On behalf of the Rhode Island State Epidemiology and Outcomes Workgroup [December 2016]

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1 Prepared by: Samantha R. Rosenthal, PhD, MPH, Anna Cimini, MA & Stephen L. Buka, ScD Department of Epidemiology Brown University School of Public Health On behalf of the Rhode Island State Epidemiology and Outcomes Workgroup [December 2016]

2 INTRODUCTION The purpose of this report is to identify and present documentation on substance use (i.e., alcohol, tobacco, and other drugs) and mental health indicators for both adults and youth in the communities of Rhode Island as compared to the State. In particular, we focus on demographics, prevalence indicators, risk and protective factors, and consequences. The report is designed to be used as a resource by various RI state agencies, such as the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH); the State Epidemiological Outcomes Workgroup (SEOW); and the many community-based Substance Abuse Prevention Task Forces in RI. It is important to note that this is a working document. The Rhode Island Community Profiles 2016 is understood to be an evolving document, to be improved and updated regularly both with additional indicators and years of data, when available. ACKNOWLEDGEMENTS Thank you to SEOW membership and BHDDH staff. Funding for this report comes from the Substance Abuse and Mental Health Services Administration Award number U579SP The Brown University Team Stephen Buka, ScD Samantha Rosenthal, PhD, MPH Anna Cimini, MA Department of Behavioral Healthcare, Developmental Disabilities and Hospitals Rebecca Boss, MA, Interim Director Elizabeth Kretchman, CPSS, Associate Administrator, Program Services and Community Engagement Unit Linda Barovier, CPSS, Associate Administrator, Policy and Planning Candace Rodgers, MPH, CHES, SPF-PFS Project Director Daniel Fitzgerald, Rhode Island Prevention Coordinator NOTE: For the purposes of this report New Shoreham and Block Island are synonymous and Block Island will be referenced throughout. Suggested Citation: Rosenthal SR, Cimini A, Buka SL. On behalf of the State Epidemiology and Outcomes Workgroup of Rhode Island and the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. Rhode Island Community Profiles Cranston, RI: Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, 2016.

3 CONTENTS OF THE PROFILE Overall Demographics o Population per Square Mile in Rhode Island Communities o Gender Distribution in Rhode Island Communities o Age Distribution in Rhode Island Communities o Racial/Ethnic Distribution in Rhode Island Communities o Unemployment in Rhode Island Communities o Below Federal Poverty Level in Rhode Island Communities Individual Profile o Demographics o Prevalence High School o Prevalence Middle School o Risk and Protective Factors o Consequences Overdose o Consequences Substance Abuse Admissions o Consequences Mental Health Admissions o Consequences Suicidality

4 Central Falls Providence Pawtucket North Providence West Warwick East Providence Newport Cranston Warwick Bristol Barrington Warren Cumberland Middletown Johnston Lincoln Narragansett RHODE ISLAND TOTAL Smithfield East Greenwich Westerly Portsmouth North Kingstown Coventry Jamestown Tiverton South Kingstown North Smithfield Burrillville Scituate Charlestown Hopkinton Richmond Glocester Little Compton West Greenwich Exeter Block Island Foster POPULATION PER SQUARE MILE IN RHODE ISLAND COMMUNITIES 3,666 3,520 3,195 2,821 2,312 2,227 1,939 1,702 1,285 1,237 1,223 1,170 1,120 1, ,553 5, ,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 8,197 9,652 15,043 Source: 2014 American Communities Survey 5 Year Aggregated Estimates

5 GENDER DISTRIBUTION IN RHODE ISLAND COMMUNITIES Little Compton North Smithfield Westerly Smithfield East Providence North Providence Barrington South Kingstown Johnston Burrillville Bristol West Warwick Warwick Middletown Providence Cumberland Tiverton Richmond Lincoln RHODE ISLAND TOTAL North Kingstown Coventry Pawtucket Block Island East Greenwich Newport Warren Glocester Cranston Narragansett Jamestown Exeter West Greenwich Portsmouth Scituate Charlestown Central Falls Foster Hopkinton Male (%) Female (%) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Source: 2014 American Communities Survey 5-Year Aggregated Estimates

6 AGE DISTRIBUTION IN RHODE ISLAND COMMUNITIES Block Island Narragansett Bristol Newport South Kingstown Foster Jamestown Smithfield North Providence Exeter Hopkinton Warwick Johnston Charlestown North Smithfield Glocester Little Compton Tiverton Scituate Cranston Warren Coventry Portsmouth RHODE ISLAND TOTAL Cumberland Westerly West Warwick Burrillville East Providence North Kingstown Lincoln Providence Pawtucket East Greenwich Middletown Richmond Barrington West Greenwich Central Falls % 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Source: 2014 American Communities Survey 5 Year Aggregated Estimates

