559, 75% Brazoria County: Total Population, 331,741; Population Density (per square mile), Native Hawaiian, 7, 0% Asian, 19,735, 6% Native Race American,, 1,058, 0% Other, 13,855, 4% Multiple, 6,163, 2% Ethnicity Hispanic or Latino, 96,011, 29% Black, 43,117, 13% White, 247,806, 75% Non- Hispanic, 235,730, 71% P a g e

23 Regional Profile and Demographics Chambers County: Total Population, 37,251; Population Density (per square mile) Asian, 486, 1% Native Hawaiian, 13, 0% Black, 2,957, 8% Other, 1,433, 4% Race Native American,, 86, 0% Multiple, 959, 3% Ethnicity Hispanic or Latino, 96,011, 29% White, 31,317, 84% Non- Hispanic, 235,730, 71% Colorado County: Total Population, 20,757; Population Density (per square mile), Other, 1,107, 19% Native Hawaiian, 0, 0% Race Multiple, 50, 1% White, 1,620, 28% Ethnicity Hispanic or Latino, 5,780, 28% Native American,, 111, 2% Asian, 38, 1% Black, 2,831, 49% Non- Hispanic, 14,977, 72% Fort Bend County: Total Population, 658,331; Population Density (per square miles) Other, Native 35,653, 5% American,, 1,501, 0% Native Hawaiian, 200, 0% Race Multiple, 17,032, 3% Ethnicity Hispanic or Latino, 158,162, 24% Asian, 121,050, 18% Black, 137,227, 21% White, 345,668, 53% Non- Hispanic, 500,169, 76% P a g e

24 Regional Profile and Demographics Galveston County: Total Population 308,163; Population Density (per square mile), Native American,, 1,107, 0% Asian, 10,200, 3% Native Hawaiian, 73, 0% Black, 41,017, 13% Race Other, 7,458, 3% Multiple, 8,182, 3% Ethnicity Hispanic or Latino, 72,332, 23% White, 240,126, 78% Non- Hispanic, 235,831, 77% Harris County: Total Population, 4,356,362; Population Density (per square mile), 2, Other, 380,495, 9% Native Hawaiian, 3,060, 0% Asian, 286,331, 7% Race Native American,, 19,522, 0% Multiple, 96,457, 2% Ethnicity Hispanic or Latino, 1,810,720, 42% Black, 821,686, 19% White, 2,749,811, 63% Non- Hispanic, 2,545,642, 58% Liberty County: Total Population, 77,486; Population Density (per square mile), Asian, 517, 0% Native Hawaiian, 15, 0% Black, 8,287, 11% Other, 4,485, Race Native American,, 232, 0% Multiple, 1,342, 2% Ethnicity Hispanic or Latino, 15,521, 20% White, 62,608, 81% Non- Hispanic, 61,965, 80% P a g e

25 Regional Profile and Demographics Matagorda County: Total Population, 36,598; Population Density (per square mile), Asian, 763, 2% Native Hawaiian, 72, 0% Other, 1,053, 3% Race Native American,, 167, 1% Multiple, 1,384, 4% Ethnicity Hispanic or Latino, 14,587, 40% Black, 3,730, 10% White, 29,429, 80% Non- Hispanic, 22,011, 60% Montgomery County: Total Population, 502,586; Population Density (per square mile), Asian, 12,631, 2% Native Hawaiian, 131, 0% Black, 17,809, 4% Other, 18,679, Race Native American,, 2,750, 1% Multiple, 16,322, 3% Ethnicity Hispanic or Latino, 111,408, 22% White, 434,264, 86% Non- Hispanic, 391,178, 78% Walker County: Total Population, 69,330; Population Density (per square mile), Asian, 817, 1% Native Hawaiian, 10, 0% Other, 950, 2% Race Native American,, 205, 0% Multiple, 799, 1% Ethnicity Hispanic or Latino, 12,242, 18% Black, 15,735, 23% White, 50,814, 73% Non- Hispanic, 57,088, 82% P a g e

