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2015
Regional Needs
Assessment
REGION 8: UPPER SOUTH TEXAS
PREVENTION RESOURCE CENTER
South Texas Centre
AT&T Building
750...
2015 Regional Needs Assessment
PRC 8 2 |P a g e
San Antonio Council on Alcohol and Drug Abuse
South Texas Centre AT&T Buil...
2015 Regional Needs Assessment
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Message
from Our
Executive
Director
It is my great honor and privilege to ...
2015 Regional Needs Assessment
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Proudly Serving South Central Texas
The Prevention Resource Center (PRC) R...
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Table of Contents
Executive Summary..........................................
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Hospitalization and Treatment ...............................................
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Executive Summary
The Regional Needs Assessment (RNA) is a document assemb...
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Our Regions
Region 1: Panhandle and South Plains
Armstrong, Bailey, Brisco...
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Regional Evaluators
Regional PRC Evaluators are responsible for developing...
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Key Concepts in This Report
As one reads this document, two guiding conce...
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endorse the examination of drug and alcohol trends, the associated harms ...
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Examination of risk and protective factors provides a meaningful understa...
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be the single cause of a consequence, measureable evidence must support a...
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Introduction
The Department of State Health Services (DSHS), Substance Ab...
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3. To determine regional differences and disparities throughout the state...
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Source: http://factfinder.census.gov/faces/tableservices/jsf/pages/produc...
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 National health surveys
 Maternal and Child Health Bureau
 Behavioral...
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collected by this research will serve to identify avenues for further res...
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Sugar Land–Baytown, San Antonio–New Braunfels, and Austin–Round Rock–San ...
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Age
Texans continue to grow older, with an average age over 33 years. At ...
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Ethnicity
Ethnicity is defined as being part ofor identifying witha socia...
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language, and Chinese (including Cantonese and Mandarin) is spoken as the...
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General Socioeconomics
Economic and social indicators like income, educat...
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Household Composition
Household and Family Size
 The number of one-perso...
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Housing Occupancy and Tenure
As the Texas population grows, the total num...
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U.S. Job Growth, 2004-2014
Texas Job Growth
Among the largest counties in...
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Industry
Texas has numerous resources, a forceful economy, and an excepti...
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Employment estimates released by TWC are produced in cooperation with the...
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TANF Recipients
According to the US Department of Health and Human Servic...
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The Temporary Assistance for Needy Families (TANF) program is designed to...
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 10.5% of recipient’s age 15 and older report illicit drug use in the pa...
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Source: The United States Department of Agriculture (USDA), Supplemental ...
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Source: The United States Department of Agriculture (USDA), Supplemental ...
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Federal Benefits Denied to Drug Offenders
Texas is one of the few states ...
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Cash Payments 249,685,221 259,332,648 271,131,370 285,454,670 303,447,828...
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Report Area Total Population Total Land Area (sq.
mi.)
Population Density...
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Age
Age distribution representsthe population for Region8byage group. See...
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Ethnicity
This chart shows the population by Hispanic or Latino Ethnicity...
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Census Area Estimated
population as of
July 1, 2014
2010 Census 2000 Cens...
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MILITARY CITY, USA
San Antonio is home to six U.S. military installations...
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personnel with multiple deployments and combat exposure are more suscepti...
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drinkers, and infrequent/light drinkers endorsing this more often than mo...
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often in the Marine Corps (92.3%) and Coast Guard (92.9%), and peer marij...
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 Illicit and Prescription Drugs
 Patients in U.S. Department of Veteran...
PRC Region 8 2015 Regional Needs Assessment
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PRC Region 8 2015 Regional Needs Assessment
PRC Region 8 2015 Regional Needs Assessment
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PRC Region 8 2015 Regional Needs Assessment

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The PRC Region 8 Regional Needs Assessment (RNA) is report on the 28 counties of South Central Texas assessing the substance abuse trends, identifying community resources and helping communities utilize data to help guide prevention strategies. This report is the complete full version of the RNA.

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PRC Region 8 2015 Regional Needs Assessment

  1. 1. 2015 Regional Needs Assessment REGION 8: UPPER SOUTH TEXAS PREVENTION RESOURCE CENTER South Texas Centre AT&T Building 7500 US Hwy 90 West, Suite 100 San Antonio, TX 78227 210.225.4741 www.prcregion8.org p. (210) 225-4741 f. (210) 225-4768 amoore@sacada.org www.prcregion8.org
  2. 2. 2015 Regional Needs Assessment PRC 8 2 |P a g e San Antonio Council on Alcohol and Drug Abuse South Texas Centre AT&T Building 7500 US Hwy 90 West, Suite 100 San Antonio, TX 78227 210.225.4741 www.prcregion8.org The Regional Needs Assessment has been conducted to provide the state, the PRC, and the community at large with a comprehensive view of information about the trends, outcomes and consequences associated with drug and alcohol use in Region 8. THANK YOU TO ALL OUR PARTNERS The State Collaborative began formally in 2013 when the state transformed all 11 Regional Drug and Alcohol Clearinghouse Organizations into a Central Data Repository. The Regions within Texas agreed to put aside their competitive business practices to conduct a comprehensive drug and alcohol needs assessment in the interest in improving the awareness of the community by working together. SACADA was founded in 2014, making this the initial RNA for Region 8. Collaboration within Region 8 has developed a powerful network of citizens, community organizations and businesses.
  3. 3. 2015 Regional Needs Assessment PRC 8 3 |P a g e Message from Our Executive Director It is my great honor and privilege to serve as the Executive Director for the San Antonio Council on Alcohol and Drug Abuse. I passionately believe in the great work this organization has provided our community for over 53 years, and I’m excited about the new opportunities we have in bringing hope and healing through prevention and intervention services. We know that substance abuse is one of the leading problems that affects San Antonio. It isa significant factor in broken homes, domestic violence, child abuse, health problems, soaring medical costs, crime, DWI fatalities, unplanned pregnancies, school performance problems, truancy, high dropout rates, loss of productivity and many workplace issues. Its effects reach far beyond the user to family, friends, the workplace, and the entire community. Collaboration with other organizations and agencies is crucial in preventing substance abuse and addiction. Working with our many partners, we are making our community safer and healthier. By utilizing community assessments and implementing evidence-based strategies, we will be able to monitor our success and be strategic in all the work we do. I’m extremely grateful to our Board of Directors, Staff and Community Partners for their unwavering support of the San Antonio Council on Alcohol and Drug Abuse. Together, we’re reducing the impact of substance abuse and addiction. Sincerely, Abigail Moore MA, LPC, LCDC, ACPS Executive Director San Antonio Council on Alcohol and Drug Abuse
  4. 4. 2015 Regional Needs Assessment PRC 8 4 |P a g e Proudly Serving South Central Texas The Prevention Resource Center (PRC) Region 8 proudly serves the 28 counties of South Central Texas by providing access to data regarding alcohol, tobacco, and other drug use and misuse, as well as behavioral, mental, and physical health issues related to drug use. PRC 8 also collaborates with community stakeholders and builds strong partnerships with organizations that collect data through questionnaires, needs assessments, surveys, focus groups, and informant interviews. Our Mission The mission of the Prevention Resource Center 8 is to serve as a central data repository and substance abuse training liaison for the Region 8 community. As the central data repository, the PRC will develop a Regional Needs Assessment (RNA) that will tell the story of the 28 counties. The data collection will include, but is not limited to, the state’s three main priorities of alcohol, marijuana and prescription drugs. ACKNOWLEDGMENTS The members of the Needs Assessment Team for Region 8 include: GYNA JUAREZ, M.P.A., ACPS PRC REGION 8 DIRECTOR BETSY JONES, TOBACCO PREVENTION SPECIALIST TERESA STEWART, REGIONAL COMMUNITY LIAISON HORTENCIA C. CARMONA, M.S., REGIONAL EVALUATOR ALEXIS LAWRENCE, M.S., REGIONAL COMMUNITY LIAISON
  5. 5. 2015 Regional Needs Assessment PRC 8 5 |P a g e Table of Contents Executive Summary................................................................................................................................ 7 What is the PRC?..................................................................................................................................... 7 Key Concepts in This Report ................................................................................................................. 10 Adolescence...................................................................................................................................... 10 Epidemiology.................................................................................................................................... 10 Risk and Protective Factors............................................................................................................... 11 Consequences and Consumption ...................................................................................................... 12 Introduction.......................................................................................................................................... 14 How to Use This Document............................................................................................................... 14 Methodology .................................................................................................................................... 15 Process.............................................................................................................................................. 15 Quantitative Data Selection............................................................................................................ 156 Qualitative Data Selection .................................................................................................................17 Demographic Overview ........................................................................................................................ 18 State Demographics ......................................................................................................................... 18 Regional Demographics.................................................................................................................... 35 Environmental Risk Factors...................................................................................................................48 Education..........................................................................................................................................48 Criminal Activity................................................................................................................................52 Mental Health ...................................................................................................................................63 Social Factors.................................................................................................................................... 70 Accessibility ......................................................................................................................................80 Perceived Risk of Harm .....................................................................................................................90 Regional Consumption..........................................................................................................................94 Alcohol..............................................................................................................................................95 Marijuana..........................................................................................................................................99 Prescription Drugs .......................................................................................................................... 104 Tobacco ...........................................................................................................................................107 Emerging Trends............................................................................................................................. 109 Consequences..................................................................................................................................... 123 Mortality......................................................................................................................................... 124 Legal Consequences ....................................................................................................................... 128
  6. 6. 2015 Regional Needs Assessment PRC 8 6 |P a g e Hospitalization and Treatment ....................................................................................................... 132 Economic Impacts........................................................................................................................... 140 Environmental Protective Factors........................................................................................................147 Community Domain........................................................................................................................ 149 School Domain................................................................................................................................ 156 Family Domain................................................................................................................................ 160 Individual Domain........................................................................................................................... 164 Trends of Declining Substance Use ..................................................................................................170 Region in Focus....................................................................................................................................171 Gaps in Services ...............................................................................................................................171 Gaps in Data.....................................................................................................................................172 Regional Partners.............................................................................................................................172 Regional Successes ..........................................................................................................................173 Comparison to State/Nation ............................................................................................................174 Conclusion ...........................................................................................................................................175 References...........................................................................................................................................178 Appendices......................................................................................................................................... 185 Glossary of Terms ................................................................................................................................217
  7. 7. 2015 Regional Needs Assessment PRC 8 7 |P a g e Executive Summary The Regional Needs Assessment (RNA) is a document assembled by the Prevention Resource Center in Texas Region 8 (PRC 8). This needs assessment has been conducted to provide the state, the PRC, and the community at large with a comprehensive view of information about the trends and outcomes associated with regional and statewide drug and alcohol use. The assessment was intended to enable PRCs, DSHS, and community stakeholders to effect long-term strategic prevention planning based on the most up-to-date information relative to the needs of the community. The data obtained and presented regionallycan be usedby local agencies,community providers,citizensof the community,and Texas DSHS to better understand the needs of the communities and to evaluate how best to serve these needs. Defining community needs requires a thoughtful, scientific, and qualitative approach. Community is not a set of numbers, but a tapestry of collective experiences, lifestyles, histories, traditions, and expectations. While Texas offers a cultural, geographical, and social experience of diversity, it is also culturally similar across all of its towns and cities. While each town from the gulf coast to the Hill Country is brilliantly distinctive in its own structure, Texans are resilient, industrious people united by a singular pride. The information presented in this document has been acquired by a team of regional evaluators through state and local resources, and compared with state and national rates. Secondary data such as local surveys, focus groups, and interviews with key informants may also allow for input from others in the community, whose expertise lends a specific and qualitative description to identified issues. It is not the aim of this document to assume causation between any substance and prevalence rate in any given area or cultural context. What is the PRC 8? Prevention Resource Center, Region 8, is a program of the San Antonio Council on Alcohol and Drug Abuse (SACADA) providing substance abuse prevention services to twenty-eight counties in Upper South Texas. PRC-8 is one of eleven PRCs supported by the Texas Department of State Health Services (DSHS). These centers are part of a larger network of youth prevention programs and community coalitions. This network of substance abuse prevention services works to improve the welfare of Texans by discouraging and reducing substance abuse. Their work provides valuable resources to address the state’s three prevention priorities of (1) under-age drinking, (2) marijuana use, and (3) prescription drug abuse, as well as tobacco and other illicit drugs. These priorities are outlined in the Texas Behavioral Health Strategic Plan developed in 2012. Our Purpose There are eleven regional Prevention Resource Centers serving the State of Texas. Each PRC acts as the central data repository and substance abuse prevention training liaison for its region. The Prevention Resource Centers also collaborate with local community and county data resources to maximize regional data collection,identify trainingneedsin the community andthe region,andassist in conducting tobacco retailer compliance checks.
