Regional Needs Assessment

2015

Regional Needs Assessment REGION 8: UPPER SOUTH TEXAS PREVENTION RESOURCE CENTER

South Texas Centre AT&T Building 7500 US Hwy 90 West, Suite 100 San Antonio, TX 78227 210.225.4741 www.prcregion8.org

p. (210) 225-4741 f. (210) 225-4768

[email protected] www.prcregion8.org

2015 Regional Needs Assessment

San Antonio Council on Alcohol and Drug Abuse South Texas Centre AT&T Building 7500 US Hwy 90 West, Suite 100 San Antonio, TX 78227 210.225.4741 www.prcregion8.org

THANK YOU TO ALL OUR PARTNERS

The State Collaborative began formally in 2013 when the state transformed all 11 Regional Drug and Alcohol Clearinghouse Organizations into a Central Data Repository. The Regions within Texas agreed to put aside their competitive business practices to conduct a comprehensive drug and alcohol needs assessment in the interest in improving the awareness of the community by working together.

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SACADA was founded in 2014, making this the initial RNA for Region 8. Collaboration within Region 8 has developed a powerful network of citizens, community organizations and businesses. The Regional Needs Assessment has been conducted to provide the state, the PRC, and the community at large with a comprehensive view of information about the trends, outcomes and consequences associated with drug and alcohol use in Region 8.

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Message from Our Executive Director It is my great honor and privilege to serve as the Executive Director for the San Antonio Council on Alcohol and Drug Abuse. I passionately believe in the great work this organization has provided our community for over 53 years, and I’m excited about the new opportunities we have in bringing hope and healing through prevention and intervention services. We know that substance abuse is one of the leading problems that affects San Antonio. It is a significant factor in broken homes, domestic violence, child abuse, health problems, soaring medical costs, crime, DWI fatalities, unplanned pregnancies, school performance problems, truancy, high dropout rates, loss of productivity and many workplace issues. Its effects reach far beyond the user to family, friends, the workplace, and the entire community. Collaboration with other organizations and agencies is crucial in preventing substance abuse and addiction. Working with our many partners, we are making our community safer and healthier. By utilizing community assessments and implementing evidence-based strategies, we will be able to monitor our success and be strategic in all the work we do. I’m extremely grateful to our Board of Directors, Staff and Community Partners for their unwavering support of the San Antonio Council on Alcohol and Drug Abuse. Together, we’re reducing the impact of substance abuse and addiction.

Sincerely, Abigail Moore MA, LPC, LCDC, ACPS Executive Director San Antonio Council on Alcohol and Drug Abuse

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Proudly Serving South Central Texas The Prevention Resource Center (PRC) Region 8 proudly serves the 28 counties of South Central Texas by providing access to data regarding alcohol, tobacco, and other drug use and misuse, as well as behavioral, mental, and physical health issues related to drug use. PRC 8 also collaborates with community stakeholders and builds strong partnerships with organizations that collect data through questionnaires, needs assessments, surveys, focus groups, and informant interviews. Our Mission The mission of the Prevention Resource Center 8 is to serve as a central data repository and substance abuse training liaison for the Region 8 community. As the central data repository, the PRC will develop a Regional Needs Assessment (RNA) that will tell the story of the 28 counties. The data collection will include, but is not limited to, the state’s three main priorities of alcohol, marijuana and prescription drugs.

ACKNOWLEDGMENTS The members of the Needs Assessment Team for Region 8 include: GYNA JUAREZ, M.P.A., ACPS PRC REGION 8 DIRECTOR BETSY JONES, TOBACCO PREVENTION SPECIALIST TERESA STEWART, REGIONAL COMMUNITY LIAISON HORTENCIA C. CARMONA, M.S., REGIONAL EVALUATOR ALEXIS LAWRENCE, M.S., REGIONAL COMMUNITY LIAISON

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Table of Contents Executive Summary ................................................................................................................................ 7 What is the PRC?..................................................................................................................................... 7 Key Concepts in This Report ................................................................................................................. 10 Adolescence ...................................................................................................................................... 10 Epidemiology .................................................................................................................................... 10 Risk and Protective Factors ............................................................................................................... 11 Consequences and Consumption ...................................................................................................... 12 Introduction .......................................................................................................................................... 14 How to Use This Document ............................................................................................................... 14 Methodology .................................................................................................................................... 15 Process.............................................................................................................................................. 15 Quantitative Data Selection ............................................................................................................ 156 Qualitative Data Selection .................................................................................................................17 Demographic Overview ........................................................................................................................ 18 State Demographics ......................................................................................................................... 18 Regional Demographics .................................................................................................................... 35 Environmental Risk Factors................................................................................................................... 48 Education .......................................................................................................................................... 48 Criminal Activity................................................................................................................................ 52 Mental Health ................................................................................................................................... 63 Social Factors .................................................................................................................................... 70 Accessibility ...................................................................................................................................... 80 Perceived Risk of Harm ..................................................................................................................... 90 Regional Consumption.......................................................................................................................... 94 Alcohol .............................................................................................................................................. 95 Marijuana .......................................................................................................................................... 99 Prescription Drugs .......................................................................................................................... 104 Tobacco ...........................................................................................................................................107 Emerging Trends............................................................................................................................. 109 Consequences ..................................................................................................................................... 123 Mortality ......................................................................................................................................... 124 Legal Consequences ....................................................................................................................... 128

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2015 Regional Needs Assessment Hospitalization and Treatment ....................................................................................................... 132 Economic Impacts ........................................................................................................................... 140 Environmental Protective Factors ........................................................................................................147 Community Domain ........................................................................................................................ 149 School Domain................................................................................................................................ 156 Family Domain ................................................................................................................................ 160 Individual Domain ........................................................................................................................... 164 Trends of Declining Substance Use ..................................................................................................170 Region in Focus .................................................................................................................................... 171 Gaps in Services ............................................................................................................................... 171 Gaps in Data.....................................................................................................................................172 Regional Partners .............................................................................................................................172 Regional Successes .......................................................................................................................... 173 Comparison to State/Nation ............................................................................................................174 Conclusion ........................................................................................................................................... 175 References ...........................................................................................................................................178 Appendices ......................................................................................................................................... 185 Glossary of Terms ................................................................................................................................217

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Executive Summary The Regional Needs Assessment (RNA) is a document assembled by the Prevention Resource Center in Texas Region 8 (PRC 8). This needs assessment has been conducted to provide the state, the PRC, and the community at large with a comprehensive view of information about the trends and outcomes associated with regional and statewide drug and alcohol use. The assessment was intended to enable PRCs, DSHS, and community stakeholders to effect long-term strategic prevention planning based on the most up-to-date information relative to the needs of the community. The data obtained and presented regionally can be used by local agencies, community providers, citizens of the community, and Texas DSHS to better understand the needs of the communities and to evaluate how best to serve these needs. Defining community needs requires a thoughtful, scientific, and qualitative approach. Community is not a set of numbers, but a tapestry of collective experiences, lifestyles, histories, traditions, and expectations. While Texas offers a cultural, geographical, and social experience of diversity, it is also culturally similar across all of its towns and cities. While each town from the gulf coast to the Hill Country is brilliantly distinctive in its own structure, Texans are resilient, industrious people united by a singular pride. The information presented in this document has been acquired by a team of regional evaluators through state and local resources, and compared with state and national rates. Secondary data such as local surveys, focus groups, and interviews with key informants may also allow for input from others in the community, whose expertise lends a specific and qualitative description to identified issues. It is not the aim of this document to assume causation between any substance and prevalence rate in any given area or cultural context.

What is the PRC 8? Prevention Resource Center, Region 8, is a program of the San Antonio Council on Alcohol and Drug Abuse (SACADA) providing substance abuse prevention services to twenty-eight counties in Upper South Texas. PRC-8 is one of eleven PRCs supported by the Texas Department of State Health Services (DSHS). These centers are part of a larger network of youth prevention programs and community coalitions. This network of substance abuse prevention services works to improve the welfare of Texans by discouraging and reducing substance abuse. Their work provides valuable resources to address the state’s three prevention priorities of (1) under-age drinking, (2) marijuana use, and (3) prescription drug abuse, as well as tobacco and other illicit drugs. These priorities are outlined in the Texas Behavioral Health Strategic Plan developed in 2012.

Our Purpose There are eleven regional Prevention Resource Centers serving the State of Texas. Each PRC acts as the central data repository and substance abuse prevention training liaison for its region. The Prevention Resource Centers also collaborate with local community and county data resources to maximize regional data collection, identify training needs in the community and the region, and assist in conducting tobacco retailer compliance checks.

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Our Regions

Region 1: Panhandle and South Plains Armstrong, Bailey, Briscoe, Carson, Castro, Childress, Cochran, Collingsworth, Crosby, Dallam, Deaf Smith, Dickens, Donley, Floyd, Garza, Gray, Hale, Hall, Hansford, Hartley, Hemphill, Hockley, Hutchinson, King, Lamb, Lipscomb, Lubbock, Lynn, Moore, Motley, Ochiltree, Oldham, Parmer, Potter, Randall, Roberts, Sherman, Swisher, Terry, Wheeler, and Yoakum Counties. Region 2: Northwest Texas Archer, Baylor, Brown, Callahan, Clay, Coleman, Comanche, Cottle, Eastland, Fisher, Foard, Hardeman, Haskell, Jack, Jones, Kent, Knox, Mitchell, Montague, Nolan, Runnels, Scurry, Shackelford, Stonewall, Stephens, Taylor, Throckmorton, Wichita, Wilbarger, and Young Counties.

Region 7: Central Texas Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, Travis, Washington, and Williamson Counties.

Region 3: Dallas/Fort Worth Metroplex Collin, Cooke, Dallas, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, and Wise Counties.

Region 8: Upper South Texas Atascosa, Bandera, Bexar, Calhoun, Comal, DeWitt, Dimmit, Edwards, Frio, Gillespie, Goliad, Gonzales, Guadalupe, Jackson, Karnes, Kendall, Kerr, Kinney, La Salle, Lavaca, Maverick, Medina, Real, Uvalde, Val Verde, Victoria, Wilson, and Zavala Counties.

Region 4: Upper East Texas Anderson, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Harrison, Henderson, Hopkins, Lamar, Marion, Morris, Panola, Rains, Red River, Rusk, Smith, Titus, Upshur, Van Zandt, and Wood Counties. Region 5: Southeast Texas Angelina, Hardin, Houston, Jasper, Jefferson, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Trinity, and Tyler Counties. Region 6: Gulf Coast Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, and Wharton Counties.

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Region 9: West Texas Andrews, Borden, Coke, Concho, Crane, Crockett, Dawson, Ector, Gaines, Glasscock, Howard, Irion, Kimble, Loving, Martin, Mason, McCulloch, Menard, Midland, Pecos, Reagan, Reeves, Schleicher, Sterling, Sutton, Terrell, Tom Green, Upton, Ward, and Winkler Counties. Region 10: Upper Rio Grande Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, and Presidio Counties. Region 11: Rio Grande Valley/Lower South Texas Aransas, Bee, Brooks, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Live Oak, McMullen, Nueces, Refugio, San Patricio, Starr, Webb, Willacy, and Zapata Counties.

