Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
www.circlesofsa.org 1 COSA Needs Assessment September 2014
Circles of San Antonio Community
Coalition
Needs Assessment
Sep...
www.sacada.org 2 COSA Needs Assessment June 2014
Table of Contents
Introduction..............................................
www.sacada.org 3 COSA Needs Assessment June 2014
q. Treatment episode admission data.........................................
www.sacada.org 4 COSA Needs Assessment June 2014
Introduction
As a Community Coalition Partnership grantee the San Antonio...
www.sacada.org 5 COSA Needs Assessment June 2014
and consequences. The coalition needs assessment also aims to document ga...
www.sacada.org 6 COSA Needs Assessment June 2014
Part I – Geographic / Target Population
Bexar County is the 4th
largest c...
www.sacada.org 7 COSA Needs Assessment June 2014
Census Bureau’s 3-Year American Community Survey estimates.
DP05: ACS DEM...
www.sacada.org 8 COSA Needs Assessment June 2014
American Indian and Alaska Native 129,874 13,540 11,031
Cherokee tribal g...
www.sacada.org 9 COSA Needs Assessment June 2014
Two races including Some other race 18,975 1,478 972
Two races excluding ...
www.sacada.org 10 COSA Needs Assessment June 2014
Part II – Prevention Resource, Capacities and Gaps
a. Prevention Resourc...
www.sacada.org 11 COSA Needs Assessment June 2014
DWI saturation patrols and Texas Alcoholic Beverage Commission seller-se...
www.sacada.org 12 COSA Needs Assessment June 2014
d. School Programs
Communities in Schools of San Antonio (CIS-SA), a non...
www.sacada.org 13 COSA Needs Assessment June 2014
San Antonio Council on Alcohol and Drug Abuse is funded by DSHS to provi...
www.sacada.org 14 COSA Needs Assessment June 2014
f. Direct Prevention Service Providers
In Bexar County there are four ag...
www.sacada.org 15 COSA Needs Assessment June 2014
Max # of
Patients
Substance-
Use Spec.
Prog
Residential
(R) or
Outpatien...
www.sacada.org 16 COSA Needs Assessment June 2014
The University of Texas at San Antonio (UTSA) is the newest higher educa...
www.sacada.org 17 COSA Needs Assessment June 2014
with the Sheriff’s Office and has plans for meeting with the Sheriff to ...
www.sacada.org 18 COSA Needs Assessment June 2014
campuses because it might attach a stigma that their schools have a drug...
www.sacada.org 19 COSA Needs Assessment June 2014
years and there has also been a increase in enforcement by SAPD. Still, ...
www.sacada.org 20 COSA Needs Assessment June 2014
Graph 5
Source: San Antonio District Attorney’s office
Source: San Anton...
www.sacada.org 21 COSA Needs Assessment June 2014
b. Alcohol Related Vehicular Fatalities
In 2011, Bexar County was in the...
www.sacada.org 22 COSA Needs Assessment June 2014
2012 Bexar County Alcohol Related Crash Fatalities
Source: NHTSA FARS Da...
www.sacada.org 23 COSA Needs Assessment June 2014
Source: National Highway Traffic Safety Administration
2008 2009 2010 20...
www.sacada.org 24 COSA Needs Assessment June 2014
Source: National Highway Traffic Safety Administration
2008 2009 2010 20...
www.sacada.org 25 COSA Needs Assessment June 2014
c. Violent Crimes
Source: Bexar County Juvenile Probation
Source: Bexar ...
www.sacada.org 26 COSA Needs Assessment June 2014
Source: UCR Crime Data FBI.gov
Violent
crime
Murder
and
nonnegl
igent
ma...
www.circlesofsa.org 27 COSA Needs Assessment September
2014
TEXAS
Full-time Law Enforcement
Employees
2012
County
Total la...
www.sacada.org 28 COSA Needs Assessment June 2014
Source: Texas Department of Public Safety (2012 Crime in Texas)
e. Publi...
www.sacada.org 29 COSA Needs Assessment June 2014
f. Suicide Rates
Suicides - Drugs Alcohol
2007 2008 2009 2010 2011 2012 ...
www.sacada.org 30 COSA Needs Assessment June 2014
j. Underage binge drinking rates
Combined school district data taken fro...
www.sacada.org 31 COSA Needs Assessment June 2014
TEXAS EDUCATION AGENCY
PEIMS Discipline Data for 2012-2013
04-CONTROLLED...
www.sacada.org 32 COSA Needs Assessment June 2014
a decline from 19% in 2006 to 16.9% in 2008, but then sharply increased ...
www.sacada.org 33 COSA Needs Assessment June 2014
Source: Behavioral Risk Factor Surveillance System (BRFSS)
10.0%
15.0%
2...
www.circlesofsa.org 34 COSA Needs Assessment September
2014
Prevalence of Binge Drinking
San Antonio MSA
Adults Ages 18 Ye...
www.circlesofsa.org 35 COSA Needs Assessment September
2014
l. Current 30 day drinking rates
Source: Behavioral Risk Facto...
www.sacada.org 36 COSA Needs Assessment June 2014
2010 Youth Risk Behavior Survey Results
Percentage of students who had a...
www.sacada.org 37 COSA Needs Assessment June 2014
m. Current 30 day illicit drug use rates
Percentage of students who used...
www.circlesofsa.org 38 COSA Needs Assessment September
2014
n. Perceptions of harmfulness of use (alcohol and other substa...
www.sacada.org 39 COSA Needs Assessment June 2014
How dangerous do you think it is for kids your age to use...
Never
heard...
www.sacada.org 40 COSA Needs Assessment June 2014
How dangerous do you think it is for kids your age to use
marijuana
Neve...
www.sacada.org 41 COSA Needs Assessment June 2014
How dangerous do you think it is for kids your age to use...
Very
danger...
www.sacada.org 42 COSA Needs Assessment June 2014
How dangerous do you think it is for kids your age to use...
Very
danger...
www.circlesofsa.org 43 COSA Needs Assessment September 2014
o. HIV infection rates and transmission route
2005 2006 2007 2...
www.circlesofsa.org 44 COSA Needs Assessment September
2014
Primary and Secondary Syphilis Rates by Race/Ethnicity, United...
www.sacada.org 45 COSA Needs Assessment June 2014
*2012 Local Preliminary Data 2-15-13
q. Treatment episode admission data...
www.sacada.org 46 COSA Needs Assessment June 2014
Source: Substance Abuse Trends in Texas: June 2013, Maxwell
Calls to the...
www.sacada.org 47 COSA Needs Assessment June 2014
Source: Substance Abuse Trends in Texas: June 2013, Maxwell
The increase...
www.sacada.org 48 COSA Needs Assessment June 2014
Source: Substance Abuse Trends in Texas: June 2013, Maxwell
www.sacada.org 49 COSA Needs Assessment June 2014
s. Truancy data / drop out rates
In Bexar County there are 14 school dis...
www.sacada.org 50 COSA Needs Assessment June 2014
Source TEA Website http://loving1.tea.state.tx.us/lonestar/selectdist.as...
www.circlesofsa.org 51 COSA Needs Assessment September 2014
Education Statistics by Bexar County School Districts 2011
Sou...
www.circlesofsa.org 52 COSA Needs Assessment September 2014
t. Texas School Survey Data
Long Term Trends of Use by Texas Y...
www.circlesofsa.org 53 COSA Needs Assessment September
2014
v. Tobacco sales to minors
Total state minor tobacco stings re...
www.sacada.org 54 COSA Needs Assessment June 2014
FY08 FY09 FY10 FY11 FY12 FY13
Q1-Q2
Number of controlled buys 990 717 66...
www.circlesofsa.org 55 COSA Needs Assessment September
2014
Past 30-day Youth Overall Tobacco Use
Cigarette Use (%) Any To...
www.sacada.org 56 COSA Needs Assessment June 2014
x. Other data sources
Mexican American and Latino Population
The Core of...
www.sacada.org 57 COSA Needs Assessment June 2014
Regardless of the actual population numbers, Latinos are in many ways at...
www.sacada.org 58 COSA Needs Assessment June 2014
Levels of acculturation and assimilation among Mexican Americans are con...
www.sacada.org 59 COSA Needs Assessment June 2014
Graph 1
Source: The National Survey on Drug Use and Health (NSDSU) “ ”
M...
www.sacada.org 60 COSA Needs Assessment June 2014
Colleges and Universities
San Antonio is home to 11 colleges and univers...
www.sacada.org 61 COSA Needs Assessment June 2014
Graph 16
Source Core Survey of College Students: San Antonio, 2010
The a...
www.sacada.org 62 COSA Needs Assessment June 2014
Graph 18
Knowing where students obtain or use alcohol most frequently is...
www.sacada.org 63 COSA Needs Assessment June 2014
Most students reported “Where Lived” as the place where they get and con...
www.sacada.org 64 COSA Needs Assessment June 2014
Table 4
Bexar County National
Been Arrested for DWI/DUI 0.8 1.2
Been in ...
www.sacada.org 65 COSA Needs Assessment June 2014
Military
Because there has been a lack of research in recent years on th...
www.sacada.org 66 COSA Needs Assessment June 2014
comprehensive public health approach and there has been an increase in s...
www.sacada.org 67 COSA Needs Assessment June 2014
 The average level of education for all categories was roughly 9th grad...
www.sacada.org 68 COSA Needs Assessment June 2014
Graph 21
Source: Department of State Health Services (DSHS) Treatment Ep...
www.sacada.org 69 COSA Needs Assessment June 2014
Only eleven of the thirty drug and alcohol treatment facilities in Bexar...
www.sacada.org 70 COSA Needs Assessment June 2014
Juvenile Adult
DSHS Funded Treatment
Centers In-Patient
Out-
Patient Mal...
www.sacada.org 71 COSA Needs Assessment June 2014
Since 2010 the City of San Antonio Municipal Court handles the alcohol l...
www.sacada.org 72 COSA Needs Assessment June 2014
Part IV – Intervening Variables
Contributors to Alcohol Use. Alcohol ava...
www.sacada.org 73 COSA Needs Assessment June 2014
Inconsistent Enforcement or Low Enforcement also contributes to alcohol ...
www.sacada.org 74 COSA Needs Assessment June 2014
that a lack of perception of harm and the availability of prescription d...
www.sacada.org 75 COSA Needs Assessment June 2014
Part VI – Putting it all together
Target Population
The coalition has de...
www.sacada.org 76 COSA Needs Assessment June 2014
References
Alamo Area Council of Governments (AACOG), 2010. Bexar County...
www.sacada.org 77 COSA Needs Assessment June 2014
National Highway Traffic Safety Administration (NHTSA), 2004-2011. Fatal...
www.sacada.org 78 COSA Needs Assessment June 2014
Texas Labor Market Review, 2013. http://www.tracer2.com/?PAGEID=133
Texa...
Upcoming SlideShare
Loading in …5
×

Circles of San Antonio Community Coalition Bexar County Needs Assessment September 2014

1,204 views

Published on

As a Community Coalition Partnership grantee the San Antonio Council on Alcohol and Drug Abuse (SACADA) and the Circles of San Antonio (COSA) Community Coalition have been tasked by Department of State Health Services (DSHS) with developing a needs assessment as part of an overall strategic plan that will be implemented over the next two years. This community needs assessment is a fluid document and subject to revision as our understanding of the data develops, further data becomes available or conditions within the community change.

