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PRC Region 8 2016 Regional Needs Assessment

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The Regional Needs Assessment (RNA) is a document created by the Prevention Resource Center (PRC) in Region 8 along with Evaluators from PRCs across the State of Texas and supported by San Antonio Council on Alcohol and Drug Abuse (SACADA) and the Texas Department of State Health Services (DSHS). The PRC Region 8 serves 28 counties in Upper South Texas.

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PRC Region 8 2016 Regional Needs Assessment

  1. 1. 2016 Regional Needs Assessment REGION 8: UPPER SOUTH TEXAS PREVENTION RESOURCE CENTER 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 p. (210) 225-4741 f. (210) 225-4768 amoore@sacada.org www.prcregion8.org
  2. 2. 2016 Regional Needs Assessment Population 1 Contents Executive Summary................................................................................................................................5 Prevention Resource Centers..................................................................................................................8 Conceptual Framework of This Report................................................................................................... 10 Report Purpose and Methods................................................................................................................ 13 Demographic Overview ........................................................................................................................ 16 State Demographics by Region .......................................................................................................... 16 State Socioeconomics by Region ......................................................................................................20 Regional Demographics....................................................................................................................26 Regional Socioeconomics...................................................................................................................45 Environmental Risk Factors...................................................................................................................52 Education.......................................................................................................................................... 53 Source: Texas Education Agency, Discipline Actions, 2013-2014...................................................... 57 Criminal Activity................................................................................................................................58 Mental Health ...................................................................................................................................63 Social Factors....................................................................................................................................69 Accessibility ...................................................................................................................................... 83 Regional Consumption.......................................................................................................................... 91 Alcohol.............................................................................................................................................. 91 Marijuana..........................................................................................................................................93 Prescription Drugs ............................................................................................................................96 Emerging Trends...............................................................................................................................98 Consequences..................................................................................................................................... 103 Overview of Consequences ............................................................................................................. 103 Mortality......................................................................................................................................... 104 Legal Consequences ........................................................................................................................ 106 Hospitalization and Treatment......................................................................................................... 108 Economic Impacts............................................................................................................................ 109 Environmental Protective Factors....................................................................................................... 114 Overview of Protective Factors.........................................................................................................115 Community Domain........................................................................................................................ 116 School Domain ................................................................................................................................ 123 Family Domain................................................................................................................................. 126
  3. 3. 2016 Regional Needs Assessment Population 2 Individual Domain............................................................................................................................ 128 Trends of Declining Substance Use ...................................................................................................131 Region in Focus ................................................................................................................................... 132 Gaps in Services............................................................................................................................... 132 Gaps in Data.................................................................................................................................... 134 Regional Partners ............................................................................................................................ 134 Regional Successes ...........................................................................................................................135 Conclusion........................................................................................................................................... 136 Summary of Region Compared to State ............................................................................................137 Moving Forward ...............................................................................................................................137 THANK YOU TO ALL OUR 2015-2016 PARTNERS ........................................................................... 139 References.......................................................................................................................................... 141 PREVENTION RESOURCE CENTERS.................................................................................................. 148 Appendix A - Regional Population ....................................................................................................... 154 Appendix B -Population Density ......................................................................................................... 155 Appendix C - Regional Race and Ethnicity........................................................................................... 156 Appendix D Total Population by Age Groups .......................................................................................157 Appendix E - Total Population by Race Alone ..................................................................................... 159 Appendix F -Total Population by Ethnicity Alone................................................................................ 160 Appendix G - Population under Age 18................................................................................................ 161 Appendix H - Population Age 18-24 .................................................................................................... 162 Appendix I - Population with Any Disability ........................................................................................ 163 Appendix J - Language-Population in Limited English Households..................................................... 168 Appendix J - Language- Asian and Pacific Island Language Speaking Population by Language - Spoken at Home...............................................................................................................................................173 Appendix K - Veteran Population.........................................................................................................175 Appendix L - Employment and wages, third quarter 2015....................................................................176 Appendix M - Unemployment Rate, 2016 - April..................................................................................177 Appendix N – TANF – The government’s Temporary Assistance for Needy Families program.............179 Appendix Q SNAP – Supplemental Nutrition Assistance Program...................................................... 182 Appendix W- 2014 DUI (Alcohol) Rlated Fatalities by County and Age.................................................197 Glossary of Terms ...............................................................................................................................204
  4. 4. 2016 Regional Needs Assessment Population 3 San Antonio Council on Alcohol and Drug Abuse South Texas Centre AT&T Building 7500 US Hwy 90 West, Suite 100 San Antonio, TX 78227 210.225.4741 www.prcregion8.org THANK YOU TO ALL OUR PARTNERS The State Collaborative began formally in 2013 when the Texas Department of State Health Services (DSHS) changed the scope of work for all the Prevention Resource Centers (PRC) from literature clearinghouses into central data repositories, one for each of the 11 Regions of Texas. Regional PRCs worked in educating communities about substance abuse by disseminating literature and resources. Now Regional PRCs are working together to conduct a comprehensive drug and alcohol assessment in the interest of improving community awareness and helping communities become more stratigeic in planning prevention strategies. The San Antonio Council on Alcohol and Drug Abuse (SACADA) is a nonprofit organization that provides substance abuse prevention, intervention and recovery programs to the Bexar and surrounding counties in South Central Texas. Operating since 1957, SACADA serves nearly 60,000 people annually. SACADA received funding for the PRC Program in 2014 and is home to the PRC Region 8. The 2016 Regional Needs Assessment (RNA) is the 2nd publication developed for the Region 8 community. The Regional Needs Assessment has been created 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.
  5. 5. 2016 Regional Needs Assessment Population 4 Message from Our CEO It is my great honor and privilege to serve as the CEO 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 59 years, and I’m excited about the new opportunities we have in bringing hope and healing through prevention and intervention and recovery services. We know that substance abuse is one of the leading problems that affects San Antonio. It is a common denominator in: 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 the Regional Needs Assessment 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 for you, our Community Partners, and the unwavering support of the Region 8 Preventioin Resource Center (PRC). Together, we’re reducing the impact of substance abuse and addiction in our community. Sincerely, Abigail Moore MA, LPC, LCDC, ACPS CEO San Antonio Council on Alcohol and Drug Abuse
  6. 6. 2016 Regional Needs Assessment Population 5 Executive Summary The Regional Needs Assessment (RNA) is a document created by the Prevention Resource Center (PRC) in Region 8 along with Evaluators from PRCs across the State of Texas and supported by San Antonio Council on Alcohol and Drug Abuse (SACADA) and the Texas Department of State Health Services (DSHS). The PRC Region 8 serves 28 counties in Upper South Texas. This assessment was designed to aid PRC’s, DSHS, and community stakeholders in long-term strategic prevention planning based on most current information relative to the unique needs of the diverse communities in the State of Texas. This document will present a summary of statistics relevant to risk and protective factors associated with drug use, as well as consumption patterns and consequences data, at the same time it will offer insight related to gaps in services and data availability challenges. A team of regional evaluators has procured national, state, regional, and local data through partnerships of collaboration with diverse agencies in sectors such as law enforcement, public health, and education, among others. Secondary qualitative data collection has also been conducted, in the form of surveys, focus groups, and interviews with key informants. The information obtained through these partnerships has been analyzed and synthesized in the form of this Regional Needs Assessment. PRC Region 8 recognizes those collaborators who contributed to the creation of this RNA. Region 8 Key Findings Chldren living in poverty in Region 8 declined 6% over the past 5 years from 2010 (32%) to 2015 (26%). The Region however, continues to be higher than Texas (25%) and the Nation (22%). 71% of our Counties have children living in poverty with a rate more than Texas and the Nation. From 2009 through 2014, the Texas Poison Center Network received 280,518 calls involving human exposures to substances from the state of Texas and from those calls 32,346 were from Region 8 according to the data received from the center. Of all the calls in the state of Texas almost 23% were because of human exposure to sedatives/ Hypnotics/ antipsychotics; followed by 14% for Antidepressants. Region 8 population with disabilities is higher than Texas (12.25%) and Nation (11.69%) at (13.93%). According to data collected from TEA, Region 8 accounts for 51% of Texas dropouts for grades 7-8 in 2013-2014 school year, an alarming increase across grade span in Region 8. In Region 8, during 2014 there was a total of 3,878 crimes reported by youth 0 – 20 years of age. Fourty-one percent (41%) were alcohol or drug related. Youth alcohol and drug crimes almost doubled from 16 year olds (24.2%) to 17 (41.7%) year olds. The psychiatric hospital discharges for Region 8 are the same as for the U.S. at 4.8, which is higher than Texas at 4.5. County rates vary throughout with Bexar (6.1) at the highest rate and Val Verde (1.2) at the lowest. In 2014 substance abuse treatment included 351 treatment admissions (7% of the state’s total), 38% of admissions were 16 year olds, 21% 15 years old, 18%- 17 year olds, 14%- 14 year olds, 7%- 13 year olds and 1% were 12 year olds.
