Preventing Substance Abuse and Promoting Mental Health in Kentucky

Transcription

1 Preventing Substance Abuse and Promoting Mental Health in A Community Profile to Promote Positive Mental and Behavioral Health State Epidemiological Outcomes Workgroup (SEOW) Report 2012 WESTERN KENTUCKY: Purchase Pennyrile Prepared for the Division of Behavioral Health, Department for Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services by REACH of Louisville, Inc.

2 Preventing Substance Abuse and Promoting Mental Health in A Community Profile to Promote Positive Mental and Behavioral Health State Epidemiological Outcomes Workgroup (SEOW) Report 2012 WESTERN KENTUCKY: Purchase Pennyrile Acronymns ADD Area Development District BRFSS Behavioral Risk Factor Surveillance System CDC WONDER Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research CSAP Center for Substance Abuse Prevention DAHC Dartmouth Atlas of Health Care DBHDID Department for Behavioral Health, Developmental and Intellectual Disabilities KASPER All Schedule Prescription Reporting System KCR Cancer Registry KIP Incentives for Prevention NSDUH National Survey on Drug Use and Health SAMHSA Substance Abuse and Mental Health Services Administration SEOW State Epidemiological Outcomes Workgroup Artwork: Yung-chao Chen Dreamstime.com

3 Contents Executive Summary... 2 Regional Findings...2 County Findings...3 State Epidemiological Outcomes Workgroup...3 Introduction... 4 Purpose...4 Profile Development...4 Data Sources...5 Demographics and Context... 6 Population Profile...6 Substance Abuse and Consumption... 8 Alcohol...8 Tobacco Use...10 Illicit Drug Use...11 Prescription Drugs...13 Substance Abuse Consequences Morbidity and Mortality...17 Risk and Protective Factors Age of Onset...21 Risk Perception...21 Accessibility...22 Mental and Behavioral Health Poor Mental Health Days...23 Peer Victimization...23 Suicide Mortality...23 Findings and Recommendations Appendices Appendix 1: Data Sources...26 Appendix 2: NSDUH Substate Regions...28

4 Executive Summary The 2012 Community Profile of Western has been produced under the supervision of the State Epidemiological Outcomes Workgroup (SEOW). This initiative was funded by the Substance Abuse and Mental Health Services Administration s (SAMHSA) Center for Substance Abuse Prevention (CSAP). s SEOW is coordinated by REACH of Louisville, Inc. through a subcontract with the Division of Behavioral Health within the Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID). The SEOW includes key representatives from state agencies, organizations, and academic institutions. The 2012 Western Profile utilizes a condensed and graphic format to make it more accessible to policy makers and coalition members. The Profile expands the focus on three priority areas originally identified in 2011 cigarette smoking, binge drinking, and prescription drug abuse to further identify geographic and epidemiologic trends throughout 17 counties that comprise Western. qthe 2012 Western Profile utilizes a condensed and graphic format to make it more accessible to policy makers and coalition members. Regional and county estimates were derived from a multitude of data sources including the 2010 Census, 2010 Incentives for Prevention (KIP) Survey, National Survey on Drug Use and Health (NSDUH), Behavioral Risk Factor Surveillance System (BRFSS), Dartmouth Atlas, Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER), and Cancer Registry (KCR). The major regional and county-level findings are below: Regional Findings Purchase and Pennyrile had comparable rates of alcohol, cigarette, marijuana, cocaine, and oxycodone abuse as the state. (KIP 2010, NSDUH ) While past-month cigarette use among 10th graders was marginally lower in Purchase (19.9%) than (21.7%), Pennyrile (24.2%) exceeded the state rate. (KIP 2010) Past-month tranquilizer abuse in Pennyrile (2.3%) and (2.4%) were comparable, although abuse in Purchase (3.9%) exceeded the rate and ranked the highest out of 15 area development districts. (KIP 2010) With the exception of regular alcohol consumption, early onset (<12 years) of cigarette, marijuana, and acute alcohol abuse was lower among Purchase 10th graders than. Early onset abuse in Pennyrile, however, was higher than for all substances: cigarettes (21.1% vs. 18.7%), marijuana (8.7% vs. 6.6%), acute alcohol (18.1% vs. 15.8%), and regular alcohol (4.6% vs. 3.7%). (KIP 2010) Purchase 10th graders had similar rates of perceiving great risk of cigarette, marijuana (at least one time), regular marijuana, and regular alcohol abuse as 10th graders throughout. Risk perceptions in Pennyrile were lower than for all substances except acute marijuana: cigarettes (43.5% vs. 46.1%), regular marijuana (46.9% vs. 47.5%), and regular alcohol (22.6% vs. 23.6%). (KIP 2010) Purchase 10th graders had similar rates of very easy access to cigarettes, marijuana, alcohol, and illicit drugs. Pennyrile again emerged as a high-risk region, with higher rates of very easy access to all substances when compared 2 Preventing Substance Abuse and Mental Illness in

