Regional Needs Assessment REGION 1: PANHANDLE AND SOUTH PLAINS PREVENTION RESOURCE CENTER

Transcription

1 2017 PRC 1 Regional Needs Assessment REGION 1: PANHANDLE AND SOUTH PLAINS PREVENTION RESOURCE CENTER

2 Table of Contents Executive Summary... iii Prevention Resource Centers... v Conceptual Framework of This Report... vi Introduction... 1 Methodology... 2 Regional Demographics... 4 Population... 4 General Socioeconomics... 9 Environmental Risk Factors Education Criminal Activity Mental Health Social Factors Accessibility Perceived Risk of Harm Regional Consumption Alcohol Marijuana Prescription Drugs Special Topic: Opiates Region in Focus: Hockley County Emerging Trends Consequences Overview of Consequences Mortality Legal Consequences Hospitalization and Treatment Economic Impacts Environmental Protective Factors Overview of Protective Factors Community Domain i

3 School Domain Family Domain Individual Domain Trends of Declining Substance Use Region in Focus Gaps in Services Gaps in Data Regional Partners Regional Successes Conclusion Key Findings Summary of Region Compared to State References Glossary of Terms ii

4 Executive Summary The Regional Needs Assessment (RNA) is a document created by the Prevention Resource Center (PRC) in Region 1 along with Evaluators from PRCs across the State of Texas and supported by Managed Care Center and the Texas Health and Human Services Commision (HHSC). The PRC Region 1 serves 41 counties in the Panhandle and South Plains. A team of regional evaluators 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. Secondary qualitative data collection has also been conducted, in the form of surveys, focus groups, and interviews with key informants. The information obtained through these partnerships has been analyzed and synthesized in the form of this Regional Needs Assessment. PRC Region 1 recognizes those collaborators who contributed to the creation of this RNA. This assessment is designed to aid PRC s, 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 presents a summary of statistics relevant to risk and protective factors associated with drug use, as well as consumption patterns and consequences data, at the same time it offers insight related to gaps in services and data availability challenges. Overall, regional adolescents consume AOD substances below both state-levels and national-levels of abuse. Still, some points do stand out concerning regional-level and local-level data on how regional adolescents approach AOD substances. Main key findings from this assessment include: 1. In Region 1, the most common lax attitude about AOD substances is that of alcohol. In interviews, many rural communities do not report or prosecute adolescents who consume alcohol. Often, this is because the Law Enforcement Officer knows the family and makes the choice to just take the teen home instead of to jail. Sometimes, communities are indulgent of adolescents who play sports especially football and provide a venue to drink as well as the alcohol. Many adults remember drinking in high school and consider it an implicit rite of passage into adulthood. Unfortunately, adolescents generally have a different view of drinking. In interviews, many adults in Region 1 report that they remember drinking as adolescents in order to feel grown up or more adult. Adolescents, who participated in these interviews with their parents, often report that they drink in order to get drunk. Because adults have a different understanding of the current motives behind regional adolescent alcohol consumption, they may not be motivated to enforce no drinking ordinances. 2. After looking at the data, it does seem that many communities in Region 1 are taking the threat of prescription drug use/misuse/abuse by adolescents seriously. VOICES of Lubbock and Hockley counties have actively instituted prescription drug collection and disposal programs and Lubbock VOICES have successful installed a drug collection box in the Lubbock Police Department. Adolescents in our region continue to misuse/abuse prescription drugs at a lower rate than other regions in Texas and at a much lower rate than the national averages. iii

5 Overall, 94.4% of regional adolescents report never using prescription opioids not prescribed to them, although it is more likely that they may misuse as they get older. Regional adolescents are most likely to misuse codeine cough syrup (13.7%). In fact, only 5.9% report that using prescription drugs that are not prescribed to them is not dangerous. 3. Generally speaking, available data seems to indicate that fewer adolescents in Region 1 (21.5%) have ever used marijuana when compared to national (44%) and state (26.2% or 37.5%) results. Equally encouraging, fewer regional adolescents (12.1%, 18%) report using marijuana in the last 30 days than national teens (24%). Still, it is troubling that 46% of Lubbock-area adolescents reported that they have tried marijuana at least once. Equally troubling is that 18% of Lubbock-area adolescents report that they have used marijuana within the last 30 days. Although this is slightly less than Texas Students surveyed by the Youth Risk Behavior Surveillance System (YRBS), it is over 5% higher than the Texas Students surveyed by the TSS. iv

6 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 PRC 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 ATOD use among adolescents and adults and share findings with community partners via the Regional Needs Assessment, 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, performing data analysis, and disseminating findings to the community. Data collection strategies are developed around drug use risk and protective factors, consumption data, and related consequences. 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 the 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. Our Regions Current areas serviced by a Prevention Resource Center are: 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 v

7 Conceptual Framework of This Report As one reads through this document, 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 drug use. Adolescence According to the National Institute on Drug Abuse, there is a higher likelihood for people to begin abusing drugs including tobacco, alcohol, and illegal and prescription drugs during adolescence and young adulthood. The teenage years are a critical period of vulnerability to substance use disorders given that the brain is still developing and some brain areas are less mature than others. The Texas Department of State Health Services posits a traditional definition of adolescence as ages (Texas Administrative Code 441, rule 25). However, The World Health Organization (WHO) and American Psychological Association both define adolescence as the period of age from 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 RNA is comprised of 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, epidemiology helps prevention professionals identify and analyze community patterns of substance misuse and the various factors that influence behavior. Epidemiology is the theoretical framework for which this document evaluates the impact of drug and alcohol use on the public at large. Meaning to study what is of the people, epidemiology frames drug and alcohol use as a public health concern that is both preventable and treatable. According to the World Health Organization, 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. The Substance Abuse Mental Health Services Administration has also adopted the epi-framework for the purpose of surveying and monitoring systems which currently provide indicators regarding the use of drugs and alcohol nationally. Ultimately, the WHO, SAMHSA, and several other organizations are endeavoring to create an ongoing systematic infrastructure (such as a repository) that will enable effective analysis and strategic planning for the nation s disease burden, while identifying demographics at risk and evaluating appropriate policy implementation for prevention and treatment. vi

8 Risk and Protective Factors For many years, the prevalent belief was rooted in the notion that the physical properties of drugs and alcohol were the primary determinant of addiction; however, the individual s environmental and biological attributions play a distinguished role in the potential for the development of addiction. 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 drug use among adolescents. Protective factors are characteristics that decrease an individual s risk for a substance abuse 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. 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. Determining if consumption of alcohol or other drugs has resulted in a specific consequence can be challenging. This report examines rates of consumption among adolescents and related consequences in the context of their cyclical relationship; it is not the intention of this report to infer causality between consumption patterns and consequences. Consumption Patterns Defined SAMHSA defines consumption as the use and high-risk use of alcohol, tobacco, and illicit drugs. Consumption includes patterns of use of alcohol, tobacco, and illicit drugs, including initiation of use, regular or typical use, and high-risk use. Some examples of consumption factors for alcohol include terms of frequency, behaviors, and trends, such as current use (within the previous 30 days), current binge drinking, heavy drinking, age of initial use, drinking and driving, alcohol consumption during pregnancy, and per capita sales. Consumption factors associated with illicit drugs may include route of administration such as intravenous use and needle sharing. vii

9 The concept also encompasses standardization of substance unit, duration of use, route of administration, and intensity of use. 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, and, within each of those categories, the percentage of the pure alcohol may vary. Consequently, 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 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 understanding the spectrum of consuming alcoholic beverages. 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 5 or more drinks for men, and 4 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. Consequences For the purpose of the RNA, consequences are defined as adverse social, health, and safety problems or outcomes associated with alcohol and other drugs use. 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 World Health Organization 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. State and regional level data related to consequences of alcohol and other drug use are summarized in later sections of this report. viii

10 Stakeholders Potential 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. 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 with varying definitions of concepts related to substance abuse prevention, a description of definitions can be found in the section titled Key Concepts. The core of the report focuses on substance use risk and protective factors, consumption patterns, and consequences. ix

11 Introduction The Health and Human Services Commission (HHSC) and the Substance Abuse & 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 (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 provided by CSAP guides many prevention activities in Texas. 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. 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 abuse. 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 Our Audience Potential 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. 1

12 Purpose of This Report This needs assessment is a review of data on substance abuse and related variables across the state that will 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 consumption trends and consequences. Additionally, the report explores related risk and protective factors as identified by the Center for Substance Abuse Prevention (CSAP). Methodology This needs assessment was developed to provide relevant substance abuse prevention data related to adolescents throughout the state. Specifically, this regional assessment serves the following purposes: To discover patterns of substance use among adolescents and monitor changes in substance use trends over time; To identify gaps in data where critical substance abuse information is missing; To determine regional differences and disparities throughout the state; To identify substance use issues that are unique to specific communities and regions in the state; 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 abuse prevention, intervention, and treatment in the state of Texas. Process The state evaluator and the regional evaluators collected primary and secondary data at the county, regional, and state levels between September 1, 2016 and May 30, The state evaluator met with the regional evaluators at a statewide conference in September 2016 to discuss the expectations of the regional needs assessment for the third year. 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. Additionally, qualitative data was collected through primary sources such as surveys and focus groups conducted with stakeholders and participants at the regional level. Primary and secondary data sources were 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. 2

13 Quantitative 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). The following were criterion for selection: For the purpose of this Regional Needs Assessment, 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); however, older data might 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 in Texas and across the eleven human services regions. Accuracy: Data is an accurate measure of the associated indicator. Qualitative Data Selection During the year, focus groups, surveys and interviews were 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 served to identify avenues for further research and provide access to any quantitative data that each participant may have access to. Focus Groups Participants for the focus groups were 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 discussed their perceptions of how their communities are affected by alcohol, marijuana, and prescription drugs. Interviews Interviews were conducted primarily with school officials and law enforcement officers. Participants were randomly selected by city and then approached to participate in an interview with the Regional Evaluator. Each participant was 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? Other questions inevitably arose during the interviews, but these four were asked of each participant. Surveys 3

14 Occasionally, organizations approach the PRC asking for guidance to construct and administer surveys in order to collect information about how their adolescents perceive and consume AOD. All survey questions are either copied from tools that have been tested and vetted or they are subjected to rigorous testing through focus groups or other research methods. Many of the questions used by the PRC originate from the following survey tools: 40 Developmental Assets Survey Youth Risk Behavior Surveillance System Monitoring the Future Texas School Survey Regional Demographics Texas is a state of vast land area and a rapidly growing population. Compared to the U.S. as a whole, Texas 2015 population estimate of 26,538,614 people ranks it as the second-most populous state, behind California s 39,144,818, and Texas ranks as the second-fastest growing state with a growth change of 9.24%, behind only North Dakota at 12.54%, well ahead of the national growth rate of 4.10%. Texas is the second most populous state in the nation and six cities have a population of at least 500,000, including Dallas and Houston. There are 25 cities that have a population of 100,000 or more including Lubbock (284,890) and Amarillo (249,881). As of 2015, there are 26,538,614 people living in the State of Texas. Given the various distinctions between each town and region, it would be easy to see how trends may present differently amongst geographical locations. One may assume that border regions are plagued by more cartel activity, for instance. However, it should be noted that cartel activity plagues many of our more interior regions, as they are integral to supply and trade routes for these powerful cartels (see Texas DPS Threat Overview, 2013). Still, Region 1 is comprised of 41 counties and has the largest geographical area of all the regions at 39,348.3 square miles. Most of the population resides in Amarillo and Lubbock and data is sparse in large areas within the region. In the future, we hope to acquire more data for those areas by conducting more focus groups and meetings with local stakeholders. Population Population change within the region from is shown below. During the fourteen-year period, total population estimates for Region 1 grew by 9.99 percent, increasing from 780,733 persons in 2000 to 858,722 persons in Table 1: Population Change, Region 1, Total Population, 2015 ACS Total Population, 2000 Census Population Change from Census/ACS Percent Change from Census/ACS Region 1 858, ,733 77, % Armstrong 1,943 2, % Bailey 7,126 6, % Briscoe 1,670 1, % 4

15 Carson 6,068 6, % Castro 7,948 8, % Childress 7,059 7, % Cochran 2,993 3, % Collingsworth 3,058 3, % Crosby 6,007 7,072-1, % Dallam 7,014 6, % Deaf Smith 19,245 18, % Dickens 2,281 2, % Donley 3,588 3, % Floyd 6,178 7,771-1, % Garza 6,410 4,872 1, % Gray 22,983 22, % Hale 35,504 36,602-1,098-3% Hall 3,203 3, % Hansford 5,559 5, % Hartley 6,121 5, % Hemphill 4,115 3, % Hockley 23,322 22, % Hutchinson 21,858 23,857-1, % King % Lamb 13,742 14, % Lipscomb 3,483 3, % Lubbock 290, ,628 48, % Lynn 5,764 6, % Moore 22,281 20,121 2, % Motley 1,071 1, % Ochiltree 10,642 9,006 1, % Oldham 2,071 2, % Parmer 10,004 10, % Potter 122, ,546 8, % Randall 126, ,312 22, % Roberts % Sherman 3,066 3, % Swisher 7,713 8, % Terry 12,687 12, % Wheeler 5,618 5, % Yoakum 8,213 7, % Texas 26,538,614 20,851,820 5,686, % United States 316,515, ,421,906 35,093, % Data Source: US Census Bureau, American Community Survey. US Census Bureau, Decennial Census Source geography: County Age and Gender Population by gender within Region 1 is shown below. According to ACS year population estimates for the region, the female population comprised 49.77% of the report area, while the male population represented 50.23%. Table 2: Regional Age and Gender Demographics 0 to 4 Male 0 to 4 Female 5 to 17 Male 5 to 17 Female 18 to 64 Male 18 to 64 Female Over 64 Male Over 64 Female 5