  7. 7. 2016 Regional Needs Assessment Population 6 Outpatient services accounted for 76% of the services given and 24% werer residential services. Treatment admissions for marijuana/hashish were 89% of treatment admissions 3% methamphetamine. Alcohol and other cannabinoids each account for 2% of the treatment admissions. One third (33%) of our children are growing up in single-parent families, while Texas (36%) and the US (35%) rates are even higher. Zavala (51%) and Real (64%) counties rank the highest with single-parent families, while Kendall (18%) and Comal (21%) rank the lowest. Youth under the age of 21 accounted for 13% of the fatalities in Region 8. Bexar County accounts for 50% of fatalities in Region 8 and 5% of all fatalities in Texas. Region 8 accounts for 11% of fatalities in Texas and 1% of the fatalities in the Nation.. Youth under the age of 25 account for 33% of fatalities in Texas and 39% in Region 8. 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. In 2014 Region 8 accounted for over half (54%) of all dose units of Barbiturates seized in Texas. Texas School Survey In 2014, reported 46% of the students in Region 7&8 reported having used alcohol at some point in their lives. Students also reported that in the past 30 days 11% of students reported having at least one instance of binge drinking (5 or more drinks in one sitting). In addition, students not living with two parents (32%) reported using marijuana more than twice as much as those living in a two parent household (17%). Over half of (52%) those students surveyed reported that they would not see help if they had a drug or alcohol problem and needed help.
  8. 8. 2016 Regional Needs Assessment Population 7 Introduction The Department of State Health Services (DSHS), Substance Abuse & Mental Health Services Administration (SAMHSA), funds approximately 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 SAMHSA’s Center for Substance Abuse Prevention (CSAP). The Strategic Prevention Framework (SPF) 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 in close collaboration with local communities in order to tailor services to meet local needs for substance abuse prevention. This prevention framework provides a continuum of services that target the three classifications of prevention activities under the Institute of Medicine (IOM), which are universal, selective, and indicated. The Department of State Health Services Substance Abuse Services funds Prevention Resource Centers (PRCs) across the state of Texas. These centers are part of a larger network of youth prevention programs providing direct prevention education to youth in schools and the community, as well as community coalitions that focus on implementing effective environmental strategies. This network of substance abuse prevention services work to improve the welfare of Texans by discouraging and reducing substance use and abuse. Their work provides valuable resources to enhance and improve our state's prevention services aimed to address our state’s three prevention priorities to reduce: (1) underage drinking; (2) marijuana use; and (3) non-medical prescription drug abuse. These priorities are outlined in the Texas Behavioral Health Strategic Plan developed in 2012.
  9. 9. 2016 Regional Needs Assessment Population 8 Prevention Resource Centers There are eleven regional Prevention Resource Centers (PRCs) servicing the State of Texas. Each PRC acts as the central data repository and substance abuse prevention training liaison for their region. Data collection efforts carried out by PRC are focused on the state’s prevention priorities of alcohol (underage drinking), marijuana, and prescription drug use, as well as other illicit drugs. Our Purpose Prevention Resource Centers have four fundamental objectives related to services provided to partner agencies and the community in general: (1) collect data relevant to ATOD use among adolescents and adults and share findings with community partners via the Regional Needs Assessment, presentations, and data reports, (2) ensure sustainability of a Regional Epidemiological Workgroup focused on identifying strategies related to data collection, gaps in data, and prevention needs, (3) coordinate regional prevention trainings and conduct media awareness activities related to risks and consequences of ATOD use, and (4) provide tobacco education to retailers to encourage compliance with state law and reduce sales to minors. What Evaluators Do Regional PRC Evaluators are primarily tasked with developing data collection strategies and tools, performing data analysis, and disseminating findings to the community. Data collection strategies are developed around drug use risk and protective factors, consumption data, and related consequences. Along with the Community Liaison and Tobacco Specialists, PRC Evaluators engage in building collaborative partnerships with key community members who aid in securing access to information. How We Help the Community PRCs provide technical assistance and consultation to providers, community groups and other stakeholders related to data collection activities for the data repository. PRCs also contribute to the increase in stakeholders’ knowledge and understanding of the populations they serve, improve programs, and make data-driven decisions. Additionally, the program provides a way to identify community strengths as well as gaps in services and areas of improvement.
  10. 10. 2016 Regional Needs Assessment Population 9 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
  11. 11. 2016 Regional Needs Assessment Population 10 Conceptual Framework of This Report As one reads through this document, two guiding concepts will appear throughout the report: a focus on the youth population, and the use of an empirical approach from a public health framework. For the purpose of strategic prevention planning related to drug and alcohol use among youth populations, this report is based on three main aspects: risk and protective factors, consumption patterns, and consequences of drug use. Adolescence According to the National Institute on Drug Abuse, there is a higher likelihood for people to begin abusing drugs—including tobacco, alcohol, and illegal and prescription drugs—during adolescence and young adulthood. The teenage years are a critical period of vulnerability to substance use disorders given that the brain is still developing and some brain areas are less mature than others. The Texas Department of State Health Services posits a traditional definition of adolescence as ages 13- 17 (Texas Administrative Code 441, rule 25). However, The World Health Organization (WHO) and American Psychological Association both define adolescence as the period of age from 10-19. WHO identifies adolescence as the period in human growth and development that represents one of the critical transitions in the life span and is characterized by a tremendous pace in growth and change that is second only to that of infancy. Behavior patterns that are established during this process, such as drug use or nonuse and sexual risk taking or protection, can have long-lasting positive and negative effects on future health and well-being. The information presented in this RNA is comprised of regional and state data, which generally define adolescence as ages 10 through 17-19. The data reviewed here has been mined from multiple sources and will therefore consist of varying demographic subsets of age. Some domains of youth data conclude with ages 17, 18 or 19, while others combine “adolescent” and “young adult” to conclude with age 21. Epidemiology As established by the Substance Abuse and Mental Health Services Administration, epidemiology helps prevention professionals identify and analyze community patterns of substance misuse and the various factors that influence behavior. Epidemiology is the theoretical framework for which this document evaluates the impact of drug and alcohol use on the public at large. Meaning ‘to study what is of the people’, epidemiology frames drug and alcohol use as a public health concern that is both preventable and treatable. 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.” The Substance Abuse Mental Health Services Administration 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 several other organizations are endeavoring to create an ongoing systematic infrastructure (such as a repository) that will enable effective analysis and strategic planning for the nation’s disease burden, while identifying demographics at risk and evaluating appropriate policy implementation for prevention and treatment.
  12. 12. 2016 Regional Needs Assessment Population 11 Risk and Protective Factors For many years, the prevalent belief was rooted in the notion that the physical properties of drugs and alcohol were the primary determinant of addiction; however, the individual’s environmental and biological attributions play a distinguished role in the potential for the development of addiction. More than 20 years of research has examined the characteristics of effective prevention programs. One component shared by effective programs is a focus on risk and protective factors that influence drug use among adolescents. Protective factors are characteristics that decrease an individual’s risk for a substance abuse disorder, such as: strong and positive family bonds, parental monitoring of children's activities and peers, and clear rules of conduct that are consistently enforced within the family. Risk factors increase the likelihood of substance abuse problems, such as: chaotic home environments, history of parental abuse of substances or mental illnesses, poverty levels, and failure in school performance. Risk and protective factors are classified under four main domains: community, school, family, and individual/peers.