5 to statewide rates: cigarettes (50.1% vs. 46.8%), marijuana (37% vs. 32.7%), alcohol (33.4% vs. 29.8%), and illicit drugs (9.9% vs. 7.8%). (KIP 2010) Rates of past-year peer victimization in Purchase (44.2%) and Pennyrile (40.4%) were both higher than (38.7%), and ranked as the first and fifth highest, respectively, out of 15 area development districts. (KIP 2010) County Findings In 2010, the poverty rate in was 18.9%, with Fulton (27.1%), (23.6%), (21%), Crittenden (20%), Christian (19.7%), and Graves (19.7%) emerging as counties with the five highest poverty rates in Western. (US Census 2010) Fulton ($30,662), Crittenden ($33,966), Graves ($34,811), and ($36,173) also had the four lowest median household incomes in Western compared to $50,046 for in (US Census 2010) Livingston County consistently had one of the five highest prescription rates in Western for oxycodone (62.4 per 1,000), hydrocodone ( per 1,000), alprazolam (88.98 per 1,000), and diazepam (40.55 per 1,000) in Quarter Prescription rates in Carlisle County also ranked in the five highest in the state for oxycodone (61.32 per 1,000), hydrocodone ( per 1,000), alprazolam (60.74 per 1,000), and diazepam (33.7 per 1,000). (KASPER 2011) Fulton County averaged an additional 5 poor mental health days in the past month than (9.3 vs. 4.3 days) during and had a suicide mortality rate (27.5 per 100,000) that was over twice the state rate of 13.3 per 100,000 in (BRFSS ; CDC WONDER ). This particularly high rate of poor mental health days also coincided with the second highest diazepam prescription rate (39.78 per 1,000) in Western during Quarter (KASPER 2011) Carlisle County also had an elevated suicide mortality rate compared to (23.4 per 100,000) and had one of the five highest prescription rates in Western for oxycodone (61.32 per 1,000), hydrocodone ( per 1,000), alprazolam (60.74 per 1,000), and diazepam (33.7 per 1,000). (CDC WONDER ; KASPER 2011) State Epidemiological Outcomes Workgroup Connie Smith (Chair), Division of Behavioral Health, Department for Behavioral Health, Developmental and Intellectual Disabilities Steve Cambron (Co-Chair), Division of Behavioral Health, Department for Behavioral Health, Developmental and Intellectual Disabilities Amy Baker, Justice Cabinet Irene Centers, Tobacco Cessation Program, Department for Public Health Richard Clayton, Department of Health Behavior, University of Ron Crouch, Office of Employment and Training, Education and Workforce Development Cabinet Robert Illback, REACH of Louisville, Inc. Van Ingram, Office of Drug Control Policy Connie Neal, Administrative Office of Courts Nicholas Peiper, REACH of Louisville, Inc. Dennis Peyton, Tobacco Cessation Program, Department for Public Health Michael Razor, Division of Enforcement, Alcoholic Beverage Control Vestena Robbins, Department for Behavioral Health, Developmental and Intellectual Disabilities, Division of Behavioral Health Ramona Stone, Department of Health Behavior, University of Libby Taylor, Department of Education Jan Ulrich, Department for Behavioral Health, Developmental and Intellectual Disabilities, Division of Behavioral Health Richard Wilson, Department of Health Promotion and Behavioral Sciences, University of Louisville Preventing Substance Abuse and Mental Illness in 3

6 Introduction qthe SEOW developed this profile to facilitate stateand community-level planning that focuses on the prevention of morbidity and mortality while promoting positive mental, emotional, and behavioral health among youth. Purpose The 2012 State Epidemiological Profile and Community Profile of Western have been created under the supervision of the State Epidemiological Outcomes Workgroup (SEOW). This initiative was funded by the Substance Abuse and Mental Health Services Administration s (SAMHSA) Center for Substance Abuse Prevention (CSAP). s SEOW is coordinated by REACH of Louisville, Inc. through a subcontract with the Division of Behavioral Health within the Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID). The SEOW includes key representatives from state agencies, organizations, and academic institutions. s State Profile extends the original SEOW activities associated with substance abuse assessment and surveillance that utilized CSAP s Strategic Prevention Framework (SPF). This profile expands the focus of monitoring and surveillance to include mental and behavioral health indicators through an update of current datasets. The SEOW developed this profile to facilitate stateand community-level planning that focuses on the prevention of morbidity and mortality while promoting positive mental, emotional, and behavioral health among youth. These data will be integrated into the data warehouse located at reachoflouisville.com. Through the data warehouse, these data will be accessible to preventionists throughout the Commonwealth to inform their decision-making at state and community levels. Profile Development Between January 2011 and March 2012, the SEOW produced two state profiles that identified high levels of substance abuse and poor mental health throughout several Western counties. This report expands the findings from the state profile to highlight substance abuse and mental health trends in two area development districts: Purchase and Pennyrile. Together, these districts comprise 17 counties that cover the majority of Western and were chosen to facilitate integration of substate regional data released by SAMHSA. This profile utilizes a lifespan model developed by the SEOW to guide an outline of indicators related to substance abuse that includes demographics and context, substance abuse consumption and consequences, risk and protective factors, and mental/behavioral health relevant to substance abuse. Each section includes bulleted findings along with relevant tables, figures, and maps. When applicable, indicators are stratified by age and grade to provide snapshots of infancy (ages 0-2), childhood (ages 3-11), adolescence (ages 12-17), young adulthood (ages 18-25), or adulthood (ages 26+) in relation to substance abuse consumption and outcomes, risk and protective factors, and mental/behavioral health. Other relevant stratification terms include race/ethnicity, sex/gender, and socioeconomic status (i.e., poverty level, education, or income depending on the data source). 4 Preventing Substance Abuse and Mental Illness in