26 Regional Profile and Demographics Waller County: Total Population, 45,847; Population Density (per square mile), Asian, 354, 1% Native Hawaiian, 0, 0% Other, 908, 2% Race Native American,, 106, 0% Multiple, 1,223, 3% Ethnicity Hispanic or Latino, 13,352, 29% Black, 11,629, 25% White, 31,627, 69% Non- Hispanic, 32,495, 71% Wharton: Total Population, 41,264; Population Density (per square mile), Asian, 23, 0% Native Hawaiian, 0, 0% Other, 784, 2% Race Native American,, 49, 0% Multiple, 277, 1% Ethnicity Hispanic or Latino, 16,171, 39% Black, 5,936, 14% White, 34,195, 83% Non- Hispanic, 25,093, 61% Source: US Census Bureau, American Community Survey. 5-Year Population Totals and Density Estimates by Regions and Counties Accessed May 31, P a g e

27 Regional Profile and Demographics Table 4. Region 6 county-level population estimate totals by race: County White Black Asian Native American / Alaska Native Native Hawaiian / Pacific Islander Some Other Race Multiple Races Austin 24,483 2, Brazoria 247,806 43,117 19,735 1, ,855 6,163 Chambers 31,317 2, , Colorado 16,620 2, , Fort Bend 345, , ,050 1, ,653 17,032 Galveston 240,126 41,017 10,200 1, ,458 8,182 Harris 2,749, , ,331 19,522 3, ,495 95,457 Liberty 62,608 8, ,485 1,342 Matagorda 29,429 3, ,053 1,384 Montgomery 434,264 17,809 12,631 2, ,679 16,322 Walker 50,814 15, Waller 31,627 11, ,223 Wharton 34,195 5, Region 6 4,298,768 1,114, ,945 26,901 3, , ,035 Texas 19,874,610 3,152,917 1,124, ,493 21,655 1,585, ,062 US 232,943,055 39,908,095 16,235,305 2,569, ,255 14,865,258 9,447,883 Source: US Census Bureau, American Community Survey. 5-Year Population Totals and Density Estimates by Regions and Counties Accessed May 31, P a g e

28 Regional Profile and Demographics Table 5. Region 6 county-level population estimate percentages by race: County White Black Asian Native American / Alaska Native Native Hawaiian / Pacific Islander Some Other Race Multiple Races Austin 84.76% 8.84% 0% 0.02% 0% 3.45% 2.93% Brazoria 74.70% 13% 5.95% 0.32% 0% 4.18% 1.86% Chambers 84.07% 7.94% 1.30% 0.23% 0.03% 3.85% 2.57% Colorado 80.07% 13.64% 0.18% 0.53% 0% 5.33% 0.24% Fort Bend 52.51% 20.84% 18.39% 0.23% 0.03% 5.42% 2.59% Galveston 77.92% 13.31% 3.31% 0.36% 0.02% 2.42% 2.66% Harris 63.12% 18.86% 6.57% 0.45% 0.07% 8.73% 2.19% Liberty 80.80% 10.69% 0.67% 0.30% 0.02% 5.79% 1.73% Matagorda 80.41% 10.19% 2.08% 0.46% 0.20% 2.88% 3.78% Montgomery 86.41% 3.54% 2.51% 0.55% 0.03% 3.72% 3.25% Walker 73.29% 22.70% 1.18% 0.30% 0.01% 1.37% 1.15% Waller 68.98% 25.36% 0.77% 0.23% 0% 1.98% 2.67% Wharton 82.87% 14.39% 0.06% 0.12% 0% 1.90% 0.67% Region % 17.11% 6.95% 0.41% 0.05% 7.18% 2.30% Texas 74.89% 11.88% 4.24% 0.48% 0.08% 5.98% 2.46% US 73.60% 12.61% 5.13% 0.81% 0.17% 4.70% 2.98% Source: US Census Bureau, American Community Survey. 5-Year Population Totals and Density Estimates by Regions and Counties Accessed May 31, P a g e

29 Regional Profile and Demographics Table 6. Region 6 county-level population estimate totals and percentages by ethnicity: Hispanic or Latino Population Non-Hispanic Population County Total Population Total % Total % Austin 28,886 7, , Brazoria 331,741 96, , Chambers 37,251 7, , Colorado 20,757 5, , Fort Bend 658, , , Galveston 308,163 72, , Harris 4,356,362 1,810, ,545, Liberty 77,486 15, , Matagorda 36,598 14, , Montgomery 502, , , Walker 69,330 12, , Waller 45,847 13, , Wharton 41,264 16, , Region 6 6,514,602 2,341, ,173, Texas 26,538,614 10,196, ,342, US 316,515,021 54,232, ,282, Source: US Census Bureau, American Community Survey. 5-Year Population Totals and Density Estimates by Regions and Counties Accessed May 31, P a g e