  13. 13. 2016 Regional Needs Assessment Population 12 Consumption Patterns and Consequences Consequences and consumption patterns share a complex relationship; they are deeply intertwined and often occur in the context of other factors such as lifestyle, culture, or education level. It is a challenging task to determine if consumption of alcohol and other drugs has led to a consequence, or if a seemingly apparent consequence has resulted due to consumption of a substance. This report examines rates of consumption among adolescents and related consequences in the context of their cyclical relationship; it is not the intention of this report to infer causality between consumption patterns and consequences. Consumption Patterns Defined 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, behaviors, and trends, such as current use (within the previous 30 days), current binge drinking, heavy drinking, age of initial use, drinking and driving, alcohol consumption during pregnancy, and per capita sales. Consumption factors associated with illicit drugs may include route of administration such as intravenous use and needle sharing. The 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. With alcohol, for instance, beverages are available in various sizes and by volume of alcohol. Variation occurs between beer, wine and distilled spirits, and, within each of those categories, the percentage of the pure alcohol may vary. 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 defines the “drink” as half an ounce of alcohol, or 12 ounces of beer, a 5 ounce glass of wine, or 1.5 ounce shot of distilled spirits. With regard to intake, the NIAAA has also established a rubric for understanding the spectrum of consuming alcoholic beverages. Binge drinking has historically been operationalized as more than five drinks within a conclusive episode of drinking. The NIAAA (2004) defines it further 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, and 4 or more for women, within a two hour time span. Risky drinking, on the other hand, is predicated by a lower BAC over longer spans of time, while “benders” are considered two or more days of sustained heavy drinking. Source: National Institute on Alocohol
  14. 14. 2016 Regional Needs Assessment Population 13 Consequences For the purpose of the RNA, consequences are defined as adverse social, health, and safety problems or outcomes associated with alcohol and other drugs 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 be the single cause of a consequence, measureable evidence must support a link to alcohol and/or drugs as a contributing factor to the consequence. The World Health Organization estimates alcohol use as the world’s third leading risk factor for loss of healthy life, and that the world disease burden attributed to alcohol is greater than that for tobacco and illicit drugs. In addition, stakeholders and policymakers have a vested interest in the monetary costs associated with substance-related consequences. State and regional level data related to consequences of alcohol and other drug use are summarized in later sections of this report. Stakeholders Potential readers of this document include stakeholders from a variety of disciplines such as substance use prevention and treatment providers; medical providers; school districts and higher education; substance use prevention community coalitions; city, county, and state leaders; and community members interested in increasing their knowledge of public health factors related to drug consumption. The information presented in this report aims to contribute to program planning, evidence-based decision making, and community education. The executive summary found at the beginning of this report will provide highlights of the report for those seeking a brief overview. Since readers of this report will come from a variety of professional fields with varying definitions of concepts related to substance abuse prevention, a description of definitions can be found in the section titled “Key Concepts.” The core of the report focuses on substance use risk and protective factors, consumption patterns, and consequences. Report Purpose and Methods This needs assessment was developed to provide relevant substance abuse prevention data related to adolescents throughout the state. Specifically, this regional assessment serves the following purposes:  To discover patterns of substance use among adolescents and monitor changes in substance use trends over time;  To identify gaps in data where critical substance abuse information is missing;  To determine regional differences and disparities throughout the state;  To identify substance use issues that are unique to specific communities and regions in the state;  To provide a comprehensive resource tool for local providers to design relevant, data-driven prevention and intervention programs targeted to needs;  To provide data to local providers to support their grant-writing activities and provide justification for funding requests;  To assist policy-makers in program planning and policy decisions regarding substance abuse prevention, intervention, and treatment in the state of Texas.
  15. 15. 2016 Regional Needs Assessment Population 14 Methodology The state evaluator and the regional evaluators collected primary and secondary data at the county, regional, and state levels between September 1, 2015 and May 30, 2016. The state evaluator met with the regional evaluators at a statewide conference in September 2016 to discuss the expectations of the regional needs assessment for the third year. Between September 2015 and June 2016, the state evaluator met with regional evaluators via bi-weekly conference calls to discuss the criteria for processing and collecting data. The information was primarily gathered through established secondary sources including federal and state government agencies. In addition, region-specific data collected through local law enforcement, community coalitions, school districts and local-level governments are included to address the unique regional needs of the community. Additionally, qualitative data was collected through primary sources such as surveys and focus groups conducted with stakeholders and participants at the regional level. Primary and secondary data sources were identified when developing the methodology behind this document. Readers can expect to find information from the American Community Survey, Texas Department of Public Safety, Texas School Survey of Drug and Alcohol Use, and the Community Commons, among others. Also, adults and youth in the region were selected as primary sources. Quantitative Data Selection Relevant data elements were determined and reliable data sources were identified through a collaborative process among the team of regional evaluators and with support from resources provided by the Southwest Regional Center for Applied Prevention Technologies (CAPT). The following were criterion for selection: o For the purpose of this Regional Needs Assessment, the Regional Evaluators and the Statewide Prevention Evaluator chose secondary data sources as the main resource for this document based on the following criteria: o Relevance: The data source provides an appropriate measure of substance use consumption, consequence, and related risk and protective factors. o Timeliness: Our attempt is to provide the most recent data available (within the last five years); however, older data might be provided for comparison purposes. o Methodologically sound: Data that used well-documented methodology with valid and reliable data collection tools. o Representative: We chose data that most accurately reflects the target population in Texas and across the eleven human services regions. o Accuracy: Data is an accurate measure of the associated indicator. 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. Together, qualitative and quantitative data help to define the scope and extent of a community’s needs and to identify its gaps. This year, feedback questionniares were conducted by the PRC team in order to better understand what members of the communities believe their greatest needs are. The information collected by this
  16. 16. 2016 Regional Needs Assessment Population 15 research has served to identify avenues for further research, trainings, resources, and provide access to any quantitative data that participants may have access to. Participants were from a wide selection of professionals including law enforcement, health care providers, community leaders, clergy, educators, town council, state representatives, university professors, local business owners, and also students. The data collected 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.
  17. 17. 2016 Regional Needs Assessment Population 16 Demographic Overview The starting point for any thorough analysis of descriptors of a region is first setting its context in the state. The following section will describe basic demographics first for the state of Texas, then how those demographics vary in Region 8, if so. State Demographics by Region The state of Texas demographic section will describe statewide conditions for the following categories: Population, Age, Race, Ethnicity, Languages, Concentrations of Populations, and General Socioeconomics, which includes: Average Wages by County, Household Composition, Employment Rates, Industry, TANF Recipients, Food Stamp Recipients, and Free School Lunch Recipients. Population Texas is a state of vast land area and a rapidly growing population. Compared to the U.S. as a whole, Texas’ 2015 population estimate of 27,469,114 people ranks it as the second-most populous state, behind California’s 39,144,818, and Texas ranks as the second-fastest growing state with a 2010-2015 growth change of 9.24%, behind only North Dakota at 12.54%, well ahead of the national growth rate of 4.10%1 Below in Table 1 are the regional components of Texas’ significant population increases during the 2010-2015 period. Note that Region 6 (Houston and surrounding counties) leads the growth component, followed Midland-Odessa area of Region 9 and that of Austin and surrounding counties in Region 7. TABLE 1 - REGIONAL POPULATION AND PERCENT CHANGE, 2010-2015 Region 2010 Population 2015 Population Estimate Growth (+/-) Percent 1 839,736 868,300 28,564 3.40% 2 550,422 550,041 (381) -0.07% 3 6,733,271 7,418,525 685,254 10.18% 4 1,111,701 1,133,629 21,928 1.97% 5 767,306 775,006 7,700 1.00% 6 6,087,210 6,826,772 739,562 12.15% 7 2,948,316 3,294,790 346,474 11.75% 8 2,604,657 2,866,126 261,469 10.04% 9 571,870 639,189 67,319 11.77% 10 825,912 859,385 33,473 4.05% 11 2,105,704 2,237,351 131,647 6.25% Texas 25,146,105 27,469,114 2,323,009 9.24% U.S. 308,758,105 321,418,820 12,660,715 4.1% Age and Sex Texas’ population is significantly younger than the United States as whole. In the categories of teen-aged youth (0-19 years of age), Texas stands at 29.3% while the U.S. is 25.8%. The younger population is also 1 U.S. Census Bureau, 2015 Population, Population Change, and Components of Change.
  18. 18. 2016 Regional Needs Assessment Population 17 revealed in the category of persons 65 years and over, where Texas has fewer in that group (11.8%) than the U.S. at 14.5%.2 TABLE 2 - REGIONAL POPULATION BY AGE CATEGORY Region Population 0-19 Percent Population 65+ Percent 1 257,260 29.2% 117,297 13.3% 2 146,676 26.0% 95,632 17.0% 3 2,118,676 29.3% 777,568 10.8% 4 300,659 26.1% 199,394 17.3% 5 208,746 26.4% 128,501 16.2% 6 1,927,254 29.3% 678,720 10.3% 7 900,633 28.1% 363,486 11.4% 8 799,191 28.7% 373,269 13.4% 9 175,219 29.1% 81,331 13.5% 10 279,754 31.6% 102,419 11.6% 11 772,692 33.8% 266,081 11.7% Texas 7,886,760 29.3% 3,183,698 11.8% U.S. 82,135,602.00 25.8% 46,243,211 14.5% Race and EthnicityTexas is an increasingly diverse state with a strong Hispanic representation. The table below shows the racial and ethic make-up of Texas’ population, which is represented by slightly fewer black and other races and significantly higher Hispanic or Latino population.3 TABLE 3 - REGIONAL POPULATION BY RACE AND ETHNICITY Region White Alone, Not Hispanic Black Alone Hispanic Other 1 54.39% 5.29% 36.70% 3.62% 2 69.33% 5.94% 21.44% 3.29% 3 48.96% 14.38% 28.81% 7.85% 4 66.82% 15.36% 14.99% 2.83% 5 62.18% 19.95% 14.44% 3.43% 6 37.49% 16.62% 37.27% 8.62% 7 55.18% 9.75% 28.70% 6.38% 8 35.19% 5.56% 55.53% 3.71% 9 47.17% 4.15% 46.30% 2.37% 10 12.61% 2.45% 82.74% 2.20% 11 13.48% 1.04% 84.01% 1.47% Texas 42.99% 11.44% 39.56% 6.01% U.S. 62.10% 13.20% 17.40% 7.30% 2 Texas State Data Center, 2015 Population Projections, and U.S. Census Bureau, 2014 Annual Estimates of Population. 3 Texas State Data Center, 2015 Population Projections, and U.S. Census Bureau, 2015 Annual Estimates of Population.