Published in: Government & Nonprofit
  • Be the first to comment

  • Be the first to like this

Circles of San Antonio Community Coalition Bexar County Needs Assessment September 2014

  1. 1. www.circlesofsa.org 1 COSA Needs Assessment September 2014 Circles of San Antonio Community Coalition Needs Assessment September 2014 For information about the Circles of San Antonio Community Coalition or this Needs Assessment contact Vickie B. Adams or Charles Villafranca coalition@sacada.org
  2. 2. www.sacada.org 2 COSA Needs Assessment June 2014 Table of Contents Introduction.....................................................................................................................................4 Part I – Geographic / Target Population.......................................................................... 6 Part II – Prevention Resource, Capacities and Gaps............................................................10 a. Prevention Resource Center.....................................................................................................10 b. Other Coalitions...........................................................................................................................10 c. Other State and Federally Funded Programs.........................................................................11 d. School Programs.........................................................................................................................12 Community Programs and Services..................................................................................................13 e. Parent Programs .........................................................................................................................13 f. Direct Prevention Service Providers ........................................................................................14 g. Treatment Providers ...................................................................................................................14 h. Healthcare Providers ..................................................................................................................15 i. Higher Education Prevention.....................................................................................................15 j. Law Enforcement ........................................................................................................................16 Gaps in Service ....................................................................................................................................17 Part III – Consequences and Consumption Patterns of the Community............................18 a. DWI Rates.........................................................................................................................18 b. Alcohol Related Vehicular Fatalities...................................................................................21 c. Violent Crimes ...................................................................................................................25 d. Possession of illicit drugs (arrests) ....................................................................................27 e. Public Intoxications............................................................................................................28 f. Suicide Rates .....................................................................................................................29 g. Homicide Rates .................................................................................................................29 j. Underage binge drinking rates............................................................................................30 k. College age binge drinking ................................................................................................31 l. Current 30 day drinking rates..............................................................................................35 m. Current 30 day illicit drug use rates...................................................................................37 n. Perceptions of harmfulness of use (alcohol and other substances).........................................38 o. HIV infection rates and transmission route..................................................................................43
  3. 3. www.sacada.org 3 COSA Needs Assessment June 2014 q. Treatment episode admission data....................................................................................45 s. Truancy data / drop out rates.............................................................................................49 t. Texas School Survey Data .................................................................................................52 v. Tobacco sales to minors....................................................................................................53 x. Other data sources ............................................................................................................56 Colleges and Universities...................................................................................60 Military ...............................................................................................................65 Public Health......................................................................................................66 Part IV – Intervening Variables ......................................................................................72 Part V – Community Readiness.....................................................................................74 Part VI – Putting it all together .......................................................................................75 Target Population ..................................................................................................................75 Primary Substance use behaviors .........................................................................................75 Secondary Substance use behavior ......................................................................................75 Strategic Planning Process....................................................................................................75 References....................................................................................................................76
  4. 4. www.sacada.org 4 COSA Needs Assessment June 2014 Introduction As a Community Coalition Partnership grantee the San Antonio Council on Alcohol and Drug Abuse (SACADA) and the Circles of San Antonio (COSA) Community Coalition have been tasked by Department of State Health Services (DSHS) with developing a needs assessment as part of an overall strategic plan that will be implemented over the next two years. This community needs assessment is a fluid document and subject to revision as our understanding of the data develops, further data becomes available or conditions within the community change. It is evident that the misuse of alcohol and the manufacture, sale and use of illicit drugs have a far reaching and negative impact on most communities. We observe many of the social problems in our neighborhoods, such as economic deprivation and crime, and we intuitively know that drugs and alcohol play some role in creating these problems, sustaining them, or making them worse. From a social point of view, substance abuse hinders the ability of all individuals affected by it to reach their full potential. Economically, almost all individuals and institutions in society are impacted by drug addiction and alcoholism. In the United States, in 2007 the cost of drug abuse to society – health care costs, productivity losses and other costs - was $193.8 billion (ONDCP Update, June 2011). Furthermore, substance abuse creates a strain on, and limits the effectiveness of those institutions, which are designed to help people, such as hospitals and mental health care facilities. Bexar County is not unlike most other large metropolitan areas in that drugs and alcohol are a significant problem. This needs assessment should serve as a comprehensive snapshot of Bexar County and as a tool for substance use prevention. The purpose is to describe demographic characteristics, identify both risk and protective factors, and to discover substance use consumption patterns
  5. 5. www.sacada.org 5 COSA Needs Assessment June 2014 and consequences. The coalition needs assessment also aims to document gaps and resources so we can better shape prevention in our community and capitalize on existing efforts. While the information contained within provides us with baseline data which serves to aid COSA in prioritizing problem areas so that we can strategically target prevention efforts, we also encourage community stakeholders in drug and alcohol prevention to use this needs assessment in their own work and to help us to improve it if needed.
  6. 6. www.sacada.org 6 COSA Needs Assessment June 2014 Part I – Geographic / Target Population Bexar County is the 4th largest county in Texas with a population of over 1.785 million. Bexar County consists of 27 cities and municipalities of which San Antonio is the county seat. The 2012 population estimate of San Antonio is 1,382,951, (a 4.2% increase between April 1, 2010 and July 1, 2012 compared to only a 3.6% increase for the state of Texas during that same time period) and is the largest metropolitan area in Bexar County. As the central region of the San Antonio Metropolitan Statistical Area (MSA), Bexar County serves as an area of social and economic integration for its adjacent counties – Kendall, Bandera, Medina, Atascosa, Wilson, Guadalupe and Comal. Table 1 shows 2009-2011 general demographic figures for Bexar County, from the Census
  7. 7. www.sacada.org 7 COSA Needs Assessment June 2014 Census Bureau’s 3-Year American Community Survey estimates. DP05: ACS DEMOGRAPHIC AND HOUSING ESTIMATES 2010-2012 American Community Survey 3-Year Estimates Subject Texas Bexar County, Texas San Antonio city, Texas Estimate Estimate Estimate SEX AND AGE Total population 25,644,550 1,754,058 1,358,143 Male 12,729,073 861,044 661,308 Female 12,915,477 893,014 696,835 Under 5 years 1,933,935 130,982 100,588 5 to 9 years 1,954,052 131,499 100,506 10 to 14 years 1,915,750 130,776 98,675 15 to 19 years 1,884,763 132,316 101,206 20 to 24 years 1,875,333 137,960 111,418 25 to 34 years 3,686,704 261,870 206,401 35 to 44 years 3,506,544 234,263 176,115 45 to 54 years 3,445,849 229,520 177,643 55 to 59 years 1,468,038 96,875 75,374 60 to 64 years 1,251,062 84,289 63,694 65 to 74 years 1,555,124 101,742 80,386 75 to 84 years 845,579 57,709 46,479 85 years and over 321,817 24,257 19,658 Median age (years) 33.8 33.0 32.8 18 years and over 18,716,209 1,283,988 999,364 21 years and over 17,555,099 1,200,073 934,600 62 years and over 3,449,337 232,554 183,421 65 years and over 2,722,520 183,708 146,523 18 years and over 18,716,209 1,283,988 999,364 Male 9,188,796 621,552 477,603 Female 9,527,413 662,436 521,761 65 years and over 2,722,520 183,708 146,523 Male 1,193,661 78,155 61,271 Female 1,528,859 105,553 85,252 RACE Total population 25,644,550 1,754,058 1,358,143 One race 25,063,369 1,702,180 1,322,402 Two or more races 581,181 51,878 35,741 One race 25,063,369 1,702,180 1,322,402 White 19,116,593 1,315,323 1,020,761 Black or African American 3,030,320 127,092 90,907
  8. 8. www.sacada.org 8 COSA Needs Assessment June 2014 American Indian and Alaska Native 129,874 13,540 11,031 Cherokee tribal grouping 16,338 891 696 Chippewa tribal grouping 1,192 134 116 Navajo tribal grouping 2,881 582 447 Sioux tribal grouping 2,575 523 272 Asian 1,010,831 42,698 30,501 Asian Indian 263,050 9,475 7,227 Chinese 166,908 6,010 4,582 Filipino 103,685 8,734 5,331 Japanese 19,116 2,205 1,922 Korean 75,450 4,030 2,721 Vietnamese 225,925 5,131 4,495 Other Asian 156,697 7,113 4,223 Native Hawaiian and Other Pacific Islander 21,954 2,378 1,719 Native Hawaiian 7,234 553 420 Guamanian or Chamorro 6,609 1,100 939 Samoan 2,598 324 231 Other Pacific Islander 5,513 401 129 Some other race 1,753,797 201,149 167,483 Two or more races 581,181 51,878 35,741 White and Black or African American 132,433 10,637 6,911 White and American Indian and Alaska Native 116,914 7,110 4,743 White and Asian 95,639 8,800 6,039 Black or African American and American Indian and Alaska Native 19,609 885 550 Race alone or in combination with one or more other races Total population 25,644,550 1,754,058 1,358,143 White 19,611,359 1,357,565 1,050,382 Black or African American 3,232,576 146,078 103,098 American Indian and Alaska Native 296,040 24,884 19,122 Asian 1,158,983 57,714 40,272 Native Hawaiian and Other Pacific Islander 46,585 4,821 3,192 Some other race 1,915,405 218,451 180,720 HISPANIC OR LATINO AND RACE Total population 25,644,550 1,754,058 1,358,143 Hispanic or Latino (of any race) 9,741,366 1,034,687 859,533 Mexican 8,543,694 932,457 779,605 Puerto Rican 140,745 20,780 14,803 Cuban 52,920 3,838 3,026 Other Hispanic or Latino 1,004,007 77,612 62,099 Not Hispanic or Latino 15,903,184 719,371 498,610 White alone 11,481,091 524,036 361,500 Black or African American alone 2,956,974 120,864 86,267 American Indian and Alaska Native alone 68,615 3,668 2,616 Asian alone 996,546 40,995 29,275 Native Hawaiian and Other Pacific Islander alone 18,402 1,649 1,082 Some other race alone 33,049 2,664 1,933 Two or more races 348,507 25,495 15,937
  9. 9. www.sacada.org 9 COSA Needs Assessment June 2014 Two races including Some other race 18,975 1,478 972 Two races excluding Some other race, and Three or more races 329,532 24,017 14,965 Total housing units 10,073,268 667,117 529,614 Of the population 16 and over in Bexar County, 65.3% were in the labor force in 2011 according to the American Community Survey. Table 2 illustrates employment by sector for the greater San Antonio Area. Between August 2012 and August 2013, in the San Antonio Metropolitan Statistical Area, there modest increases or no change in employment, with only the Financial Activities and the Professional, Business & Other Services sectors showing decreases. According to the 2009-2011 American Community Survey, the number of Armed Forces personnel that reside in Bexar County is estimated to be 1.9% of the labor force or 363,238 persons. The remainder of San Antonio’s Department of Defense workforce is civil servants and subcontractors. Table 2 San Antonio Employment by Sector Industry May ‘14 Apr '14 May '13 Change Education and Health Services 135,300 135,400 134,700 From May '13 Education Services 142,200 140,800 138,900 2.38% Leisure and hospitality Services 124,900 121,400 119,000 4.96% Financial Activities 76,700 75,700 75,700 1.32% Retail Trade 102,800 102,500 99,500 3.32% Government 162,500 163,000 162,200 0.18% Professional, Business & Other Svcs. 113,500 114,500 109,600 3.56% Transportation, Warehousing and Utilities 23,500 23,300 22,700 3.52% Source: Texas Labor Market Review May 2014
  10. 10. www.sacada.org 10 COSA Needs Assessment June 2014 Part II – Prevention Resource, Capacities and Gaps a. Prevention Resource Center In July 2014, the San Antonio Council on Alcohol and Drug Abuse was awarded a DSHS Prevention Resource Center (PRC) grant to be a clearing house of Substance Abuse data and resources for Region 8. The data the coalition has already obtained will be shared with the PRC and will work on promoting the use of the Texas School b. Other Coalitions The city of San Antonio is home to four Drug Free Communities Grantees. Bethel Community Development Corporation was awarded in 2013, Circles of San Antonio Community Coalition was awarded in 2014 along with East Point Promise Prevention Coalition and George Gervin Youth Center-project alert. The DSHS funding for the San Antonio Tobacco Prevention and Control Coalition (SATPCC) ended in August 2013. As a result of strategic planning conducted during FY-13 the SATPCC has scaled back their goals to continue serving the community. SATPCC provides technical assistance for implementing the Teens Against Tobacco Use curriculum in five area high schools through Family Service Association and in youth community centers across Bexar County through SACADA their youth component HYPE. SATPCC will also continue to work with local law enforcement to reduce tobacco sales to minors. COSA maintains an active membership status in the SATPCC and the former SATPCC Coordinator is now the COSA Coalition Specialist. In summer 2014 TATU training was facilitated to train new instructors in the schools. American Lung Association coordinated the training. The San Antonio Police Department has implanted the SA Team DWI as a combined law enforcement effort to reduce DWI rates and fatalities associated with alcohol use. SA Team DWI matches current data related to DWI and motor vehicle incidences to strategically place
  11. 11. www.sacada.org 11 COSA Needs Assessment June 2014 DWI saturation patrols and Texas Alcoholic Beverage Commission seller-server compliance checks. The Bexar County District Attorney’s office has implemented a full time year round no- refusal initiative for alcohol intoxication checks across Bexar County. COSA maintains an active partnership with SA TEAM DWI. A number of community-based coalitions exist within Bexar County and most have a stake in addressing alcohol and other drugs. Four coalitions exist in Bexar County for reducing alcohol related motor vehicle fatalities: COSA, the Shattered Dreams Coalition, the Bexar County DWI Taskforce and The Texas Department of Transportation Traffic Jam Coalition. Other coalitions that are an important part of prevention in Bexar County are the Healthy Futures Alliance and the Men’s Health Coalition. The Healthy Futures Alliance serves to prevent teen pregnancy, and unplanned pregnancy among young adults in San Antonio. The Men’s Health Coalition addresses issues surrounding access to medical services. The San Antonio Coalition for Veterans and Families provides networking with Veterans Service Agencies and addresses gaps. c. Other State and Federally Funded Programs COSA maintains an active member of Texans Standing Tall (TST), a statewide coalition and is an active member on the TST statewide strategy team. COSA utilizes Texans Standing Tall as their technical assistance provider for strategic planning and environmental strategy process to reduce underage alcohol access and use and replicates the same strategies that are currently being implemented in communities across the state. In 2014 the Texas Counter Drug Task Force-National Guard conducted a Kaizan Model self- assessment of our coalition and results will be available in Fall 2014.
