Strategic Prevention Framework State Incentive Grant (SPF-SIG) SPF SIG Statewide Epidemiological Outcomes Workgroup. Spring 2007

Transcription

1 Pennsylvania State Epidemiology Profile On Substance Use & Consequences Strategic Prevention Framework State Incentive Grant (SPF-SIG) SPF SIG Statewide Epidemiological Outcomes Workgroup Spring 2007

2 SPF-SIG STATEWIDE EPIDEMIOLOGY WORKGROUP The SPF-SIG State Epidemiology Outcomes Workgroup (SEOW) is a group of twenty three members that collaborated on the development of this document, with the help of the larger State SPF-SIG Advisory Council (see Appendix for a list of SEOW and Advisory Council members). PA Department of Health Bureau of Drug and Alcohol Programs Gene Boyle Data Section Garrison Gladfelter Division of Prevention Lonnie Barnes Joseph Powell VI Jacqueline Spaid Melissa Trainor Bureau of Epidemiology Gene Weinberg Division of Community Epidemiology James Logue Ronald Tringali Bureau of Health Planning Division of Plan Development Ray Moneta Bureau of Health Statistics Alden Small Phyllis Zitzer Alvernia College Sam Frankhouser Temple University School of Social Administration Marsha Zibalese-Crawford Institute for Survey Research Len LoSciuto Peter Mulcahy University of Pennsylvania School of Social Policy & Practice Dennis Culhane Penn State University Prevention Research Center Mark Feinberg Mark Greenberg Jennifer Sartorius University of Pittsburgh School of Pharmacy Michael Melczak Janice Pringle PA Commission on Crime and Delinquency Center for Research, Evaluation and Statistical Analysis Douglas Hoffman

3 ACKNOWLEDGEMENTS This profile is based on research made possible by support from the Pennsylvania Department of Health s Bureau of Drug and Alcohol Programs (BDAP) and the Substance Abuse and Mental Health Administration s (SAMHSA) Center for Substance Abuse Prevention (CSAP). The authors wish to thank Gene Boyle, Director, BDAP, Joseph Powell VI, who directs BDAP s Prevention Division, and Jacqueline Spaid, the Division s Program Supervisor, for their guidance, support, and encouragement in compiling this profile as well as the SPF-SIG Advisory Council for its concrete suggestions. Mark Greenberg Director Prevention Research Center Pennsylvania State University Jennifer Sartorius Statistical Analyst Prevention Research Center Pennsylvania State University

4 TABLE OF CONTENTS I. Executive Summary...1 II. Introduction A. About the SPF-SIG...6 B. Goals...8 C. Understanding the Profile...9 III. Data Sources...10 IV. Data Limitations...13 V. Data Processes A. Choosing Indicators...15 B. Indicators Chosen...17 VI. Consumption & Consequences A. Alcohol 1. Indicator Definitions Adult & Youth Consumption Adult & Youth Consequences Alcohol Summary...41 B. Tobacco 1. Indicator Definitions Adult & Youth Consumption Adult & Youth Consequences Tobacco Summary...58 C. Illicit Drugs 1. Indicator Definitions Adult & Youth Consumption Adult & Youth Consequences Illicit Drugs Summary...70 VII. Appendix A. SEOW & Advisory Council Member List...73 B. Acronyms in Profile...82 C. Detailed Tables 1. NSDUH Pennsylvania Substate Regions NSDUH Substate Data Tables Used FARS Calculated Crash Data Tables Used Percent Smoking During Pregnancy by County PAYS Survey (2005) Data Tables Used...99 D. Other Pennsylvania Drug & Alcohol Resources...110

5 I. EXECUTIVE SUMMARY GOALS OF THIS REPORT This report of the Pennsylvania State Epidemiology Profile On Substance Use & Consequences (hereafter referred to as the profile) was developed by the State Epidemiological Outcomes Workgroup (SEOW) as a tool for substance abuse prevention planners for Pennsylvania, including the Single County Authorities (SCA), who are responsible for countywide assessment, planning, implementation and evaluation of prevention. The process of using data to improve prevention practice and to improve decision-making is important for several reasons: It helps to inform and anchor problem identification and goal setting; It increases the likelihood that the most significant problems will be targeted for intervention; It drives prevention planning and implementation decisions assuring that strategies appropriately target problems; and, It provides the basis for ongoing monitoring and evaluation to improve efforts. The profile is intended to support efforts related to the Substance Abuse and Mental Health Services Administration (SAMHSA) Strategic Prevention Framework State Incentive Grant (SPF-SIG) received in Pennsylvania in October, The SPF-SIG will provide funding for Pennsylvania communities to assess the problems of substance use and its consequences and to plan and implement evidence-based prevention programs, policies, and practices. This profile is the first step in the SPF-SIG process of developing a statewide needsassessment. The goal of this profile is to review and summarize both federal and state data sets that provide a set of state-specific indicators of: (1) substance use-related consequences and (2) substance use patterns related to these consequences. As directed by SAMSHA, this assessment includes measures of: Overall consumption; Acute, heavy consumption; Consumption in risky situations (drinking and driving); Consumption by high risk groups (youth, college students, pregnant women); and Consequences that result from consumption. Finally, certain criteria were used for selecting indicators to ensure that the indicators: Reflect critical substance use related problem or consumption patterns; Have high validity; Have periodic collection; Be available with a limited burden; and Can be disaggregated geographically, by age, gender and/or race/ethnicity. 1

6 As this is the initial report of the SEOW, a wide range of scores and indicators were utilized. These indicators serve as a baseline for later decision-making in developing priority indicators in the SPF process. FINDINGS OF THIS REPORT For each type of substance (alcohol, tobacco, and illicit/other drugs (ATOD)) this report summarizes the magnitude of the problem in Pennsylvania, time trends in recent data, and comparison to national data. Alcohol Consumption and Consequences. In terms of magnitude, alcohol is the most frequently reported substance used. Many Pennsylvanians show high rates of consumption and many are affected by its consequences. Adult binge drinking is reported by approximately 16% of Pennsylvania adults and similar rates are reported by high school students. Pennsylvania has a large number of admissions for alcohol treatment and the effects of alcohol use problems impact many aspects of life for affected adults, spouses, relatives, and children. Alcohol played a role in 40% of all fatal crashes in The highest percentage of drinking drivers in fatal motor vehicle crashes is among those drivers aged 21-29; almost 50% of all young adult drivers who died had been drinking. The majority of the alcoholrelated DUIs and fatalities involve white males. Males report both higher rates of binge and heavy drinking and also experience the majority of the alcohol consequences, including abuse and dependence. Teen girls show similar rates of 30-day alcohol use, but lower rates of binge drinking than teen boys. Young adults show particularly high rates compared to older adults and should be considered a target for reductions within the adult age range. For most consequences, the highest rates are shown for those aged Geographically, it appears that the certain substate regions show higher rates of consumption & consequences for both adults and youth. Higher rates are seen in Allegheny County, the northwest corner (regions 19 and 23 in the National Survey on Drug Use and Health (NSDUH, see Appendix for region definitions), and the northcentral area of the state. Perhaps surprisingly for the largest urban area, Philadelphia has lower rates than many other areas of the state. There is a need for further data that can permit better assessment of regional rates for youth in urban, suburban, and rural areas of Pennsylvania. During the past three years there have been reductions in rates of problem drinking in adults (binge & heavy drinking) which appear to be the result of reductions in drinking by men, who still show substantially higher rates than women. No downward change has been shown in binge drinking or 30-day use among youth. On most indicators, comparisons with the national rates show that Pennsylvania is not far from the national averages. However, Pennsylvania shows a substantially lower rate of 2

7 alcoholic liver disease deaths. In contrast, Pennsylvania rates are somewhat higher than national levels for 30-day adult binge drinking and the percent of all alcohol-impaired drivers involved in fatal crashes (26% in 2004). Tobacco Consumption and Consequences. Tobacco use affects many Pennsylvanians. Almost 24% of adults are current smokers and about 18% smoke daily. A substantial public health concern is that 18% of new mothers voluntarily reported that they smoked during their pregnancy during Further, the rates are substantially higher among pregnant women below the age of 25 (almost 30%). Educational attainment is significantly associated with smoking status. Smoking prevalence is more than tripled for those with less than a high school education compared to those who graduate from college. Adults between the ages of have the highest tobacco use prevalence rates. Additionally, a significant difference was found between Whites and Blacks with regard to adult current smoking. In 2005, Blacks had an 8% higher prevalence rate than Whites. In contrast, for youth under 18, White students have higher tobacco usage rates than Black students. For youth, the prevalence rates for smoking do not differ between girls and boys, but three times as many boys use smokeless tobacco as do girls. In 2005 almost 55% of 12 th graders surveyed said they had tried smoking in their lifetime. With regard to tobacco use consequences, Black people showed disproportionately higher rates of lung cancer. Men also show higher rates of death than women that are attributable to tobacco use. Geographically, there is no clear pattern of hot spots. Trends across time indicate somewhat lower rates of consumption as reflected in reported rates of usage and the decreasing number of cigarettes legally sold in Pennsylvania over the past decade. However, in many cases these are non-significant trends. Between 2002 and 2005 there has been a small decline in adult rates of daily smoking. Pennsylvania is above the national median levels with regard to all consumption and consequence indicators for tobacco including number of cigarettes sold, daily use by adults and teens, smoking during pregnancy and rates of lung cancer. Adult and Youth Illicit Drug Use and Consequences. There is substantial use of illicit drugs in Pennsylvania among youth and adults. The year old age group stands out with regard to all types of self-reported illicit drug use both marijuana and other illicit drug use rates are much higher than the other age groups. Correspondingly, the percent of year olds meeting DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4 th edition) criteria for illicit drug abuse or dependence is much higher than the other age groups, with 8% meeting criteria for drug abuse or dependence. These rates then decline as young adults move further into the roles and responsibilities of adulthood. 3

8 There were 45,983 treatment admissions in Pennsylvania (based on 2005 Treatment Episode Data (TEDS) where illicit drugs were identified as the drug of choice at admission. The most frequently cited drugs (in order of ranking) were: heroin, marijuana, and cocaine (smoked). This data is limited, however, to federal block grant/state funded services, plus available Medicaid information, and does not reflect all treatment services provided in Pennsylvania. Among youth, current marijuana use increases dramatically by grade: there is almost no reported use in 6 th graders, over 3% among 8 th graders, 12% among 10 th graders, and a jump to 23% in 12 th graders. Almost 45% of 12 th graders reported that they had tried marijuana in their lifetime. While marijuana shows the highest prevalence, there is substantial use of inhalants among all grades (6 th, 8 th, 10 th, 12 th ) and non-medical use of prescription drugs as reported by 10 th and 12 th graders. In 2005, over 10% of 12 th graders reported substantial non-medical use of prescription drugs including amphetamines, sedatives, tranquilizers and over 15% reported use of narcotic pain medications. For youth under 18, marijuana and inhalant use were most often identified as the illicit drugs of choice at admission to treatment. The Philadelphia region is statistically higher, or close to being statistically higher than the rest of the state with regard to the rate of drug-induced deaths, the percent of people who meet the DSM-IV criteria for illicit drug abuse or dependence, and current marijuana consumption prevalence. The use of marijuana and other illicit drugs (other than non-medical use of prescription drugs) appears relatively stable the past few years. For youth, it appears that 30-day inhalant use is on the rise (3.4% in 2005 vs. 1.8% in 2001). Although non-medical use of amphetamines, sedatives, tranquilizers, and narcotic drugs are of substantial concern in 10 th and 12 th graders, there is inadequate data to study time trends because 2005 was the first time that this data was reported in the Pennsylvania Youth Survey (PAYS). Compared with the rest of the nation, Pennsylvania is about average for consumption and consequence rates for illicit drugs; however, current marijuana use for years old is slightly above the national level. Cross-Substance Summary Alcohol, tobacco and illicit drugs are used at substantial rates in Pennsylvania. For students or youth, alcohol is the most frequently reported substance used, followed by tobacco and marijuana. However, for adults, the daily smoking prevalence is higher than the prevalence of 30-day adult binge or heavy drinking ( problem drinking ). There is dramatic growth in binge drinking, tobacco, and illicit drug use during the high schools years and these activities continue at high rates through the young adult years (ages 18-25). Reported smoking during pregnancy also affects many people (24,760 live births in 2004). For consequences, the largest number of people are affected by: DUI arrests (43,699 persons in 2004), admissions to treatment (71,901 admissions in 2004), lung cancer deaths (7,949 deaths in 2003), and the percent of people in Pennsylvania meeting DSM-IV criteria for abuse or dependence (7.5% for alcohol and 2.7% illicit drugs,

9 2004). All of these issues are considered serious and may be amenable to some intervention models. In order to make changes in these indicators, intervening variables (risk and protective factors) may be targets for intervention and thus should also be measured. NEXT STEPS During the next 3-6 months the SEOW will accomplish four goals. First, it will rereview the possible inclusion of other priority indicators. Second, it will make recommendations for the inclusion of key measures of youth or adult risk and protective factors (intervening variables) that are directly related to either substance use or consequences in adolescence or adulthood. Third, the SEOW will establish criteria and a process for prioritizing need based on the epidemiological data to support the work of the Pennsylvania SFP-SIG process. Fourth, the SEOW will make recommendations regarding the need for changes or additions to data /monitoring efforts. 5