  19. 19. 2016 Regional Needs Assessment Population 18 Texas has a significantly higher number of residents that are foreign born (16.5%) than the U.S. as a whole (13.1%). As a result, there are also significantly higher numbers of the population (ages 5+, 2010- 2014) that report a “language other than English is spoken at home,” with Texas at 34.9% compared to 20.9% nationally.4 Another similar indicator is the population with limited English proficiency (LEP). In Texas, it is much higher at 14.22% of the population versus 8.60% for the U.S. Persons are considered to have limited English proficiency they indicated that they spoke a language other than English, and if they spoke English less than "very well,” measured as a percentage of the population aged 5 or older.5 Note the significantly higher percentages in the border counties surrounding the El Paso (Region 10) and Brownsville (Region 11) metro areas. TABLE 4 - REGIONAL LIMITED ENGLISH PROFICIENCY Region Persons 5+ in Household Numebr 5+ with LEP Percent 5+ with LEP 1 789,750 69,948 8.86% 2 514,095 26,457 5.15% 3 6,495,307 843,803 12.99% 4 1,048,689 56,541 5.39% 5 719,756 39320 5.46% 6 5,885,315 987,163 16.77% 7 2,873,636 264,024 9.19% 8 2,516,577 299,357 11.90% 9 550,027 65,133 11.84% 10 780,139 240,145 30.78% 11 1,977,989 543,369 27.47% Texas 24,151,279 3,435,260 14.22% United States 294,133,388 25,305,204 8.60% 4 U.S. Census Bureau: State and County QuickFacts. 2014 Vintage. 5 U.S. Census Bureau, American Community Survey. 2010-14. 42.99% 11.44% 39.56% 6.01% 62.10% 13.20% 17.40% 7.30% WH I T E ALON E, N OT H I SP AN I C BLACK ALON E, N OT H I SP AN I C H I SP AN I C OT H ER RACE AND ETHNICITY Texas U.S.
  20. 20. 2016 Regional Needs Assessment Population 19 Concentrations of Populations Texas’ land area of 268,580.82 square miles places it as the 2nd largest state, behind Alaska’s vast 663,267.26 square miles. Texas 96.3 persons per square mile (density) is very close to the national average of 87.3, with New Jersey (1195.5) and Alaska (1.2) representing the highest and lowest density.6 Also, Table 5 below contains the 2010 Census designations of populations by urban and rural status. To qualify as an urban area, the territory identified according to criteria must encompass at least 2,500 people, at least 1,500 of which reside outside institutional group quarters. Areas adjacent to urban areas and cores are also designated as urban when they are non-residential, but contain urban land uses, or when they contain low population, but link outlying densely settled territory with the densely settled core. "Rural" areas consist of all territory, population, and housing units located outside UAs and UCs. Geographic entities, such as metropolitan areas, counties, minor civil divisions, places, and census tracts, often contain both urban and rural territory, population, and housing units. TABLE 5 - REGIONAL URBAN AND RURAL POPULATIONS Region 2010 Population Urban Urban Percent Rural Rural Percent 1 839,586 649,052 77.31% 190,534 22.69% 2 550,250 354,892 64.50% 195,358 35.50% 3 6,733,179 6,100,919 90.61% 632,260 9.39% 4 1,111,696 542,818 48.83% 568,878 51.17% 5 767,222 432,088 56.32% 335,134 43.68% 6 6,087,133 5,625,713 92.42% 461,420 7.58% 7 2,948,364 2,309,329 78.33% 639,035 21.67% 8 2,604,647 2,143,709 82.30% 460,938 17.70% 9 571,871 451,190 78.90% 120,681 21.10% 10 825,913 793,905 96.12% 32,008 3.88% 11 2,105,700 1,894,424 89.97% 211,276 10.03% Texas 25,145,561 21,298,039 84.70% 3,847,522 15.30% United States 312,471,327 252,746,527 80.89% 59,724,800 19.11% 6 U.S. Census Bureau: State and County QuickFacts. Last Revised: Thursday, 28-May-2015. (See Appendix A, Table 2.)
  21. 21. 2016 Regional Needs Assessment Population 20 State Socioeconomics by Region With the basic population characteristics of the Texas population described, a closer look at the general socioeconomic conditions of the population is helpful. Per Capita Income One of the most important factors related to risk for, and protection from, substance abuse is the ability to provide for the necessities of life. One of the indicators that measures this is per capita income, or the mean money income received in the past 12 months computed for every man, woman, and child in a geographic area, according to the Census Bureau. It is derived by dividing the total income of all people 15 years old and over in a geographic area by the total population in that area. In Texas, the per capita income (2014 dollars, 2010-2014 data) is $26,512. This is significantly lower than the U.S. per capita income measure of $28,554.7 Table 6 below features the higher per capita income Regions 3, 6 and 7 associated with the metro areas of Dallas/Fort Worth, Houston and Austin, respectively. Regions 11, 10 and 5 present with the lowest per capita income in comparison to the rest of the regions in the State. TABLE 6 - REGIONAL PER CAPITA INCOME Region Total Population Total Income ($) Per Capita Income ($) 1 852,813 $20,063,979,988 $23,527 2 549,812 $12,414,759,612 $22,580 3 7,012,720 $206,705,337,504 $29,476 4 1,121,471 $25,454,054,744 $22,697 5 770,091 $17,240,982,928 $22,388 6 6,371,624 $186,909,543,360 $29,335 7 3,091,787 $87,291,704,328 $28,233 8 2,709,360 $67,011,716,504 $24,733 9 596,648 $16,002,279,536 $26,820 10 848,562 $15,931,207,356 $18,774 11 2,167,145 $36,746,206,204 $16,956 Texas 26,092,032 $691,771,801,600 $26,512 U.S. 314,107,072 $8,969,237,037,056 $28,554 Household Composition Another way to gain a basic understanding of stresses to the family unit is the composition of the household. One basic indicator is the number of persons per household. Texas has a greater number of persons per household (2.83, 2010-2014) than the U.S. as a whole (2.63).8 The Community Commons report defines an overcrowede unit as one that has more than one occupant per room. Information related to the percent of overcrowded housing is presented below. This indicator is relevant as housing 7 U.S. Census Bureau, American Community Survey. 2010-14. 8 U.S. Census Bureau, American Community Survey. 2010-14.
  22. 22. 2016 Regional Needs Assessment Population 21 conditions are associated with a wide range of health conditions and increased risk for diseases. Region 11 has the highest percent of population living in an overcrowded unit. Also, though increasingly the norm, children in single-parent households are statistically at greater risk for adverse health outcomes such as mental health problems (including substance abuse, depression, and suicide) and unhealthy behaviors such as smoking and excessive alcohol use. Self-reported health has been shown to be worse among lone parents (male and female) than for parents living as couples, even when controlling for socioeconomic characteristics. Mortality risk is also higher among lone parents. Children in single-parent households are at greater risk of severe morbidity and all-cause mortality then their peers in two-parent households. As indicated in Table 7 below, several regions bear the societal pressure of more single-parent households than others.9 TABLE 7 - REGIONAL HOUSEHOLD COMPOSITION Region Total Households Total Occupied Housing Units Overcrowded Housing Units % of Housing Units Overcrowded 1 219,977 265,700 11,853 4.46 2 126,251 181,040 4,975 2.75 3 1,885,207 1,808,092 112,394 6.22 4 267,054 330,486 14,660 4.44 5 181,057 213,909 8,707 4.07 6 1,722,230 1,467,564 113,200 7.71 7 752,154 894,120 39,920 4.46 8 703,721 765,356 44,339 5.79 9 157,358 180,319 9,008 5 10 244,547 221,461 17,542 7.92 11 673,940 581,640 68,111 11.71 Texas 6,933,496 6,909,687 444,709 6.44 U.S. 73,019,542 90,364,208 3,852,710 4.26 Employment Rates Texas generally enjoys a substantially more favorable employment climate than most states, as previously evidenced in part by the population growth figures. This indicator is relevant because unemployment creates financial instability and barriers to access including insurance coverage, health services, healthy food, and other necessities that contribute to poor health status. The latest data from the Bureau of Labor Statistics (BLS, April 2016) indicates that Texas currently holds an April 2016 unemployment rate of 4.2%, while the nation as a whole sits at 4.7%. The current rate of 4.2% represents a 0.1% increase from April 2015. The rates by region are indicated below, with Regions 3 and 1 in the metro Austin and Panhandle areas having the least current unemployment. Regions 11, 5 and 9 have the highest unemployment rate in comparison to the rest of the regions of the State. 9 U.S. Census Bureau, American Community Survey. 2010-14.