7 Data Sources Purchase A variety of data sources were utilized to describe Purchase and Pennyrile. Demographic statistics are from the 2010 US Census. Data regarding substance consumption and intervening factors among 10th graders are from the 2010 Incentives Carlisle for Prevention (KIP) Survey; for combined youth and adults Fulton (i.e., age 12 and older), consumption and intervening factor Graves data are from the National Survey on Drug Use Hickman and Health (NSDUH). Prescription drug rates are from third Livingston quarter 2011 data derived from the All Schedule Prescription Electronic Reporting (KASPER) system. Morbidity and mortality data are from the Behavioral Risk Factor Surveillance System (BRFSS), the Dartmouth Atlas of Health Care (DAHC), the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER), and the Cancer Registry (KCR). Mental and behavioral health outcomes are from the NSDUH, the BRFSS, and the CDC WONDER. Table 1. County Profile of Western Districts Pennyrile Christian Crittenden A detailed listing of data sources may be found in Appendix 1, page 26. Preventing Substance Abuse and Mental Illness in 5

8 Demographics and Context Population Profile According to the 2010 Census, Western is comprised of approximately 416,000 people living in 17 counties within two area development districts (ADD), Purchase and Pennyrile. This area represents roughly 10% of s population. Although the majority of these counties have poverty rates lower than the 2010 state average of 18.9% (Figure 1), all counties throughout Purchase and Pennyrile have median household incomes lower than the state rate of $50,046 (Figure 2). Between 2003 and 2010, Purchase (-2.06%) and Pennyrile (-2.13%) experienced greater decreases in private sector employment than the state (-1.43%) (Figure 3). Figure 1. Poverty Rate (All Ages) Among Pennyrile and Purchase Counties, US Census 2010 Fulton Crittenden Christian Graves Hickman Livingston Carlisle Preventing Substance Abuse and Mental Illness in

9 Figure 2. Median Household Income Among Pennyrile and Purchase Counties, US Census 2010 Hickman Livingston Carlisle Chris an Graves Cri enden Fulton $43,825 $42,387 $41,776 $41,585 $39,738 $39,588 $39,087 $39,038 $38,608 $38,182 $37,614 $36,542 $36,255 $36,173 $34,811 $33,966 $30,662 $50,046 Figure 3. Change in Private Sector Employment by Area Development District, US Census 2010 NKY Lake Cumberland KIPDA Buffalo Trace/ Gateway FIVCO Pennyrile Purchase Green River Bluegrass Cumberland Valley Big Sandy River Barren River Lincoln Trail % % -5.00% 0.00% 5.00% 10.00% 15.00% Preventing Substance Abuse and Mental Illness in 7

10 Substance Abuse and Consumption Alcohol. According to the Incentives for Prevention (KIP) Survey, the state prevalence of binge drinking in the past two weeks among 10th graders was 16.3% in 2010 (Figure 4). Purchase (16.5%) and Pennyrile (15.1%) had similar rates as the rate, with the highest rates being found in Lincoln Trail (18.6%), KIPDA (18.3%), and FIVCO (18.2%). Figure 4. Two-Week Binge Drinking Among 10th Graders, KIP 2010 Purchase Pennyrile Lincoln Trail KIPDA FIVCO KY River Green River Lake Cumberland NKY Bluegrass Big Sandy Buffalo Trace Gateway Barren River Cumberland Valley The NSDUH asks the question about teenage drinking differently, with the question pertaining to rates of binge drinking within the past 30 days. Findings from the NSDUH ( ) for youth 12+ years old reflected the following: the combined region of Pennyrile and Purchase had lower rates of binge drinking in the past 30 days (18.5%) than both (20.1%) and the United States (23.3%) (Figure 5). The highest rates of past 30-day binge drinking were in Region 2 (22.8%) and Region 6 (21.8%) in (see Appendix 2, p. 28, for a breakdown of counties in the Federally designated regions). Figure Day Binge Drinking Among Age 12+, NSDUH US Pennyrile & Purchase 35.2 Region 6 Region Region 3 40 Region 1 Region For a listing of counties in these Federally designated regions, see Appendix 2, p Preventing Substance Abuse and Mental Illness in