  12. 12. www.sacada.org 12 COSA Needs Assessment June 2014 d. School Programs Communities in Schools of San Antonio (CIS-SA), a non-profit organization, provides on campus Case Managers and Social Workers to operate programs in 74 schools across Bexar County covering 7 School Districts and additionally the Bexar County Juvenile Justice Academy at the Bexar County Juvenile Detention Center and 1 IDEA campus to work directly with at risk students and families with the goal of increasing retention and graduation rates of students. The identified districts are San Antonio ISD, Edgewood ISD, Harlandale ISD, Northeast ISD, Northside ISD, South San ISD, and Somerset ISD. All of these districts have been identifies through a process of evaluating socio-economic status, risk and protective factors, and past year graduation rates. COSA and SACADA maintain a current Memorandum of Understanding with CIS-SA and are available to provide ATOD information directly to students and parents through their site offices. Family Service Association (FSA) is funded by DSHS to conduct Youth Prevention for 2 Indicated populations with Project Towards No Drug Abuse ages 14-19 and Curriculum Based Support Group for ages 11-17 and one Youth Prevention for a Selective Population using the Positive Curriculum. COSA is currently discussing the ability of FSA to expand the outreach of ZAYC program to make it available for their High School and campus groups. In addition FSA is implementing the Teens Against Tobacco Use (TATU) as part of the Youth Against Gang Activity (YAGA) activities on the High School Campuses they service. Family Violence and Prevention Services is funded by DSHS to conduct Reconnecting Youth Curriculum with a Indicated Populations ages 14-19. JOVEN is funded by DSHS to conduct Youth Prevention for a Selective Population Postive Action with 6-9 year olds and 9-18 year olds
  13. 13. www.sacada.org 13 COSA Needs Assessment June 2014 San Antonio Council on Alcohol and Drug Abuse is funded by DSHS to provide Youth Prevention to three Universal Populations utilizing Life Skills Training Curriculum with ages 8-9 and 9-12 year olds, Too Good For Drugs with 9-18 year olds, and Project Toward No Drug Abuse with 14-19 year olds. SACADA also serves a Selective population with Curriculum Based Support Group with 6-9 and 9-17 year olds. With the Indicated Population Project Toward No Drug Abuse is also used serving ages 14-19 year olds. COSA and Texans Standing Tall are currently in dialogue with Claudia Taylor Johnson HS to implement the Zero Alcohol for Youth Campaign on their campus through the Winner’s Club. Johnson High School is located in the northern most area of San Antonio and is one of the newest High Schools in Bexar County. The same geographic area has been identified by the SAPD as a consistent hot spot for DWI related incidences and school district personnel have identified their biggest problem to be underage access to alcohol. Most Colleges and universities in San Antonio have alcohol awareness and prevention resources and programs in place that encompass some form of the CSAP six prevention strategies. The University of Texas is working on Environmental strategies as well as information dissemination. Community Programs and Services e. Parent Programs The Circles of San Antonio will maintain their collaboration with Communities in Schools of San Antonio. Through CIS-SA campus operations, COSA will be available as a resource to provide ATOD awareness and community education to their parent support network. COSA is available to PTA groups for ATOD presentations for awareness and under-age alcohol use prevention.
  14. 14. www.sacada.org 14 COSA Needs Assessment June 2014 f. Direct Prevention Service Providers In Bexar County there are four agencies that are funded by DSHS to conduct prevention programing- Family Service Association, Family Violence Prevention Services, JOVEN, and the San Antonio Council on Alcohol and Drug Abuse. These are listed in the School Based Providers section. g. Treatment Providers In 2013, the Recovery Systems of Care (ROSC) was awarded a grant initiative to form a Recovery Web Portal and enlist recovery coaches for one on one service to the recovery community. The group is starting a adolescent ROSC. COSA serves as an active partner on the Alamo Area Recovery Initiative. COSA is also a partner with the San Antonio Addiction to Recovery Coalition and assists the organization of the 3-5K Recovery Walk. The mission of the 3-5K Recovery Walk is to raise awareness of Recovery Support Services available in the community. The University of Health Science Center San Antonio received a 1115 Waiver to provide substance abuse treatment with adolescents, they completed their Problem Identification and Community Needs Assessment of Youth Substance Use Treatment in August 2014. One of the key finding is that Bexar County would benefit from increased data collection on youth substance use. Currently, nine facilities offer youth substance use treatment in Bexar County, and six offer substance use-specific programs. The table below shows the nine existing programs and whether they (a) have a specific youth substance use program; (b) offer residential and/or outpatient programs; and (c) offer individual, family, and/or group therapy, and/or (d) offer continued care. Table 24. Existing Youth Substance Use Treatment Programs
  15. 15. www.sacada.org 15 COSA Needs Assessment June 2014 Max # of Patients Substance- Use Spec. Prog Residential (R) or Outpatient (OP) Individual (I), Family (F), or Group (G) Continued Care (CC) Alpha Home 47 R & OP I & G Center for Health Care Services N/A Y OP G Elite Counseling N/A Y OP I & G Family Services (Keeping It Real) 33 Y OP I &F CC Laurel Ridge N/A R & OP I, F, & G Palmer Drug Abuse Program N/A Y OP I & G Project Tejas 50 Y OP I, F, & G SA Counseling & Beh Center 50 OP I & F Selena Center for Youth Potential 16 Y R I, F, & G h. Healthcare Providers COSA has met with the epidemiology team of the San Antonio Metropolitan Health District (SAMHD). Through this partnership COSA is able to work with the SAMHD on data sharing and strategic alignment of service initiatives that correlate with health disparities. COSA is a member of the Bexar County Health Collaborative, a combined collaborative effort to identify and direct services for the most needed health services of Bexar County residents. i. Higher Education Prevention Most Colleges and universities in San Antonio have alcohol awareness and prevention resources and programs in place. COSA has a well-established working relationship with several Higher Educational Institutions and active membership from UTSA, University of Incarnate Word, St, Mary’s University, and Alamo Community College District. COSA will continue to work with local colleges and universities to provide prevention and educational support to the campuses.
  16. 16. www.sacada.org 16 COSA Needs Assessment June 2014 The University of Texas at San Antonio (UTSA) is the newest higher education campus to adopt a smoke-free campus wide policy. This policy has been in a phase in status beginning on June 1, 2013 and will take full effect on June 1, 2014 for the main campus and the downtown campus as well as any satellite campus. In addition, UTSA Student Activities Department and Be A Responsible Roadrunner student organization host Alcohol Awareness Week Programs and other student led initiatives that have become staple events with the purpose of educating students about campus policy and state law regarding alcohol, reducing alcohol violations on campus and reducing high risk drinking among college students. The University Of Incarnate Word Office Of Student Health Services conducts alcohol awareness activities on campus and hosts “SOBER Roads” a yearly campus wide health fair. Several of the professors require their students to attend the health fair and complete a research study on alcohol use and consequences utilizing information form the resource providers attending the health fair. j. Law Enforcement COSA has a well-established working relationship with local law enforcement agencies. COSA’s extensive network of relationships involves the San Antonio Police Department, San Antonio Team DWI, Bexar County DWI Task Force, Alamo Area Council of Governments Law Enforcement Academy, Texas Comptroller’s Office Criminal Investigations Division, The University of Texas at San Antonio Police Department, local school district police and municipal police departments. In Bexar County, there are 25 municipal city jurisdictions and COSA is continually trying to network with these smaller departments such as Alamo Heights, Leon Valley, and Balcones Heights just to name a few. In 2012 the Bexar County voters elected a new Sheriff and this change resulted in an administrative and structure change to the operations of the Bexar County Sheriff’s Office. COSA is currently working to strengthen the relationship
  17. 17. www.sacada.org 17 COSA Needs Assessment June 2014 with the Sheriff’s Office and has plans for meeting with the Sheriff to discuss environmental strategies that are currently being work on. Gaps in Service We feel that a priority for prevention is continuum of care. In order to address risk factors and maximize protective factors, ideally there should be a continuum of care which includes a network of providers. Not only does this prevent duplication of services, but it makes for a more cost effective and efficient use of resources. However, in order to even consider what gaps in service there are, there first must be recognition that a problem exists and risk factors need to be prioritized. A continuum of prevention across the life span is a gap that prevents co-morbidity, relapse, disability and the consequences of severe mental illness. In addition, it is commonly accepted that individuals are most at risk for substance use and abuse at “transition” points in their life and at key stages across the life span cycle. We also know that drug use and alcohol abuse exists within the workplace and is costly to employers and the community alike. Having prevention programs for the workplace is a good use of prevention resources that can have a greater economic and social impact. San Antonio Metropolitan Health Collaborative has identified four areas of priority that currently are not being addressed: 1) Lack of public health resources to study substance-exposed infants. 2) Lack of hospital data on the type of substance abuse and cost. 3) Lack of consistent standards in substance abuse treatment programs that treat pregnant women. 4) Harm reduction programs to help prevent infectious diseases such as needle exchange programs. Texas eliminated the Safe and Drug Free Communities grants to schools. We feel that many of the schools in San Antonio are reluctant to implement DSHS funded programs on their
  18. 18. www.sacada.org 18 COSA Needs Assessment June 2014 campuses because it might attach a stigma that their schools have a drug and alcohol problem. Educating the educators is something that needs to take place in all communities because the objective evidence shows that no community, regardless of socio-economic stature, is immune from the destructive influence of alcohol and drugs. One of our biggest concerns is lack of data needed to help us understand the entire scope of drug and alcohol use in Bexar County. Having a more comprehensive, data-driven, picture of prevention needs in the community would enable us to better target prevention efforts. It is important to emphasize that Bexar County lacks a local infrastructure for collaborating on data collection and analysis; this includes the sharing of data between agencies. Bexar County is home to eleven colleges and universities. In order to address risky behavior among college students in Bexar County, we need uniform data across all campuses. The Core Survey is one such tool that would make uniform data available. A short term goal for COSA is to motivate colleges in Bexar County to administer the Core Survey. Additionally, since armed forces personnel are represented in significant numbers in Bexar County, greater collaboration with the military for prevention and data would be equally as beneficial. From our own experience, SACADA envisions a culture of prevention where agencies are not operating so much in silos, but collaborating and sharing resources. Even though there has been much headway in this direction, there is still a lot of work to do Part III – Consequences and Consumption Patterns of the Community a. DWI Rates The graphs that follow on the next several pages highlight pertinent data points taken from the San Antonio Police Department and the Bexar County Sherriff’s Office. These graphs show DWI trends and patterns in San Antonio and Bexar County. DWI arrests have increased in recent
  19. 19. www.sacada.org 19 COSA Needs Assessment June 2014 years and there has also been a increase in enforcement by SAPD. Still, a priority intervening variable to be considered for prevention interventions in Bexar County should be low enforcement. Thirty-eight is the mean age for persons arrested for DWI in Bexar County and that the average BAC (Blood Alcohol Concentration) of those arrested is .151, nearly twice the legal limit (Bexar County Sherriff’s Office). Most arrestees are by far, first time offenders (Graph 3). Graph 3 Source: Bexar County Sheriff’s Office 68% 14% 7% 7% 4% Bexar County DWI Disposition 2007-2011 Five Year Average DWI-1ST DWI-2ND DWI-3RD DUI-MINOR UNKNOWN
  20. 20. www.sacada.org 20 COSA Needs Assessment June 2014 Graph 5 Source: San Antonio District Attorney’s office Source: San Antonio Police Department 2009 2010 2011 2012 2013 Arrests 6095 6872 6873 7517 7712 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 AxisTitle DWI Arrest Data by Year
  21. 21. www.sacada.org 21 COSA Needs Assessment June 2014 b. Alcohol Related Vehicular Fatalities In 2011, Bexar County was in the lower third of counties within the state for number of alcohol- related crash fatalities, with a rate of 4.50 fatalities per 100,000 residents. The following graphs illustrate Bexar County’s alcohol-related crash fatality trend compared to that of Texas and the United States. The data was collected from the National Highway Traffic Safety Administration and “alcohol-related crash fatality” is defined as a fatality that resulted from a crash that involved at least one driver or motorcycle rider with a BAC (Blood Alcohol Concentration) of .08 or above. Although Bexar County had shown a 10% decrease in fatalities between 2007 and 2009, it has since spiked well above the state and national average in 2010. Source: National Highway Traffic Safety Administration 2008 2009 2010 2011 2012 Bexar County 46% 42% 53% 53% 48% Texas 38% 41% 42% 40% 38% United States 31% 32% 31% 30% 31% 0% 10% 20% 30% 40% 50% 60% % Alcohol Related Motor Vehicle Fatalities
  22. 22. www.sacada.org 22 COSA Needs Assessment June 2014 2012 Bexar County Alcohol Related Crash Fatalities Source: NHTSA FARS Data (Bexar County, BAC >.08, Fatalities)
  23. 23. www.sacada.org 23 COSA Needs Assessment June 2014 Source: National Highway Traffic Safety Administration 2008 2009 2010 2011 2012 Bexar 74 64 80 80 78 Cameron 18 14 16 17 16 Dallas 99 73 82 71 84 El Paso 27 33 33 46 30 Harris 168 162 182 172 166 Tarrant 67 62 68 63 50 0 20 40 60 80 100 120 140 160 180 200 Texas Vehicular Alcohol Fatalities by County
  24. 24. www.sacada.org 24 COSA Needs Assessment June 2014 Source: National Highway Traffic Safety Administration 2008 2009 2010 2011 2012 Bexar 4.48 3.8 4.64 4.56 4.37 Cameron 4.58 3.5 3.92 4.12 3.85 Dallas 4.28 3.11 3.45 2.95 3.42 El Paso 3.51 4.19 4.11 5.62 3.63 Harris 4.27 4.02 4.43 4.12 3.9 Tarrant 3.84 3.48 3.74 3.41 2.66 2 2.5 3 3.5 4 4.5 5 5.5 6 Texas Vehicular Alcohol Fatalities by County Per 100,000
  25. 25. www.sacada.org 25 COSA Needs Assessment June 2014 c. Violent Crimes Source: Bexar County Juvenile Probation Source: Bexar County Juvenile Probation 2009 2010 2011 2012 2013 Murder/Manslaughter 5 3 2 4 3 Attempted Murder 0 1 0 0 0 0 1 2 3 4 5 6 Bexar County Juvenile Probation Violent Referrals 2009 2010 2011 2012 2013 Sexual Assault, related 82 92 88 87 89 Robbery 58 56 50 42 34 Aggravated Assault 203 198 197 152 147 0 50 100 150 200 250 Bexar County Juvenile Probation Violent Referrals cont.