  8. 8. 2015 Regional Needs Assessment PRC 8 8 |P a g e Our Regions Region 1: Panhandle and South Plains Armstrong, Bailey, Briscoe, Carson, Castro, Childress, Cochran, Collingsworth, Crosby, Dallam, Deaf Smith, Dickens, Donley, Floyd, Garza, Gray, Hale, Hall, Hansford, Hartley, Hemphill, Hockley, Hutchinson, King, Lamb, Lipscomb, Lubbock, Lynn, Moore, Motley, Ochiltree, Oldham, Parmer, Potter, Randall, Roberts, Sherman, Swisher, Terry, Wheeler, and Yoakum Counties. Region 2: Northwest Texas Archer, Baylor, Brown, Callahan, Clay, Coleman, Comanche, Cottle, Eastland, Fisher, Foard, Hardeman, Haskell, Jack, Jones, Kent, Knox, Mitchell, Montague, Nolan, Runnels, Scurry, Shackelford, Stonewall, Stephens, Taylor, Throckmorton, Wichita, Wilbarger, and Young Counties. Region 3: Dallas/Fort Worth Metroplex Collin, Cooke, Dallas, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, and Wise Counties. Region 4: Upper East Texas Anderson, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Harrison, Henderson, Hopkins, Lamar, Marion, Morris, Panola, Rains, Red River, Rusk, Smith, Titus, Upshur, Van Zandt, and Wood Counties. Region 5: Southeast Texas Angelina, Hardin, Houston, Jasper, Jefferson, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Trinity, and Tyler Counties. Region 6: Gulf Coast Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, and Wharton Counties. Region 7: Central Texas Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, Travis, Washington, and Williamson Counties. Region 8: Upper South Texas Atascosa, Bandera, Bexar, Calhoun, Comal, DeWitt, Dimmit, Edwards, Frio, Gillespie, Goliad, Gonzales, Guadalupe, Jackson, Karnes, Kendall, Kerr, Kinney, La Salle, Lavaca, Maverick, Medina, Real, Uvalde, Val Verde, Victoria, Wilson, and Zavala Counties. Region 9: West Texas Andrews, Borden, Coke, Concho, Crane, Crockett, Dawson, Ector, Gaines, Glasscock, Howard, Irion, Kimble, Loving, Martin, Mason, McCulloch, Menard, Midland, Pecos, Reagan, Reeves, Schleicher, Sterling, Sutton, Terrell, Tom Green, Upton, Ward, and Winkler Counties. Region 10: Upper Rio Grande Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, and Presidio Counties. Region 11: Rio Grande Valley/Lower South Texas Aransas, Bee, Brooks, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Live Oak, McMullen, Nueces, Refugio, San Patricio, Starr, Webb, Willacy, and Zapata Counties.
  9. 9. 2015 Regional Needs Assessment PRC 8 9 |P a g e Regional Evaluators Regional PRC Evaluators are responsible for developing data collection strategies, conducting surveys and focus groups, analyzing data, creating reports and databases for the central data repository, and collaborating with the DSHS Statewide Prevention Evaluator. The evaluators also work with Community Liaisons and Prevention Specialists to identify potential collaborators and provide data resources. Regional PRC Evaluators are primarily responsible for gathering alcohol and drug consumption data and related risk and protective factors within their respective service regions. Their work in tracking substance use patterns is disseminated to stakeholders and the public through a variety of methods including fact sheets, social media, traditional news outlets, presentations, and reports such as this Regional Needs Assessment. Their work serves to provide state and local agencies valuable prevention data to assess target communities and high-risk populations in need of prevention services. How We Help the Community The data we collect serves as a useful tool in Data-Driven Decision Making (DDDM). Over the past two years, the PRC teams have taken the cause of the data initiative into the community through presentations, workgroup meetings, and media awareness activities to inform decision-makers and others about the significance of data. Once published,the analysis in these reports will be made available to the public and marketed as a regional tool.
  10. 10. 2015 Regional Needs Assessment PRC 8 10 |P a g e Key Concepts in This Report As one reads this document, two guiding concepts will appear throughout. The reader will become familiar with a focus on the youth population (adolescence), and an approach from a public health framework (epidemiology). Subsequent to understanding reasons for the targeted youth demographic and public health approaches, readers will be presented with discussions about other key concepts such as risk and protective factors, consequences, consumption factors, and contextual indicators. Substance use is not restricted to any age, gender identification, race, ethnicity, cultural experience, or religious affiliation. While the incidence and prevalence rates of substance use among all demographics are concerning, evidence indicates that prevention work done with adolescents has a positive and sustainable community impact (Treatment Research Institute, 2014). Most concerning are the effects that substance use has on youth brain development, the potential for high-risk behavior, possible injury, and death. Also concerning are social consequences such as poor academic standing, negative peer relationships, aversive childhood experiences, and overall community strain (Healthy People 2020). Adolescence The Texas Department of State Health Services maintains the definition of Adolescence as ages 12-17 (Texas Administrative Code 441, rule 25.), while the World Health Organization (WHO) and American Psychological Association (APA) both define adolescence as the period of age from 10-19. Many scientists and professionals prefer to define adolescence in terms of developmental milestone markers including behaviors, cognitive reason, aptitude, attitude, and competencies. Both the WHO and APA concede that there are characteristics generally corresponding with adolescence, such as the hormonal and sexual maturation process, social change in prioritization emphasizing peer relations, and attempts to establish autonomy. The National Institute on Drugs and Alcohol (NIDA) and National Institute on Mental Health (NIMH) support an expanded definition of adolescence beyond the age of 19. Neurological research indicates that the human brain is not fully developed until approximately age 25. The Massachusetts Institute for Technology hosts the Young Adult Development Project, one of many research-based entities that provide an overview of brain development into the mid-twenties. The frontal lobe of the brain known for judgment andreason isthe last to develop.These recent findings are particularlyimportant in developing a greater understanding of prevention work with the college-aged groups most likely to experiment with high-risk behaviors. The information presented in the RNA is comprised of regional and state data mined from different sources, and will therefore consist of different age subsets. Some domains of youth data may yield breakdowns that conclude with age 17, for instance, and some will end at age 19. The authoring team has endeavored to standardize the information presented here. Epidemiology Epidemiology is the theoretical framework for which this document evaluates the impact of drug and alcohol use on the public at large. As a study of disease, when applied to drug and alcohol use trends, epidemiology underscores thispublichealth concern asboth preventable andtreatable. According to the World Health Organization, “Epidemiology is the study of the distribution and determinants of health- related states or events (including disease), and the application of this study to the control of diseases and other health problems” (WHO, 2014). The WHO is one of many research-based agencies that
  11. 11. 2015 Regional Needs Assessment PRC 8 11 |P a g e endorse the examination of drug and alcohol trends, the associated harms and treatments, as well as policy development, from an epidemiological perspective. The Substance Abuse Mental Health Services Administration (SAMHSA) has also adopted the epi- framework for the purpose of surveying and monitoring systems which currently provide indicators regarding the use of drugs and alcohol nationally. Ultimately, the WHO, SAMHSA, and others endeavor to create an ongoing systematic infrastructure (such as a repository) that will enable effective analysis and strategic planning for the nation’s disease burden, while identifying demographics at risk and evaluating appropriatepolicyimplementation for prevention andtreatment.Manystates have evaluated drug and alcohol use from an epidemiological perspective for the last several years and have gained ground in prevention work as a result. By investigating risk factors, protective factors, and consequences of substance abuse-related issues, society can address causality rather than merely identifying symptoms. Ongoing surveillance of data necessitates the standardization of measurement with regard to indicators, which translates to methodological processes at the state and regional levels. Risk and Protective Factors Adiscussion ofRisk and Protective Factors isessentialto understanding how prevention work iscurrently done in at-risk populations. There are many personal characteristics that influence or culminate in abstinence from drug and alcohol use, the comprehension of which is relevant to grasping the big picture of substance use and potential for substance use disorders (SUD). Historically, professionals and others believed that the physical properties of drugs and alcohol were the primary determinant of addiction. Science has more recently determined that while the effect of substance use is initially a reward in and of itself, the individual’s physical and biological attributes play a significant role in the potential for the development of addiction. Genetic predisposition and prenatal exposure to alcohol, when combined with poor self-image, self- control, or social competence, are influential factors in substance use disorders. Other risk factors include family strife, loose-knit communities, intolerant society, and exposure to violence, emotional distress, poor academics, extreme socio-economic status, and involvement with children’s protective services, law enforcement, and parental absence. Protective factors include an intact and distinct set of values, high IQ and GPA, positive social experiences, spiritual affiliation, family and role model connectedness, open communications and interaction with parents, awareness of high expectations from parents, shared morning, afterschool, meal-time or night time routines, peer social activities, and commitment to school. Kaiser Permanente originated and now collaborates with the Centers for Disease Control on the Adverse Child Experience study, which compared eight categories of negative childhood experiences against adult health status. Participants were surveyed on the following experiences: recurrent and severe physical abuse, recurrent and severe emotional abuse, and contact sexual abuse growing up in a household with: an alcoholic or drug user, a member incarcerated, a mentally ill, chronically depressed, or institutionalized member, the mother treated violently, and both biological parents not being present. The study results underscore the reality of adverse childhood experiences as more common than typically perceived, and exhibit a prominent relationship between these experiences and poor behavioral health management later in life.