  23. 23. 2016 Regional Needs Assessment Population 22 TABLE 8 - REGIONAL EMPLOYMENT RATES Region Labor Force Number Employed Number Unemployed Unemployment Rate 1 419,920 406,118 13802 3.3% 2 240,701 230,916 9785 4.1% 3 3,817,091 3,682,390 134,701 3.5% 4 504,920 480,735 24185 4.8% 5 324,390 305,323 19067 5.9% 6 3,339,025 3,178,131 160894 4.8% 7 1,667,407 1,613,950 53,457 3.2% 8 1,341,361 1,290,956 50405 3.8% 9 307,732 292,266 15466 5.0% 10 359,309 342,895 16414 4.6% 11 935,605 873,072 62533 6.7% Texas 13,257,468 12,696,755 560,713 4.2% U.S. 159,624,372 152,082,706 7,541,666 4.7% 1 U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics Information and Analysis, April 2016. Rates are seasonally adjusted. Industry When compared to the U.S., Texas firms employ roughly the same proportions of workers by industry type. The data in the chart below indicates that Texas has a slightly more “blue collar” workforce, with marginally fewer management and business employees and slightly more mining, construction and similar labor force types. Region 7 (Austin area) and Region 3 (Dallas/Ft. Worth area) pace the state for white collar, high-tech industries.10 TABLE 9 - REGIONAL EMPLOYMENT BY INDUSTRY TYPE Region Civilian employed population 16+ Management, business, science, arts Service Sales and office Natural resources, construction, maintenance Production, transportation, and material moving 1 394,362 30.73% 19.02% 24.18% 12.94% 13.12% 2 228,357 29.97% 19.93% 23.94% 12.86% 13.31% 3 3,374,570 37.38% 16.07% 25.31% 9.51% 11.73% 4 463,091 28.20% 18.71% 23.71% 13.48% 15.89% 5 302,876 28.00% 19.30% 23.00% 14.24% 15.45% 6 2,977,406 36.35% 16.71% 23.61% 11.08% 12.25% 7 1,451,071 39.71% 17.50% 24.18% 9.64% 8.97% 8 1,197,426 33.48% 19.37% 25.58% 10.91% 10.66% 9 269,715 27.70% 16.34% 24.40% 17.09% 14.46% 10 330,951 29.63% 21.41% 26.48% 9.90% 12.59% 10 Series S2406: Occupation by Class of Worker for the Civilian Employed Population 16 Years and Over. U.S. Census Bureau, American Community Survey. 2010-14.
  24. 24. 2016 Regional Needs Assessment Population 23 11 819,185 26.90% 23.42% 25.26% 12.87% 11.55% Texas 11,809,010 34.88% 17.77% 24.59% 10.94% 11.82% U.S. 143,435,233 36.42% 18.16% 24.36% 8.98% 12.09% TANF Recipients This indicator reports the percentage reipients per 100,000 populations receiving public assistance income. Public assistance income includes general assistance and Temporary Assistance to Needy Families (TANF). Separate payments received for hospital or other medical care (vendor payments) is excluded. This does not include Supplemental Security Income (SSI) or noncash benefits such as Food Stamps. The percentage of households in Texas who receive public assistance income of this type varies significantly from county to county, but the rates in Regions 11 and 10 are higher than the state rate of 242.27 per 100K population.11 There is no U.S. calculation available for this measure. TABLE 10 - REGIONAL TANF RECIPIENTS PER 100K POPULATION Region 2015 Population 2015 TANF Recipients Recipients Per 100K Population 1 882,775 1,523 172.52 2 563,104 1,272 225.89 3 7,225,438 9,898 136.99 4 1,152,494 1,965 170.50 5 792,109 1,390 175.48 6 6,575,370 8,668 131.83 7 3,210,292 4,119 128.31 8 2,776,839 4,088 147.22 9 601,840 780 129.60 10 883,702 3,863 437.14 11 2,283,153 27,368 1198.69 Texas 26,947,116 65,286 242.27 SNAP Recipients Another estimate of instability in providing for basic needs is the estimated percentage of households receiving the Supplemental Nutrition Assistance Program (SNAP) benefits. This indicator is relevant because it assesses vulnerable populations which are more likely to have multiple health access, health status, and social support needs; when combined with poverty data, providers can use this measure to identify gaps in eligibility and enrolment. The number of recipients per 100K population in Texas is highest in Regions 11, 10 and 5.12 Footnote 7 11 Texas Health and Human Services Commission, TANF Recipients by County, December 2015. 12 Texas Health and Human Services Commission, SNAP Recipients by County, December 2015.
  25. 25. 2016 Regional Needs Assessment Population 24 TABLE 11 - REGIONAL SNAP RECIPIENTS PER 100K POPULATION Region 2015 Population Number of SNAP Recipients Recipients Per 100K Population 1 880,203 115,693 13,143.90 2 563,104 76,555 13,595.18 3 7,225,438 850,614 11,772.49 4 1,152,494 165,803 14,386.45 5 792,109 127,457 16,090.84 6 6,575,370 849,699 12,922.45 7 3,199,811 338,074 10,565.44 8 2,787,320 432,505 15,516.88 9 601,840 69,078 11,477.80 10 886,274 189,491 21,380.63 11 2,283,153 591,670 25,914.60 Texas 26,947,116 3,806,639 14,126.33 Free and Reduced-Price School Lunch Recipients The National School Lunch Program is a federally assisted meal program operating in public and nonprofit private schools and residential child care institutions. Children from families with incomes at or below 130 percent of the poverty level are eligible for free meals. Those with incomes between 130 percent and 185 percent of the poverty level are eligible for reduced-price meals, for which students can be charged no more than 40 cents. Total student counts and counts for students eligible for free and reduced price lunches are acquired for the school year 2013-2014 from the NCES Common Core of Data (CCD) Public School Universe Survey. School-level data is summarized to the county, state, and national levels for reporting purposes. Texas reports that of the total student population, 60.08% are eligible to receive the school meal benefit, which is greater than the U.S. rate of 52.35%. The regional percentages vary greatly from a high in Region 10 to a low in Region 2.13 13 National Center for Education Statistics, NCES Common Core of Data. 2013-14.
  26. 26. 2016 Regional Needs Assessment Population 25 TABLE 12 - REGIONAL SCHOOL LUNCH ASSISTANCE Region Total Students Number Free/Reduced Price Lunch Eligible Percent Free/Reduced Price Lunch Eligible 1 512,729 293,229 57.19% 2 229,556 123,627 53.85% 3 1,004,629 554,721 55.22% 4 196,361 108,819 55.42% 5 155,512 100,401 64.56% 6 1,181,436 708,715 59.99% 7 315,751 192,759 61.05% 8 498,551 306,658 61.51% 9 399,449 219,950 55.06% 10 184,051 137,773 74.86% 11 471,000 345,435 73.34% Texas 5,149,025 3,092,087 60.08% U.S. 50,195,195 26,012,902 52.35% 1 Texas Health and Human Services Commission, SNAP Recipients by County, December 2015. 1 National Center for Education Statistics, NCES Common Core of Data. 2013-14.
  27. 27. 2016 Regional Needs Assessment Population 26 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 2014 the region had an estimated population of 2.8 million, with more than half residing in Bexar County. The Region 8 PRC is located at the San Antonio Council on Alcohol and Drug Abuse. Source: www.dfps.state.tx.us/About_DFPS/region/images/REGION8.GIF Population A total of 2,709,360 people live in the 31,637.33 square mile in Region 8 for this assessment according to the U.S. Census Bureau American Community Survey 2010-14 5-year estimates. The population density for this area, estimated at 85.64 persons per square mile, is less than the state and national average population density of 88.93 and 99.88 persons per square mile. The population growth of Region 8 from the 2010 Census to the 2015 Census Estimate was 10.04% which is more than Texas at 9.24% and the U.S. at 4.10%.
  28. 28. 2016 Regional Needs Assessment Population 27 Data Source: US Census Bureau, American Community Survey. 2010-14. Source geography: Tract Region 8 Population and Percent Change Area 2010 Population 2015 Population Growth (+/-) Percent (%) Region 8 2,604,618 2,866,126 261,508 10.04% Texas 25,146,105 27,469,114 2,323,009 9.24% U.S. 308,758,105 321,418,820 12,660,715 4.10% Highest Growth Counties in Region 8 (2010 – 2015) Guadalupe 131,537 151,249 19,712 15% Comal 108,477 129,048 20,571 19% Kendall 33,415 40,384 6,969 20.90% Lowest Growth Counties in Region 8 (2010 – 2015) Edwards 2,002 1,894 -108 -5.40% Kinney 3,598 3,549 -49 -1.40% Real 3,309 3,307 -2 -0.10% Data Source: US Census Bureau, American Community Survey. 2010-14. Source geography: Tract Age Age distribution represents the population for Region 8 by age group. See Appendix D for age distribution by county. An estimated 26.2% percent of the population in Region 8 is under the age of 18 according to the U.S. Census Bureau American Community Survey 2010-14 5-year estimates. An estimated total of 709,882 youths resided in the area during this time period. Also the percentage of youth aged 18-24 in Region 8 is an estimated 10.23%, that is an estimated 277,139 youth aged 18-24. This indicator is relevant because it is important to understand the percentage of youth in the community, as this population has unique needs which should be considered separately from other age groups.