  26. 26. www.sacada.org 26 COSA Needs Assessment June 2014 Source: UCR Crime Data FBI.gov Violent crime Murder and nonnegl igent manslau ghter Forcible rape Robbery Aggrava ted assault Propert y crime Burglary Larceny- theft Motor vehicle theft Arson Bexar 487 10 70 99 308 6,398 2,081 3,865 452 80 Cameron 143 4 15 19 105 1,732 619 1,027 86 19 Dallas 51 0 2 6 43 296 91 181 24 0 El Paso 250 5 28 23 194 1,260 303 829 128 13 Harris 7,416 77 295 2,744 4,300 52,551 13,848 32,259 6,444 331 Tarrant 126 1 17 12 96 1,246 411 746 89 15 0 10,000 20,000 30,000 40,000 50,000 60,000 2012 Offenses Known to Law Enforcement
  27. 27. www.circlesofsa.org 27 COSA Needs Assessment September 2014 TEXAS Full-time Law Enforcement Employees 2012 County Total law enforcement employees Total officers Total civilians Bexar 1,627 527 1,100 Cameron 502 112 390 Denton 583 234 349 El Paso 1,126 258 868 Source: FBI.gov d. Possession of illicit drugs (arrests) Source: Texas Department of Public Safety (2012 Crime in Texas) Synthetic Narcotics 52% Marijuana 12% Other 11% Opium or Cocaine 25% Drug Sale & Manufacturing Arrests by Drug Type
  28. 28. www.sacada.org 28 COSA Needs Assessment June 2014 Source: Texas Department of Public Safety (2012 Crime in Texas) e. Public Intoxications Source: Texas Department of Public Safety Sythetic Narcotics 8% Opium or Cocaine 19% Other 15% Marijuana 58% Drug Possession Arrests by Drug Type 2008 2009 2010 2011 2012 Drunkeness 145184 142631 131565 118451 114436 Liquor Laws 31366 29292 26797 24062 22889 Driving Under the Influence 94248 96350 94440 87644 89256 Texas Arrest Data for Alcohol Involved Crimes
  29. 29. www.sacada.org 29 COSA Needs Assessment June 2014 f. Suicide Rates Suicides - Drugs Alcohol 2007 2008 2009 2010 2011 2012 2013 Alcohol Only 18 27 34 * * * * Drugs Only 64 59 75 * * * * Drugs and Alcohol 27 31 32 19 27 23 27 Total Tests Performed 163 172 204 199 194 206 198 *The M.E. no longer reports on Alcohol Only or Drugs Only, instead they classify as Drug(s)/Chemical(s). g. Homicide Rates Homicides - Drugs Alcohol 2007 2008 2009 2010 2011 2012 2013 Total Performed 159 175 151 124 118 136 137 Source: Bexar County Medical Examiner Annual Reports 2008 2009 2010 2011 2012 2013 Homicide 175 151 124 118 136 137 Suicide 172 204 119 194 206 198 0 50 100 150 200 250 Manner of Death - Bexar County
  30. 30. www.sacada.org 30 COSA Needs Assessment June 2014 j. Underage binge drinking rates Combined school district data taken from the Texas Education Agencies (TEA) Public Education Information Management System (PEIMS) data shows that there was a decrease in controlled substance violations during the 2010-2011 school year (See Graph 10). Additionally controlled substance violations are markedly more common an offense than either alcohol or tobacco. Alcohol violations, also from PEIMS, showed a 6% increase from 08-09 to 09-10, at its highest since 05-06 but dropped off during 10-11 (See Graph 11). Tobacco violations showed an 11% increase from 08-09 to 09-10 but dropped off during 10-11 nearing the 08-09 levels (See Graph 12). Submission of PEIMS data to the TEA is required by all school districts in the state of Texas and the reporting requirements are uniform. Furthermore, for the graphs below, yearly rates were adjusted for school enrollment growth which has increased by 10% since the 05-06 school year.
  31. 31. www.sacada.org 31 COSA Needs Assessment June 2014 TEXAS EDUCATION AGENCY PEIMS Discipline Data for 2012-2013 04-CONTROLLED SUBSTANCE/DRUGS 05-ALCOHOL VIOLATION 33-TOBACCO Alamo Heights ISD 20 25 n/a Boerne ISD 39 9 n/a East Central ISD 64 n/a 8 Edgewood ISD 127 n/a 8 Ft. Sam Houston ISD n/a not reported n/a Harlandale ISD 133 n/a n/a Judson ISD 203 11 n/a Lackland ISD n/a not reported not reported North East ISD 463 54 61 Northside ISD 633 40 68 San Antonio ISD 621 18 132 Somerset ISD 17 9 n/a South San Antonio ISD 73 n/a not reported Southside ISD 42 n/a n/a Southwest ISD 104 6 5 Counts less than 5 and greater than 0, and, when necessary, other associated counts are masked with the value "N/A" to comply with FERPA. Source: http://ritter.tea.state.tx.us/adhocrpt/Disciplinary_Data_Products/Download_District_Summaries.html k. College age binge drinking The Behavioral Risk Factor Surveillance System (BRFSS) data for the San Antonio MSA (Metropolitan Statistical Area – See demographics section) shows that from 2005 to 2010 the binge drinking rates for adults 18 and over were higher than both the state and national rates. While the state and national binge drinking rates follow each other almost exactly and have remained relatively constant since 2005 (between 14% and 15%), the local rate started to show
  32. 32. www.sacada.org 32 COSA Needs Assessment June 2014 a decline from 19% in 2006 to 16.9% in 2008, but then sharply increased in 2009 to 21% (a 4% increase). Though there was a drop in 2010 numbers, the rate is still higher than in 2006 and could rebound again as the trend line indicates. As with binge drinking, state and national heavy drinking rates since 2006 have remained more or less constant at about five percent. Like binge drinking, heavy drinking remains higher, but not remarkably so, than the state and national rates. In 2010 the San Antonio heavy drinking rate was 8.2% while the state and national rates were 4.9% and 6.7%, respectively. In 2010, 57.4% of adults twenty-one and over in Bexar and surrounding counties reported having consumed alcohol within the past thirty days. As a SAMHSA grantee, the University of Texas San Antonio conducted a survey in 2014 with 395 students from undergraduate classes. (Sociology, political science, history, biology). 235 were ages 18-20 and of this number 48% reported drinking within the past 30 days. 32% of all participants said they used marijuana in the past year and 55/9% said it was easy to obtain drugs and alcohol in the community. Graph 2, shows Behavioral Risk Factor Surveillance system (BRFSS) results for respondents 18 years and older who reported having 5 or more drinks on one occasion in the past 30 days and Graph 2.1 shows heavy drinking behavior in the last 30 days for respondents 18 years and older.