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Regional Evaluators Regional PRC Evaluators are responsible for developing data collection strategies, conducting surveys and focus groups, analyzing data, creating reports and databases for the central data repository, and collaborating with the DSHS Statewide Prevention Evaluator. The evaluators also work with Community Liaisons and Prevention Specialists to identify potential collaborators and provide data resources. Regional PRC Evaluators are primarily responsible for gathering alcohol and drug consumption data and related risk and protective factors within their respective service regions. Their work in tracking substance use patterns is disseminated to stakeholders and the public through a variety of methods including fact sheets, social media, traditional news outlets, presentations, and reports such as this Regional Needs Assessment. Their work serves to provide state and local agencies valuable prevention data to assess target communities and high-risk populations in need of prevention services.

How We Help the Community The data we collect serves as a useful tool in Data-Driven Decision Making (DDDM). Over the past two years, the PRC teams have taken the cause of the data initiative into the community through presentations, workgroup meetings, and media awareness activities to inform decision-makers and others about the significance of data. Once published, the analysis in these reports will be made available to the public and marketed as a regional tool.

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Key Concepts in This Report As one reads this document, two guiding concepts will appear throughout. The reader will become familiar with a focus on the youth population (adolescence), and an approach from a public health framework (epidemiology). Subsequent to understanding reasons for the targeted youth demographic and public health approaches, readers will be presented with discussions about other key concepts such as risk and protective factors, consequences, consumption factors, and contextual indicators. Substance use is not restricted to any age, gender identification, race, ethnicity, cultural experience, or religious affiliation. While the incidence and prevalence rates of substance use among all demographics are concerning, evidence indicates that prevention work done with adolescents has a positive and sustainable community impact (Treatment Research Institute, 2014). Most concerning are the effects that substance use has on youth brain development, the potential for high-risk behavior, possible injury, and death. Also concerning are social consequences such as poor academic standing, negative peer relationships, aversive childhood experiences, and overall community strain (Healthy People 2020).

Adolescence The Texas Department of State Health Services maintains the definition of Adolescence as ages 12-17 (Texas Administrative Code 441, rule 25.), while the World Health Organization (WHO) and American Psychological Association (APA) both define adolescence as the period of age from 10-19. Many scientists and professionals prefer to define adolescence in terms of developmental milestone markers including behaviors, cognitive reason, aptitude, attitude, and competencies. Both the WHO and APA concede that there are characteristics generally corresponding with adolescence, such as the hormonal and sexual maturation process, social change in prioritization emphasizing peer relations, and attempts to establish autonomy. The National Institute on Drugs and Alcohol (NIDA) and National Institute on Mental Health (NIMH) support an expanded definition of adolescence beyond the age of 19. Neurological research indicates that the human brain is not fully developed until approximately age 25. The Massachusetts Institute for Technology hosts the Young Adult Development Project, one of many research-based entities that provide an overview of brain development into the mid-twenties. The frontal lobe of the brain known for judgment and reason is the last to develop. These recent findings are particularly important in developing a greater understanding of prevention work with the college-aged groups most likely to experiment with high-risk behaviors. The information presented in the RNA is comprised of regional and state data mined from different sources, and will therefore consist of different age subsets. Some domains of youth data may yield breakdowns that conclude with age 17, for instance, and some will end at age 19. The authoring team has endeavored to standardize the information presented here.

Epidemiology Epidemiology is the theoretical framework for which this document evaluates the impact of drug and alcohol use on the public at large. As a study of disease, when applied to drug and alcohol use trends, epidemiology underscores this public health concern as both preventable and treatable. According to the World Health Organization, “Epidemiology is the study of the distribution and determinants of healthrelated states or events (including disease), and the application of this study to the control of diseases and other health problems” (WHO, 2014). The WHO is one of many research-based agencies that PRC 8

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2015 Regional Needs Assessment endorse the examination of drug and alcohol trends, the associated harms and treatments, as well as policy development, from an epidemiological perspective. The Substance Abuse Mental Health Services Administration (SAMHSA) has also adopted the epiframework for the purpose of surveying and monitoring systems which currently provide indicators regarding the use of drugs and alcohol nationally. Ultimately, the WHO, SAMHSA, and others endeavor to create an ongoing systematic infrastructure (such as a repository) that will enable effective analysis and strategic planning for the nation’s disease burden, while identifying demographics at risk and evaluating appropriate policy implementation for prevention and treatment. Many states have evaluated drug and alcohol use from an epidemiological perspective for the last several years and have gained ground in prevention work as a result. By investigating risk factors, protective factors, and consequences of substance abuse-related issues, society can address causality rather than merely identifying symptoms. Ongoing surveillance of data necessitates the standardization of measurement with regard to indicators, which translates to methodological processes at the state and regional levels.

Risk and Protective Factors A discussion of Risk and Protective Factors is essential to understanding how prevention work is currently done in at-risk populations. There are many personal characteristics that influence or culminate in abstinence from drug and alcohol use, the comprehension of which is relevant to grasping the big picture of substance use and potential for substance use disorders (SUD). Historically, professionals and others believed that the physical properties of drugs and alcohol were the primary determinant of addiction. Science has more recently determined that while the effect of substance use is initially a reward in and of itself, the individual’s physical and biological attributes play a significant role in the potential for the development of addiction. Genetic predisposition and prenatal exposure to alcohol, when combined with poor self-image, selfcontrol, or social competence, are influential factors in substance use disorders. Other risk factors include family strife, loose-knit communities, intolerant society, and exposure to violence, emotional distress, poor academics, extreme socio-economic status, and involvement with children’s protective services, law enforcement, and parental absence. Protective factors include an intact and distinct set of values, high IQ and GPA, positive social experiences, spiritual affiliation, family and role model connectedness, open communications and interaction with parents, awareness of high expectations from parents, shared morning, afterschool, meal-time or night time routines, peer social activities, and commitment to school. Kaiser Permanente originated and now collaborates with the Centers for Disease Control on the Adverse Child Experience study, which compared eight categories of negative childhood experiences against adult health status. Participants were surveyed on the following experiences: recurrent and severe physical abuse, recurrent and severe emotional abuse, and contact sexual abuse growing up in a household with: an alcoholic or drug user, a member incarcerated, a mentally ill, chronically depressed, or institutionalized member, the mother treated violently, and both biological parents not being present. The study results underscore the reality of adverse childhood experiences as more common than typically perceived, and exhibit a prominent relationship between these experiences and poor behavioral health management later in life.

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2015 Regional Needs Assessment Examination of risk and protective factors provides a meaningful understanding of how and why youth substance use trends develop from an epidemiological perspective. Accessing data that links childhood experiences with current behavioral health trends allows prevention planners to identify core determinants where attention should be focused. Trends become more obvious when consequences and consumption factors are surveyed, as they are considered the distribution of a public health problem. In other words, today’s reported history enables researchers and practitioners to implement tomorrow’s prevention initiatives. Beverly Tremain, an epidemiologist with the Center for Applied Prevention Techniques states, “Today’s incidence rates are tomorrow’s prevalence rates.”

Consequences and Consumption A tangible way to understand drug and alcohol trends is through sequentially analyzing consequences and consumption patterns. This often occurs at the community level after a notable tragedy has taken place, such as a drunk driving incident involving a fatality. Support for prevention standards may be more pronounced in the wake of such tragedies. On the other hand, prevention efforts are often unnoticed during times of calm. The epidemiological approach calls for consistent examination of consequences and consumption. This highlights how the public deals with tragedies as well as aversive health trends and the effectiveness of prevention efforts during “calm” years. Consequences and consumption will be described in this document as it relates to alcohol, prescription drugs, and illicit drugs. This will enable the reader to conceptualize public health problems in an organized manner. SAMHSA has provided an excellent example of how these concepts are tied together with alcohol. “With respect to alcohol, constructs related to consequences include mortality and crime, and constructs related to consumption patterns include current binge drinking and age of initial use. For each construct, one or more specific data measures (or ‘indicators’) are used to assess and quantify the prevention-related constructs. Indicator data is collected and maintained by various community and government organizations.” Therefore, the state of Texas will continue to build an infrastructure for monitoring trends by examining consequence-related data followed by an assessment of consumption. There is a complex relationship between consequences and consumption patterns. Many substancerelated problems are multi-causal in nature, and often include exacerbating and sustaining dynamics such as lifestyle, family culture, peer relations, education level, criminal justice involvement, and so on. Because consumption and consequences are intertwined and occur within a constellation of other factors, separating clear relationships is difficult. Researchers must look at aggregate data in order to ascribe meaningful relationships to the information obtained. Consumption data alone may be vulnerable to inaccuracy, as it is often gathered through the self-report process, and may not include co-occurring aspects of substance use problems. Moreover, stakeholders and policymakers have a vested interest in the monetary costs associated with substance-related consequences. As such, the process may appear to be a method of working backwards, however it incorporates a pragmatic version of inductive reasoning.

Consequences For the purpose of the RNA, consequences are defined as adverse social, health, and safety problems or outcomes associated with alcohol, prescription, or illicit drug use. Consequences include events such as mortality, morbidity, violence, crime, health problems, academic failure, and other undesired events for which alcohol and/or drugs are clearly and consistently involved. Although a specific substance may not

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2015 Regional Needs Assessment be the single cause of a consequence, measureable evidence must support a link to alcohol and/or drugs as a contributing factor. The World Health Organization estimates alcohol use as the world’s third leading risk factor for loss of healthy life, and that the world disease burden attributed to alcohol is greater than that for tobacco and illicit drugs. Evaluation of the global impact of drug and alcohol-related consequences presents a consistent and reliable allegory of local consequence and consumption factors.

Consumption SAMHSA defines consumption as “the use and high-risk use of alcohol, tobacco, and illicit drugs. Consumption includes patterns of use of alcohol, tobacco, and illicit drugs, including initiation of use, regular or typical use, and high-risk use.” Some examples of consumption factors for alcohol include terms of frequency, related behaviors, and trends, such as current use (within the previous 30 days), current binge drinking, heavy drinking, age of initial use, drinking and driving, alcohol consumption during pregnancy, and per capita sales. Consumption factors associated with illicit drugs may include route of administration, such as intravenous use and needle sharing. Needle sharing is an example of how a specific construct yields greater implications than just the consumption of the drug: it may provide contextual information regarding potential health risks like STD/HIV and hepatitis for the individual, and contributes to the incidence rates of these preventable diseases. Just as needle sharing presents multiple consequences, binge drinking also beckons a specific set of multiple consequences, albeit potentially different from needle sharing. The consumption concept also encompasses standardization of substance unit, duration of use, route of administration, and intensity of use. Understanding the measurement of the substance consumed plays a vital role in consumption rates. Alcoholic beverages are available in various sizes and by volume of alcohol. Variation occurs between beer, wine, and distilled spirits; within each of these categories, the percentage of pure alcohol varies. Consequently, a unit of alcohol must be standardized in order to derive meaningful and accurate relationships between consumption patterns and consequences. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines a “drink” as half an ounce of alcohol, or 12 ounces of beer, a 5-ounce glass of wine, or a 1.5-ounce shot of distilled spirits. The NIAAA (2004) defines “binge drinking” as the drinking behaviors that raise an individual’s Blood Alcohol Concentration (BAC) up to or above the level of .08gm%, which is typically 5 or more drinks for men or 4 or more for women within a two-hour time span. “Risky drinking” is predicated by a lower BAC over a longer span of time, while a “bender” is considered to be two or more days of sustained heavy drinking. Standardizing units continues to prove difficult, so guidelines have been included in the tables section of this document. Because alcohol is legal, commercially available, and federally regulated, it is a better example to employ regarding standardization. This is why the BAC is such an important element in determining risk associated with consumption. Unfortunately, the purity of heroin or the amount of amphetamine found in speed are often ascertained in lab or toxicology reports, which are usually accessible only when a health or legal consequence has already occurred. The inability to know or regulate the purity of street drugs is one of the riskiest determinants for consumption, and is potentially a contributing factor to the recent epidemic of heroin overdoses in the U.S. Moreover, pharmaceutical-related consumption material has an entirely separate consumption variation potential. There are vast pharmaceutical differences in effect, potency, and half-life found between the various opioids, stimulants, and benzodiazepines.