  12. 12. 2015 Regional Needs Assessment PRC 8 12 |P a g e Examination of risk and protective factors provides a meaningful understanding of how and why youth substance use trends develop from an epidemiological perspective. Accessing data that links childhood experiences with current behavioral health trends allows prevention planners to identify core determinants where attention should be focused. Trends become more obvious when consequences and consumption factors are surveyed, as they are considered the distribution of a public health problem. In other words, today’s reported history enables researchers and practitioners to implement tomorrow’s prevention initiatives. Beverly Tremain, an epidemiologist with the Center for Applied Prevention Techniques states, “Today’s incidence rates are tomorrow’s prevalence rates.” Consequences and Consumption A tangible way to understand drug and alcohol trends is through sequentially analyzing consequences and consumption patterns. This often occurs at the community level after a notable tragedy has taken place, such asa drunk driving incident involving a fatality. Support for prevention standardsmaybe more pronounced in the wake of such tragedies. On the other hand, prevention efforts are often unnoticed during times of calm. The epidemiological approach calls for consistent examination of consequences and consumption. This highlights how the public deals with tragedies as well as aversive health trends and the effectiveness of prevention efforts during “calm” years. Consequences and consumption will be described in this document as it relates to alcohol, prescription drugs, and illicit drugs. This will enable the reader to conceptualize public health problems in an organized manner. SAMHSA has provided an excellent example of how these concepts are tied together with alcohol. “With respect to alcohol, constructs related to consequences include mortality and crime, and constructs related to consumption patterns include current binge drinking and age of initial use. For each construct, one or more specific data measures (or ‘indicators’) are used to assess and quantify the prevention-related constructs. Indicator data is collected and maintained by various community and government organizations.” Therefore, the state of Texas will continue to build an infrastructure for monitoring trends by examining consequence-related data followed by an assessment of consumption. There is a complex relationship between consequences and consumption patterns. Many substance- related problems are multi-causal in nature, and often include exacerbating and sustaining dynamics such as lifestyle, family culture, peer relations, education level, criminal justice involvement, and so on. Because consumption and consequences are intertwined and occur within a constellation of other factors, separating clear relationships is difficult. Researchers must look at aggregate data in order to ascribe meaningful relationships to the information obtained. Consumption data alone may be vulnerable to inaccuracy, as it is often gathered through the self-report process, and may not include co-occurring aspects of substance use problems. Moreover, stakeholders and policymakers have a vested interest in the monetary costs associated with substance-related consequences. As such, the process may appear to be a method of working backwards, however it incorporates a pragmatic version of inductive reasoning. Consequences For the purpose of the RNA, consequences are defined as adverse social, health, and safety problems or outcomes associated with alcohol, prescription, or illicit drug use. Consequences include events such as mortality, morbidity, violence, crime, health problems, academic failure, and other undesired events for which alcohol and/or drugs are clearly and consistently involved. Although a specific substance may not
  13. 13. 2015 Regional Needs Assessment PRC 8 13 |P a g e be the single cause of a consequence, measureable evidence must support a link to alcohol and/or drugs asa contributing factor. The WorldHealth Organization estimates alcoholuse asthe world’sthirdleading risk factor for loss of healthy life, and that the world disease burden attributed to alcohol is greater than that for tobacco and illicit drugs. Evaluation of the global impact of drug and alcohol-related consequences presents a consistent and reliable allegory of local consequence and consumption factors. Consumption SAMHSA defines consumption as “the use and high-risk use of alcohol, tobacco, and illicit drugs. Consumption includes patterns of use of alcohol, tobacco, and illicit drugs, including initiation of use, regular or typical use, and high-risk use.” Some examples of consumption factors for alcohol include terms of frequency, related behaviors, and trends, such as current use (within the previous 30 days), current binge drinking, heavy drinking, age of initial use, drinking and driving, alcohol consumption during pregnancy, and per capita sales. Consumption factors associated with illicit drugs may include route ofadministration,such as intravenoususe andneedle sharing.Needle sharing isan example ofhow a specific construct yields greater implications than just the consumption of the drug: it may provide contextual information regarding potential health risks like STD/HIV and hepatitis for the individual, and contributes to the incidence rates of these preventable diseases. Just as needle sharing presents multiple consequences, binge drinking also beckons a specific set of multiple consequences, albeit potentially different from needle sharing. The consumption concept also encompasses standardization of substance unit, duration of use, route of administration, and intensity of use. Understanding the measurement of the substance consumed plays a vital role in consumption rates. Alcoholic beverages are available in various sizes and by volume of alcohol. Variation occurs between beer, wine, and distilled spirits; within each of these categories, the percentage of pure alcohol varies. Consequently, a unit of alcohol must be standardized in order to derive meaningful and accurate relationships between consumption patterns and consequences. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines a “drink” as half an ounce of alcohol, or 12 ounces of beer, a 5-ounce glass of wine, or a 1.5-ounce shot of distilled spirits. The NIAAA (2004) defines “binge drinking” as the drinking behaviors that raise an individual’s Blood Alcohol Concentration (BAC) up to or above the level of .08gm%, which is typically 5 or more drinks for men or 4 or more for women within a two-hour time span. “Risky drinking” is predicated by a lower BAC over a longer span of time, while a “bender” is considered to be two or more days of sustained heavy drinking. Standardizing units continues to prove difficult, so guidelines have been included in the tables section of this document. Because alcohol is legal, commercially available, and federally regulated, it is a better example to employ regarding standardization. This is why the BAC is such an important element in determining risk associated with consumption. Unfortunately, the purity of heroin or the amount of amphetamine found inspeedareoftenascertainedinlabortoxicologyreports,whichareusuallyaccessible onlywhenahealth or legal consequence has already occurred. The inability to know or regulate the purity of street drugs is one of the riskiest determinants for consumption, and is potentially a contributing factor to the recent epidemic of heroin overdoses in the U.S. Moreover, pharmaceutical-related consumption material has an entirelyseparate consumptionvariation potential.There arevastpharmaceuticaldifferences ineffect, potency, and half-life found between the various opioids, stimulants, and benzodiazepines.
  14. 14. 2015 Regional Needs Assessment PRC 8 14 |P a g e Introduction The Department of State Health Services (DSHS), Substance Abuse & Mental Health Services Section, funds 188 school- and community-based programs statewide to prevent the use and consequences of alcohol, tobacco, and other drugs (ATOD) among Texas youth and families. These programs provide evidence-based curricula and effective prevention strategies identified by the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Prevention (CSAP). The Strategic Prevention Framework provided by CSAP guides many prevention activities in Texas. In 2004, Texas received a state incentive grant from CSAP to implement the Strategic Prevention Framework, with Texas DSHS working in close collaboration with local communities to tailor services and meet local needs for substance abuse prevention. This strategic prevention framework provides a continuum of services that target the three classifications of at risk populations under the Institute ofMedicine (IOM): universal, selective, and indicated. Our Audience Potential readers of this document include stakeholders who are vested in the prevention, intervention, and treatment of substance abuse in adolescents and adults in the state of Texas. Stakeholders include, but are not limited to, substance abuse prevention and treatment providers, medical providers, schools and school districts, community coalitions, city, county, and state leaders, prevention program staff, and community members committed to preventing substance use. Our Purpose Prevention Resource Centers serve the community byproviding infrastructure andother indirect services to support the network of substance abuse prevention providers. Beginning in 2013, PRCs became a regional resource for substance abuse prevention data. Whereas PRCs formerly served as clearinghouses for substance use literature, prevention education, and media resources, their primary purpose now is to gather and disseminate data to support prevention programs in Texas. PRCs assist state and local prevention programs by providing data for program planning and evaluation of long-term impact of prevention efforts in Texas. Other valuable services include media campaigns, alcohol retailer compliance monitoring, tobacco activities, and access to prevention training resources. How to Use This Document This RNA is a review of data on substance abuse and related variables across the state that will aid in substance abuse prevention decision making. It seeks to address substance abuse prevention data needs at the state, county, and local levels. The assessment focuses on the state’s prevention priorities of alcohol (underage drinking), marijuana, and prescription drugs and other drug use among adolescents in Texas. This report explores drug consumption trends, consequences, and related risk and protective factors as identified by the Center for Substance Abuse Prevention (CSAP). Purpose of This Report This RNA was developed to provide relevant substance abuse prevention data on adolescents in Region 8 and throughout Texas. Specifically, this regional assessment serves the following purposes: 1. To discover patterns of substance use among adolescents and monitor changes in trends over time. 2. To identify gaps in data where critical substance abuse information is missing.
  15. 15. 2015 Regional Needs Assessment PRC 8 15 |P a g e 3. To determine regional differences and disparities throughout the state. 4. To identify substance use issues unique to communities and regions in the state. 5. To provide a comprehensive resource tool for local providers to design targeted, relevant, data-driven prevention and intervention programs. 6. To provide data to local providers to support grant-writing activities and funding requests. 7. To assist policy-makers in program planning and policy decisions regarding substance abuse prevention, intervention, and treatment in the state of Texas. Features of This Report This report includes an overview of regional substance abuse information as well as more detailed data on trends and consequences of specific drugs. Since readers come from a variety of professional fields with varying definitions of concepts related to substance abuse prevention, we include our definitions in the section titled “Key Concepts.” The core of the report focuses on substance use data. For each of the substances included, we focus on the following factors: age of initiation, early initiation, current use, lifetime use, and consequences. Methodology This Regional Needs Assessment (RNA) incorporates data from many quantitative secondary sources such as governmental, law enforcement, educational, and mental health organizations. Data was obtained through agency reports and databases as well as national, state, and local surveys with relevant information related to substance use trends, demographic information, vital statistics, criminal activity, health disparities, educational attainment, and co-morbid mental health disorders. PRC-8 will conduct qualitative primary research in the form of focus groups with key community members and youth populations. The Regional Evaluators and the Statewide Prevention Evaluator determined that the target population for the purpose of this RNA is adolescents, both males and females. As defined in the earlier sections of this document, adolescence includes individuals ages 10-24. Process The state and regional evaluators collected primary and secondary data at the county, region, and state levels between September 1, 2014 and May 30, 2015. The state evaluator met with the regional evaluator in March 2015 to discuss the expectations of the RNA. Relevant data elements were determined and reliable sources identified through a collaborative process among the team of regional evaluators and with support provided by the Southwest Regional Center for Applied Prevention Technologies (CAPT). Between October 2014 and June 2015, the state evaluator met with regional evaluators via bi-weekly conference calls to discuss criteria for processing and collecting data. Region-specific data collected through local organizations, community coalitions, school districts and local-level governments is included to provide unique local-level information. Additionally, data was collected through primary sources including one-on-one stakeholder interviews and focus groups. Stratification of Region 8 Region 8 is comprised of 28 counties and has a geographical area of 31,637.10 square miles. Most of the population resides in Bexar County. San Antonio is the second largest city in Texas with more than 1.3 million people. In the future, we will acquire data from smaller areas through focus groups and meetings with local stakeholders.
