Pennsylvania State Epidemiology Profile
On Substance Use & Consequences
Strategic Prevention Framework – State Incentive Grant (SPF-SIG)
SPF – SIG Statewide Epidemiological Outcomes Workgroup
Spring 2012
SPF-SIG STATEWIDE EPIDEMIOLOGY WORKGROUP
The SPF-SIG State Epidemiology Outcomes Workgroup (SEOW) is a group of twenty
members that collaborated on the development of this document, with the help of the
larger State SPF-SIG Advisory Council (see Appendix for a list of SEOW and Advisory
Council members).
PA Department of Health
Department of Transportation
Bureau of Drug and Alcohol Programs
Robin Rothermel
Daniel Miller
Terry Matulevich
Division of Prevention
Garrison Gladfelter
Lonnie Barnes
Kim Fitzpatrick
Bureau of Highway Safety and Traffic
Engineering
Ryan McNary
Bureau of Epidemiology
Division of Community Epidemiology
Ronald Tringali
Bureau of Health Promotion and Risk
Reduction
Carol Thornton
Emergency Medical Services Office
Robert D Cooney
University of Pittsburgh
School of Pharmacy
Michael Melczak
Janice Pringle
PA Commission on Crime and
Delinquency
Office of Juvenile Justice & Delinquency
Prevention
Kim Nelson
Department of Education
Office for Safe Schools
Mike Kozup
Temple University
School of Social Administration
Marsha Zibalese-Crawford
Institute for Survey Research
Peter Mulcahy
Bloomsburg University
Drug, Alcohol & Wellness Network
Barry L. Jackson
Pennsylvania State University
Prevention Research Center
Brittany Rhoades
Mark Greenberg
Sebrina Doyle
ACKNOWLEDGMENTS
This profile is based on research made possible by support from the Pennsylvania
Department of Health’s Bureau of Drug and Alcohol Programs (BDAP) and the
Substance Abuse and Mental Health Administration’s (SAMHSA) Center for Substance
Abuse Prevention (CSAP).
Mark Greenberg, Ph.D.
Director
Prevention Research Center
Pennsylvania State University
Brittany Rhoades, Ph.D.
Research Associate
Prevention Research Center
Pennsylvania State University
Sebrina Doyle, M.S.
Research Assistant
Prevention Research Center
Pennsylvania State University
TABLE OF CONTENTS
I. Executive Summary...........................................................................................................1
II. Introduction
A. About the SPF-SIG ..............................................................................................4
B. About Pennsylvania.................................................................................... .........5
C. Goals ....................................................................................................................6
D. Understanding the Profile ....................................................................................7
III. Data Sources ....................................................................................................................8
IV. Data Limitations ..............................................................................................................11
V. Data Processes
A. Choosing Indicators .............................................................................................13
B. Indicators Chosen .................................................................................................14
VI. Consumption & Consequence Indicators
A. Alcohol
1. Indicator Definitions ................................................................................15
2. Adult & Youth Consumption ...................................................................16
3. Adult & Youth Consequences .................................................................21
4. Alcohol Summary ....................................................................................29
B. Tobacco
1. Indicator Definitions ................................................................................31
2. Adult & Youth Consumption ...................................................................32
3. Adult & Youth Consequences .................................................................39
4. Tobacco Summary ...................................................................................42
C. Illicit Drugs
1. Indicator Definitions ................................................................................44
2. Youth Consumption .................................................................................45
3. Adult & Youth Consequences .................................................................47
4. Tobacco Summary ...................................................................................51
VII. Appendix
A. SEOW & Advisory Council Member List ...........................................................53
B. Acronyms in Profile .............................................................................................57
C. Detailed Tables
1. FARS Calculated Crash Data Tables Used ..............................................58
D. Other Pennsylvania Drug & Alcohol Resources..................................................60
I. EXECUTIVE SUMMARY
GOALS OF THIS REPORT
The Pennsylvania State Epidemiology Profile on Substance Use & Consequences
(hereafter referred to as the profile) was developed by the State Epidemiological
Outcomes Workgroup (SEOW) as a tool for substance abuse prevention planners for
Pennsylvania, including the Single County Authorities (SCA), who are responsible for
countywide assessment, planning, implementation, and evaluation of prevention. The
process of using data to improve prevention practice and decision-making is important
for several reasons:
• It helps to inform and anchor problem identification and goal setting;
• It increases the likelihood that the most significant problems will be targeted
for intervention;
• It drives prevention planning and implementation decisions—assuring that
strategies appropriately target problems; and,
• It provides the basis for ongoing monitoring and evaluation to improve efforts.
The profile is intended to support efforts related to the Substance Abuse and Mental
Health Services Administration (SAMHSA) Strategic Prevention Framework State
Incentive Grant (SPF-SIG) received in Pennsylvania in October, 2006. The SPF-SIG has
provided funding for Pennsylvania communities to assess the problems of substance use
and its consequences and to plan and implement evidence-based prevention programs,
policies, and practices.
This profile is part of a continuing component of the SPF-SIG process of developing a
statewide needs-assessment. The goal of this profile is to review and summarize both
federal and state data sets that provide a set of state-specific indicators of: (1) substance
use-related consequences and (2) substance use patterns related to these consequences.
As directed by SAMSHA, this assessment includes measures of:
• Overall consumption;
• Acute, heavy consumption;
• Consumption in risky situations (drinking and driving);
• Consumption by high-risk groups (youth, college students, pregnant women);
• Consequences that result from consumption.
Finally, certain criteria were used for selecting indicators to ensure that the indicators:
• Reflect critical substance use related problem or consumption patterns;
• Have high validity;
• Have periodic collection;
• Are available with a limited burden; and
• Can be disaggregated geographically, by age, gender and/or race/ethnicity.
This is the third report of the SEOW and captures data available through September
2011. The report updates the previous epidemiological profile completed in 2009.
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FINDINGS OF THIS REPORT
For each type of substance (alcohol and tobacco), this report summarizes the magnitude
of the problem in Pennsylvania, time trends in recent data, and comparison to national
data.
Alcohol Consumption and Consequences. In terms of magnitude, alcohol is the most
frequently reported substance used. Many Pennsylvanians show high rates of
consumption and many are affected by its consequences. Adult binge drinking is
reported by approximately 15% of Pennsylvania adults and similar rates are reported by
high school students. Pennsylvania has a large number of admissions for alcohol
treatment and the effects of alcohol use problems impact many aspects of life for affected
adults, spouses, relatives, and children.
Alcohol played a role in 32% of all fatal crashes in 2009. The highest percentage of
drinking drivers in fatal motor vehicle crashes is among those drivers aged 21–25. The
majority of the alcohol-related DUIs and fatalities involve White males. DUI arrests also
influence a large number of lives, with 48,698 persons arrested in 2006. Males report
substantially higher rates of binge and heavy drinking and also experience the majority of
the alcohol consequences, including abuse and dependence.
Young adults show particularly high rates of binge drinking compared to older adults and
should be considered a target for reductions within the adult age range. For most
consequences, the highest rates are shown for those aged 18–24 (26.8%) and aged 24–34
(24.7%). From 2006–2010 there have been substantial reductions in heavy drinking in
the 18–24 age group from 12% to 5%. Evidence-based prevention programs and policies
prior to this age (early and middle adolescence) are an important component in a plan to
continue to reduce heavy use in the late teen age years and early adulthood.
From 2006–2010, the rate of binge drinking in adults was relatively steady, but adult
heavy drinking appears to have declined in the past two years from 5.2% in 2009 to 3.9%
in 2010. A small downward trend exists in past 30-day use and binge drinking among
10th- and 12th-grade students, but appears mostly stable for 6th and 8th graders.
On most indicators, comparisons with the national rates show that Pennsylvania is not far
from the national averages. However, Pennsylvania shows a substantially lower rate of
alcoholic liver disease deaths.
Tobacco Consumption and Consequences. Tobacco use affects many Pennsylvanians.
18.4% of adults are current smokers and about 16% smoke daily. This rate has shown a
substantial decline over the past decade. In spite of these important reductions in
smoking, a substantial public health concern is that 16.5% of new mothers voluntarily
reported smoking during their pregnancy during 2009. Further, the rates are substantially
higher among pregnant women below the age of 25. Educational attainment is
significantly associated with smoking status. Smoking prevalence is more than triple the
rate for those with less than a high school education compared to those who graduate
from college.
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Adults between the ages of 25–34 have the highest smoking prevalence rates, with no
differences in use between males and females. For youth, the prevalence rates for
smoking do not differ between girls and boys, but three times as many boys use
smokeless tobacco as do girls.
With regard to tobacco use consequences, Black people showed disproportionately higher
rates of lung cancer. Men also show higher rates of death than women, with these rates
attributable to tobacco use. Geographically, there is no clear pattern of “hot spots.”
Recent time trends indicate lower rates of smoking among youth and adults. Yet,
Pennsylvania is somewhat above the national median levels with regard to all
consumption indicators for tobacco, including daily use by adults and teens and
especially smoking during pregnancy.
Illicit Drug Use and Consequences. Among youth, current marijuana use increases
dramatically by grade: there is almost no reported use in 6th graders, 5.4% among 8th
graders, 14% among 10th graders, and a jump to 24% in 12th graders. 41% of 12th graders
reported having tried marijuana in their lifetime. While marijuana shows the highest
prevalence, there is substantial and increasing use of inhalants among all grades (6th, 8th,
10th, 12th) and non-medical use of prescription drugs as reported by 10th and 12th graders.
In 2009, over 8% of 12th graders reported substantial non-medical use of prescription
drugs, including tranquilizers and stimulants, and nearly 15% reported non-medical use
of pain medications. For youth under 18, marijuana use was most often identified as the
illicit drug of choice at admission to treatment.
There were 32,677 treatment admissions in Pennsylvania based on 2010 Treatment
Episode Data (TEDS), where illicit drugs were identified as the drug of choice at
admission. The most frequently cited drugs (in order of ranking) were: heroin,
marijuana, and crack/cocaine. These data are limited to federal block grant/state-funded
services and Medicaid information, and do not reflect all treatment services provided.
Cross-Substance Summary. Alcohol and tobacco are used at substantial rates in
Pennsylvania. For students or youth, alcohol is the most frequently reported substance
used, followed by tobacco and marijuana. However, for adults, the daily smoking
prevalence is higher than the prevalence of 30-day adult binge or heavy drinking
(‘problem drinking’). There is dramatic growth in binge drinking, tobacco, and illicit
drug use during the high school years. Reported smoking during pregnancy also affects
many people (24,003 live births in 2009). For consequences, the substantial numbers of
people are affected by: DUI arrests (53,084 persons in 2009), and admissions to
treatment (13,399 admissions for alcohol in 2010) and lung cancer deaths (23,454 deaths
in 2007-2009). All of these issues are considered serious and may be amenable to some
intervention models. Promising trends indicate lower rates of smoking and heavy
drinking among the 18–24 age group. If such trends continue, they could substantially
decrease morbidity from cancer, heart disease, and stroke. In order to make further
reductions in these indicators, intervening variables (risk and protective factors) should
be targets for intervention and thus such risk and protective factors should also be
measured.
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II. INTRODUCTION
II. A. About the SPF-SIG
This profile is to be used as a tool for substance abuse prevention planners for the state of
Pennsylvania. The primary purpose of this profile is to utilize data to monitor programs
and practices for substance abuse prevention. The goals of this profile are aligned with
the Strategic Prevention Framework and it supports efforts related to the SAMHSA SPFSIG in Pennsylvania. The SPF-SIG will provide funding for Pennsylvania communities
to assess substance use and its consequences and intervening variables in order to address
those needs with planning and implementation of evidence-based prevention programs,
policies, and practices. The intervening variables include risk and protective factors that
are related to both consumption indicators and consequence indicators.
The goals of the broader SPF-SIG initiative are to:
• Prevent the onset and reduce the progression of substance abuse, including
childhood and underage drinking;
• Reduce substance abuse-related problems in the communities; and
• Build prevention capacity and infrastructure at the State and community
levels.