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Introduction The Department of State Health Services (DSHS), Substance Abuse & Mental Health Services Section, funds 188 school- and community-based programs statewide to prevent the use and consequences of alcohol, tobacco, and other drugs (ATOD) among Texas youth and families. These programs provide evidence-based curricula and effective prevention strategies identified by the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Prevention (CSAP). The Strategic Prevention Framework provided by CSAP guides many prevention activities in Texas. In 2004, Texas received a state incentive grant from CSAP to implement the Strategic Prevention Framework, with Texas DSHS working in close collaboration with local communities to tailor services and meet local needs for substance abuse prevention. This strategic prevention framework provides a continuum of services that target the three classifications of at risk populations under the Institute of Medicine (IOM): universal, selective, and indicated.

Our Audience Potential readers of this document include stakeholders who are vested in the prevention, intervention, and treatment of substance abuse in adolescents and adults in the state of Texas. Stakeholders include, but are not limited to, substance abuse prevention and treatment providers, medical providers, schools and school districts, community coalitions, city, county, and state leaders, prevention program staff, and community members committed to preventing substance use.

Our Purpose Prevention Resource Centers serve the community by providing infrastructure and other indirect services to support the network of substance abuse prevention providers. Beginning in 2013, PRCs became a regional resource for substance abuse prevention data. Whereas PRCs formerly served as clearinghouses for substance use literature, prevention education, and media resources, their primary purpose now is to gather and disseminate data to support prevention programs in Texas. PRCs assist state and local prevention programs by providing data for program planning and evaluation of long-term impact of prevention efforts in Texas. Other valuable services include media campaigns, alcohol retailer compliance monitoring, tobacco activities, and access to prevention training resources.

How to Use This Document This RNA is a review of data on substance abuse and related variables across the state that will aid in substance abuse prevention decision making. It seeks to address substance abuse prevention data needs at the state, county, and local levels. The assessment focuses on the state’s prevention priorities of alcohol (underage drinking), marijuana, and prescription drugs and other drug use among adolescents in Texas. This report explores drug consumption trends, consequences, and related risk and protective factors as identified by the Center for Substance Abuse Prevention (CSAP).

Purpose of This Report This RNA was developed to provide relevant substance abuse prevention data on adolescents in Region 8 and throughout Texas. Specifically, this regional assessment serves the following purposes: 1. To discover patterns of substance use among adolescents and monitor changes in trends over time; 2. To identify gaps in data where critical substance abuse information is missing;

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2015 Regional Needs Assessment 3. To determine regional differences and disparities throughout the state; 4. To identify substance use issues unique to communities and regions in the state; 5. To provide a comprehensive resource tool for local providers to design targeted, relevant, data-driven prevention and intervention programs; 6. To provide data to local providers to support grant-writing activities and funding requests; 7. To assist policy-makers in program planning and policy decisions regarding substance abuse prevention, intervention, and treatment in the state of Texas.

Features of This Report This report includes an overview of regional substance abuse information as well as more detailed data on trends and consequences of specific drugs. Since readers come from a variety of professional fields with varying definitions of concepts related to substance abuse prevention, we include our definitions in the section titled “Key Concepts.” The core of the report focuses on substance use data. For each of the substances included, we focus on the following factors: age of initiation, early initiation, current use, lifetime use, and consequences.

Methodology This Regional Needs Assessment (RNA) incorporates data from many quantitative secondary sources such as governmental, law enforcement, educational, and mental health organizations. Data was obtained through agency reports and databases as well as national, state, and local surveys with relevant information related to substance use trends, demographic information, vital statistics, criminal activity, health disparities, educational attainment, and co-morbid mental health disorders. PRC-8 will conduct qualitative primary research in the form of focus groups with key community members and youth populations. The Regional Evaluators and the Statewide Prevention Evaluator determined that the target population for the purpose of this RNA is adolescents, both males and females. As defined in the earlier sections of this document, adolescence includes individuals ages 10-24.

Process The state and regional evaluators collected primary and secondary data at the county, region, and state levels between September 1, 2014 and May 30, 2015. The state evaluator met with the regional evaluator in March 2015 to discuss the expectations of the RNA. Relevant data elements were determined and reliable sources identified through a collaborative process among the team of regional evaluators and with support provided by the Southwest Regional Center for Applied Prevention Technologies (CAPT). Between October 2014 and June 2015, the state evaluator met with regional evaluators via bi-weekly conference calls to discuss criteria for processing and collecting data. Region-specific data collected through local organizations, community coalitions, school districts and local-level governments is included to provide unique local-level information. Additionally, data was collected through primary sources including one-on-one stakeholder interviews and focus groups.

Stratification of Region 8 Region 8 is comprised of 28 counties and has a geographical area of 31,637.10 square miles. Most of the population resides in Bexar County. San Antonio is the second largest city in Texas with more than 1.3 million people. In the future, we will acquire data from smaller areas through focus groups and meetings with local stakeholders.

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Region 8 Counties by Ranking Population in Texas Atascosa Bandera Bexar Calhoun Comal DeWitt Dimmit Edwards Frio Gillespie Goliad Gonzales Guadalupe Jackson Karnes

68 115 4 112 33 117 160 236 127 100 183 118 29 141 140

Kendall Kerr Kinney La Salle Lavaca Maverick Medina Real Uvalde Val Verde Victoria Wilson Zavala Region 8 Texas

79 63 219 184 122 57 67 221 98 65 41 70 156 4 2

Source: http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk

Quantitative Data Selection Identification of Variables Core measures were identified for standardized comparability across Texas; additional indicators may be selected as needed to explore issues important to a particular region.

Key Data Sources Epidemiology acquires numerous data sources including vital statistics data, government surveillance data and reports, CDC data, health surveys, and disease registries in order to study dynamics linked with certain diseases or conditions. Primary Sources 1. A document or record containing first-hand information or original data on a topic. 2. A work created at the time of an event or by an evaluator who directly experienced an event. 3. Examples: interviews, diaries, letters, journals, original hand-written manuscripts, newspaper and magazine clippings, government documents, etc. Secondary Sources 1. Any published or unpublished work that is one step removed from the original source, usually describing, summarizing, analyzing, evaluating, derived from, or based on primary source materials. 2. A source that is one step removed from the original event or experience. 3. A source that provides criticism or interpretation of a primary source. 4. Examples: textbooks, review articles, biographies, historical films, music and art, articles about people and events from the past. The following is a list of commonly used data sources including data collection systems and organizations with numerous reports.   PRC 8

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2015 Regional Needs Assessment      

National health surveys Maternal and Child Health Bureau Behavioral risk factor surveys Other surveillance programs and state cancer registries World Health Organization Private organizations and universities

Data, mainly quantitative data, is imperative in epidemiology. Evaluating and documenting frequency, type, and distribution of incidence is key to understanding substance use and abuse, what causes them, whom is affected, and how to prevent further occurrence. Understanding data allows communities, public officials, and stakeholders to target causes, affected citizens, and gaps in resources.

Criteria for Selection The Regional Evaluators and the Statewide Prevention Evaluator chose secondary data sources as the main resource for this document based on the following criteria: 1. Relevance: The data source provides an appropriate measure of substance consumption, consequence, and related risk and protective factors. 2. Timeliness: We attempt to provide the most recent data available (within the last five years); however, older data might be provided for comparison. 3. Methodological soundness: Data that used well-documented methodology with valid and reliable data collection tools. 4. Representativeness: We chose data that most accurately reflected the target population in Texas and across the eleven human services regions. 5. Accuracy: Data is an accurate measure of the associated indicator. In this needs assessment for Region 8, regional surveys, reports, anecdotal and other qualitative data will only be mentioned to add narrative to each section. Data employed in the following tables comes from the most recently available datasets reflecting the criteria above.

Qualitative Data Selection While quantitative data often takes priority in assessments, it is equally important to provide context through the appropriate use of qualitative data. The term “qualitative data” refers to data and information describing a specific event or set of circumstances that is not originally organized or obtainable numerically. Together, qualitative and quantitative data help to define the scope and extent of a community’s needs and to identify its gaps.

Key Informant Interviews Key informant interviews involve capturing the knowledge, belief, and perspective of a person who has an in-depth understanding of a particular subject, circumstance, geographic area, or population subgroup. Quotations from the key informant and a summary of the interview are commonly included in the health needs assessment.

Focus Groups In the upcoming year, focus groups and interviews will be conducted by the PRC team in order to better understand what members of the communities believe their greatest needs to be. The information

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2015 Regional Needs Assessment collected by this research will serve to identify avenues for further research and provide access to any quantitative data that participants may have access to. 1. 2. 3. 4.

What problems do you see in your community? What is the greatest problem you see in your community? What evidence do you have to support this as the greatest problem? What services do you lack in your communities?

Participants for focus groups will be invited from a wide selection of professionals including law enforcement, health care providers, community leaders, clergy, educators, town council, state representatives, university professors, and local business owners. In these sessions, participants will discussed their perceptions of how their communities are affected by alcohol, marijuana, and prescription drugs.

Surveys The discussion of survey covers any motion that gathers or obtains statistical data. It can include censuses, sample surveys, the collection of data from organizational records, and resulting statistical events. A survey within this study is an investigation of the features of a given population by means of gathering data from a sample of that population and estimating their features through logical use of statistical methodology.

Demographic Overview 2014 Census data indicate that Texas added 451,321 residents in the last year, a 1.7 percent increase since 2013, totaling a population of over 26.9 million residents. Texas ranked 1st nationally for the highest numeric increase in population and 2nd as the most populous state, behind California. The nation’s regional population in the South, which includes Texas, grew the most at 14.3 percent. Texas’s population growth from 2000 to 2010 was twice that of the United States as a whole. The U.S. population grew only 9.7 percent to 308,745,538 residents, the slowest growth rate in decades.

State Demographics The Lone Star State's growth over the past decade was concentrated in its major urban regions, according to 2010 Census population distribution data. Texas cities showed healthy growth from 2000 to 2010. Houston ranked 4th, San Antonio 7th, and Dallas 9th compared to other cities in the U.S. Houston continues to be the state's largest city, with a 7.5 percent increase to 2,099,451. In 2nd statewide, San Antonio and its population grew 6.1 percent to 1,327,407, while Dallas, 3rd largest city in Texas, gained 0.8 percent to grow to 1,197,816. Austin was the 4th largest city, while Fort Worth, with 741,206 people, and El Paso, with 649,121, ranked 5th and 6th in population.

Population Texas is the second most populous state in the nation and has three cities with populations exceeding one million: Houston, San Antonio, and Dallas. These three cities rank among the ten most populous cities in the United States. According to the US Census 2010, six Texas cities had populations greater than 600,000 people. Austin, Fort Worth, and El Paso are among the 20 largest U.S. cities. Texas has four metropolitan areas with populations greater than a million: Dallas–Fort Worth–Arlington, Houston–

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Commented [BS1]: Violeta has pointed out that this information could be presented in table format.