  16. 16. 2015 Regional Needs Assessment PRC 8 16 |P a g e Source: http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk Quantitative Data Selection Identification of Variables Core measures were identified for standardized comparability across Texas; additional indicators may be selected as needed to explore issues important to a particular region. Key Data Sources Epidemiology acquires numerous data sources including vital statistics data, government surveillance data and reports, CDC data, health surveys, and disease registries in order to study dynamics linked with certain diseases or conditions. Primary Sources 1. A document or record containing first-hand information or original data on a topic. 2. A work created at the time of an event or by an evaluator who directly experienced an event. 3. Examples: interviews, diaries, letters, journals, original hand-written manuscripts, newspaper and magazine clippings, government documents, etc. Secondary Sources 1. Any published or unpublished work that is one step removed from the original source, usually describing, summarizing, analyzing, evaluating, derived from, or based on primary source materials. 2. A source that is one step removed from the original event or experience. 3. A source that provides criticism or interpretation of a primary source. 4. Examples: textbooks, review articles, biographies, historical films, music and art, articles about people and events from the past. The following isa list ofcommonlyuseddata sources including data collection systemsandorganizations with numerous reports.  U.S. Census Bureau  National Vital Statistics System Region 8 Counties by Ranking Population in Texas Atascosa 68 Kendall 79 Bandera 115 Kerr 63 Bexar 4 Kinney 219 Calhoun 112 La Salle 184 Comal 33 Lavaca 122 DeWitt 117 Maverick 57 Dimmit 160 Medina 67 Edwards 236 Real 221 Frio 127 Uvalde 98 Gillespie 100 Val Verde 65 Goliad 183 Victoria 41 Gonzales 118 Wilson 70 Guadalupe 29 Zavala 156 Jackson 141 Region 8 4 Karnes 140 Texas 2
  17. 17. 2015 Regional Needs Assessment PRC 8 17 |P a g e  National health surveys  Maternal and Child Health Bureau  Behavioral risk factor surveys  Other surveillance programs and state cancer registries  World Health Organization  Private organizations and universities Data, mainly quantitative data, is imperative in epidemiology. Evaluating and documenting frequency, type, and distribution of incidence is key to understanding substance use and abuse, what causes them, whom is affected, and how to prevent further occurrence. Understanding data allows communities, public officials, and stakeholders to target causes, affected citizens, and gaps in resources. Criteria for Selection The Regional Evaluators and the Statewide Prevention Evaluator chose secondary data sources as the main resource for this document based on the following criteria: 1. Relevance: The data source provides an appropriate measure of substance consumption, consequence, and related risk and protective factors. 2. Timeliness: We attempt to provide the most recent data available (within the last five years); however, older data might be provided for comparison. 3. Methodological soundness: Data that used well-documented methodology with valid and reliable data collection tools. 4. Representativeness: We chose data that most accurately reflected the target population in Texas and across the eleven human services regions. 5. Accuracy: Data is an accurate measure of the associated indicator. In this needs assessment for Region 8, regional surveys, reports, anecdotal and other qualitative data will only be mentioned to add narrative to each section. Data employed in the following tables comes from the most recently available datasets reflecting the criteria above. Qualitative Data Selection While quantitative data often takes priority in assessments, it is equally important to provide context through the appropriate use of qualitative data. The term “qualitative data” refers to data and information describing a specific event or set of circumstances that is not originally organized or obtainable numerically. Together, qualitative and quantitative data help to define the scope and extent of a community’s needs and to identify its gaps. Key Informant Interviews Key informant interviews involve capturing the knowledge, belief, and perspective of a person who has an in-depth understanding of a particular subject, circumstance, geographic area, or population subgroup. Quotations from the key informant and a summary of the interview are commonly included in the health needs assessment. Focus Groups In the upcoming year, focus groups and interviews will be conducted by the PRC team in order to better understand what members of the communities believe their greatest needs to be. The information
  18. 18. 2015 Regional Needs Assessment PRC 8 18 |P a g e collected by this research will serve to identify avenues for further research and provide access to any quantitative data that participants may have access to. 1. What problems do you see in your community? 2. What is the greatest problem you see in your community? 3. What evidence do you have to support this as the greatest problem? 4. What services do you lack in your communities? Participants for focus groups will be invited from a wide selection of professionals including law enforcement, health care providers, community leaders, clergy, educators, town council, state representatives, university professors, and local business owners. In these sessions, participants will discussed their perceptions of how their communities are affected by alcohol, marijuana, and prescription drugs. Surveys The discussion of survey covers any motion that gathers or obtains statistical data. It can include censuses, sample surveys, the collection of data from organizational records, and resulting statistical events. A survey within this study is an investigation of the features of a given population by means of gathering data from a sample of that population and estimating their features through logical use of statistical methodology. Demographic Overview 2014 Census data indicate that Texas added 451,321 residents in the last year, a 1.7 percent increase since 2013, totaling a population of over 26.9 million residents. Texas ranked 1st nationally for the highest numeric increase in population and 2nd as the most populous state, behind California. The nation’s regionalpopulation in theSouth,which includes Texas,grew themost at 14.3 percent.Texas’s population growth from 2000 to 2010 was twice that of the United States as a whole. The U.S. population grew only 9.7 percent to 308,745,538 residents, the slowest growth rate in decades. State Demographics The Lone Star State's growth over the past decade was concentrated in its major urban regions, according to 2010 Census population distribution data. Texas cities showed healthy growth from 2000 to 2010. Houston ranked 4th, San Antonio 7th , and Dallas 9th compared to other cities in the U.S. Houston continues to be the state's largest city, with a 7.5 percent increase to 2,099,451. In 2nd statewide, San Antonio and its population grew 6.1 percent to 1,327,407, while Dallas, 3rd largest city in Texas, gained 0.8 percent to grow to 1,197,816. Austin was the 4th largest city, while Fort Worth, with 741,206 people, and El Paso, with 649,121, ranked 5th and 6th in population. Population Texas is the second most populous state in the nation and has three cities with populations exceeding one million: Houston, San Antonio, and Dallas. These three cities rank among the ten most populous cities in the United States. According to the US Census 2010, six Texas cities had populations greater than 600,000 people. Austin, Fort Worth, and El Paso are among the 20 largest U.S. cities. Texas has four metropolitan areas with populations greater than a million: Dallas–Fort Worth–Arlington, Houston–
  19. 19. 2015 Regional Needs Assessment PRC 8 19 |P a g e Sugar Land–Baytown, San Antonio–New Braunfels, and Austin–Round Rock–San Marcos. The Dallas– Fort Worth and Houston metropolitan areas number about 6.3 million and 5.7 million citizens. As of 2014, there are 26,956,958 people living in the state of Texas, an increase of 6.1 million since the year 2000, including increases in population in all three subcategories of population growth: natural increase (births minus deaths), net immigration, and net migration. It is estimated that as many as 1.8 million immigrants are living undocumented in Texas as of 2012, according to the Department of Homeland Security (DHS, 2012). Texas Metropolitan Status by County Metropolitan Areas in this table were defined in 2013 by the Office of Management and Budget (OMB). Metropolitan Areas are characterized by a central urban area surrounded by other urban areas that work together economically or socially. The central urban area must have a population of at least 50,000 people with a combined regional population of 100,000. Texas- Core Based Statistical Areas (CBSAs) and Counties Source: U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau, 2013 20 22 24 26 28 P O P U L A T I O N E S T I M AT E S , AP R I L 1 , 2 0 0 0 , ( C E N S U S 2 0 0 0 D AT A) P O P U L A T I O N E S T I M AT E S B AS E , AP R I L 1 , 2 0 1 0 , ( V 2 0 1 3 ) P O P U L A T I O N E S T I M AT E S , J U L Y 1 , 2 0 1 3 , ( V 2 0 1 3 ) P O P U L A T I O N E S T I M AT E S , J U L Y 1 , 2 0 1 4 , ( V 2 0 1 4 ) MILLIONS TEXAS POPULATION Texas Population
  20. 20. 2015 Regional Needs Assessment PRC 8 20 |P a g e Age Texans continue to grow older, with an average age over 33 years. At the same time, the number of women at older ages is increasing. A grasp of the population’s age and gender structure produces understanding of changing outcomes, and predicts upcoming social and economic encounters. Examining age demographics is important for increasing prevention efforts, especially with potential first-time users. Source: SOURCE: U.S. Census Bureau, Current Population Survey, and Annual Social and Economic Supplement, 2012. Race Race is the key dissection of humanity, having distinct physicalcharacteristics.It is important to understandthata person can belongto only one race. Although he or she belongs to just one race, they may still have multiple ethnic identifications. Race is socially imposed, whereas ethnicity is not. The census officially identifies six racial categories: White American, Native American and Alaska Native, Asian American, Black or African American, Native Hawaiian and Other Pacific Islander. "Some other race" is also used in the census and other surveys, but is not an official response. 0 200,000 400,000 600,000 800,000 1,000,000 1,200,000 TEXAS POPULATION BY AGE & SEX male female White--Anglo (non- Hispanic) 72% African American (non- Hispanic) 18% American Indian (non- Hispanic) 1% Asian (non- Hispanic) 6% Other (non- Hispani c) 0% Multi-Racial (non- Hispanic) 3% Race White--Anglo (non-Hispanic) African American (non-Hispanic) American Indian (non-Hispanic) Asian (non-Hispanic) Other (non-Hispanic) Multi-Racial (non-Hispanic) Source: U.S. Census Bureau, Total population estimates of the state of Texas as of July 1, 2014.