The SPF-SIG takes a public health approach to prevent substance related problems.
This approach focuses on change for entire populations. A basic foundation of effective
prevention activity is grounding the planning process in a solid understanding of alcohol,
tobacco and other drug consumption and consequence patterns. Understanding the
nature and extent of consumption (e.g., underage drinking) and consequences (e.g.,
motor-vehicle crashes) is critical for determining prevention priorities and aligning
strategies to address them. The Strategic Prevention Framework includes 5 iterative steps
(see Figure 1).
Figure 1. SAMHSA’s Strategic Prevention Framework Steps
Profile population
needs, resources,
and readiness to
address needs and
gaps
Evaluation
Monitor, evaluate,
sustain, and improve
or replace those that
fail
Implementation
Assessment
Capacity
Mobilize and/or build
capacity to address needs
Sustainability &
Cultural Competence
Implement
evidence-based
prevention
programs and
activities
Develop a
Comprehensive
Strategic Plan
Planning
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The SPF-SIG strives to use data across all steps of the Strategic Prevention
Framework (SPF). A well-structured process is followed to collect, analyze,
interpret, and apply lessons from substance use and consequence data to drive state
efforts across the entire SPF. Ongoing and integrated data analyses are critical to:
• Identify problems and set priorities;
• Assess and mobilize capacity for using data;
• Inform prevention planning and funding decisions;
• Guide selection of strategies to address problems and goals; and
• Monitor key milestones and outcomes and adjust plans as needed.
II. B. About Pennsylvania
Pennsylvania has the 6th largest population in the U.S., with over 12 million residents.
The state has two major metropolitan areas, 12 cities with 100,000–1,000,000 residents,
hundreds of smaller towns, and vast rural areas. Nearly one-third of the population (3.8
million) lives in Philadelphia and its four surrounding counties. With regard to race and
ethnicity, Pennsylvania is approximately 85% White, 11% Black, 2% Asian, and 5%
Hispanic/Latino. Economically, the median household income is approximately $49,520,
with 12.5% of the population living in poverty.
Figure 2. PA Counties: Total Population: 2010
Prepared by: The Pennsylvania State Data Center
Source: U.S. Department of Commerce United States Census, Census 2010 Redistricting Data
(Public Law 94-171) Summary File.
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II. C. Goals
GOALS OF SEOW
The goals of the SEOW are to:
• Bring systematic, analytical thinking to the causes and consequences of the
use of substances in order to effectively and efficiently utilize prevention
resources;
• Promote data-driven decision making at all stages in the Strategic Prevention
Framework;
• Promote cross-systems planning, implementation, and monitoring efforts; and
• Provide core support to the SPF Advisory Council.
GOALS OF THIS PROFILE
This report is a component in the continuing SPF-SIG process of statewide needs
assessment. The initial activity is to assess substance use and related problems leading to
recommendations regarding state and community priorities. The assessment should
include a profile of consumption and related problems in Pennsylvania and identify a set
of state-specific indicators of (1) substance use-related consequences and (2) substance
use patterns related to these consequences.
As directed by SAMSHA, this assessment should include measures of:
• Overall consumption;
• Acute, heavy consumption;
• Consumption in risky situations (drinking and driving);
• Consumption by high-risk groups (youth, college students, pregnant women);
• Consequences that result from consumption.
Finally, certain criteria were used in selecting indicators. These indicators should:
• Reflect critical substance use-related problems or consumption patterns;
• Have high validity (research-based evidence accurately measures construct);
• Have consistent, periodic collection (over at least last 3 to 5 years);
• Be readily available and accessible; and
• Be sensitive (able to detect change over time).
The current assessment report focuses on utilizing existing data sources and should
establish baseline levels, trends over time, and, when available, patterns by age, gender,
race/ethnicity, and geography.
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II. D. Understanding the Profile
PROFILE LAYOUT
Each consumption and consequence section begins by listing and defining all indicators
used for a particular substance (indicator definitions in this profile follow the definitions
from the data sources used in the sections). Next, data are presented by indicator. Within
these sections, short descriptions of findings are also presented. At the end of each
section is an overall summary.
ABOUT NUMBERS IN PROFILE
The data and statistics shown in this profile were obtained mainly at the state level as that
is the level at which most of the estimates are statistically accurate due to typical survey
sampling frames and methodologies. When statistically possible, the data were
disaggregated into smaller geographical areas to more accurately identify regions of
higher risk for the indicators. In addition, when possible, 95% confidence or prediction
intervals for the estimates are provided for comparison purposes. When the term
‘significant’ is used in making comparisons in this profile, it is conservatively utilized
and refers to non-overlapping 95% confidence or prediction intervals. The term
‘prevalence rate’ refers to how prevalent the measurement is in the population (higher
numbers indicate greater prevalence); this can be presented as a percentage or count per
population.
As the estimates and data were obtained from many data sources, each table or chart is
briefly labeled with the data source. The full data sources are described in the section
titled ‘Data Sources’. In addition, most of the data is presented in the form of figures or
graphs. The actual numbers are usually then reported in the Appendix, as noted in the
sections.
DATA DIMENSIONS
Most of the indicators in each substance section are summarized by a matrix using three
comparison dimensions. One dimension summarized is the magnitude of the problem,
either with numbers impacted, rates of severity, or both (when possible). Another
dimension examined is time trends with an indicator of whether there is improvement or
decline over time. Finally, a third dimension examined (when possible) is comparison
with national rates. For this dimension, the same measure is compared for Pennsylvania
with the latest available national data to calculate a rate ratio. A rate ratio can be
interpreted as:
1 = Pennsylvania’s rate is the same as the national one;
Over 1 = Pennsylvania’s rate is higher than the national one, higher numbers
indicate an increasing difference; and
Under 1 = Pennsylvania’s rate is lower than the national one.
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III. DATA SOURCES
Alcohol Sales: Alcohol Epidemiologic Data System. LaVallee, R. A., & Yi, H.
Surveillance report #92: Apparent per capita alcohol consumption: National, state, and
regional trends, 1977–2009. Bethesda, MD: National Institute on Alcohol Abuse and
Alcoholism, Division of Epidemiology and Prevention Research (August 2011).
Behavioral Risk Factor Surveillance System (BRFSS) Survey: Centers for Disease
Control and Prevention. Behavioral risk factor surveillance system survey data. Atlanta,
GA: U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, 1999–2010. Data obtained on the Centers for Disease Control and Prevention
(CDC) website: http://www.cdc.gov/brfss/index.htm. The BRFSS survey in Pennsylvania
is conducted by the Pennsylvania Department of Health.
Census: U.S. resident population by county, single-year of age, sex, race, and Hispanic
origin, prepared by the U.S. Census Bureau. Year 2000 data were used for this report
because of availability. Data were downloaded from the Census website at
www.census.gov.
Centers for Disease Control and Prevention: National Vital Statistics Reports Volume
58, Number 19, published May 20, 2010, reporting on number and type of deaths in the
U.S., including alcohol-related http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf
tobacco statistics for the Pennsylvania compared to the nation
http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2010/pdfs/states/p
ennsylvania.pdf.
Court Convictions: Administrative Office of the Pennsylvania Courts (AOPC) provided
data on the outcomes of criminal court cases for drug- and alcohol-related offenses. Web
docket data on individual court cases can be obtained from
http://www.aopc.org/default.htm. A formal data request is required to obtain data on the
entire state of Pennsylvania. The magisterial district courts and the court of common
pleas maintain separate databases. The latest data available at the time of this report were
from 2008.
Fatality Analysis Reporting System (FARS): National Highway Traffic Safety
Administration, Department of Transportation, 2009. FARS includes blood alcohol
content (BAC) values for every case in the file, either through BAC measurement or
imputation where an actual measurement was not taken (or the result was unknown).
Those persons for whom a BAC is missing had their BAC imputed probabilistically from
a model developed by NHTSA analysts that has been validated as having a high degree
of predictive accuracy (Rubin, Schafer, & Subramanian, 1998).
Pennsylvania EpiQMS (Epidemiologic Query and Mapping System): Pennsylvania
Department of Health website:
http://app2.health.state.pa.us/epiqms/Asp/ChooseDataset.asp EpiQMS includes data from
Pennsylvania’s death and birth certificates across years and by demographics and
8
geography. PA Department of Health disclaimer: These data were provided by the
Bureau of Health Statistics and Research, Pennsylvania Department of Health. The
Department specifically disclaims responsibility for any analyses, interpretations or
conclusions.
Pennsylvania State Police: Uniform Crime Statistics obtained from Online Annual
Crime Reports that can be found at:
http://ucr.psp.state.pa.us/UCR/Reporting/Annual/AnnualSumArrestUI.asp
Pennsylvania State Data Center: Census data and figures were obtained from the
Pennsylvania State Data Center “Pennsylvania Facts 2011” sheet as well as “PA counties
Total Population 2010 map”. http://pasdc.hbg.psu.edu/.
Pennsylvania Youth Survey (PAYS): 2009 PA Youth Survey Report (Statewide)
obtainable online
(http://www.pccd.state.pa.us/portal/server.pt/community/justice_research/5259) as
publication from Pennsylvania Commission on Crime and Delinquency (PCCD). Since
1989, the Commonwealth of Pennsylvania has conducted a survey of secondary school
students on their behavior, attitudes, and knowledge concerning alcohol, tobacco, other
drugs, and violence. The Pennsylvania Youth Survey (PAYS) of 6th–, 8th–, 10th– and 12th–
grade public school students is conducted every two years. The effort is sponsored and
conducted by the Pennsylvania Commission on Crime and Delinquency (PCCD). The
data gathered in the PAYS serve two primary needs. First, the results provide school
administrators, state agency directors, legislators, and others with critical information
concerning changes in patterns of use and abuse of these harmful substances and
behaviors. Second, the survey assesses risk factors related to these behaviors and the
protective factors that help guard against them. This information allows community
leaders to direct prevention resources to intervening variables where they are likely to
have the greatest impact.
Pennsylvania Youth Tobacco Survey (YTS): 2008/9 PA Youth Tobacco Survey
statewide report is available online
(http://www.portal.state.pa.us/portal/server.pt?open=514&objID=598865&mode=2) as a
publication of the Pennsylvania Department of Health, Bureau of Health Promotion and
Risk Reduction and the Bureau of Health Statistics and Research. The YTS is a tool,
developed by the Centers for Disease Control (CDC), to measure students’ tobaccorelated knowledge, behaviors, and attitudes. The Pennsylvania Department of Health,
Division of Tobacco Prevention and Control, conducted the PA YTS during the fall and
winter of the 2008–2009 school year. The results of this survey are intended to be used
by tobacco control program staff, researchers, healthcare providers, local health
departments, and community partners.
Treatment Episode Data Sets (TEDS): Office of Applied Studies, Substance Abuse and
Mental Health Services Administration (http://wwwdasis.samhsa.gov/dasis2/teds.htm).
TEDS provides information on the demographic and substance abuse characteristics of
the 1.9 million annual admissions to treatment for abuse of alcohol and drugs in facilities
9
that report to individual state administrative data systems. TEDS is an admission-based
system, and TEDS admissions do not represent individuals. It includes admissions to
facilities that are licensed or certified by the state substance abuse agency to provide
substance abuse treatment (or are administratively tracked for other reasons). In general,
facilities reporting TEDS data are those that receive state alcohol and/or drug agency
funds (including Federal Block Grant funds) for the provision of alcohol and/or drug
treatment services.
Note: the National Survey on Drug Use and Health (NSDUH) report was not available
at the time of this report.
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IV. DATA LIMITATIONS
A number of data limitations currently exist in attempting to accurately represent
substance use and consequences in Pennsylvania. Additionally, some of the data
included in this profile (Pennsylvania Youth Survey (PAYS), DUI arrest rates, Treatment
Episode Data Set (TEDS) provide important information but should be interpreted with
caution. Within the profile we address the cautionary inferences for specific data
indicators and we also include an overall summary of such data limitations here.