2015 Regional Needs Assessment Sugar Land–Baytown, San Antonio–New Braunfels, and Austin–Round Rock–San Marcos. The Dallas– Fort Worth and Houston metropolitan areas number about 6.3 million and 5.7 million citizens. Commented [BS2]: Here is a pie chart with just sample data. These colors are the default (color 1) for this template.

TEXAS POPULATION MILLIONS

Texas Population 28 26 24 22 20

POPULATI ON E STIM ATE S, APRI L 1, 2000, (CENSUS 2000 DATA)

POPULATI ON E STIM ATE S BASE , APRI L 1, 2010, (V2013)

POPULATI ON E STIM ATE S, JULY 1, 2013, (V2013)

POPULATI ON E STIM ATE S, JULY 1, 2014, (V2014)

As of 2014, there are 26,956,958 people living in the state of Texas, an increase of 6.1 million since the year 2000, including increases in population in all three subcategories of population growth: natural increase (births minus deaths), net immigration, and net migration. It is estimated that as many as 1.8 million immigrants are living undocumented in Texas as of 2012, according to the Department of Homeland Security (DHS, 2012). Texas Metropolitan Status by County Metropolitan Areas in this table were defined in 2013 by the Office of Management and Budget (OMB). Metropolitan Areas are characterized by a central urban area surrounded by other urban areas that work together economically or socially. The central urban area must have a population of at least 50,000 people with a combined regional population of 100,000. Texas- Core Based Statistical Areas (CBSAs) and Counties

Source: US Department of Commerce, Economics and Statistics Administration, US Census Bureau, 2013

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2015 Regional Needs Assessment Age Texans continue to grow older, with an average age over 33 years. At the same time, the number of women at older ages is increasing. A grasp of the population’s age and gender structure produces understanding of changing outcomes, and predicts upcoming social and economic encounters. Examining age demographics is important for increasing prevention efforts, especially with potential first-time users.

TEXAS POPULATION BY AGE & SEX male

female

1,200,000 1,000,000 800,000 600,000 400,000 200,000 0

Source: SOURCE: U.S. Census Bureau, Current Population Survey, and Annual Social and Economic Supplement, 2012.

Race Race is the key dissection of humanity, having distinct physical characteristics. It is important to understand that a person can belong to only one race. Although he or she belongs to just one race, they may still have multiple ethnic identifications. Race is socially imposed, whereas ethnicity is not. The census officially identifies six racial categories: White American, Native American and Alaska Native, Asian American, Black or African American, Native Hawaiian and Other Pacific Islander. "Some other race" is also used in the census and other surveys, but is not an official response.

Race Asian (nonHispanic) 6% American Indian (nonHispanic) 1%

Other (nonHispani c) 0%

Multi-Racial (nonHispanic) 3%

African American (nonHispanic) 18%

White--Anglo (non-Hispanic)

White--Anglo (nonHispanic) 72%

African American (non-Hispanic) American Indian (non-Hispanic) Asian (non-Hispanic)

Source: U.S. Census Bureau, Total population estimates of the state of Texas as of July 1, 2014.

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Other (non-Hispanic) Multi-Racial (non-Hispanic)

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2015 Regional Needs Assessment Ethnicity Ethnicity is defined as being part of or identifying with a social group that has a mutual national or cultural tradition and customs. Ethnicity refers to shared cultural practices, perspectives, and distinctions that distinguish one group of people from another, or a shared cultural heritage. The most common characteristics differentiating other ethnic groups are ancestry, language, religion, attire, and a sense of history. Ethnic differences are not inherited; they are learned. The U.S. Census Bureau classifies Americans as "Hispanic or Latino" and "Not Hispanic or Latino" because Hispanic and Latino Americans are a racially diverse ethnicity that make up the largest minority group in the U.S. Each individual has two classifying elements: racial identity and whether or not they are of Hispanic ethnicity. These categories are sociopolitical ideas and should not be taken as logical or anthropological in nature according to the U.S. Ethnicity Department of Labor. Therefore, no separate racial category exists for Hispanic and Latino Americans, as they do not establish a race, nor a national group. Each person is asked to choose from the six racial classifications as all Americans are included in the numbers reported for those races. In this assessment Hispanic the information collected from the U.S. Census and --Latino 38% other sources identifies: Non Hispanic-Latino 62%

1. Persons reporting only one race. 2. Hispanics may be of any race, and are included in applicable race categories. Commented [BS3]: This is another chart but with the color options “color 2”.

Source: U.S. Census Bureau, Total population estimates of the state of Texas as of July 1, 2014.

Languages The majority of the U.S. population speak English as their first language, but many other languages are spoken in homes as the primary language. Currently there are 382 identified language codes, according to the U.S. Census. These are categorized into four major language groups: Spanish; Other Indo-European languages, Asian and Pacific Island languages, and All Other languages. A more comprehensive subcategory divides the 382 codes into 39 languages and language groups. According to the U.S. Census Bureau, 2009-2013 5Year American Community Survey, about 65% (15,471,149) of Texas residents age five and older speak English as their primary language, more than 29% (6,983,384) speak Spanish as their first language, 0.82% (193,408) spoke Vietnamese as their primary

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Top 10 Non-English Languages Spoken in Texas Language % of Texas Population 1. Spanish 29.46% 2. Vietnamese 0.82% 3. Chinese (including 0.59% Mandarin and Cantonese) 4. Other Asian Languages 0.38% 5. African Languages 0.34% 6. Tagalog 0.30% 7. German 0.29% 8. 9.

French Hindi

10. Urdu

0.26% 0.25% 0.24%

Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey Survey

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2015 Regional Needs Assessment language, and Chinese (including Cantonese and Mandarin) is spoken as the primary language by 0.59% (140,871). Other languages have been documented in Texas by the American Community Survey and include German/Texas German, Tagalog, French/Cajun French, and others. In total, almost 35%) of Texas's residents age five and older spoke a language other than English. Concentrations of Populations There are five large concentrations of populations in the state of Texas according to the U.S. Census: European, Hispanic, African American, Asian, and American Indian. English Americans prevail in eastern, central, and northern Texas; German Americans in central and western Texas. African Americans make up one-third of the Lone Star’s population and are concentrated in eastern Texas as well as the Dallas-Fort Worth and Houston metropolitan areas. As of 2010 the U.S. Census shows 45% of Texas citizens identify with Hispanic heritage; these take into account present-day immigrants from Mexico, Central America, and South America and include Tejanos, whose descendants lived in Texas as early as the 1700s. Tejanos are concentrated in and around Bexar County including San Antonio, where over one million Hispanics live. Texas has the 2nd greatest Hispanic-identifying population in the United States, behind California. American Indian tribes who once subsisted or migrated inside the frontiers of today’s Texas include the Alabama, Apache, Atakapan, Bidai, Caddo, Cherokee, Chickasaw, Choctaw, Comanche, Coushatta, Hueco, the Karankawa of Galveston, Kiowa, Lipan Apache, Muscogee, Natchez, Quapaw, Seminole, Tonkawa, Wichita, and others. There are three federally recognized Native American tribes in Texas, one of which is the Kickapoo Traditional Tribe of Texas in Region 8: 1. Alabama-Coushatta Tribe of Texas in eastern Texas 2. Kickapoo Traditional Tribe of Texas in the Rio Grande Valley 3. Ysleta Del Sur Pueblo of El Paso, Texas

Source: texaspolitics.utexas.edu

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General Socioeconomics Economic and social indicators like income, education, and social connectedness have a direct impact on health. These socio-economic factors interact to affect quality of life within communities. Improving on any of these factors can enhance positive well-being and outcomes throughout societies. “By 2020, mental and substance use disorders will surpass all physical diseases as a major cause of disability worldwide.” Stress and a lack of resources, skills, social support, or connection to the community contribute to poor coping skills and/or harmful behaviors such as smoking, overconsumption of alcohol and drugs, or poor eating habits. Social support, social networking, and connection to culture protect against the health effects of living in disadvantaged circumstances. Having a good start in life and learning can help set the path for a healthier life. Prevention gives children life skills that help them become more resistant to substance abuse. Challenges for adults such as mental health issues, obesity, heart disease, criminality, low literacy, and welfare dependency can be traced to events in early childhood. Providing children with helpful environments that include positive parental involvement and behavior, particularly during the first six years, can modify poor outcomes in later life. “Preventing mental and/or substance use disorders and related problems in children, adolescents, and young adults is critical to Americans’ behavioral and physical health.” SAMHSA promotes and implements prevention and early intervention strategies to reduce the impact of mental and substance use disorders in America’s communities. “Addressing the impact of substance use alone is estimated to cost Americans more than $600 billion each year” (Prevention of Substance Abuse and Mental Illness, Substance Abuse and Mental Health Services Administration, 2014).

Average Wages According to the U.S. Department of Labor, 19 of Texas’s 26 largest counties recorded wage growth above the 2.9-percent national increase in 2014. Average weekly wages in 5 of the 26 largest Texas counties were at least 10% above the national average of $949 per week in the third quarter of 2014. Texas also had four of the lowest-paying large counties in the United States, all located along the border with Mexico. Counties with the highest average weekly wages were located around the large metropolitan areas of Dallas, Houston, and Austin, as well as the smaller areas of Midland, Odessa, and Amarillo. Lower-paying counties were concentrated in the agricultural areas of central Texas and the Texas Panhandle, and along the Texas-Mexico border.   

254 Counties in Texas 212 had wages below the national average 54 counties average weekly wages under $650 76 registered wages from $650 to $749

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  

52 had wages from $750 to $849 30 had wages from $850 to $949 42 had wages of $950 or more per week

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Household Composition Household and Family Size  The number of one-person households is growing slightly.  The total number of households in Texas grew 1,493,117 since 2000.  The average household size increased from 2.74 persons in 2000 to 2.82 persons in 2013.  The average family size increased from 3.28 persons in 2000 to 3.41 in 2013.

Texas Household and Family 2000 2010

Texas Household 2000 2010 2011 2012 2013 0

1,000,000 2,000,000 3,000,000 4,000,000

2011

2012

Nonfamily household

2013 0

2,000,000 4,000,000 6,000,000 8,000,000

total families

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Female householder, no husband present, family household

Male householder, no wife present, family household Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey

total household

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2015 Regional Needs Assessment Housing Occupancy and Tenure As the Texas population grows, the total number of housing units tends to grow as well. The proportion of housing units that are owner-occupied, renter-occupied, or vacant varies slightly throughout the state as a result of boom-and-bust periods or regulatory changes which encourage or discourage development patterns.  The American Community Survey reported over 10 million housing units in Texas, based on 2013 estimates.  The Texas vacancy rate is 11.8%, 0.7% below the national average.  In 2013, 63.3% of the state’s housing units were owner-occupied, 1.6% lower than the national ACS 2013 average.