  33. 33. www.sacada.org 33 COSA Needs Assessment June 2014 Source: Behavioral Risk Factor Surveillance System (BRFSS) 10.0% 15.0% 20.0% 25.0% 2005 2006 2007 2008 2009 2010 Nationwide Texas San Antonio Trend Line (San Antonio) Past 30 Day Binge Drinking At Risk
  34. 34. www.circlesofsa.org 34 COSA Needs Assessment September 2014 Prevalence of Binge Drinking San Antonio MSA Adults Ages 18 Years and Over Texas BRFSS, 2011 Area Groups Demographics Sample Size Percent Not at Risk (95% CI) Percent At Risk (95% CI) San Antonio MSA Totals Totals 1116 77.5 (72.3-81.9) 22.5 (18.1-27.7) Gender Male 420 72.2 (65.0-78.4) 27.8 (21.6-35.0) Female 696 82.6 (74.4-88.6) 17.4 (11.4-25.6) Race/Ethnicit y White 635 74.7 (66.1-81.7) 25.3 (18.3-33.9) Black 77 89.7 (74.0-96.4) 10.3 (3.6-26.0) Hispanic 360 77.8 (70.2-83.9) 22.2 (16.1-29.8) Other < 50 0.0 (-) 0.0 (-) Age Group 18-29 Years 85 56.5 (42.4-69.6) 43.5 (30.4-57.6) 30-44 Years 221 78.2 (70.0-84.6) 21.8 (15.4-30.0) 45-64 Years 413 83.9 (77.9-88.5) 16.1 (11.5-22.1) 65+ Years 390 94.7 (88.6-97.6) 5.3 (2.4-11.4) Education < High School 96 77.2 (61.4-87.8) 22.8 (12.2-38.6) High School Grad 259 85.0 (76.6-90.7) 15.0 (9.3-23.4) Some College 333 71.1 (60.0-80.1) 28.9 (19.9-40.0) College Grad 424 78.3 (71.3-84.1) 21.7 (15.9-28.7) Income < $25,000 293 80.3 (71.1-87.1) 19.7 (12.9-28.9) $25,000-$49,999 244 73.8 (64.3-81.5) 26.2 (18.5-35.7) $50,000 + 450 81.7 (75.1-86.8) 18.3 (13.2-24.9)
  35. 35. www.circlesofsa.org 35 COSA Needs Assessment September 2014 l. Current 30 day drinking rates Source: Behavioral Risk Factor Surveillance System (BRFSS) 0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00% 7.00% 8.00% 9.00% 10.00% 2004 2005 2006 2007 2008 2009 2010 Past 30 Day Heavy Drinking Nationwide Texas San Antonio
  36. 36. www.sacada.org 36 COSA Needs Assessment June 2014 2010 Youth Risk Behavior Survey Results Percentage of students who had at least one drink of alcohol on one or more days during their life CPPW: San Antonio, TX High School Survey Percentage of students who had at least one drink of alcohol on one or more of the past 30 days CPPW: San Antonio, TX High School Survey 72.6 68.9 76.4 61.4 75.3 78.2 80.5 62.9 74.2 72.7 0 20 40 60 80 100 Total Male Female 9th 10th 11th 12th Black*Hispanic/…White* 37.7 34.7 41.0 29.2 38.0 42.5 45.3 22.2 40.1 37.5 0 20 40 60 80 100 Total Male Female 9th 10th 11th 12th Black*Hispanic/…White*
  37. 37. www.sacada.org 37 COSA Needs Assessment June 2014 m. Current 30 day illicit drug use rates Percentage of students who used marijuana one or more times during the past 30 days CPPW: San Antonio, TX High School Survey Percentage of students who were offered, sold, or given an illegal drug by someone on school property during the past 12 months CPPW: San Antonio, TX High School Survey 23.5 27.0 19.9 17.7 23.7 27.5 28.2 15.3 25.7 19.9 0 20 40 60 80 100 Total Male Female 9th 10th 11th 12th Black*Hispanic/…White* 29.7 29.3 30.1 26.6 29.8 32.7 30.7 19.1 32.4 26.1 0 20 40 60 80 100 Total Male Female 9th 10th 11th 12th Black*Hispanic/…White*
  38. 38. www.circlesofsa.org 38 COSA Needs Assessment September 2014 n. Perceptions of harmfulness of use (alcohol and other substances) How dangerous do you think it is for kids your age to use... Never heard of Very dangerous Dangerous Not at all dangerous Do not know Any tobacco product? All 1.70% 78.00% 16.60% 0.50% 3.20% Grade 4 3.80% 82.00% 11.30% 0% 3.00% Grade 5 0.70% 82.80% 14.90% 0% 1.50% Grade 6 0.50% 69.30% 23.70% 1.50% 5.00% Cigarettes? All 2.70% 67.70% 24.70% 0.80% 4.10% Grade 4 5.30% 73.50% 18.20% * 3.00% Grade 5 1.50% 71.40% 24.10% * 3.00% Grade 6 1.30% 58.10% 31.90% 2.30% 6.30% Smokeless tobacco? All 9.40% 65.80% 17.60% 0.90% 6.30% Grade 4 21.70% 62.80% 10.10% 0.80% 4.70% Grade 5 3.80% 74.80% 16.00% * 5.30% Grade 6 2.80% 59.80% 26.60% 2.00% 8.80% Source: San Antonio, TX NISD Texas School Survey 2012 How dangerous do you think it is for kids your age to use tobacco? Very dangerous Somewhat dangerous Not very dangerous Not at all dangerous Do not know All 56.10% 26.80% 9.10% 2.90% 5.20% Grade 7 71.80% 18.30% 2.80% 1.40% 5.60% Grade 8 65.80% 15.20% 6.30% 1.30% 11.40% Grade 9 54.70% 28.10% 9.00% 2.30% 5.80% Grade 10 52.10% 30.60% 10.70% 5.00% 1.70% Grade 11 49.70% 33.30% 10.50% 2.90% 3.50% Grade 12 43.00% 35.50% 14.70% 4.30% 2.40% Source: San Antonio, TX NISD Texas School Survey 2012
  39. 39. www.sacada.org 39 COSA Needs Assessment June 2014 How dangerous do you think it is for kids your age to use... Never heard of Very dangerous Dangerous Not at all dangerous Do not know Any alcohol product? All 1.10% 70% 21.60% 2.50% 4.80% Grade 4 2.30% 80% 12.90% * 5.30% Grade 5 0.70% 71.10% 22.20% 2.20% 3.70% Grade 6 0.40% 59.40% 29.60% 5.20% 5.30% Beer? All 0.90% 50.40% 33.70% 5.90% 9.10% Grade 4 2.40% 60.30% 27.80% 0.80% 8.70% Grade 5 0.00% 51.90% 32.60% 6.20% 9.30% Grade 6 0.40% 39.10% 40.60% 10.60% 9.30% Wine coolers? All 15.00% 43.90% 23.50% 4.80% 12.80% Grade 4 20.00% 52.30% 16.90% 0.80% 10.00% Grade 5 16.20% 43.10% 23.10% 3.10% 14.60% Grade 6 8.80% 36.30% 30.60% 10.50% 13.70% Wine? All 2.00% 47.80% 29.30% 10.40% 10.50% Grade 4 4.60% 58.50% 25.40% 6.20% 5.40% Grade 5 0.80% 49.25% 27.30% 9.40% 13.30% Grade 6 0.60% 35.80% 35.00% 15.60% 13.00% Liquor? All 6.70% 61.80% 22.90% 2.50% 6.20% Grade 4 13.20% 64.30% 16.30% 0.00% 6.20% Grade 5 4.70% 66.70% 22.50% 2.30% 3.90% Grade 6 2.20% 54.50% 29.80% 5.20% 8.40% Source: San Antonio, TX NISD Texas School Survey 2012 How dangerous do you think it is for kids your age to use alcohol? Very dangerous Somewhat dangerous Not very dangerous Not at all dangerous Do not know All 47.90% 31.40% 14.00% 3.20% 3.50% Grade 7 67.60% 11.30% 11.30% 4.20% 5.60% Grade 8 48.70% 28.90% 10.50% 3.90% 7.90% Grade 9 43.10% 32.60% 17.50% 3.00% 3.80% Grade 10 43.80% 33.10% 18.20% 4.10% 0.80% Grade 11 44.30% 39.50% 12.60% 1.80% 1.80% Grade 12 42.30% 42.10% 12.70% 1.60% 1.20% Source: San Antonio, TX NISD Texas School Survey 2012
  40. 40. www.sacada.org 40 COSA Needs Assessment June 2014 How dangerous do you think it is for kids your age to use marijuana Never heard of Very dangerous Dangerous Not at all dangerous Do not know All 15.50% 67% 9.10% 1.60% 6.60% Grade 4 27.00% 59% 6.30% * 7.90% Grade 5 15.60% 71.10% 7.80% 0.00% 5.50% Grade 6 4.30% 71.50% 12.90% 4.80% 6.50% Source: San Antonio, TX NISD Texas School Survey 2012
  41. 41. www.sacada.org 41 COSA Needs Assessment June 2014 How dangerous do you think it is for kids your age to use... Very dangerou s Somewhat dangerous Not very dangerous Not at all dangerous Do not know Marijuana? All 47.60% 17.20% 14.80% 17.70% 2.70% Grade 7 74.60% 11.30% 4.20% 5.60% 4.20% Grade 8 49.30% 19.20% 9.60% 19.20% 2.70% Grade 9 49.60% 15.80% 14.80% 16.30% 3.50% Grade 10 40.70% 16.30% 17.10% 24.40% 1.60% Grade 11 38.50% 20.70% 20.10% 18.30% 2.40% Grade 12 34.50% 20.10% 22.80% 20.90% 1.60% Cocaine? All 84.20% 8.40% 1.80% 1.10% 4.50% Grade 7 81.20% 5.80% 2.90% 2.90% 7.20% Grade 8 83.30% 9.70% 1.40% 0.00% 5.60% Grade 9 83.40% 9.20% 1.60% 0.70% 5.10% Grade 10 82.50% 10.80% 3.30% 1.70% 1.70% Grade 11 87.30% 6.70% 0.60% 0.60% 4.80% Grade 12 88.10% 7.40% 1.10% 0.70% 2.60% Crack? All 85.50% 7.60% 1.20% 0.70% 5.00% Grade 7 80.90% 10.30% 1.50% 1.50% 5.90% Grade 8 84.50% 5.60% 1.40% 0.00% 8.50% Grade 9 85.40% 7.10% 1.40% 0.90% 5.20% Grade 10 83.10% 11.90% 1.70% 0.80% 2.50% Grade 11 88.90% 4.90% 0.60% 0.60% 4.90% Grade 12 90.50% 5.40% 0.70% 0.50% 2.90% Ecstasy? All 74.80% 12.20% 3.20% 1.40% 8.40% Grade 7 81.80% 4.50% 3.00% 0.00% 10.60% Grade 8 76.40% 9.70% 0.00% 1.40% 12.50% Grade 9 73.40% 10.80% 4.20% 1.70% 9.80% Grade 10 68.10% 20.40% 3.50% 1.80% 6.20% Grade 11 74.40% 13.80% 3.10% 1.90% 6.90% Grade 12 75.80% 13.30% 5.10% 1.50% 4.30% Continued on next page…
  42. 42. www.sacada.org 42 COSA Needs Assessment June 2014 How dangerous do you think it is for kids your age to use... Very dangerous Somewhat dangerous Not very dangerous Not at all dangerous Do not know Steroids? All 74.00% 14.60% 4.30% 1.40% 8.40% Grade 7 80.30% 7.60% 6.10% 0.00% 10.60% Grade 8 77.50% 12.70% 0.00% 1.40% 12.50% Grade 9 71.60% 15.70% 4.60% 1.70% 9.80% Grade 10 72.20% 21.70% 2.60% 1.80% 6.20% Grade 11 69.90% 12.90% 8.00% 1.90% 6.90% Grade 12 73.70% 15.90% 5.10% 1.50% 4.30% Heroin? All 87.10% 5.40% 1.00% 0.90% 5.70% Grade 7 86.60% 3.00% 1.50% 1.50% 7.50% Grade 8 84.70% 6.90% 1.40% 0.00% 6.90% Grade 9 85.50% 5.58% 1.20% 0.70% 7.20% Grade 10 85.50% 9.40% 0.90% 1.70% 2.60% Grade 11 89.00% 3.70% 0.60% 0.60% 6.10% Grade 12 91.80% 3.50% 0.30% 0.70% 3.70% Source: San Antonio, TX NISD Texas School Survey 2012 2012 was the most recent year in which the Texas School Survey (TSS) of Drug and Alcohol Use was conducted in Bexar County. Only one school district was surveyed in 2012.