NSDUH data were not available for this report and therefore sections of the report that
were previously available were not available at the time of publishing.
Concerns about PAYS Data
Although of great value, a number of issues should be considered in the Pennsylvania
Youth Survey (PAYS). The overall school response rate for the 2009 survey was 37.9%.
Of the schools that did participate, the average student participation rate was 67.7%. This
resulted in an overall participation rate of 25.6%. While appropriate weighting was
conducted to minimize effects on the estimates of this low response rate, no amount of
adjustment can remove the very real possibility that a substantial and unknown amount of
bias remains. Second, the accuracy of 12th-grade data is difficult to judge due to the high
rate of dropouts in some communities. Therefore, the 12th-grade data should be used
with caution. Third, the PAYS report does not compute confidence intervals and thus it
is often unknown whether differences by grade, sex, ethnicity, etc. are statistically
different.
Concerns about TEDS Data
Licensed drug and alcohol treatment providers in Pennsylvania that receive funds from
the Department of Health (DOH) are required to report on treatment services provided
through the Bureau of Drug and Alcohol Programs' (BDAP) Client Information System
(CIS). These data are largely limited to block grant/state-funded services, plus available
Medicaid information. BDAP submits treatment admissions data on a quarterly basis to
SAMHSA for inclusion in the national Treatment Episode Data Set (TEDS).
There are differences in TEDS and CIS treatment admissions counts for Pennsylvania for
several reasons. TEDS data are aggregated on a calendar year basis, while state-level
CIS publications use a state fiscal year reporting period (July 1 to the following June 30).
Admissions may also be counted differently in TEDS and CIS. Pennsylvania treatment
providers are instructed to report a new treatment admission in the Client Information
System (CIS) every time a client changes between levels of care, although it is not known
how consistently this is done. TEDS defines a treatment episode differently, and would
only show a new admission for a change in level of care if a different treatment provider
was involved. Changes in level of care at the same provider are counted as a transfer
rather than a new admission in TEDS. Finally, the reported admissions are only to
facilities that are either state-certified for treatment and/or receive government funds;
thus, these numbers do not represent the entire scope of those admitted for treatment in
Pennsylvania. Finally, the extent to which the treatment admissions data submitted by
Pennsylvania to TEDS are edited by SAMHSA's contractor (Synectics) is unknown.
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Concerns about DUI Arrest Data
Although included in this profile, DUI arrest data must be used with caution as they may
not accurately reflect consumption patterns in Pennsylvania. Instead, these arrest data are
likely to reflect local priorities and concerns and may also reflect budgetary priorities of
local law enforcement. This could erroneously reflect increased targeting of certain
geographic regions rather than actual increases in consumption. If targeted prevention
programs are conducted to reduce alcohol abuse, these may not be reflected in DUI
arrests. However, it is possible that increased enforcement and thus higher rates of DUI
arrests might lead to a reduction in other consequences such as reports of drinking and
driving, alcohol-related fatalities, etc.
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V. DATA PROCESSES
V. A. Choosing Indicators
An important goal of this report is to provide a wide variety of data indicators for
Pennsylvania that bear on the issue of substance use and abuse. Choices were made to
include indicators based on data availability (should be easily available), data validity
(should be research-based evidence that the indicator accurately measures the construct),
data consistency (data should be measured in a very similar way across several years),
and sensitivity (data should reflect changes in consumption or consequences of
substance).
The process of indicator selection was facilitated by following the guidelines for
indicators suggested by SAMHSA along with associated data SAMHSA supplied for
Pennsylvania. For consumption indicators, these included: current use of substances,
binge drinking, heavy drinking, drinking and driving self-reported rates, alcohol/tobacco
sales, daily tobacco use, age of initial use of substances, lifetime use of some substances
for youth, and alcohol use during pregnancy. Almost all of these are contained in this
profile. These are all nationally obtained by SAMHSA. However, importantly, most of
the youth consumption data utilized by SAMHSA are obtained through the Youth Risk
Behavioral Surveillance Survey in which Pennsylvania does not participate. We filled
this data gap with the Pennsylvania Youth Survey (PAYS).
Within the Commonwealth of Pennsylvania, there are data estimates of many of these
consumption indicators as well. We utilized Pennsylvania Department of Health data for
the indicator of smoking while pregnant which provides some disaggregation by
demographics and by county. We do not report current alcohol use rates for adults since
this is a normative, legal behavior and the majority of Pennsylvania adults surveyed have
had a drink within 30-days. As age at first use of ATOD is an unreliable indicator (it
varies by age with the question asked), we instead report lifetime use of substances for
youth by grade level.
For consequences, SAMHSA-recommended indicators included: deaths from liver
disease (alcoholic and/or chronic), suicides, homicides, motor vehicle crashes, percent of
persons over 12 meeting DSM-IV criteria for alcohol abuse or dependence, crime data,
deaths from lung cancer, deaths from Chronic Obstructive Pulmonary Disease (COPD) or
Emphysema, deaths from cardiovascular disease, and deaths from drugs. We exclude
almost all crime data (violent crimes and homicides) as these indicators do not reflect
consumption and are an inaccurate measure of the influence of ATOD. However, we do
include DUI arrest data as one indicator to monitor to assess for Pennsylvania’s burden
(monetary and otherwise) that results from drinking (see ‘Data Limitations’ for cautions
in interpreting this indicator). We also exclude suicides and deaths from cardiovascular
disease as we decided that these measures were very limited in accurately measuring our
constructs. It is unclear what role ATOD plays in suicide and many factors other than
ATOD are related to cardiovascular mortality.
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V. B. Chosen Indicators
Table 1.
Construct
Mortality
Crime
ALCOHOL
Alcoholic Liver Disease Death
Rate
Percent Fatal Motor Vehicle
Lung Cancer Death Rate
Crashes Involving Alcohol
Emphysema Death Rate
Fatal Motor Vehicle Death
Rate Involving Alcohol
Percent Drinking Drivers of
Total Drivers in Fatal Crashes
DUI Arrest Rate
Self-reported DUI (youth
only)
Public Drunkenness
Conviction Rate
Underage Purchase of
Alcohol/Tobacco Conviction
Rate
DUI Conviction Rate
Other
Treatment Admissions (%) for
Alcohol Use
Consequences
Consumption
TOBACCO
ILLICIT DRUGS
Drug-induced Death Rate
Drug-related Convictions
Treatment Admissions
(%)for Illicit Substances
Current Marijuana Use
Current Use
(youth)
Current Use (youth only)
Lifetime Marijuana Use
Lifetime Use (youth only)
Lifetime Use (youth only)
(youth)
Daily Smokers (adults
Binge Drinking
Current Other Illicit Drug
only)
Heavy Drinking (adults only)
Smoking During Pregnancy
Use (youth)
Alcohol Sales
Lifetime Other Illicit Drug
Use (youth)
VI. CONSUMPTION & CONSEQUENCE INDICATORS
14
VI. A. Alcohol
VI. A. 1. Alcohol Indicators Defined
Consumption
Binge Drinking--defined as drinking 5 or more drinks for males and four or more drinks
for females on at least one occasion in the previous 30 days.
Heavy Drinking—defined for persons 18 or older as consuming 2 or more (men) OR 1
or more (women) drinks per day.
Current Use—defined as consuming 1 or more drinks in the last 30-days.
Lifetime Use—defined as use of alcohol in their lifetime (youth under 18).
Self-Reported Driving Under the Influence (DUI)—defined as any occasion of driving
either while or shortly after drinking
Alcohol Sales—defined as total sales of ethanol in gallons per 10,000 population aged 14
and older.
Consequences
DUI Arrest Rate—defined as the number of arrests due to driving under the influence of
alcohol or narcotics per 100,000 persons in population.
Percent Fatal Motor Vehicle Crashes Involving Alcohol—defined as the percent of all
fatal motor vehicle crashes involving alcohol (FARS includes blood alcohol content
(BAC) values for every case in the file, either through BAC measurement, or imputation
where an actual measurement was not taken (or the result was unknown). Those persons
for whom a BAC is missing had their BAC imputed probabilistically from a model that
has a high degree of predictive accuracy (Rubin, Schafer, & Subramanian, 1998).
Alcohol-related Fatal Motor Vehicle Death Rate— defined as alcohol-related motor
vehicle death rate (per 100 million vehicle miles travelled).
Percent Drinking Drivers of Total Drivers in Fatal Crashes—defined as the percent
of drivers using alcohol among all drivers involved in a fatal motor vehicle crash.
Alcoholic Liver Disease Death Rate—defined as the age-adjusted death rate (except
when broken down by age in which case is age-specific) per 100,000 persons due to an
underlying cause of death specified as ICD-10 code K70.
Percent Treatment Admissions for Alcohol Use—defined as the percent of admissions
for alcohol treatment to facilities that are licensed or certified by the state substance abuse
agency to provide substance abuse treatment (or are administratively tracked for other
reasons). In general, facilities reporting data are those that receive state alcohol and/or
drug agency funds (including Federal Block Grant funds) for the provision of alcohol
and/or drug treatment services.
Percent Meeting DSM-IV Criteria for Alcohol Abuse or Dependence—defined as
percent of persons aged 12 and older meeting DSM-IV criteria for alcohol abuse or
dependence (Diagnostic and statistical manual of mental disorders, 4th ed. [DSM-IV)
(American Psychiatric Association, 1994)].
VI. A. 2. Adult & Youth Alcohol Consumption
15
YOUTH CURRENT USE
Figure 3. Pennsylvania Youth, Past 30-Day Alcohol Use
As illustrated in
Figure 3, youth
current use (one
or more drinks
in the last 30days) from the
PAYS indicates
that a very large
percentage of
10th and 12th
graders are
consuming
alcohol.
Twelfth-graders
Source: Pennsylvania Youth Survey Report (PAYS)
showed a
substantial drop between 2005 and 2007; however, there was a concern in the 2007 report
that the 2005 data may have been unreliable. There was also a trend towards a decline
among 10th graders. Overall, 25.5% of students in 6, 8, 10, and 12 grades reported past
30-day use in the 2009 PAYS.
YOUTH LIFETIME USE
In 2009, Pennsylvania youth (6th, 8th, 10th, and 12th graders), on average, reported having
their first use of alcohol (having more than a sip or two of alcohol) at age 13.1. In 2009,
on average, 20.8% of 6th graders, 45% of 8th graders, 59.7% of 10th graders, and 70% of
12th graders sampled reported that they had used alcohol in their lifetime.
BINGE DRINKING
Figure 4. Pennsylvania Youth Binge Drinking in Past Two Weeks
Source: Pennsylvania Youth Survey Report (PAYS)
Note: Binge drinking is defined as five or more drinks in a row in past two weeks
Figure 4depicts
2001–2009
statewide
estimates for
youth in grades
6, 8, 10, and 12
from the
Pennsylvania
Youth Survey
(PAYS) Report.
Students in the
12th grade have
the highest
16
absolute rates across years. However, they showed a substantial drop between 2005 and
2007 (there was a concern in the 2007 report that the 2005 data may have been
unreliable) and a slight increase from 2007 to 2009. There was also a trend towards a
decline among 10th graders. Overall, from the 2009 PAYS, 13.6% of students in these
grades report binge drinking in the two weeks before the survey.
The most substantial difference in binge drinking occurs in rates by gender. For example,
in 2010, 20.8% of men reported binge drinking compared to only 10% of women in
Pennsylvania. This difference is depicted in Figure 5. Figure 5 also illustrates a small
reduction in binge drinking in men between 2002 and 2010.
30.0
30.0
25.0
25.0
PA
20.0
US
Percent of Females
20.0
15.0
10.0
5.0
10.0
5.0
0.0
2002
2003
2004
2005
2006
2007
2008
2009
2010
0.0
15.0
2002
2003
2004
2005
2006
2007
2008
2009
2010
Percent of Males
Figure 5. Pennsylvania & U.S. Adult Male & Female Binge Drinking
Source: BRFSS, Center for Disease Control (CDC) (State Prevalence).