Texas Housing Occupancy 100% 80% 60% 40% 20% 0%

Texas Housing Tenure 100%

9.4%

10.6%

12.2%

12.0%

11.8%

90.6%

89.4%

87.8%

88.0%

88.2%

80%

36.2%

36.3%

35.5%

36.1%

36.7%

63.8%

63.7%

64.5%

63.9%

63.3%

2000

2010

2011

2012

2013

60% 40% 20% 0%

2000

2010

2011

Occupied

2012

Vacant

2013

Renter-occupied housing units Owner-occupied housing units

Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey

Employment Rates The Bureau of Labor Statistics reports that the state unemployment rate at 4.2% in April 2015, down from 5.2% in 2014. Texas continues to trend below the national unemployment rate of 5.4%. Employment rose in 25 of the 26 largest counties in Texas from September 2013 to September 2014.

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Source: Texas Labor Market Review, April 2015

Texas Job Growth Among the largest counties in Texas, employment was highest in Harris County (2,269,500) in September 2014, followed by Dallas County (1,558,500). Tarrant, Bexar, and Travis Counties had employment levels exceeding 600,000. Combined, the 26 largest Texas counties attributed for 80.1% of total employment within Texas. According to the Texas Data Center, the US Department of Labor, and the Bureau of Labor Statistics, the Lone Star State continues to lead the country in job development for over a decade, even through the recession. U.S. Job Growth, 2004-2014

Source: Demographic Characteristics and Trends in Texas: Dr. Lloyd Potter, State Demographer, Texas State Data Center, the University of Texas at San Antonio

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Industry Texas has numerous resources, a forceful economy, and an exceptional quality of life. Place of work are categorized into industries based on their primary product or activity as decided from figures on annual sales volume. Industry statistics are delivered by the North American Industry Classification System (NAICS) and are revised every five years.

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Texas and U.S. Labor Markets Change NonFarm Employment Texas US

Mar-15 11,728,000 140,326,000

Mar-14 11,407,600 137,214,000

Absolute Percent 320,400 2.8% 3,112,000 2.3%

Private Employment Texas US

Mar-15 9,863,600 118,035,000

Mar-14 9,559,300 114,989,000

Absolute Percent 304,300 3.2% 3,046,000 2.6%

Not Seasonally Adjusted Unemployment Rate Texas US

Mar-15 4.2% 5.6%

Mar-14 5.4% 6.8%

Seasonally adjusted Mar-15 4.2% 5.5%

Mar-14 5.3% 6.6%

Sources: Texas Workforce Commission and U.S. Bureau of Labor Statistics

Employment estimates released by TWC are produced in cooperation with the U.S. Department of Labor’s Bureau of Labor Statistics. Growing industries include Mining and Logging, Construction, Manufacturing, Trade/Transportation/Utilities, Financial Activities, Professional and Business Services, Education and Health Services, Leisure and Hospitality, Information and Government, and Other Services. Texas added 320,400 nonagricultural jobs between March 2014 and March 2015 for an annual growth rate of 2.8%, compared with 2.3% for the U.S. as a whole. The private sector for the state contributed 304,300 jobs, an increase of 3.2%, in comparison with 2.6% for the nation’s private sector. Texas’s seasonally adjusted unemployment rate fell to 4.2% in March 2015 from 5.3% in March 2014, while the U.S. rate fell from 6.6% to 5.5% during the same time. Texas has added an estimated 287,000 seasonally adjusted jobs over the past year, including an additional 1,200 positions during the month of April 2015. Texas added jobs in seven of eleven major industries, with more than 260,000 currently available jobs posted on WorkInTexas.com as of April 2015. Job increases were led by the Leisure and Hospitality industry, which added 6,900 positions. The Information industry showed its largest monthly gain since June 2000 with 3,400 jobs. Other Services gained 2,800 jobs, followed by Trade/Transportation/Utilities, which grew by 2,100 positions.

NAICS Industry Structure The NAICS industry hierarchy classifies data to the six-digit level. The first level consists of the GoodsProducing and Service-Providing industries. Below this is the Super Sector level. The third layer is the Sector level. Statewide data is published at both the Super Sector and Sector levels. Data for the 254 Texas counties is published at the Super Sector level only.

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TANF Recipients According to the US Department of Health and Human Services, “a welfare recipient is any person living in a family where someone received benefits from any of just three programs—Temporary Assistance to Needy Families (formerly Aid to Families With Dependent Children), Supplemental Security Income, and the Supplemental Nutrition Assistance Program (or food stamps).” According to the Advisory Board on Welfare Indicators, “A family is dependent on welfare if more than 50% of its total income in a one-year period comes from TANF (which replaced AFDC), SNAP (formerly food stamps) and/or SSI, and this welfare income is not associated with work activities.”

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2015 Regional Needs Assessment The Temporary Assistance for Needy Families (TANF) program is designed to help needy families attain self-sufficiency. Temporary Assistance for Needy Children is formerly AFDC, Aid for Families with Dependent Children. Cash assistance, or "welfare," is disbursed by the Texas Health and Human Services Commission, TxHHSC, formerly the Texas Department of Human Services. Single and two-parent families are eligible for aid based on financial need, and must engage in work or work-related activities to remain eligible.

686

1,106

910

954

1,277

TANF State Program Two-Parent Cases

1,046

992

1,404

930

2,539

1,898

31,594

TANF STATE PROGRAM

26,912

41,489

TANF Basic Program One-Parent and Child Only Cases

36,107

47,620

44,608

45,275

57,373

50,439

77,825

66,133

TANF BASIC PROGRAM

One Time Temporary Assistance for Needy Families helps families solve a short-term crisis. Households are eligible for temporary assistance in cases of job loss, loss of financial support, underemployment, or a crisis situation such as loss of transportation/shelter or a medical emergency. Recipients must engage in work-related activities in order to remain eligible. TANF GRANDPARENTS PROGRAM

TANF ONE-TIME PROGRAM

TANF Grandparents Program Cases

28

26

35

45

42

69 39

42

32 78

100

168

134

169

268

236

387

283

62

903

82

1,358

TANF One-Time Program Cases

OTTANF has lowered reliance on TANF, allowing more resources to support individuals with barriers to employment, including those with substance abuse or mental health issues. The rate of substance use among welfare recipients is likely to be greater as the number of recipients decreases, because participants with fewer obstacles to employment are likely to use temporary services. According to the 2000 report Addressing Substance Abuse Problems among TANF Recipients: A Guide for Program Administrators: 

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1 in 5 welfare recipients abuses drugs and/or alcohol.

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2015 Regional Needs Assessment        

10.5% of recipient’s age 15 and older report illicit drug use in the past month. 10.6% of female adults in households receiving aid have “some impairment” involving alcohol or other drugs. 27% of females over the age of 14 receiving aid abuse alcohol or other drugs. 37% of women 18-24 receiving aid have used illicit drugs or engaged in binge drinking. 1 in 20 welfare recipients has difficulty holding regular employment due to substance use. 5.2% of adults in welfare households are dependent on alcohol or other drugs. 7.6% of recipients are dependent on alcohol and 3.6% are dependent on other drugs. 27% of mothers over age 14 receiving aid abuse alcohol or other drugs, compared to 9% of other women.

While the majority of alcohol and drug users are not public assistance recipients, substance use issues are more common in the welfare population than in the general population. This is not meant to suggest a causal relationship between substance abuse and welfare receipt; rather, it reflects the fact that people at risk for substance abuse are overrepresented in the welfare population.

Texas Supplemental Nutrition Assistance Program (SNAP) More than 3.9 million Texans receive food benefits from the Supplemental Nutrition Assistance Program (SNAP). SNAP provides monthly benefits that help eligible low-income households purchase healthy food. For most households, SNAP funds account for only a portion of their food budgets; they must also use their own funds to buy enough food to last throughout the month. Recipients are eligible for SNAP benefits based on residence, citizenship, employment services, work requirements, resources, income, and social security numbers. While many Texans receive food assistance 27.1% of Texas children still have food insecurity, the inability to access nutritious food. National data from the U.S. Census Bureau and U.S. Department of Agriculture determined that Zavala County in South Texas has the highest rate of food insecurity in the nation. Nearly half the children in Zavala County are at risk of hunger. Texas is one of eight states that impose a lifetime ban on both TANF and SNAP benefits for individuals with felony drug convictions. SNAP AT A GLANCE According to the U.S. Census Bureau 2009-2013 5-Year American Community Survey, out of 8.8 million Texas households:     

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Almost 1.2 million households receive SNAP benefits 24.9% have one or more residents 60 years and over 66.8% have children under age 18 52.4% receiving SNAP are below poverty level 42% have at least one household member with a disability

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Households recieving SNAP by Race Race 0%

10%

White

20%

30%

African American

40%

Asian

50%

60%

70%

American Indian/ AN/NA/ Other PI

80%

90%

100%

Other/two or more races

Households recieving SNAP by Ethnicity Ethnicity 0%

10%

20%

30%

Hispanic

40%

50%

White-non hispanic

60%

70%

80%

90%

100%

other-non Hispanic

Commented [BS4]: Here is a line chart with “color 3”

TEXAS SNAP: BENEFITS Benefits

5,993,125,493

6,006,734,649

5,934,441,831

5,447,397,414 5,330,650,619 FY 2010

FY2011

FY2012

FY2013

FY2014

Source: The United States Department of Agriculture (USDA), Supplemental Nutrition Assistance Program (SNAP), Annual State Level Data: FY 2010-2014

Texas SNAP: Participants 4,100,000

Texas SNAP: Households Participating

4,000,000

1,700,000

3,900,000

1,650,000 1,600,000

3,800,000

1,550,000

3,700,000

1,500,000

3,600,000

1,450,000

3,500,000

1,400,000

Avg. Monthly Participation- Persons

Avg. Monthly Participation- Housholds


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Texas SNAP: Monthly Household

Texas SNAP: Monthly Person

$330.00

$129.00 $127.00 $125.00 $123.00 $121.00 $119.00 $117.00 $115.00

$320.00 $310.00 $300.00 $290.00 $280.00 $270.00

Avg. Monthly Benefits per Household

Avg. Mothly Benefits per person


LATEST TEXAS SNAP PARTICIPATION & BENEFITS SNAP Benefits

SNAP Housholds

SNAP Participants

3,826,274 1,596,864 3,715,414 3,684,002 1,557,496 1,544,770 438,532,682

434,569,783

FEB-14

JAN 2015 PRELIMINARY

433,304,585

FEB 2015 I NI TI AL


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2015 Regional Needs Assessment Federal Benefits Denied to Drug Offenders Texas is one of the few states that continue to impose a full ban on TANF and SNAP benefits for individuals with felony drug convictions. The federal ban on TANF and SNAP benefits has been in effect since 1996 with the signing of the Personal Responsibility and Work Opportunity Reconciliation Act TANF SNAP (PRWORA). PRWORA imposed a denial of Full Ban Modified Ban NO Ban Full Ban Modified Ban NO Ban federal benefits to individuals convicted in state AK AR KS AK AR DE AL AZ ME AL AZ IA or federal courts of felony drug offenses. The DE CA MI GA CA KS ban is imposed for no other offenses but drug GA CO NH MO CO ME IL CT NJ MS CT MI crimes. Its provisions that subject individuals MO FL NM SC FL NH MS HI NY TX HI NJ who are otherwise eligible for receipt of SNAP or NE IA OH WV ID NM TANF benefits to a lifetime disqualification SC ID OK WY IL NY SD IN PA IN OH applies to all states unless they act to opt out of TX KY RI KY OK VA LA VT LA PA the ban. As of 2011, 37 states either fully or WV MA WY MA RI partially enforce the TANF ban, while 34 states MD MD SD MN MN VT either fully or partially enforce the SNAP ban. MT NC ND NV OR TN UT WA WI