11 Similar to binge drinking in the past two weeks, 10th graders in Purchase (25.8%) and Pennyrile (25.7%) had comparable rates as (26.1%) (Figure 6, KIP). KIPDA (31.8%), Lincoln Trail (29.8%), and FIVCO (28.8%) had the highest ADD rates. Figure Day Alcohol Intoxication Among 10th Graders, KIP 2010 Purchase Pennyrile KIPDA Lincoln Trail FIVCO NKY Barren River Bluegrass Lake Cumberland Green River KY River Buffalo Trace Big Sandy Gateway Cumberland Valley Among 12+ year olds, the combined region of Pennyrile and Purchase (35.2%) had lower rates of alcohol use in the past 30 days than (40.5%) and the US (51.2%) in (Figure 7, NSDUH). Region 6 (48.1%) and Region 2 (47.7%) had the highest rates of past 30-day alcohol use. Figure Day Alcohol Use Among Age 12+, NSDUH US Pennyrile & Purchase 35.2 Region 6 Region Region 3 40 Region 1 Region For a listing of counties in these Federally designated regions, see Appendix 2, p. 28. Preventing Substance Abuse and Mental Illness in 9

12 Tobacco Use. Past 30-day cigarette use in 2010 among 10th graders in Purchase (19.9%) was lower than the state rate (21.7%), while the prevalence in Pennyrile (24.2%) slightly exceeded the rate (Figure 8, KIP). The highest rates in were in River (27.2%), Barren River (26.8%), and Lake Cumberland (26.1%). Figure Day Cigarette Use Among 10th Graders, KIP 2010 Purchase Pennyrile KY River Barren River Lake Cumberland Cumberland Valley Green River Buffalo Trace KIPDA Big Sandy Lincoln Trail Gateway FIVCO Bluegrass NKY Among those 12+ years old, the combined region of Pennyrile and Purchase (30.6%) was slightly lower than (32.2%), but still exceeded the US (24.6%) in (Figure 9, NSDUH). Region 1 (36%) and Region 5 (34.2%) had the highest rates of past 30-day cigarette use. Figure Day Cigarette Use Among Age 12+, NSDUH US 24.6 Pennyrile & Purchase Region 1 Region 5 Region Region 2 32 Region For a listing of counties in these Federally designated regions, see Appendix 2, p Preventing Substance Abuse and Mental Illness in

13 Illicit Drug Use. In 2010, marijuana among 10th graders was the most commonly abused illicit drug in. Both Pennyrile (15%) and Purchase (14%) had comparable rates to (14.4%), with the highest rates in KIPDA (18.5%), Northern (17.5%), and Bluegrass (16.4%) (Figure 10). Figure Day Marijuana Use Among 10th Graders, KIP 2010 Purchase Pennyrile KIPDA NKY Bluegrass FIVCO Barren River KY River Green River Lincoln Trail Lake Cumberland Gateway Cumberland Valley Big Sandy Buffalo Trace Among those 12+ years old, the rate of past-year use in the combined region of Pennyrile and Purchase (9%) was comparable to (9.6%), but slightly lower than the US (10.3%) in (Figure 11). Figure 11. Past-Year Marijuana Use Among Age 12+, NSDUH US Pennyrile & Purchase Region 6 Region 2 Region 3 Region 5 Region For a listing of counties in these Federally designated regions, see Appendix 2, p. 28. Preventing Substance Abuse and Mental Illness in 11

14 Rates of cocaine use in the past 30-days among 10th graders in Pennyrile (0.9%) and Purchase (1%) were virtually identical to (0.9%) (Figure 12). The highest rates were in KIPDA (1.5%), Green River (1.3%), and River (1.2%). Figure Day Cocaine Use Among 10th Graders, KIP 2010 Purchase Pennyrile KIPDA Green River KY River Gateway Lincoln Trail Barren River Bluegrass Cumberland Valley FIVCO NKY Lake Cumberland Big Sandy Buffalo Trace Among those 12+ years old, the rate of past-year cocaine use in the combined region of Pennyrile and Purchase (1.6%) was slightly lower than (1.8%) and the US (2.3%) in (Figure 13). The highest rates were in Region 6 (2.1%) and Region 2 (2%). Figure 13. Past-Year Cocaine Use Among 12+, NSDUH US Pennyrile & Purchase 1.6 Region Region 2 2 Region Region Region For a listing of counties in these Federally designated regions, see Appendix 2, p Preventing Substance Abuse and Mental Illness in