Note: Binge drinking is defined as drinking five or more drinks for males and four or more drinks for
females on at least one occasion in the previous 30 days.
Table 2 displays adult binge drinking trends as reported from the Behavioral Risk Factor
Surveillance System (BRFSS) survey data from 2006–2010 as well as patterns by age,
gender, race/ethnicity, and education level. Nationally, 15.1% of adults reported binge
drinking (males having five or more drinks on one occasion, females having four or more
drinks on one occasion) in 2010. In Pennsylvania, in 2010, the estimate was 15.2% (95%
CI: 14.1–16.2%).
In addition, binge drinking shows a decline with increasing age. In 2010 binge drinking
percentages were 26.8% in the 18–24 age range, compared to 16.0% of those aged 45–54
and only 3.3% of those aged 65 or older. Findings indicate lower rates of binge drinking
for Blacks (12.7%) as compared to Whites (15.7%) in 2010. Educational level does not
appear to have a consistent influence on the rate of binge drinking.
17
Table 2.
PA Adult Binge Drinking
All Adults
2006 (N =12,882)
2007 (N =13,007)
2008 (N =12,921)
2009 (N =8,885)
2010 (N =10,961)
n (yes) % yes
CI
n (yes) % yes
CI
n (yes) % yes
CI
n (yes) % yes
n (yes) % yes
CI
CI
1664
16.6 15.2-18.0
1579
16.2 14.8-17.6
1579
16.7 15.5-18.0
1060 16.6 15.2-17.9
1248
15.2 14.1-16.2
Male
Female
928
736
22.3
11.5
19.8-24.8
10.0-13.0
899
680
22.7
10.3
20.3-25.1
8.9-11.7
869
710
22.6
11.4
20.4-24.7
10.0-12.8
612
448
22.7
11
20.4-25
9.5-12.4
707
541
20.8
10
19-22.7
9.0-11.0
18–24
25–34
35–44
45–54
55–64
65+
186
324
426
385
223
120
33.2
24.7
19.9
13.8
11.5
3.8
25.5-40.9
20.5-28.9
17.1-22.7
11.6-16.0
9.1-13.9
2.7-4.9
118
312
406
410
208
125
30.6
22.3
21.6
17
7.8
3.5
23.3-37.9
18.4-26.2
18.7-24.5
14.6-19.4
6.0-9.6
2.5-4.5
123
278
384
419
240
135
32.5
25.1
20.9
16
8.7
3.6
25.9-39.2
21.3-28.9
18.3-23.5
14.0-18.1
7.2-10.3
2.8-4.5
90
179
233
266
176
116
33.9
24.8
19.3
14.4
10.3
4.1
27-40.8
20.8-28.8
16.5-22
12.3-16.5
8.4-12.1
3.2-5
73
188
281
328
239
139
26.8
24.7
20.4
15.4
9.1
3.3
20.4-33.3
21-28.5
17.8-23.1
13.5-17.4
7.8-10.4
2.7-4
White
Black
Other
1445
122
23
17.4
9.9
7.1
15.9-18.9
3.6-16.2
1.4-12.8
1363
130
26
16.4
10.5
19.5
15.0-17.8
6.6-14.4
9.5-29.5
1363
143
NA
17.3
13.7
NA
16.0-18.6
9.2-18.2
NA
1363
143
NA
17
14.3
NA
15.6-18.3
8.8-19.8
NA
1115
65
19
15.7
12.7
11.5
14.6-16.8
8.4-17
5.5-17.5
<HS
125
12.8
8.2-17.4
114
14.1
8.6-19.6
128
15.1 10.5-19.7
66 12.3
8.2-16.4
73
12.4
8.7-16
HS
664
16.4 14.0-18.8
663
16 14.0-18.0
579
15.4 13.4-17.5
405 14.7 12.7-16.7
463
15.3 13.5-17.1
Some College
400
17.8 14.5-21.1
368
18.9 15.6-22.2
387
19.2 16.4-22.1
231 18.9 15.7-22.2
315
16.9 14.7-19.1
College Grad
475
17.2 14.8-19.6
433
15.1 12.9-17.3
485
16.8 14.8-18.9
358
18 15.7-20.3
396
14.5 12.8-16.3
% = Percentage, CI = Confidence Interval, n = Cell Size N/A = Not available if the unweighted sample size for the denominator was < 50 or the CI half width was
> 10 for any cell, or if the state did not collect data for that calendar year.
Individual categories may not add to total count, due to sparse or missing data.
*Source: BRFSS, CDC (State Prevalences).
18
ADULT HEAVY DRINKING
Table 3 presents the Pennsylvania rates of self-reported adult heavy drinking from the BRFSS survey (data from years 2003-2004
were not included due to much smaller sampling sizes). Overall rates have remained relatively stable from 2006-2009 with a slight
decrease in 2010 (5.2% in 2009 and 3.9% in 2010). However, there has been a substantial decrease in the 18-24 period over the past
five years from 12.6% (2006) to 4.9% (2010). Nationally, in 2009, adult heavy drinking prevalence was 5.2%. A greater percentage
of men (4.8%) compared to women (3%) report that they are heavy drinkers in PA.
Table 3.
PA Adult Heavy Drinking
2006 (12,879)
2007 (12,861)
2008 (12,820)
2009 (8,885)
2010 (10,961)
n (yes) % yes
CI
n (yes) % yes
CI
n (yes) % yes
CI
n (yes) %yes
CI
n (yes) % yes
CI
552
4.9
4.0-5.8
560
5.2
4.4-6.0
602
5.5
4.7-6.2
420
5.2
4.5-5.9
408
3.9 3.3-4.4
All adults
5.4
3.9-6.9
285
6.9
5.3-8.5
308
7
5.7-8.3
195
5.7
4.6-6.7
198
4.8 3.8-5.7
Male 264
4.4
3.4-5.4
275
3.7
2.9-4.5
294
4
3.3-4.7
225
4.8
3.9-5.8
210
3
2.5-3.6
Female 288
Age
12.6 7.1-18.1
31
9.6
5.1-14.1
28
8.1
4.3-11.9
26
8.7
5.0-12.5
14
4.9 2.0-7.8
18-24 62
3.8
2.2-5.4
69
5.2
2.3-8.1
61
6.2
4.1-8.3
46
6.2
4.1-8.3
36
5.3 3.2-7.4
25-34 68
4.7
3.3-6.1
113
5.5
3.9-7.1
126
6.8
5.2-8.5
63
5
3.5-6.4
55
3.8 2.6-5.0
35-44 135
4.8
3.4-6.2
157
6
4.6-7.4
161
5.7
4.4-7.0
105
5.3
4.1-6.5
99
4.2 3.2-5.2
45-54 108
3.7
2.3-5.1
104
3.6
2.4-4.8
124
4.6
3.5-5.8
90
4.5
3.3-5.6
97
3.4 2.7-4.2
55-64 98
81
2.1
1.3-2.9
86
2.7
1.9-3.5
102
2.4
1.8-3.1
90
3
2.3-3.8
107
2.6 2.0-3.2
65+
Race/Ethnicity
4.9
4.0-5.8
485
5.3
4.5-6.1
520
5.7
4.9-6.5
383
5.6
4.8-6.4
379
4.1 3.5-4.6
White 473
3.2
1.4-5.0
49
2.9
0.7-5.1
55
4.7
2.2-7.2
19
3.8
1.8-5.8
17
3.2 1.0-5.3
Black 52
ND
ND
ND
ND
ND
10
3.7
0.7-6.8
7
3.3
0.6-6.1
3
1.8 0.0-4.2
Hispanic ND
Education
46
4.2
1.7-6.7
47
7.3
2.2-12.4
42
5
2.0-8.0
24
4.1
1.7-6.6
24
4.1 1.8-6.5
<HS
218
4
2.9-5.1
226
5.3
3.9-6.7
234
5.4
4.2-6.7
170
5.3
4.2-6.3
141
3.8 2.9-4.7
HS or GED
6.9
4.2-9.6
125
5.2
3.4-7.0
138
5.6
4.0-7.2
79
5
3.5-6.5
114
5.5 4.1-6.8
Some College 131
4.6
3.3-5.9
161
4.6
3.2-6.0
188
5.5
4.4-6.5
147
5.6
4.3-7.0
129
2.8 2.2-3.5
College Grad 157
Heavy drinking is defined as adult men having more than two drinks per day and adult women having more than one drink per day.
% = Percentage, CI = Confidence Interval, n = Cell Size, N = total sample size that answered 'yes' or 'no'. Percentages are weighted to population
characteristics. Use caution in interpreting cell sizes less than 50.
Note: Hispanic can be of any race. Individual categories may not add to total count, due to sparse or missing data.
*Source: BRFSS, CDC (State Prevalence).
19
Table 4 presents regional rates of adult heavy drinking from the BRFSS survey. Regional
estimates were created by aggregating all data collected in 2008, 2009, and 2010. Results
indicate that rates of heavy drinking range from 3–9% across the state, with the Dauphin,
Lebanon region showing significantly lower rates than the overall state average.
Table 4.
PA Adult At-Risk Heavy Drinking by Region 2008–2010
County/Region
Percent
5
Pennsylvania
6
Philadelphia
4
Bucks
6
Montgomery
9
Chester
6
Delaware
3
Lancaster
4
Berks, Schuylkill
5
Carbon, Lehigh, Northampton
5
Pike, Monroe, Susquehanna, Wayne
6
Lackawanna, Luzerne, Wyoming
4
Adams, Franklin, Fulton
6
York
6
Cumberland, Perry
3
Dauphin, Lebanon
3
Bedford, Blair, Huntingdon, Juniata, Mifflin
5
Cntr, Colmbia, Montr, Nrthumbrlnd, Snyder, Union
7
Bradford, Sullivan, Tioga, Lycoming, Clinton, Potter
6
Erie
4
Crawford, Lawrence, Mercer, Venango
7
Forst, Elk, Camrn, Clrfd, Jefrsn, Clarn, McKn, Wrrn
6
Allegheny
4
Westmoreland
4
Indiana, Cambria, Somerset, Armstrong
4
Beaver, Butler
4
Fayette, Greene, Washington
CI = 95% Confidence Interval
*Source: BRFSS, PA Dept. of Health EpiQMS.
Blue lettering indicates significantly lower average than overall state.
CI
(5–6)
(5–8)
(3–7)
(4–9)
(6–14)
(4–9)
(2–6)
(3–6)
(3–7)
(3–7)
(5–8)
(2–7)
(4–8)
(3–11)
(2–4)
(2–6)
(3–9)
(4–11)
(4–9)
(3–7)
(4–11)
(4–8)
(3–6)
(3–7)
(2–7)
(3–7)
20
ALCOHOL SALES
Table 5 displays data on alcohol sales between 1990 and 2009. The data indicate a decrease in
Pennsylvania from 1990 to 1995, and then an increasing trend since 1995. Beer accounts for the
largest volume of ethanol sold, followed by spirits and then wine. Nationally, the median rate of
ethanol (all beverages) per capita sold in 2009 was 2.30, while in Pennsylvania it was 2.19.
Table 5.
PA Sales of Ethanol in Gallons per 10,000 Persons (14 years or older)
Beverage Type
1990
1995
2000
2005
2006
2007
2009
Beer
1.42
1.23
1.21
1.29
1.30
1.34
1.35
Wine
0.18
0.18
0.21
0.24
0.24
0.24
0.23
Spirits
0.55
0.45
0.47
0.55
0.57
0.59
0.61
All Beverages
2.15
1.86
1.90
2.08
2.12
2.16
2.19
Sources: Alcohol Epidemiologic Data System. LaVallee, R. A., & Yi, H. Surveillance report #92: Apparent per
capita alcohol consumption: National, state, and regional trends, 1977–2009. Bethesda, MD: National
Institute on Alcohol Abuse and Alcoholism, Division of Epidemiology and Prevention Research (August
2011).)