TOTAL

13

24

13

9

MT NE NC ND NV OR TN UT VA WI 25

WA

16

Source: GAO analysis of federal law, GAO-05-238 Denial of Federal Benefits

Child Nutrition Programs The National School Lunch Program (NSLP) is a federally assisted meal program providing nutritious low-cost or free lunches to more than 3 million Texas children in public and private schools, residential institutions, and juvenile correctional institutions. Texas Level Child Nutrition Table

National School Lunch Participation Meals Served Cash Payments Commodity Costs School Breakfast Participation Meals Served Cash Payments Special Milk Half-Pints Served Child and Adult Care Food Avg. Daily Attendance Meals Served

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FY2010

FY2011

FY2012

FY2013

FY2014

3,352,757 559,012,658 1,148,951,410 111,274,444

3,401,746 565,877,470 1,197,859,307 122,407,751

3,374,154 553,231,282 1,208,097,479 128,978,087

3,314,611 561,616,917 1,313,210,138 114,926,509

3,322,460 561,428,486 1,352,110,572 154,674,858

1,635,423 274,505,543 405,772,076

1,744,587 292,635,028 439,611,825

1,786,414 296,630,348 457,608,859

1,818,710 312,178,181 495,699,455

1,864,859 318,776,536 518,897,627

280,465

218,703

162,687

121,638

107,566

315,295 195,784,705

307,976 200,905,491

351,922 202,035,064

369,515 204,530,523

409,466 207,907,315

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2015 Regional Needs Assessment Cash Payments Summer Food Services Avg. Daily Attendance

249,685,221

259,332,648

271,131,370

285,454,670

303,447,828

162,502

173,243

176,587

180,355

181,174

Meals Served

15,747,612

16,143,253

17,860,474

17,414,743

17,868,686

Cash Payments

36,094,568

37,494,624

42,012,960

42,079,455

44,268,651

Source: The United States Department of Agriculture (USDA), Child Nutrition Tables, State Level Tables: FY 2010-2014

Texas Level Tables Current Activity National School Lunch Participation School Breakfast Participation

Feb 2014

Jan 2015

Feb 2015

% change Feb15 vs Feb14

3,350,928

3,389,981

3,386,614

1.1%

1,852,119

1,869,686

1,885,738

1.8%

Source: The United States Department of Agriculture (USDA), Child Nutrition Tables, State Level Tables--Current Activity

Regional Demographics DSHS Region 8 includes a 28-county area of South Central Texas. This area borders the Rio Grande River and Mexico in the west and the Gulf Coast in the east. Region 8 contains almost every type of geographical setting found in Texas: rolling hills and plains, hill country, coastal plains, brush country, and desert. In 2010 the region had an estimated population of 3 million, with over half residing in Bexar County. The Region 8 PRC is located at the San Antonio Council on Alcohol and Drug Abuse (SACADA).

Source: www.dfps.state.tx.us/About_DFPS/region/images/REGION8.GIF

Population The regional population in 2014 was 2,751,696. The population density is 87 persons per square mile, while Texas has a population density of 96.3 persons/sq. mi. and the U.S. has 87.4 persons/sq. mi. The total land area for Region 8 is 31,637.1 square miles.

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2015 Regional Needs Assessment Report Area Region 8

2,751,696

Total Land Area (sq. mi.) 31,637.10

Atascosa

47,774

1,219.54

Bandera

Total Population

Population Density (per sq. mi.) 87

Ranking Population in Texas

36.8

68

4

20,601

790.96

25.9

115

1,817,610

1,239.82

1,383.10

4

Calhoun

21,806

506.84

42.2

112

Comal

118,480

559.48

193.9

33

DeWitt

20,503

908.98

22.1

117

Dimmit

10,897

1,328.88

7.5

160

Edwards

1,884

2,117.86

0.9

236

Frio

18,065

1,133.50

15.2

127

Gillespie

25,357

1,058.21

23.5

100

Bexar

Goliad

7,465

852.01

8.5

183

Gonzales

20,312

1,066.69

18.6

118

Guadalupe

143,183

711.3

184.9

29

Jackson

14,591

829.44

17

141

Karnes

15,081

747.56

19.8

140

Kendall

37,766

662.45

50.4

79

Kerr

49,953

1,103.32

45

63

Kinney

3,586

1,360.06

2.6

219

La Salle

7,369

1,486.69

4.6

184

Lavaca

19,581

969.71

19.9

122

Maverick

55,932

1,279.26

42.4

57

Medina

47,399

1,325.36

34.7

67

Real

3,350

699.2

4.7

221

Uvalde

26,926

1,551.95

17

98

Val Verde

48,623

3,144.75

15.5

65

Victoria

90,028

882.14

98.4

41

Wilson

45,418

803.73

53.4

70

Zavala

12,156

1,297.41

9

156

Texas

26,956,958 (V2014)

261,231.71

96.3

2

U.S.

318,857,056 (V2014)

3,531,905.43

87.4

-

Source U.S. Census Bureau: State and County Quick Facts; (The vintage year (e.g., V2014) refers to the final year of the series (2010 thru 2014)).

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2015 Regional Needs Assessment Age Age distribution represents the population for Region 8 by age group. See Appendix P for age distribution by county.

Region 8 Age Distribution 250,000 200,000 150,000 100,000 50,000 -

Region 8


Race This chart displays the total population in Region 8 by the six racial categories identified by the U.S.: White American, Native American and Alaska Native, Asian American, Black or African American, Native Hawaiian and Other Pacific Islander, and Two or More Races. Native Hawaiian and Other Pacific Islander

0%

Two or More Races 3%

Asian 2%

American Indian/Alaska Native 1%

Black/African American 6% white Black/African American American Indian/Alaska Native Asian Native Hawaiian and Other Pacific Islander Some Other Race Two or More Races

Some Other Race 9%

white 79%

Race Region 8


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Ethnicity This chart shows the population by Hispanic or Latino Ethnicity of any race of the population for Region 8.

Region 8 NonHispanic/Latino 46%

Hispanic/Latino 54%

Region 8 Non-Hispanic/Latino

Race Region 8

Hispanic/Latino Source: US Census Bureau, 2009-2013 5-Year American Community Survey

Even though the Hispanic population accounts for 54% of Region 8, certain areas contain a larger percentage of Hispanic population. See Appendix F for a detailed analysis of ethnic populations within Region 8. Languages The majority of the Region 8 population speak English as their first language, but many other native languages are spoken in homes. The growing population of English language learners is identified in this report as it can cause language barriers to obtaining services. About 61% (1,500,099) of Region 8 citizens ages five and older speak English at home as their first language, while more than 36% (891,829) speak Spanish as their first language. Further language data for region 8 is provided in Appendix D. Concentrations of Populations

Top 10 Non-English Languages Spoken in Region 8 Language % of Region 8 Population 1.Spanish 2.German 3.Tagalog 4.Chinese 5.Vietnamese 6.Other Asian 7.German

36.14% 0.47% 0.27% 0.23% 0.23% 0.30% 0.29%

8.French 9.Hindi 10.Urdu

0.26% 0.25% 0.24%

METROPOLITAN AREAS San Antonio–New Braunfels is an eight-county metropolitan area referred to as Greater San Antonio. U.S. Census estimates showed the Greater San Antonio Source: U.S. Census Bureau, American Community Survey area population increased from 1,711,703 in 2000 to 2,328,652 in 2014, making th it the 25 largest metropolitan area in the United States. San Antonio–New Braunfels is the third-largest metro area in Texas after Dallas–Fort Worth–Arlington and Houston–The Woodlands–Sugar Land. It is also the second-fastest growing metropolitan area in Texas.

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2009-2013 5-Year

2015 Regional Needs Assessment Census Area

San Antonio–New Braunfels Metropolitan Statistical Area Atascosa Bandera Bexar Comal Guadalupe Kendall Medina Wilson

Estimated population as of July 1, 2014 2,328,652

2010 Census

2000 Census

1990 Census

2,142,508

1,711,703

1,407,745

47,774 20,892 1,855,866 123,694 147,250 38,880 47,894 46,402

44,911 20,485 1,714,773 108,472 131,533 33,410 46,006 42,918

38,628 17,645 1,392,931 78,021 89,023 23,743 39,204 32,408

30,533 10,562 1,185,394 51,832 64,873 14,589 27,312 22,650

Source: U.S. Bureau of the Census: Metropolitan Areas. Population Division

Victoria Metropolitan Statistical Area, sometimes referred to as the Golden Crescent region, consists of three counties in the Coastal Bend region of Texas, anchored by the city of Victoria. As of the 2000 census, the Victoria MSA had a population of 111,163. Census Area

Victoria Metropolitan Statistical Area Calhoun Goliad Victoria

Estimated population as of July 1, 2014 98,630

2010 Census

2000 Census

1990 Census

94,003

91,000

80,341

21,806 7,465 90,028

21,381 7,210 74,361

20,645 6,923 84,077

19,053 5,980 86,793

Source: U.S. Bureau of the Census: Metropolitan Areas. Population Division

SOVEREIGN NATION The Kickapoo Traditional Tribe of Texas, previously recognized as the Texas Band of Traditional Kickapoo, is one of three federally acknowledged tribes of Kickapoo people. The other Kickapoo tribes are the Kickapoo Tribe of Indians of the Kickapoo Reservation in Kansas and the Kickapoo Tribe of Oklahoma. The tribe had a village under the international bridge across the Rio Grande. The Kickapoo Indian Reservation of Texas is located on the U.S.-Mexico border in western Maverick County, just south of the city of Eagle Pass, as part of the community of Rosita South. It has a land area 118.6 acres and a 2010 census population of 721 persons. The Texas Indian Commission officially recognized the tribe in 1977. Source: 2010 CENSUS - TRIBAL TRACT REFERENCE MAP: Kickapoo (TX) Reservation

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2015 Regional Needs Assessment MILITARY CITY, USA San Antonio is home to six U.S. military installations, their supporting governmental and commercial institutions, and many military-related organizations.  Joint Base San Antonio (JBSA) – Consists of Fort Sam Houston, Randolph AFB, and Lackland AFB.  Fort Sam Houston – North of downtown San Antonio. o Home to more than 27,000 military personnel and civilians. o Brooke Army Medical Center (BAMC) trains 25,000 people annually.  Randolph Air Force Base – Northeast side of San Antonio in the town of Universal City. o Houses pilot training and a large contingency of support personnel. o Headquarters of the Air Education and Training Command (AETC).  Lackland Air Force Base – West side of San Antonio. o 6,000 enlisted Air Force personnel in recruit training (basic training) at any given time. o Wilford Hall Medical Center is the largest medical facility in the Air Force and over 120 other units.  Kelly Air Force Base/Kelly Field – Adjacent to Lackland AFB. o Semi-functional base supporting the Air Force and city of San Antonio. o Military aircraft repair base and major aerospace support facility for Boeing.  Brooks AFB/Brooks City Base – Joint project between San Antonio and the Air Force in southeast San Antonio. o Medical training facility training over 5,000 aeromedical personnel each year.  Camp Bullis – in the Texas hill country north of San Antonio o 30,000 acre military reservation used for field exercise training, medic training, and combat preparation Total Active Duty U.S.