16 Region 1 32,498 30,427 82,173 78, , ,419 43,044 60,922 Armstrong Bailey ,076 1, Briscoe Carson ,696 1, Castro ,267 2, Childress ,954 1, Cochran Collingsworth Crosby ,605 1, Dallam ,231 2, Deaf Smith ,168 2,157 5,477 5, ,256 Dickens Donley ,038 1, Floyd ,654 1, Garza ,393 1, Gray ,146 2,016 7,639 5,969 1,394 1,999 Hale 1,340 1,489 3,623 3,524 11,381 9,721 1,818 2,433 Hall Hansford ,595 1, Hartley ,698 1, Hemphill ,125 1, Hockley ,272 2,257 6,952 7,015 1,251 1,764 Hutchinson ,165 2,065 6,516 6,378 1,358 1,673 King Lamb ,576 1,261 3,804 3, ,253 Lipscomb , Lubbock 10,324 9,879 25,468 24,673 93,573 93,416 13,079 19,116 Lynn ,712 1, Moore 1, ,604 2,388 6,827 6, ,155 Motley Ochiltree ,226 1,182 3,175 3, Oldham Parmer ,103 1,046 3,045 2, Potter 5,265 4,990 11,983 11,603 39,610 35,063 5,217 7,854 Randall 4,408 3,893 11,665 11,115 38,881 40,144 6,690 9,374 Roberts Sherman Swisher ,478 1, Terry ,271 1,098 4,272 3, ,031 Wheeler ,617 1, Yoakum ,349 2, Texas 996, ,235 2,607,044 2,500,661 8,257,045 8,254,327 1,195,527 1,657,075 USA 10,175,713 9,736,305 27,479,063 26,292,744 98,539,826 99,675,893 17,538,907 25,075,799 Data Source: US Census Bureau, American Community Survey Source geography: County Race Population by race within the region is shown below. According to ACS year population estimates, the white population comprised 88.1% of Region 1, black population represented 5.73%, and other races combined were 6.17%. Persons identifying themselves as mixed race made up 3.29% of the population. Table 3: Regional Race Demographics 6

17 White Total Black Total American Indian Total Asian Total Native Hawaiian Total Mixed Race Total Region 1 717,548 46,695 6,052 16, ,777 Armstrong 1, Bailey 6, Briscoe 1, Carson 5, Castro 7, Childress 5, Cochran 2, Collingsworth 2, Crosby 5, Dallam 6, Deaf Smith 16, Dickens 2, Donley 3, Floyd 5, Garza 5, Gray 19,728 1, Hale 29,843 1, ,946 Hall 2, Hansford 5, Hartley 5, Hemphill 3, Hockley 19, Hutchinson 19, King Lamb 11, Lipscomb 3, Lubbock 231,263 20,682 2,023 5, ,258 Lynn 4, Moore 17, , Motley 1, Ochiltree 9, Oldham 1, Parmer 8, Potter 96,039 11, , ,582 Randall 114,939 3, , ,262 Roberts Sherman 2, Swisher 6, Terry 11, Wheeler 4, Yoakum 7, Texas 19,874,610 3,152, ,493 1,124,011 21, ,062 United States 232,943,055 39,908,095 2,569,170 16,235, ,255 9,447,883 Data Source: US Census Bureau, American Community Survey Source geography: County 7

18 Population, Minority (Non-White), Percent by County, ACS Over 25.0% % % Under 5.1% No Minority Population Reported No Data or Data Suppressed Region 1 Data Source: US Census Bureau, American Community Survey Source geography: County Ethnicity According to the 2014 US Census, Region 1 is 52.63% Anglo (or Caucasian), 5.77% Black (or African American), 35.62% Hispanic, and 5.98% Other. This Other category includes those regional folks that self-identify as Asian, American Indian, Native Hawaiian, and Mixed. Figure 1: Regional Ethnicity Regional Ethnicity Caucasian Hispanic African American Other Data Source: US Census Bureau, American Community Survey Source geography: County Concentrations of Populations 8

19 Our region is sparsely populated. Of the 858,722 people living in the 41 counties of Region 1, 539,916 live in just three of these counties (Lubbock, Randall, and Potter). Most of this region have less than 51 persons living per square mile. The most densely populated area in Region 1 is Lubbock County (311.3/mi²) followed by Potter County (133/mi²) and Randall County (132.4/mi²). This follows as the city of Lubbock is in Lubbock County and Amarillo is divided between Potter and Randall Counties. The least densely populated county in Region 1 is King County (0.3/mi²). Table X: Region 1 Population Density Population, Density (Persons per Sq Mile) by Tract, ACS Over 5,000 1,001-5, , Under 51 No Data or Data Suppressed Region 1 Data Source: US Census Bureau, American Community Survey. US Census Bureau, Decennial Census Source geography: County Languages Texas has a significantly higher number of residents that are foreign born (16.5%) than the U.S. as a whole (13.1%). As a result, there are also significantly higher numbers of the population (ages 5+, ) that report a language other than English is spoken at home, with Texas at 34.9% compared to 20.9% nationally 1. Another similar indicator is the population with limited English proficiency (LEP). In Texas, it is much higher at 14.22% of the population versus 8.60% for the U.S. Persons are considered to have limited English proficiency they indicated that they spoke a language other than English, and if they spoke English less than "very well, measured as a percentage of the population aged 5 or older 2. In Region 1, 8.86% of people over the age of five have limited English proficiency. General Socioeconomics 2015 poverty estimates show a total of 144,044 persons living below the poverty level in the region. Poverty information is at 100% of the federal poverty income guidelines. Poverty rate change in the region from 2000 to 2015 is shown below. According to the U.S. Census, the poverty rate for the area increased by 0.8%, compared to a national increase of 3.4%. The number and percentage of households 1 U.S. Census Bureau: State and County QuickFacts Vintage. 2 U.S. Census Bureau, American Community Survey

20 in poverty are shown below. In 2015, it is estimated that there were 50,738 households, or 16.46%, living in poverty within Region 1. The following shows population estimates for all persons in poverty for report area. According to the American Community Survey 5 year estimates, an average of percent of all persons lived in a state of poverty during the period. The poverty rate for all persons living in the region is greater than the national average of percent. Average Wages by County Median annual household incomes in Region 1 are shown in the table below. According to the U.S. Census, Median Annual Household Incomes in 2016 ranged from a low of $32,158 in Hall County, Texas to a high of $71,859 in Roberts County, Texas. Table 4: Median Annual Household Income, 2016 Reported Regional Median Annual Household Income by County Armstrong $55,198 Garza $54,606 Moore $49,345 Bailey $38,299 Gray $49,415 Motley $40,575 Briscoe $42,261 Hale $41,999 Ochiltree $67,136 Carson $61,083 Hall $32,158 Oldham $53,797 Castro $43,372 Hansford $ Parmer $46,827 Childress $37,732 Hartley $66,231 Potter $40,353 Cochran $39,398 Hemphill $71,177 Randall $62,080 Collingsworth $38,775 Hockley $48,768 Roberts $71,859 Crosby $34,562 Hutchinson $53,085 Sherman $54,010 Dallam $47,559 King $69,588 Swisher $40,584 Deaf Smith $45,713 Lamb $41,807 Terry $43,357 Dickens $39,169 Lipscomb $60,955 Wheeler $51,114 Donley $36,986 Lubbock $47,139 Yoakum $60,738 Floyd $36,859 Lynn $38,922 Texas $55,653 Data source: U.S. Census Bureau. Small Area Income & Poverty Estimates Poverty According to the American Community Survey 5 year estimates, an average of percent of all persons lived in a state of poverty during the period. The poverty rate for all persons living in the region is greater than the national average of percent. Table 5: Regional Poverty Rates Total Population Population in Poverty Percent Population in Poverty Region 1 822, , % Armstrong 1, % Bailey 6,954 1, % Briscoe 1, % Carson 5, % Castro 7,835 1, % Childress 5,823 1, % Cochran 2, % Collingsworth 2, % 10

21 Crosby 5,921 1, % Dallam 6,958 1,183 17% Deaf Smith 18,980 3, % Dickens 2, % Donley 3, % Floyd 6,126 1, % Garza 4, % Gray 21,262 2, % Hale 32,816 7,548 23% Hall 3, % Hansford 5, % Hartley 4, % Hemphill 4, % Hockley 22,569 3, % Hutchinson 21,684 3, % King % Lamb 13,498 3, % Lipscomb 3, % Lubbock 278,842 54, % Lynn 5,726 1, % Moore 21,985 4, % Motley 1, % Ochiltree 10,582 1, % Oldham 1, % Parmer 9,845 1, % Potter 115,574 25, % Randall 124,322 13, % Roberts % Sherman 3, % Swisher 7,064 1, % Terry 11,492 1, % Wheeler 5, % Yoakum 8, % Texas 25,923,852 4,472, % United States 308,619,550 47,749, % Data Source: US Census Bureau, American Community Survey Source geography: Tract These estimates show a total of 138,542 persons living below the poverty rate in the Region 1. In 2015, Hall County had the highest poverty rate (26.9%), while Roberts County had the lowest poverty rate (1.5%). Region 1 has an overall higher poverty rate (17.7%) than Texas (17.3%) and higher than the United States (15.5%). In 2015, it is estimated that there were 50,738 households, or 16.46%, living in poverty within our region. Table 6: Households in Poverty, Region 1 Total Households Households in Poverty Percent Households in Poverty Region 1 308,184 50, % Armstrong % Bailey 2, % Briscoe % 11

22 Carson 2, % Castro 2, % Childress 2, % Cochran 1, % Collingsworth 1, % Crosby 2, % Dallam 2, % Deaf Smith 6,194 1,179 19% Dickens % Donley 1, % Floyd 2, % Garza 1, % Gray 8, % Hale 11,513 2, % Hall 1, % Hansford 1, % Hartley 1, % Hemphill 1, % Hockley 8,089 1,215 15% Hutchinson 8,297 1, % King % Lamb 4,865 1, % Lipscomb 1, % Lubbock 107,540 19, % Lynn 2, % Moore 6,893 1,101 16% Motley % Ochiltree 3, % Oldham % Parmer 3, % Potter 43,227 8, % Randall 48,770 5, % Roberts % Sherman % Swisher 2, % Terry 4, % Wheeler 2, % Yoakum 2, % Texas 9,149,196 1,419, % United States 116,926,305 16,811, % Data Source: US Census Bureau, American Community Survey Source geography: County According to the U.S. Census, the poverty rate for the 41 county area increased by 0.8% since 2000, compared to a national increase of 3.4%. Garza County experienced the greatest change in poverty, increasing by 4.9% from and Yoakum County experienced the least amount of change, decreasing by -6.1%. In addition, According to the American Community Survey 5 year data, an average of 23.2% of Region 1 children lived in a state of poverty during the 2015 calendar year. Roberts County, Texas, had the lowest 12

23 poverty rate (8.7%) while Hall County had the highest child poverty rate of 39.8%. The poverty rate for children living in Region 1 is greater than the national average of 20.4%. Table 7: Adolescent Poverty Rates, Region 1 All Ages No of Persons All Ages Poverty Rate Age 0-17 No of Persons Age 0-17 Poverty Rate Age 5-17 No of Persons Age 5-17 Poverty Rate Region 1 144, % 51, % 34, % Armstrong % % % Bailey 1, % % % Briscoe % % 65 28% Carson % % % Castro 1, % % % Childress 1, % % % Cochran % % % Collingsworth % % % Crosby 1, % % % Dallam % % % Deaf Smith 3, % 1, % 1, % Dickens % % % Donley % % % Floyd 1, % % % Garza 1, % % % Gray 2,750 13% 1, % % Hale 6, % 2, % 1, % Hall % % % Hansford % % % Hartley % % % Hemphill % % % Hockley 3, % 1, % % Hutchinson 3, % 1, % % King 31 11% % 8 17% Lamb 2, % 1, % % Lipscomb % % % Lubbock 57, % 17, % 11,717 23% Lynn 1, % % % Moore 3, % 1, % % Motley % % % Ochiltree % % % Oldham % % % Parmer 1, % % % Potter 25, % 10, % 6, % Randall 10, % 3,713 12% 2, % Roberts % % % Sherman % % % Swisher 1, % % % Terry 2, % 1, % % Wheeler % % % Yoakum % % % Texas 8,511, % 3,268, % 2,251, % United States 46,153, % 15,000, % 10,245, % 13

24 Data Source: US Census Bureau, Small Area Income Poverty Estimates Source geography: County Houshold Composition The number of families in poverty by type are shown in the region. According to ACS year estimates for Region 1, there were 26,491 families living in poverty. It is estimated that 12.8% of all households were living in poverty within the region, compared to the national average of 11.3%. Of the households in poverty, female headed households represented 6.8% of all households in poverty, compared to 4.8% and 1.2% of households headed by males and married couples, respectively. Table 8: Regional Households in Poverty Total Families Families in Poverty Total Families in Poverty Married Couples Families in Poverty Male Householder Families in Poverty Female Householder Region 1 206,812 26,491 9,846 2,556 14,089 Armstrong Bailey 1, Briscoe Carson 1, Castro 1, Childress 1, Cochran Collingsworth Crosby 1, Dallam 1, Deaf Smith 4, Dickens Donley Floyd 1, Garza 1, Gray 5, Hale 8,491 1, Hall Hansford 1, Hartley 1, Hemphill 1, Hockley 6, Hutchinson 5, King Lamb 3, Lipscomb Lubbock 66,941 8,383 2,570 1,182 4,631 Lynn 1, Moore 5, Motley Ochiltree 2, Oldham Parmer 2, Potter 27,782 5,118 1, ,793 14