  29. 29. 2016 Regional Needs Assessment Population 28 Population with Any Disability Disabled individuals comprise a vulnerable population that requires targeted services and outreach by providers and according to the the Census Bureau American Community Survey 2010-14 5-year estimates Region 8 has a higher percentage of civilian non-institutionalized population with a disability than in the state or nation. Age 0-4 7% Age 5-17 19% Age 18-24 10% Age 25-34 14% Age 35-44 13% Age 45-54 13% Age 55-64 11% Age 65+ 13% Total Population by Age Groups 13.93 11.59 12.25 0 0 2 4 6 8 10 12 14 16 Region 8 Texas U.S. Percent Population with a Disability
  30. 30. 2016 Regional Needs Assessment Population 29 Race This chart displays the total population in Region 8 by the 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, Two or More Races, and other. REGION 8 BY RACE White Black Asian Native American/Alaska Native Native Hawaiian/Pacific Islander Some Other Race
  31. 31. 2016 Regional Needs Assessment Population 30 Ethnicity This chart shows the population by Hispanic or Latino Ethnicity of any race of the population for Region 8 and has a higher percentage of Hispanic population compared to the state and national percentage. 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 Almost 6% percent of the population aged 5 and older live in a Limited English speaking household in Region 8, according to the the Census Bureau American Community Survey 2010-14 5-year estimates. A “Limited English speaking household” is one in which no member 14 years old and over (1) speaks only English at home or (2) speaks a language other than English at home and speaks English “Very well.” 45.58 [VALUE] REGION 8 BY ETHNICITY ALONE Hispanic or Latino Population Non-Hispanic Population
  32. 32. 2016 Regional Needs Assessment Population 31 The percentage of the population aged 5 and older who speak a language other than English at home and speak English less than "very well" in Region 8 is almost 12%. This indicator is relevant because an inability to speak English well creates barriers to healthcare access, provider communications, health literacy and education. The majority of the Region 8 population speaks English as their first language, but many other native languages are spoken in homes. 5.77 8 4.66 0 1 2 3 4 5 6 7 8 9 Region 8 Texas U.S. Percent Population Linguistically isolated 11.9 14.22 8.6 0 2 4 6 8 10 12 14 16 Region 8 Texas U.S. Percent Population Age 5 with Limited English Proficiency
  33. 33. 2016 Regional Needs Assessment Population 32 91.67% 2.56% 4.70% 1.06% REGION 8 POPULATION WITH LIMITED ENGLISH PROFICIENCY BY LANGUAGE SPOKEN AT HOME (4 CATEGORY) Spanish Other Indo-European Asian & Pacific Island Other Island Language 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 56.90% 14.97% 15.56% 2.69% 0.23% 0.23% 1.87% 7.54% Region 8 Indo-European Language Speaking population by language spoken at home part 1 Column1
  34. 34. 2016 Regional Needs Assessment Population 33 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 27.44% 6.12% 1.93% 3.34% 8.73% 13.59% 4.41% 7.63% 9.72% 13.95% 3.15% Region 8 Indo-European Language Speaking population by language spoken at home part 2 Column1 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 20.39% 23.38% 14.78% 5.69% 0.13% 1.17% 2.41% 12.76% 2.83% 1.97% 14.50% Region 8 Asian & Pacific Island Language Speaking Population by Language Spoken at home Column1
  35. 35. 2016 Regional Needs Assessment Population 34 The growing population of English language learners are identified in this assessment as it can cause language barriers to obtaining services and identifies households and populations that may need English-language assistance here in Region 8. Further language data for counties in region 8 are provided in Appendix J. Concentrations of Populations According to the United States Census Bureau Decennial Census, between 2000 and 2010 the population in Region 8 grew by 458,489 persons, a change of 21.36%. A significant positive or negative shift in total population over time impacts healthcare providers and the utilization of community resources. 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 52.78% 34.69% 4.18% 2.95% 2.67% 2.04% 0.69% Region 8 Other Language Speaking population by language spoken at home Column1
  36. 36. 2016 Regional Needs Assessment Population 35 Population Change, Percent by County, US Census 2000 - 2010 Over 10.0% Increase ( ) 2.0 - 10.0% Increase ( ) Less Than 2.0% Change ( /- ) 2.0 - 10.0% Decrease ( - ) Over 10.0% Decrease ( - ) No Population or No Data Report Area Hispanic Population The projected population that is of Hispanic, Latino, or Spanish origin in region 8 is 1,474,509. This is 54.42% of the total region 8 population, which is greater than the national 16.62% rate. Origin can be viewed as the heritage, nationality group, lineage, or country of birth of the person or the person’s parents or ancestors before their arrival in the U.S. People who identify their origin as Hispanic, Latino, or Spanish may be of any race. The female total regional population 747,839, which is 50.72%, greater than the US rate of 49.35% and Texas rate of 49.68%. 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 Region 8
  37. 37. 2016 Regional Needs Assessment Population 36 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. Greater San Antonio has a number of communities across several counties. It is centered around the City of San Antonio, the second largest city in Texas and the seventh largest municipality in the U.S., grew by 8.55% between 2010 and 2016, and is projected to grow an additional 6.90% through the year 2021. San Antonio, the largest city in Bexar County, encompasses a total geographic area of 467 square miles with a population density of 3,393 persons per square mile. The city’s metropolitan area grew by 11.75% between 2010 and 2016, and is projected to grow an additional 8.12% through the year 2021 according to the US Census Bureau, 2014. 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 2010 census, the Victoria MSA had a population of 115,375 with an increase in 2015 to 121,808, thus showing a 5.50% population growth from 2010 to 2015. Victoria Metropolitan Population Change (2010 – 2015) County 2010 Population 2015 Population Groth (+/-) Percent % Goliad 7,201 7,531 330 4.50% Victoria 86,793 92,382 5,589 6.40% Calhoun 21,381 21,895 514 2.40% Victoria Metro 115,375 121,808 6,433 5.50%
  38. 38. 2016 Regional Needs Assessment Population 37 Sovereign Nation The Kickapoo Traditional Tribe of Texas, also known as Kickapoo Indian Reservation of Texas, and previously recognized as the Texas Band of Traditional Kickapoo, is one of three federally acknowledged tribes of Kickapoo people. The land area is 0.4799 square kilometres (118.6 acres), their Tribal Headquarters is located in Rosita South, Texas, just south of the city of Eagle Pass on the Rio Grande on the US-Mexico border, in western Maverick County. Original numbers of the Kickapoo population have been placed at around 4,000. In 1684 French traders estimated that there were about 2,000 Kickapoos. Today, about 3,000 Kickapoo people live in three groups in the US (Kansas, Oklahoma, and Texas) and one in Mexico (Coahuila). The reservation population is estimated between 650 and 750 members according to the 2010 census. Kickapoo Traditional Tribe of Texas [Southern Plains] Juan Garza, Jr., (Chairman) Tel: (830) 773-2105 Fax: (830) 757-9228 Recognition Status: Federal HC 1 Box 9700 Eagle Pass, TX78852-9752 Website: http://www.texasindians.com The Texas Department of State Health Services (DSHS) collaborates with federally recognized Tribal governments in the prevention of underage drinking and other drug use. Texas has three federally recognized Tribal governments: the Kickapoo Tribe, the Ysleta Del Sur, and the Alabama Coshautta. DSHS currently meets quarterly with two of the federally recognized Tribes. Discussions and collaborations continue with local substance abuse, mental health providers, and Tribal leaders. The current goal is to establish a Memorandum of Understanding between the Tribes and DSHS. The Ysleta Del Sur are currently funded by DSHS to provide comprehensive prevention services to the indicated population within their Tribe. They provide one-to-one indicated prevention counseling to the identified youth and provide goals for the individual based on the indicated prevention assessment, which identifies the risk and protective factors. In addition, an evidence-based curriculum identified by the National Registry of Evidence-Based Programs and Practices (NRFPP) is delivered in a structured setting. The curriculum identified for the Ysleta del Sur is a family-focused curriculum called Creative Lasting Family Connections (CLFC) that aims to build the resiliency of youth ages 9 to 17 and reduce the frequency of their alcohol and other drug use, according to a report to Congress on the Prevention and Reduction of Underage Drinking. Military City, USA San Antonio has the honor of being recognized as “Military City, USA”, becauase it has been home to a consistent military existence for nearly 300 years. Today the city has one of the nation's largest active and retired military populations and is also home to the Department of Defense’s largest medical center at Joint Base San Antonio Fort Sam Houston. Military City USA welcomes the families of the 132,000 students who graduate from military training each year, creating a training, equipping and caring environment for America’s service members.