15 Prescription Drugs. Past 30-day oxycodone abuse among 10th graders in Pennyrile (1.5%) and Purchase (1.5%) were comparable to (1.6%) in 2010 (Figure 14). Barren River (2.8%), Buffalo Trace (2.5%), and FIVCO (2.2%) had the highest rates in Figure Day Oxycodone Use Among 10th Graders, KIP 2010 Purchase Pennyrile Barren River Buffalo Trace FIVCO NKY KIPDA Lincoln Trail Green River Cumberland Valley Bluegrass Gateway Lake Cumberland Big Sandy KY River Among those 12+ years old, the rate of past-year nonmedical use of opioid analgesics in the combined region of Pennyrile and Purchase (5.8%) was slightly lower than (6.1%), but higher than the US (5%) in (Figure 15). The highest rates were in Region 6 (6.6%) and Region 2 (6.4%). Figure 15. Past-Year Opioid Abuse Among Age 12+, NSDUH US Pennyrile & Purchase Region 6 Region 2 Region 3 Region 5 Region For a listing of counties in these Federally designated regions, see Appendix 2, p. 28. Preventing Substance Abuse and Mental Illness in 13

16 For past 30-day tranquilizer abuse, 10th graders in Pennyrile (2.3%) had a comparable rate as (2.4%), while Purchase (3.9%) had the highest rate in the state in 2010 (Figure 16). Figure Day Tranquilizer Use Among 10th Graders, KIP 2010 Purchase Pennyrile Barren River Lincoln Trail Green River NKY KIPDA Lake Cumberland FIVCO Bluegrass Gateway Cumberland Valley Big Sandy KY River Buffalo Trace Preventing Substance Abuse and Mental Illness in

17 Figures illustrate third quarter 2011 KASPER prescription rates for oxycodone, hydrocodone, alprazolam, and diazepam for counties in Pennyrile and Purchase. The highest rate of oxycodone prescriptions was in County (66.63 per 1,000) (Figure 17). For as a whole, Clay County ( per 1,000), Owsley County ( per 1,000), Martin County ( per 1,000), and Johnson County ( per 1,000) had the highest prescription rates for oxycodone, hydrocodone, alprazolam, and diazepam, respectively (Figures 17, 18, 19, 20). Figure 17. Oxycodone Prescription Rate Per 1,000, KASPER 2011 (Quarter 3) Livingston Carlisle Graves Crittenden Fulton Christian Hickman Livingston County had the highest prescription rates for hydrocodone ( per 1,000), alprazolam (88.98 per 1,000), and diazepam (40.55 per 1,000) (Figure 18). Figure 18. Hydrocodone Prescription Rate Per 1,000, KASPER 2011 (Quarter 3) Livingston Crittenden Carlisle Fulton Graves Christian Hickman Preventing Substance Abuse and Mental Illness in 15

18 Figure 19. Alprazolam Prescription Rate Per 1,000, KASPER 2011 (Quarter 3) Livingston Graves Carlisle Crittenden Fulton Christian Hickman Figure 20. Diazepam Prescription Rate Per 1,000, KASPER 2011 (Quarter 3) Livingston Fulton Carlisle Graves Crittenden Christian Hickman Preventing Substance Abuse and Mental Illness in

19 Substance Abuse Consequences Morbidity and Mortality. Adults 18 and older living in Western counties tended to report rates of poor/fair health similar to the state rate of 22% in (Figure 21). The counties with the highest prevalence of poor/fair health included (28%), Crittenden (28%), and Graves (25%). Figure 21. Prevalence of Poor/Fair Health, BRFSS Crittenden Graves Christian Poor/fair health corresponds with preventable hospital stays with Crittenden County (245 per 1,000) and Livingston County (216 per 1,000) emerging as two communities with over twice the state rate (105 per 1,000) in (Figure 22). Figure 22. Preventable Hospital Stays Rate Per 1,000 Medicaid Enrollees, Dartmouth Atlas Crittenden Livingston Graves Hickman Fulton Christian Carlisle Preventing Substance Abuse and Mental Illness in 17

20 Elevated rates of poor/fair health are also related to chronic disease mortality. For coronary heart disease in , the age-adjusted rates for Western ranged from per 100,000 in County to per 100,000 in Crittenden County, with a state rate of per 100,000 (Figure 23). Figure 23. Coronary Heart Disease Mortality Rate Per 100,000, CDC WONDER Crittenden Fulton Hickman Livingston Christian Carlisle Graves For stroke in , the age-adjusted rates ranged from 98.8 per 100,000 in County to per 100,000 in Carlisle County (Figure 24). Figure 24. Stroke Mortality Rate Per 100,000, CDC WONDER Carlisle Fulton Crittenden Livingston Hickman Graves Christian Preventing Substance Abuse and Mental Illness in

21 For diabetes in , age-adjusted rates ranged from 24.4 per 100,000 in Carlisle County to 95.1 per 100,000 in Fulton County (Figure 25). Figure 25. Diabetes Mortality Rate Per 100,000, CDC WONDER Fulton Hickman Graves Crittenden Christian Livingston Carlisle Cigarette smoking and other unhealthy behaviors also correspond with cancer mortality. For lung and bronchus mortality in , the age-adjusted rates for Western ranged from 56 per 100,000 in Christian County to 90 per 100,000 in Carlisle County, with a state rate of 74 per 100,000 (Figure 26). Figure 26. Lung and Bronchus Mortality Rate Per 100,000, KCR Carlisle Fulton Hickman Livingston Graves Crittenden Christian Preventing Substance Abuse and Mental Illness in 19