21
VI. A. 3. Adult & Youth Alcohol Consequences
DUI ARREST RATES
Table 6 displays DUI arrests by year from 2000–2009. It is important to point out that these data
should be considered an indicator of amount of enforcement and not an indicator of
consumption. DUI arrests are driven by many forces and are likely to reflect local priorities and
concerns; variation may be due to increased enforcement targeting certain geographic regions.
As indicated in Table 6, DUI arrest rates are higher for adults than at any time since 2000 in
Pennsylvania. As in previous years, in 2009 DUI arrest rates for juveniles are much lower than
those for adults. For example, in 2009, the adult arrest rate per 100,000 persons in Pennsylvania
was 590.4; for juveniles (under 18) it was 32.1. DUI arrests in Pennsylvania overwhelmingly
include White males (see Table 7; arrests are 77% [although female DUI arrest rates have been
increasing over the years]). Figure 6 illustrates variation by geographical area. There is
considerable variation by county, which is likely to reflect variation in enforcement.
Table 6.
Number of DUI Arrests and Number per 100,000 Population:
Pennsylvania and United States
Year
Total Number in PA
Total PA Rate
Total US Rate
PA Adult Rate
PA Juvenile Rate
2000
41,058
342.3
508.6
431.4
23.5
2001
40,011
325.8
491.6
414
2002
41,284
336
497.4
429
2003
41,613
337.4
492.9
430.9
2004
43,699
352.2
482.3
450.3
2005
44,722
359.8
458.1
459.1
2006
48,698
391.4
479.3
499
2007
51,542
398.6
468.2
534.9
2008
54,114
434.7
480.8
552.8
2009
53,084
421.1
463.8
590.4
Note: Juveniles are 17 years of age or younger. Rates use U.S. Census population numbers.
Source: PA State Police, Uniform Crime Report
20.6
22.3
21.1
21.3
20.9
21.8
25.1
20.6
32.1
Table 7.
Percent of DUI Arrest Offenders by Gender and Race/Ethnicity
Year
Male
Female
White
Minority
84%
16%
90%
10%
2000
83%
17%
88%
12%
2001
82%
18%
91%
9%
2002
81%
19%
92%
8%
2003
81%
19%
91%
9%
2004
81%
19%
90%
10%
2005
79%
21%
90%
10%
2006
79%
21%
89%
11%
2007
78%
22%
87%
13%
2008
77%
23%
87%
13%
2009
Source: Pennsylvania State Police, Uniform Crime Report
22
Figure 6.
Number of Arrests per 10,000 in County Population for Driving Under the Influence, 2010
Source: PA State Police, Uniform Crime Code Report
YOUTH SELF-REPORTED DRIVING UNDER THE INFLUENCE (OF ALCOHOL)
For youth, Figure 7 shows the rates of 10th and 12th graders’ self-reported driving while under the
influence of alcohol (from the PAYS; note that only a percentage of 10th graders are of legal
driving age). Similar to other data discussed above for 12th graders, there is also a decline
between 2005 and 2009 in self-reported DUI.
Percent of Youth
Figure 7. Percent of Youth Reporting Any Occasion of Driving Under the Influence of
Alcohol
30
25
20
15
10th
10
12th
5
0
2001
2003
2005
2007
2009
Source: Pennsylvania Youth Survey Report (PAYS)
23
ALCOHOL-RELATED CONVICTIONS IN PENNSYLVANIA
Table 8.
Alcohol-related Convictions per 100,000 People in 2008
Table 8 shows that in
2008, there were 248
public drunkenness
convictions per
100,000 people in
Pennsylvania. Rates
for Single County
Authorities (SCA)
ranged from 48 in
Potter to 492 in
Venango. There were
201 underage
purchases of
alcohol/tobacco
convictions per
100,000 Pennsylvania
residents. When
broken out by SCA,
this number ranged
from 76 convictions
per 100,000 in
Lawrence to 696
convictions per
100,000 in Centre.
There were 705 DUI
convictions per
100,000 Pennsylvania
residents. This
conviction rate ranged
from 330 in
Philadelphia to 1099
in Venango.
Underage
Public
DUI - Alcohol or
Purchase of
SCA
Drunkeness
Drug Related
Alcohol/Tob.
Pennsylvania
248
201
705
Allegheny
279
119
738
Armstrong/Indiana
328
314
632
Beaver
235
79
803
Bedford
50
137
559
Berks
225
138
449
Blair
261
240
842
Bradford/Sullivan
91
148
701
Bucks
169
123
886
Butler
219
186
1057
Cambria
447
146
768
Cameron/Elk/McKean
289
245
717
Carbon/Monroe/Pike
211
137
502
Centre
448
696
994
Chester
290
196
720
Clarion
343
428
700
Clearfield/Jefferson
239
155
398
Columbia/Montour/Snyder/Union
116
282
710
Crawford
356
224
552
Cumberland/Perry
212
229
731
Dauphin
405
228
581
Delaware
262
155
764
Erie
419
211
541
Fayette
286
106
588
Forest/Warren
151
221
637
Franklin/Fulton
151
160
406
Greene
241
145
943
Huntingdon/Mifflin/Juniata
275
221
751
Lackawanna/Susquehanna
241
149
587
Lancaster
256
151
518
Lawrence
285
76
602
Lebanon
164
204
942
Lehigh
206
103
822
Luzerne/Wyoming
376
210
888
Lycoming/Clinton
247
338
1008
Mercer
369
177
883
Montgomery
303
114
782
Northampton
233
198
521
Northumberland
188
280
754
Philadelphia
NA
NA
330
Potter
48
263
789
Schuylkill
255
217
787
Somerset
170
173
532
Tioga
121
182
417
Venango
492
277
1099
Washington
270
187
694
Wayne
56
165
550
Westmoreland
189
108
717
York/Adams
212
221
938
Note: 2008 was the latest data able to be obtained for this report.
Source: Records from the Court of Common Pleas and the Magistrate Courts in Pennsylvania
Population estimates for 2008 provided by the U.S. Census Bureau
24
PERCENT FATAL MOTOR VEHICLE CRASHES INVOLVING ALCOHOL
Table 9 shows the percent of alcohol-related motor vehicle crashes in Pennsylvania from years
2003–2009. The percent of alcohol-related fatal crashes in Pennsylvania has remained relatively
constant from 2003 to 2007, with a slight decrease in 2008 and 2009. In 2009, 32% of all crash
deaths were alcohol-related, which is identical to the national rate in 2009. Figure 8 reports
county-level crash data for 2009 on alcohol-related traffic fatalities adjusted for population size
(see Appendix for additional information). Bradford, Cameron, Fulton, McKean, Montour,
Potter, and Susquehanna Counties reported no alcohol-related traffic fatalities. Forest (44.28),
Wyoming (21.58) and Sullivan (16.29) Counties reported the highest levels of alcohol-related
traffic fatalities per 100,000 people.
Table 9.
Alcohol-related Crashes in PA—Seven Year Trends
2003
2004
140,207
137,410
All Crashes
106,372
105,222
All Injuries
1,577
1,490
All Deaths
13,689
13,624
Alcohol-related Crashes
11,274
10,822
Alcohol-related Injuries
558
541
Alcohol-related Deaths
10%
10%
% Crashes Alcohol-related
11%
10%
% Injuries Alcohol-related
35%
36%
% Deaths Alcohol-related
Source: Fatality Analysis Reporting System (FARS)
2005
132,829
100,381
1,616
13,179
10,423
580
10%
10%
36%
2006
128,342
96,597
1,525
13,616
10,529
545
11%
11%
36%
2007
130,675
94,633
1,491
12,867
9,825
535
10%
10%
36%
2008
125,327
88,709
1,468
12,752
9,565
499
10%
11%
34%
2009
121,242
87,126
1,256
12,712
9,536
406
10%
10%
32%
Figure 8. Total Number of Alcohol-related Traffic Fatalities (BAC = .08+) per 100,000 by
County in Pennsylvania (2009)
Source: Fatality Analysis Reporting System (FARS)
25
FATAL MOTOR VEHICLE DEATH RATE INVOLVING ALCOHOL
Figure 9.
Figure 9 shows the
alcohol-related motor
PA and U.S. Alcohol-impaired
vehicle death rate (per
Driving Fatalities per 100 Million
100 million vehicle miles
travelled) in
VMT
Pennsylvania and in the
U.S. by year. The rate of 0.6
alcohol-related driving
0.5
0.49
0.46
0.46
fatalities has been steady:
0.45
0.45
0.43
0.4
around .46 per 100
0.39
0.39
0.37
million VMT since 2005
0.3
but declined to .39 in
2009. The national
0.2
average also appears to
0.1
be declining from .45
deaths per 100 million
0
VMT in 2005 to .37 in
2005
2006
2007
2008
2009
2009.
Source: Fatality Analysis Reporting System (FARS)
PA
US
PERCENT DRINKING DRIVERS (AMONG ALL DRIVERS) IN CRASHES
Age-related differences for this indicator are shown in Figure 10. There are substantial agerelated changes, with the highest rates (10.8%) at ages 21–25. Rates gradually decrease among
older adults. According to the Pennsylvania Department of Transportation, in 2009, 73% of
drinking drivers in traffic crashes were male.
Figure 10.
% of Alcohol-related Crashes by Age in 2009
12%
10%
8%
6%
4%
2%
0%
Under 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 Over 60
16
Source: FARS PA Crash Data.
26
ALCOHOLIC LIVER DISEASE DEATH RATE
The annual average age-adjusted death rate due to an underlying cause of alcoholic liver disease
is shown in Table 10. The data indicate that the death rate from alcoholic liver disease affects
only a small portion of the population. In 2007–2009, 2.6 persons died each year per 100,000
(95% CI: 2.5–2.8). For comparison purposes, the U.S. rate in 2007 was 4.8 deaths per 100,000.
The rates of death significantly affect more males than females (about three times higher).
Regarding race and ethnicity, Blacks appear to have lower rates than Whites and Hispanics.
Table 10.
PA Rates of Death from Alcoholic Liver Disease: Annual Average (2007–2009)
CATEGORY
COUNT
POPULATION
RATE1
95% CI
1,105
37,485,838
2.6
2.5–2.8
All
Gender
802
18,216,527
4.0
3.7–4.3
Male
303
19,269,311
1.4
1.3–1.6
Female
Race
1,013
32,105,032
2.7
2.6–2.9
White
85
4,030,002
2.3
1.8–2.9
Black
33
1,796,642
3.2
2.1–4.6
Hispanic
Source: Pennsylvania Certificates of Death
1
Per 100,000 People
PERCENT TREATMENT ADMISSIONS FOR ALCOHOL USE
This indicator is drawn from the TEDS (Treatment Episode Data Set) and represents the number
of admissions, not the number of people admitted. In addition, the reported admissions are only
for facilities that are either state-certified for treatment and/or receive government funds; thus,
these numbers do not represent the entire scope of those admitted for treatment in Pennsylvania.
However, this indicator does provide some insight into the extent of alcohol usage consequences.
Table 11 shows that thousands of Pennsylvania treatment admissions are related to alcohol use
every year. Between 2000 and 2005, the percent of admissions for alcohol as the only drug of
choice showed a steady decline until 2003 and then a substantial increase from 2004 to 2009 in
Pennsylvania. The number of admissions for alcohol plus another drug also showed a steady
decline from 2000 to 2009. However, the percent of all admissions involving treatment for
alcohol has declined as treatment for illicit drugs has increased. Combining both alcohol
treatment only and alcohol treatment with another drug, the percent of all admissions was 46.2%
in 2000 and 39.1% in 2010 (the absolute total number of admission generally declined over this
period as well). Table 12 shows that clients are largely male, White, and 21–50 years old.
27
Table 11.