Texas Total Active Duty

Joint Base San Antonio

Military: 1,305,292

Military: 124,796

Fort Sam Houston Population: 161,971

Air Force: 307,378 Army: 491,911

Total Military Civilians: 50,253 Army: 80,830

Lackland AFB Population: 117,994 Randolph AFB Population: 15,942

Coast Guard: 40,564

Army Civilians: 28,643

Marine Corps: 184,688

Navy: 6,337

Navy: 321,315

Navy Civilians: 1,504 Air Force: 33,878 Air Force Civilians: 16,338 Marine Corps: 1,980 Coast Guard: 1,771 Defense Department Civilians: 3,768 Total Military Civilians: 50,253 Source: Defense Manpower Data Center, 2015, military instillations.dod.mil

Illicit drug use is lower in the armed forces than among civilians, according to the National Institute on Drug Abuse (NIDA), however, heavy alcohol, tobacco use, and prescription drug abuse are on the rise. Military culture, deployments, stigma, and lack of confidentiality are some reasons identified as causing substance use or preventing military members from seeking treatment. NIDA has found that military

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2015 Regional Needs Assessment personnel with multiple deployments and combat exposure are more susceptible to developing substance use or abuse. According to the Department of Defense 2011 Health Related Behaviors Survey of Active Duty Military Personnel:  Illicit and Prescription Drugs  Prohibited substance use (excluding prescription drug misuse) in the military was low, with about 1.4% reporting illicit drug, synthetic cannabis, or inhalant use in the past 12 months.  24.9% of active duty personnel reported prescription drug use (including proper use and misuse) in the past 12 months, composed of pain reliever (20.0%), sedative (13.4%), stimulant (2.8%), and anabolic steroid (1.4%) use and misuse.  1.3% of active duty personnel reported prescription drug misuse in the past 12 months. Of those who reported prescription drug use in the past year, 5.7% reported misuse, with steroids (16.6%) and stimulants (11.6%) most commonly misused among prescription drug users.  89.8% of active duty personnel reported receiving drug testing in the past year, with 27.5% tested in the past month, 62.3% tested within the past 2-12 months, 8.4% tested more than 12 months ago, and 1.8% reported no history of drug testing.  Alcohol Use  Among current drinkers, 39.6% reported binge drinking in the past month, with the Marine Corps reporting the highest prevalence of binge drinking (56.7%), and the Air Force reporting the lowest prevalence (28.1%). Across all military branches, 9.9% were classified as abstainers, 5.7% were former drinkers, and 84.5% were current drinkers; 58.6% of all personnel were classified as infrequent/light drinkers, 17.5% were moderate drinkers, and 8.4% were classified as heavy drinkers.  Heavy drinkers were more often in the Marine Corps (15.5%), had a high school education or less (12.6%), were 21-25 years old (13.2%), unmarried (11.9%), and stationed OCONUS (9.9%).  Active duty personnel who were heavy drinkers, initiated alcohol use at earlier ages, or drank at work more often reported higher work-related productivity loss, serious consequences from drinking, and engagement in risk behaviors than personnel who reported lower levels of drinking, began drinking at older ages, or did not drink at work.  Across all drinking levels, 11.3% of active duty personnel were classified as problem drinkers (AUDIT≥8), with 58.4% of heavy drinkers considered problem drinkers compared to 22.6% of moderate drinkers and 3.8% of infrequent/light drinkers.  About one-fifth (21.3%) of active duty personnel reported consuming an energy drink combined with alcohol in the past 30 days; this group was more often male (22.4%), had a high school education or less (29.7%), were 18-20 years old (37.8%), unmarried (27.5%) or married with a spouse not present (24.8%), junior enlisted E1-E4 (28.0%), and stationed OCONUS (24.2%).  The most common reasons for drinking among current drinkers were to celebrate (50.2%), enjoyment of drinking (46.2%), and to be sociable (33.4%). The most commonly reported deterrent to drinking among all personnel was cost (22.6%), with abstainers, former

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2015 Regional Needs Assessment drinkers, and infrequent/light drinkers endorsing this more often than moderate and heavy drinkers.  1.5% of all active duty personnel indicated being currently in treatment or likely to seek treatment in the next 6 months for alcohol use. Of possible treatment options, seeking help from church (30.0%) or a military chaplain (29.7%) were most endorsed, and military residential treatment facilities (13.2%) and private residential treatment outside the military (12.7%) were most often cited as unfamiliar resources.  Tobacco Use  58.7% of active duty personnel were abstainers or former smokers (17.3%). Out of the 24.0% of current smokers, 8.2% were classified as infrequent smokers, 12.6% were light/moderate smokers, and 3.2% were heavy smokers.  Similar to alcohol, earlier age of initiation for cigarette smoking was associated with being a heavy smoker in adulthood, with those who started smoking at age 14 or younger more likely to be a heavy smoker than those who began smoking at age 21 or older, particularly for males.  Current cigarette smokers were more often in the Marine Corps (30.8%), male (25.2%), had a high school education or less (37.1%), were junior enlisted E1-E4 (30.3%) or E5-E6 (28.0%), and were stationed OCONUS (25.6%).  The most commonly cited reasons for cigarette smoking among current heavy smokers were to help relax or calm down (83.6%) and to help relieve stress (81.5%). In addition, over half (52.9%) reported smoking when drinking alcohol.  Infrequent smokers more often reported that limiting areas where smoking is permitted and increasing prices on military installations would deter smoking compared to light/moderate and heavy smokers.  Across all services, 49.2% reported any nicotine use in the past 12 months, with over 60% of Marine Corps reporting nicotine use in the past year. For all personnel, 22.6% reported cigar use, 10.2% reported pipe use, and 19.8% reported smokeless tobacco use in the past 12 months.  When examining new forms of smokeless tobacco, 4.6% reported using electronic or smoking nicotine delivery products, less than 1% reported using nicotine dissolvables or nicotine gel, and 1.6% reported using caffeinated smokeless tobacco in the past 12 months.  Among heavy cigarette smokers, 45.2% endorsed prescription medication most often as the preferred form of treatment for nicotine dependence.  The UCANQUIT2 online quit support was the least recognized of the treatment options, with 19.4% of infrequent smokers, 14.5% of light/moderate smokers, and 10.8% of heavy smokers indicating that they were not familiar with the treatment option.  Among daily smokeless tobacco users, 44.3% endorsed stopping all at once or “cold turkey” as the preferred method of cessation, and 15.7% were unfamiliar with the UCANQUIT2 online quit support method.  Culture of Substance Use  Active duty personnel reported that peers engaged in alcohol use (89.0%), cigarette use (73.1%), and smokeless tobacco use (61.2%) in their off-duty hours. Although less often reported, 6.5% reported peer marijuana use, and 4.5% reported peer prescription drug misuse.  Cigarette (81.9%) and smokeless tobacco (77.7%) use was perceived highest among the Marine Corps compared to other services. In addition, peer alcohol use was perceived more

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



often in the Marine Corps (92.3%) and Coast Guard (92.9%), and peer marijuana use was perceived as highest in the Coast Guard (10.6%) than all other services. Active duty personnel reported that leadership most often deterred marijuana (92.8%) and prescription drug misuse (90.6%), and 51.2% reported leadership deterrence of alcohol, cigarettes (50.0%), and smokeless tobacco (48.1%). Leadership deterrence of alcohol was more often reported in the Navy (61.2%), and tobacco deterrence was more often reported in the Navy, Air Force, and Coast Guard than in the Army and Marine Corps. Heavy drinkers reported higher network facilitation meaning meeting regularly with others and they are large enough to provide continuous use or misuse of cigarette use (88.2%), marijuana use (15.2%), and prescription drug misuse (10.4%) compared to light or moderate drinkers. In addition, heavy and light/moderate smokers perceived higher peer facilitation of cigarette use than other smoking levels. Source: 2011 DOD Survey of Health Related Behaviors among Active Duty Military Personnel (2011 Active Duty HRB Survey)

 Suicides and Substance Use  Suicide rates in the military were lower than among civilians in the same age range, but in 2004 the suicide rate in the U.S. Army began to climb, surpassing the civilian rate in 2008.  The 2010 report of the Army Suicide Prevention Task Force found that 29% of active duty Army suicides from FY 2005 to FY 2009 involved alcohol or drug use.  In 2009, prescription drugs were involved in almost one third of military personnel suicides. (NIDA March, 2013). VETERANS IN TX AND REGION 8 According to SAMHSA, thousands of troops leave active duty service yearly and become military veterans within their communities. Veterans are more likely than others to fall victim to substance abuse as a means of coping with traumatic situations faced during their service. According to the 2013 National Survey on Drug Use and Health, 1.5 million veterans aged 17 or older (6.6% of veterans) had a substance use disorder in the past year. About 1 in 15 veterans had a past year substance use disorder, whereas the national average among persons aged 17 or older was about 1 in 11, or 8.6%. The rate of substance use disorders among veterans ranged from 3.7% among pre-Vietnam-era veterans to 12.7% among those serving since September 2001. There are an estimated 21.2 million veterans in the U.S. according to the Census, and about 2.2 million military service members and 3.1 million immediate family members. As of September 2014, there are about 2.7 million American veterans of the Iraq and Afghanistan wars and at least 20% of Iraq and Afghanistan veterans have PTSD and/or diagnosed depression. Report Area

Veterans

Region 8

231,185

Texas

1,583,272

U.S.

21,263,779


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2015 Regional Needs Assessment  Illicit and Prescription Drugs  Patients in U.S. Department of Veterans Affairs hospitals are victims of drug overdose twice as often as the national average.  Opioids such as morphine, oxycodone, and methadone are the drugs that patients most frequently misuse and abuse.  Alcohol Use  Veterans show increased rates of binge drinking more often than they abuse drugs.  Alcohol abuse is the most serious substance abuse issue in the veteran community.  Many soldiers abuse alcohol as a coping mechanism for untreated mental health issues.  Suicides and Substance Use  Veterans commit 22 suicides per day, or 8,000 per year, and 11,000 non-fatal suicide attempts a year.  Male veterans are twice as likely as male civilians to commit suicide.  Suicide rates go up as people age.  More men than women die from suicide.  Veterans Courts in Texas  Courts are now being implemented across the country to provide a teambased approach to ensure an appropriate treatment for the underlying risk factors that can contribute to criminal behavior. Currently, 65 drug courts in 20 states work exclusively with the veteran population.  One in five veterans has symptoms of a mental health disorder or cognitive impairment.  One in six veterans who served in Operation Enduring Freedom and Operation Iraqi Freedom suffer from a substance abuse issue. Research continues to draw a link between substance abuse and combat–related mental illness.

Source: Texas Bar Journal, Vol. 75, No. 8

In the absence of community involvement, great stress falls upon military households. Many veterans face critical problems such as trauma, suicide, homelessness, and/or involvement with the criminal justice system which scars families and neighborhoods. NIDA, SAMHSA, and other government agencies are supporting research to understand the causes of drug abuse and other mental health issues among military personnel, veterans, and their families, and how best to prevent and treat them.

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Commented [BS5]: Here is a pie chart with a monochrome style. Personally, I hate them but to each his or her own.


General Socioeconomics Economic strength continues to develop throughout Region 8, but harmful use of alcohol, illicit drugs, prescription drugs, over-the-counter drugs, and tobacco affects most communities.