22 For invasive cancer mortality in , age-adjusted rates ranged from 163 per 100,000 in Hickman County to 240 per 100,000 in County, with a state rate of 218 per 100,000 (Figure 27). Figure 27. Invasive Cancer Mortality Rate Per 100,000, KCR Carlisle Fulton Livingston Graves Crittenden Christian Hickman Preventing Substance Abuse and Mental Illness in

23 Risk and Protective Factors Age of Onset. Rates of early onset substance abuse among 10th graders were lower in Purchase than for cigarettes (16.1% vs. 18.7%), marijuana (5.9% vs. 6.6%), and a sip or two of alcohol (15.6% vs. 15.8%); while early onset regular alcohol abuse in Purchase was slightly higher (4.5% vs. 3.7) in 2010 (Figure 28). For Pennyrile, rates were higher for early onset cigarette (21.1% vs. 18.7%), marijuana (8.4% vs. 6.6%), sip or two of alcohol (18.1% vs. 15.8%), and regular alcohol abuse (4.6% vs. 3.7%) than the rate in 2010 (Figure 28). Figure 28. Early Onset (<12 years) Substance Abuse Among 10th Graders, KIP 2010 Cigarettes Marijuana Alcohol (Sip) Alcohol (Regular) Purchase Pennyrile Risk Perception. Underestimating risks associated with substance abuse is highly related to early onset abuse. Compared to, 10th graders in Purchase had higher rates of perceiving cigarette (47.7% vs. 46.1%), marijuana (20.7% vs. 17.7%), regular marijuana (48.4% vs. 47.5%), and regular alcohol (26.1% vs. 23.6%) abuse as posing a greak risk to harming themselves in 2010 (Figure 29). For Pennyrile, a lower rate of 10th graders perceived great risk than for cigarette (43.5% vs. 46.1%), regular marijuana (46.9% vs. 47.5%), and regular alcohol (22.6% vs. 23.6%) abuse in 2010 (Figure 29). Figure 29. Risk Perception (Great Risk) of Substance Abuse Among 10th Graders, KIP 2010 Cigarettes (1+ Pack) Marijuana (Regular) Marijuana (at least 1 time) Alcohol (Regular) Purchase Pennyrile Preventing Substance Abuse and Mental Illness in 21

24 Accessibility. Similarly, ease of substance access influences early onset abuse. In Purchase, a lower rate of 10th graders reported very easy access to cigarettes (44.3% vs. 46.8%) and marijuana (31.1% vs. 32.7%) than in 2010 (Figure 30), while rates for alcohol (30% vs. 29.8%) and illicit drugs (8% vs. 7.8%) were comparable. For Pennyrile, 10th graders had slightly higher rates of very easy access to all substances compared to in 2010 (Figure 30). Figure 30. Substance Accessibility (Very Easy) Among 10th Graders, KIP 2010 Cigarettes Marijuana Alcohol Illicit Drugs Purchase Pennyrile 22 Preventing Substance Abuse and Mental Illness in

25 Mental and Behavioral Health Poor Mental Health Days. High rates of substance abuse and poor physical health cluster with poor mental health. In , the average number of past-month poor mental health days in Western ranged from 2.7 days in County to 9.3 days in Fulton County, with a state average of 4.3 days (Figure 31). Figure 31. Average Poor Mental Health Days in Past Month, BRFSS Fulton Hickman Livingston Crittenden Carlisle Graves Christian Peer Victimization. Elevated rates of peer victimization and bullying have been shown to be associated with poor mental health and suicide. Among 10th graders in 2010, the past-year rates of peer victimization in Purchase and Pennyrile were 44.2% and 40.4%, respectively (Figure 32). Past-year peer victimization ranged from 33.7% in Big Sandy to a high of 44.2% in Purchase, with a state rate of 38.7% in Suicide Mortality. Poor mental health and peer victimization also corresponds with suicide mortality. Combined suicide mortality rates in Western ranged from 6 per 100,000 in County to 27.5 per 100,000 in Fulton County, with a state rate of 13.3 per 100,000 (Figure 33). These observed rates of suicide mortality in County and Fulton County followed an identical pattern as poor mental health days. Preventing Substance Abuse and Mental Illness in 23

26 Figure 32. Past-year Peer Victimization Among 10th Graders, KIP 2010 Purchase Pennyrile FIVCO Buffalo Trace NKY KIPDA Green River Lincoln Trail Gateway KY River Big Sandy Figure 33. Suicide Mortality Rate Per 100,000, CDC WONDER Fulton Carlisle Hickman Graves Crittenden Livingston Christian Preventing Substance Abuse and Mental Illness in