Number and Percent of Treatment Admissions for Alcohol Use
Pennsylvania Alcohol
National Alcohol Pennsylvania Alcohol
National
Year
Only
Only
+
Alcohol +
15,615
(24.4%)
25.8%
14,002
(21.8%)
21.2%
2000
14,817
(24.2%)
24.4%
12,430
(20.3%)
20.6%
2001
14,573
(23.9%)
23.7%
11,721
(19.2%)
20.1%
2002
14,525
(22.5%)
23.1%
10,926
(16.9%)
19.2%
2003
19,536
(22.5%)
22.2%
14,500
(16.7%)
18.8%
2004
16,785
(21.9%)
21.7%
12,738
(16.6%)
17.9%
2005
15,880
(22.2%)
21.9%
11,810
(16.5%)
18.2%
2006
16,621
(23.9%)
22.3%
11,188
(16.2%)
18.3%
2007
17,834
(23.4%)
Not available
12,109
(15.9%) Not available
2008
15,512
(25.2%)
Not available
9,362
(15.2%) Not available
2009
13,399
(23.4%)
Not available
9,026
(15.8%) Not available
2010
Note: Alcohol + refers to admissions for alcohol along with a secondary drug
Source: Treatment Episode Data Set (TEDS), SAMHSA
Table 12.
% Pennsylvania Treatment Admissions for Alcohol Use by Demographics, 2010
Alcohol with
Alcohol only
Total N=57,300
secondary drug
(n=13,399, 23.4%)
(n=9,026, 15.8%)
Gender
Male
Female
73.0
27.0
72.7
27.3
12–17 years
18–20 years
21–25 years
26–30 years
31–35 years
36–40 years
41–45 years
46–50 years
51–55 years
56 and over
1.8
2.9
12.1
13.0
11.5
12.0
14.3
14.8
10.0
7.4
4.4
6.0
16.8
15.7
12.1
11.2
12.7
11.8
6.6
2.5
White
Black
84.6
10.0
76.2
17.9
Age at Admission
Race
Ethnicity
Hispanic
4.0
4.4
N=All admissions, n=admissions for substance
Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration,
Treatment Episode Data Set (TEDS).
28
VI. A. 4. Alcohol Summary
The results of the data on key alcohol indicators are summarized in Table 14. This table
summarizes key indicators by comparing across three data dimensions: magnitude, time trends,
and comparisons to national rates as described in the earlier section, “Understanding the Data.”
This summary can be a useful tool in determining problem areas.
Magnitude. Many Pennsylvanians show high rates of consumption and many are affected by its
consequences. Adult binge drinking is reported by approximately 15% of Pennsylvania adults.
These rates are substantially higher for high school seniors and in the age 18–24 range.
Pennsylvania has a large number of treatment admissions related to alcohol use, and its effects
impact many aspects of life for those admitted and their families. 32% of all traffic deaths are
alcohol-related. Males both report higher rates of binge and heavy drinking and also experience
the majority of the alcohol consequences, including abuse, dependence, and alcohol-related
fatalities. Young adults show particularly high rates compared to older adults and thus should be
considered a target for reductions within the adult age range. For most consequences the highest
rates are shown for those aged 18–34. However, in the 18–24 age group there has been a
substantial reduction in heavy drinking.
On the PAYS Survey, 12th graders show the highest rate of alcohol use. Tenth graders have
shown a small decline in alcohol use between 2005 and 2009.
Time Trends. During the past three years, the rates of “problem drinking” in adults appear to be
relatively stable. There does appear to be a recent decline in adult heavy drinking from 5.2% in
2009 to 3.9% in 2010. From 2005 to 2009 there appears to be a slight decrease in binge drinking
among high school students according to the PAYS data. Over the past decade there have been
some increases in DUI arrests; in 2009, 53,084 people were arrested for driving under the
influence, which is more than any previous year.
National Comparisons. On most indicators, comparisons with national rates show that
Pennsylvania is not far from the national averages. However, Pennsylvania shows substantially
lower rates of death from alcoholic liver disease. Furthermore, Pennsylvania has slightly lower
rates of adult heavy drinking, and fewer DUI arrests per 100,000 persons.
29
Table 13.
Alcohol Indicators Compared by:
Magnitude, Time Trends, and National Comparisons
CONSUMPTION
30-Day Adult Binge Drinking (2010, BRFSS)
30-Day Adult Heavy Drinking (2010, BRFSS)
Alcohol Sales per Capita (all beverages) (2009, Alcohol
Epidemiologic Data System)
CONSEQUENCES
DUI Arrests & Rate per 100,000 Persons (2009, PA State Police)
Alcohol Impaired Driving Fatalities per 100 Million Vehicle Miles
Traveled (2009, FARS)
Alcohol Impaired Driving Fatalities with BAC = .8+ (2009, FARS)
Alcoholic Liver Disease Deaths & Rate per 100,000 Persons (2007–
2009, PA Certificates of Death)
Number & % Admissions to Treatment Centers for Alcohol (2010,
TEDS)
PA
Magnitude
Time
Trend
15.2%
3.9%
-1.4
-1.3
National
Rate Ratio
(RR)
1.01
0.76
2.19
0.03
0.95
53,084
(421.1)
-13.6
0.91
.39
-.07
1.05
406 (32%)
-2.0
1.00
1,105 (2.6)
0.2
0.54
13,399
(23.4%)
-1.8
1.05
Note: RR=1, no difference; RR>1, PA higher than U.S.; RR<1, PA lower than U.S.
30
VI. B. Tobacco
VI. B. 1. Tobacco Indicators Defined
Consumption
Current use—defined for youth (under 18) as using a tobacco product (smoking and smokeless) on one or more days of the past 30 days and for adults (aged 18 or older) as having smoked
at least 100 cigarettes in their lifetime and who currently smoke either ‘everyday’ or ‘some
days’.
Daily Smoking—defined for persons aged 18 or older who have smoked at least 100 cigarettes
in their lifetime and who categorize themselves as currently ‘smoking everyday’.
Lifetime Use—defined as any tobacco use in their lifetime (youth under 18).
Percent Smoking During Pregnancy—defined as the percent of mothers who had a live birth
and who reported smoking at least one cigarette during pregnancy, of all mothers with live births
(excluding unknowns).
Consequences
Lung (and Bronchus) Cancer Death Rate—defined as the age-adjusted (except when broken
down by age in which case the rate is then age-specific) death rate per 100,000 persons due to an
underlying cause of death specified as ICD-10/9 code: C34.
Emphysema Death Rate—defined as the age-adjusted (except when broken down by age in
which case the rate is then age-specific) death rate per 100,000 persons due to an underlying
cause of death specified as ICD-10 code: J43.
31
VI. B. 2. Adult & Youth Tobacco Consumption
CURRENT USE
As shown in Figure 11, Pennsylvania has been above the national median for the prevalence of
adult current smoking for the past decade. Specifically, in 2010, Pennsylvania adult current
smoking prevalence was 18.4% (95% CI: 17.4-19.5%) while nationally it was 17.3%. Smoking
rates in both the U.S. and Pennsylvania show declines in 2006–2010, as compared with earlier
years. However, between 2008 and 2010 PA rates appear to have declined more rapidly and to
now be closer to the national average.
Figure 11.
PA/U.S. Adult Current Smoking
30%
25%
20%
PA
15%
US
10%
5%
0%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Notes: Current Smokers defined as persons who currently smoke either ‘everyday’ or ‘some days’
Source: BRFSS, CDC (State Prevalence & US Median Prevalence)
Table 14 contrasts rates of adult current smoking in Pennsylvania for 2005, 2007, 2008, 2009,
and 2010, disaggregating by age, gender, race/ethnicity, and educational level. The prevalence
of smoking has significantly declined over this time-period. Although in previous years men
showed slightly higher rates of current smoking, it appears that as of 2010 there is little
difference in smoking prevalence between men and women in the Commonwealth. Smoking
prevalence begins to decline substantially after age 55. In 2010, Blacks (25.6%) had a higher
rate of current smoking than Whites (17.6%). Educational attainment is related to substantial
differences in smoking rates, with lower smoking rates associated with higher educational
attainment in all years (see Figure 12). For example, in 2010, respondents with less than a high
school education had a smoking rate of 32.8% while respondents who were college graduates
had a smoking rate of 7.4%.
32
Table 14.
PA Adult Current Smoking Prevalence by Smokers’ Characteristics
2005 (N=13,314)
n
%
(yes) yes
CI
2007 (N=13,163)
n (yes)
%
yes
2834
21
CI
2008 (N=13,133)
n (yes)
%
yes
CI
n (yes) % yes
CI
2010 (10,961)
n
% yes
(yes)
CI
1925 18.4
17.4-19.5
All adults
3011 23.6 22.4-24.8
Male
1138 25.0 23.0-27.0
984
Female
1873 22.4 21.0-23.8
1850 21.1 19.5-22.7 1617 19.4 18.0-20.9
18–24
243 35.0 29.5-40.5
143
26.8 20.3-33.3
131
28.6 22.3-34.8
88
27.5
21.3-33.8
52
18.6
12.7-24.5
25–34
473 27.8 24.4-31.2
401
28.6 24.5-32.7
336
28.6 24.6-32.7
200
27.4
23-31.8
201
24.8
21.2-28.3
35–44
703 28.8 26.2-31.4
607
22.1-27.9
534
25.3 22.6-28.1
292
22
19.2-24.9
319
20.9
18.3-23.4
45–54
767 25.5 23.1-27.9
703
22.7 20.2-25.2
727
23.9 21.6-26.3
415
20.6
18.1-23
531
23.8
21.5-26.1
55–64
506 19.8 17.5-22.1
583
18.1 15.7-20.5
554
17.8 15.6-20.0
398
19
16.8-21.3
478
16.5
14.7-18.3
65+
319
397
8.4
364
7.7
284
9.4
8-10.7
344
7.7
6.7-8.6
White
2428 22.4 21.2-23.6
2279 20.4 19.0-21.8 2083 20.2 18.9-21.4
1477 19.5
18.2-20.8
1594 17.6
Black
376 30.8 25.2-36.4
385
27.5 21.6-33.4
383
26.8 21.0-32.5
117
29
22.8-35.3
201
25.6
21-30.1
Hispanic
71
31.1 22.2-40.0
48
15.1 7.5-22.7
59
26.5 17.3-35.8
28
13.1
7.3-18.8
38
19.4
11.9-26.8
<HS
447 38.6 33.9-43.3
401
33.3 27.8-38.8
356
34.5 28.6-40.4 215
31.7
26.2-37.2
238
32.8
28-37.7
HS or GED
1432 28.3 26.3-30.3
1326 25.9 23.5-28.3 1254 26.7 24.4-28.9 774
24.3
22-26.5
900
24.9
22.9-26.9
703
Some College
9.4
8.0-10.8
24.3 21.7-26.9
683
19.6-22.4 2646 21.3 20.0-22.6
2009 (8,885)
20.8 18.6-23.0 1029 23.4 21.2-25.5
25
7.0-9.8
23.7 20.8-26.6 627
6.6-8.9
1677 20.2
18.9-21.6
671
21.5
19.3-23.7
745
18.5
16.8-20.2
1006 19.1
17.5-20.6
1180 18.4
17.1-19.6
22.5 19.7-25.2 391
22.4 19.3-25.4
495
21.2
16.6-18.7
19-23.5
425 11.7 10.2-13.2 420
10.5 8.7-12.3 406
10.6 9.2-12.1
291
11.3 9.5-13.1
290 7.4
6.3-8.6
College Grad
% = Percentage, CI = Confidence Interval, n = Cell Size, N = total sample size that answered 'yes' or 'no'. Percentages are weighted to population
characteristics. Use caution in interpreting cell sizes less than 50.
Note: Hispanic can be of any race. Individual categories may not add to total count, due to sparse or missing data.
Source: BRFSS, CDC (State Prevalences).
Figure 12.
2009 PA Smoking Prevalence by Education
30%
20%
10%
0%
Less than H.S.
H.S. or G.E.D.