  39. 39. 2016 Regional Needs Assessment Population 38 The relationship between military bases and their surrounding communities is extremely important to all parties. The military relies on the location, access and infrastructure of an area to support its missions. Local businesses are supported and patronized by civilian and military personnel at the base, thus boosting jobs and sales tax revenue. And housing for military members and their families near the installations add to property tax rolls. 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. o 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. o 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). o 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. o 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. o 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. o 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 Alcohol and Illicit Drugs in the Military Few service members risk using illicit drugs in the military because it can result in a dishonorable discharge, according to the National Institute on Drug Abuse (NIDA). Drinking, however, is an ingrained part of military culture that often carries on into civilian life. All too often, veterans and service members self-medicating with alcohol give in to an addiction. Approximately 20 percent of service members reported binge drinking at least once a week. This rate is even higher for those with combat exposure. Some veterans addicted to prescriptions for pain and PTSD turn to illicit substances. Illicit drugs like heroin are often cheaper and easier to obtain than prescription painkillers. 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 personnel with multiple deployments and combat exposure are more susceptible to developing substance use or abuse.
  40. 40. 2016 Regional Needs Assessment Population 39 According to the Department of Defense 2011 Health Related Behaviors Survey of Active Duty Military Personnel:  Illicit and Prescription Drugs o 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. o 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. o 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. o 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 o Among current drinkers, 39.6% reported binge drinking in the past month, with the Marine Corps reporting the highest prevalence of binge drinking (56.7%), and the Air Force reporting the lowest prevalence (28.1%). Across all military branches, 9.9% were classified as abstainers, 5.7% were former drinkers, and 84.5% were current drinkers; 58.6% of all personnel were classified as infrequent/light drinkers, 17.5% were moderate drinkers, and 8.4% were classified as heavy drinkers. o 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%). o 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. o 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. o 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%). o 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
  41. 41. 2016 Regional Needs Assessment Population 40 drinkers, and infrequent/light drinkers endorsing this more often than moderate and heavy drinkers. o 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 o 58.7% of active duty personnel were abstainers or former smokers (17.3%). Out of the 24.0% of current smokers, 8.2% were classified as infrequent smokers, 12.6% were light/moderate smokers, and 3.2% were heavy smokers. o 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. o Current cigarette smokers were more often in the Marine Corps (30.8%), male (25.2%), had a high school education or less (37.1%), were junior enlisted E1-E4 (30.3%) or E5-E6 (28.0%), and were stationed OCONUS (25.6%). o The most commonly cited reasons for cigarette smoking among current heavy smokers were to help relax or calm down (83.6%) and to help relieve stress (81.5%). In addition, over half (52.9%) reported smoking when drinking alcohol. o 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. o 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. o 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. o Among heavy cigarette smokers, 45.2% endorsed prescription medication most often as the preferred form of treatment for nicotine dependence. o The UCANQUIT2 online quit support was the least recognized of the treatment options, with 19.4% of infrequent smokers, 14.5% of light/moderate smokers, and 10.8% of heavy smokers indicating that they were not familiar with the treatment option. o 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 o 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
  42. 42. 2016 Regional Needs Assessment Population 41 reported, 6.5% reported peer marijuana use, and 4.5% reported peer prescription drug misuse. o 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 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. o 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. o Heavy drinkers reported higher network facilitation meaning meeting regularly with others and they are large enough to provide continuous use or misuse of cigarette use (88.2%), marijuana use (15.2%), and prescription drug misuse (10.4%) compared to light or moderate drinkers. In addition, heavy and light/moderate smokers perceived higher peer facilitation of cigarette use than other smoking levels. Source: 2011 DOD Survey of Health Related Behaviors among Active Duty Military Personnel (2011 Active Duty HRB Survey)  Suicides and Substance Use o 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. o 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. o In 2009, prescription drugs were involved in almost one third of military personel suicides (NIDA March, 2013) Veterans in Region 8 According to SAMHSA, thousands of troops leave active duty service yearly and become veterans within their communities. The veterans’ regional population is estimated to be 232,720, which is 11.77% of the total regional population. The percentage rate is greater than the US rate of 8.65% and Texas rate of 8.23% of the total population. Report Area Total Population Age 18 Total Veterans Veterans, Percent of Total Population Region 8 1,976,568 232,720 11.77% Texas 19,004,448 1,564,501 8.23% US 239,305,216 20,700,712 8.65% Source: U.S. Census Bureau, 2009-2013 – Year American Community Survey 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
  43. 43. 2016 Regional Needs Assessment Population 42 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.  Illicit and Prescription Drugs o Patients in U.S. Department of Veterans Affairs hospitals are victims of drug overdose twice as often as the national average. o Opioids such as morphine, oxycodone, and methadone are the drugs that patients most frequently misuse and abuse.  Alcohol Use o Veterans show increased rates of binge drinking more often than they abuse drugs. o Alcohol abuse is the most serious substance abuse issue in the veteran community. o Many soldiers abuse alcohol as a coping mechanism for untreated mental health issues.  Suicides and Substance Use o Veterans commit 22 suicides per day, or 8,000 per year, and 11,000 non-fatal suicide attempts a year. o Male veterans are twice as likely as male civilians to commit suicide. o Suicide rates go up as people age. o More men than women die from suicide. Veterans Courts in Texas o 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. o One in five veterans has symptoms of a mental health disorder or cognitive impairment. o 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. CURRENT TEXAS VETERANS COURTS BEXAR COUNTY VETERANS TREATMENT COURT Judge Wayne Christian, County Court at Law #6 DALLAS COUNTY VETERANS COURT Judge Michael Snipes, Criminal District Court #7 DENTON COUNTY VETERANS COURT Multiple Courts EL PASO VETERANS COURT PROGRAM FOR FELONY CASES Judge Angie Juarez Barill, 346th District Court EL PASO VETERANS TREATMENT COURT Judge Ricardo Herrera, County Court at Law #1 GUADALUPE COUNTY VETERANS TREATMENT COURT Judge Linda Z. Jones, County Court at Law HARRIS COUNTY VETERANS COURT Judge Marc Carter, 228th District Court HIDALGO COUNTY VETERANS COURT
  44. 44. 2016 Regional Needs Assessment Population 43 Judge Israel Ramon, Jr., 430th District Court NUECES COUNTY VETERANS COURT PROGRAM Judge Tom Greenwell, 319th District Court TARRANT COUNTY VETERANS COURT Judge Brent A. Carr, County Criminal Court #9 TRAVIS COUNTY VETERANS COURT Judge Mike Denton, County Court at Law #4 VETERANS COURT FUNDING GOVERNOR’S OFFICE CRIMINAL JUSTICE DIVISION http://governor.state.tx.us/cjd/ TEXAS INDIGENT DEFENSE COMMISSION http://www.txcourts.gov/tidc/TFID_Grant_Program.asp TEXAS VETERANS COMMISSION FUND FOR VETERANS ASSISTANCE http://www.tvc.state.tx.us/Fund-for-Veterans-Assistance.aspx In the absence of community involvement, great stress falls upon military households. Many veterans face critical problems such as trauma, suicide, homelessness, and/or involvement with the criminal justice system which scars families and neighborhoods. NIDA, SAMHSA, and other government agencies are supporting research to understand the causes of drug abuse and other mental health issues among military personnel, veterans, and their families, and how best to prevent and treat them Male, 87% [VALUE] Region 8 Veteran Population by Gender Male Female
  45. 45. 2016 Regional Needs Assessment Population 44 Veterans are more likely than others to fall victim to substance abuse as a means of coping with traumatic situations faced during their service.  There was a 56% percent increase of soldiers seeking treatment for alcoholism from 2003 to 2009.  A 2008 survey of veterans deployed to Iraq and Afghanistan found that 13.8% percent of veterans were diagnosed with PTSD.  In 2009, military doctors wrote approximately 3.8 million prescriptions for painkillers. Veterans looking for treatment for their addiction have more options than the average civilian. In addition to traditional inpatient and outpatient rehab programs, veterans have the unique option to seek treatment through the Department of Veterans Affairs. This is beneficial for veterans who may not be able to find an affordable treatment program on their own. The VA offers:  One-on-one counseling  Family counseling  Group therapy  PTSD treatment  Inpatient/outpatient rehab  Medications for withdrawal In cases of serious PTSD and/or addiction, getting immediate treatment is essential and seeking treatment outside the VA can be beneficial. There are many qualified treatment centers for addicted veterans with underlying PTSD. 18-34 12% 35-54 31% 55-64 22% 65-74 18% 75+ 17% Region 8 Veteran Population by Age Region 8
  46. 46. 2016 Regional Needs Assessment Population 45 In the absence of community involvement, great stress falls upon military households. Many veterans face critical problems such as trauma, suicide, homelessness, and/or involvement with the criminal justice system which scars families and neighborhoods. NIDA, SAMHSA, and other government agencies are supporting research to understand the causes of drug abuse and other mental health issues among military personnel, veterans, and their families, and how best to prevent and treat them. Regional 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. Average Wages by County Economic strength continues to develop throughout Region 8, according to the ACS survey, the median household income for Region 8 in 2014 was 46,726 which is higher than it was in 2013, $45,658. However it continues to be lower than the median Texas household income of $53,067, in 2014. According to the U.S. Bureau of Labor Statistics, the average weekly wages for Region 8 are $769; for the state of Texas, $999; and the US $974 for 2015. See Appendix L for average weekly wages in Region 8 by county. Region 8 1,132,372 $769 Texas 11,680,983 $999 United States 140,442,224 $974 Household Composition Children in households with only one parent present are more likely to experience unsupervised periods of time. Gaps in direct supervision increase the likelihood that outside influences can affect the child. Our data does not support the assumption that parental absence and economic hardship are directly responsible for youth substance use. Region 8
  47. 47. 2016 Regional Needs Assessment Population 46 However, substance dependence was positively associated with family or household changes, unstable living arrangements (including domestic violence), and other risk factors, according to SAMHSA’s National Household Survey on Drug Abuse. According to the County Health Rankings Social & Economic Factor data, there are 693,571 households in Region 8 and 243,891 are single-parent households, that’s 35% of the households in region 8 are single parent. Employment Rates Unemployment creates financial instability and puts strain on a household as well as the community, and creates difficulties obtaining necessities like insurance coverage, health services, healthy food, and other needs that contribute to a better quality of life. According to labor force data, as of April 2016 the unemployment rate in Region 8 was 50,405, or 3.8% of the civilian non-institutionalized population age 16 and older (non-seasonally adjusted), lower than the state of Texas rate of 4.2% and national of 4.7%. Data from the Census of Employment and Wages, Bureau of Labor Statistics state that there are almost 1.3 million employed in in Region 8. See Appendix M for County data. 3.8 4.2 4.7 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 Region 8 Texas U.S. Unemployment Rate Region 8 Texas U.S.