27 Findings and Recommendations This report is one of two community profiles created by s State Epidemiological Outcomes Workgroup (SEOW). It expands upon the original SEOW priorities to further identify geographic patterns and epidemiologic trends of substance abuse and mental health throughout SAMHSA s Region 1 that includes Area Development Districts 1 and 2 (Purchase and Pennyrile). County-level portrayals are also provided to illustrate patterns and trends in the 17 counties comprising Western. It is anticipated that this report will be disseminated among two regional prevention centers and the local Agencies for Substance Abuse Policy (ASAP) boards for their review and action. It will be used to help inform the work of the county and district level prevention staff and community coalitions. For example, in Pennyrile, the findings of the Incentives for Prevention (KIP) survey documenting higher rates of past-month cigarette abuse and past-month tranquilizer abuse compared to statewide rates warrant additional attention. Similarly, less perceived risk associated with cigarettes, marijuana and alcohol within Pennyrile also demonstrate needed attention at the regional level. In both Purchase and Pennyrile, the higher rates of past-year peer victimization compared to the state warrant significant attention among entities that focus on school safety, suicide prevention, and mental health promotion. Community coalitions and prevention specialists may also want to focus resources on elevated prescription rates of opioids and tranquilizers in Livingston and Carlisle counties and suicide mortality in Carlisle and Fulton counties. Other findings are further summarized throughout the profile, with each figure illustrating regional and county findings, and state comparisons. qit is anticipated this report will be disseminated among two regional prevention centers and the local Agencies for Substance Abuse Policy (ASAP) boards for their review and action. It will be used to help inform the work of the county and district level prevention staff and community coalitions. The findings included in this profile provide an opportunity to prioritize regional and county issues related to substance abuse, mental health, and their risk factors. Although it is often difficult to know exactly how to allocate limited prevention resources, data within this profile are intended to serve as an evidence-based guide to professionals who address these problems in their communities. Because of the number of risk factors associated with substance abuse and dependence, continued surveillance and data infrastructure are vital tools in reducing the toll on individual users, their families, and communities. Preventing Substance Abuse and Mental Illness in 25

28 Appendices Appendix 1. Data Sources BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) Description: The BRFSS is a state-based system of telephone surveys that measure data pertaining to health risk behaviors, clinical preventive practices, and health care access and use primarily related to chronic diseases and injury. States use standard procedures to collect data from adults 18 years or older. Sponsor(s): Centers for Disease Control and Prevention (CDC) Geographic level: National, State, County Frequency: Data collected and reported monthly Years Used: Indicators: Poor mental health days, poor or fair health. Strengths: Standardized and comparable across states; County-level estimates;wide range of health indicators and outcomes Weaknesses: Cross-sectional data; Unreliable county-level estimates; Variations in indicators and outcomes across national surveys Link: CDC WIDE-RANGING ONLINE DATA FOR EPIDEMIOLOGIC RESEARCH (CDC WONDER) Description: The CDC WONDER contains population, morbidity, and mortality data for all US counties from 1979 to Frequencies and rates of death may be obtained for underlying cause of death, state, county, age, race, sex, and year. The International Classification of Diseases 9th Revision (ICD 9) codes are used for underlying causes of death from 1979 to In 1999, the ICD 10 was adopted to specify cause of death. Sponsor(s): Centers for Disease Control and Prevention (CDC) Geographic level: National, State, County Frequency: Data collected and reported annually Years Used: Indicators: Coronary heart disease mortality (ICD-10 codes: I20-I25), stroke mortality (I60-I69), diabetes mortality (E10-E14), drug overdose mortality (injury mechanism: poisoning), and suicide mortality (injury intent: suicide). Strengths: Standardized and comparable across states; County-level estimates; Trends available from Weaknesses: Limited racial categories; Unreliable county-level estimates; Variations in ICD codes Link: DARTMOUTH ATLAS OF HEALTH CARE (DAHC) Description: The DAHC documents variations in how medical resources are distributed and utilized throughout the US using Medicare data. Small area analysis is used to focus on a defined geographic area or a population that uses a specific hospital. Sponsor(s): Center for Medicare and Medicaid Services (CMS) Geographic level: National, State, County Frequency: Data collected and reported annually Years Used: Indicators: Preventable hospital visits Strengths: Standardized and comparable across states; County-level estimates Weaknesses: Limited to adults 65 and older; Unreliable county-level estimates; Most recent years unavailable Link: KENTUCKY ALL SCHEDULE PRESCRIPTION REPORTING SYSTEM (KASPER) Description: KASPER tracks controlled substances dispensed in the Commonwealth of. Data are primarily intended for physicians, pharmacists, and law enforcement officials. Sponsor(s): Cabinet for Health and Family Services (CHFS) Geographic level: State, County Frequency: Data collected and reported quarterly Years Used: 2011 Indicators: Prescription rates for oxycodone, hydrocodone, alprazolam, and diazepam Strengths: Fast reporting; County-level estimates Weaknesses: Limited data access; No data on diverted prescriptions; Unstandardized across states Link: KENTUCKY CANCER REGISTRY (KCR) Description: KCR began as a voluntary reporting system in In 1990, the State General Assembly passed legislation establishing KCR as the centralized population-based cancer registry for the Commonwealth of. Mandatory reporting to KCR began in All hospitals and associated outpatient facilities are required to report cancer cases to the Cancer Patient Data Management System developed by KCR Sponsor(s): National Cancer Institute (NCI) and Centers for Disease Control and Prevention (CDC) Geographic level: State, County Frequency: Data collected and reported annually Years Used: Indicators: Invasive cancer mortality (ICD-10 codes: C00-D49), lung and bronchus cancer mortality (C34) Strengths: Rigorous data quality control and assurance; Large annual state samples; Countylevel estimates Weaknesses: Unreliable county-level estimates; Most recent years unavailable; Variations in rates across data sources Link: 26 Preventing Substance Abuse and Mental Illness in