7 RACIAL/ETHNIC DISTRIBUTION IN RHODE ISLAND COMMUNITIES Glocester Scituate Warren North Smithfield Little Compton Coventry Narragansett Block Island Burrillville Foster Richmond Jamestown Bristol Hopkinton Charlestown Portsmouth Exeter Westerly Smithfield East Greenwich Barrington North Kingstown Cumberland Warwick West Greenwich South Kingstown West Warwick Lincoln Johnston North Providence East Providence Newport Middletown Cranston RHODE ISLAND TOTAL Pawtucket Providence Central Falls White Black Hispanic Other 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Source: 2014 American Communities Survey 5-Year Aggregated Estimates

8 Pawtucket Providence Central Falls West Greenwich Coventry Warren Foster East Providence Cranston West Warwick RHODE ISLAND TOTAL Warwick Middletown Burrillville North Providence Tiverton Exeter Bristol Westerly North Kingstown Charlestown Portsmouth Smithfield Little Compton Scituate Glocester Johnston Richmond Lincoln South Kingstown Barrington Newport North Smithfield Cumberland East Greenwich Jamestown Block Island Hopkinton Narragansett UNEMPLOYMENT IN RHODE ISLAND COMMUNITIES 7.00% 6.90% 6.80% 6.40% 6.20% 6.10% 5.90% 5.60% 5.50% 5.50% 5.50% 5.20% 5.20% 5.20% 5.20% 5.10% 4.80% 4.70% 4.70% 4.60% 4.60% 4.40% 4.30% 4.20% 4.20% 3.90% 3.80% 3.40% 3.30% 3.30% 3.30% 3.00% 2.60% 2.40% 8.80% 8.50% 8.20% 7.90% 7.70% 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 9.30% Source: 2014 American Communities Survey 5-Year Aggregated Estimates

9 Central Falls Providence Pawtucket West Warwick Narragansett RHODE ISLAND TOTAL Newport East Providence Cranston Charlestown Little Compton North Providence Warren Westerly Johnston Exeter Bristol Block Island South Kingstown Burrillville Lincoln Jamestown North Kingstown Coventry Portsmouth Warwick Middletown Foster Scituate East Greenwich Tiverton West Greenwich Cumberland Richmond North Smithfield Smithfield Glocester Hopkinton Barrington BELOW FEDERAL POVERTY LEVEL IN RHODE ISLAND COMMUNITIES 1.8% 11.5% 11.5% 11.2% 11.2% 11.1% 10.9% 10.3% 10.0% 10.0% 9.4% 8.9% 8.9% 8.7% 8.6% 8.3% 8.3% 8.2% 8.0% 7.9% 7.3% 7.1% 6.2% 6.1% 6.1% 6.0% 5.6% 5.6% 5.0% 4.6% 4.1% 3.9% 3.8% 14.3% 16.0% 16.0% 0% 5% 10% 15% 20% 25% 30% 35% 21.4% 26.1% 29.7% 31.7% Source: 2014 American Communities Survey 5-Year Aggregated Estimates

10 Demographics Total Population: 41,136 Total Households: 16,979 GENDER AGE 50.50% 49.50% Male (%) Female (%) 85 YEARS+ 75 TO 84 YEARS 65 TO 74 YEARS 60 TO 64 YEARS 55 TO 59 YEARS 45 TO 54 YEARS 35 TO 44 YEARS 25 TO 34 YEARS 20 TO 24 YEARS 15 TO 19 YEARS 10 TO 14 YEARS 5 TO 9 YEARS UNDER 5 YEARS 2.80% 4.30% 6.90% 5.80% 6.10% 5.90% 5.30% 7.40% 5.50% 7.60% 14.70% 12.90% 14.60% HEALTH INSURANCE RACE/ETHNICITY MULTIRACIAL 2.60% 11.40% OTHER RACE 0.10% NH/PI** 0.00% ASIAN 7.10% 88.60% AI/AN* BLACK 0.30% 6.00% WHITE 69.80% No Health Insurance (%) Health Insurance (%) EMPLOYMENT HISPANIC OR LATINO 14.20% **Native Hawaiian or Pacific Islander; *American Indian or Alaska Native ANNUAL HOUSEHOLD INCOME $200,000 OR MORE 1.60% $150,000 TO $199, % $100,000 TO $149, % 41.20% 53.80% $75,000 TO $99,999 $50,000 TO $74, % 15.10% $35,000 TO $49, % 0.30% 4.80% $25,000 TO $34,999 $15,000 TO $24,999 $10,000 TO $14, % 13.00% 13.50% Employed (%) Unemployed (%) LESS THAN $10, % Armed Forces (%) Not in Labor Force (%) SOURCE: All demographic variables are from 2014 American Community Survey 5-Year Aggregated Estimates

11 Prevalence High School 45 Alcohol Use PAST 30 DAYS Percent of High School Students Highest Value RI Average Lowest Value Percent of High School Students Cigarette Use PAST 30 DAYS Percent of High School Students Felt Sad or Hopeless PAST 12 MONTHS NOTE: Highest/lowest indicates the highest/lowest value across all communities in a given school year; Highest/Lowest community may vary by school year. RHODE ISLAND WOONSOCKET Under the influence of alcohol at school PAST 12 MONTHS % 10.6% % 9.7% Marijuana use PAST 30 DAYS % 53.0% % 55.9% Prescription Drug Misuse PAST 30 DAYS % 53.4% % 55.0% SOURCE: Rhode Island Department of Education SurveyWorks