10 II. INTRODUCTION II. A. About the SPF-SIG This profile is to be used as a tool for substance abuse prevention planners for the state of Pennsylvania. The primary purpose of this profile is to utilize data to monitor programs and practices for substance abuse prevention. The goals of this profile are aligned with the Strategic Prevention Framework and it supports efforts related to the SAMHSA SPF- SIG in Pennsylvania. The SPF-SIG will provide funding for Pennsylvania communities to assess substance use and its consequences and intervening variables in order to address those needs with planning and implementation of evidence-based prevention programs, policies, and practices. The intervening variables include risk and protective factors that are related to both consumption indicators and consequence indicators. The goals of the broader SPF-SIG initiative are to: Prevent the onset and reduce the progression of substance abuse, including childhood and underage drinking; Reduce substance abuse-related problems in the communities; and Build prevention capacity and infrastructure at the State and community levels. The SPF-SIG takes a public health approach to prevent substance related problems. This approach focuses on change for entire populations. A basic foundation of effective prevention activity is grounding the planning process in a solid understanding of alcohol, tobacco and other drug consumption and consequence patterns. Understanding the nature and extent of consumption (e.g., underage drinking, illicit drug use) and consequences (e.g., motor-vehicle crashes, school failure) is critical for determining prevention priorities and aligning strategies to address them. The Strategic Prevention Framework includes 5 iterative steps (see Figure 1). Figure 1.: SAMHSA s Strategic Prevention Framework Steps Evaluation Monitor, evaluate, sustain, and improve or replace those that fail Profile population needs, resources, and readiness to address needs and gaps Assessment Sustainability & Cultural Competence Mobilize and/or build capacity to address needs Capacity Implementation Implement evidence-based prevention programs and activities Develop a Comprehensive Strategic Plan Planning 6

11 The SPF-SIG strives to use data across all steps of the Strategic Prevention Framework (SPF). There is a well-structured process to collect, analyze, interpret, and apply lessons from substance use and consequence data to drive state efforts across the entire SPF. Ongoing and integrated data analyses are critical to: Identify problems and set priorities; Assess and mobilize capacity for using data; Inform prevention planning and funding decisions; Guide selection of strategies to address problems and goals; and Monitor key milestones and outcomes and adjust plans as needed. 7

12 II. B. Goals GOALS OF SEOW Over the next five years, the goals of the SEOW are to: Bring systematic, analytical thinking to the causes and consequences of the use of substances in order to effectively and efficiently utilize prevention resources; Promote data-driven decision making at all stages in the Strategic Prevention Framework; Promote cross systems planning, implementation, and monitoring efforts; and Provide core support to the SPF Advisory Council. GOALS OF THIS PROFILE This report is the first step in the SPF-SIG process of developing a statewide needs assessment. The initial activity is to assess substance use and related problems leading to recommendations regarding state and community priorities. The assessment should include a profile of consumption and related problems in Pennsylvania and identify a set of state-specific indicators of (1) substance use-related consequences and (2) substance use patterns related to these consequences. As directed by SAMSHA, this assessment should include measures of: Overall Consumption; Acute, heavy consumption; Consumption in risky situations (drinking and driving); Consumption by high risk groups (youth, college students, pregnant women); and Consequences that result from consumption. Finally, certain criteria were used for selecting indicators. These indicators should: Reflect critical substance use related problem or consumption pattern; Have high validity (research-based evidence accurately measures construct); Have consistent, periodic collection (over at least last 3 to 5 years); Be readily available and accessible; and Be sensitive (able to detect change over time). The current assessment report was focused on utilizing existing data sources and should establish baseline levels, trends over time, and, when available, patterns by age, gender, race/ethnicity, and geography. 8

13 II. C. Understanding the Profile PROFILE LAYOUT Each consumption and consequence section begins by listing and defining all indicators used for a particular substance (indicator definitions in this profile follow the definitions from the data sources used in the sections). Next, data is presented by indicator. Within these sections, short descriptions of findings are also presented. At the end of each section is an overall summary. ABOUT NUMBERS IN PROFILE The data and statistics shown in this profile were obtained mainly at the state level as that is the level at which most of the estimates are statistically accurate due to typical survey sampling frames and methodologies. When statistically possible, the data were disaggregated into smaller geographical areas to more accurately identify regions of higher risk for the indicators. In addition, when possible, 95% confidence or prediction intervals for the estimates are provided for comparison purposes. When the term significant is used in making comparisons in this profile, it is conservatively utilized and refers to non-overlapping 95% confidence or prediction intervals. The term prevalence rate refers to how prevalent the measurement is in the population (higher numbers indicate greater prevalence); this can be presented as a percentage or count per population. As the estimates and data were obtained from many data sources, each table or chart is briefly labeled with the data source. The full data sources are described in the section titled Data Sources. In addition, most of the data is presented in forms of figures or graphs. The actual numbers are usually then reported in the Appendix, as noted in the sections. DATA DIMENSIONS Most of the indicators in each substance section are summarized by a matrix using three comparison dimensions. One dimension summarized is the magnitude of the problem, either with numbers impacted, rates of severity, or both (when possible). Another dimension examined is time trends with the indicator. Is the indicator getting better or worse over time? Finally, a third dimension examined (when possible) is comparison with national rates. For this dimension, the same measure is compared for Pennsylvania with the national one to calculate a rate ratio. A rate ratio can be interpreted as: 1 = Pennsylvania s rate is the same as the national one; Over 1 = Pennsylvania s rate is higher than the national one, higher numbers indicate an increasing difference; and Under 1 = Pennsylvania s rate is lower than the national one. 9

14 III. DATA SOURCES Alcohol Sales: Lakins, N.E., Williams, G.D., Yi, H., and Smothers, B.A., Surveillance Report #66: Apparent Per Capita Alcohol Consumption: National, State, and Regional Trends, Bethesda, MD: NIAAA, Alcohol Epidemiologic Data System. Behavioral Risk Factor Surveillance System (BRFSS) Survey: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Data obtained on the Centers for Disease Control and Prevention (CDC) website: The BRFSS survey in Pennsylvania is conducted by the Pennsylvania Department of Health. Census: National Center for Health Statistics. Bridged-race intercensal estimates of the July 1, 1990-July 1, 1999, United States resident population by county, single-year of age, sex, race, and Hispanic origin, prepared by the U.S. Census Bureau with support from the National Cancer Institute (April 24, 2004). Estimates of the July 1, 2000-July 1, 2004, United States resident population from the Vintage 2004 postcensal series by year, county, age, sex, race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau (September 9, 2005). Data were downloaded from the Centers for Disease Control and Prevention website at Fatality Analysis Reporting System (FARS): National Highway Traffic Safety Administration, Department of Transportation, FARS includes blood alcohol content (BAC) values for every case in the file, either through BAC measurement, or imputation where an actual measurement was not taken (or the result was unknown). Those persons for whom a BAC is missing had their BAC imputed probabilistically from a model developed by NHTSA analysts that has been validated as having a high degree of predictive accuracy (Rubin, Schafer, and Subramanian, 1998). Mortality: U.S. Dept. of Health and Human Services, National Center for Health Statistics. Multiple Cause of Death, 1990 [Computer File]. Hyattsville, MD: U.S. Dept. of Health and Human Services, National Center for Health Statistics [producer], Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], U.S. Dept. of Health and Human Services, National Center for Health Statistics. Multiple Cause of Death, [CD-ROM]. Hyattsville, MD. Individual-level data were obtained from the National Center for Health Statistics (NCHS) Multiple Cause of Death Public-Use Files for NCHS used the International Classification of Diseases-9th revision (ICD-9) system for classifying mortality data to record the underlying cause of death for years The International Classification of Diseases-10th revision (ICD-10) system for classifying mortality data was used to record the underlying cause of death for years

15 National Survey on Drug Use and Health (NSDUH): Wright, D., & Sathe, N. (2006). State Estimates of Substance Use from the National Surveys on Drug Use and Health (DHHS Publication No. SMA , NSDUH Series H-29). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Some figures, numbers, and regional break-downs obtained online from website. State estimates are calculated by combining two years of data and substate estimates combine 3 years of data. All estimates are based on a survey-weighted hierarchical Bayesian approach. Annual updates and state estimates are available at: Publication used for substate estimates ( Substate Estimates from the National Survey on Drug Use and Health. Pennsylvania Adult Tobacco Survey (PA ATS): Pennsylvania Adult Tobacco Survey 2005 report obtained from the Bureau of Health Statistics and Research, Division of Tobacco Prevention and Control, PA Department of Health ( Pennsylvania EpiQMS (Epidemiologic Query and Mapping System): Pennsylvania Department of Health website: EpiQMS includes data from Pennsylvania s death and birth certificates across years and by demographics and geography. PA Department of Health disclaimer: These data were provided by the Bureau of Health Statistics and Research, Pennsylvania Department of Health. The Department specifically disclaims responsibility for any analyses, interpretations or conclusions. Pennsylvania State Police: Uniform Crime Statistics obtained from PCCD (PA Commission on Crime and Delinquency), Center for Research, Evaluation, and Statistical Analysis as DUI Fact Sheets downloaded from: Pennsylvania Youth Survey (PAYS): 2005 PA Youth Survey Report (Statewide) obtainable online ( as publication from Pennsylvania Commission on Crime and Delinquency (PCCD). Tables used in this report are Tables D4-D10 (prevalence estimates by substance), Tables D14-D15 (average age of first use by substance), and Table D17 (self-reported DUI). Since 1989, the Commonwealth of Pennsylvania has conducted a survey of secondary school students on their behavior, attitudes and knowledge concerning alcohol, tobacco, other drugs, and violence. The Pennsylvania Youth Survey (PAYS) of 6 th, 8 th, 10 th and 12 th grade public school students is conducted every two years. The effort is sponsored and conducted by the Pennsylvania Commission on Crime and Delinquency (PCCD). The data gathered in the PAYS serve two primary needs. First, the results provide school administrators, state agency directors, legislators and others with critical information concerning the changes in patterns of the use and abuse of these harmful substances and behaviors. Second, the survey assesses risk factors that are related to these behaviors and the protective factors that help guard against them. This information allows community leaders to direct prevention resources to intervening variables where they are likely to have the greatest impact. 11

16 Treatment Episode Data Sets (TEDS): Office of Applied Studies, Substance Abuse and Mental Health Services Administration ( TEDS provides information on the demographic and substance abuse characteristics of the 1.9 million annual admissions to treatment for abuse of alcohol and drugs in facilities that report to individual State administrative data systems. TEDS is an admission-based system, and TEDS admissions do not represent individuals. It includes admissions to facilities that are licensed or certified by the State substance abuse agency to provide substance abuse treatment (or are administratively tracked for other reasons). In general, facilities reporting TEDS data are those that receive State alcohol and/or drug agency funds (including Federal Block Grant funds) for the provision of alcohol and/or drug treatment services. Tobacco Sales: Orzechowski & Walker. (2003). The tax burden on tobacco. Historical Compilation, Vol. 37, Arlington, VA: Orzechowski & Walker. 12

17 IV. DATA LIMITATIONS There are a number of data limitations that currently exist in attempting to accurately represent substance use and consequences in Pennsylvania. Additionally, some of the data included in this profile (Pennsylvania Youth Survey (PAYS), DUI arrest rates, Treatment Episode Data Set (TEDS)) provides important information but should be interpreted with caution. Within the profile we address the cautionary inferences for specific data indicators and we also include an overall summary of such data limitations here. Concerns About PAYS Data: Although of great value, there are a number of issues to be considered in the Pennsylvania Youth Survey (PAYS). The overall school response rate for the 2005 survey was 40%. Sixty percent of schools in the original sample did not participate. While appropriate weighting was conducted to minimize the effects on the estimates of this low response rate, no amount of adjustment can remove the very real possibility that a substantial and unknown amount of bias remains. Second, there was no participation from either the Philadelphia or Pittsburgh school districts; hence the estimates do not allow for estimates of Pennsylvania s two large urban areas and thus may provide unreliable estimates regarding differences by ethnicity. Third, the accuracy of 12 th grade data is difficult to judge due to the high rate of dropouts in some communities. Therefore, the 12 th grade data should be used with caution. Fourth, the PAYS report does not compute confidence intervals and thus it is often unknown whether differences by grade, sex, ethnicity, etc. are statistically different. Concerns About TEDS Data: Licensed drug and alcohol treatment providers in Pennsylvania that receive funds from the Department of Health (DOH) are required to report on treatment services provided through the Bureau of Drug and Alcohol Programs' (BDAP) Client Information System (CIS). This data is largely limited to block grant/state funded services, plus available Medicaid information. BDAP submits treatment admissions data on a quarterly basis to SAMHSA for inclusion in the national Treatment Episode Data Set (TEDS). There are differences in TEDS and CIS treatment admissions counts for Pennsylvania for several reasons. TEDS data is aggregated on a calendar year basis, while state level CIS publications use a state fiscal year reporting period (July 1 to the following June 30). Admissions may also be counted differently in TEDS and CIS. Pennsylvania treatment providers are instructed to report a new treatment admission in the Client Information System (CIS) every time a client changes between levels of care, although it is not known how consistently this is done. TEDS defines a treatment episode differently, and would only show a new admission for a change in level of care if a different treatment provider was involved. Changes in level of care at the same provider are counted as a transfer rather than a new admission in TEDS. Finally, the reported admissions are only to facilities that are either state-certified for treatment and/or receive government funds; thus, these numbers don t represent the entire scope of those admitted for treatment in 13

18 Pennsylvania. Finally, it is unknown as to what extent the treatment admissions data submitted by Pennsylvania to TEDS is edited by SAMHSA's contractor (Synectics). Concerns About DUI Arrest Data: Although included in this profile, DUI arrest data must be used with caution as it may not accurately reflect consumption patterns in Pennsylvania. Instead, this arrest data is likely to reflect local priorities and concerns and may also reflect budgetary priorities of local law enforcement. This could erroneously reflect increased targeting of certain geographic regions rather than actual increases in consumption. If targeted prevention programs are conducted to reduce alcohol abuse, these may not be reflected in DUI arrests. However, it is possible that increased enforcement and thus higher rates of DUI arrests might lead to a reduction in other consequences such as reports of drinking and driving, alcohol-related fatalities, etc. 14