  43. 43. www.circlesofsa.org 43 COSA Needs Assessment September 2014 o. HIV infection rates and transmission route 2005 2006 2007 2008 2009 2010 Sexually Transmitted Diseases Cases Rate per 100k Cases Rate per 100k Cases Rate per 100k Cases Rate per 100k Cases Rate per 100k Cases Rate per 100k Chlamydia 7,400 501.2 7,594 488.2 8,054 505.1 8,849 545.3 10,440 632.2 11,455 668 Gonorrhea 2,184 147.9 2,562 164.7 2,465 154.6 2,898 178.6 3,401 205.9 3,520 205.3 Syphilis 422 28.6 438 28.2 384 24.1 550 33.9 705 42.7 670 39.1 HIV (not AIDS) Reports * 330 22.4 208 13.4 223 14 205 12.6 * * AIDS Reports ** 205 13.9 207 13.3 226 14.2 198 12.2 ** ** HIV Infection Diagnoses *** *** *** *** *** 312 18.9 253 14.8 AIDS Diagnoses **** **** **** **** **** 200 12.1 165 9.6 * HIV (not AIDS) cases were not tracked before 1999 in Texas ** AIDS cases are no longer presented by year of report as of 2009 *** Diagnoses of HIV infection regardless of disease satus (either HIV or AIDS) are presented by year ****Diagnoses of AIDS are presented by year of diagnosis as of 2009 Source: Bexar County Health Profiles 2010 (courtesy of Dr. Anil Mangla and John Berlanga
  44. 44. www.circlesofsa.org 44 COSA Needs Assessment September 2014 Primary and Secondary Syphilis Rates by Race/Ethnicity, United States, 2002–2011 Source: Syphilis in Bexar County (courtesy of Dr. Anil Mangla), Aug 14, 2013 Primary and Secondary Syphilis Rates, 2000-2012* Source: Syphilis in Bexar County (courtesy of Dr. Anil Mangla), Aug 14, 2013
  45. 45. www.sacada.org 45 COSA Needs Assessment June 2014 *2012 Local Preliminary Data 2-15-13 q. Treatment episode admission data Cannabis was the primary problem for 23 percent of admissions to treatment programs in 2012 compared with 8 percent in 1995. While 43 percent of cannabis admissions in 2012 reported no second substance abuse problem, 29 percent had a problem with alcohol. The average age of cannabis clients was 23. Approximately 43 percent were Hispanic, 25 percent were White, and 26 percent were Black; 72 percent were male. Seventy-eight percent were involved with the criminal justice system and only 13 percent were employed fulltime. (Source: Substance Abuse Trends in Texas: June 2013, Maxwell ) Source: Substance Abuse Trends in Texas: June 2013, Maxwell Texas Poison Center Network abuse and misuse calls involving the use of cocaine increased from 497 in 1998 to 1410 in 2008 and then declined to 552 in 2012 (exhibit 7). Sixty-five percent of the cocaine cases in 2012 were male and average age was 33. (Source: Substance Abuse Trends in Texas: June 2013, Maxwell )
  46. 46. www.sacada.org 46 COSA Needs Assessment June 2014 Source: Substance Abuse Trends in Texas: June 2013, Maxwell Calls to the Texas Poison Center Network involving confirmed exposures to heroin ranged from 181 in 1998 to 268 in 2012 (exhibit 11). Heroin was the primary drug of abuse for 13 percent of clients admitted to treatment in 2012 (Appendix 1). The characteristics of these users vary by route of administration, as exhibit 12 illustrates. Most heroin addicts entering treatment inject the drug, but the proportion inhaling heroin increased from 4 percent of all heroin admissions in 1996 to 18 percent in 2012. Smoking black tar heroin is very rare in Texas because the chemical composition tends to flare and burn rather than smolder. (Source: Substance Abuse Trends in Texas: June 2013, Maxwell ) Source: Substance Abuse Trends in Texas: June 2013, Maxwell Exhibit 14 shows the changes in race/ethnicity over the years. In 2011 and 2012, the proportion of White admissions increased and the proportion of Hispanic admissions decreased. (Source: Substance Abuse Trends in Texas: June 2013, Maxwell )
  47. 47. www.sacada.org 47 COSA Needs Assessment June 2014 Source: Substance Abuse Trends in Texas: June 2013, Maxwell The increase in young persons entering treatment for dependence on heroin is a concern. The proportion of heroin clients under age 30 increased from 40 percent in 2005 to 48 percent in 2012, while the proportion of older admissions decreased correspondingly (exhibit 13). The proportion of teenagers entering treatment remained low, but given the lag between first use and dependence, many of the admissions in their twenties began their heroin use as teenagers. (Source: Substance Abuse Trends in Texas: June 2013, Maxwell ) Source: Substance Abuse Trends in Texas: June 2013, Maxwell In 2012, there were 354 heroin poisoning deaths in Texas (exhibit 15). The decline in average age of the decedents from 40 in 2008 to 36 in 2012 is evidence of the increasing use by young adults. Of these deaths, 51 percent involved only heroin and 24 percent also involved cocaine. Of these decedents, 85 percent were male; 52 were White, 90 percent were Hispanic, and 8 percent were Black. (Source: Substance Abuse Trends in Texas: June 2013, Maxwell )
  48. 48. www.sacada.org 48 COSA Needs Assessment June 2014 Source: Substance Abuse Trends in Texas: June 2013, Maxwell
  49. 49. www.sacada.org 49 COSA Needs Assessment June 2014 s. Truancy data / drop out rates In Bexar County there are 14 school districts. In 2011, the average number of students that were determined by the Texas Education Agency (TEA) to be disadvantaged was sixty-six percent for a total of 219,165 students. Five school districts – Edgewood, Harlandale, San Antonio ISD, South San Antonio ISD and Southwest ISD - had on average, 90% of their students classified as economically disadvantaged. Also according to the TEA, in 2010 these same five school districts were among the top seven with the highest enrollment of Hispanic students (averaging collectively over 95%). In San Antonio, 2011, for the population represented by those 25 and older, only 15% attained a Bachelor’s degree, less than 7% earned an Associates or equivalent, 25% graduated from high school only with either a diploma or GED equivalent while 20% of that population never completed high school. These rates were nearly the same as those for Texas. For both African Americans (13%) and Hispanics (29%) the dropout rate, and the mean SAT score for those in high school were considerably worse than they were for Whites.
  50. 50. www.sacada.org 50 COSA Needs Assessment June 2014 Source TEA Website http://loving1.tea.state.tx.us/lonestar/selectdist.aspx?level=district Bexar County is home to 11 universities and colleges with a combined student population of over 371,000. AHISD BISD ECISD EISD FtSHI SD HISD JISD LISD NEISD NISD SAISD Some rISD SSanI SD SouSI SD SWIS D 2005-06 1.1% 0.3% 3.5% 8.4% 0.3% 2.7% 4.0% 0.0% 1.2% 3.3% 8.5% 4.6% 6.2% 4.8% 5.2% 2006-07 1.1% 0.2% 4.5% 4.8% 1.1% 3.5% 4.3% 0.6% 0.8% 3.2% 8.1% 6.7% 6.7% 5.7% 4.1% 2007-08 0.6% 0.2% 2.8% 4.0% 0.3% 2.5% 4.6% 0.0% 1.2% 1.7% 6.8% 2.1% 6.8% 6.7% 4.3% 2008-09 0.4% 0.0% 3.7% 5.8% 0.0% 4.5% 3.3% 0.5% 1.7% 1.0% 6.3% 3.7% 5.7% 4.8% 3.8% 2009-10 0.7% 0.1% 2.0% 5.3% 0.5% 3.2% 3.5% 1.2% 1.8% 1.0% 5.9% 4.6% 3.9% 3.8% 3.9% 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 9.0% Drop Out Rates Grades 9 - 12
  51. 51. www.circlesofsa.org 51 COSA Needs Assessment September 2014 Education Statistics by Bexar County School Districts 2011 Source: Bexar County Health Profiles 2011 (courtesy of Dr. Anil Mangla and John Berlanga
  52. 52. www.circlesofsa.org 52 COSA Needs Assessment September 2014 t. Texas School Survey Data Long Term Trends of Use by Texas Youth Grades 7-12 Texas SAISD NISD NISD Ever Used 2000 2010 % of Change 2000 - 2010 2012 % of Change 2010 - 2012 2010 % of Change 2010 State 2010 % of Change 2010 State 2012 % of Change 2010 State Alcohol 70.7% 61.8% -12.6% 58.0% -6.1% 59.0% -4.5% 68.0% 10.0% 62.0% 6.9% Tobacco 51.1% 30.5% -40.3% 28.0% -8.2% 23.0% -24.6% 34.0% 11.5% 26.0% -7.1% Marijuana 32.2% 26.2% -18.6% 15.0% -42.7% 13.0% -50.4% 19.0% -27.5% 24.0% 60.0% Texas SAISD NISD NISD Past Month Use 2000 2010 % of Change 2000 - 2010 2012 % of Change 2010 - 2012 2010 % of Change 2010 State 2010 % of Change 2010 State 2012 % of Change 2010 State Alcohol 36.1% 29.0% -19.7% 25.0% -13.8% 31.0% 6.9% 35.0% 20.7% 27.0% 8.0% Tobacco 22.4% 12.5% -44.2% 11.0% -12.0% 9.0% -28.0% 14.0% 12.0% 9.0% -18.2% Marijuana 13.7% 11.4% -16.8% 5.0% -56.1% 4.0% -64.9% 8.0% -29.8% 9.0% 80.0% Source: San Antonio, TX NISD Texas School Survey 2012
  53. 53. www.circlesofsa.org 53 COSA Needs Assessment September 2014 v. Tobacco sales to minors Total state minor tobacco stings recorded for the September 2012, through August 2013, period was 262. There are only two agencies, Precinct 3 Constable’s office and Bexar County Sheriff’s department, in Bexar County funded to do tobacco compliance stings in the county. Precinct 3 only covers one quarter of the county. The Sheriff’s department only focuses on stings outside the city limits, within the county. Source: San Antonio Police Department, Lt, R. Phelan Amarillo Austin Bay City Bexar Dallas Denton El Paso Fort Worth Harris Houston Incidents 8 12 3 15 35 4 15 9 7 10 0 5 10 15 20 25 30 35 40 Texas Minor Tobacco Stings Sep 2012 - Aug 2013
  54. 54. www.sacada.org 54 COSA Needs Assessment June 2014 FY08 FY09 FY10 FY11 FY12 FY13 Q1-Q2 Number of controlled buys 990 717 661 1,865 4851 2432 87 % youth whose age not questioned in successful buy 80% 93.8% 33.3% 23.9% 25%1 20%2 NA % tobacco sales to minors in controlled buy 0.51% 2.2% 2.7% 3.8% 1.6%1 2.1%2 0% Source: Texas Comptroller of Public Accounts, Tobacco Compliance Grant Program 1. FY12 CPA 2. FY12 DSHS TEP Source: SATPCC Community Needs Assessment Current Adult Cigarette Use 2012 Population 18+ years old Extrapolation of Current # of Adult Smokers in 2012**‘04-07 ‘11 All Adults 18+ 18.3% 15.7% 1,228,450 192,867 Gender Males 23.2% 15.7% 592,579 93,506 Females 13.6% 15.6% 635,871 99,196 Source: BRFSS [≥100 cigarettes in lifetime and still smoke every day or some days]; 2012 Census Comments: 2012 ACS population http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk Source: SATPCC Community Needs Assessment *Current smokers = 2012 smoking rate x 2012 population 18+.
  55. 55. www.circlesofsa.org 55 COSA Needs Assessment September 2014 Past 30-day Youth Overall Tobacco Use Cigarette Use (%) Any Tobacco Use (%) Smokeless Tobacco Use (%) ‘08 ‘12 ‘08 ‘12 ‘08 ‘12 16.1% 13.6% 22.7% 18.7% 7% 3.8% Source: Texas Youth Tobacco Survey Source: SATPCC Community Needs Assessment Past 30-day Youth Cigarette Use by Grade Level and Gender Grade Level and Gender ‘08 ‘12 Middle School Males 10.2% 11.3% Females 4.7% 3.8% High School Males 26.7% 23% Females 17.9% 11.8% Source: Texas Youth Tobacco Survey Source: SATPCC Community Needs Assessment
  56. 56. www.sacada.org 56 COSA Needs Assessment June 2014 x. Other data sources Mexican American and Latino Population The Core of San Antonio’s population consists primarily of first, second and third generation Mexican Americans. People of Mexican descent account for 91% of the Latino population in San Antonio and people of Hispanic or Latino origin account for 63% of the entire San Antonio population (US Census Bureau). Compared to the United States, where only 16% of the population is of Hispanic or Latino decent, in San Antonio there is a clear need for a culturally appropriate response to issues surrounding healthcare and substance use prevention. Number and proportion of all quality measures for which members of selected groups experienced better, same, or worse quality of care compared with reference group 2012 Nat'l Healthcare Disparities Report 1
  57. 57. www.sacada.org 57 COSA Needs Assessment June 2014 Regardless of the actual population numbers, Latinos are in many ways at a distinct disadvantage. As displayed in the above graph, Hispanics received worse care than non-Hispanic Whites for about 40% of quality measures. Compared to their non-white counterparts “Latinos are more likely to experience disparities across a wide spectrum of social indicators such as education, income and health care”. (Ramirez, Chalela, Gallion, 2011). Remaining true since the publishing of the 2011 National Healthcare Report from the Agency for Healthcare Research and Quality, health disparities in quality of care are becoming larger for Latinos “Hispanics had worse access to care than non-Hispanic Whites”. In 2011, 26.0% of the Latino population in Bexar County was uninsured, compared to 20.4% of the Anglo population (American Factfinder). In addition, Latinos living in Bexar County account for 82% of the population that resides within 10 zip codes which the San Antonio Metropolitan Health District has identified as high-risk areas. Due to the high concentration of poverty in these zip codes and health problems resulting from high numbers of births to both single and school-age mothers, children in these areas are more likely to experience problems which may serve as barriers to success. The 10 Zip Codes – San Antonio Metropolitan Health District
  58. 58. www.sacada.org 58 COSA Needs Assessment June 2014 Levels of acculturation and assimilation among Mexican Americans are contrasted by a generational divide. While first and many second generation Latinos linguistically adhere to their native tongue and traditional value systems, more and more young people from this group are adopting many of the values and culture of mainstream America. For example, older generations tend to hold traditional views on gender roles and have been forced, based upon poor economic upbringing, to choose work before education. In contrast, younger generations, both male and female, tend to value a more progressive cultural identity where the opportunity for success and education supersede more traditional role distinctions. It should be highlighted, however, that regardless of generational differences there are still strong cultural ties to traditional Mexican mores and customs. For instance, values placed on strong family bonds and deep-seated religious ties, traditions and practices are vitally important to understand when developing social programs and prevention messages. A downside to reaching higher levels of acculturation among Hispanics, and other immigrant groups for that matter, is that as these groups become more acculturated the more likely it is that they will adopt substance abuse and binge drinking behavior in addition to experiencing other public health concerns. This phenomenon is known as the Latino paradox and data from a wide range of sources including academic literature, and The National Survey on Drug Use 2010 and Health (NSDSU) support this conclusion. “Hispanic adults who were born in the United States had higher rates of past month substance use than Hispanic adults who were not born in the United States, regardless of age. Among Hispanic adolescents, those who were born in the United States had higher rates of past month cigarette use, alcohol use, and marijuana use than those who were not born in the United States.” The data shown on Graph 1, is statistically significant and the .05 level.