29 KENTUCKY INCENTIVES FOR PREVENTION (KIP) Description: The KIP Survey is administered to students in grades six, eight, 10, and 12 to provide data to school districts regarding use of alcohol, tobacco, and other drugs. Data regarding risk perceptions, age of onset, accessibility, school safety, and gambling are also measured. Sponsor(s): Division of Behavioral Health, Office of Drug Control Policy (ODCP), and Center for Substance Abuse Prevention (CSAP) at the Substance Abuse and Mental Health Services Administration (SAMHSA) Geographic level: State, County Frequency: Data collected and reported biennially Years Used: 2010 Indicators: Current alcohol, tobacco, and drug use; age of onset, risk perceptions, and accessibility of substance use Strengths: Rigorous data quality control and assurance; Large samples; County-level estimates; Voluntary participation Weaknesses: Variations in county rates across years; Non-probability sampling Link: htm NATIONAL SURVEY ON DRUG USE AND HEALTH (NSDUH) Description: The NSDUH is a national survey involving in-home interviews with approximately 70,000 randomly selected individuals age 12 and older. Sponsor(s): Substance Abuse and Mental Health Services Administration (SAMHSA) Geographic level: National, State, County Frequency: Data collected annually and reported biennially Years Used: , Indicators: Current alcohol, tobacco and drug use, risk perceptions, serious psychological distress, major depressive episode Strengths: Regional estimates; Standardized and comparable across states; Clinically significant estimates Weaknesses: Limited state-level indicators; Most recent years unavailable Link: UNITED STATES CENSUS BUREAU Description: The Census Bureau develops population estimates with a component of population change using administrative records to estimate the household and group population. Sponsor(s): US Census Bureau Geographic level: National, State, County Frequency: Data collected and reported annually Years Used: 2010 Indicators: Total population, gender, race and ethnicity, poverty, median household income Strengths: Data include citizens, non-citizen legal residents, non-citizen long-term visitors, and illegal immigrants Weaknesses: Most recent years unavailable Link: Preventing Substance Abuse and Mental Illness in 27

30 Appendix 2. National Survey on Drug Use and Health Substate Regions Region 1 Lake Cumberland Adair Casey Clinton Cumberland Green McCreary Pulaski Russell Taylor Wayne Cumberland Valley Bell Clay Harlan Jackson Knox Laurel Rockcastle Whitley Barren River Allen Barren Butler Edmonson Hart Logan Metcalfe Monroe Simpson Warren Region 2 Bluegrass Anderson Bourbon Boyle Clark Estill Fayette Franklin Garrard Harrison Jessamine Lincoln Madison Mercer Nicholas Powell Scott Woodford Buffalo Trace Bracken Fleming Lewis Mason Robertson Northern KY Boone Campbell Carroll Gallatin Grant Kenton Owen Pendleton Region 3 Lincoln Trail Breckinridge Grayson Hardin Larue Marion Meade Nelson Washington Green River Daviess Hancock Henderson McLean Ohio Union Webster Region 4 Purchase Carlisle Fulton Graves Hickman Livingston Pennyrile Christian Crittenden Region 5 River Breathitt Knott Lee Leslie Letcher Owsley Perry Wolfe Big Sandy Floyd Johnson Magoffin Martin Pike Gateway/FIVCO Bath Boyd Carter Elliott Greenup Lawrence Menifee Montgomery Morgan Rowan Region 6 KIPDA Bullitt Henry Jefferson Oldham Shelby Spencer Trimble 28 Preventing Substance Abuse and Mental Illness in

31 Prepared for: Division of Behavioral Health Department for Behavioral Health, Developmental and Intellectual Disabilities Cabinet for Health and Family Services Frankfort, Funded by: Center for Substance Abuse Prevention Substance Abuse and Mental Health Services Administration Rockville, Maryland Prepared by: REACH of Louisville, Inc. 501 Park Avenue, Louisville, KY phone fax Preventing Substance Abuse and Mental Illness in 29

32 Resources for Education, Adaptation, Change and Health REACH of Louisville, Inc. consults with organizations, communities, and programs to enhance effectiveness and accountability, facilitate change, and improve the welfare of people. Over the years, REACH has established an exceptional reputation in planning and evaluation of integrated health, human service, and community programs. With a multidisciplinary team of research and planning professionals, REACH specializes in delivering a product that is substantive, responsive, and practical.