25 Randall 33,292 2, ,356 Roberts Sherman Swisher 1, Terry 2, Wheeler 1, Yoakum 2, Texas 6,364, , ,187 76, ,829 United States 77,260,546 8,761,164 3,171, ,758 4,648,079 Data Source: US Census Bureau, American Community Survey Source geography: County Employment Labor force, employment, and unemployment data for each county in the region is provided in the table below. Overall, Region 1 experienced an average 3.3% percent unemployment rate in April 2017, which is lower than Texas (4.3%) and The United States (4.7%). Table 9: Regional Unemployment Rates Labor Force Number Employed Number Unemployed Unemployment Rate Region 1 419, ,189 13, % Armstrong % Bailey 2,832 2, % Briscoe % Carson 3,122 3, % Castro 3,612 3, % Childress 2,958 2, % Cochran 1,252 1, % Collingsworth 1,252 1, % Crosby 2,715 2, % Dallam 4,067 3, % Deaf Smith 8,876 8, % Dickens % Donley 1,625 1, % Floyd 2,796 2, % Garza 2,119 2, % Gray 8,647 8, % Hale 12,769 12, % Hall 1,194 1, % Hansford 3,006 2, % Hartley 3,072 3, % Hemphill 2,074 1, % Hockley 11,286 10, % Hutchinson 9,788 9, % King % Lamb 5,398 5, % Lipscomb 1,713 1, % Lubbock 152, ,313 4,583 3% Lynn 2,827 2, % Moore 11,005 10, % Motley % 15

26 Ochiltree 4,803 4, % Oldham % Parmer 5,013 4, % Potter 56,936 55,280 1, % Randall 69,948 68,146 1, % Roberts % Sherman 1,402 1, % Swisher 2,779 2, % Terry 5,443 5, % Wheeler 2,552 2, % Yoakum 3,860 3, % Texas 13,236,855 12,672, , % United States 159,211, ,689,735 7,521, % Data Source: US Department of Labor, Bureau of Labor Statistics April. Source geography: County Unemployment change within the region during the 1-year period from April 2016 to April 2017 is shown in the table below. According to the U.S. Department of Labor, unemployment for this one year period grew from 13,419 persons to 13,791 persons, a rate change of 0.06%. Table 10: Regional Unemployment Rate Change Unemployment April 2016 Unemployment April 2017 Unemployment Rate April 2016 Unemployment Rate April 2017 Rate Change Region 1 13,419 13, % 3.28% 0.06% Armstrong % 2.42% 0.27% Bailey % 4.1% 0.14% Briscoe % 4.4% 0.6% Carson % 3.14% 0.28% Castro % 2.46% -0.65% Childress % 2.81% 0.16% Cochran % 5.27% 1.46% Collingsworth % 2.96% -0.5% Crosby % 4.09% -0.03% Dallam % 1.82% -0.02% Deaf Smith % 2.63% -0.23% Dickens % 4.29% -0.13% Donley % 3.82% 0.52% Floyd % 4.86% -0.61% Garza % 3.92% 0.3% Gray % 6.8% 1.7% Hale % 5.28% -0.72% Hall % 6.95% 2.16% Hansford % 2.83% -0.01% Hartley % 1.82% -0.14% Hemphill % 4.05% 1.08% Hockley % 4.47% 0.82% Hutchinson % 4.67% 0.73% King % 3.26% 0.05% Lamb % 6.35% -2.34% Lipscomb % 4.61% 0.85% Lubbock 4,451 4,583 3% 3% 0% 16

27 Lynn % 3.61% -0.13% Moore % 2.61% -0.19% Motley % 3.09% -0.46% Ochiltree % 5.31% 1.33% Oldham % 2.8% 0.08% Parmer % 2.07% 0.02% Potter 1,628 1, % 2.91% 0.01% Randall 1,757 1, % 2.58% 0.03% Roberts % 3.71% 0% Sherman % 2.35% 0.12% Swisher % 4.07% -0.12% Terry % 4.67% 0.31% Wheeler % 5.05% 1.81% Yoakum % 4.87% 1.43% Texas 526, , % 4.26% 0.22% United States 8,097,377 7,521, % 4.72% -0.42% Data Source: US Department of Labor, Bureau of Labor Statistics April. Source geography: County Unemployment change within the region from April 2013 to April 2017 is shown in the chart below. According to the U.S. Department of Labor, unemployment for this five year period fell from 4.86% to 3.28%. Table 11: Regional Five Year Unemployment Rate, April 2013 April 2014 April 2015 April 2016 April 2017 Region % 4.95% 3.67% 3.22% 3.28% Armstrong 4.46% 3.75% 2.95% 2.15% 2.42% Bailey 6.4% 6.84% 4.74% 3.96% 4.1% Briscoe 4.97% 5.65% 3.52% 3.8% 4.4% Carson 4.16% 4.16% 3.07% 2.86% 3.14% Castro 4.23% 4.31% 3.79% 3.12% 2.46% Childress 4.28% 4.13% 3.18% 2.65% 2.81% Cochran 7.33% 6.61% 5.15% 3.81% 5.27% Collingsworth 4.68% 4.86% 3.97% 3.45% 2.96% Crosby 7.12% 5.93% 4.31% 4.12% 4.09% Dallam 3.47% 3.27% 2.65% 1.84% 1.82% Deaf Smith 4.48% 4.24% 3.18% 2.86% 2.63% Dickens 10.48% 8.46% 6.68% 4.41% 4.29% Donley 5.27% 4.19% 3.87% 3.29% 3.82% Floyd 6.04% 9.24% 6.36% 5.47% 4.86% Garza 4.87% 4.26% 3.54% 3.61% 3.92% Gray 5.33% 4.98% 3.88% 5.1% 6.8% Hale 6.47% 15% 9.47% 6% 5.28% Hall 7.76% 7.02% 6.11% 4.79% 6.95% Hansford 3.08% 3.1% 2.19% 2.84% 2.83% Hartley 3.16% 2.76% 2.12% 1.97% 1.82% Hemphill 2.59% 2.76% 2.08% 2.97% 4.05% Hockley 4.92% 4.69% 3.48% 3.64% 4.47% Hutchinson 6.26% 6.09% 4.15% 3.94% 4.67% King 4.35% 4.24% 4.35% 3.21% 3.26% 17

28 Lamb 6.6% 6.84% 4.95% 8.69% 6.35% Lipscomb 3.55% 3.67% 2.91% 3.76% 4.61% Lubbock 4.95% 4.57% 3.5% 3% 3% Lynn 6.13% 5.21% 3.84% 3.74% 3.61% Moore 4.03% 4.01% 3.13% 2.8% 2.61% Motley 5.97% 6.49% 4.21% 3.56% 3.09% Ochiltree 3.59% 3.51% 2.65% 3.97% 5.31% Oldham 3.58% 3.95% 3.45% 2.71% 2.8% Parmer 3.7% 3.53% 2.7% 2.06% 2.07% Potter 4.96% 4.73% 3.59% 2.9% 2.91% Randall 4.13% 4.01% 3.08% 2.55% 2.58% Roberts 5.24% 3.97% 3.56% 3.71% 3.71% Sherman 3.72% 3.69% 2.62% 2.23% 2.35% Swisher 5.69% 8.96% 5.83% 4.18% 4.07% Terry 6.21% 5.83% 3.97% 4.36% 4.67% Wheeler 3.84% 4.24% 3.39% 3.25% 5.05% Yoakum 3.82% 3.62% 2.67% 3.44% 4.87% Texas 6.4% 5.97% 4.77% 4.04% 4.26% United States 7.79% 7.16% 5.92% 5.14% 4.72% Data Source: US Department of Labor, Bureau of Labor Statistics April. Source geography: County TANF Recipients In 2016, there were 1663 familes receiving TANF in Region 1. This is up from 2015 (1523) and down slightly from 2013 (1670). Table 12: TANF Recipients by County 2016 Total Population Receiving TANF 2016 Total Population Receiving per 100K 2015 Total Population Receiving TANF 2015 Total Population Receiving per 100K 2014 Total Population Receiving TANF 2014 Total Population Receiving per 100K Region Armstrong Bailey Briscoe Carson Castro Childress Cochran Collingsworth Crosby Dallam Deaf Smith Dickens Donley Floyd

29 Garza Gray Hale Hall Hansford Hartley Hemphill Hockley Hutchinson King Lamb Lipscomb Lubbock Lynn Moore Motley Ochiltree Oldham Parmer Potter Randall Roberts Sherman Swisher Terry Wheeler Yoakum Texas 63, , , Data Source: Food Assistance Recipients The below table shows that according to the American Community Survey (ACS), 40,385 households (or 13.1%) received SNAP payments during During this same period there were 29,818 households with income levels below the poverty level that were not receiving SNAP payments. Table 13: Households Receiving SNAP by Pverty Status Households Receiving SNAP Total Households Receiving SNAP Percent Households Receiving SNAP Income Below Poverty Households Receiving SNAP Income Above Poverty Households Not Receiving SNAP Total Households Not Receiving SNAP Percent Households Not Receiving SNAP Income Below Poverty Households Not Receiving SNAP Income Above Poverty Region 1 40, % 20,920 19, , % 29, ,981 Armstrong % %

30 Bailey % , % 270 1,728 Briscoe % % Carson % , % 101 2,075 Castro % , % 255 1,941 Childress % , % 246 1,820 Cochran % % Collingsworth % % Crosby % , % 214 1,511 Dallam % , % 204 1,806 Deaf Smith % ,203 84% 522 4,681 Dickens % % Donley % , % 133 1,047 Floyd % , % 203 1,677 Garza % , % 87 1,239 Gray % , % 551 6,893 Hale 2, % 1, , % 930 8,397 Hall % % Hansford % , % 156 1,613 Hartley % , % 58 1,619 Hemphill % , % 84 1,262 Hockley 1, % , % 718 6,238 Hutchinson 1, % , % 657 6,502 King 0 0% % Lamb % , % 470 3,507 Lipscomb % , % 84 1,051 Lubbock 14, % 7,112 6,920 93, % 12,456 81,052 Lynn % , % 176 1,603 Moore % , % 570 5,377 Motley % % Ochiltree % , % 323 3,014 Oldham % % Parmer % , % 275 2,600 Potter 7, % 4,352 3,398 35, % 4,460 31,017 Randall 3, % 1,361 2,353 45, % 3,781 41,275 Roberts % % Sherman % % Swisher % , % 264 1,905 Terry % , % 300 2,982 Wheeler % , % 160 1,920 Yoakum % , % 321 2,233 Texas 1,229, % 637, ,782 7,919, % 781,911 7,137,948 United States 15,399, % 7,892,966 7,506, ,526, % 8,918,629 92,608,025 Data Source: US Census Bureau, American Community Survey Source geography: County Free and Reduced-Price School Lunch Recipients The following report shows that 97,946 students (or percent) were eligible for free or reduced price lunches during the school year, which is more than the national average of percent. Table 14: Students Eligible Free/Reduced Price Lunch Total Students Number Free/Reduced Price Lunch Eligible Percent Free/Reduced Price Lunch Eligible Region 1 165,135 97, % Armstrong % Bailey 1,423 1, % 20

31 Briscoe % Carson 1, % Castro 1,707 1, % Childress 1, % Cochran % Collingsworth % Crosby 1, % Dallam % Deaf Smith 4,352 3, % Dickens % Donley % Floyd 1, % Garza 1, % Gray 4,251 2, % Hale 7,374 5, % Hall % Hansford 1, % Hartley 1,886 1, % Hemphill 1, % Hockley 4,970 2, % Hutchinson 4,237 2, % King % Lamb 3,074 2, % Lipscomb % Lubbock 50,301 28, % Lynn 1, % Moore 5,092 3, % Motley % Ochiltree 2,425 1, % Oldham % Parmer 2,381 1, % Potter 25,535 18, % Randall 21,805 8, % Roberts % Sherman % Swisher 1,566 1, % Terry 2,415 1, % Wheeler 1, % Yoakum 2,215 1, % Texas 5,233,736 3,074, % United States 50,436,641 26,213, % Data Source: National Center for Education Statistics, NCES - Common Core of Data Source geography: Address The table below shows local, state, and National trends in student free and reduced lunch eligibility. Note: Data for the school year are omitted due to lack of data for some counties. Table 15: Free and Reduced-Price School Lunch Recipients, Region % 60.12% 60.13% 59.31% Armstrong 40.4% 41.14% 40.65% 40.9% 21