19 V. DATA PROCESSES V. A. Choosing Indicators An important goal of this report is to provide a wide variety of data indicators for Pennsylvania that bear on the issue of substance use and abuse. Choices were made to include indicators based on data availability (should be easily available), data validity (should be research-based evidence that the indicator accurately measures the construct), data consistency (data should be measured in a very similar way across several years), and sensitivity (data should reflect changes in consumption or consequences of substance). The process of indicator selection was facilitated by following the guidelines for indicators suggested by SAMHSA along with associated data SAMHSA supplied for Pennsylvania. For consumption indicators, these included: current use of substances, binge drinking, heavy drinking, drinking and driving self-reported rates, alcohol/tobacco sales, daily tobacco use, age of initial use of substances, lifetime use of some substances for youth, and alcohol use during pregnancy. Almost all of these are contained in this profile. These are all nationally obtained by SAMHSA. However, importantly, most of the youth consumption data utilized by SAMHSA is obtained through the Youth Risk Behavioral Surveillance Survey in which Pennsylvania does not participate. We filled this data gap with the Pennsylvania Youth Survey (PAYS). Where possible (in order to compare with the national rate), we also report the applicable rates for youths from the National Survey on Drug Use and Health (NSDUH). Within the State of Pennsylvania, there are data estimates of many of these consumption indicators as well. We utilized Pennsylvania Department of Health data for the indicator of smoking while pregnant which provides some disaggregation by demographics and by county. We do not report current alcohol use rates for adults since this is a normative, legal behavior and the majority of Pennsylvania adults surveyed have had a drink within 30-days. As age at first use of ATOD is an unreliable indicator (it varies by age with the question asked), we instead report lifetime use of substances for youth by grade level. For consequences, SAMHSA recommended indicators included: deaths from liver disease (alcoholic and/or chronic), suicides, homicides, motor vehicle crashes, the percent of persons over 12 meeting DSM-IV criteria for alcohol/drug abuse or dependence, crime data, deaths from lung cancer, deaths from Chronic Obstructive Pulmonary Disease (COPD) or Emphysema, deaths from cardiovascular disease, and deaths from drugs. We exclude almost all crime data (violent crimes and homicides) as these indicators do not reflect consumption and are an inaccurate measure of the influence of ATOD. However, we do include DUI arrest data as one indicator to monitor to assess for Pennsylvania s burden (monetary and otherwise) that results from drinking (see Data Limitations for cautions in interpreting this indicator). We also exclude suicides and deaths from cardiovascular disease as we decided that these measures were very limited in accurately measuring our constructs. It is unclear what role ATOD plays in suicide and many factors other than ATOD are related to cardiovascular mortality. As there are no other 15

20 available consequence indicators specific to the use of illegal drugs, we include the percent of admissions to treatment centers across the state for alcohol or other substances, detailed by each substance (see Data Limitations for cautions in interpreting this indicator). 16

21 V. B. Chosen Indicators Table 1. Construct ALCOHOL TOBACCO ILLICIT DRUGS Mortality Alcoholic Liver Disease Death Rate Percent Fatal Motor Vehicle Crashes Involving Alcohol Fatal Motor Vehicle Death Rate Involving Alcohol Percent Drinking Drivers of Total Drivers in Fatal Crashes Lung Cancer Death Rate Emphysema Death Rate Drug Death Rate Percent Persons 12+ Meeting DSM-IV Criteria for Illicit Drug Abuse/Dependence Crime Other Consequences Consumption DUI Arrest Rate Percent Persons 12+ Meeting DSM-IV Criteria for Alcohol Abuse/Dependence Treatment Admissions (%) for Alcohol Use Current Use (youth only) Binge Drinking Lifetime Use (youth only) Heavy Drinking (adults only) Drinking & Driving Alcohol Sales Current Use Lifetime Use (youth only) Daily Smokers (adults only) Smoking During Pregnancy Tobacco Sales Treatment Admissions (%) for Illicit Drug Use Current Use Lifetime Use (youth only) 17

22 VI. CONSUMPTION & CONSEQUENCE INDICATORS VI. A. Alcohol VI. A. 1. Alcohol Indicators Defined Consumption Binge Drinking defined as drinking 5 or more drinks on at least one occasion (i.e., at the same time or within a couple of hours of each other) usually in the previous 30-days. Heavy Drinking defined for persons 18 or older as consuming 2 or more (men) OR 1 or more (women) drinks per day. Current Use defined as consuming 1 or more drinks in the last 30-days. Lifetime Use defined as use of alcohol in their lifetime (youth under 18). Self-Reported Driving Under the Influence (DUI) defined as any occasion of driving either while or shortly after drinking for youth under 18 and for persons 18 or older as driving one or more times in the past 30-days when they have perhaps had too much to drink. Alcohol Sales defined as total sales of ethanol in gallons per 10,000 population aged 14 and older. Consequences DUI Arrest Rate defined as the number of arrests due to driving under the influence of alcohol or narcotics per 100,000 persons in population. Percent Fatal Motor Vehicle Crashes Involving Alcohol defined as the percent of all fatal motor vehicle crashes involving alcohol (FARS includes blood alcohol content (BAC) values for every case in the file, either through BAC measurement, or imputation where an actual measurement was not taken (or the result was unknown). Those persons for whom a BAC is missing had their BAC imputed probabilistically from a model developed by NHTSA analysts that has been validated as having a high degree of predictive accuracy (Rubin, Schafer, and Subramanian, 1998)). Alcohol-Related Fatal Motor Vehicle Death Rate defined as the number of deaths resulting from fatal motor vehicle crashes involving alcohol per 10,000 persons in census population. Percent Drinking Drivers of Total Drivers in Fatal Crashes defined as the percent of drivers using alcohol among all drivers involved in a fatal motor vehicle crash. Alcoholic Liver Disease Death Rate defined as the age-adjusted death rate (except when broken down by age in which case is age-specific) per 100,000 persons due to an underlying cause of death specified as ICD-10 code K70. Percent Treatment Admissions for Alcohol Use defined as the percent of admissions for alcohol treatment to facilities that are licensed or certified by the state substance abuse agency to provide substance abuse treatment (or are administratively tracked for other reasons). In general, facilities reporting data are those that receive state alcohol and/or 18

23 drug agency funds (including Federal Block Grant funds) for the provision of alcohol and/or drug treatment services. Percent Meeting DSM-IV Criteria for Alcohol Abuse or Dependence defined as percent of persons aged 12 and older meeting DSM-IV criteria for alcohol abuse or dependence (Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM- IV) (American Psychiatric Association, 1994)]. 19

24 VI. A. 2. Adult & Youth Alcohol Consumption BINGE DRINKING Table 2 displays adult binge drinking trends as reported from the Behavioral Risk Factor Surveillance System (BRFSS) survey data from 2002 to 2005 as well as patterns by age, gender, race/ethnicity, and education level. Nationally, the median level of reported adult binge drinking in 2005 was 14.4%. In Pennsylvania, in 2005, the estimate is 16% (95% CI: %). The most substantial difference occurs in rates by gender. For example, in 2005, 23.7% of men reported binge drinking compared to only 9.0% of women. This difference is also depicted in Figure 1. Figure 1 also illustrates that there is a small, steady reduction in binge drinking in men across this time period. In addition, binge drinking shows a decline with increasing age. In 2005 binge drinking percentages were 24.1% in the age range, compared to 15.8% of those aged and only 3.2% of those aged 65 or older. Although findings in 2005 apparently show an ethnic difference with substantially higher rates in the Hispanic population (24%) versus White (16.2%) and Black (14.4%) persons, the very small sample size and high variability across years renders this finding unreliable. Educational level does not appear to influence the rate of binge drinking. Figure 1. % Adult Binge Drinking Across Years All Adults Males Females Source: BRFSS, Center for Disease Control (CDC) (State Prevalence). 20

25 Table 2. PA Adult Binge Drinking 2002 (N=13,370) 2003 (N=3,641) 2004 (N=6,026) 2005 (N=13,245) n (yes) % yes CI n (yes) % yes CI n (yes) % yes CI n (yes) % yes CI All Adults Male Female White Black Hispanic <HS HS Some College College Grad % = Percentage, CI = Confidence Interval, n = Cell Size N/A = Not available if the unweighted sample size for the denominator was < 50 or the CI half width was > 10 for any cell, or if the state did not collect data for that calendar year. Percentages are weighted to population characteristics. Use caution in interpreting cell sizes less than 50. Note: Hispanic can be of any race. Individual categories may not add to total count, due to sparse or missing data. *Source: BRFSS, CDC (State Prevalences). 21

26 Figure 2 displays regional rates of binge drinking among all persons aged 12 or older in Pennsylvania, according to the National Survey on Drug Use and Health (NSDUH) ( , see Appendix for data table). It appears that the Allegheny region (includes Pittsburgh) and northwest region have the highest overall binge drinking rates. In addition, the north-central region is higher than average for reports of binge drinking. Figure 2. Binge Alcohol Use in Past Month by Persons Aged 12 or Older by PA Substate Region Note: The legend's ranges were created by dividing 340 substate regions, nationally, into 7 groups based on the magnitude of their percentages. For substate region definitions, see Appendix. Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and

27 Figure 3 represents underage (aged 12-20) substate data from the NSDUH (see Appendix for data table). Substate estimates based on the NSDUH indicate substantial differences within Pennsylvania regions in underage binge drinking. The Allegheny County region (including Pittsburgh) with a rate of 25.3% and the north-central region with a rate of 28.9% (which includes Bradford, Sullivan, Centre, Columbia, Montour, Snyder, Union, Clinton, Lycoming, Northumberland, Potter, Susquehanna, and Tioga counties) show the highest rates and are substantially higher than the statewide average estimate of 21.2%. Philadelphia County shows the lowest rate at 15.3% and is significantly lower than the statewide average. Figure 3. Binge Alcohol Use in Past Month by Persons aged by PA Substate Region Note: The legend's ranges were created by dividing 340 substate regions, nationally, into 7 groups based on the magnitude of their percentages. For substate region definitions, see Appendix. Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and

28 Figure 4 depicts 2005 statewide estimates for youth in grades 6, 8, 10, and 12 from the 2005 Pennsylvania Youth Survey (PAYS) Report (please see Appendix for data tables). Students in grade 12 appear to be the biggest concern with the highest absolute rates and possible increase between 2001 (31.2%) and 2005 (33.7%). In addition, in 2005, 16.1% of the males (across the four grades) reported engaging in binge drinking compared to 13.8% of the females. These differences held true when the grade level of the student was considered. For example, in 12th grade, 37.7 percent of the males reported binge drinking compared to 29.5 percent of the females. Overall, from the 2005 PAYS, 14.9% (15.3% in 2003) of students in these grades report binge drinking in the two weeks before the survey. In comparison, the NSDUH ( ), estimates 11.1% (95% CI: %; in the estimate was 11.2%, 95% CI: %) of Pennsylvania youth aged reported binge drinking in the 30-days prior to the survey. Nationally, from NSDUH ( ), the median estimate is 10.9%. Figure 4. 40% 35% 30% 25% 20% 15% 10% 5% 0% 2-Week % Binge Drinking th 8th 10th 12th All Grades Source: 2005 Pennsylvania Youth Survey Report (PAYS) 24

29 HEAVY DRINKING Table 3 presents the Pennsylvania rates of self-reported adult heavy drinking from the BRFSS survey (data from years were not included due to much smaller sampling sizes). Results indicate a significant reduction among all adults between 2002 and 2005, from 6.1% down to 4.6%. Nationally, in 2005, adult heavy drinking prevalence was 5.1%. Similar to binge drinking, younger adults show higher rates of heavy drinking than do older adults. A greater percentage of men compared to women report that they are heavy drinkers. In 2005, there appears to be no substantial differences in heavy drinking by race/ethnicity or educational attainment. Table 3. PA Adult Heavy Drinking 2002 (N=13,386) 2005 (N=13,124) n (yes) % yes CI n (yes) % yes CI All Adults Male Female White Black Hispanic <HS HS or GED Some College College Grad % = Percentage, CI = Confidence Interval, n = Cell Size, N = total sample size that answered 'yes' or 'no'. Percentages are weighted to population characteristics. Use caution in interpreting cell sizes less than 50. Note: Hispanic can be of any race. Individual categories may not add to total count, due to sparse or missing data. *Source: BRFSS, CDC (State Prevalences). 25

30 CURRENT USE As illustrated in Figure 5, youth current use (one or more drinks in the last 30-days) from the PAYS indicates that a very large percentage of 10 th and 12 th graders are consuming alcohol. It appears that current use for 12 th graders might be increasing in the past four years from 48.5% in 2001 to 53.7% in Overall, 26.3% of students in 6, 8, 10, and 12 grades report past 30-day use in the 2005 PAYS. Overall, in Pennsylvania, the NSDUH estimate for current alcohol use for youth aged was 17.8% (95% CI: %; was 18.1%, 95% CI: %). Nationally, from the NSDUHs, 17.7% of youth aged reported past 30-day use of alcohol. Figure 5. 60% % Past 30-Day Alcohol Use 50% 40% 30% 20% 10% 0% th 8th 10th 12th All Grades Source: 2005 Pennsylvania Youth Survey Report (PAYS) 26