  21. 21. 2015 Regional Needs Assessment PRC 8 21 |P a g e Ethnicity Ethnicity is defined as being part ofor identifying witha socialgroup that hasa mutual nationalor cultural tradition and customs. Ethnicity refers to shared cultural practices, perspectives, and distinctions that distinguish one group of people from another, or a shared cultural heritage. The most common characteristics differentiating other ethnic groups are ancestry, language, religion, attire, and a sense of history. Ethnic differences are not inherited; they are learned. The U.S. Census Bureau classifies Americans as "Hispanic or Latino" and "Not Hispanic or Latino" because Hispanic and Latino Americans are a racially diverse ethnicity that make up the largest minority group in the U.S. Each individual has two classifying elements: racial identity and whether or not they are of Hispanic ethnicity. These categories are sociopolitical ideas and should not be taken as logical or anthropological in nature according to the U.S. Department of Labor. Therefore, no separate racial category exists for Hispanic and Latino Americans, as they do not establish a race, nor a national group. Each person is asked to choose from the six racial classifications as all Americans are included in the numbers reported for those races. In this assessment the information collected from the U.S. Census and other sources identifies: 1. Persons reporting only one race. 2. Hispanics may be of any race, and are included in applicable race categories. Languages The majority of the U.S. population speak English as their first language, but many other languages are spoken in homes as the primary language. Currently there are 382 identified language codes, according to the U.S. Census. These are categorized into four major language groups: Spanish; Other Indo-European languages, Asian and Pacific Island languages, and All Other languages. A more comprehensive subcategory divides the 382 codes into 39 languages and language groups. According to the U.S. Census Bureau, 2009-2013 5- Year American Community Survey, about 65% (15,471,149) of Texas residents age five and older speak English as their primary language, more than 29% (6,983,384) speak Spanish as their first language, 0.82% (193,408) spoke Vietnamese as their primary Top 10 Non-English Languages Spoken in Texas Language % of Texas Population 1. Spanish 29.46% 2. Vietnamese 0.82% 3. Chinese (including Mandarin and Cantonese) 0.59% 4. Other Asian Languages 0.38% 5. African Languages 0.34% 6. Tagalog 0.30% 7. German 0.29% 8. French 0.26% 9. Hindi 0.25% 10. Urdu 0.24% Hispanic --Latino 38% Non Hispanic- -Latino 62% Ethnicity Source: U.S. Census Bureau, Total population estimates ofthe state of Texas as of July 1, 2014. Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey Survey
  22. 22. 2015 Regional Needs Assessment PRC 8 22 |P a g e language, and Chinese (including Cantonese and Mandarin) is spoken as the primary language by 0.59% (140,871). Other languages have been documented in Texas by the American Community Survey and include German/Texas German, Tagalog, French/Cajun French, and others. In total, almost 35%) of Texas's residents age five and older spoke a language other than English. Concentrations of Populations There are five large concentrations of populations in the state of Texas according to the U.S. Census: European, Hispanic, African American, Asian, and American Indian. English Americans prevail in eastern, central, and northern Texas; German Americans in central and western Texas. African Americans make up one-third of the Lone Star’s population and are concentrated in eastern Texas as well as the Dallas-Fort Worth and Houston metropolitan areas. As of 2010 the U.S. Census shows 45% of Texas citizens identify with Hispanic heritage; these take into account present-dayimmigrants fromMexico, CentralAmerica,and South America and include Tejanos, whose descendants lived in Texas as early as the 1700s. Tejanos are concentrated in and around Bexar County including San Antonio, where over one million Hispanics live. Texas has the 2nd greatest Hispanic-identifying population in the United States, behind California. American Indian tribes who once subsisted or migrated inside the frontiers of today’s Texas include the Alabama, Apache, Atakapan, Bidai, Caddo, Cherokee, Chickasaw, Choctaw, Comanche, Coushatta, Hueco, the Karankawa of Galveston, Kiowa, Lipan Apache, Muscogee, Natchez, Quapaw, Seminole, Tonkawa, Wichita, and others. There are three federally recognized Native American tribes in Texas, one of which is the Kickapoo Traditional Tribe of Texas in Region 8: 1. Alabama-Coushatta Tribe of Texas in eastern Texas 2. Kickapoo Traditional Tribe of Texas in the Rio Grande Valley 3. Ysleta Del Sur Pueblo of El Paso, Texas Source: texaspolitics.utexas.edu
  23. 23. 2015 Regional Needs Assessment PRC 8 23 |P a g e General Socioeconomics Economic and social indicators like income, education, and social connectedness have a direct impact on health. These socio-economic factors interact to affect quality of life within communities. Improving on any of these factors can enhance positive well-being and outcomes throughout societies. “By 2020, mental and substance use disorders will surpass all physical diseases as a major cause of disability worldwide.” Stress and a lack of resources, skills, social support, or connection to the community contribute to poor coping skills and/or harmful behaviors such as smoking, over- consumption of alcohol and drugs, or poor eating habits. Social support, social networking, and connection to culture protect against the health effects of living in disadvantaged circumstances. Having a good start in life and learning can help set the path for a healthier life. Prevention gives children life skills that help them become more resistant to substance abuse. Challenges for adults such as mental health issues, obesity, heart disease, criminality, low literacy, and welfare dependency can be traced to events in early childhood. Providing children with helpful environments that include positive parental involvement and behavior, particularly during the first six years, can modify poor outcomes in later life. “Preventing mental and/or substance use disorders and related problems in children, adolescents, and young adults is critical to Americans’ behavioral and physical health.” SAMHSA promotes and implements prevention and early intervention strategies to reduce the impact of mental and substance use disorders in America’s communities. “Addressing the impact of substance use alone is estimated to cost Americans more than $600 billion each year” (Prevention of Substance Abuse and Mental Illness, Substance Abuse and Mental Health Services Administration, 2014). Average Wages According to the U.S. Department of Labor, 19 of Texas’s 26 largest counties recorded wage growth above the 2.9-percent national increase in 2014. Average weekly wages in 5 of the 26 largest Texas counties were at least 10% above the national average of $949 per week in the third quarter of 2014. Texas also had four of the lowest-paying large counties in the United States, all located along the border with Mexico. Counties with the highest average weekly wages were located around the large metropolitan areas of Dallas, Houston, and Austin, as well as the smaller areas of Midland, Odessa, and Amarillo. Lower-paying countieswere concentrated in the agricultural areas of central Texas andthe Texas Panhandle, and along the Texas-Mexico border. 254 Counties in Texas  212 had wages below the national average  54 counties average weekly wages under $650  76 registered wages from $650 to $749  52 had wages from $750 to $849  30 had wages from $850 to $949  42 had wages of $950 or more per week
  24. 24. 2015 Regional Needs Assessment PRC 8 24 |P a g e Household Composition Household and Family Size  The number of one-person households is growing slightly.  The total number of households in Texas grew 1,493,117 since 2000.  The average household size increased from 2.74 persons in 2000 to 2.82 persons in 2013.  The average family size increased from 3.28 persons in 2000 to 3.41 in 2013. 0 2,000,000 4,000,000 6,000,000 8,000,000 2013 2012 2011 2010 2000 Texas Household and Family total families total household 0 1,000,000 2,000,000 3,000,000 4,000,000 2013 2012 2011 2010 2000 Texas Household Nonfamily household Female householder, no husband present, family household Male householder, no wife present, family household Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey
  25. 25. 2015 Regional Needs Assessment PRC 8 25 |P a g e Housing Occupancy and Tenure As the Texas population grows, the total number of housing units tends to grow as well. The proportion of housing units that are owner-occupied, renter-occupied, or vacant varies slightly throughout the state as a result of boom-and-bust periods or regulatory changes which encourage or discourage development patterns.  The American Community Survey reported over 10 million housing units in Texas, based on 2013 estimates.  The Texas vacancy rate is 11.8%, 0.7% below the national average.  In 2013, 63.3% of the state’s housing units were owner-occupied, 1.6% lower than the national ACS 2013 average. Employment Rates The Bureau of Labor Statistics reports that the state unemployment rate at 4.2% in April 2015, down from 5.2% in 2014. Texas continues to trend below the national unemployment rate of 5.4%. Employment rose in 25 of the 26 largest counties in Texas from September 2013 to September 2014. 90.6% 89.4% 87.8% 88.0% 88.2% 9.4% 10.6% 12.2% 12.0% 11.8% 0% 20% 40% 60% 80% 100% 2000 2010 2011 2012 2013 Texas Housing Occupancy Occupied Vacant 63.8% 63.7% 64.5% 63.9% 63.3% 36.2% 36.3% 35.5% 36.1% 36.7% 0% 20% 40% 60% 80% 100% 2000 2010 2011 2012 2013 Texas Housing Tenure Renter-occupied housing units Owner-occupied housing units Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey
  26. 26. 2015 Regional Needs Assessment PRC 8 26 |P a g e U.S. Job Growth, 2004-2014 Texas Job Growth Among the largest counties in Texas, employment was highest in Harris County (2,269,500) in September 2014, followed by Dallas County (1,558,500). Tarrant, Bexar, and Travis Counties had employment levels exceeding 600,000. Combined, the 26 largest Texas counties attributed for 80.1% of total employment within Texas. According to the Texas Data Center, the US Department of Labor, and the Bureau of Labor Statistics, the Lone Star State continues to lead the country in job development for over a decade, even through the recession. Source: Demographic Characteristics and Trends in Texas: Dr. Lloyd Potter, State Demographer, Texas State Data Center, the University of Texas at San Antonio Source: Texas Labor Market Review, April 2015
  27. 27. 2015 Regional Needs Assessment PRC 8 27 |P a g e Industry Texas has numerous resources, a forceful economy, and an exceptional quality of life. Place of work are categorized into industries based on their primary product or activity as decided from figures on annual sales volume. Industry statistics are delivered by the North American Industry Classification System (NAICS) and are revised every five years.