Some post-H.S.
College Graduate
Source: BRFSS, CDC (State Prevalence)
33
Table 15 combine several years (2008–2010) of BRFSS data collection to produce more accurate
county/regional estimates of current smoking. Findings indicate that the Lackawanna, Luzerne,
and Wyoming regions and the Forest, Elk, Cameron, Clearfield, Jefferson, Clarion, McKean, and
Warren regions have higher rates of adult smoking than Pennsylvania as a whole. Lancaster and
Westmoreland Counties both have lower rates of smoking as compared to the state.
Table 15.
PA Adult Current Smoking (2008–2010)
County/Region
Percent
CI
Pennsylvania
20
(19-21)
Philadelphia
24
(21-27)
Bucks
15
(12-19)
Montgomery
18
(15-22)
Chester
17
(13-22)
Delaware
19
(16-23)
Lancaster
13
(10-17)
Berks, Schuylkill
22
(19-26)
Carbon, Lehigh, Northampton
18
(15-21)
Pike, Monroe, Susquehanna, Wayne
23
(19-28)
Lackawanna, Luzerne, Wyoming
25
(22-28)
Adams, Franklin, Fulton
15
(11-19)
York
20
(17-24)
Cumberland, Perry
16
(12-22)
Dauphin, Lebanon
17
(14-20)
Bedford, Blair, Huntingdon, Juniata, Mifflin
19
(16-23)
Cntr, Colmbia, Montr, Nrthumbrlnd, Snyder, Union
20
(16-25)
Bradford, Sullivan, Tioga, Lycoming, Clinton, Potter
21
(18-25)
Erie
24
(20-30)
Crawford, Lawrence, Mercer, Venango
23
(19-27)
Forst, Elk, Camrn, Clrfd, Jefrsn, Clarn, McKn, Wrrn
29
(24-34)
Allegheny
18
(16-21)
Westmoreland
15
(12-18)
Indiana, Cambria, Somerset, Armstrong
24
(20-29)
Beaver, Butler
18
(14-22)
Fayette, Greene, Washington
24
(21-28)
CI = 95% Confidence Interval
A percent that appears in red for a region denotes a significantly higher value
compared to the state’s corresponding percent. A percent in blue denotes a
significantly lower value.
*Source: BRFSS, PA Dept. of Health EpiQMS.
34
For youth, Table 16 and Figure 13 show results from the PAYS survey in 2001–2009. Results
for 6th and 8th graders indicate that both cigarette use and smokeless tobacco have declined since
2001, except for a slight up-tick in use for 8th graders from 2007 to 2009 for both cigarettes and
smokeless tobacco. For 10th and 12th graders (high school-aged students), cigarette use has
substantially declined, but smokeless tobacco use has remained steady. In addition, gender
differences indicate much higher rates of smokeless tobacco use for boys: 10.1% of males
versus only 2.5% of females in 2009.
Table 16. PA Youth Tobacco Use by Year
2001
Cigarettes
Smokeless Tobacco
Past 30 Day Use
Past 30-Day Use
2003
2005
2007
2009
2001
2003
2005
2007
2009
2.1
6th 2.2
10.9
8th 10.6
19.0
10th 20.2
25.8
12th 31.9
15.4
14.1
All Grades
Gender
14.9
Females 16.0
13.1
Males 14.9
Source: PAYS Statewide Report.
1.0
6.4
18.4
28.5
13.3
1.3
5.5
13.7
20.6
10.2
0.9
6.7
13.9
20.8
11.0
1.5
4.1
7.0
9.7
5.4
1.0
3.1
7.1
9.5
5.0
0.5
2.4
8.7
11.1
5.6
0.8
2.6
7.1
9.7
5.0
0.6
4.7
7.6
10.9
6.2
14.3
12.4
10.6
9.9
11.0
11.0
2.2
8.7
1.7
8.5
1.9
9.1
1.7
8.5
2.5
10.1
Grade
Figure 13. Current PA High School Youth Cigarette and Smokeless Tobacco Use
Smokeless Tobacco
Percent of Youth
Cigarettes
35.0
35
30.0
30
25.0
25
20.0
20
15.0
15
10.0
10
5.0
5
0.0
0
2001 2003 2005 2007 2009
10th
12th
2001
2003
2005
2007
2009
Source: Pennsylvania Youth Survey Report
Data on tobacco use among students is also available from the Pennsylvania Youth Tobacco
Survey. Findings indicate that cigarette use is declining among middle school and high school
students. As illustrated in Figure 14, current cigarette use among middle school students in
Pennsylvania has dropped by nearly half, from an estimate of 8% in 2002 to around 4% in 2009.
35
With respect to high school students (grades 9–12), cigarette use has fallen from an estimate of
23% in 2002 to an estimate of 18% in 2009. Survey data from 2009 also indicate that rates of
tobacco use are higher among male high school students as compared to females and White high
school students as compared to Black students (see Figure 15).
Figure 14.
Current Cigarette Use among PA
Middle School Students
10%
Current Cigarette Use among PA
High School Students
25%
8%
20%
7.80%
6%
23.00%
15%
4%
2%
4.10%
4.30%
2006-2007
2008-2009
0%
18.00%
18.40%
2006-2007
2008-2009
10%
5%
0%
2002-2003
2002-2003
Source: Pennsylvania Youth Survey Report
Figure 15.
PA High School Students Current Smoking Rates by Age and Race
20.0%
11.9%
Black
20.7%
16.0%
18.4%
10.8%
Hispanic
White
Female
Male
Total
Source: Pennsylvania Youth Survey Report
YOUTH LIFETIME USE
In 2009, Pennsylvania youth (6th, 8th, 10th, and 12th graders), on average, reported using
cigarettes for the first time at age 13. In 2007, on average, 4.6% of 6th graders, 20.6% of 8th
graders, 32% of 10th graders, and 44% of 12th graders reported that they had tried smoking
cigarettes in their lifetime.
36
ADULT DAILY SMOKING
As seen in Table 17, in 2010, Pennsylvania adult daily smoking prevalence is lower (15.6%) than in 2005 (17.9%). However, the
2010 estimate is above the national median rate of 12.4%. The most rapid decline was in the 18-24 age group which showed a drop
from 27% (2005) to 9.7% (2010). As with current smoking, educational attainment plays a substantial role in adult daily smoking;
rates decline with greater educational attainment at both assessments. Additionally, daily smoking rates decline with age. However,
there are no significant differences by gender or ethnicity.
Table 17.
PA Adult Daily Cigarette Use by Smoker’s Demographics
2005 (N=13,314)
n
%
(yes)
yes
CI
2007 (N=13,163)
n
%
(yes)
yes
CI
2008 (N=13,163)
n
(yes) % yes
CI
2009 (N=9,140)
n
%
(yes)
yes
CI
2010 (N=11,161)
n
%
CI
(yes)
yes
2295
849
1446
17.9
18.8
17.2
16.8-19.0
17.0-20.6
15.9-18.5
2186
750
1436
15.1
14.4
15.8
13.9-16.3
12.6-16.2
14.4-17.2
1275
771
1215
15.1
17.2
14.2
14-16.3
15.3-19.1
13.0-15.4
1438
513
762
13.4
15.6
14.7
12.5-14.3
13.7-17.5
12.4-14.5
1986
574
864
15.6
13.3
13.5
14.5-16.7
11.9-14.8
12.4-14.5
183
360
560
591
380
221
27.0
20.5
22.8
19.4
15.3
6.2
21.8-32.2
17.4-23.6
20.4-25.2
17.3-21.5
13.2-17.4
5.1-7.3
104
305
492
561
439
285
16.3
20.3
18.5
17.9
14.4
5.4
11.0-21.6
16.8-23.8
16.0-21.0
15.7-20.1
12.2-16.6
4.4-6.4
99
245
407
555
413
267
19.6
19.1
19.3
18.7
13.8
5.6
14.3-24.8
15.5-22.6
16.8-21.8
16.5-20.9
11.8-15.9
4.7-6.6
62
143
227
330
292
221
17.8
20.4
17.1
16.8
14
7.1
12.6-23
16.3-24.4
14.5-19.7
14.4-19.1
12-15.9
5.9-8.3
32
151
244
402
362
247
9.7
18.8
15.6
17.1
12.5
5.6
5.8-13.5
15.6-22
13.3-17.9
15.1-19
10.9-14.1
4.8-6.4
White
Black
Hispanic
1887
266
50
17.2
21.9
22.4
16.1-18.3
16.6-27.2
14.1-30.7
1781
269
33
15.1
15.3
12.5
13.9-16.3
11.2-19.4
5.2-19.8
1611
244
44
15.2
17.5
20.4
14.1-16.3
12.6-22.4
11.8-29.0
1117
91
24
14.4
23
11.7
13.3-15.5
17.1-28.9
11.8-29.0
1211
134
26
13.2
16.8
13.6
12.3-14.1
12.9-20.8
7.1-20.1
<HS
HS or GED
Some College
College Grad
369
1120
511
292
31.5
22.4
17.3
7.7
27.0-36.0
20.5-24.3
15.0-19.6
6.5-8.9
310
1065
520
288
24.6
19.5
17.6
6.4
19.5-29.7
17.5-21.5
15.1-20.1
5.2-7.6
264
999
441
279
27.4
21.1
14.1
7.2
21.6-33.2
19.0-23.1
12.1-16.2
6.0-8.4
175
603
294
198
25.8
18.6
16.5
7.5
20.6-31
16.6-20.7
14-19.1
6.1-9
185
707
353
193
25.5
18.9
14.9
4.6
21.2-29.7
17.1-20.7
13-16.8
3.7-5.5
All Adults
Male
Female
18–24
25–34
35–44
45–54
55–64
65+
% = Percentage, CI = Confidence Interval, n = Cell Size, N = total sample size that answered 'yes' or 'no'. Percentages are weighted to population characteristics. Use caution
in interpreting cell sizes less than 50.
Note: Hispanic can be of any race. Individual categories may not add to total count, due to sparse or missing data.
*Source: BRFSS, CDC (State Prevalences).
37
PERCENT SMOKING DURING PREGNANCY
Table 18 provides information on the percentage of Pennsylvania mothers who voluntarily
reported smoking during pregnancy. There was little change in the prevalence rates between
1996 (18.2%) and 2009 (16.5% or 24,003 live births). Pennsylvania rates were substantially
higher than the national rates. Nationally, in 2008, 9.7% of mothers with a live birth reported
smoking while pregnant (CDC National Vital Statistics System). The highest rate during
pregnancy is for those under age 25. Ethnicity/race comparisons indicate possible lower
rates for pregnant women of Hispanic origin.
Table 18.
Total
Race/Ethnicity
% PA Mothers Who Smoked During Pregnancy, By Race/Ethnicity
1996
2002
2004
2007
2008
18.2
15.8
17.9
17.5
17.0
18.3
16.5
19.2
White
20.4
14.5
17.6
Black
13.9
11.2
12.4
Hispanic
Note: Unknowns excluded in calculations.
Source: Pennsylvania Vital Statistics, PA Department of Health
19.3
15.6
10.6
19
15
10
2009
16.5
18.5
14.6
10.4
Figure 16.
% PA Mothers Smoking during Pregnancy by Age and Year
40%
1996
30%
2002
2004
20%
2007
10%
2008
0%
<20 20-24 25-29 30-34 35-39 40+
2009
38
VI. B. 3. Adult & Youth Tobacco Consequences
LUNG CANCER DEATH RATE
Over 23,000 deaths were directly attributed to lung cancer during 2007–2009 in
Pennsylvania (Table 19). On average, annually, the rate of death was 51.2 persons per
100,000 (PA Department of Health data). For comparison purposes, according to U.S.
Department of Health, in 2005–2007, the rate was 51.6 nationally.
Although a greater number of White people died of lung cancer, Blacks have
disproportionately higher rates, while Hispanics appear to have significantly lower rates.