31 Figure 6 presents substate data from the NSDUH for youth aged (see Appendix for data table). Substate estimates based on the NSDUH indicate substantial differences within Pennsylvania regions in youth current use of alcohol. These findings are similar to those reported for binge drinking. Both the Allegheny County region (37.2%) and the north-central region (36.4%) showed significantly higher rates than the state average of 30.7%. Philadelphia County again showed the lowest underage 30-day alcohol consumption rate at 25%. Figure 6. Alcohol Use in Past 30-days by Persons Aged by PA Substate Region Note: The legend's ranges were created by dividing 340 substate regions, nationally, into 7 groups based on the magnitude of their percentages. For substate region definitions, see Appendix. Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and LIFETIME USE In 2005, Pennsylvania youth (6 th, 8 th, 10 th, and 12 th graders), on average, reported having their first use of alcohol (having more than a sip or two of alcohol) at age In 2005, on average, 23.5% of 6 th graders, 52.9% of 8 th graders, 74.8% of 10 th graders, and 85% of 12 th graders sampled reported that they had used alcohol in their lifetime. 27

32 SELF-REPORTED DRIVING UNDER THE INFLUENCE (OF ALCOHOL) In Table 4, it can be seen that adult self-reported DUI (driving one or more times in the past 30-days when they have perhaps had too much to drink ) is lower in 2004 (1.9%) than in 1999 (2.4%), although not significantly so. Men self-report DUI almost three times more than women. Due to the size of the confidence intervals, it is difficult to determine differences by age group except for the much higher rate in young adulthood (ages 21-29). There are no consistent differences reported by race/ethnicity except a low reporting in 1999 by Black people (.3%). Nationally, from the BRFSS, in 2004, adult self-reported 30-day DUI was 2.1%. Table 4. PA Adult Self-Reported DUI (of Alcohol) % yes CI % yes CI All Adults Male Female White Black Hispanic % = Percentage, CI = Confidence Interval. Percentages are weighted to population characteristics. Note: Hispanic can be of any race. Individual categories may not add to total count, due to sparse or missing data. *Source: BRFSS, CDC (State Prevalences). 28

33 For youth, Figure 7 shows the rates of 10 th and 12 th graders self-reported driving while under the influence of alcohol (from the 2005 PAYS Report; note that only a percentage of 10 th graders are of legal driving age). Rates across the past four years show a possible increase for 12 th graders from 21.5% in 2001 to 23.9% in Figure 7. 30% % Past 30-Day Self-Reported DUI (of Alcohol) 25% 20% 15% 10% 5% 0% th 12th ALCOHOL SALES Source: 2005 Pennsylvania Youth Survey Report (PAYS) Table 5 displays data on alcohol sales between 1990 and The data indicate that there was a decreasing trend in Pennsylvania between and then an increasing trend since All sales rates are highest in 2003 (most recent data) except for the spirits sales rate. Beer accounts for the largest volume of ethanol sold, followed by spirits and then wine. Nationally, the median rate of ethanol (all beverages) per capita sold in 2003 was 2.2, while in Pennsylvania it was also 2.2. Table 5. PA Sales of Ethanol in Gallons per 10,000 Persons (14 years or older) Beverage Type Spirits Wine Beer All beverages Source: Surveillance Report #66: Apparent Per Capita Alcohol Consumption: National, State, and Regional Trends, Bethesda, MD: NIAAA, Alcohol Epidemiologic Data System. 29

34 VI. A. 3. Adult & Youth Alcohol Consequences DUI ARREST RATES Table 6 displays DUI arrests by year from 1990 through It is important to point out that this data should be considered an indicator of amount of enforcement and is not necessarily related to consumption. Further, DUI arrests are driven by many forces and are likely to reflect local priorities and concerns and variation may be due to increased enforcement targeting certain geographic regions. As indicated in Table 6, DUI arrest rates for juveniles are much lower than that for adults from For example, in 2004, the adult arrest rate per 100,000 persons in Pennsylvania was and for juveniles (under 18) it was DUI arrests in Pennsylvania overwhelmingly include White males (see Table 7; arrests are over 80% male (although female DUI arrest rates are increasing over the years)). Figure 8 illustrates variation by geographical area. There is considerable variation by county, which is likely to reflect variation in degree of enforcement. Table 6. Number of DUI Arrests and Number Per 100,000 Population: Pennsylvania and United States Year Total Number in PA Total PA Rate Total US Rate PA Adult Rate PA Juvenile Rate , , , , , , , , , , , , , , , *Juveniles are persons 17 years of age or younger. Rates computed using US Census population numbers. Source: PA State Police, Uniform Crime Report 30

35 Table 7. Percent of DUI Arrest Offenders by Gender and Race/Ethnicity Year Male Female White Minority % 12% 93% 7% % 13% 92% 8% % 13% 93% 7% % 13% 92% 8% % 13% 92% 8% % 14% 91% 9% % 15% 92% 8% % 15% 91% 9% % 16% 91% 9% % 16% 92% 8% % 16% 90% 10% % 17% 88% 12% % 18% 91% 9% % 19% 92% 8% % 19% 91% 9% Source: Pennsylvania State Police, Uniform Crime Report. Figure 8. 31

36 PERCENT FATAL MOTOR VEHICLE CRASHES INVOLVING ALCOHOL Figure 9 shows the percent of fatal motor vehicle crashes involving alcohol in Pennsylvania from years (please see Appendix for data table). The percent of alcohol-related fatal crashes in Pennsylvania has remained relatively constant from 1999 to In 2004, 40.4% of all fatal motor vehicle crashes had alcohol involved. The comparable national rate in 2004 was 39.1%. Figures 10 and 11 combine five years of crash data ( ) to obtain county level figures. Figure 10 illustrates that the more urban areas (both southeast and southwest areas) have the highest number of fatal alcohol motor vehicle crashes. However, when the percentage of crashes that involved alcohol is examined (Figure 11), there is no clear regional or urban vs. non-urban pattern of the highest or lowest ranking counties (see Appendix for data tables). Figure 9. % PA Alcohol Related Fatal Crashes by Year Percent Year Source: FARS PA Crash Data, see Appendix for calculated data tables. 32

37 Figure 10. Five Year Average of The Total Number of Alcohol-Related Fatal Crashes By County, Pennsylvania ( ) Erie Crawford Warren McKean Potter Tioga Bradford Susquehanna Wayne Forest Elk Cameron Sullivan Venango Mercer Lycoming Clinton Clarion Jefferson Lawrence Clearfield Centre Union Butler Armstrong Snyder Beaver Indiana Mifflin Juniata Allegheny Cambria Blair Perry Dauphin Westmoreland Huntingdon Washington Cumberland Montour Columbia Northumberland Wyoming Lackawanna Pike Luzerne Monroe Carbon Northampton Schuylkill Lehigh Berks Lebanon Bucks Montgomery Greene Fayette Somerset Bedford Fulton Franklin Adams York Lancaster Chester Philadelphia Delaware Average Source: FARS, SEDS. Calculated by using total number alcohol-related fatal crashes and non-alcohol-related fatal crashes by county over and then taking averages. Figure 11. Five Year Average of The Percentage of Alcohol-Related Fatal Crashes By County, Pennsylvania ( ) Erie Crawford Warren McKean Potter Tioga Bradford Susquehanna Wayne Forest Wyoming Elk Cameron Sullivan Lackawanna Venango Pike Mercer Lycoming Clinton Clarion Luzerne Jefferson Monroe Columbia Lawrence Montour Clearfield Centre Union Butler Carbon Armstrong Indiana Northumberland Schuylkill Snyder Northampton Beaver Mifflin Lehigh Juniata Allegheny Cambria Blair Huntingdon Berks Perry Dauphin Lebanon Bucks Westmoreland Washington Montgomery Cumberland Philadelphia Greene Fayette Somerset Bedford Fulton Franklin Adams York Lancaster Chester Delaware Percent Source: FARS, SEDS. Calculated by using total number alcohol-related fatal crashes and non-alcohol-related fatal crashes by county over and then taking averages. Maps made by PA Department of Health, Bureau of Health Statistics and Research 33

38 FATAL MOTOR VEHICLE DEATH RATE INVOLVING ALCOHOL Figure 12 shows the alcohol-related motor vehicle death rate (per 100,000 persons) in Pennsylvania by year (see Appendix for data tables). This rate appears to be fairly stable since In 2004, there were 5 deaths per 100,000 persons from alcohol-related motor vehicle crashes; there were a total of 613 alcohol-related deaths in Of those 613 deaths, 77% were males. Additionally, males between the ages of were the gender/age category accounting for the largest percent: 27% of fatalities. A close second were males aged 21-29, whom accounted for 21.8% of fatalities. Nationally, in 2004, there were about 5.7 deaths per 100,000 persons from alcohol-related motor vehicle crashes. Figure Alcohol-Related Vehicle Crash Death Rate per 100,000 Persons in PA Year Source: FARS PA Crash Data, see Appendix for calculated data tables. PERCENT DRINKING DRIVERS (AMONG ALL DRIVERS) IN FATAL CRASHES Figure 13 depicts the percent of drivers who were drinking in fatal crashes between 1990 and It can be seen that the rate has been fairly stable since The percent of all drivers involved in fatal crashes that were drinking was 26.5% (2002), 24.5% (2003), and 25.9% (2004) (detailed in Appendix; also detailed is a combined 5 year rate by county). The national rate using all combined states and territories crash (FARS) data in 2004 was 24.0%. Age and gender-related differences for this indicator are shown in Figure 14. There are substantial age-related changes with the lowest rates generally at younger (younger than 34

39 18) and older (older than 55) ages compared to beginning and middle adulthood with rates at their highest levels between ages 21 and 34. In addition, males have much higher rates than females. Figure 13. Percent % PA Drinking Drivers of Total Drivers in Fatal Crashes by Year Year Source: FARS PA Crash Data, see Appendix for calculated data tables. Figure % PA Drinking Drivers of Total Drivers in Fatal Crashes by Gender and Age Male Female Percent Source: FARS PA Crash Data, see Appendix for calculated data tables. 35

40 ALCOHOLIC LIVER DISEASE DEATH RATE The annual average age-adjusted death rate due to an underlying cause of alcoholic liver disease is shown in Table 8. The data indicate that the death rate from alcoholic liver disease affects only a small portion of the population. In , 2.2 persons died each year per 100,000 (in , the annual average rate was 2.3, 95% CI: ). For comparison purposes, the US rate in 2003 was 4.3 deaths per 100,000 (same ICD-10 code). The age-adjusted rates of death significantly affect more males than females (about three times higher). Regarding race and ethnicity, although the total number is small, it does appear that people with Hispanic ethnicity are affected disproportionately more compared to White or Black people. As these liver diseases develop slowly, there are almost no events for people under 30 years old and the age-specific death rates for the most part increase with age. Figure 15 shows the rate of alcoholic liver disease by county. It appears that the highest age-adjusted death rates are in the southeast/southcentral, southwest and Erie regions, primarily small and large urban areas. The counties in bright red are: Lycoming, Blair, Schuylkill, and Berks. Table 8. Annual Average ( ) PA Rates of Death from Alcoholic Liver Disease Count Population Rate* L* U* Total ,106, Gender Male ,968, Female ,138, Race/Ethnicity White ,095, Black 74 3,860, Hispanic 34 1,314, Age ,336, ,641, ,868, ,814, ,549, ,125, ,709, ,490, ,386, ,226, , , *Rate is annual-averaged (for years ), age-adjusted rate (except for ages which is age-specific) per 100,000 persons; limits L and U are lower and upper 95% confidence intervals for the estimated rate. Note: Hispanic can be of any race. Individual categories may not add to total count, due to sparse or missing data. ICD-10 codes used: K70 Source: PA Department of Health, EPIQMS, PA Certificates of Death 36

41 Figure 15. *NA=not available, ND=not displayed if count less than 10 Source: PA Department of Health, EPIQMS, PA Certificates of Death PERCENT TREATMENT ADMISSIONS FOR ALCOHOL USE This indicator is drawn from the TEDS (Treatment Episode Data Set) and represents the number of admissions, not the number of people admitted. In addition, the reported admissions are only to facilities that are either state-certified for treatment and/or receive government funds; thus, these numbers don t represent the entire scope of those admitted for treatment in Pennsylvania. However, this indicator does provide some insight into the extent of alcohol usage consequences. Table 9 shows that there are thousands of Pennsylvania treatment admissions related to alcohol use every year. Between 1995 and 2005, the percent of admissions for alcohol as the only drug of choice showed a steady decline until 2003 and then a substantial increase in 2004 and The number of admissions for alcohol plus another drug also showed a steady decline until However, the percent of all admissions involving treatment for alcohol has declined as treatment for illicit drugs has increased. Combining both alcohol treatment only and alcohol treatment with another drug, the percent of all admissions was 53.1% in 1995 and 38.6% in 2005 (however, the absolute total number of admission increased over this period). Table 10 shows that clients are largely male, White, and between years old. 37

42 Table 9. Percent and Number of Treatment Admissions for Alcohol Use* Pennsylvania National Pennsylvania National Alcohol Only Alcohol Only Alcohol+ Alcohol ,978 (28.5%) 29.4% 15,506 (24.6%) 21.7% ,383 (27.7%) 28.8% 14,007 (23.7%) 21.9% ,489 (25.9%) 27.7% 12,901 (23.1%) 21.8% ,473 (24.1%) 27.0% 11,724 (23.0%) 21.3% ,658 (25.1%) 26.7% 12,828 (23.5%) 21.0% ,568 (24.5%) 25.8% 13,853 (21.8%) 20.5% ,834 (24.2%) 24.3% 12,413 (20.3%) 20.0% ,580 (23.9%) 23.6% 11,714 (19.2%) 19.2% ,533 (22.5%) 23.1% 10,918 (16.9%) 18.5% ,538 (22.5%) 22.4% 14,498 (16.7%) 18.0% ,628 (22.0%) NA 12,574 (16.6%) NA Note: Alcohol+ refers to admissions for alcohol along with a secondary drug, NA=not available yet *Admissions to facilities that are licensed or certified by the State substance abuse agency to provide substance abuse treatment (or are administratively tracked for other reasons). In general, facilities reporting TEDS data are those that receive State alcohol and/or drug agency funds (including Federal Block Grant funds) for the provision of alcohol and/or drug treatment services Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). 38