  59. 59. www.sacada.org 59 COSA Needs Assessment June 2014 Graph 1 Source: The National Survey on Drug Use and Health (NSDSU) “ ” Most current data available 57.7 32.6 11.3 37.2 21.6 3 0 10 20 30 40 50 60 70 Alcohol Use Binge Alcohol Use Illicit Drug Use Past Month Substance Use among Hispanic Adults, by Nativity: 2004 to 2008 Born in the United States Not Born in the United States
  60. 60. www.sacada.org 60 COSA Needs Assessment June 2014 Colleges and Universities San Antonio is home to 11 colleges and universities with a combined student population of over one hundred thousand. Two of the four-year universities are public and four are private. Alcohol is permitted on campus at all four of the private universities and is sold on-campus at two of these schools. In 2007, according to data obtained from each school though the Clery Act, there were a combined 732 alcohol-related incidences on all campuses. Having a detailed picture of alcohol, drug use and related issues on college campuses is important so that prevention efforts can be strategically targeted. The most comprehensive instrument for gathering data that allows comparison to national level data is the Core Survey, which was developed by the Core Institute and is considered to be the standard survey instrument for higher education. As of 2011 we have Core Survey data for two of our most prominent universities. The following are key demographics of survey respondents: Table 3 24.4% Freshmen 64.6% Typical college age range of 18-22 17.0% Sophomores 64.1% Female 23.7% Juniors 78.6% Live off campus 19.3% Seniors 55.4% Work full time or part time 3.8% Graduates 90.7% Full-time students 1.9% Other 28.2% 5 hours per month in volunteer work For comparison purposes data collected nationally from 74,481 students at 169 institutions was aggregated from 2008 findings and then compared to local data. A side by side comparison shows that the two surveyed schools in San Antonio reported lower rates of past 30 day use for every category of licit and illicit substances than what was reported at the national level. The following graph describes 30 day prevalence rates.
  61. 61. www.sacada.org 61 COSA Needs Assessment June 2014 Graph 16 Source Core Survey of College Students: San Antonio, 2010 The annual prevalence rate for use of alcohol among survey respondents is 78.4% and past month use was reported to be 61.3%. Lending credence to Social Norms Theory that most college students overestimate their peers attitudes of levels of alcohol consumption, only 18.1% of students participating in the Core reported that they use alcohol once a week, compared to the perception that 28.6% of other students use alcohol once a week. Graph 16 shows data from the Core Survey on the perceived effects of alcohol on college social life. Graph 17 Source: Core Survey of College Students: San Antonio, 2010 0.0% 20.0% 40.0% 60.0% 80.0% Alcohol Tobacco Marijuana Ampheta… Sedatives Cocaine Hallucino… Opiates Designer… Steroids Other… Inhalants 30 Day Local/National Prevalence Comparison Bexar County Colleges National 15.4% 40.9% 42.7% 45.9% 52.7% 54.4% 57.2% 57.3% 62.5% 67.1% 67.7% Makes Food Taste Better Makes it Easier to Deal With Stress Facilitates Female Bonding Facilitates Sexual Opportunity Facilitates Male Bonding Facilitates Connection with Peers Allows People to Have More Fun Give People Something to Talk… Gives People Something to Do Breaks the Ice Enhances Social Activity Perceived Effects of Alcohol CORE Survey 2010
  62. 62. www.sacada.org 62 COSA Needs Assessment June 2014 Graph 18 Knowing where students obtain or use alcohol most frequently is important for prevention. The graph below indicates “social access” categories and associated percentages. Graph 19 19.2% 36.4% 51.8% 62.7% 71.9% 77.4% 79.6% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Faculty/Staff Alumni Athelets Female Students Sororities Male Students Fraternities Percentages of students who see drinking as a central part of social life, by affiliation Core Survey 2010 4.6% 7.3% 10.0% 10.4% 17.8% 18.1% 50.2% 59.6% 60.7% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% On Campus Events Frat/Soroity Residence Hall In a car Other Never Used Bar/retaurant Private Parties Where Lived Access to Alcohol CORE Survey 2010
  63. 63. www.sacada.org 63 COSA Needs Assessment June 2014 Most students reported “Where Lived” as the place where they get and consume alcohol and of those surveyed 78% live off campus. Students who responded to the Core were asked to rank the following variables by degree of perceived risk. These percentages indicate the distribution of students who feel that there is “great risk” associated with the following behaviors:  15.7% Try marijuana once or twice  22.0% Smoke marijuana occasionally  48.5% Smoke marijuana regularly  52.6% Try amphetamines once or twice  47.6% Try cocaine once or twice  56.8% Try LSD once or twice  62.4% Have five or more drinks in one setting  50.0% Consume alcohol prior to being sexually active  49.1% Regularly engage in sexual activity with a single partner  87.9% Regularly engage in unprotected sex with multiple partners Students are considerably more permissive about marijuana use than binge drinking or use of other drugs. Only 49.1% of students felt that there is great risk in “regularly engaging in unprotected sex with a single partner”. Driving under the influence, another high risk behavior, was reported to be similar for both males (29.4%) and females (24.2%). As for consequences of engaging in risky behavior (for example, “been in trouble with police…”, “performed poorly on a test or project”, or “done something later regretted”), our universities ranked lower than the national averages in nearly every category. The comparative table below describes a whole array negative experiences that can result from substance use.
  64. 64. www.sacada.org 64 COSA Needs Assessment June 2014 Table 4 Bexar County National Been Arrested for DWI/DUI 0.8 1.2 Been in trouble with police, residence hall, college authorities 6.4 13.3 Damaged property 2.8 5.6 Driven a car while under the influence 26.1 22.3 Got into an argument or fight 20.8 31.2 Tried to commit suicide 1.1 1.1 Seriously thought about suicide 3.8 4.2 Been hurt or injured 9.6 16.3 Been taken advantaged of sexually 6.5 9.5 Taken advantage of another sexually 2.4 2.5 Tried unsuccessfully to stop using 4.2 4.9 Thought I might have a drinking or drug problem 6.8 10.8 Performed poorly on a test or important project 15.3 20.8 Done something I later regretted 22.7 36.0 Missed class 18.2 28.1 Been criticized by someone I know 22.6 29.7 Had memory loss 22.3 34.7 Got nauseated or vomited 43.2 54.0 Had a hang over 51.3 62.0 Source: Core Survey of College Students: San Antonio, 2010 Following are some key findings on opinions about the campus environment:  81.5% of students said the campus has alcohol or drug policies  17.8% said they “don’t know”  0.8% said there wasn’t a policy  51.3% said the campus has an alcohol and drug prevention program  27.6% said they “don’t know”  1.2% said there wasn’t a program  78.7% of students said the campus is concerned about the prevention of drug and alcohol use  16.0% said they “don’t know”  5.2% said the campus is not concerned
  65. 65. www.sacada.org 65 COSA Needs Assessment June 2014 Military Because there has been a lack of research in recent years on the negative consequences of drinking within the Armed Forces, a study that was published in 2009 – “Binge Drinking Among U.S. Active-Duty Military Personnel” - is currently our only source of information on ADMP for episodes of binge drinking, characteristics of ADMP who binge drink, and the relationship between binge drinking and related harms. According to the study, half of all ADMP reported at least one episode of past-month binge drinking and two-thirds of binge-drinking episodes involved personnel aged seventeen to twenty-five. Furthermore, age specific rates are higher for ADMP than for the civilian population (44% for ADMP aged 17-70 versus 26.1% for comparably aged civilians). The prevalence of binge drinking is higher among males who are in the Army, followed, in order, by the Marines, Navy and Air Force. However, the per-capita rate of binge drinking for women in the military is higher than that of women in the civilian population. More than half of all ADMP who binge drink reported alcohol related problems such as drinking and driving, job performance and criminal activity. A notable consequence for women is that half of all pregnancies in the military are unintended and there is usually a delay in recognition of pregnancy, so unborn children are at a higher risk for fetal alcohol syndrome. Traditionally, the military has focused less on prevention than on individual identification of problem drinkers. However, this approach is unlikely to be as successful as environmental strategies because only a small minority of ADMP meets the diagnostic criteria for alcohol dependence. The military has been successful in reducing smoking rates using a
  66. 66. www.sacada.org 66 COSA Needs Assessment June 2014 comprehensive public health approach and there has been an increase in small, base-specific environmental strategy programs targeted at binge drinking that are showing positive results. Because 13.3% of U.S. adults report having served in the military, binge drinking by ADMP has an impact that reaches beyond active service and into the civilian population. Working toward developing and implementing sound prevention practices is therefore crucial not only for ADMP, but can have an impact on reducing drinking behavior in the general population. Public Health Juvenile Treatment Juvenile admissions data for DSHS funded drug and alcohol treatment facilities is more or less consistent with juvenile probation drug and alcohol probation referrals and UCR data for offences in that most admissions are for marijuana. From 2003 to 2010, marijuana, alcohol, heroin, sedative and cocaine accounted for the highest number of youth admissions to DSHS funded treatment programs. The most number of admissions by far were for marijuana; 414 in 2010 compared to the next highest which was 28 admissions for heroin. Marijuana admissions declined by 38% since 2008. However, this could be because of a shortage of beds in treatment centers. On the other hand juvenile probation also showed a decline in referrals. Juvenile Treatment Facts (DSHS, 2010):  Admits for cannabis (85.37%) and opioid (76.19%) were largely male whereas females were more likely to be admitted for alcohol (52%) and sedative (58.33%)  IV drug use was mostly in the opioid category (76.19%). All IV drug users for opioids were male (this is a turnaround from last year where most were female).  Criminal Justice referrals were more evenly distributed: Sedative (83.33%), Alcohol (80%), Cannabis (78.90%), Opioid (76.19%)
  67. 67. www.sacada.org 67 COSA Needs Assessment June 2014  The average level of education for all categories was roughly 9th grade: High (9.89) and Low (9.33%) Adult Treatment For adults, heroin, alcohol, marijuana, cocaine and amphetamines accounted for the most number of DSHS funded treatment center admissions between 2003 and 2010. Not surprisingly, alcohol and marijuana had the lowest age of first use (under the age of 17) compared to all other drugs (21 or over). Between 2003 and 2010, heroin and alcohol, followed by marijuana accounted for the most treatment admissions for adults 18 and over. Adult Treatment Facts (DSHS, 2010):  Only 35.47% of admits for amphetamines were male  69.26% of admits for alcohol were men  Users of opioids had the lowest rate of employment (6.47%)  Users of alcohol were most likely to be homeless (23.93%), followed by opioids (8.03%)  Users of opioids were more likely to use needles (58.64%) followed by amphetamines (26.74%).  Only 12.19% of opioid users were criminal justice referred compared to amphetamine (37.79%), cannabis (39.31%) and sedative (31.03%).  Users of sedative and amphetamine had the most education (13 years)
  68. 68. www.sacada.org 68 COSA Needs Assessment June 2014 Graph 21 Source: Department of State Health Services (DSHS) Treatment Episode Data (TEDS) Substance abuse treatment rates vary by the class or type of drug causing impairment. Alcohol is the most common drug leading to entry to substance abuse treatment in Texas. Alcohol treatment occurs 2.4 times the rate of cocaine treatment and 2.9 times the rate of opioid treatment in Texas in 2013. 1225 1249 613 492 189 38 11 0 200 400 600 800 1000 1200 1400 Opioid Alcohol Cannabis Cocaine Amphetamine Sedative Other Adult Admissions to DSHS Funded Treatment Facilities Bexar County, 2011
  69. 69. www.sacada.org 69 COSA Needs Assessment June 2014 Only eleven of the thirty drug and alcohol treatment facilities in Bexar County are DSHS funded. If a large number of the people in Bexar County needing or seeking substance abuse treatment are either uninsured or indigent, then a comparative lack of subsidized treatment centers means that a significant portion of the population is underserved. Of adults treated at DSHS funded treatment centers between 2003 and 2008 the highest annual income of patients being treated was less than $10,000, and less than half were employed. According to the Center for Health Care Services, lack of detoxification resources for the indigent, uninsured or underinsured has created a community wide crisis in Bexar County, and at the root of the problem is lack of state and federal funding for treatment services Health insurance rates among Bexar County adults with DWI are much lower than the general population. DWI Offender Health Insurance Rates .