32 Bailey 83.69% 81.91% 83.8% 85.1% Briscoe 54.73% 55.39% 55.21% 51.07% Carson 32.97% 33.15% 31.91% 30.5% Castro 58.44% 78.98% 80.56% 79.03% Childress 54.89% 56.95% 57.51% 51.56% Cochran 74.8% 72.61% 74.26% 73.13% Collingsworth 64.18% 65.7% 62.15% 61.42% Crosby 62.53% 82.61% 82.93% 80.45% Dallam 61.86% 70.31% 63.68% 67.05% Deaf Smith 78.76% 78.93% 81.69% 82.58% Dickens 42.18% 61.79% 62.31% 59.63% Donley 57.69% 54.59% 56.67% 52.95% Floyd 71.78% 71.48% 70.74% 76.7% Garza 66.53% 66.7% 68.97% 71.35% Gray 60.05% 56.01% 54.62% 55.47% Hale 70.98% 71.45% 76.12% 73.42% Hall 69.44% 68.84% 66.4% 69.52% Hansford 58.99% 54.93% 53.1% 51.96% Hartley 55.52% 59.03% 58.73% 58.8% Hemphill 35.38% 42.8% 40.76% 40% Hockley 59.78% 56.57% 57.64% 55.88% Hutchinson 48.26% 48.68% 49.21% 47.58% King 29.31% 29.17% 20.35% 0% Lamb 67.34% 73.45% 70.98% 70.79% Lipscomb 65.02% 52.61% 56.84% 52.85% Lubbock 56.5% 57.58% 57.45% 56.18% Lynn 56.59% 64.64% 61.95% 59.59% Moore 66.54% 66.85% 66.65% 67.66% Motley 78.14% 74.47% 78.05% 76.05% Ochiltree 62.6% 57.38% 57.05% 54.52% Oldham 26.62% 56.28% 53.88% 51.35% Parmer 36.55% 72.26% 75.56% 75.64% Potter 71.64% 72.91% 72.79% 72.7% Randall 38.86% 38.68% 38.9% 37.84% Roberts 25.39% 19.07% 12.74% 18.18% Sherman 48.64% 51.55% 48.71% 56.65% Swisher 71.15% 71.73% 71.26% 72.29% Terry 69.88% 70.34% 71.54% 75.94% Wheeler 51.59% 46.03% 50.38% 41.98% Yoakum 57.75% 53.6% 52.49% 51.42% Texas 50.26% 60.26% 60.08% 58.75% United States 48.15% 51.32% 51.99% 51.8% Data Source: National Center for Education Statistics, NCES - Common Core of Data Source geography: Address Environmental Risk Factors Environmental risk factors are characteristics in a person's surroundings that increase their likelihood of becoming addicted to drugs. A person may have many environments, or domains, of influence such as the community, family, school, and friends. Their risk of addiction can develop in any of these domains. 22

33 Influential factors in substance abuse disorders include genetic predisposition and prenatal exposure to alcohol when combined with poor self-image, self-control, or social competence. Other risk factors include family strife, loose knit communities, participating in an intolerant society, being exposed to violence, emotional distress, poor academics, socio-economic status, and involvement with children s protective services, law enforcement, and parental absence. Education Researchers have found evidence that early drug and alcohol use is associated with lower levels of educational attainment. Studying male twins who served in the military during the Vietnam era, they found that those who began drinking or using drugs as young teens or who became dependent on alcohol, nicotine or marijuana, were less likely to finish college than those who didn t use alcohol or drugs until later in life and never became dependent 3. The table below shows the distribution of educational attainment levels in Region 1. Education attainment is calculated for persons over the age of 25 and is an average for the period from Table 16: Education Attainment Percent No High School Diploma Percent High School Only Percent Some College Percent Associates Degree Percent Bachelors Degree Percent Graduate or Professional Degree Region % 27.39% 25.36% 6.74% 14.36% 7.11% Armstrong 9.31% 24.3% 34% 9.5% 16.1% 6.9% Bailey 31.77% 32.4% 23.2% 4.8% 4.6% 3.2% Briscoe 24.22% 25.6% 22.4% 6% 16% 5.8% Carson 10.17% 28.4% 28% 9.1% 15.4% 9% Castro 29.94% 33.1% 19.5% 4.2% 9.4% 3.8% Childress 13.11% 40.1% 22.1% 7.9% 11.6% 5.2% Cochran 34.21% 29.7% 19.3% 4.7% 7.4% 4.8% Collingsworth 21.3% 32.7% 24.5% 6.4% 10.9% 4.3% Crosby 30.32% 30.7% 22.7% 4.6% 9.2% 2.6% Dallam 25.42% 33.3% 25% 5.2% 9% 2.1% Deaf Smith 27.84% 30.8% 21.1% 5.4% 10.8% 4% Dickens 23.68% 28.3% 28.6% 3.9% 11.4% 4% Donley 16.5% 33.5% 26.7% 8.1% 9.6% 5.6% Floyd 26.17% 29.1% 22% 6.1% 12.9% 3.7% Garza 40.33% 27.8% 19% 3.5% 5.4% 4% Gray 19.52% 33% 25.3% 8.6% 9.8% 3.8% Hale 27.64% 32.3% 20.8% 4.6% 9.1% 5.6% Hall 26.54% 27.9% 27.7% 5.2% 8.9% 3.8% Hansford 24.7% 29.6% 21.5% 4.8% 15.1% 4.3% Hartley 20.23% 34.3% 19.4% 4.8% 16% 5.3% Hemphill 17.63% 25.8% 27.8% 4.4% 19.9% 4.5% Hockley 22.24% 26.2% 27.2% 8.7% 11.2% 4.5% Hutchinson 15.83% 31.2% 30.1% 7.7% 10.8% 4.3% King 20% 39.6% 17.3% 1.4% 15% 6.8% Lamb 26.14% 30.5% 22.6% 4.5% 11.6% 4.8% Lipscomb 17.38% 37.2% 20% 6.8% 14.2% 4.4% 3 Grant JD, et al. 23

34 Lubbock 15.25% 26% 25.2% 6.1% 17.4% 10.1% Lynn 22.62% 31.9% 24.3% 4.8% 12.5% 4% Moore 35.87% 26.1% 20.6% 5.3% 9.5% 2.6% Motley 16.06% 31.8% 29.9% 5% 14.7% 2.5% Ochiltree 25.23% 29.3% 23.5% 6.8% 10.5% 4.7% Oldham 16.38% 19.6% 29% 7.2% 20.2% 7.6% Parmer 32.26% 30.4% 18.3% 3.7% 10.7% 4.6% Potter 23.93% 27.8% 26.2% 7.2% 10.3% 4.5% Randall 8.23% 22.1% 29.9% 9.4% 20.4% 9.9% Roberts 3.41% 30.2% 30.8% 3.7% 25.2% 6.7% Sherman 26.55% 27.9% 19% 5.9% 16.1% 4.6% Swisher 21.77% 35% 23.4% 4% 11.2% 4.8% Terry 30.77% 29.5% 20.9% 6.2% 8.7% 3.9% Wheeler 18.7% 31.3% 26.6% 6.5% 13.4% 3.5% Yoakum 29.12% 29.7% 19.7% 6.8% 10.6% 4% Texas 18.06% 25.2% 22.5% 6.7% 18.2% 9.4% United States 13.35% 27.8% 21.1% 8.1% 18.5% 11.3% Data Source: US Census Bureau, American Community Survey Source geography: County Dropout Rates Overall, Region 1 has a 90.6% graduation rate with only a 5.3% dropout rate. Childress County has the highest dropout rate with 12.2% while nine counties have a dropout rate of 0.0%. Table 17: Regional High School Dropout Rates, 2015 Reported Regional High School Dropout Rates by County 2015 Armstrong 0.7 Garza 3.8 Moore 1.6 Bailey 0.0 Gray 1.6 Motley 0.0 Briscoe 0.0 Hale 6.0 Ochiltree 3.5 Carson 4.8 Hall 0.0 Oldham 7.8 Castro 2.9 Hansford 0.0 Parmer 2.4 Childress 12.2 Hartley 3.3 Potter 6.7 Cochran 2.5 Hemphill 10.2 Randall 2.0 Collingsworth 5.9 Hockley 12.9 Roberts 0.0 Crosby 2.6 Hutchinson 5.5 Sherman 7.5 Dallam 6.3 King 0.0 Swisher 5.8 Deaf Smith 5.2 Lamb 5.7 Terry 2.0 Dickens 5.3 Lipscomb 0.0 Wheeler 4.7 Donley 1.8 Lubbock 8.2 Yoakum 0.8 Floyd 3.4 Lynn 0.0 Texas 6.6 Data Source: Texas Education Agency, 2015 Adult Literacy The National Center for Education Statistics (NCES) produces estimates for adult literacy based on educational attainment, poverty, and other factors in each county. Region 1 has a higher literacy rate than Texas but is less literate than the national average. Table 18: Adult Literacy, Region 1 Estimated Population over 16 Percent Lacking Literacy Skills 24

35 Region 1 568, % Armstrong 1,575 9% Bailey 4,744 26% Briscoe 1,264 15% Carson 4,897 10% Castro 5,562 26% Childress 4,726 20% Cochran 2,523 24% Collingsworth 2,336 15% Crosby 4,873 24% Dallam 4,335 21% Deaf Smith 12,623 27% Dickens 1,815 18% Donley 3,005 10% Floyd 5,304 23% Garza 3,392 23% Gray 15,744 14% Hale 24,108 23% Hall 2,791 25% Hansford 3,828 23% Hartley 3,266 13% Hemphill 2,450 12% Hockley 16,636 18% Hutchinson 17,147 14% King % Lamb 10,692 22% Lipscomb 2,337 17% Lubbock 183,345 13% Lynn 4,540 22% Moore 13,871 32% Motley 1,035 15% Ochiltree 6,490 22% Oldham 1,358 11% Parmer 6,922 30% Potter 80,970 20% Randall 81,275 7% Roberts 669 7% Sherman 2,265 18% Swisher 5,550 18% Terry 8,702 25% Wheeler 3,679 15% Yoakum 5,239 29% Texas 15,936,279 19% United States 219,016, % Data Source: National Center for Education Statistics, NCES - Estimates of Low Literacy. Source geography: County School Discipline In Region 1, many school districts in specific counties report no expulsions. Lubbock County reported the most expulsions (64) followed by Potter County (28) and Moore Conty (5). 10 counties report less than five expulsions in

36 Table 19: School Expulsions by County, Reported Regional High School Expulsions by County 2016 Armstrong 0 Garza * Moore 5 Bailey 0 Gray 0 Motley 0 Briscoe 0 Hale * Ochiltree 0 Carson 0 Hall * Oldham * Castro 0 Hansford * Parmer 0 Childress 0 Hartley 0 Potter 28 Cochran 0 Hemphill 0 Randall * Collingsworth 0 Hockley * Roberts 0 Crosby 0 Hutchinson 0 Sherman 0 Dallam 0 King 0 Swisher * Deaf Smith * Lamb 0 Terry 0 Dickens 0 Lipscomb 0 Wheeler 0 Donley 0 Lubbock 64 Yoakum 0 Floyd * Lynn 0 Data Source: Texas Education Agency, Expulsion/Discipline Data, 2017 Criminal Activity Arguably, the most significant risks to adolescents who use AOD products is the connection between these products and crime. There are three types of alcohol or drug related criminal offenses: Alcohol and Drug-Defined: AOD possession or use Alcohol and Drug-Related: Criminal behavior resulting from AOD use Alcohol and Drug-Using Lifestyle: A lifestyle where a person may not have a job or source of income and is exposed to situations and individuals that encourage crime Besides being illegal, substance abuse is also associated with violent and income-generating crime by youth, which increases regional residents level of fear and the demand for juvenile and criminal justice services, thereby further increasing the burden on these resources. Gangs, drug trafficking, prostitution, and youth homicides are other related social and criminal justice problems often linked to adolescent substance abuse. In Region 1, most convicted crimes committed by juvenile offenders are found in the higher urban areas, as one would expect. Lubbock County had the most (301) while Amarillo also had 151 reported crimes committed by juveniles (Potter 77, Randall 74). Table 20: Convicted Offenses by Juveniles in Region 1, Calendar Year 2016 County 2016 Juvenile Offense Type Conviction Total Assault Drugs Property Crime Other Region Armstrong * denotes less than 5. In rural communities, posting a specific number of expulsions could allow people to identify exactly who the expelled individual or individuals are. 26

37 Bailey Briscoe Carson Castro Childress Cochran Collingsworth Crosby Dallam Deaf Smith Dickens Donley Floyd Garza Gray Hale Hall Hansford Hartley Hemphill Hockley Hutchinson King Lamb Lipscomb Lubbock Lynn Moore Motley Ochiltree Oldham Parmer Potter Randall Roberts Sherman Swisher Terry Wheeler Yoakum Texas Data Source: Texas Juvenile Justice Department, 2017 Here is the average age of juvenile offenders by and the average age of first offenders by county from Table 21: Age of Juvenile Offenders by County,

38 AVG Age 1 st Offense AVG Age 1 st Offense AVG Age 1 st Offense Armstrong Bailey Briscoe Carson Castro Childress Cochran Collingsworth Crosby Dallam Deaf Smith Dickens Donley Floyd Garza Gray Hale Hall Hansford Hartley Hemphill Hockley Hutchinson King Lamb Lipscomb Lubbock Lynn Moore Motley Ochiltree Oldham Parmer Potter Randall Roberts Sherman Swisher Terry Wheeler Yoakum Texas Data Source: Texas Juvenile Justice Department, 2017 Index Violent Crime Here are the regional violent offenses by county from Over half of the murders (17) and assaults (1851) occurred in Lubbock County. 28