43 Table 10. % Pennsylvania Treatment Admissions for Alcohol Use by Demographics, 2005 Alcohol only (n=16,628; 22%) Alcohol with secondary drug (n=12,574; 16.6%) Total N=75,749 Gender Male Female Age at admission years years years years years years years years years years years years and over Race White Black Ethnicity Hispanic or Latino N=All admissions, n=admissions for substance. Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). PERCENT MEETING DSM-IV FOR ALCOHOL ABUSE OR DEPENDENCE The NSDUH includes a series of questions to assess the prevalence of substance use disorders (i.e., dependence on or abuse of a substance) in the past 12 months. These questions are used to classify persons as being dependent on or abusing specific substances based on criteria specified in the DSM-IV manual. The questions on dependence concern health and emotional problems, attempts to cut down on use, tolerance, withdrawal, and other symptoms associated with substances used. The questions on abuse assess problems at work, home, and school; problems with family or friends; physical danger; and trouble with the law due to substance use. Across the nation, 7.6% of the population aged 12 or older was classified in as being dependent on or having had an alcohol abuse disorder in the past year. In Pennsylvania, 7.6% of persons 12 or older met the DSM-IV criteria in (Table 11). Age disaggregation indicates that people aged showed significantly higher rates than 39

44 other age groups with 19.1% categorized as dependent on or abusing alcohol in Figure 16 shows substance abuse/dependence rates by substate NSDUH regions: the northwest corner and the north-central region show the highest rates. Table 11. % Persons 12 or Older in PA Meeting DSM-IV Alcohol Abuse/Dependence in Past Year (Annual Average) Dependence/Abuse 95% PI Dependence/Abuse 95 % PI Ages 12 thru ( ) 5.63 ( ) Ages 18 thru ( ) ( ) Ages 26 and over 5.33 ( ) 5.92 ( ) Total 6.93 ( ) 7.56 ( ) PI = Prediction Interval Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and Figure 16. % Meeting DSM-IV Alcohol Abuse/Dependence in Past Year by Persons Aged 12+ by PA Substate Region Note: The legend's ranges were created by dividing 340 substate regions, nationally, into 7 groups based on the magnitude of their percentages. For substate region definitions, see Appendix. Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and

45 VI. A. 4. Alcohol Summary The results of the data on key alcohol indicators are summarized in Table 12. This table summarizes key indicators by comparing across three data dimensions: magnitude, time trends, and comparisons to national rates as described in the earlier section Understanding the Data. This summary can be a useful tool in determining problem areas. Magnitude. Many Pennsylvanians show high rates of consumption and many are affected by its consequences. Adult binge drinking is reported by approximately 16% of Pennsylvania adults and similar rates are reported by high school students. Pennsylvania has a large number of treatment admissions related to alcohol use, and its effects impact many aspects of life for those admitted and their families. About 40% of all fatal crashes are alcohol related. Males both report higher rates of binge and heavy drinking and also experience the majority of the alcohol consequences, including abuse, dependence, and alcohol-related fatalities. For youth, it appears that girls show similar rates of 30-day alcohol use, but lower rates of binge drinking than teen boys. Young adults show particularly high rates compared to older adults and thus should be considered a target for reductions within the adult age range. For most consequences the highest rates are shown for those aged Geographically, it appears that the certain substate regions show higher rates of consumption & consequences for both adults and youth. Higher rates are seen in Allegheny County, the northwest corner (regions 19 and 23 in the NSDUH), and the north-central area of the state. Perhaps surprisingly for the largest urban area, Philadelphia has lower rates than many other areas of the state. Time Trends. During the past three years there have been reductions in rates of problem drinking in adults and these appear to be mostly the result of declining male alcohol use, whom, however, still show substantially higher rates than females. No downward change has been shown in binge drinking or 30-day use among high school students. Over the past decade or so there have been some increases in DUI arrests and alcohol sales per capita. Although PAYS data does not provide confidence intervals there is a small percentage increase in 30-day alcohol and binge drinking among 12 th graders. National Comparisons. On most indicators, comparisons with the national rates show that Pennsylvania is not far from the national averages. However, Pennsylvania shows substantially lower rates of alcoholic liver disease death rate. In contrast, compared to national rates, Pennsylvania rates of 30-day adult binge drinking and the percent of alcohol-impaired drivers involved in fatal crashes (26% in 2004) are somewhat higher than the national levels. In addition, the number of DUI arrests is increasing while the national trend is declining across the period of

46 Table 12. Alcohol Indicators Compared by: Magnitude, Time Trends, and National Comparisons CONSUMPTION PA Magnitude Trend Rate Ratio (RR) 30-Day Adult Binge Drinking (2005, BRFSS) 16.0% Down Day Youth Binge Drinking ( , NSDUH) 11.2% Stable Day Adult Heavy Drinking (2005, BRFSS) 4.6% DOWN Day Youth Alcohol Use ( , NSDUH) 17.8% Stable Day Adult DUI (2004, BRFSS) 1.9% Down 0.90 Alcohol Sales per Capita (all beverages) (2003) 2.2 Up 1.00 CONSEQUENCES DUI Arrests & Rate per 100,000 Persons (2004) 43,699 (352.2) Up 0.73 Number & % Alcohol-Related Fatal Crashes (2004) 550 (40.4%) Stable 1.03 Number & Fatality Rate per 100,000 from Alcohol-Involved Crashes (2004) 613 (5.0) Stable 0.88 % Drinking Drivers of Total Drivers in Fatal Alcohol-Involved Crash (2004) 545 (25.9%) Stable 1.08 Alcoholic liver Disease Deaths & Rate per 100,000 Persons (2003) 289 (2.3) Stable 0.53 Number & % Admissions to Treatment Centers for Alcohol (2004) 19,538 (22.5%) Down 1.00 Meeting DSM-IV for Alcohol Abuse or Dependence ( ) 7.6% Up 1.00 Note: Trends shown in BOLD indicate significant change. Also, this table did not include youth lifetime alcohol use nor youth self-reported DUI as there weren't comparable national rates. RR=1, no difference; RR>1, PA higher than US; RR<1, PA lower than US 42

47 VI. B. Tobacco VI. B. 1. Tobacco Indicators Defined Consumption Current use defined for youth (under 18) as using a tobacco product (smoking and smoke-less) on one or more days of the past 30-days and for adults (aged 18 or older) as having smoked at least 100 cigarettes in their lifetime and who currently smoke either everyday or some days. Daily Smoking defined for persons aged 18 or older who have smoked at least 100 cigarettes in their lifetime and who categorize themselves as currently smoking everyday. Lifetime Use defined as any tobacco use in their lifetime (youth under 18). Percent Smoking During Pregnancy defined as the percent of mothers whom had a live birth and who reported smoking at least one cigarette during pregnancy out of all mothers whom had live births (excluding unknowns). Tobacco Sales defined as the number of packs of cigarettes taxed at the wholesale level per capita (persons aged 18 and older). Consequences Lung (and Bronchus) Cancer Death Rate defined as the age-adjusted (except when broken down by age in which case is then age-specific) death rate per 100,000 persons due to an underlying cause of death specified as ICD-10/9 code: C34. Emphysema Death Rate---defined as the age-adjusted (except when broken down by age in which case is then age-specific) death rate per 100,000 persons due to an underlying cause of death specified as ICD-10 code: J43. 43

48 VI. B. 2. Adult & Youth Tobacco Consumption CURRENT USE As shown in Figure 17, Pennsylvania has been above the national median for the prevalence of adult current smoking for the past decade. Specifically, in 2005, the Pennsylvania adult current smoking prevalence was 23.6% (95% CI: %) while nationally it was 20.5%. Figure % Adult Current Smoking PA US Source: BRFSS, CDC (State Prevalence & US Median Prevalence) 44

49 Table 13 contrasts rates of adult current smoking in Pennsylvania between 1995 and 2005 and disaggregates by age, gender, race/ethnicity, and educational level. Men show somewhat higher rates (not significant) of current smoking than women. The smoking prevalence shows a gradual decline with age. In 2005, Blacks (30.8%) have a higher rate of current smoking than Whites (22.4%). Educational attainment is related to substantial differences in smoking rates as well, with lower smoking rates associated with higher educational attainment in both years. For example, respondents with less than a high school education have a smoking rate of 38.6% while respondents who are college graduates have a smoking rate of 11.7%. Table 13. % Adult Current Smoking Prevalence by Smokers Characteristics PA Adult Current Smoking 1995 (N=3,591) 2005 (N=13,314) n (yes) % yes CI n (yes) % yes CI All Adults Male Female White Black Hispanic <HS HS or GED Some College College Grad % = Percentage, CI = Confidence Interval, n = Cell Size, N = total sample size that answered 'yes' or 'no'. Percentages are weighted to population characteristics. Use caution in interpreting cell sizes less than 50. Note: Hispanic can be of any race. Individual categories may not add to total count, due to sparse or missing data. *Source: BRFSS, CDC (State Prevalences). 45

50 For youth, Table 14 and Figure 18 show results from the PAYS survey in 2001, 2003, and Results for 6 th and 8 th graders indicate that both cigarette use and smokeless tobacco may have declined since For 10 th and 12 th graders (high school aged students), smokeless tobacco use may be on the rise (without confidence intervals it s not possible to say whether the change is significant). In addition, gender differences indicate possibly higher cigarette smoking rates in girls, but much higher rates of smokeless tobacco use for boys: 9% of males versus only 2% of females in In contrast to the adult data, White students show twice the rate of cigarette and smokeless tobacco as compared to Black students. Figure 18. Table 14. % PA Youth Tobacco Use by Year Cigarettes Past 30 Day Use Smokeless Tobacco Past 30 Day Use Grade 6th th th th All Grades Gender Females Males Race Black White Source: PAYS 2005 Statewide Report % PA Student Current Use Across Years by Grade Cigarettes Smokeless Tobacco 10th 12th Source: Pennsylvania Youth Survey Report 46

51 NSDUH survey data from permits comparison of youth smoking rates in Pennsylvania compared to national youth rates. The surveys estimated that 13.7% (95% CI: %) of Pennsylvania youth aged currently smoke (from the NSDUHs the estimate was 14.7%, 95% CI: %). This can be compared with the US prevalence rate from the NSDUHs for youth aged 12-17: 12.0%. Figures 19 and 20 display regional data from the NSDUHs ( ) for all persons in Pennsylvania aged 12 or older. Most regions of Pennsylvania have higher current smoking use (Figure 18) and current tobacco use (any tobacco product Figure 20) than the rest of the nation (please see Appendix for data tables). Figure 19. PA Cigarette Use in Past Month Among Persons 12 or Older Note: The legend's ranges were created by dividing 340 substate regions, nationally, into 7 groups based on the magnitude of their percentages. For substate region definitions, see Appendix. Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and

52 Figure 20. PA Tobacco Use in Past Month Among Persons 12 or Older Note: The legend's ranges were created by dividing 340 substate regions, nationally, into 7 groups based on the magnitude of their percentages. For substate region definitions, see Appendix. Any Tobacco product includes cigarettes, smokeless tobacco (i.e., chewing tobacco or snuff), cigars, or pipe tobacco. Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and

53 DAILY SMOKING As seen in Table 15, in 2005, Pennsylvania adult daily smoking prevalence is somewhat lower (17.9%) than in 2002 (19.5%). However, the 2005 estimate is above the national median rate of 15.3%. As with current smoking, educational attainment plays a substantial role in adult daily smoking; rates decline with greater educational attainment at both assessments (see Figure 21). Additionally, daily smoking rates decline with age. However, there are no significant differences by gender or ethnicity. Table 15. % PA Adult Daily Cigarette Use by Smokers Demographics PA Adult Daily Smoking 2002 (N=13,464) 2005 (N=13,314) n % n % (yes) yes CI (yes) yes CI All Adults Male Female White Black Hispanic <HS HS or GED Some College College Grad % = Percentage, CI = Confidence Interval, n = Cell Size, N = total sample size that answered 'yes' or 'no'. Percentages are weighted to population characteristics. Use caution in interpreting cell sizes less than 50. Note: Hispanic can be of any race. Individual categories may not add to total count, due to sparse or missing data. *Source: BRFSS, CDC (State Prevalences). 49

54 Figure Smoking Prevalence of PA Everyday Smokers by Education Less than H.S. H.S. or G.E.D. Some post- H.S. College graduate Source: BRFSS, CDC (State Prevalence) LIFETIME USE In 2005, Pennsylvania youth (6 th, 8 th, 10 th, and 12 th graders), on average, reported using cigarettes for the first time at age In 2005, on average, 6.3% of 6 th graders, 20.4% of 8 th graders, 38.8% of 10 th graders, and 54.5% of 12 th graders reported that they had tried smoking cigarettes in their lifetime. 50

55 PERCENT SMOKING DURING PREGNANCY Table 16 provides information on the percentage of Pennsylvania mothers who voluntarily reported smoking during pregnancy. There was little change in the prevalence rates between 1996 (18.2%) and 2004 (17.9% or 24,760 live births) in spite of a temporary decrease in 2002 (15.8% or 21,780 live births). Pennsylvania rates were substantially higher than the national rates in Nationally, in 2002, 11.4% of mothers whom gave a live birth reported smoking while pregnant (CDC - Smoking During Pregnancy, October 8, 2004/53(39); ). Age-related trends in Pennsylvania indicate that smoking while pregnant has increased for those younger than age 24, up to almost 30% in In contrast, for those 25 or older, the prevalence rates show small declines between 1996 to Ethnicity/race comparisons indicate possible lower rates for pregnant women of Hispanic origin. See Appendix for the prevalence rates in 2004 by county. Table 16. Pennsylvania Mothers Who Smoked During Pregnancy by Maternal Characteristics % Smokers During % Smokers During % Smokers During Pregnancy Pregnancy Pregnancy Total Age < Race/Ethnicity White Black Hispanic Note: Unknowns excluded in calculations. Source: Pennsylvania Vital Statistics 2004, Tables B-19A- B20B, PA Department of Health 51