30 Regional Profile and Demographics Socioeconomics There are many socioeconomic variables that deserve attention when describing the county- and region-level populations in Region 6, especially those variables that have been found to be highly associated with substance misuse and SUDs. The Surgeon General s recent report on addiction specifically cites the findings of longitudinal research in identifying predictors of such substance use problems. These predictors 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, have 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. 4 Therefore, the county- and region-level demographic indicators that are most reflective of such risk factors, as well as imposed by socioeconomic status, will be discussed here. The following indicators will be covered in the present Socioeconomics section: per capita income, household composition, employment, assistance programs, and access to health insurance. Per Capita Income Since socioeconomic status is an important variable in addressing the potential for youth to develop substance use and misuse problems, evaluating per capita income in relation to the 2017 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 2017 is contingent upon number of persons in a household. Figure 7 shows the 2017 Federal Poverty Level guidelines for the 48 border states and Washington D.C. according to the number of persons per household. 5 Table 7 shows the per capita income for each county in Region 6. 4 U.S. Department of Health and Human Services. Facing addiction in America: the surgeon general s report on alcohol, drugs, and health. Published Accessed July 30, U.S. Department of Health and Human Services. Federal poverty level guidelines. Published Accessed July 30, P a g e

31 Amount in Dollars PRC 6 RNA 2017 Regional Profile and Demographics Figure 7. Federal Poverty Level: 2017 $50,000 $40,000 $30,000 $20,000 $10,000 $41,320 $37,140 $32,960 $28,780 $24,600 $20,420 $16,240 $12,060 $ Persons per Household Source: U.S. Department of Health and Human Services. Federal poverty level guidelines. Published Accessed July 30, P a g e

32 Regional Profile and Demographics Table 7. Region 6 county-level per capita income: County Total Population Total Income ($) Per Capita Income ($) Austin 28,886 $798,934,800 $27,658 Brazoria 331,741 $10,162,511,600 $30,633 Chambers 37,251 $1,138,839,700 $30,572 Colorado 20,757 $530,929,300 $25,578 Fort Bend 658,331 $23,674,855,700 $35,961** Galveston 308,163 $9,733,446,500 $31,585 Harris 4,356,362 $126,537,977,300 $29,046 Liberty 77,486 $1,642,221,300 $21,193 Matagorda 36,598 $793,932,800 $21,693 Montgomery 502,586 $17,195,787,400 $34,214 ** Walker 69,330 $1,118,656,900 $16,135* Waller 45,847 $1,047,566,200 $22,849 Wharton 41,264 $890,538,100 $21,581 Region 6 6,514,602 $195,266,197,600 $29,973 Texas 26,538,614 $716,519,339,400 $26,999 United States 316,515,021 $9,156,731,836,300 $28,929 *Lowest per capita income: Walker County **Highest per capita income: Fort Bend County, Montgomery County Source: US Census Bureau, American Community Survey. 5-Year Population Totals and Density Estimates by Regions and Counties Accessed May 31, P a g e

33 Regional Profile and Demographics 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 misuse and SUDs. As indicated in Table 8, there exists a 20 percent range between the lowest and highest percentages of single-parent households among the 13 counties in Region 6, with the most recent data (2017) showing Wharton county as holding the largest percentage of such households (40%). P a g e

34 Regional Profile and Demographics Table 8. Region 6 county-level totals and percentages of single-parent households: 2015, 2016, County Single-Parent Households Total Single-Parent Households % Single- Parent Households Total Single- Parent Households % Single- Parent Households Total Single-Parent Households % Austin 7, , , Brazoria 87, , , Chambers 9, , ,352 20* Colorado 4, , , Fort Bend 176, , , * Galveston 73, , , Harris 1,150, ,165, ,181, Liberty 19, , , Matagorda 9, , ,401 39** Montgomery 128, , , Walker 10, , , Waller 10, , , Wharton 4, , ,663 40** Texas 2,283, ,933, ,003, *Lowest percent of single-parent households, 2017: Chambers County, Fort Bend County **Highest percent of single-parent households, 2017: Matagorda County, Wharton County Source: County Health Rankings and Roadmaps. Published Accessed July 30, P a g e