39 Table 22: Regional Violent Offense, 2015 County Violent Offense Type Total Murder Rape Assault Region Armstrong Bailey Briscoe Carson Castro Childress Cochran Collingsworth Crosby Dallam Deaf Smith Dickens Donley Floyd Garza Gray Hale Hall Hansford Hartley Hemphill Hockley Hutchinson King Lamb Lipscomb Lubbock Lynn Moore Motley Ochiltree Oldham Parmer Potter Randall Roberts Sherman Swisher Terry Wheeler Yoakum Data Source: Texas Department of Public Saftey, UCR,

40 Index Property Crime Here are the regional property crimes for 2015 by county. Table 23: Regional Property Crimes, 2015 County Property Offense Type Total Robbery Burglary Larceny Auto Theft Region Armstrong Bailey Briscoe Carson Castro Childress Cochran Collingsworth Crosby Dallam Deaf Smith Dickens Donley Floyd Garza Gray Hale Hall Hansford Hartley Hemphill Hockley Hutchinson King Lamb Lipscomb Lubbock Lynn Moore Motley Ochiltree Oldham Parmer Potter Randall Roberts Sherman Swisher

41 Terry Wheeler Yoakum Data Source: Texas Department of Public Saftey, UCR, 2017 Family Violence and Child Abuse Child abuse and neglect is a scourge on any community in which it is found. Often, community members are hesitant to report these crimes for fear of being wrong or the general shame that is involved in the crime. In Region 1, 1,735 cases of child abuse or neglect, in which 3,149 children were victimized, were confirmed by CPS. In Lubbock County, 1,138 children were victims of child abuse and neglect. Table 24: Confirmed Incidents of Child Abuse in Region 1. FY2105 Child Population Confirmed Victims of Child Abuse CPS Completed Investigations CPS Cases Confirmed % Confirmed Region 1 233,103 3,149 6,725 1, Armstrong Bailey 2, Briscoe Carson 1, Castro 2, Childress 1, Cochran Collingsworth Crosby 1, Dallam 2, Deaf Smith 6, Dickens Donley Floyd 1, Garza 1, Gray 6, Hale 10, Hall Hansford 1, Hartley 1, Hemphill 1, Hockley 6, Hutchinson 5, King Lamb 3, Lipscomb Lubbock 74,078 1,138 2, Lynn 1, Moore 7, Motley Ochiltree 3, Oldham Parmer 3,

42 Potter 35, , Randall 32, Roberts Sherman Swisher 2, Terry 3, Wheeler 1, Yoakum 2, Texas 7,311,923 66, ,868 40, Data Source: Texas Department of Family Protective Services, Confirmed Victims of Child Abuse and Neglect, FY2015 Drug Seizures Here are the drug seizures reported by county to the FBI for Table 25: 2015 Drug Seizures by County Drugs Seizures by County, 2015 County Drugs Seized Armstrong 2oz marijuana; 36 dose units synthetic narcotics Bailey 1lb marijuana; 11gm cocaine (solid); 6gm amphetamines; 2oz methamphetamine; 23gm methamphetamine; 47 dose units tranquilizers Briscoe No drugs seized Carson No drugs seized Castro 1oz marijuana; 1gm cocaine (solid); 2oz methamphetamine; 19gm methamphetamine; 5 liquid ounces methamphetamine Childress 121lb marijuana; 14oz marijuana; 2 marijuana plants; 2 marijuana green house; 9 liquid ounces hashish oil; 5gm hashish (solid); 20gm heroin; 1oz cocaine (solid); 12gm cocaine(solid); 3gm hallucinogens (mushrooms); 1oz barbiturates; 8gm methamphetamine; 38 dose units synthetic narcotics Cochran 1lb marijuana; 1oz marijuana; 3gm cocaine (solid); 4gm hallucinogens (mushrooms); 8gm methamphetamine Collingsworth No drugs seized Crosby 4lb marijuana; 8oz marijuana; 5gm cocaine (solid); 1gm hallucinogen (LSD); 1oz methamphetamine; 3gm methamphetamine Dallam 16lb marijuana; 3oz marijuana; 5 marijuana plants; 1 marijuana garden; 3oz hashish (solid); 3oz cocaine (solid); 1gm hallucinogen (designer drug); 5oz methamphetamine; 23gm methamphetamine; 1 liquid ounce synthetic narcotics; 530 dose units synthetic narcotics Deaf Smith 15oz marijuana; 1gm cocaine (solid); 1oz amphetamine; 4 dose units amphetamine; 8oz methamphetamine; 24gm methamphetamine; 1 liquid ounce synthetic narcotics Dickens 4oz marijuana; 2oz methamphetamine Donley 1lb marijuana; 2 liquid ounces hashish oil; 4gm hallucinogens (designer drugs); 14gm methamphetamine Floyd No drugs seized Garza 1oz marijuana; 2lb hashish (solid); 9oz hashish (solid); 22gm hashish (solid); 1oz cocaine (solid); 1gm cocaine (solid); 4oz methamphetamine; 6gm methamphetamine Gray 27lb marijuana; 7oz marijuana; 2lb hashish (solid); 1lb heroin; 1gm codeine; 15gm cocaine (solid); 39 dose units barbiturates; 21lb methamphetamine; 1oz methamphetamine; 14 gm methamphetamine Hale 12oz marijuana; 8oz cocaine (solid); 1gm cocaine (solid); 2oz methamphetamine; 14gm methamphetamine 32

43 Hall Hansford Hartley Hemphill Hockley Hutchinson King Lamb Lipscomb Lubbock Lynn Moore Motley Ochiltree Oldham Parmer Potter No drugs seized 11oz marijuana; 7gm cocaine(solid); 3oz methamphetamine; 4gm methamphetamine; 23 dose units tranquilizers No drugs seized No drugs seized 1lb marijuana; 1gm morphine; 11oz cocaine (solid); 18 gm cocaine (solid); 4gm hallucinogens (mushrooms); 1gm hallucinogens (designer drugs); 2gm amphetamines; 1lb methamphetamine; 12oz methamphetamine; 13gm methamphetamine; 39 dose units synthetic narcotics 4oz marijuana; 2gm cocaine (solid); 3gm amphetamine; 2oz methamphetamine; 5gm methamphetamine; 446 dose units synthetic narcotics No drugs seized 1lb marijuana; 13oz marijuana; 1 marijuana (wild fields); 1gm heroin; 18gm cocaine (solid); 3oz hallucinogens (designer drugs); 5gm hallucinogens (designer drugs); 23gm methamphetamine; 4 clandestine labs 1oz methamphetamine; 21gm methamphetamine 122lb marijuana; 13oz marijuana; 1 marijuana plant; 1 marijuana garden; 75 liquid ounces hashish oil; 7lb hashish (solid); 5oz hashish (solid); 20gm hashish (solid); 1 dose unit morphine; 1lb heroin; 3oz heroin; 1gm heroin; 22gm codeine; 3gm gum opium; 17lb cocaine (solid); 13oz cocaine (solid); 25gm cocaine (solid); 8gm LSD; 725 dose units LSD; 4oz hallucinogens (mushrooms); 8oz hallucinogens (designer drugs); 3gm hallucinogens (designer drugs); 28 liquid ounces barbiturates; 3 dose units barbiturates; 6gm amphetamine; 5 liquid ounces amphetamine; 42 dose units amphetamine; 18lb methamphetamine; 12oz methamphetamine; 19gm methamphetamine; 2 liquid ounces methamphetamine; 2 dose units methamphetamine; 90 liquid ounces tranquilizers; 152 dose units tranquilizers; 8 liquid ounces synthetic narcotics; 772 dose units synthetic narcotics No drugs seized 52lb marijuana; 13oz marijuana; 365 liquid ounces hashish; 6gm hashish (solid); 7gm codeine; 35 dose units codeine; 7gm cocaine (solid); 17gm hallucinogens (mushrooms); 1oz hallucinogens (designer drugs); 6gm hallucinogens (designer drugs); 12 liquid ounces hallucinogens (designer drugs); 26 dose units hallucinogens (designer drugs); 2lb methamphetamine; 1oz methamphetamine; 26gm methamphetamine; 822 dose units synthetic narcotics No drugs seized 1lb marijuana; 1oz marijuana; 2 dose units codeine; 5gm cocaine (solid); 24 dose units barbiturates; 2oz methamphetamine; 2gm methamphetamine; 3 dose units tranquilizers; 94 dose units synthetic narcotics 123lb marijuana; 5oz marijuana; 3lb hashish (solid); 3oz hashish (solid); 20lb heroin; 50 dose units barbiturates; 11lb methamphetamine; 3gm methamphetamine; 199 dose units synthetic narcotics 3oz marijuana 606lb marijuana; 13oz marijuana; 2 marijuana plants; 1 marijuana garden; 1 liquid ounce hashish oil; 6lb hashish (solid); 6oz hashish (solid); 9gm hashish (solid); 2 dose units morphine; 1lb heroin; 15oz heroin; 3gm heroin; 2oz codeine; 6gm codeine; 390 dose units codeine; 9lb cocaine (solid); 8oz cocaine (solid); 9gm cocaine (solid); 1345 dose units LSD; 1lb hallucinogens (mushrooms); 8oz hallucinogens (mushrooms); 1lb hallucinogens (designer drugs); 4gm hallucinogens (designer drugs); 3 dose units hallucinogens (designer drugs); 5 liquid ounces amphetamine; 6 dose units amphetamine; 92lb methamphetamine; 2oz methamphetamine; 23gm methamphetamine; 2 dose units methamphetamine; 390 liquid ounces tranquilizers; 1 dose unit tranquilizers; 1 clandestine lab 33

44 Randall 2lb marijuana; 2oz marijuana; 24gm hashish (solid); 1gm heroin; 2gm codeine; 18 dose units codeine; 1oz cocaine (solid); 3gm cocaine (solid); 4oz hallucinogens (designer drugs); 21gm hallucinogens (designer drugs); 355 dose units hallucinogens (designer drugs); 10oz methamphetamine; 6gm methamphetamine; 329 dose units tranquilizers Roberts No drugs seized Sherman 21lb marijuana; 14oz marijuana; 2gm cocaine (solid); 4gm hallucinogens (designer drugs); 2oz amphetamine; 25gm methamphetamine Swisher No drugs seized Terry 3lb marijuana; 13oz marijuana; 1gm heroin; 6gm codeine; 3oz cocaine (solid); 6gm cocaine (solid); 2oz methamphetamine; 2gm methamphetamine; 1 liquid ounce methamphetamine Wheeler 117lb marijuana; 12oz marijuana; 5gm hashish (solid); 17gm hallucinogens (designer drugs); 1oz amphetamine; 7gm amphetamine; 3oz methamphetamine; 22gm methamphetamine; 23 dose units synthetic narcotics Yoakum 2oz marijuana Data Source: FBI Uniform Crime Reports, 2015 Drug Seizures by County Mental Health It is estimated that one in five Americans will experience a mental health issue during their lifetime and that one in 20 will develop a serious mental illness. Mental illness is not a personality weakness; it is a disease like many other diseases, such as cancer or diabetes 5. Suicide Suicide is an important public health issue involving psychological, biological, and societal factors. After a period of nearly consistent decline in suicide rates in the United States from 1986 through 1999, suicide rates have increased almost steadily from 1999 through While suicide among adolescents and young adults is increasing and among the leading causes of death for those demographic groups, suicide among middle-aged adults is also rising 6. Table 26: Suicides by County, Suicides in Region 1 by County, Total Region Armstrong Bailey Briscoe Carson Castro Childress Cochran Collingsworth Crosby Dallam Deaf Smith A Guide to Understanding Mental Health Systems and Services in Texas, Second Edition, Curtin SC, Warner M, Hedegaard H. Increase in suicide in the United States, NCHS data brief, no 241. Hyattsville, MD: National Center for Health Statistics

45 Dickens Donley Floyd Garza Gray Hale Hall Hansford Hartley Hemphill Hockley Hutchinson King Lamb Lipscomb Lubbock Lynn Moore Motley Ochiltree Oldham Parmer Potter Randall Roberts Sherman Swisher Terry Wheeler Yoakum Texas Psychiatric Hospital Data Overall, Potter County had both the highest number of hospital discharges for mental disease (1,090) and the highest rate per 100,000 population (8.8). Lamb County had the highest mean cost for treatment ($42,661). Table 27: Hospital Discharge Data for Mental Disease, 2012 Texas Hospital Discharge Data for Mental Disease, 2012 County Number of Discharges Rate of Discharges per Mean Cost in Dollars 100K Armstrong $8,553 Bailey $19,304 Briscoe Carson $13,653 Castro $15,199 Childress $17,949 Cochran 9 3 $6,103 35

46 Collingsworth $12,102 Crosby $13,276 Dallam $13,312 Deaf Smith 58 3 $19,332 Dickens Donley $15,935 Floyd $17,977 Garza $7,422 Gray $24,638 Hale $21,148 Hall $26,647 Hansford $18,306 Hartley Hemphill $18,574 Hockley $14,163 Hutchinson $18,695 King Lamb $42,661 Lipscomb $12,028 Lubbock 1, $15,043 Lynn $19,220 Moore $18,449 Motley Ochiltree $11,712 Oldham $18,783 Parmer $23,040 Potter 1, $15,800 Randall $15,147 Roberts $22,188 Sherman 6 2 $23,596 Swisher $12,233 Terry $21,490 Wheeler $26,047 Yoakum $10,133 Data Source: Texas (MONAHRQ) Hospital Data: Utilization and Quality, 2012 Adolescents and Adults Receiving Substance Abuse Treatment Outreach, Screening, Assessment and Referral Centers (OSARs) may be the first point of contact for those seeking substance use disorder treatment services. Regardless of ability to pay, Texas residents who are seeking substance use disorder services and information may qualify for services based on need. OSARs are now located at Local Mental Health Authorities (LMHAs) in 11 Health and Human Service regions. To schedule a screening, contact: StarCare Specialty Health System 1950 Aspen Avenue Lubbock, TX Crisis Phone: or (800) Intake Phone:

47 Table 28: Drug Screening Data Region 1, Substance Screening Data Region 1, Preliminary Diagnosis 2015 Number Screened 2016 Number Screened Alcohol Amphetamines Cannabis Cocaine Diagnosis Deferred Hallucinogens 0 0 Inhalants 4 0 No Diagnosis Opioids Other 0 0 PCPs 0 0 Polysubstance Abuse Sedatives, Hypnotics, or Anxiolytics 15 7 Data Source: Texas Department of State Health Services, OSAR. Substance Screening Data, Depression Depression affects millions of people keeping them from living normal, happy lives. The Centers for Disease Control and Prevention (CDC) estimates that 10 percent of Americans suffer from this psychiatric disorder. Substance abuse is common among people who are battling a depressive disorder. Because alcohol is a central nervous system depressant, the use of this drug tends to trigger depression symptoms like lethargy, sadness and hopelessness. However, many depressed individuals reach for drugs or alcohol as a way to lift their spirits or to numb painful thoughts. As a result, depression and substance abuse feed into each other, and one condition will often make the other worse. Figure 2: Texas Adults Ever Diagnosed With Some Form of Depression,

48 Regional Needs Assessment Prevention Resource Center, Region 1 TEXAS ADULTS WITH SOME FORM OF DEPRESSION, Some None Data Source: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data Social Factors Often, social standards and conduct contribute to adolescent substance abuse. In many communities, parents and peers implicitly or explicitly approve of underage drinking or other substance use or misuse. This can take the form of unwritten cultural norms to parents providing alcohol for teens at a social event. We aim to reduce the incidence and prevalence of ATOD in the general population by establishing and/or changing written and unwritten standards, codes and attitudes within the community. This strategy also aims to combat substance abuse and related harms with concerted, community-based and comprehensive efforts to change norms, behaviors, systems and context that contribute to substance abuse problems in our communities. Youth Perception of Parental Approval of Consumption Often parents contribute to adolescent substance use by approving of, either implicitly or explicitly, their children consuming these substances. Alcohol is usually the commonly supplied substance that adolescents consume. Surprisingly, prescription drugs are perceived by Lubbock-area adolescents as what parents disapprove of most strongly with 85% saying that parents view it as very wrong. However, smoking tobacco is seen as most disapproved of by Lubbock-area parents (95% wrong/very wrong) followed by prescription drugs (94% wrong/very wrong), two drinks a day (91% wrong/very wrong) and finally marijuana (88% wrong/very wrong). Figure 3: Parental Approval, Lubbock Area

49 Regional Needs Assessment Prevention Resource Center, Region 1 PARENTAL APPROVAL Very Wrong Wrong Not Wrong T W O D R I N K S E V E R Y D AY S M O K E M AR I J U AN A M I S U S E R X D R U G S S M O K E T O B AC C O Data Source: 40 Developmental Asset Survey, Lubbock Area, 2015 Youth Perception of Peer Approval of Consumption Often adolescents seek the approval of peers for consuming ATOD substances. Peers can contribute to the social norm by implicit or explicit approval of the consumption of these substances in social settings. Alcohol is still the most widely consumed substance by adolescents in Region 1. Figure 4: Peer Approval, Lubbock Area, 2015 PEER APPROVAL Very Wrong Wrong Not Wrong T W O D R I N K S E V E R Y D AY S M O K E M AR I J U AN A M I S U S E R X D R U G S S M O K E T O B AC C O Data Source: 40 Developmental Asset Survey, Lubbock Area,

50 Cultural Norms and Substance Abuse In Region 1, the most common lax attitude about abused substances is that of alcohol. In interviews, many rural communities do not report or prosecute adolescents who consume alcohol. Often, this is because the Law Enforcement Officer knows the family and makes the choice to just take the teen home instead of to jail. Sometimes, communities are indulgent of adolescents who play sports especially football and provide a venue to drink as well as the alcohol. Many adults remember drinking in high school and consider it an implicit rite of passage into adulthood. Unfortunately, adolescents generally have a different view of drinking. In interviews, many adults in Region 1 report that they remember drinking as adolescents in order to feel grown up or more adult. Adolescents, who participated in these interviews with their parents, often report that they drink in order to get drunk. Because adults have a different understanding of the current motives behind regional adolescent alcohol consumption, they may not be motivated to enforce no drinking ordinances. Adolescent Sexual Behavior There is little data available on teen sexual behaviors that are specific to Region 1. However, there is data concerning this for Texas. Table 29: Reported Sexual Behaviors for Texan Teens Question Grade 9th 10th 11th 12th Sex for first time before 13 years old 8.0% 6.1% 7.5% 6.1% Four or more partners in lifetime 8.3% 13.9% 20.9% 26.6% One or more partners in last three months 20.9% 32.5% 44.6% 51.4% Drank alcohol or drugs before last sexual intercourse 24.3% 23.0% 25.2% 23.6% Used condoms during the last three months 56.0% 57.9% 52.8% 51.5% Used birth control prior to intercourse 8.5% 9.1% 10.4% 15.6% Data Source: Behavior Risk Factor Surveillance System. Center for Disease Control. July 15, 2013 Teen Births In 2014, there were 468 births by teens in Region 1. Lubbock County had the most (163) followed by the Amarillo area (118). Table 30: Teen Births by County, Teen Births by County, Region Armstrong Bailey Briscoe Carson Castro Childress Cochran Collingsworth Crosby

51 Dallam Deaf Smith Dickens Donley Floyd Garza Gray Hale Hall Hansford Hartley Hemphill Hockley Hutchinson King Lamb Lipscomb Lubbock Lynn Moore Motley Ochiltree Oldham Parmer Potter Randall Roberts Sherman Swisher Terry Wheeler Yoakum Texas 14,638 13,476 12,245 11,113 Data Source: Texas Department of State Health Services, Vital Statistics Annual Reports, Misunderstandings about Marijuana During regional interviews and focus groups, many participants are surprised to discover that the consumption of marijuana is illegal. Many parents believe that marijuana is similar to alcohol or even safer than alcohol and even have expressed sentiments such as At least it s not meth or some equivalent. Many adolescents report surprise at the illegality of marijuana due to all the sites on Facebook and the Internet that discuss how to grow the plants, the places to purchase all required to grow the plants, and where to buy edibles which are foodstuffs, often baked goods, with cannabis oil included. Accessibility Adolescents can only use AOD substances if they have access to these substances. In general, the less able adolescents can find these substances, the less likely they are to consume these substances. Laws exist in order to limit adolescent s access to legal yet harmful substances such as alcohol and tobacco in addition to the banning of illegal substances. 41

52 Even though laws exist to restrict access to AOD substances, adolescents can often find and consume these substances. Enforcing current laws may help limit access or community groups may need to lobby for stronger laws to protect adolescents. Perceived Access of Alcohol Adolescents can only use Alcohol and Other Drug (AOD) substances if they have access to these substances. The Texas Student Survey asks 7th to 12th grade students to rate how easily they can find these products. In general, the less able adolescents can find these substances, the less likely they are to consume these substances. Overall, Texan high school students perceive alcohol to be the easiest to get with 58.2% reporting that access to alcohol is either somewhat or very easy for them. Table 31: Perceived Accessibility to Alcohol, TSS 2016 If you wanted to, how difficult would it be for you to get alcohol? Never Heard Impossible Very Difficult Somewhat Somewhat Very Easy of It Difficult Easy All Grades 16.0% 15.2% 7.2% 12.0% 19.6% 29.9% Grade % 29.5% 9.3% 8.5% 11.0% 13.3% Grade % 20.1% 10.4% 14.0% 19.2% 17.3% Grade % 13.7% 7.1% 13.1% 17.7% 29.7% Grade % 12.6% 6.2% 12.3% 27.4% 32.6% Grade % 7.2% 2.0% 11.3% 19.3% 49.9% Grade % 4.6% 7.2% 13.4% 24.9% 42.4% Data Source: Texas Student Survey of Drug and Alcohol Use, 2016; Regions 1-2 Perhaps of greatest concern regarding access is that 67.3% of Texas twelfth grade students report that alcohol is either somewhat easy or very easy to obtain. Still, one quarter (24.3%) of Texas seventh grade students report that alcohol is either somewhat easy or very easy to obtain. Amarillo-area adolescents report a slightly lower perception of access to alcohol. In 2014, 39.6% of these teens reported that alcohol is either very or fairly easy to obtain 7. It may be that adolescents are less likely to access alcohol when compared to the Texas state average. However, 46.5% of Amarillo-area adolescents report that alcohol is either likely or very likely to be present at parties. Interestingly, Amarillo-area students believe that 39% of other students drink at least once a month and that 29% of other students binge drink 8. This is higher than what their peers report actually drinking. In order to limit access to alcohol, communities in Region 1 need to work together with law enforcement and retailers. Many communities have laws on the books but may not enforce them. Many factors, including culture, may contribute to granting access to adolescents to alcohol. Although region-specific data is limited, here is where Region 1 teens report acquiring alcohol: Table 32: People and Places Texas Teens Get Alcohol, TSS How often, if ever, do you get alcoholic beverages from Texas Prevention Impact Index 8 Ibid. 9 Texas School Survey of Drug and Alcohol Use:

53 Do Not Drink Never Seldom Most of the Time Always At home? All Grades 52.4% 21.8% 18.3% 4.2% 3.2% Grade % 17.4% 8.2% 3.5% 1.2% Grade % 18.3% 13.9% 3.6% 1.1% Grade % 21.6% 18.0% 4.9% 3.2% Grade % 24.5% 23.8% 3.8% 5.5% Grade % 25.1% 24.5% 4.9% 4.1% Grade % 25.8% 24.6% 5.1% 5.2% From friends? All Grades 50.4% 18.8% 15.5% 11.3% 4.1% Grade % 19.2% 4.3% 3.1% 0.8% Grade % 19.9% 9.2% 5.9% 1.4% Grade % 18.2% 17.8% 9.2% 4.1% Grade % 19.8% 23.1% 11.8% 5.1% Grade % 17.1% 25.6% 14.9% 7.0% Grade % 18.0% 15.3% 27.2% 7.4% From a store? All Grades 53.5% 39.3% 3.7% 2.4% 1.1% Grade % 25.5% 1.2% 0.3% 0.7% Grade % 29.5% 3.2% 0.8% 0.2% Grade % 38.8% 4.1% 1.0% 0.6% Grade % 48.0% 3.2% 5.5% 1.2% Grade % 47.8% 6.4% 1.8% 2.7% Grade % 51.6% 4.7% 6.0% 1.6% At parties? All Grades 48.4% 18.9% 11.1% 11.8% 9.9% Grade % 19.6% 3.7% 4.8% 1.6% Grade % 18.7% 7.6% 7.6% 4.5% Grade % 18.4% 11.7% 12.6% 9.7% Grade % 19.4% 13.6% 15.5% 12.9% Grade % 21.3% 15.4% 15.2% 14.8% Grade % 15.5% 16.7% 17.3% 19.2% Other source? All Grades 53.7% 25.7% 10.7% 5.1% 4.8% Grade % 18.9% 5.1% 3.4% 1.0% Grade % 19.9% 7.8% 5.2% 2.3% Grade % 24.6% 10.4% 4.9% 5.1% Grade % 32.0% 14.7% 5.5% 4.5% Grade % 28.9% 14.3% 4.4% 9.6% Grade % 32.6% 14.0% 7.5% 8.1% Data Source: Texas Student Survey of Drug and Alcohol Use, 2016; Regions 1-2 Perceived Access of Marijuana The Texas Student Survey asks 7th to 12th grade students in our region to rate how easily they can find AOD products. In general, the less able adolescents can find these substances, the less likely they are to consume these substances. Overall, Region 1 high school students perceive alcohol to be the easiest to get with 49.5% reporting that access to alcohol is either somewhat or very easy for them. 43