56 TOBACCO SALES It can be seen in Figure 22 that there is a decreasing trend in Pennsylvania and the US for tobacco sales between , although Pennsylvania has a higher sales rate. In 2002, the rate in Pennsylvania was while nationally, the rate was Figure Number of Cigarette Packs Sold per Capita (age 18 or older) by Year Pennsylvania United States Year Source: Orzechowski & Walker. (2003).The tax burden on tobacco. Historical Compilation, Vol. 37, Arlington, VA: Orzechowski & Walker. 52

57 VI. B. 3. Adult & Youth Tobacco Consequences LUNG CANCER DEATH RATE Almost 24,000 deaths were directly attributed to lung cancer during the three years in Pennsylvania (Table 17). On average, annually, the rate of death was 53 persons per 100,000 (PA Department of Health data). For comparison purposes, rates were calculated from US Department of Health data provided (same ICD-10 code). According to this data, in 2003 only, 64.3 out of 100,000 people (7,949 deaths) died in Pennsylvania (in 2002 the rate was 65.7) and the rate was 54.3 nationally. Although a greater number of White people died of lung cancer, Blacks have disproportionately higher rates, while Asians and Hispanics appear to have significantly lower rates. Higher rates occur in men than in women, but the gender gap has declined, with female rates slightly increasing over the years while male rates decreased between 1990 and 2004 (see Figure 23). As expected, rates increase with age. The highest death rate is for those people aged 80-84, for whom about 396 out of 100,000 died from lung cancer on average annually from Figure 24 displays death rates by county. It can be seen that almost all of the regions in Pennsylvania are affected, with the highest rates in the far western end of the state. The counties in bright red are: Philadelphia, Potter, and Venango. 53

58 Table 17. Annual Average ( ) PA Death Rates from Lung Cancer Count Population Rate* L* U* Total 23,797 37,106, Gender Male 13,459 17,968, Female 10,338 19,138, Race/Ethnicity White 21,444 32,095, Black 2,231 3,860, Hispanic 140 1,314, Asian/PI , Age ,336, ,641, ,868, ,814, ,006 2,549, ,784 2,125, ,394 1,709, ,134 1,490, ,085 1,386, ,581 1,226, , , , , *Rate is annual-averaged (years ), age-adjusted rate (except for ages which is age-specific) per 100,000 persons; limits L and U are lower and upper 95% confidence intervals for the estimated rate Note: Hispanic can be of any race. Individual categories may not add to total count, due to sparse or missing data. PI=Pacific Islander. ICD-10/9 codes used: C34/ Source: PA Department of Health, EPIQMS, PA Certificates of Death 54

59 Figure PA Lung Cancer Death Rate per 100,000 Persons by Gender, Males Females Source: PA Department of Health, EPIQMS, PA Certificates of Death Figure 24. *NA=not available, ND=not displayed if count less than 10 Source: PA Department of Health, EPIQMS, PA Certificates of Death 55

60 EMPHYSEMA DEATH RATE Almost 2,000 deaths were attributed to emphysema during the three years in Pennsylvania (Table 18). On average, annually, 4.3 people died per 100,000 persons (PA Department of Health data). For comparison purposes, in 2004 only, the US rate was 4.7 deaths per 100,000 persons (CDC, National Center for Health Statistics, compared to 4.2 (95% CI: ) in Pennsylvania. Most deaths occurred in White persons and those over the age of 60. The death rate for men was disproportionately higher than for women. However, between (Figure 25), the gender gap has declined, with female rates staying fairly stable over the years while male rates decreased. The highest death rate is for those people over 85. In Figure 26, it can be seen that the southeast and western regions of the state are more affected by this condition. The county in bright red is McKean. Table 18. Annual Average ( ) PA Death Rates from Emphysema Count Population Rate* L* U* Total 1,945 37,106, Gender Male ,968, Female ,138, Race/Ethnicity White 1,820 32,095, Black 119 3,860, Age ,814, ,549, ,125, ,709, ,490, ,386, ,226, , , *Rate is annual-averaged (years ), age-adjusted rate (except for ages which is age-specific) per 100,000 persons; limits L and U are lower and upper 95% confidence intervals for the estimated rate Note: Hispanic can be of any race. Individual categories may not add to total count, due to sparse or missing data. ICD-10/9 codes used: J43/492 Source: PA Department of Health, EPIQMS, PA Certificates of Death 56

61 Figure PA Emphysema Death Rate per 100,000 Persons by Gender, Males Females Source: PA Department of Health, EPIQMS, PA Certificates of Death Figure 26. *NA=not available, ND=not displayed if count less than 10 Source: PA Department of Health, EPIQMS, PA Certificates of Death 57

62 VI. B. 4. Tobacco Summary The results of the data on key tobacco indicators are summarized in Table 19. This table summarizes key indicators by comparing across three data dimensions: magnitude, time trends, and comparisons to national rates as described in the earlier section Understanding the Data. This summary can be a useful tool in determining problem areas. Table 19. Tobacco Indicators Compared by: Magnitude, Time Trends, and National Comparisons CONSUMPTION PA Magnitude Trend Rate Ratio (RR) Current Adult Smoking Prevalence (2005, BRFSS) 23.6% Down Day Youth Cigarette Use ( , NSDUH) 13.7% Down 1.14 Daily Adult Smoking Prevalence (2005, BRFSS) 17.9% Down 1.17 Smoking While Pregnant Births and Percent (2002) 21, % Stable 1.39 Number Cigarette Packs Sold per Capita (2002) Down 1.16 CONSEQUENCES Lung Cancer Deaths & Rate per 100,000 Persons (2003) 7,949 (64.3) Down 1.18 Emphysema Deaths & Rate per 100,000 Persons (2004) 642 (4.2) Stable 0.89 Note: Trends shown in BOLD indicate significant change. Also, this table did not include 30-Day Youth Smokeless Tobacco Use nor Youth Lifetime Use as there weren't comparable national rates. RR=1, no difference; RR>1, PA higher than US; RR<1, PA lower than US. Magnitude. Tobacco use affects many Pennsylvanians. Almost 24% of adults are current smokers and about 18% smoke daily. Of substantial public health concern is that 18% of new mothers report that they smoked during their pregnancy during Further, the rates are substantially higher among pregnant women below the age of 25 (almost 30%). Educational attainment plays a large role in determining smoking status. Smoking prevalence is more than tripled for those with less than a high school education compared to those who graduate from college. Among age groups, adults between the ages of have the highest prevalence rates. Additionally, a significant difference was found between Whites and Blacks with regard to adult current smoking (in 2005, Blacks had an 8% higher prevalence rate than Whites). In contrast, for youth under 18, White students have higher tobacco usage rates than Black students. For youth, the prevalence rates for smoking do not differ between girls and boys, but three times as many boys use smokeless tobacco as do girls. From the PAYS survey, almost 55% of 12 th graders surveyed said they had tried smoking in their lifetime. With regard to tobacco use consequences, Black people showed disproportionately higher rates of lung cancer. Men also have higher rates of death than women that are attributable to tobacco use. Geographically, there is no clear pattern of hot spots. 58

63 Time Trends. In a broad sense there is a trend toward somewhat lower rates of consumption as indicated in Table 19 and as reflected in the decreasing number of cigarettes legally sold in Pennsylvania over the past decade. However, these are nonsignificant trends in the years examined for this profile. Between 2002 and 2005 there has been a small decline in adult rates of daily smoking. National Comparisons. Pennsylvania is above the national median levels with regard to all consumption and consequence indicators for tobacco as shown in Table 19, except for the emphysema death rate. This includes the number of cigarettes sold, daily use by adults and teens, smoking during pregnancy and rates of lung cancer. 59

64 VI. C. Illicit Drugs VI. C. 1. Indicators Defined Consumption Current Marijuana Use defined as any use of marijuana/hashish in the past month or 30-days prior to the survey. Lifetime Marijuana Use defined as any use of marijuana/hashish in their lifetime (youth under 18). Current Other Illicit Drug Use defined as any use of any other illicit drug (this includes: cocaine, heroin, and hallucinogens (LSD, PCP, peyote, mescaline, mushrooms, and ecstasy) and abusable legal products including prescription drugs (pain relievers, tranquilizers, stimulants, and sedatives) and inhalants (amyl nitrate, cleaning fluids, gasoline, paint, and glue)) other than marijuana/hashish in the past month or 30-days prior to the survey. Lifetime Other Illicit Drug Use defined as any use of any other illicit drug except non-medical use of prescription drugs and marijuana/hashish in their lifetime (youth under 18, by substance). Consequences Drug (including non-illicit)-induced Death Rate defined as age-adjusted death rate (except when broken down by age in which case is age-specific) per 100,000 persons due to an underlying cause of death specified as ICD-10 codes: F110-F115, F117-F119, F120-F125, F127-F129, F130-F135, F137-F139, F140-F145, F147-F149, F150-F155, F157-F165, F167-F169, F170, F173-F175, F177-F179, F180-F185, F187-F189, F190- F195, F197-F199, U016, X40-X44, X60-X64, X85, Y10-Y14. Percent of Admissions (by illicit drug) to Treatment Centers for Illicit Drugs defined as the percent of admissions for illicit drug treatment to facilities that are licensed or certified by the state substance abuse agency to provide substance abuse treatment (or are administratively tracked for other reasons). In general, facilities reporting data are those that receive state alcohol and/or drug agency funds (including Federal Block Grant funds) for the provision of alcohol and/or drug treatment services. Percent Meeting DSM-IV for Illicit Drug Abuse/Dependence defined as percent of persons aged 12 and older meeting DSM-IV criteria for illicit drug abuse or dependence (Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association [APA], 1994)). 60

65 VI. C. 2. Adult & Youth Other Drug Consumption CURRENT MARIJUANA USE Table 20 displays current estimates of 30-day marijuana use from the NSDUH for different age groups. Rates increase substantially from around 8% for youth aged to 18% for young adults aged Pennsylvania rates are very similar to the national rates for : 7.7% (12-17), 16.6% (18-25), 4.1% (>25), and overall 6.1%. Substate regional estimates indicate that the Philadelphia region shows a non-significant trend toward higher marijuana use rates than the rest of the state (see Appendix for data tables). Table 20. % PA Marijuana Use in Past Month by Age Group Estimate 95% PI Estimate 95% PI All Ages 5.64 ( ) 6.02 ( ) ( ) 7.75 ( ) ( ) ( ) ( ) 3.87 ( ) Note: PI=Prediction Interval Source: SAMHSA, Office of Applied Statistics, NSDUHs More detailed data by grade, gender, and race for Pennsylvania students are provided by the PAYS data (Table 21 and Figure 27). There appear to be substantial increases in 30- day use in each grade, beginning in 8 th grade. Over 20% of 12 th graders report current marijuana use which is somewhat higher than the rates discussed above for young adults. There do not appear to be large differences as a result of gender or ethnicity. Table 21. % PA Youth Current Marijuana Use Past 30-Day Use Grade 6th th th th All Grades Gender Females Males Race Black White Source: PAYS 2005 Statewide Report. 61

66 Figure % Marijuana Current Use by Grade Year 6th 8th 10th 12th LIFETIME MARIJUANA USE Source: PAYS 2005 Statewide Report. In 2005, Pennsylvania youth, on average, reported using marijuana for the first time around age 13.9 (average of grades 6, 8, 10, and 12). In 2005,.8% of 6 th graders, 7.7% of 8 th graders, 25.2% of 10 th graders, and 44.8% of 12 th graders reported that they had used marijuana in their lifetime. There may be slightly higher prevalence among males. CURRENT OTHER ILLICIT DRUG USE Illicit drug use as assessed in the NSDUH includes all drugs other than alcohol and marijuana/hashish. As displayed in Table 22, the highest illicit drug use is among year olds, who report that about 9% used illicit drugs 30-days before the survey. Youth under 18 years old show a lower rate at 5.5%. Pennsylvania rates are very similar to the national rates from the NSDUHs: rates are 5.5% (aged 12-17), 8.3% (aged 18-25), 2.5% (adults >25), and overall 3.6%. Regionally, no area stood out as being significantly higher than another (see Appendix for data tables). Table 22. % PA Other Illicit Drug Use in Past Month by Age Group Estimate 95% PI Estimate 95% PI All Ages 3.44 ( ) 3.42 ( ) ( ) 5.47 ( ) ( ) 8.55 ( ) ( ) 2.31 ( ) Note: PI=Prediction Interval Source: SAMHSA, Office of Applied Statistics, NSDUH 62

67 Table 23 shows the youth estimates for other illicit drug use from the PAYS (does not include non-medical use of prescription drugs), broken down by some demographics. As expected, prevalence increases by grade with almost three times as many 12 th graders showing past 30-day use as compared to that of 6 th graders. White students prevalence rate in 2005 is almost double that of Black students, but this data on ethnicity may be unreliable due to lack of urban data in the 2005 PAYS (no reporting from Pittsburgh or Philadelphia). Table 23. % PA Youth Current Other Illicit Drug Use* Past 30-Day Use Grade 6th th th th All Grades Gender Females Males Race Black White Data Not Available * In PAYS, 'Other Illicit Drug Use' does NOT include non-medical use of prescription drugs. Source: PAYS 2005 Statewide Report. Figure 28 shows the breakdown of other illicit drug use by substance for youth under 18. There is an increase in inhalant use with an overall prevalence rate of 3.4% in 2005 (data tables in Appendix). Not depicted here is 30-day non-medical use of prescription drugs for youth which was first assessed in the PAYS in Across grades, in 2005, 2.5% of youth report that they used amphetamines, 2.6% used sedatives, 1.7% used tranquilizers, and 2.3% used other prescription narcotics (see Appendix for data tables). In summary, for illicit drug use among Pennsylvania youth, marijuana shows the highest prevalence, followed by inhalants and prescription drugs. 63