  28. 28. 2015 Regional Needs Assessment PRC 8 28 |P a g e Employment estimates released by TWC are produced in cooperation with the U.S. Department of Labor’s Bureau of Labor Statistics. Growing industries include Mining and Logging, Construction, Manufacturing, Trade/Transportation/Utilities, Financial Activities, Professional and Business Services, Education and Health Services, Leisure and Hospitality, Information and Government, and Other Services. Texas added 320,400 nonagricultural jobs between March 2014 and March 2015 for an annual growth rate of 2.8%, compared with 2.3% for the U.S. as a whole. The private sector for the state contributed 304,300 jobs, an increase of 3.2%, in comparison with 2.6% for the nation’s private sector. Texas’s seasonally adjusted unemployment rate fell to 4.2% in March 2015 from 5.3% in March 2014, while the U.S. rate fell from 6.6% to 5.5% during the same time. Texas has added an estimated 287,000 seasonally adjusted jobs over the past year, including an additional 1,200 positions during the month of April 2015. Texas added jobs in seven of eleven major industries, with more than 260,000 currently available jobs posted on WorkInTexas.com as of April 2015. Job increases were led by the Leisure and Hospitality industry, which added 6,900 positions. The Information industry showed its largest monthly gain since June 2000 with 3,400 jobs. Other Services gained 2,800 jobs, followed by Trade/Transportation/Utilities, which grew by 2,100 positions. NAICS Industry Structure The NAICS industry hierarchy classifies data to the six-digit level. The first level consists of the Goods- Producing and Service-Providing industries. Below this is the Super Sector level. The third layer is the Sector level. Statewide data is published at both the Super Sector and Sector levels. Data for the 254 Texas counties is published at the Super Sector level only. Mar-15 Mar-14 Absolute Percent Texas 11,728,000 11,407,600 320,400 2.8% US 140,326,000 137,214,000 3,112,000 2.3% Mar-15 Mar-14 Absolute Percent Texas 9,863,600 9,559,300 304,300 3.2% US 118,035,000 114,989,000 3,046,000 2.6% Mar-15 Mar-14 Mar-15 Mar-14 Texas 4.2% 5.4% 4.2% 5.3% US 5.6% 6.8% 5.5% 6.6% Sources: Texas Workforce Commission and U.S. Bureau of Labor Statistics Texas and U.S. Labor Markets NonFarm Employment Private Employment Unemployment Rate Change Not Seasonally Adjusted Seasonally adjusted
  29. 29. 2015 Regional Needs Assessment PRC 8 29 |P a g e TANF Recipients According to the US Department of Health and Human Services, “a welfare recipient is any person living in a family where someone received benefits from any of just three programs—Temporary Assistance to Needy Families (formerly Aid to Families With Dependent Children), Supplemental Security Income, and the Supplemental Nutrition Assistance Program (or food stamps).” According to the Advisory Board on Welfare Indicators, “A family is dependent on welfare if more than 50% of its total income in a one-year period comes from TANF (which replaced AFDC), SNAP (formerly food stamps) and/or SSI, and this welfare income is not associated with work activities.”
  30. 30. 2015 Regional Needs Assessment PRC 8 30 |P a g e The Temporary Assistance for Needy Families (TANF) program is designed to help needy families attain self-sufficiency. Temporary Assistance for Needy Children is formerly AFDC, Aid for Families with Dependent Children. Cash assistance, or "welfare," is disbursed by the Texas Health and Human Services Commission, TxHHSC, formerly the Texas Department of Human Services. Single and two-parent families are eligible for aid based on financial need, and must engage in work or work-related activities to remain eligible. One Time Temporary Assistance for Needy Families helps families solve a short-term crisis. Households are eligible for temporary assistance in cases of job loss, loss of financial support, underemployment, or a crisis situation such as loss of transportation/shelter or a medical emergency. Recipients must engage in work-related activities in order to remain eligible. OTTANF has lowered reliance on TANF, allowing more resources to support individuals with barriers to employment, including those with substance abuse or mental health issues. The rate of substance use among welfare recipients is likely to be greater as the number of recipients decreases, because participants with fewer obstacles to employment are likely to use temporary services. According to the 2000 report Addressing Substance Abuse Problems among TANF Recipients: A Guide for Program Administrators:  1 in 5 welfare recipients abuses drugs and/or alcohol. 26,912 31,594 36,107 41,489 44,608 47,620 45,275 50,439 57,373 66,133 77,825 TANF BASIC PROGRAM TANF Basic Program One-Parent and Child Only Cases 686 910 1,106 954 1,046 1,277 992 930 1,404 1,898 2,539 TANF STATE PROGRAM TANF State Program Two-Parent Cases 78 100 134 168 169 236 268 283 387 1,358 903 TANF ONE-TIME PROGRAM TANF One-Time Program Cases 26 28 35 42 45 69 39 62 42 32 82 TANF GRANDPARENTS PROGRAM TANF Grandparents Program Cases
  31. 31. 2015 Regional Needs Assessment PRC 8 31 |P a g e  10.5% of recipient’s age 15 and older report illicit drug use in the past month.  10.6% of female adults in households receiving aid have “some impairment” involving alcohol or other drugs.  27% of females over the age of 14 receiving aid abuse alcohol or other drugs.  37% of women 18-24 receiving aid have used illicit drugs or engaged in binge drinking.  1 in 20 welfare recipients has difficulty holding regular employment due to substance use.  5.2% of adults in welfare households are dependent on alcohol or other drugs.  7.6% of recipients are dependent on alcohol and 3.6% are dependent on other drugs.  27% of mothers over age 14 receiving aid abuse alcohol or other drugs, compared to 9% of other women. While the majority of alcohol and drug users are not public assistance recipients, substance use issues are more common in the welfare population than in the general population. This is not meant to suggest a causal relationship between substance abuse and welfare receipt; rather, it reflects the fact that people at risk for substance abuse are overrepresented in the welfare population. Texas Supplemental Nutrition Assistance Program (SNAP) More than 3.9 million Texans receive food benefits from the Supplemental Nutrition Assistance Program (SNAP). SNAP provides monthly benefits that help eligible low-income households purchase healthy food. For most households, SNAP funds account for only a portion of their food budgets; they must also use their own funds to buy enough food to last throughout the month. Recipients are eligible for SNAP benefits based on residence, citizenship, employment services, work requirements, resources, income, and social security numbers. While many Texans receive food assistance 27.1% of Texas children still have food insecurity, the inability to access nutritious food. National data from the U.S. Census Bureau and U.S. Department of Agriculture determined that Zavala County in South Texas has the highest rate of food insecurity in the nation. Nearly half the children in Zavala County are at risk of hunger. Texas is one of eight states that impose a lifetime ban on both TANF and SNAP benefits for individuals with felony drug convictions. SNAP AT A GLANCE According to the U.S. Census Bureau 2009-2013 5-Year American Community Survey, out of 8.8 million Texas households:  Almost 1.2 million households receive SNAP benefits  24.9% have one or more residents 60 years and over  66.8% have children under age 18  52.4% receiving SNAP are below poverty level  42% have at least one household member with a disability
  32. 32. 2015 Regional Needs Assessment PRC 8 32 |P a g e Source: The United States Department of Agriculture (USDA), Supplemental Nutrition Assistance Program (SNAP), Annual State Level Data: FY 2010-2014 Source: The United States Department of Agriculture (USDA), Supplemental Nutrition Assistance Program (SNAP), Annual State Level Data: FY 2010-2014 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Race Households recieving SNAP by Race White African American Asian American Indian/ AN/NA/ Other PI Other/two or more races 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Ethnicity Households recieving SNAP by Ethnicity Hispanic White-non hispanic other-non Hispanic 5,447,397,414 5,993,125,493 6,006,734,649 5,934,441,831 5,330,650,619 FY 2010 FY2011 FY2012 FY2013 FY2014 TEXAS SNAP: BENEFITS Benefits 3,500,000 3,600,000 3,700,000 3,800,000 3,900,000 4,000,000 4,100,000 Texas SNAP: Participants Avg. Monthly Participation- Persons 1,400,000 1,450,000 1,500,000 1,550,000 1,600,000 1,650,000 1,700,000 Texas SNAP: Households Participating Avg. Monthly Participation- Housholds
  33. 33. 2015 Regional Needs Assessment PRC 8 33 |P a g e Source: The United States Department of Agriculture (USDA), Supplemental Nutrition Assistance Program (SNAP), Annual State Level Data: FY 2010-2014 Source: The United States Department of Agriculture (USDA), Supplemental Nutrition Assistance Program (SNAP), Annual State Level Data: FY 2010-2014 $270.00 $280.00 $290.00 $300.00 $310.00 $320.00 $330.00 Texas SNAP: Monthly Household Avg. Monthly Benefits per Household $115.00 $117.00 $119.00 $121.00 $123.00 $125.00 $127.00 $129.00 Texas SNAP: Monthly Person Avg. Mothly Benefits per person 438,532,682 434,569,783 433,304,585 1,596,864 1,557,496 1,544,770 3,826,274 3,715,414 3,684,002 FEB-14 JAN 2015 - P R ELI M INAR Y FEB 2015 - I NI TI AL LATEST TEXAS SNAP PARTICIPATION & BENEFITS SNAP Benefits SNAP Housholds SNAP Participants
  34. 34. 2015 Regional Needs Assessment PRC 8 34 |P a g e Federal Benefits Denied to Drug Offenders Texas is one of the few states that continue to impose a full ban on TANF and SNAP benefits for individuals with felony drug convictions. The federal ban on TANF and SNAP benefits has been in effect since 1996 with the signing of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). PRWORA imposed a denial of federal benefits to individuals convicted in state or federal courts of felony drug offenses. The ban is imposed for no other offenses but drug crimes. Its provisions that subject individuals who are otherwise eligible for receipt of SNAP or TANF benefits to a lifetime disqualification applies to all states unless they act to opt out of the ban. As of 2011, 37 states either fully or partially enforce the TANF ban, while 34 states either fully or partially enforce the SNAP ban. Source: GAO analysis of federal law, GAO-05-238 Denial of Federal Benefits Child Nutrition Programs The National School Lunch Program (NSLP) is a federally assisted meal program providing nutritious low-cost or free lunches to more than 3 million Texas children in public and private schools, residential institutions, and juvenile correctional institutions. Texas Level Child Nutrition Table FY2010 FY2011 FY2012 FY2013 FY2014 National School Lunch Participation 3,352,757 3,401,746 3,374,154 3,314,611 3,322,460 Meals Served 559,012,658 565,877,470 553,231,282 561,616,917 561,428,486 Cash Payments 1,148,951,410 1,197,859,307 1,208,097,479 1,313,210,138 1,352,110,572 Commodity Costs 111,274,444 122,407,751 128,978,087 114,926,509 154,674,858 School Breakfast Participation 1,635,423 1,744,587 1,786,414 1,818,710 1,864,859 Meals Served 274,505,543 292,635,028 296,630,348 312,178,181 318,776,536 Cash Payments 405,772,076 439,611,825 457,608,859 495,699,455 518,897,627 Special Milk Half-Pints Served 280,465 218,703 162,687 121,638 107,566 Child and Adult Care Food Avg. Daily Attendance 315,295 307,976 351,922 369,515 409,466 Meals Served 195,784,705 200,905,491 202,035,064 204,530,523 207,907,315 TANF SNAP Full Ban Modified Ban NO Ban Full Ban Modified Ban NO Ban AK AR KS AK AR DE AL AZ ME AL AZ IA DE CA MI GA CA KS GA CO NH MO CO ME IL CT NJ MS CT MI MO FL NM SC FL NH MS HI NY TX HI NJ NE IA OH WV ID NM SC ID OK WY IL NY SD IN PA IN OH TX KY RI KY OK VA LA VT LA PA WV MA WY MA RI MD MD SD MN MN VT MT MT WA NC NE ND NC NV ND OR NV TN OR UT TN WA UT WI VA WI TOTAL 13 24 13 9 25 16
  35. 35. 2015 Regional Needs Assessment PRC 8 35 |P a g e Cash Payments 249,685,221 259,332,648 271,131,370 285,454,670 303,447,828 Summer Food Services Avg. Daily Attendance 162,502 173,243 176,587 180,355 181,174 Meals Served 15,747,612 16,143,253 17,860,474 17,414,743 17,868,686 Cash Payments 36,094,568 37,494,624 42,012,960 42,079,455 44,268,651 Source: The United States Department of Agriculture (USDA), Child Nutrition Tables, State Level Tables: FY 2010-2014 Texas Level Tables Current Activity Feb 2014 Jan 2015 Feb 2015 % change Feb15 vs Feb14 National School Lunch Participation 3,350,928 3,389,981 3,386,614 1.1% School Breakfast Participation 1,852,119 1,869,686 1,885,738 1.8% Source: The United States Department of Agriculture (USDA), Child Nutrition Tables, State Level Tables--Current Activity Regional Demographics DSHS Region 8 includes a 28-county area of South Central Texas. This area borders the Rio Grande River and Mexico in the west and the Gulf Coast in the east. Region 8 contains almost every type of geographical setting found in Texas: rolling hills and plains, hill country, coastal plains, brush country, and desert. In 2010 the region had an estimated population of 3 million, with over half residing in Bexar County. The Region 8 PRC is located at the San Antonio Council on Alcohol and Drug Abuse (SACADA). Source: www.dfps.state.tx.us/About_DFPS/region/images/REGION8.GIF Population The regional population in 2014 was 2,751,696. The population density is 87 persons per square mile, while Texas has a population density of 96.3 persons/sq. mi. and the U.S. has 87.4 persons/sq. mi. The total land area for Region 8 is 31,637.1 square miles.