Average Wages by County According to the U.S. Census ACS 2009-2013, the median household income for Region 8 was $45,658 in 2013, $6,242 lower than the median Texas household income of $51,900. The ACS survey shows that the median family income for Region 8 was $54,476 in 2013, $6,590 lower than the median Texas family income of $61,066. A household is defined as one or more people living in a residence. A family is more than one person living together, either married or of the same bloodline according to the U.S. Census. See Appendix H for an in-depth analysis of median household income levels in Region 8.

Household Composition Children in households with only one parent present are more likely to experience unsupervised periods of time. Gaps in direct supervision increase the likelihood that outside influences can affect the child. Our data does not support the assumption that parental absence and economic hardship are directly responsible for youth substance use. However, substance dependence was positively associated with family or household changes, unstable living arrangements (including domestic violence), and other risk factors, according to SAMHSA’s National Household Survey on Drug Abuse. This survey is the primary source of information on the prevalence, patterns, and consequences of alcohol, tobacco, and illegal drug abuse in the general U.S. population over age 12. Region 8

Estimates

Total: 921,190 Family households: 645,482 Married-couple family 459,915 Other family: 185,567 Male householder, no wife present Female householder, no husband present Nonfamily households:

45,380 140,187

Employment Rates Unemployment creates financial instability and puts strain on a household as well as the community, and creates difficulties obtaining necessities like insurance coverage, health services, healthy food, and other needs that contribute to a better quality of life. According to labor force data, in April 2015 the unemployment rate in Region 8 was 4.1%, down from 4.6% in April 2014. The weekly wage in in 2014 for Region 8 was $750, lower than the Texas average weekly wage of $988, according to the 2014 Third Quarter from the Quarterly Census of Employment and Wages, Bureau of Labor Statistics.

275,708 Householder living alone

Unemploy-

231,325 Householder not living alone 44,383 Source: U.S. Census ACS 2009-2013

Area

All Industries, Region 8, 2014 Third Qtr., Average weekly wages

Region 8

$773

Texas

$988

PRC 8

Region 8

Period

Labor Force

Employed

Unemployed

ment Rate (%)

Region 8

Mar-14

1,313,678

1,247,616

66,062

5.3%

Region 8

Apr-14

1,312,748

1,255,134

57,614

4.6%

Region 8

Mar-15

1,322,289

1,271,783

50,706

4.4%

Region 8

Apr-15

1,322,250

1,275,044

47,206

4.1%

Source: U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics (LAUS); Quarterly Census of Employment and Wages

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2015 Regional Needs Assessment Since 2014, unemployment has steadily decreased in Region 8 with the exception of Dimmit, Karnes, and Lavaca Counties. Unemployment rates for those counties are still lower than the state unemployment rate of 4.2% in April 2015, and well below the national unemployment rate of 5.4%, according to the Bureau of Labor Statistics. The four counties with rates higher than the national unemployment rate were Maverick (10.3%), Zavala (10.2%), Kinney (5.9%), and Val Verde (5.8%). Additionally, 23 of the 28 counties in Region 8 are at or below the state unemployment rate of 4.2% as of April 2015. Refer to Appendix O for more detailed information.

Industry Detailed information on the industry sectors is available through the Quarterly Census of Employment and Wages database provided by the Bureau of Labor Statistics. It is critical to understand employment patterns in order to understand the target population’s means of support. The most recent employment data from BLS by major industrial sector for 2013-14 are shown below. The Department of Labor calls these major categories "Super Sectors." One benefit of going through employment changes at broad industrial levels is that it permits for a distinctive snapshot of variances in the total workforce for a particular study area when compared to any larger statewide and national trend. When employment changes at a greater rate than the state or nation, comparative gains in the local economy may be motivating these changes. REGION 8 EMPLOYMENT Industry Sector Total, All Industries

2013 3rd Qtr.

2014 3rd Qtr.

STATEWIDE EMPLOYMENT

Emp Chg.

Pct. Chg.

1,066,725 1,102,526 35,801

3.36

Private, All Industries

870,698

904,676 33,978

3.90

Goods-producing

137,155

145,378 8,223

6.00

Natural Resources & Mining

21,596

23,882 2,286 10.59

2013 3rd Qtr.

2014 3rd Qtr.

US EMPLOYMENT

Emp Chg.

11,094,014 11,433,567 339,553 9,333,293 9,665,116 331,823 1,849,204 1,924,811 350,995

Pct. Chg. 3.06 3.56

75,607

4.09

372,074 21,079

6.01

2013 3rd Qtr.

2014 3rd Qtr.

Emp Pct. Chg. Chg.

135,015,597 137,724,117 2,708,520 2.01 113,936,704 116,563,52 2,626,81 2.31 0 6 20,268,141 20,797,753 529,612 2.61 2,133,416 2,200,475

Construction

53,392

57,419 4,027

7.54

622,412

663,657 41,245

6.63

Manufacturing

59,979

59,985

0.01

875,797 7,484,089

889,080 13,283 7,740,305 256,216

1.52 3.42

12,059,073 12,226,273 167,200 1.39 93,668,563 95,765,767 2,097,204 2.24

2,232,453

2,297,391 64,938

2.91

25,626,941 26,099,305

6

Service-providing

733,544

758,298 24,754

3.37

Trade, Transport. & Utilities

187,181

195,759 8,578

4.58

Information

22,095

22,658

563

2.55

Financial Activities Group

79,783

83,257 3,474

4.35

121,815

127,160 5,345

4.39

158,119

163,870 5,751

3.64

2,478

1.85

Prof., Business & Other Svcs Education & Health Svcs. Leisure & Hospitality Group Other Services Unclassified

133759

136237

30145 231

30021 206

200,308

201,777

6,075,652

295,353 4.86

472,364 1.84

1,469

0.73

2,723,041

30,423 1.13

676,050 690,315 14,265 1,476,197 1,561,954 85,757

2.11 5.81

7,634,376 7,692,621 18,665,531 19,249,602

58,245 0.76 584,071 3.13

1,434,160 1,468,462 34,302 1,152,844 1,202,351 49,507

2.39 4.29

20,236,231 20,622,519 14,495,036 14,882,694

386,288 1.91 387,658 2.67

1.81

4,160,940 4,239,982

79,042 1.90

-124 -0.41

308,552

314,132

-25 -10.82

3,525

3,923

5,580

2,692,618

6,371,005

67,059 3.14

398 11.29

156,890

256,003

99,113 63.17

Source: Quarterly Census of Employment and Wages - Bureau of Labor Statistics

TANF Recipients The government's Temporary Assistance for Needy Families program provides up to 60 months of coverage throughout a recipient's lifetime. Texas has the 6th highest poverty rate and 42nd in public assistance use in the country, according to data collected from the U.S. Census Bureau.

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2015 Regional Needs Assessment Poverty Estimate

County Name

Persons below poverty level

Total Estimate

Region 8 Texas United States

Percent Persons below poverty level

2,594,999 25,032,531

443,006 4,416,829

17.1% 17.6%

303,692,076

46,663,433

15.4%


TANF Participation

County Name

Total Households


Percent Households with Public Assistance Income

Households with Public Assistance Income

921,190 8,886,471

16,813 163,371

1.83% 1.84%

115,610,216

3,255,213

2.82%

Commented [BS6]: Here is a column chart with color 1, but in “style 2”. Personally, I like this.

Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, American Community Survey 2009-13. Source geography: Tract

Food Stamp Recipients High rates of poverty and food hardship affect thousands in Texas. Texas Households Receiving SNAP Benefits County Name

Households Receiving SNAP Benefits

Total Households


Percent Households Receiving SNAP Benefits

921,190 8,886,471

132,345 1,173,314

14.37% 13.20%

115,610,216

14,339,330

12.40%

Note: This indicator is compared with the state average. Data Source: U.S. Census Bureau, American Community Survey. 2009-13. Source geography: Tract

Free School Lunch Recipients Free or reduced-price meals are available to students whose families are eligible based on total income and size on 130% (free) and 185% (reduced) of the federal poverty guidelines or are enrolled in other programs for low-income children, such as SNAP or TANF. Children in foster care or who attend schools using the Community Eligibility Provision are also eligible. National School Lunch Program participation Area

Region 8 Texas

Total Number of Students

Total Estimated Students Eligible

Free or Reduced Price Meals Given

Percent Free and Reduced Lunch Given

510,467

346,853

259,493

74.80%

4,850,003

3,119,380

2,392,551

76.70%

Source: Texas Department of Agriculture, Year(s): 2013-14, CCD public school district data for the 2012-2013, 20132014 school years

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2015 Regional Needs Assessment Within Region 8, about 74.8% of eligible students took advantage of free or reduced meals. The School Lunch Program indicator assesses vulnerable populations that are more likely to have health access, health status, and social support needs. Additionally, when combined with poverty data, providers can use this measure to identify gaps in eligibility and enrollment. Region 8 contains a large population of these nutritionally disadvantaged students.

Environmental Risk and Protective Factors In this section, data from several statistically valid surveys will be used to indicate consumption patterns in the state and region. Due to the focus on state-level reporting, direct consumption data at geographical levels smaller than the state level has been historically unavailable, difficult to find, and/or collected for smaller, less formal area studies. SAMHSA’s Center’s for Applied Prevention Techniques (CAPT) organization has identified many of the ways youth are at risk of, or gain protection from, alcohol use. As you read this section and note the data listed in the tables, it is helpful to keep these risk and protection factors in mind for decreasing the likelihood of use, especially for alcohol, as it is by far the greatest problem in magnitude and severity.  Perceived parental disapproval of substance use is a consistent protective factor against youth substance abuse.  Limited exposure to peer problem behavior and peers engaging in healthy alternative activities correlate with decreased alcohol and other substance use.  High-risk, aggressive, or antisocial behavior in early adolescence predicts later adolescent aggressiveness, drug abuse, and alcohol problems.  Adolescents who report high parental or other adult monitoring are less likely to use a variety of substances.  Youth with high perception of harm, or attitudes and values unfavorable to alcohol or drugs, are less likely to initiate substance use.  Adolescents who have a close relationship with their parents and positive adult role models are less likely to initiate substance abuse.  Most alcohol consumed by youth is obtained through social sources such as parents and friends, at underage parties, or at home.  Adolescents with a high commitment to school or academic achievement and/or organized activities are less likely to initiate substance abuse. (Source: Modified from SAMHSA CAPT’s “Common Risk and Protective Factors for Alcohol and Drug Use.”)

Education Although researchers have known of the correlation between substance use and academic failure for quite some time, the contribution of substance use to poor academic performance has been underrecognized by policy makers. This correlation tells the community and key decision makers that preventing substance use is a worthwhile option for improving academic performance. Research indicates that almost one quarter of students will eventually drop out of high school, and that high school dropouts are much more likely than graduates to have health problems, to earn less income over their lifetimes, and to become involved with the legal system.

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Dropout Rates In Region 8, the annual dropout rates by grade span for the state of Texas averaged 1.6% for grades 7-12, and for Region 8 averaged 2.1%. According to data collected from TEA, Region 8 accounts for 44.6% of Texas dropouts for grades 7-8 in 2012-2013 school year. Annual Dropout Rates by Grade Span, 2012-2013 Texas Grade Span

Dropouts

Students

Rate (%)

Grades 7-8

3,187

760,623

0.4%

Grades 9-12

31,509

1,428,819

2.2%

Grades 7-12

34,696

2,189,442

1.6%

Annual Dropout Rates by Grade Span, 2012-2013 Region 8 Grade Span

Dropouts

Students

Grades 7-8

≥1,421