68 Figure 28. % 30-Day Youth Prevalence by Illicit Drug Steroids Ecstasy Methamphetamines Hallucinogens Heroin Cocaine Inhalants Source: 2005 PAYS Report. LIFETIME OTHER ILLICIT DRUG USE Table 24 displays 2005 youth rates of lifetime use of illicit substances from the PAYS survey. 12 th graders reported substantial non-medical use of prescription drugs including amphetamines, sedatives, tranquilizers and narcotic pain medications. 10 th graders also show substantial use of a variety of illegal substances. Both 6 th and 8 th graders reported inhalants as the most prevalent substance used and reported relatively low rates of other illicit drugs. Thus, it appears that substantial illicit use of prescription drugs may start sometime after 8 th grade. Table 24. % Lifetime Prevalence of Other Illicit Substance Use by Substance by Grade 6th 8th 10th 12th All Grades Inhalants Cocaine Heroin Hallucinogens Methamphetamines Ecstasy Steroids Prescription Amphetamines Prescription Sedatives Prescription Tranquilizers Prescription Other Narcotics Source: 2005 PAYS Report. Prescription drugs here are reported used non-medically. % 64

69 VI. C. 3. Adult & Youth Illicit Drug Consequences DRUG (INCLUDING NON-ILLICIT)-INDUCED DEATH RATE The drug-induced death count was 4,114 people during in Pennsylvania as reported in Table 25. Men and Black people have substantially higher prevalence rates of such deaths. The highest death rate was in the age range of 40-44, for whom about 27 out of 100,000 persons died on average each year. Table 25. Annual Average ( ) PA Rates of Drug (non-illicit included)- Induced Death Count Population Rate* L* U* Total 4,114 37,106, Gender Male 2,805 17,968, Female 1,308 19,138, Race/Ethnicity White 3,560 32,095, Black 538 3,860, Hispanic 138 1,314, Age ,717, ,436, ,134, ,336, ,641, ,868, ,814, ,549, ,125, ,709, ,490, ,386, ,226, , , *Rate is annual-averaged (years ), age-adjusted rate (except for ages which is age-specific) per 100,000 persons; limits L and U are lower and upper 95% confidence intervals for the estimated rate Note: Hispanic can be of any race. Individual categories may not add to total count, due to sparse or missing data. ICD-10/9 codes used: F110-F115,F117-F119,F120-F125,F127 F129,F130-F135,F137-F139,F140-F145,F147-F149,F150-F155,F157-F165,F167- F169,F170,F173-F175,F177-F179,F180-F185,F187-F189,F190-F195,F197- F199,U016,X40-X44,X60-X64,X85,Y10-Y14/292,304, ,E850-E858,E9500- E9505,E9620,E9800-E9805 Source: PA Department of Health, EPIQMS, PA Certificates of Death 65

70 Figure 29 shows drug-induced death rates by county. It can be seen that a large southwest and eastern portion of Pennsylvania have the highest drug-related death rates. Due to the very low prevalence, rates cannot be estimated in the Northern Tier counties. The county in bright red is Philadelphia. Figure 29. *NA=not available, ND=not displayed if count less than 10 Source: PA Department of Health, EPIQMS, PA Certificates of Death PERCENT ADMISSIONS TO TREATMENT CENTERS FOR ILLICIT DRUGS This indicator is drawn from the TEDS (Treatment Episode Data Set) and represents the number of admissions, not the number of people admitted. In addition, the reported admissions are only to facilities that are either state-certified for treatment and/or receive government funds; thus, these numbers don t represent the entire scope of those admitted for treatment in Pennsylvania. However, this indicator does provide some insight into the extent of illicit drug usage consequences. Table 26 shows that there were 45,983 treatment admissions in Pennsylvania (in 2005) where illicit drugs were identified as the drug of choice at admission (60.7% of all admissions). The most frequent illicit drugs of choice identified (in order of ranking) were: heroin, marijuana, and cocaine (smoked). Clients were mostly male, years old, and White, except for admissions related to PCP use, which was higher among Black males. For youth under age 18, the illicit drugs of choice were marijuana and inhalants. For national comparison purposes, 60.3% (52,363) of all 2004 treatment admissions in Pennsylvania (as reported to TEDS) were related to illicit drug use, compared to 59.9% nationally. Final 2005 TEDS national data was not available in time for this report. When broken down by type of illicit drug, the percent of 2004 treatment admissions in Pennsylvania were much lower for amphetamines and much higher for heroin compared to the nation. 66

71 Table Pennsylvania Percent Admissions to Treatment Facilities* by Illicit Substance and Demographics N=75,749 Cocaine Hallu- Other Tran- Cocaine Other Amphet- Seda- Inha- (other Marijuana Heroin PCP cino- stim- quil- (smoked) opiates amines tives lants route) gens ulants izers Total n=45,983 9,961 4,006 10,877 15,830 3, Total %=60.7% Gender Male Female Age at admission years years years years years years years years years years years years and over Race White Black Ethnicity Hispanic or Latino Source: Treatment Episode Data Set, SAMHSA. Note: N=Total Admissions, n=admissions for substance. *Admissions to facilities that are licensed or certified by the state substance abuse agency to provide substance abuse treatment (or are administratively tracked for other reasons). 67

72 Figure 30 compares the Pennsylvania and national rates of treatment admissions with heroin identified as the drug of choice at admission. The percent of treatment admissions related to heroin use doubled in Pennsylvania from 1995 (10.1%) to 2004 (22.2%). In contrast, the national percent of treatment admissions for heroin use rose less than 1% from 1995 (13.6%) to 2004 (14.1%). Although some of the difference between Pennsylvania and national rates may be attributable to variations in state reporting procedures (as discussed in the Data Limitations section), this data still indicates an alarming trend in Pennsylvania. Figure % Admissions for Heroin, Pennsylvania National Source: Treatment Episode Data Set (TEDS), SAMHSA. 68

73 PERCENT MEETING DSM-IV FOR ILLICIT DRUG ABUSE OR DEPENDENCE Table 27 presents the NSDUH data on the percent of people who meet criteria for illicit drug abuse or dependence (see corresponding section in alcohol consequences for more description of this assessment technique). Overall, an estimated 2.7% of Pennsylvanians over age 12 meet DSM-IV criteria for illicit drug abuse or dependence in The age group of year olds has the highest prevalence rate with almost 8% meeting the criteria for illicit drug abuse or dependence. Almost 5% of youth under 18 met the criteria. Pennsylvania rates are quite similar to national rates. Nationally in , 5.3% (aged 12-17), 8.1% (aged 18-25), 1.7% (over age 25), and 3% overall met criteria for illicit drug abuse or dependence. Regionally (see Appendix), the Philadelphia region has significantly higher prevalence (3.2%) than the rest of the state (2.6%). Table 27. % Persons 12 or Older in PA Meeting DSM-IV Illicit Drug Abuse/Dependence in Past Year (Annual Average) Dependence/Abuse 95% PI Dependence/Abuse 95 % PI Ages 12 thru ( ) 4.73 ( ) Ages 18 thru ( ) 7.96 ( ) Ages 26 and over 1.44 ( ) 1.56 ( ) Total 2.60 ( ) 2.69 ( ) PI = Prediction Interval Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002, 2003, and

74 VI. C. 4. Illicit Drug Summary The results of the data on illicit drug indicators are summarized in Table 28. This table summarizes key indicators by comparing across three data dimensions: magnitude, time trends, and comparisons to national rates as described in the earlier section Understanding the Data. This summary can be a useful tool in determining problem areas. Table 28. Illicit Drug Indicators Compared by: Magnitude, Time Trends, and National Comparisons CONSUMPTION Magnitude Trend Rate Ratio (RR) Current Marijuana Use, Adults >25 ( , NSDUH) 3.9% Up 0.95 Current Marijuana Use, Adults ( , NSDUH) 17.7% Stable 1.07 Current Marijuana Use, Youth <18 ( , NSDUH) 7.8% Down 1.01 Current Other Illicit Drug Use, Adults >25 ( , NSDUH) 2.3% Stable 0.92 Current Other Illicit Drug Use, Adults ( , NSDUH) 8.6% Stable 1.04 Current Other Illicit Drug Use, Youth <18 ( , NSDUH) 5.5% Stable 1.00 CONSEQUENCES Number and % Admissions to Treatment Centers for Illicit Drugs (2004) 52,363 (60.3%) Up 1.01 Adults >25 Meeting DSM-IV for Illicit Drug Abuse or Dependence ( ) 1.6% Stable 0.94 Adults Meeting DSM-IV for Illicit Drug Abuse or Dependence ( ) 8.0% Stable 0.99 Youth <18 Meeting DSM-IV for Illicit Drug Abuse or Dependence ( ) 4.7% Stable 0.89 Note: Trends shown in BOLD indicate significant change. Here, Other Illicit Drug includes all illicit drugs reported other than marijuana including non-medical use of prescription drugs. Also, this table did not include Youth Lifetime Use or Drug-Induced Death Rate as there weren't comparable national rates. RR=1, no difference; RR>1, PA higher than US; RR<1, PA lower than US. Magnitude. There is substantial use of illicit drugs in Pennsylvania among youth and adults. For adults, the age group of year olds stands out with regard to all selfreported illicit drug use---both marijuana and other illicit drug use rates are much higher than the other age groups (NSDUH data). Correspondingly, the percent of year olds meeting DSM-IV criteria for illicit drug abuse or dependence is much higher than the other age groups at 8%. There were 45,983 treatment admissions related to illicit drug use reported to TEDS in This data is largely limited to block grant/state funded services, plus available Medicaid information, and does not represent all treatment services provided in Pennsylvania. The most frequent illicit drugs of choice identified at treatment admission (in order of ranking) were: heroin, marijuana, and cocaine (smoked). The drug-induced death rate in Pennsylvania (includes non-illicit drugs) affected 4,114 people during the years and the rates are highest for those between 20 and 54 years of age. Men and Blacks are disproportionately affected. Among youth, current marijuana use increases dramatically by grade: there is almost no reported use in 6 th graders, over 3% among 8 th graders, 12% among 10 th graders, and a 70

75 jump to 23% among 12 th graders. Almost 45% of 12 th graders reported that they had tried marijuana in their lifetime. While marijuana shows the highest prevalence, there is substantial use of inhalants among all grades (6 th, 8 th, 10 th, 12 th ) and non-medical use of prescription drugs as reported by 10 th and 12 th graders. In 2005, over 10% of 12 th graders reported substantial non-medical use of prescription drugs including amphetamines, sedatives, tranquilizers and over 15% reported use of narcotic pain medications. For youth under 18, marijuana and inhalant use were most often identified as the illicit drugs of choice at admission to treatment. The Philadelphia region is statistically higher, or close to being statistically higher than the rest of the state with regard to the rate of drug-induced deaths, the percent of people who meet the DSM-IV criteria for illicit drug abuse or dependence, and current marijuana consumption prevalence. Time Trends. The current use of marijuana for adults over 25 appears to be slightly on the rise (though not significantly). Otherwise, overall marijuana and other illicit drug (other than non-medical use of prescription drugs) use appears relatively stable the past few years. For youth, it appears that 30-day inhalant use is on the rise (3.4% in 2005, 1.8% in 2001). Although non-medical use of amphetamines, sedatives, tranquilizers, and narcotic drugs are of substantial concern in 10 th and 12 th graders, there is inadequate data to study time trends because 2005 was the first time that this data were reported in the Pennsylvania Youth Survey (PAYS). National Comparisons. Compared with the rest of the nation, Pennsylvania is about average for consumption and consequence rates (see rate ratio summary in Table 28) for illicit drugs; slightly higher, however, for current marijuana use in year olds. However, in 2004, Pennsylvania showed an 8% higher rate for treatment admissions related to heroin use, as compared to the national average. It is not clear how valid and reliable this difference may be given concerns with TEDS data limitations. 71

76 VII. APPENDIX 72

77 VII. A. SEOW & Advisory Council Member List *Indicates a member of the State Epidemiology Outcomes Workgroup (SEOW). Carole Alexy Director of Contracts PA Coalition Against Domestic Violence 6400 Flank Drive, #1300 Harrisburg, PA caa@pcadv.org James Anderson Executive Director PA Juvenile Court Judges' Commission Room 401 Finance Building Harrisburg, PA Donald Bailey Special Agent Drug Enforcement Administration 600 Arch Street Suite Philadelphia, PA donald.a.bailey@usdoj.gov Margaret Barajas-Brewer Executive Director PA Association of Latino Organizations 415 Market Street Suite 206 Harrisburg, PA barajas@paloweb.org Janet Bargh Statistical Analyst 2 Bureau of Health Statistics PA Department of Health Forum Place, 6th Floor 555 Walnut Street Harrisburg, PA jbargh@state.pa.us *Lonnie Barnes Program Analyst Bureau of Drug & Alcohol Programs PA Department of Health 2 Kline Plaza Harrisburg, PA lobarnes@state.pa.us Leslie Best Director Bureau of Chronic Disease & Injury Prevention PA Department of Health Room 1000 Health & Welfare Building Harrisburg, PA lbest@state.pa.us Mary Ann Bowman President Prevention Director's Association Twin Lakes Center for Drug & Alcohol Rehabilitation P.O. Box 909 Somerset, PA mabowman@floodcity.net *Gene Boyle Director Bureau of Drug & Alcohol Programs PA Department of Health 2 Kline Plaza Harrisburg, PA eboyle@state.pa.us 73