  70. 70. www.sacada.org 70 COSA Needs Assessment June 2014 Juvenile Adult DSHS Funded Treatment Centers In-Patient Out- Patient Male Female Co-ed Male Female Co-ed A Turning Point x x Alpha Home x x x Army Substance Abuse Program x x Association for Advancement of Mexican Americans x x Family Service Association x x x x Lifetime Recovery x male x co-ed x Palmer Drug Abuse x x x The Right Step x x x x Volunteers of America x x Center for Health Care Services x x x x Ripple Recovery Ranch x x
  71. 71. www.sacada.org 71 COSA Needs Assessment June 2014 Since 2010 the City of San Antonio Municipal Court handles the alcohol law violations instead of Juvenile Probation. The Municipal Court reported 1,954 Minor in Possession citations by youth ages 12 to 20 between October, 2011 and November, 2012. During that same period, they also reported 1,293 citations for Minor in Consumption of Alcohol for the same age group. (San Antonio Municipal Court Clerk 2012) DSHS reports that there is an estimated 47,824 youth in Bexar County who have been diagnosed with mental illness, and an additional 81,058 have been identified as being at-risk of being significantly impaired due to a mental disorder. In its Community Plan, the Alamo Area Council of Governments cited a national study which concluded that 70.4% of children in the juvenile justice system meet the criteria for at least one mental disorder, and 27% had a mental disorder severe enough to require immediate treatment. Only five of Bexar County’s 28 residential psychiatric facilities provide inpatient psychiatric services to adolescents, and of these five, only two offer hospitalizations for indigent youth. Because mental illness is more often than not co-occurring with substance abuse, Bexar County has recognized the need for integrated treatment and a continuum of care through the coordination of existing mental health and substance abuse treatment services. Bexar County has a drug court that aims to divert non-violent offenders into treatment; and programs such as the Mental Health Advocacy Initiative aim to reduce the recidivism of mentally ill inmates by providing access to support and treatment services. Another figure that stands out is deaths caused by motor vehicle crashes, which is a leading cause of death for every age group. Since nearly half of all fatal motor vehicle crashes involve a legally impaired driver, drinking and driving is both a serious and preventable public health issue.
  72. 72. www.sacada.org 72 COSA Needs Assessment June 2014 Part IV – Intervening Variables Contributors to Alcohol Use. Alcohol availability (social access) is a primary contributor to alcohol use among community youth. 53.8% of Bexar County 8th grade students and 59.5% of Bexar County 9h grade students report that it is somewhat easy to very easy to access alcohol (TSS, 2010). Among the Bexar County youth who drank in the past month, 26.7% report they get alcohol at parties always or most of the time, 15.2% report they get alcohol from friends, and 6.6% report they get alcohol from home. 29.5% of students report that alcohol was used “most of the time” or “always” at parties they attended this school year. The presence of eleven universities increases social access for underage youth in our community. Alcohol is permitted on campus at all four of the private universities in our area and alcohol is sold on-campus at two of these schools. 60.7% of college students report “where lived” as the place where the get and consume alcohol, and of those surveyed 78% live off of campus. 59.6% of college students report accessing and consuming alcohol at private parties. COSA as well as other coalitions throughout the state of Texas recognize that alcohol pricing contributes to too many youth consuming alcohol in our community. “A substantial body of research has shown that higher prices or taxes on alcoholic beverages are associated with lower levels of alcohol consumption and alcohol related problems, especially in young people”‐ National Institute of Alcohol Abuse and Alcoholism. According to research, Texans pay less in taxes for beer, wine and spirit than residents in neighboring states and pay significantly less in alcohol taxes than the US State average. Texas Alcohol excise tax has not been raised since 1984. In addition to youth access, another factor contributing to high rates of youth alcohol use is social norms in the community that are favorable to alcohol use.
  73. 73. www.sacada.org 73 COSA Needs Assessment June 2014 Inconsistent Enforcement or Low Enforcement also contributes to alcohol use by youth in our community. Informant interviews and some local data indicate that local youth perceive the probability of being caught as very low. Additionally, if youth are caught, the consequences are not consistently enforced. While there were 1,954 MIP citations issued last year, only a fraction of these youth attended a mandated prevention/intervention program. Initial evaluation indicates that consequences vary in both the number of hours mandated and the type of restitution required. In contrast, consistently-enforced consequences resulting from a citation would be a substantial deterrent to local youth and adults. Contributors to Marijuana Use. Social access is a major concern for marijuana use in Bexar County, with only 41% of students reporting it is “very difficult” or “impossible” to get marijuana. As a contrast, 78% of youth report cocaine would be difficult to obtain (TSS, 2010). Of those that use marijuana, more than a quarter (26%) of students state that it was available at some or all of the parties they attended (TSS, 2010). Social norms also contribute to marijuana use among Bexar County youth. Data shows that Bexar County students are considerably more permissive about marijuana use than binge drinking or use of other drugs. Twenty-seven percent of students reported most or all of their close friends smoke marijuana. Fifty-six percent of students believe that marijuana use is "very dangerous" compared to 79 percent of students who feel that use of ecstasy is "very dangerous" and 83 percent who believe that powdered cocaine use is "very dangerous." Contributors to Prescription Drug Use. The coalition lacks sufficient data to state definitively what contributes to youth prescription drug use. However, based on national data, it is likely
  74. 74. www.sacada.org 74 COSA Needs Assessment June 2014 that a lack of perception of harm and the availability of prescription drugs lead to their use. The coalition will work over the coming year to gather data to identify the contributors to prescription drug use in our community. Part V – Community Readiness The coalition conducted on line community readiness survey of coalition members in September 2013 with only 16 responses. Responses show that coalition members that answered are aware of programs and see a need for prevention programs. The coalition will continue to collect survey responses from coalition members and reach out the non-coalition members for responses. Based on coalition participation the coalition has created plans to reach out to the youth community and recruit members to be more involved with prevention planning. The challenge has been school and some state programs believe effective prevention is provision of direct prevention programs and alternative activities.
  75. 75. www.sacada.org 75 COSA Needs Assessment June 2014 Part VI – Putting it all together Target Population The coalition has determined the target population is Bexar County. Bexar County has many municipalities that are encompassed within the city limits of San Antonio Residents commute through several city limits to attend school, work or leisure activities. Primary Substance use behaviors The coalition has selected alcohol as it primary substance due to the data showing it is the number one drug of choice for youth. Secondary Substance use behavior The coalition has selected marijuana as the secondary substance as data shows it is a concern in Bexar County. National trends show increases in prescription drugs on the rise, and we have seen abuse with college youth (CORE 2010). Strategic Planning Process The coalition members will review the needs assessment results at the October Meeting and participate in a strategic planning meeting the following week. The coalition provides training on evidenced based strategies on a annual basis. The coalition will discuss which strategies would fit the community and what the capacity is for the coalition to implement these strategies.
  76. 76. www.sacada.org 76 COSA Needs Assessment June 2014 References Alamo Area Council of Governments (AACOG), 2010. Bexar County Community Plan. http://www.aacog.com/criminaljustice/communityplanning/commplan2008_2009/2008- 2009BexarCountyCommunityPlan.pdf. Bexar County Juvenile Probation, 2004-2012. Monthly Trend Report. Bexar County Medical Examiners Office, 2009, 2012. Annual Report. http://www.bexar.org/medicalexaminer/BCSD_MedExaminer_T102_R15.html. Bexar County Sherriff’s Office, 2005-2010. DWI Arrests (Unpublished Raw Data). Bexar County Sherriff’s Office, 2005-2011. Juvenile Arrests. Core Survey, 2010. San Antonio Council on Alcohol and Drug Abuse Center for Disease Control, 2004-2009. Behavioral Risk Factor Surveillance System SMART Local Health Risk Prevalence Data Query System. http://apps.nccd.cdc.gov/BRFSS-SMART/SelMMSAPrevData.asp Centers for Disease Control, 2010. “Liver Disease – 12th Most Common Cause of Death in US: Study”. http://www.medindia.net/news/Liver-Disease-12th-Most-Common-Cause-Of- Deaths-in-US-Study-76136-1.htm Cheung, Ramsey, MD. 2006. “Chronic Hepatitis C in the Hispanic Population”. The HCV Advocate. http://www.hcvadvocate.org/hcsp/hcsp_pdf/hispanics.pdf Circles of San Antonio Community Coalition, 2008. SPF Needs Assessment ESI Data. City of San Antonio, 2008. San Antonio, Texas Economic Indicators and Demographics. http://www.sanantonio.gov/edd/pdfs/Economic%20report%207-8%2008%20abridged.pdf. DSHS, 2008. DSHS Substance Abuse Services – Funded Treatment Providers (As of 11/20/2008).http://www.tcada.state.tx.us/treatment/ProfRes8.asp. DSHS, 2003-2011. DSHS Substance Abuse Treatment Episode Data, Youth and Adult [Raw Data] DSHS, 2002-2008 Substance Abuse Treatment (TCADA Funded Programs). [Raw Data] Mathias, C.W., Ryan, S.R., Mullen, J., Lake, S.L., Brown, P.C., Adams, V,. Villafranca, C., and Dougherty, D.M. (2014). Problem identification and community assessment of DWI needs for Bexar County, Texas (Center for Medicare & Medicaid Services report 085144601,2,6). University of Texas Health Science Center San Antonio. http://issuu.com/cosasacada/docs/nrlc_dwi_needs_assessment_03-31-201/1
  77. 77. www.sacada.org 77 COSA Needs Assessment June 2014 National Highway Traffic Safety Administration (NHTSA), 2004-2011. Fatality Analysis Reporting System (FARS). http://www-fars.nhtsa.dot.gov/Main/index.aspx National Survey on Drug Use and Health, 2010. “Substance use Among Hispanic Adults” Office of National Drug Control Policy (ONDCP), 2011. Economic Costs of Substance Abuse. http://www.whitehouse.gov/sites/default/files/ondcp/newsletters/ondcp_update_june_2011.p df http://www.justice.gov/archive/ndic/pubs44/44731/44731p.pdf Office of the State Demographer, Statistics on Uninsured, 2005. http://txsdc.utsa.edu/. Presley, Cheryel A., Meilman, Philip, Leichliter, Jami; College Factors That Influence Binge Drinking. Journal of Alcohol Studies, 14:2002. Ryan, S.R., Friedman, C.K., Mathias, C.W., Mullen,, Dougherty, D.M., Adams, V, and Villafranca, C.. (2014) Problem Identification and community assessment of youth substance use treatment needs for Bexar County, Texas (Center for Medicare & Medicaid Services report 085144601.2.101). University of Texas Health Science Center San Antonio SAMHSA, 2008. List of Treatment Centers in Bexar County. http://findtreatment.samhsa.gov/ufds/listsearch_00.print?seq_num=561759. San Antonio Metropolitan Health, Engaging Public Awareness of Health Disparities http://www.sanantonio.gov/health/pdf/NACCHO%2010%20Zip%20Codes.pdf San Antonio Metropolitan Health, 2004-2011. Health Profiles http://www.sanantonio.gov/health/Healthprofiles-Main.html San Antonio Metropolitan Health District. 2001-2010. Death Data. http://www.sanantonio.gov/health/pdf/hp2008/deaths/Deaths.htm San Antonio Police Department, 2003-2012. DWI Arrests [Raw Data]. Texas College Survey, 2005. Texas survey of Substance Use Among College Students Main Findings Report. www.dshs.state.tx.us/sa/Research/college/2005/2005_CollegeSurvey_lliu043007.pdf. Texas Department of Public Safety, 2008. Uniform Crime Reports. [Raw Data]. Texas Education Agency, 2011. Region 20 District Level Annual Discipline Summary PEIMS Discipline Data for 2010-2012. Texas Education Agency, 2011. Selected AEIS Campus Data, A Multi-Year History 2003-2012. Texas Education Agency, 2008. Longitudinal Completion Rates, Grades 9-12, by County and Student Group, Texas Public Schools, Class of 2007.
  78. 78. www.sacada.org 78 COSA Needs Assessment June 2014 Texas Labor Market Review, 2013. http://www.tracer2.com/?PAGEID=133 Texas School Survey, 2012. Texas School Survey of Drug and Alcohol Use. U.S. Census Bureau, 2009-2011 American Community Survey. http://www.census.gov. U.S. Census Bureau, 2009-2011 American Fact Finder. http://www.census.gov. U.S. Census Bureau: State and County QuickFacts. http://quickfacts.census.gov/qfd/states/48/48029.html

×