  36. 36. 2015 Regional Needs Assessment PRC 8 36 |P a g e Report Area Total Population Total Land Area (sq. mi.) Population Density (per sq. mi.) Ranking Population in Texas Region 8 2,751,696 31,637.10 87 4 Atascosa 47,774 1,219.54 36.8 68 Bandera 20,601 790.96 25.9 115 Bexar 1,817,610 1,239.82 1,383.10 4 Calhoun 21,806 506.84 42.2 112 Comal 118,480 559.48 193.9 33 DeWitt 20,503 908.98 22.1 117 Dimmit 10,897 1,328.88 7.5 160 Edwards 1,884 2,117.86 0.9 236 Frio 18,065 1,133.50 15.2 127 Gillespie 25,357 1,058.21 23.5 100 Goliad 7,465 852.01 8.5 183 Gonzales 20,312 1,066.69 18.6 118 Guadalupe 143,183 711.3 184.9 29 Jackson 14,591 829.44 17 141 Karnes 15,081 747.56 19.8 140 Kendall 37,766 662.45 50.4 79 Kerr 49,953 1,103.32 45 63 Kinney 3,586 1,360.06 2.6 219 La Salle 7,369 1,486.69 4.6 184 Lavaca 19,581 969.71 19.9 122 Maverick 55,932 1,279.26 42.4 57 Medina 47,399 1,325.36 34.7 67 Real 3,350 699.2 4.7 221 Uvalde 26,926 1,551.95 17 98 Val Verde 48,623 3,144.75 15.5 65 Victoria 90,028 882.14 98.4 41 Wilson 45,418 803.73 53.4 70 Zavala 12,156 1,297.41 9 156 Texas 26,956,958 (V2014) 261,231.71 96.3 2 U.S. 318,857,056 (V2014) 3,531,905.43 87.4 - Source U.S. Census Bureau: State and County Quick Facts; (The vintage year (e.g., V2014) refers to the final year of the series (2010 thru 2014)).
  37. 37. 2015 Regional Needs Assessment PRC 8 37 |P a g e Age Age distribution representsthe population for Region8byage group. See Appendix Pfor age distribution by county. Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey Race This chart displays the total population in Region 8 by the six racial categories identified by the U.S.: White American, Native American and Alaska Native, Asian American, Black or African American, Native Hawaiian and Other Pacific Islander, and Two or More Races. Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey - 50,000 100,000 150,000 200,000 250,000 Region 8 Age Distribution Region 8 white 79% Black/African American 6% American Indian/Alaska Native 1% Asian 2% Native Hawaiian and Other Pacific Islander 0% Some Other Race 9% Two or More Races 3% Race Region 8 white Black/African American American Indian/Alaska Native Asian Native Hawaiian and Other Pacific Islander Some Other Race Two or More Races
  38. 38. 2015 Regional Needs Assessment PRC 8 38 |P a g e Ethnicity This chart shows the population by Hispanic or Latino Ethnicity of any race of the population for Region 8. Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey Even though the Hispanic population accounts for 54% of Region 8, certain areas contain a larger percentage of Hispanic population. See Appendix F for a detailed analysis of ethnic populations within Region 8. Languages The majority of the Region 8 population speak English as their first language, but many other native languages are spoken in homes. The growing population of English language learners is identified in this report as it can cause language barriers to obtaining services. About 61% (1,500,099) of Region 8 citizens ages five and older speak English at home as their first language, while more than 36% (891,829) speak Spanish as their first language. Further language data for region 8 is provided in Appendix D. Concentrations of Populations METROPOLITAN AREAS San Antonio–New Braunfels is an eight-county metropolitan area referred to as Greater San Antonio. U.S. Census estimates showed the Greater San Antonio area population increased from 1,711,703 in 2000 to 2,328,652 in 2014, making it the 25th largest metropolitan area in the United States. San Antonio–New Braunfels is the third-largest metro area in Texas after Dallas–Fort Worth–Arlington and Houston–The Woodlands–Sugar Land. It is also the second-fastest growing metropolitan area in Texas. Region 8 Non- Hispanic/Latino 46% Hispanic/Latino 54% Race Region 8 Region 8 Non-Hispanic/Latino Hispanic/Latino Top 10 Non-English Languages Spoken in Region 8 Language % of Region 8 Population 1.Spanish 36.14% 2.German 0.47% 3.Tagalog 0.27% 4.Chinese 0.23% 5.Vietnamese 0.23% 6.Other Asian 0.30% 7.German 0.29% 8.French 0.26% 9.Hindi 0.25% 10.Urdu 0.24% Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey
  39. 39. 2015 Regional Needs Assessment PRC 8 39 |P a g e Census Area Estimated population as of July 1, 2014 2010 Census 2000 Census 1990 Census San Antonio–New Braunfels Metropolitan Statistical Area 2,328,652 2,142,508 1,711,703 1,407,745 Atascosa 47,774 44,911 38,628 30,533 Bandera 20,892 20,485 17,645 10,562 Bexar 1,855,866 1,714,773 1,392,931 1,185,394 Comal 123,694 108,472 78,021 51,832 Guadalupe 147,250 131,533 89,023 64,873 Kendall 38,880 33,410 23,743 14,589 Medina 47,894 46,006 39,204 27,312 Wilson 46,402 42,918 32,408 22,650 Source: U.S. Bureau of the Census: Metropolitan Areas. Population Division Victoria Metropolitan Statistical Area, sometimes referred to as the Golden Crescent region, consists of three counties in the Coastal Bend region of Texas, anchored by the city of Victoria. As of the 2000 census, the Victoria MSA had a population of 111,163. Census Area Estimated population as of July 1, 2014 2010 Census 2000 Census 1990 Census Victoria Metropolitan Statistical Area 98,630 94,003 91,000 80,341 Calhoun 21,806 21,381 20,645 19,053 Goliad 7,465 7,210 6,923 5,980 Victoria 90,028 74,361 84,077 86,793 Source: U.S. Bureau of the Census: Metropolitan Areas. Population Division SOVEREIGN NATION The Kickapoo TraditionalTribe ofTexas,previously recognized as the Texas Band of Traditional Kickapoo, is one of three federally acknowledged tribes of Kickapoo people. The other Kickapoo tribes are the Kickapoo Tribe of Indians of the Kickapoo Reservation in Kansas and the Kickapoo Tribe of Oklahoma. The tribe had a village under the international bridge across the Rio Grande. The Kickapoo Indian Reservation of Texas is located on the U.S.-Mexico border in western Maverick County, just south of the city of Eagle Pass, as part of the community of Rosita South. It has a land area 118.6 acres and a 2010 census population of 721 persons. The Texas Indian Commission officially recognized the tribe in 1977. Source: 2010 CENSUS - TRIBAL TRACT REFERENCE MAP: Kickapoo (TX) Reservation
  40. 40. 2015 Regional Needs Assessment PRC 8 40 |P a g e MILITARY CITY, USA San Antonio is home to six U.S. military installations, their supporting governmental and commercial institutions, and many military-related organizations.  Joint Base San Antonio (JBSA) – Consists of Fort Sam Houston, Randolph AFB, and Lackland AFB.  Fort Sam Houston – North of downtown San Antonio. o Home to more than 27,000 military personnel and civilians. o Brooke Army Medical Center (BAMC) trains 25,000 people annually.  Randolph Air Force Base – Northeast side of San Antonio in the town of Universal City. o Houses pilot training and a large contingency of support personnel. o Headquarters of the Air Education and Training Command (AETC).  Lackland Air Force Base – West side of San Antonio. o 6,000 enlisted Air Force personnel in recruit training (basic training) at any given time. o Wilford Hall Medical Center is the largest medical facility in the Air Force and over 120 other units.  Kelly Air Force Base/Kelly Field – Adjacent to Lackland AFB. o Semi-functional base supporting the Air Force and city of San Antonio. o Military aircraft repair base and major aerospace support facility for Boeing.  Brooks AFB/Brooks City Base – Joint project between San Antonio and the Air Force in southeast San Antonio. o Medical training facility training over 5,000 aeromedical personnel each year.  Camp Bullis – in the Texas hill country north of San Antonio o 30,000 acre military reservation used for field exercise training, medic training, and combat preparation Total Active Duty U.S. Texas Total Active Duty Joint Base San Antonio Military: 1,305,292 Military: 124,796 Fort Sam Houston Population: 161,971 Air Force: 307,378 Total Military Civilians: 50,253 Lackland AFB Population: 117,994 Army: 491,911 Army: 80,830 Randolph AFB Population: 15,942 Coast Guard: 40,564 Army Civilians: 28,643 Marine Corps: 184,688 Navy: 6,337 Navy: 321,315 Navy Civilians: 1,504 Air Force: 33,878 Air Force Civilians: 16,338 Marine Corps: 1,980 Coast Guard: 1,771 Defense Department Civilians: 3,768 Total Military Civilians: 50,253 Source: Defense Manpower Data Center, 2015, military installations.dod.mil Illicit drug use is lower in the armed forces than among civilians, according to the National Institute on Drug Abuse (NIDA), however, heavy alcohol, tobacco use, and prescription drug abuse are on the rise. Military culture, deployments, stigma, and lack of confidentiality are some reasons identified as causing substance use or preventing military members from seeking treatment. NIDA has found that military