54 Still, many Texas adolescents believe that accessing marijuana is relatively easy. Overall, there is little data on how accessible marijuana is to adolescents in Region 1. However, the 2014 TP11 10 reports that 30.7% of participating Amarillo area students indicate that marijuana is either very easy or fairly easy to get. This is consistent with the average for our region as reported by the 2016 Texas Student Survey (30.3%). Table 33: Perceived Accessibility to Marijuana, TSS 2016 If you wanted to, how difficult would it be for you to get marijuana? Never Heard Impossible Very Difficult Somewhat Somewhat Very Easy of It Difficult Easy All Grades 21.7% 27.9% 10.0% 10.0% 12.6% 17.7% Grade % 44.9% 7.2% 4.5% 4.7% 3.9% Grade % 40.6% 9.2% 7.8% 9.0% 8.8% Grade % 26.8% 13.9% 8.9% 10.2% 14.8% Grade % 23.9% 10.6% 12.6% 13.9% 24.0% Grade % 12.4% 9.7% 11.4% 19.8% 30.1% Grade % 13.2% 9.7% 16.9% 20.7% 29.6% Data Source: Texas Student Survey of Drug and Alcohol Use, 2016; Regions 1-2 Perhaps of greatest concern regarding access is that 50.3% of regional twelfth grade students report that marijuana is either somewhat easy or very easy to obtain. Still, even 8.6% of Texas seventh grade students report that marijuana is either somewhat easy or very easy to obtain. Amarillo-area adolescents report a slightly higher perception of access to marijuana. In 2014, 30.7% of these teens reported that marijuana is either very or fairly easy to obtain 11. It may be that adolescents are more likely to access marijuana when compared to the regional average. Perceived Access of Prescription Drugs Adolescents can only use ATOD substances if they have access to these substances. In general, the less able adolescents can find these substances, the less likely they are to consume these substances. Laws exist in order to limit adolescent s access to legal yet harmful substances such as alcohol and tobacco in addition to the banning of illegal substances. Even though laws exist to restrict access to ATOD substances, adolescents can often find and consume these substances. Enforcing current laws may help limit access or community groups may need to lobby for stronger laws to protect adolescents. Teens ease of access to prescription drugs in their own homes and in the homes of family and friends enables teens to misuse and abuse prescriptions. In fact, four in ten teens (40 percent) indicate prescription drugs are everywhere, while 43 percent indicate prescription drugs are easier to get than illegal drugs Texas Prevention Impact Index, Texas Prevention Impact Index 12 The Partnership at Drugfree.org 44

55 In general, teens from urbanized, but non-metropolitan areas are at the greatest risk for misusing or abusing prescription drugs, followed by rural and then metropolitan areas. 13 However, lax attitudes and permissiveness by parents toward prescription drug misuse and abuse, along with availability, are directly linked to these abuses by teens. Access to prescription drugs is usually found in the family (or friend s) medicine cabinet and teens are more likely to misuse or abuse these drugs if they think that their parents are okay with it, or if they think that any punishment would be less than for using street drugs. There is little region-specific data on how adolescents perceive access to prescription drugs. However, most parents and grandparents give little thought to how they store their prescriptions especially expired prescriptions. Some regional coalitions are starting to sponsor prescription collection programs and there seems to be a need. In 2013, the Lubbock VOICES coalition reported that, during their prescription drop off program, they collected almost 100 pounds of expired prescription medication prescribed during the 1950 s and 1960 s alone. Still, there are a lot of drugs prescribed in Region 1. Half the counties in this region have more precriptions than people in those counties. These include Lubbock, Potter, and Randal counties. This may indicate that most teens in half the counties would have access to at least one prescription from a relative. Table 34: Total Prescriptions Per Capita by County, 2014 Total Prescriptions Per Capita by County, 2014 County 2014 Population Total Prescriptions Prescriptions per 100K Armstrong Bailey Briscoe Carson Castro Childress Cochran Collingsworth Crosby Dallam Deaf Smith Dickens Donley Floyd Garza Gray Hale Hall Hansford Hartley Hemphill Hockley Hutchinson King Lamb Lipscomb SAMHSA, April 11,

56 Lubbock Lynn Moore Motley Ochiltree Oldham Parmer Potter Randall Roberts Sherman Swisher Terry Wheeler Yoakum Texas Data Source: Texas Department of Public Safety Regulatory Service Division, Texas Prescription Program Perceived Risk of Harm An adolescent s perception of the risks associated with substance use is an important determinant of whether he or she engages in substance use. For example, youths who perceive high risk of harm are less likely to use drugs than youths who perceive low risk of harm. Thus, providing adolescents with credible, accurate, and age-appropriate information about the harm associated with substance use is a key component in prevention programming. Perceived Risk of Harm from Alcohol Convincing adolescents that AOD substances are harmful to them is what Youth Prevention efforts are all about. Overall, 50.3% of Texas students report they believe alcohol to be very dangerous. This is less dangerous than they perceive marijuana (58.2%) or tobacco (56.8%) 14 to be. Regionally, adolescents do perceive AOD substances as having a higher risk of harm than Texas teens. Over 92% of Amarillo-area adolescents perceive cigarettes as harmful and 62.6% of these same students perceive marijuana as harmful. Still, only 62.7% of Amarillo-area students perceive two drinks of alcohol a day as harmful. 81.8% of participants responded that binge drinking is dangerous. Table 35: Perceived Risk of Harm to Alcohol Use, TSS 2016 How dangerous do you think it is for kids your age to use alcohol? Very Dangerous Somewhat Dangerous Not Very Dangerous Not at All Dangerous Do Not Know All Grades 50.7% 31.4% 11.8% 2.3% 3.7% Grade % 19.5% 7.0% 1.7% 3.5% Grade % 29.1% 10.7% 2.2% 1.8% Grade % 33.3% 13.7% 1.8% 6.4% Grade % 37.1% 12.7% 1.5% 4.0% Grade % 34.6% 13.9% 4.0% 3.8% Texas Student Survey of Drug and Alcohol Abuse 46

57 Grade % 37.6% 13.8% 3.2% 2.5% Data Source: Texas Student Survey of Drug and Alcohol Use, 2016; Regions 1-2 Depending on how one looks at the data, regional adolescents may or may not consider alcohol as dangerous as compared to the Texas State average. Although the TSS does report that 50.3% of Texas adolescents perceive alcohol as very dangerous, 29.7% also answered that alcohol is somewhat dangerous. Taken together, one could say that 80% of Texas adolescents feel that alcohol is either somewhat or very dangerous while only 62.7% of regional adolescents reported two drinks a day as dangerous. However, 81.8% of regional adolescents report that they believe binge drinking is harmful. Depending on how one defines drinking, regional adolescents are either consistent with or below state average for perceived risk of harm. Perceived Risk of Harm from Marijuana Convincing adolescents that AOD substances are harmful to them is what Youth Prevention efforts are all about. Regionally, adolescents may perceive AOD substances as having a higher risk of harm than Texas teens. Over 92% of Amarillo-area adolescents perceive cigarettes as harmful and 73.8% of these same students perceive marijuana as harmful. Regional educators and other prevention advocates do have reason for concern. Although the regional data does demonstrate that area teens do perceive marijuana as dangerous, these students do often perceive marijuana as less dangerous than cigarettes, binge drinking, and prescription drugs. Figure 5: Seven Years Perceived Risk of Harm for Marijuana, TPII Perceived Risk of Harm Marijuana Data Source: Texas Prevention Impact Index Survey, 2016 Between 2010 and 2014, the perception of marijuana as dangerous fell steadily each year. In 2010, 75.9% of participants perceived marijuana as dangerous while, in 2014, only 62.6% felt this way. That is a 15.3% 47

58 drop over five years. Still, that perception of harm has risen to 73.8% from 2014 to This, however, is still lower than regional average. Depending on how one looks at the data, regional adolescents may or may not consider marijuana as dangerous as compared to Amarillo-area and Lubbock-area adolescents. Regionally, the TSS reports that 61.6% of adolescents perceive marijuana as very dangerous and 14.1% also answered that marijuana is somewhat dangerous. Taken together, one could say that 75.5% of regional adolescents feel that marijuana is either somewhat or very dangerous while only 62.6% of Amarillo-area adolescents and only 56% of Lubbock-area teens perceive marijuana as dangerous. It could be argued that regional rural adolescents perceive marijuana as more dangerous than regional urban teens. Table 36: Perceived Risk of Harm to Marijuana Use, TSS 2016 How dangerous do you think it is for kids your age to use marijuana? Very Dangerous Somewhat Dangerous Not Very Dangerous Not at All Dangerous Do Not Know All Grades 61.6% 14.1% 9.5% 10.2% 4.6% Grade % 6.2% 3.9% 2.5% 3.4% Grade % 12.0% 5.9% 5.0% 3.0% Grade % 15.2% 8.4% 8.9% 6.1% Grade % 19.0% 13.0% 15.6% 3.6% Grade % 15.0% 14.3% 14.5% 8.6% Grade % 19.2% 13.8% 17.6% 3.3% Data Source: Texas Student Survey of Drug and Alcohol Use, 2016; Regions 1-2 Perceived Risk of Harm from Prescription Drugs An adolescent s perception of the risks associated with substance use is an important determinant of whether he or she engages in substance use. For example, youths who perceive high risk of harm are less likely to use drugs than youths who perceive low risk of harm. Thus, providing adolescents with credible, accurate, and age-appropriate information about the harm associated with substance use is a key component in prevention programming. Overall, Region 1 adolescents report that the misuse of prescription drugs can be harmful. 77% of Amarillo-area adolescents report them as dangerous 15 while 81% of Lubbock-area teens report the misuse of prescription drugs as a moderate or great risk 16. Regionally, 87.6% of adolescents report that using a prescription drug not prescribed for them is either very or somewhat dangerous to use. Table 37: Perceived Risk of Harm, Not Prescribed, TSS 2016 How dangerous do you think it is for kids your age to use any prescription drug not prescribed to them? Very Dangerous Somewhat Dangerous Not Very Dangerous Not at All Dangerous Do Not Know All Grades 75.7% 11.9% 4.7% 1.2% 6.5% Grade % 6.4% 3.6% 0.7% 5.6% Grade % 11.3% 4.9% 0.5% 5.0% 15 Texas Prevention Impact Index, Amarillo, Developmental Asset Survey,

59 Grade % 15.5% 5.1% 0.3% 8.2% Grade % 14.2% 5.0% 1.2% 5.3% Grade % 11.4% 6.5% 4.4% 9.1% Grade % 13.5% 3.2% 0.7% 5.7% Data Source: Texas Student Survey of Drug and Alcohol Use, 2016; Regions 1-2 Nationally, both teens and parents seem to share similar misconceptions concerning prescription drug misuse and abuse. 16% of parents and 27% of teens believe that using prescription drugs to get high is safer than using street drugs. 33% of teens believe that it is okay to use prescription drugs that are not prescribed to them in order to deal with injury, illness, or pain 17. Teens seem to have little idea about the danger of addiction in regard to prescription drugs. 25% of teens say that there is little to no risk in using prescription pain relievers without a prescription and 22% of teens say the same thing about Ritalin and Adderall. In addition, 20% of teens believe that pain relievers are not addictive at all. Regional Consumption Most of the data concerning regional adolescent substance consumption is derived from the 2016 Texas Student Survey of Substance Abuse (TSS). This information is available for state-wide results and results combining regions 1 and 2. Unfortunately, too few regional ISDs participated in the TSS to provide a statistically significant regional report. Still, results from subsequent local surveys are consistent with the TSS findings for this region. Although data specific to Region 1 on AOD consumption and use is sparse we do have access to some local data collected by these surveys: The Amarillo Texas Prevention Impact Index (TPII) 2016 The 40 Developmental Assets Survey administered in 2015 by the Lubbock YWCA VOICES of Hockley Co community survey 2016 Two of these surveys are centered in the Amarillo and Lubbock metropolitan areas but they should not be dismissed by rural areas within the region. Alcohol Underage drinking is a serious public health issue in the United States. Alcohol is the most widely used and abused substance among American adolescents 18 and this use/abuse poses enormous health and safety risks for everyone regardless of age or drinking status. Nationally, more than half (52.2%) of all Americans aged 12 or older were current alcohol users in 2013 that translates to an estimated million current drinkers 19. Anyone may feel the effects of aggressive behavior, property damage, injuries, violence, and deaths that may result from underage drinking. In short, underage drinking should be a nationwide concern rather than simply a problem for some families in our community. 17 The Partnership at Drugfree.org, National Institute on Alcohol Abuse and Alcoholism, p SAMHS A 2014, p

60 # OF PARTICIPANTS 2017 Regional Needs Assessment Prevention Resource Center, Region 1 Annually, about 5,000 people under the age of 21 die from alcohol-related injuries involving underage drinking in the United States. Of these deaths, about 1,900 (38%) involve motor vehicle crashes, 1,600 (32%) result from homicides, and 300 (6%) result from suicides 20. In addition, 40% of people who first drink before age 15 become alcohol dependent as adults. This is four times the rate of those who wait until 21 to have their first drink 21. In 2013, 11.6% of American adolescents aged 12 to 17 (or about 2.9 million adolescents) reported that they were current alcohol users 22. Many of these adolescents (6.2% or 1.6 million) reported binge drinking 23 in the past month. Adolescent alcohol consumption is a serious problem today. Still, 67.2% of all Texas adolescents report trying alcohol at least once in their lifetime 24 and 36.1% report consuming alcohol in the last thirty days. This is higher than the national average and may indicate that Texas adolescents consume more alcohol, on the average, than their peers in other states. Age of Initiation In Region 1, adolescents who drink report an average age of 12.8 as when they first consumed alcohol. This is consistent with the state average of % of regional adolescents report trying alcohol before the age of 13. This is slightly higher than the state average of 38%. Most Hockley Co students reported taking their first drink at although there is a significant increase of students reporting their first drink between 9 and 10. This could indicate that any alcohol prevention programs in Hockley Co should occur between 8 and 9 years of age. Figure 6: Age of First Drink, Hockley Co 60 AGE OF FIRST DRINK AGE OF INITIATION 20 U.S. Department of Health and Human Services, pp Ibid. p SAMHSA 2014, p Binge drinking is usually defined as 5 or more drinks in a row for men and 4 or more drinks in a row for women. 24 Center for Health Statistics (CHS) 25 Texas Student Survey, Regions 1-2, Hockley Co VOICES Survey, Question 2 (n=289): How old were you when you first drank alcohol? 50