78 Norman Bristol-Colon Executive Director Governor's Advisory Commission on Latino Affairs Room 506 Finance Building Harrisburg, PA Ivonne Bucher Chief of Staff Office of Community Services & Advocacy PA Department of Aging 5th Floor 555 Walnut Street Harrisburg, PA Carolyn Cass Director Child & Health Services Bureau of Family Health PA Department of Heath 7 th Floor East Health & Welfare Building ccass@state.pa.us Geneva Champion Assistant Director of Residence Life & Housing Cheyney University 1837 University Circle P.O. Box 200 Cheyney, PA gchampion@cheyney.edu John Cookus Director Center for Juvenile Justice Training & Research Shippensburg University 1871 Old Main Drive Shippensburg, PA jcookusl@state.pa.us Julia Cox Executive Director American Trauma Society 2 Flowers Drive Mechanicsburg, PA atspa@atspa.org *Dennis Culhane Professor of Psychiatry & Social Welfare Policy University of Pennsylvania School of Social Policy & Practice 3535 Market St. Suite 3015 (Third Floor) Philadelphia, PA culhane@mail.med.upenn.edu Felicity Debacco-Erni Program Manager Pennsylvanians Against Underage Drinking PA SADD 2413 North Front Street Harrisburg, PA fdebacco@padui.org Myrna Delgado Division Chief Bureau of Student & Community Services PA Department of Education 5th Floor 333 Market Street Harrisburg, PA mdelgado@state.pa.us 74

79 Michele Denk Director PA Association of County Drug & Alcohol Administrators 17 N. Front Street Harrisburg, PA x3132 Robert Dewar Statistical Analyst Bureau of Health Statistics PA Department of Health Forum Place, 6th Floor 555 Walnut Street Harrisburg, PA Nora Drexler President Drexler Associates 5639 Mill Street Erie, PA Joan Erney Deputy Secretary Office of Mental Health & Substance Abuse PA Department of Public Welfare P.O. Box 2675 Harrisburg, PA C. Stephen Erni Executive Director PA Driving Under the Influence Association 2413 North Front Street Harrisburg, PA *Mark Feinberg Senior Research Associate Prevention Research Center Pennsylvania State University 402J Marion Place University Park, PA *Sam Frankhouser Associate Dean of Students Alvernia College 400 Saint Bernard Dean Street Student Center Reading, PA Debra Fye President Commonwealth Prevention Alliance Mercer County Behavioral Health Commission 8406 Sharon Mercer Road Mercer, PA Brad Gebhart LBHP Program Coordinator PA Association of Latino Organizations 415 Market Street Suite 206 Harrisburg, PA *Garrison Gladfelter Public Health Program Administrator Bureau of Drug & Alcohol Programs PA Department of Health 2 Kline Plaza Harrisburg, PA ggladfelte@state.pa.us 75

80 Donna Gority Blair County Commissioner Suite 142, Courthouse 423 Allegheny Street Hollidaysburg, PA Donna Greco Special Projects Coordinator PA Coalition Against Rape 125 North Enola Drive Enola, PA x115 Jeff Greenawalt Director Public Health & Professional Licensure PA Medical Society 777 East Park Drive P.O. Box 8820 Harrisburg, PA *Mark Greenberg Director Prevention Research Center Pennsylvania State University S112B Henderson Building University Park, PA Cheryl Guthier Executive Director Community Prevention Partnership of Berks County 227 N. 5th Street Reading, PA ext. 203 Lieutenant Colonel Robert Hepner Counterdrug Coordinator PA Dept of Military & Veteran's Affairs NCTC Building 8-65 Fort Indiantown Gap Annville, PA *Douglas Hoffman Director Center for Research, Evaluation & Statistical Analysis PA Commission on Crime & Delinquency 3101 N. Front Street Harrisburg, PA x3056 Michael Huff Director Bureau of Community Health Systems PA Department of Health Room 628 Health & Welfare Building Harrisburg, PA Hunter Hurst, III Executive Director National Center for Juvenile Justice 3700 South Water Street Suite 200 Pittsburgh, PA Barry L. Jackson Director Drug, Alcohol & Wellness Network 253 SSC Bloomsburg University Bloomsburg, PA

81 Melita Jordan Director Bureau of Family Health PA Department of Health 7th Floor East Health & Welfare Building Harrisburg, PA Hai-Chow Harry Kao Executive Director Governor's Commission on Asian American Affairs Room 506 Finance Building Harrisburg, PA Susan Kelly-Dreiss Executive Director PA Coaltion Against Domestic Violence 6400 Flank Drive, #1300 Harrisburg, PA Jim Knudson, OCP State Geospatial Technologies Coordinator Office for Information Technology Governor's Office of Administration 7th Floor Health & Welfare Building Harrisburg, PA Captain John Kunstbeck Drug Demand Reduction Administrator Counterdrug Progam PA National Guard Fort Indiantown Gap Annville, PA *James Logue Epidemiologist Manager Bureau of Epidemiology PA Department of Health Room 925 Health & Welfare Building Harrisburg, PA *Len LoSciuto Director Institute for Survey Research Temple University 1601 N. Broad Street USB 502 Philadelphia, PA Troy Love Transportation Planning Specialist Supervisor PA Department of Transportation Alcohol Highway Safety Program Safety Management Division P.O.Box 2047 Harrisburg, PA Major John P. Lutz Director Bureau of Liquor Control Enforcement PA State Police 3655 Vartan Way Harrisburg, PA Lieutenant Douglas Martin Central Section Commander Bureau of Liquor Control Enforcement PA State Police 3655 Vartan Way Harrisburg, PA

82 Terry Matulevich Budget Analyst 3 PA Department of Health Bureau of Drug and Alcohol Programs 2 Kline Plaza Harrisburg, PA tmatulevic@state.pa.us Judge Eileen Maunus Chief Administrative Law Judge Office of Administrative Law Judge PA Liquor Control Board Brandywine Plaza 2221 Paxton Church Rd. Harrisburg, PA emaunus@state.pa.us Judy May-Bennett Assistant Director American Trauma Society PA Division 2 Flowers Drive Mechanisburg, PA judymaybennett@yahoo.com *Michael Melczak Research Specialist University of Pittsburgh School of Pharmacy Department of Pharmacy & Therapeutics 456 Falk Clinic, 3601 Fifth Avenue Pittsburgh, PA mam142@pitt.edu Girish Modi Division Chief Division of Highway Safety Management PA Department of Transportation 400 North Street 6th Floor Keystone Building Harrisburg, PA gmodi@state.pa.us *Ray Moneta Director Division of Plan Development Bureau of Health Planning PA Department of Health Room 1033 Health & Welfare Building Harrisburg, PA (717) rmoneta@state.pa.us *Peter Mulcahy Institute for Survey Research Temple University 1601 N. Broad Street USB 502 Philadelphia, PA peterm@temple.edu Kim Nieves Research Analyst Administrative Office of PA Courts 1515 Market Street Suite 1414 Philadelphia, PA kim.nieves@pacourts.us Judy Ochs Public Health Executive 2 Bureau of Chronic Disease & Injury Prevention PA Department of Health Room 1006 Health & Welfare Building Harriburg, PA jochs@state.pa.us 78

83 Michael Pennington Director PA Commission on Crime & Delinquency Office of Juvenile Justice & Delinquency Prevention 3101 N. Front Street Harrisburg, PA x3031 Sherry Peters Chief, Division of Planning, Policy, & Program Development Office of Mental Health and Substance Abuse Services PA Department of Public Welfare 2 nd Floor, Beechmont Building Harrisburg, PA shepeters@state.pa.us Mark Piasio President PA Medical Society 777 East Park Drive P.O. Box 8820 Harrisburg, PA mapiasio@pamedsoc.org *Joseph Powell, VI Director, Division of Prevention Bureau of Drug & Alcohol Programs PA Department of Health 2 Kline Plaza Harrisburg, PA jpowell@state.pa.us jlp127@pitt.edu Rob Quigley Executive Director Drug Free PA 300 N. Second Street Suite 1215 Harrisburg, PA quigley@drugfreepa.org Mary Ramirez Director Bureau of Community & Student Services PA Department of Education 5th floor 333 Market Street Harrisburg, PA maramirez@state.pa.us Master Sergeant Michael Reardon Drug Demand & Reduction Coordinator Counterdrug Program PA National Guard Fort Indiantown Gap Annville, PA c-mreardon@state.pa.us Delilah Rumburg Executive Director PA Coaltion Against Rape 125 North Enola Drive Enola, PA drumburg@pcar.org *Janice Pringle Research Assistant Professor University of Pittsburgh School of Pharmacy 449 Falk Clinic, 3601 Fifth Avenue Pittsburgh, PA

84 *Jennifer Sartorius Statistical Analyst Prevention Research Center Pennsylvania State University 402J Marion Place University Park, PA Kathy Schmick Executive Secretary Office of Administrative Law Judge PA Liquor Control Board Brandywine Plaza 2221 Paxton Church Rd. Harrisburg, PA Rebecca Shaver Executive Director PA MADD 2323 Patton Road Harrisburg, PA Michelle Simmons Executive Director Common Roads 221 N. Front Street Harrisburg, PA *Alden Small Statistical Analyst Supervisor Bureau of Health Statistics Forum Place, 6th Floor 555 Walnut Street Harrisburg, PA *Jacqueline Spaid Drug & Alcohol Program Supervisor Bureau of Drug & Alcohol Programs PA Department of Health 2 Kline Plaza Harrisburg, PA jspaid@state.pa.us Andrea Taylor Project Coordinator Center for Intergenerational Learning Temple University 1601 North Broad Street USB 206 Philadelphia, PA Andrea.taylor@temple.edu Carol Thornton Violence and Injury Prevention Section Bureau of Health Promotion & Risk Reduction PA Department of Health Room 1008 Health & Welfare Building Harrisburg, PA cathornton@state.pa.us Sonya Toler Executive Director Governor's Commission on African American Affairs Room 506 Finance Building Harrisburg, PA stoler@state.pa.us *Melissa Trainor CSAP Fellow Bureau of Drug & Alcohol Programs PA Department of Health 2 Kline Plaza Harrisburg, PA c-mtrainor@state.pa.us 80

85 *Ronald Tringali Epidemiologist Bureau of Epidemiology (Representing Family Health) PA Department of Health Room 925 Health & Welfare Building Harrisburg, PA *Carlton Trotman Program Analyst Bureau of Drug & Alcohol Programs PA Department of Health 2 Kline Plaza Harrisburg, PA ctrotman@state.pa.us Leslie Walburn Specialist Supervisor Bureau of Alcohol Education PA Liquor Control Board Room 602 Northwest Office Building Capital & Forster Streets Harrisburg, PA lwalburn@state.pa.us *Gene Weinberg Epidemiologist Director Division of Community Epidemiology Room 925 Health & Welfare Building Harrisburg, PA gweinberg@state.pa.us Lieutenant Harold Wilson Eastern Section Commander PA State Police 1800 Elmerton Ave. Harrisburg, PA harwilson@state.pa.us Gail Witwer Prevention & Evaluation Analyst PA Coalition Against Rape & National Sexual Violence Resource Center 125 North Enola Drive Enola, PA x116 gwitwer@nsvrc.org Lenore Wyant Program Director, Communities that Care Center for Juvenile Justice Training & Research 1871 Old Main Drive Shippensburg, PA ldwyant@ship.edu Suzanne Yunghans Executive Director American Academy of Pediactrics PA Chapter Rose Tree Corporate Center North Providence Road, Suite 3007 Media, PA *Marsha Zibalese-Crawford Chair, Social Work Department Temple University School of Social Administration 1301 Cecil B. Moore Avenue Ritter Avenue, Room 587 Philadelphia, PA mcrawfor@temple.edu *Phyllis Zitzer Program Analyst 3 Bureau of Health Statistics & Research Forum Place, 6th Floor 555 Walnut Street Harrisburg, PA pzitzer@state.pa.us 81

86 VII. B. Acronyms in Profile ATOD BAC BDAP BRFSS CDC CIS COPD CSAP DOH DSM-IV DUI FARS ICD NCHS NHTSA NIAAA NSDUH PA ATS PA EpiQMS PAYS PCCD SAMHSA SCA SEDS SEOW SPF-SIG TEDS YRBSS Alcohol, Tobacco, and Other/Illicit Drugs Blood Alcohol Content Bureau of Drug and Alcohol Programs Behavioral Risk Factor Surveillance System Centers for Disease Control and Prevention Client Information System Chronic Obstructive Pulmonary Disease Center for Substance Abuse Prevention Department of Health Diagnostic and Statistical Manual of Mental Disorders, 4 th edition Driving under the influence of alcohol or drugs Fatality Analysis Reporting System International Classification of Diseases National Center for Health Statistics National Highway Traffic Safety Administration National Institute on Alcohol Abuse and Alcoholism National Survey on Drug Use and Health Pennsylvania Adult Tobacco Survey Epidemiologic Query and Mapping System Pennsylvania Youth Survey PA Commission on Crime and Delinquency Substance Abuse and Mental Health Administration Single County Authorities State Epidemiological Data Systems State Epidemiology Outcomes Workgroup Strategic Prevention Framework State Incentive Grant Treatment Episode Data Youth Risk Behavioral Surveillance Survey 82

87 VII. C. 1. NSDUH Pennsylvania Substate Regions ( ) 83