  41. 41. 2015 Regional Needs Assessment PRC 8 41 |P a g e personnel with multiple deployments and combat exposure are more susceptible to developing substance use or abuse. According to the Department of Defense 2011 Health Related Behaviors Survey of Active Duty Military Personnel:  Illicit and Prescription Drugs  Prohibited substance use (excluding prescription drug misuse) in the military was low, with about 1.4% reporting illicit drug, synthetic cannabis, or inhalant use in the past 12 months.  24.9% of active duty personnel reported prescription drug use (including proper use and misuse) in the past 12 months, composed of pain reliever (20.0%), sedative (13.4%), stimulant (2.8%), and anabolic steroid (1.4%) use and misuse.  1.3% of active duty personnel reported prescription drug misuse in the past 12 months. Of those who reported prescription drug use in the past year, 5.7% reported misuse, with steroids (16.6%) and stimulants (11.6%) most commonly misused among prescription drug users.  89.8% of active duty personnel reported receiving drug testing in the past year, with 27.5% tested in the past month, 62.3% tested within the past 2-12 months, 8.4% tested more than 12 months ago, and 1.8% reported no history of drug testing.  Alcohol Use  Among current drinkers, 39.6% reported binge drinking in the past month, with the Marine Corps reporting the highestprevalence of binge drinking(56.7%),andthe Air Force reporting the lowest prevalence (28.1%). Across all military branches, 9.9% were classified as abstainers, 5.7% were former drinkers, and 84.5% were current drinkers; 58.6% of all personnel were classified as infrequent/light drinkers, 17.5% were moderate drinkers, and 8.4% were classified as heavy drinkers.  Heavy drinkers were more often in the Marine Corps (15.5%), had a high school education or less (12.6%), were 21-25 years old (13.2%), unmarried (11.9%), and stationed OCONUS (9.9%).  Active duty personnel who were heavy drinkers, initiated alcohol use at earlier ages, or drank at work more often reported higher work-related productivity loss, serious consequences from drinking, and engagement in risk behaviors than personnel who reported lower levels of drinking, began drinking at older ages, or did not drink at work.  Across all drinking levels, 11.3% of active duty personnel were classified as problem drinkers (AUDIT≥8), with 58.4% of heavy drinkers considered problem drinkers compared to 22.6% of moderate drinkers and 3.8% of infrequent/light drinkers.  About one-fifth (21.3%) of active duty personnel reported consuming an energy drink combined with alcohol in the past 30 days; this group was more often male (22.4%), had a high school education or less (29.7%), were 18-20 years old (37.8%), unmarried (27.5%) or married with a spouse not present (24.8%), junior enlisted E1-E4 (28.0%), and stationed OCONUS (24.2%).  The most common reasons for drinking among current drinkers were to celebrate (50.2%), enjoyment of drinking (46.2%), and to be sociable (33.4%). The most commonly reported deterrent to drinking among all personnel was cost (22.6%), with abstainers, former
  42. 42. 2015 Regional Needs Assessment PRC 8 42 |P a g e drinkers, and infrequent/light drinkers endorsing this more often than moderate and heavy drinkers.  1.5% of all active duty personnel indicated being currently in treatment or likely to seek treatment in the next 6 months for alcohol use. Of possible treatment options, seeking help from church (30.0%) or a military chaplain (29.7%) were most endorsed, and military residential treatment facilities (13.2%) and private residential treatment outside the military (12.7%) were most often cited as unfamiliar resources.  Tobacco Use  58.7% of active dutypersonnel wereabstainers orformersmokers (17.3%).Outof the 24.0% of current smokers, 8.2% were classified as infrequent smokers, 12.6% were light/moderate smokers, and 3.2% were heavy smokers.  Similar to alcohol, earlier age of initiation for cigarette smoking was associated with being a heavy smoker in adulthood, with those who started smoking at age 14 or younger more likely to be a heavy smoker than those who began smoking at age 21 or older, particularly for males.  Current cigarette smokers were more often in the Marine Corps (30.8%), male (25.2%), had a high school education or less (37.1%), werejunior enlisted E1-E4 (30.3%) or E5-E6 (28.0%), and were stationed OCONUS (25.6%).  The most commonlycitedreasons forcigarette smoking among currentheavysmokers were to help relax or calm down (83.6%) and to help relieve stress (81.5%). In addition, over half (52.9%) reported smoking when drinking alcohol.  Infrequent smokers more often reported that limiting areas where smoking is permitted and increasing prices on military installations would deter smoking compared to light/moderate and heavy smokers.  Across all services, 49.2% reported any nicotine use in the past 12 months, with over 60% of Marine Corps reporting nicotine use in the past year. For all personnel, 22.6% reported cigar use, 10.2% reported pipe use, and 19.8% reported smokeless tobacco use in the past 12 months.  When examining new forms of smokeless tobacco, 4.6% reported using electronic or smoking nicotine delivery products, less than 1% reported using nicotine dissolvables or nicotine gel, and 1.6% reported using caffeinated smokeless tobacco in the past 12 months.  Among heavy cigarette smokers, 45.2% endorsed prescription medication most often as the preferred form of treatment for nicotine dependence.  The UCANQUIT2online quitsupportwas the leastrecognized of the treatmentoptions,with 19.4% of infrequent smokers, 14.5% of light/moderate smokers, and 10.8% of heavy smokers indicating that they were not familiar with the treatment option.  Among daily smokeless tobacco users, 44.3% endorsed stopping all at once or “cold turkey” as the preferred method of cessation, and 15.7% were unfamiliar with the UCANQUIT2 online quit support method.  Culture of Substance Use  Active duty personnel reported that peers engaged in alcohol use (89.0%), cigarette use (73.1%), and smokeless tobacco use (61.2%) in their off-duty hours. Although less often reported, 6.5% reported peer marijuana use, and 4.5% reported peer prescription drug misuse.  Cigarette (81.9%) and smokeless tobacco (77.7%) use was perceived highest among the Marine Corps compared to other services. In addition, peer alcohol use was perceived more
  43. 43. 2015 Regional Needs Assessment PRC 8 43 |P a g e often in the Marine Corps (92.3%) and Coast Guard (92.9%), and peer marijuana use was perceived as highest in the Coast Guard (10.6%) than all other services.  Active duty personnel reported that leadership most often deterred marijuana (92.8%) and prescription drug misuse (90.6%), and 51.2% reported leadership deterrence of alcohol, cigarettes (50.0%), and smokeless tobacco (48.1%). Leadership deterrence of alcohol was more often reported in the Navy (61.2%), and tobacco deterrence was more often reported in the Navy, Air Force, and Coast Guard than in the Army and Marine Corps.  Heavy drinkers reported higher network facilitation meaning meeting regularly with others and they are large enough to provide continuous use or misuse of cigarette use (88.2%), marijuana use (15.2%), andprescription drug misuse (10.4%) compared to light or moderate drinkers. In addition, heavy and light/moderate smokers perceived higher peer facilitation of cigarette use than other smoking levels. Source: 2011 DOD Survey of Health Related Behaviors among Active Duty Military Personnel (2011 Active Duty HRB Survey)  Suicides and Substance Use  Suicide rates in the military were lower than among civilians in the same age range, but in 2004 the suicide rate in the U.S. Army began to climb, surpassing the civilian rate in 2008.  The 2010 report of the Army Suicide Prevention Task Force found that 29% of active duty Army suicides from FY 2005 to FY 2009 involved alcohol or drug use.  In 2009, prescription drugs were involved in almost one third of military personnel suicides. (NIDA March, 2013). VETERANS IN TX AND REGION 8 According to SAMHSA, thousands of troops leave active duty service yearly and become military veterans within their communities. Veterans are more likely than others to fall victim to substance abuse as a means of coping with traumatic situations faced during their service. According to the 2013 National Survey on Drug Use and Health, 1.5 million veterans aged 17 or older (6.6% of veterans) had a substance use disorder in the past year. About 1 in 15 veterans had a past year substance use disorder, whereas the national average among persons aged 17 or older was about 1 in 11, or 8.6%. The rate of substance use disorders among veterans ranged from 3.7% among pre-Vietnam-era veterans to 12.7% among those serving since September 2001. There are an estimated 21.2 million veterans in the U.S. according to the Census, and about 2.2 million military service members and 3.1 million immediate family members. As of September 2014, there are about 2.7 million American veterans of the Iraq and Afghanistan wars and at least 20% of Iraq and Afghanistan veterans have PTSD and/or diagnosed depression. Report Area Veterans Region 8 231,185 Texas 1,583,272 U.S. 21,263,779 Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey
  44. 44. 2015 Regional Needs Assessment PRC 8 44 |P a g e  Illicit and Prescription Drugs  Patients in U.S. Department of Veterans Affairs hospitals are victims of drug overdose twice as often as the national average.  Opioids such as morphine, oxycodone, and methadone are the drugs that patients most frequently misuse and abuse.  Alcohol Use  Veterans show increased rates of binge drinking more often than they abuse drugs.  Alcohol abuse is the most serious substance abuse issue in the veteran community.  Many soldiers abuse alcohol as a coping mechanism for untreated mental health issues.  Suicides and Substance Use  Veterans commit 22 suicides per day, or 8,000 per year, and 11,000 non-fatal suicide attempts a year.  Male veterans are twice as likely as male civilians to commit suicide.  Suicide rates go up as people age.  More men than women die from suicide.  Veterans Courts in Texas  Courts are now being implemented across the country to provide a team- based approach to ensure an appropriate treatment for the underlying risk factors that can contribute to criminal behavior. Currently, 65 drug courts in 20 states work exclusively with the veteran population.  One in five veterans has symptoms of a mental health disorder or cognitive impairment.  One in six veterans who served in Operation Enduring Freedom and Operation Iraqi Freedom suffer from a substance abuse issue. Research continues to draw a link between substance abuse and combat–related mental illness. In the absence of community involvement, great stress falls upon military households. Many veterans face critical problems such as trauma, suicide, homelessness, and/or involvement with the criminal justice systemwhich scars families and neighborhoods.NIDA,SAMHSA,andother government agencies are supporting research to understand the causes of drug abuse and other mental health issues among military personnel, veterans, and their families, and how best to prevent and treat them. Source: Texas Bar Journal, Vol. 75, No. 8

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