61 Regional Needs Assessment Prevention Resource Center, Region 1 Data Source: Hockley County VOICES Survey, 2016 Current Use The majority of regional alcohol consumption data that is available comes from the 2016 Texas Student Survey of Substance Abuse (TSS) and the 2013 Youth Risk Behavior Survey Texas Results (YRBS). Both of these surveys give data for the State of Texas and is not available at a regional or county level of detail. These do afford communities a general idea of what may be occurring among their young people. This data provides an excellent frame from which to compare any local information concerning ATOD use. Figure 7: Overview of Alcohol Consumption, Region 1 ADOLESCENT ALCOHOL CONSUMPTION - OVERVIEW REGION 1 Region 1 Texas Amarillo Lubbock H AV E E V E R U S E D L AS T 3 0 D AY S H AD 5 O R M O R E D R I N K S I N A R O W L AS T 3 0 D AY S P L AN T O U S E I N F U T U R E Data specific to Region 1 on alcohol consumption and underage drinking is sparse but there are two surveys that the PRC has access to: The Amarillo Texas Prevention Impact Index (TPII) 2016 and the Developmental Assets Survey, Lubbock ISD. These surveys are centered in the Amarillo and Lubbock metropolitan areas but they should not be dismissed by rural areas within the region. Generally speaking, available data seems to indicate that adolescents in Region 1 (61%) have consumed alcohol consistent to state (67.2%) results. Unfortunately, more regional adolescents (35.4%) report using alcohol in the last 30 days than other Texas teens (36.1%). Still, it is troubling that 23.1% of Amarillo-area adolescents reported that they engaged in binge drinking over the past month which is higher than both state and regional-level findings. Although this is only slightly more than Texas Students surveyed by the YRBS (2.1% more), it is over 7% higher than the regional students surveyed by the TSS. Finally, there is a greater disparity between having ever used and used within the last 30 days for Texas adolescents (33.1%) than for Amarillo-area adolescents (11.2%). This may indicate that regional adolescents are more likely to consume alcohol more often if they use it at all. 51

62 Table 38: Prevalence and Recent Use of Alcohol, TSS 2016 Prevalence and Recent Use of Alcohol TSS 2016 Past Month School Year Ever Used Never Used All Grades 35.4% 40.2% 61.0% 39.0% Grade % 19.2% 36.0% 64.0% Grade % 24.4% 47.9% 52.1% Grade % 43.3% 65.0% 35.0% Grade % 48.2% 70.6% 29.4% Grade % 57.5% 78.0% 22.0% Grade % 55.6% 76.0% 24.0% Data Source: Texas Student Survey of Drug and Alcohol Use, 2016; Regions 1-2 Regional adolescents are reporting, ranging from 35.4% to 18.9% of survey participants, that they have consumed alcohol in the last 30 days. Students believe that they (and other adolescents) are likely to consume alcohol during the following times and at the following locations. Parties seem to be the most likely (46.5%) opportunity for adolescents in Region 1 to consume alcohol. Table 39: Youth Alcohol Use, TPII 2016 How likely are youth in your community to use alcohol? Likely Very Likely Before School 6.0% 4.2% Week Nights 15.5% 8.9% During School 5.7% 4.1% Weekends 16.1% 24.1% At Lunch 5.4% 4.4% School Functions 4.5% 3.7% After School 16.4% 11.6% At Parties 13.0% 33.5% Data Source: Texas Prevention Impact Index Survey, 2016 Data from the 2016 Texas Student Survey seems to support the prevalence of alcohol at parties: Figure 8: Frequency of Alcohol at Parties, TSS

63 Regional Needs Assessment Prevention Resource Center, Region 1 FREQUENCY OF ALCOHOL AT PARTIES Most of the Time Always Combined G R AD E 7 G R AD E 8 G R AD E 9 G R AD E 1 0 G R AD E 1 1 G R AD E 1 2 Data Source: Texas Student Survey of Drug and Alcohol Use, 2016; Regions 1-2 Overall, it seems more likely that regional adolescents will encounter alcohol at parties than the state average (46.5% vs. 40.3%). Naturally, the older students seem more likely to encounter alcohol at parties with the biggest increase being the transition from Grade 10 (27.1%) to Grade 11 (40.7%). Although parties seem to be the most likely time for Regional Adolescents to consume alcohol, other at risk times include weeknights (24.4%), weekends (40.2%), and after school (28.0%). Parents, educators, and other regional caregivers should factor in these at risk times for alcohol consumption when developing any prevention strategies. In addition to consuming alcohol at parties, many regional adolescents either drive while under the influence of alcohol or ride with someone who has been drinking. 14% of Lubbock-area adolescents report riding once in the past year in a vehicle driven by someone who has been drinking and 11% report doing so five or more times in that same time frame. Figure 9: Lubbock-Area Adolescents Driving Under Influence of Alcohol: Past Year 53

64 Regional Needs Assessment Prevention Resource Center, Region 1 LUBBOCK-AREA ADOLESCENTS DRIVING UNDER THE INFLUENCE OF ALCOHOL: PAST YEAR Rode Drove 1 T I M E 2 T I M E S 3-4 T I M E S 5 O R M O R E T I M E S Data Source: 40 Developmental Asset Survey, Lubbock Area, 2015 Equally poignant, 15% of Amarillo-area adolescents reported operating a vehicle after drinking at least once. It seems that regional adolescents are less likely to drink and operate a vehicle than to ride with someone driving while drunk. Still, give the potential life-threatening consequences to both them and the community, more emphasis on these dangers are needed in our region. Qualitative Data During interviews and focus groups, key informants revealed a disconnection between generations concerning the reasons that teens consume alcohol. Many of the parents remember drinking as teens in order to feel grown-up or more mature. Many of the teens who participated in these groups talked about drinking to get drunk. This difference should be investigated more in this region. Marijuana The majority of regional marijuana consumption data that is available comes from the 2016 Texas Student Survey of Substance Abuse (TSS) and the 2013 Youth Risk Behavior Survey Texas Results (YRBS). Both of these surveys give data for the State of Texas and is not available at a regional or county level of detail. These do afford communities a general idea of what may be occurring among their young people. This data provides an excellent frame from which to compare any local information concerning ATOD use. Local data specific to Region 1 on marijuana consumption and abuse is sparse but there are three surveys that the PRC has access to: The Amarillo Texas Prevention Impact Index (TPII) 2016, the 2017 Hockley County VOICES Survey, and the 40 Developmental Assets Survey collected in Lubbock County 2015 by the YWCA. Two of these surveys are centered in the Amarillo and Lubbock metropolitan areas but data from Hockley County is also available to compare with other more rural areas. Age of Initiation 54

65 Regional Needs Assessment Prevention Resource Center, Region 1 In Region 1, adolescents who smoke marijuana report an average age of 13.7 as when they first consumed marijuana. This is consistent with the state average of % of regional adolescents report trying marijuana before the age of 13. This is significantly higher than the state average of 23.1%. Current Use Generally speaking, available data seems to indicate that fewer adolescents in Region 1 (21.5%) have ever used marijuana when compared to national (44%) 27 and state (26.2% or 37.5%) results. Equally encouraging, fewer regional adolescents (12.1%, 18%) report using marijuana in the last 30 days than national teens (24%) 28. Figure 10: Overview of Marijuana Consumption, Region 1 ADOLESCENT MARIJUANA CONSUMPTION - REGION 1 Region 1 Texas Amarillo Castro Co USA Lubbock Hockley Co H AV E E V E R U S E D L AS T 3 0 D AY S Still, it is troubling that 46% of Lubbock-area adolescents reported that they have tried marijuana at least once. Equally troubling is that 18% of Lubbock-area adolescents report that they have used marijuana within the last 30 days. Although this is slightly less than Texas Students surveyed by the YRBS, it is over 5% higher than the Texas Students surveyed by the TSS. Nationally, marijuana use among adolescents is basically flat over the last five years 29 and what regional information we have seems to defy this. In 2013, marijuana use among Amarillo-area adolescents are similar to 2010 rates but it continues to decline. Figure 11: Marijuana Use , TPII Partnership Attitude Tracking Study, sponsored by Met Life. Key Finds: Released July 23, Ibid. 29 Ibid. 55

66 Past 30 Days Past Year Will Use in Future Data Source: Texas Prevention Imact Index Survey, 2016 As compared to Texas state averages, our region seems mixed. Area adolescents are less likely to have ever tried marijuana but more likely to have used marijuana in the last 30 days than participants of the Texas Student Survey. The Amarillo data is showing that fewer adolescents in this area are using marijuana but, if they use at all, they are more likely to do so more often. Still, a shocking 46% or Lubbock-area students report trying marijuana at least once. This is significantly higher than the regional average (21.5%). Table 40: Prevalence and Recent Use of Marijuana, TSS 2016 Prevalence and Recent Use of Marijuana TSS 2016 Past Month School Year Ever Used Never Used All Grades 12.7% 15.3% 21.5% 78.5% Grade 7 4.9% 5.0% 6.4% 93.6% Grade 8 7.6% 8.7% 11.2% 88.8% Grade % 17.7% 20.9% 79.1% Grade % 21.6% 28.2% 71.8% Grade % 21.6% 30.7% 69.3% Grade % 20.0% 37.1% 62.9% Data Source: Texas Student Survey of Drug and Alcohol Use, 2016; Regions 1-2 State-wide, only 26.2% of adolescents report ever using marijuana but 41.8% of twelfth grade students report that they have used marijuana at least once. Overall, this is well below national findings. Methods of Consumption We have little region-wide data on how adolescents are consuming marijuana. Many of the older, more established survey tools fail to ask any questions about how teens consume marijuana but this is changing. In general, many adolescents do consume marijuana in ways other than smoking. 56

67 Edibles are a discreet way to consume marijuana by infusing cannabis with food or drink. These edible sources introduce THC into the body through the intestinal tract instead of through the lungs. Once, brownies were the most well-known way to consume edible cannabis but these edibles come in many different forms, from candy to soda to gourmet cooking, and are easy to conceal from parents and teachers. 18% of Castro Co. adolescents and 33% of Hockley Co adolescents who have used marijuana report consuming cannabinoids in edibles. These products carry a much higher concentration of THC than "flower (meaning the raw "bud" form of weed) and they produce a longer high. Typically, marijuana flowers contain between 12% and 15% THC while edibles use a concentrate that is between 50% and 90% THC. Often the concentrate is not distributed evenly or correctly labeled which can lead to accidental overdose. Vaporizing is a technique of cannabinoid consumption where a marijuana concentrate or oil is superheated into a mist which is inhaled like smoke. Vaporization is a relatively new method of administration for marijuana. This device delivers inhaled THC while reducing toxic byproducts of smoking marijuana caused by combustion. Many users believe that it provides a faster, more intense high. 18% of Castro Co. adolescents and 25% of Hockley Co adolescents who have used marijuana report consuming cannabinoids with a vaporizer. Often, vaporizing is used by people to conceal their consumption of marijuana. The latest versions of e- cigarettes can be used to vaporize cannabis oil with little or no odor as there is no fire or smoke. They can often be purchased at a local convenience store. Also, these vaporizers look like pens which are easy to conceal and do not resemble bongs or even earlier vaporizers. They simply look innocuous. Dabbing is inhaling the vapors from a concentrated form of marijuana made by an extraction method that uses butane gas. Dabs, also known as butane hash oil (BHO) which are sometimes called "budder," "honeycomb" or "earwax" are more potent than conventional forms of marijuana because they have much higher concentrations of THC, than is found in regular cannabis. At a minimum, dabs are four times as strong as a joint, and the high is administered all at once. 14% of Castro Co. adolescents and 13% of Hockley Co adolescents who have used marijuana report dabbing. Smoking is by far the most popular method of marijuana consumption for those we surveyed. Still, a surprising amount of other methods are used by the participants. Figure 12: Means of Adolescent Marijuana Consumption 57

68 MEANS OF ADOLESCENT MARIJUANA CONSUMPTION Hockley Co Castro Co Other Dabbed Vaporizer Edible Smoked Data Source: Hockley County VOICES Survey, 2016 This is significant for the following reasons: (1) methods other than smoking are more efficient in the amount of THC consumed (ex. 95% of THC is consumed with a vaporizer while only 12% is ingested via smoking); (2) edibles tends to act slowly so adolescents tend to eat more before the effects are felt leading to a greater chance of overdose; and (3) alternate methods besides smoking are more difficult for authorities to detect. Qualitative Data During regional interviews and focus groups, many participants are surprised to discover that the consumption of marijuana is illegal. Many parents believe that marijuana is similar to alcohol or even safer than alcohol and even have expressed sentiments such as At least it s not meth or some equivalent. Many adolescents report surprise at the illegality of marijuana due to all the sites on Facebook and The Internet that discuss how to grow the plants, the places to purchase all required to grow the plants, and where to buy edibles which are foodstuffs, often baked goods, with cannabis oil included. Prescription Drugs Prescription drug misuse and abuse by teens continues to be a significant health problem today and it is threatening the well-being of American adolescents. Currently, 24% of American teens that is almost one in four admit to misusing or abusing a prescription drug at least once in their lifetime. 30 This is a 33% increase over the last five years and a much larger problem than many parents and educators may realize. In general, teens from urbanized, but non metropolitan areas are at the greatest risk for misusing or abusing prescription drugs, followed by rural and then metropolitan areas. 31 However, lax attitudes and 30 The Partnership at Drugfree.org, SAMHSA, April 11,