12 Prevalence Middle School Middle School Prevalence WOONSOCKET RHODE ISLAND Past 30 Day Cigarette Use Past 30 Day Alcohol Use Ever Used Marijuana Ever Misused Prescription Drugs Felt Sad or Hopeless Past 12 Months Percent of Middle School Students NOTE: Due to changes in survey questions from year to year, trend comparisons for middle school data were unavailable. SOURCE: Rhode Island Department of Education SurveyWorks

13 Risk and Protective Factors Percent of High School Students Made Fun of at School Highest Value RI Average Lowest Value 25 Physical Fight at School PAST 12 MONTHS Percent of High School Students NOTE: Highest/lowest indicates the highest/lowest value across all communities in a given school year; Highest/Lowest community may vary by school year Middle School Prevalence WOONSOCKET RHODE ISLAND Made Fun of at School Physical Fight at School PAST 12 MONTHS Percent of Middle School Students NOTE: Due to changes in survey questions from year to year, trend comparisons for middle school data were unavailable. SOURCE: Rhode Island Department of Education SurveyWorks

14 Consequences Overdose SOURCE: Numerators Hospital Discharge Data and ED Data. Denominators Appropriate <18 or 18+ population, American Community Survey year Aggregated Estimates SOURCE: Numerator Behavioral Health On Line Database. Denominator 18+ population from American Community Survey year Aggregated Estimates SOURCE: Overdose Data (RIDOH); Methadone Data (BHDDH)

15 Consequences Substance Abuse Admissions 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 2012 Substance Abuse Admissions by Age Group, Fiscal Years RI RI %18 21 %22 30 %31 45 %46 65 %OVER 65 RI 2014 NOTE: Admissions may not be unique individuals; patients could have presented for treatment multiple times. Admissions under 18, with unknown municipality, out of state, or with unknown age were excluded. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2012 Substance Abuse Admissions by Race/Ethnicity, Fiscal Years RI RI RI 2014 NOTE: Admissions may not be unique individuals; patients could have presented for treatment multiple times. Admissions with unknown municipality, out of state, or with unknown race/ethnicity were excluded. White Black Hispanic Other 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 2012 Substance Abuse Admissions by Primary Substance, Fiscal Years RI RI RI 2014 NOTE: Admissions may not be unique individuals; patients could have presented for treatment multiple times. Admissions with unknown municipality or out of state were excluded. Alcohol Heroin/Other Opiates Marijuana Cocaine/Other/Unknown SOURCE: Behavioral Health On Line Database (BHDDH)

16 Consequences Mental Health Admissions 40% 30% 20% 10% Mental Health Admissions by Age Group, Fiscal Years NOTE: Mental Health admissions may be for mental health treatment or co morbid mental health and substance abuse treatment. Admissions may not be unique individuals; patients could have presented for treatment multiple times. 0% 2012 RI RI RI 2014 % <18 % % % % % >65 100% 80% 60% 40% 20% Mental Health Admissions by Race/Ethnicity, Fiscal Years NOTE: Mental Health admissions may be for mental health treatment or comorbid mental health and substance abuse treatment. Admissions may not be unique individuals; patients could have presented for treatment multiple times. Admissions with unknown race/ethnicity were excluded. 0% 2012 RI RI RI 2014 White Black Hispanic Other 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 2012 Mental Health Admissions by Primary Diagnosis, Fiscal Years RI RI RI 2014 Anxiety Major Depression Other Mood Disorder Schizophrenia Other NOTE: Mental Health admissions may be for mental health treatment or co morbid mental health and substance abuse treatment. Admissions may not be unique individuals; patients could have presented for treatment multiple times. Anxiety (ICD 9 CM: , , , , , ) Major Depression (ICD 9 CM: ) Other Mood Disorder (ICD 9 CM: 296.0, , 296.9, 300.4, , 311) Schizophrenia (ICD 9 CM: 295) Other (Adjustment Disorder , , , , ; Attention Deficit Disorder 314; Conduct Disorder , , ; Dementia 290, ; Autism 299, 315; Other Psychotic Disorder ; Personality Disorder ; No diagnosis or Unknown) SOURCE: Behavioral Health On Line Database (BHDDH)

17 Consequences Suicidality Considered Suicide PAST 12 MONTHS Percent of High School Students Highest Value RI Average Lowest Value 12 Attempted Suicide PAST 12 MONTHS Percent of High School Students NOTE: Highest/lowest indicates the highest/lowest value across all communities in a given school year; Highest/Lowest community may vary by school year Middle School Prevalence WOONSOCKET RHODE ISLAND Considered Suicide PAST 12 MONTHS Attempted Suicide PAST 12 MONTHS Percent of Middle School Students SOURCE: Rhodes Island Department of Education SurveyWorks