  48. 48. 2016 Regional Needs Assessment Population 47 Unemployment rates for the majority of the counties in Region 8 are higher than the state unemployment rate of 4.2% as of April 2016, and at least half of the counties in Region 8 are below the national unemployment rate of 4.7%, according to the Bureau of Labor Statistics. The five counties with the highest unemployment rates were Zavala (12.9%), Maverick (12.3%), Dimmit (6.6%), Kinney (6.4%), and Val Verde (6.3%). Additionally, 11 of the 28 counties in Region 8 are at or below the state unemployment rate of 4.2% as of 2016. Refer to Appendix M for more detailed information. Industry Detailed information on the industry sectors is available through the Quarterly Census of Employment and Wages database provided by the Bureau of Labor Statistics. It is critical to understand employment patterns in order to understand the target population’s means of support. The most recent employment data from BLS by major industrial sector for 2013-14 are shown below. The Department of Labor calls these major categories "Super Sectors." One benefit of going through employment changes at broad industrial levels is that it permits for a distinctive snapshot of variances in Region 8
  49. 49. 2016 Regional Needs Assessment Population 48 the total workforce for a particular study area when compared to any larger statewide and national trend. When employment changes at a greater rate than the state or nation, comparative gains in the local economy may be motivating these changes. TANF Recipients The government's Temporary Assistance for Needy Families program provides up to 60 months of coverage throughout a recipient's lifetime. Public assistance income includes general assistance and Temporary Assistance to Needy Families (TANF). Separate payments received for hospital or other medical care (vendor payments) are excluded. This does not include Supplemental Security Income (SSI) or noncash benefits such as Food Stamps. Percent Households with Public Assistance Income Report Area Total Households Receiving Public Assistance Income Aggregate Public Assistance Dollars Received Average Public Assistance Received (in USD) Region 8 16,944 52,514,500 $3,099 Texas 160,255 535,709,600 $3,342 US 3,274,407 12,180,443,136 $3,719 Source: U.S. Census Bureau, American Community Survey, 2009-2013 1.82 1.78 2.82 0 0.5 1 1.5 2 2.5 3 Region 8 Texas U.S. % Public Assistance Income Region 8 Texas U.S.
  50. 50. 2016 Regional Needs Assessment Population 49 Food Stamp Recipients High rates of poverty and food hardship affect thousands in Texas. The estimated percentage of households receiving the Supplemental Nutrition Assistance Program (SNAP) benefits. This indicator is relevant because it assesses vulnerable populations which are more likely to have multiple health access, health status, and social support needs; when combined with poverty data, providers can use this measure to identify gaps in eligibility and enrolment. Source: U.S. Census Bureau, American Community Survey, 2009-2013 14.55 13.52 12.98 12 12.5 13 13.5 14 14.5 15 Region 8 Texas U.S. % of Households Receiving SNAP Benefits Region 8 Texas U.S. Region 8
  51. 51. 2016 Regional Needs Assessment Population 50 Region 8 Region 8 Region 8
  52. 52. 2016 Regional Needs Assessment Population 51 Free School Lunch Recipients Within the Region 8, 325,018 public school students or 62% are eligible for Free/Reduced Price lunch out of 524,183 total students enrolled, according to the data from the National Center for Education Statistics. This indicator is relevant because it assesses vulnerable populations which are more likely to have multiple health access, health status, and social support needs. Additionally, when combined with poverty data, providers can use this measure to identify gaps in eligibility and enrollment. Region 8 has a higher percentage rate (62%) than the state rate of Texas, 60.08% and the US rate of 52.35%. Source: Texas Department of Agriculture, (Years 2013-14), CCD Public School District Data for the 2012-2013, 2013-2014 school years. 62 60.8 52.35 46 48 50 52 54 56 58 60 62 64 Region 8 Texas U.S. % of Students Eligible for Free or Reduced Lunch Region 8
  53. 53. 2016 Regional Needs Assessment Population 52 Environmental Risk Factors In this section, data from several statistically valid surveys will be used to indicate consumption patterns in the state and region. Due to the focus on state-level reporting, direct consumption data at geographical levels smaller than the state level has been historically unavailable, difficult to find, and/or collected for smaller, less formal area studies. SAMHSA’s Center’s for Applied Prevention Techniques (CAPT) organization has identified many of the ways youth are at risk of, or gain protection from, alcohol use. As you read this section and note the data listed in the tables, it is helpful to keep these risk and protection factors in mind for decreasing the likelihood of use, especially for alcohol, as it is by far the greatest problem in magnitude and severity.  Perceived parental disapproval of substance use is a consistent protective factor against youth substance abuse.  Limited exposure to peer problem behavior and peers engaging in healthy alternative activities correlate with decreased alcohol and other substance use.  High-risk, aggressive, or antisocial behavior in early adolescence predicts later adolescent aggressiveness, drug abuse, and alcohol problems.  Adolescents who report high parental or other adult monitoring are less likely to use a variety of substances.  Youth with high perception of harm, or attitudes and values unfavorable to alcohol or drugs, are less likely to initiate substance use.  Adolescents who have a close relationship with their parents and positive adult role models are less likely to initiate substance abuse.  Most alcohol consumed by youth is obtained through social sources such as parents and friends, at underage parties, or at home.  Adolescents with a high commitment to school or academic achievement and/or organized activities are less likely to initiate substance abuse. Region 8
  54. 54. 2016 Regional Needs Assessment Population 53 (Source: Modified from SAMHSA CAPT’s “Common Risk and Protective Factors for Alcohol and Drug Use.”) Education Although researchers have known of the correlation between substance use and academic failure for quite some time, the contribution of substance use to poor academic performance has been under- recognized by policy makers. This correlation tells the community and key decision makers that preventing substance use is a worthwhile option for improving academic performance. Research indicates that almost one quarter of students will eventually drop out of high school, and that high school dropouts are much more likely than graduates to have health problems, to earn less income over their lifetimes, and to become involved with the legal system. In Region 8 almost 82% of students are receiving their high school diploma within four years, higher rate than the state or nation for 2008-2009. Within 2013-2014, more than 89% of students are receiving their high school diploma within four years, slightly lower than the state but higher rate than the nation. On-Time Graduation Rate 08-09 by County, EDFacts 2013-14 81.7 75.4 75.5 72 73 74 75 76 77 78 79 80 81 82 83 Region 8 Texas U.S. On Time Graduation Rate 08-09
  55. 55. 2016 Regional Needs Assessment Population 54 Cohort Graduation Rate 13-14 Dropout Rates The annual dropout rate is the percentage of students who dropped out of either Grades 7-8, Grades 9- 12, or Grades 7-12 during the school year. The annual dropout rate formula is: In Region 8, the annual dropout rates by grade span for the state of Texas averaged 1.6% for grades 7- 12, and for Region 8 averaged 2.1%. According to data collected from TEA, Region 8 accounts for 44.6% of Texas dropouts for grades 7-8 in 2012-2013 school year. Texas Annual Dropout Rates by Grade Span, 2012-2013 Texas Grade Span Dropouts Students Rate (%) Grades 7-8 3,187 760,623 0.4% Grades 9-12 31,509 1,428,819 2.2% Grades 7-12 34,696 2,189,442 1.6% Region 8 Annual Dropout Rates by Grade Span, 2012-2013 Region 8 Grade Span Dropouts Students Rate (%) Grades 7-8 ≥1,421 <84,707 1.7% Grades 9-12 ≥2,905 <152,700 1.9% Grades 7-12 ≥5,048 <236,514 2.1% 89.2 89.6 84.3 81 82 83 84 85 86 87 88 89 90 Region 8 Texas U.S. On Time Graduation Rate 2013-2014

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