Higher rates occur in men than in women, but the gender gap has declined, with female
rates slightly increasing over the years while male rates decreased between 1990 and
2009 (see Figure 17). Figure 18 displays death rates by county. It can be seen that
almost all of the regions in Pennsylvania are affected. The counties with the highest rates
are in orange in Figure 18. Philadelphia, Monroe, Crawford, Washington and Fayette
Counties were significantly higher than the state average.
Table 19.
PA Rates of Death from Lung Cancer: Annual Average (2007–2009)
CATEGORY
COUNT
POPULATION
RATE1
95% CI
23,454
37,485,838
51.2
50.6-51.9
Total
Race
21,138
31,105,032
50.6
50.0-51.3
White
2,179
4,030,002
66.2
63.4-69.0
Black
156
1,796,642
19.4
16.3-22.9
Hispanic
Source: Pennsylvania Certificates of Death
1
Per 100,000 People
100
90
80
70
60
50
40
30
20
10
0
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
Male
Female
1990
Death Rate per 100,000
Figure 17. Lung Cancer Death Rates per 100,000 in PA, By Gender 1990–2009
Source: PA Department of Health, EPIQMS, PA Certificates of Death
39
Figure 18. PA Lung Cancer Death Rates by County
*NA=not available, ND=not displayed if count less than 10
Source: PA Department of Health, EPIQMS, PA Certificates of Death
EMPHYSEMA DEATH RATE
A total of 1,640 deaths were attributed to emphysema during 2007–2009 in Pennsylvania
(Table 20). On average, annually, 3.5 per 100,000 persons died of emphysema (PA
Department of Health data). For comparison purposes, according to the Centers for
Disease Control the rate was 4.3 nationally in 2005–2007, compared to 3.5 (95% CI: 3.4–
3.7) in Pennsylvania.
The death rate for men was disproportionately higher than for women. However, from
1990–2009 (Figure 19), both male and female rates declined. In Figure 20, it can be seen
that the northwest and southeast regions of the state were more affected by this condition.
Huntington County had the highest reported rate of deaths from emphysema.
Table 20.
PA Rates of Death from Emphysema: Annual Average (2007–2009)
CATEGORY
Total
COUNT
POPULATION
1,640
1
95% CI
37,485,838
RATE
3.5
32,105,032
4,030,002
1,796,642
3.6
3.6
ND
3.4-3.7
2.9-4.3
ND
3.4-3.7
Race
1,519
White
116
Black
8
Hispanic
Source: Pennsylvania Certificates of Death
1
Per 100,000 People
ND = Data not displayed because estimates are unreliable.
40
Figure 19. Emphysema Death Rates per 100,000 in PA by Gender, 1990–2009
Death Rate per 100,000
9
8
Male
7
Female
6
5
4
3
2
1
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
0
Source: PA Department of Health, EPIQMS, PA Certificates of Death
Figure 20. PA Emphysema Death Rates by County
*NA=not available, ND=not displayed if count less than 10
Source: PA Department of Health, EPIQMS, PA Certificates of Death
41
VI. B. 4. Tobacco Summary
The results of data analyses on key tobacco indicators are summarized in Table 21. This
table summarizes key indicators by comparison across three data dimensions: magnitude,
time trends, and comparisons to national rates as described in the earlier section
“Understanding the Data.” This summary can be a useful tool in determining problem
areas.
Table 21.
Tobacco Indicators Compared by:
Magnitude, Time Trends, and National Comparisons
PA
Time
CONSUMPTION
Magnitude
Trend
18.4%
-1.8
Current Adult Smoking Prevalence (2010, BRFSS)
Daily Adult Smoking Prevalence (2010, BRFSS)
15.6%
2.2
Smoking While Pregnant Births and Percent (2009, PA Vital
16.5%
-0.5
Statistics)
CONSEQUENCES
Lung Cancer Deaths & Rate per 100,000 Persons (2007–
51.2
.6
2009, PA Certificates of Death)
Emphysema Deaths & Rate per 100,000 Persons (2007–2009,
3.5
-0.4
PA Certificates of Death)
Note: RR=1, no difference; RR>1, PA higher than US; RR<1, PA lower than U.S.
National Rate
Ratio (RR)
1.06
1.26
1.70
0.99
0.83
Magnitude. Tobacco use affects many Pennsylvanians. A total of 18.4% of adults are
current smokers and 15.6% smoke daily. Of substantial public health concern is that 16%
of mothers reported smoking during their pregnancy in 2009. Further, of substantial
concern are the continually high rates among pregnant women below the age of 25
(27%). Educational attainment plays a large role in determining smoking status.
Smoking prevalence has more than tripled for those with less than a high school
education compared to those who graduate from college. Among age groups, adults
between the ages of 18–44 have the highest prevalence rates. For youth, the prevalence
rates for smoking cigarettes are slightly higher for girls than for boys, but four times as
many boys use smokeless tobacco as do girls. There has been a substantial decrease in
cigarette smoking among all grades as evidenced by the PAYS and the YTS data.
Further, among adults, reductions in daily smoking were most evident in young adults.
With regard to tobacco use consequences, Black people showed disproportionately higher
rates of lung cancer. Men also have higher rates of death attributable to tobacco use than
do women. Geographically, there is no clear pattern of “hot spots.”
Time Trends. In a broad sense there is a trend toward lower rates of consumption and
consequences as indicated in Table 22. However, rates of smoking while pregnant
remain relatively stable and alarmingly high at 16% and rates of daily smoking
significantly increased back to over 15% for adults.
42
National Comparisons. Pennsylvania is above national median levels with regard to all
consumption indicators for tobacco as shown in Table 21. Rates of smoking while
pregnant are 75% higher in Pennsylvania than in the U.S. as a whole. Pennsylvania is
below national median levels with regard to the consequence indicators, lung cancer
death and emphysema death.
43
VI. C. Illicit Drugs
VI. C. 1. Indicators Defined
Consumption
Current Marijuana Use—defined as any use of marijuana/hashish in the past month or
30 days prior to the survey.
Lifetime Marijuana Use—defined as any use of marijuana/hashish in their lifetime
(youth under 18).
Current Other Illicit Drug Use—defined as any use of any other illicit drug (this
includes: cocaine, heroin, and hallucinogens (LSD, PCP, peyote, mescaline, mushrooms,
and ecstasy) and abusable legal products including prescription drugs (pain relievers,
tranquilizers, stimulants, and sedatives) and inhalants (amyl nitrate, cleaning fluids,
gasoline, paint, and glue)) other than marijuana/hashish in the past month or 30-days
prior to the survey.
Lifetime Other Illicit Drug Use—defined as any use of any other illicit drug except
non-medical use of prescription drugs and marijuana/hashish in their lifetime (youth
under 18, by substance).
Consequences
Drug (including non-illicit)-Induced Death Rate—defined as age-adjusted death rate
(except when broken down by age in which case is age-specific) per 100,000 persons due
to an underlying cause of death specified as ICD-10 codes: F110-F115, F117-F119,
F120-F125, F127-F129, F130-F135, F137-F139, F140-F145, F147-F149, F150-F155,
F157-F165, F167-F169, F170, F173-F175, F177-F179, F180-F185, F187-F189, F190F195, F197-F199, U016, X40-X44, X60-X64, X85, Y10-Y14.
Percent of Admissions (by illicit drug) to Treatment Centers for Illicit Drugs—
defined as the percent of admissions for illicit drug treatment to facilities that are licensed
or certified by the state substance abuse agency to provide substance abuse treatment (or
are administratively tracked for other reasons). In general, facilities reporting data are
those that receive state alcohol and/or drug agency funds (including Federal Block Grant
funds) for the provision of alcohol and/or drug treatment services.
Percent Meeting DSM-IV for Illicit Drug Abuse/Dependence—defined as percent of
persons aged 12 and older meeting DSM-IV criteria for illicit drug abuse or dependence
(Diagnostic and statistical manual of mental disorders, 4th ed. (DSM-IV) (American
Psychiatric Association [APA], 1994)).
44
VI. C. 2. Youth Other Drug Consumption
CURRENT MARIJUANA USE
Table 22.
% PA Youth Current Marijuana Use
Detailed data by grade and gender for
Past 30-Day Use
Pennsylvania students are provided by the
2001 2003 2005
2007 2009
PAYS data (Table 22). There appear to be
Grade
substantial increases in 30-day use in each
0.3
6th
0.6
0.5
0.3
0.2
grade, beginning in 8th grade. 23.7% of
5.4
th
8th
5.3
5.2
3.5
2.8
12 graders report current marijuana use,
14.2
10th
17.0
14.5
12.0
12.0
which is quite a bit higher than the rates
23.7
12th
25.6
21.4
22.9
19.2
discussed above for young adults. In 2009,
11.4
11.4
10.0
9.4
8.5
All Grades
males (12.9%) appeared to report slightly
Gender
higher rates of use than females (9.9%).
9.9
Females
10.2
9.1
8.0
7.2
There do not appear to be large differences
12.9
Males
12.9
10.9
10.7
9.8
as a result of gender. Rates by grade have
Source: PAYS Statewide Report.
remained stable except for 12th graders,
where there was decline between 2005 and 2007, but rates appear to have risen in 2009.
LIFETIME MARIJUANA USE
In 2009, Pennsylvania youth, on average, reported using marijuana for the first time around age
14 (average of grades 6, 8, 10, and 12). In 2009, 0.6% of 6th graders, 9.8% of 8th graders, 25.1%
of 10th graders, and 41.1% of 12th graders reported having used marijuana in their lifetime.
CURRENT OTHER ILLICIT DRUG USE
Figure 21 shows the breakdown for non-marijuana illicit drug use by substance for youth under
18. In summary, for non-marijuana illicit drug use among Pennsylvania youth, inhalants show
the highest prevalence, followed by pain relievers and stimulants. Over the past decade there has
been substantial growth in the use of inhalants. There is also concern about the rates of use of
stimulants and non-prescribed pain medications.
45
Figure 21. PA Youth 30-Day Prevalence, By Illicit Drug
Stimulants
Inhalants
Heroin
2009
Methamphetamines
2007
Steroids
2005
2001
Sedatives
Other Narcotics
0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
Source: Pennsylvania Youth Survey (PAYS)
Note: In 2009, 30-day use of Simulants and Pain Relievers were asked; Amphetamines and
Sedatives were not.
LIFETIME OTHER ILLICIT DRUG USE
Table 23 displays 2009 youth rates of lifetime use of illicit substances, according to the PAYS
survey. Twelfth graders reported substantial non-medical use of prescription drugs, including
pain relievers, tranquilizers, and stimulants. Tenth graders also showed substantial use of a
variety of illegal substances. Both 6th and 8th graders reported inhalants as the most prevalent
substance used and reported relatively low rates of other illicit drugs. Thus, it appears that
substantial illicit use of prescription drugs may start sometime after 8th grade.
Table 23.
% Lifetime Prevalence of Other Illicit Substance Use by Substance by Grade
Substance
Inhalants
Cocaine
Crack Cocaine
Heroin
Hallucinogens
Methamphetamines
Ecstasy
Steroids
Pain Relievers
Prescription Tranquilizers
Prescription Stimulants
6th
10.2
0.0
0.2
0.1
0.1
0.2
0.2
0.6
1.6
0.2
0.4
8th
13.9
0.5
0.4
0.2
1.0
0.2
0.7
0.7
3.7
0.7
1.5
10th
12.2
1.8
1.2
0.9
3.7
0.7
2.2
1.1
8.3
3.0
4.3
12th
9.7
4.8
1.1
1.4
8.0
1.1
4.8
1.0
14.8
8.4
10.1
All Grades
11.5
1.9
0.8
0.7
3.3
0.6
2.1
0.8
7.4
3.2
4.2
Source: 2009 PAYS Report. Prescription drugs here are reported used non-medically.
46
VI. C. 3. Adult & Youth Illicit Drug Consequences
DRUG (INCLUDING NON-ILLICIT)-INDUCED DEATH RATE
Table 24.
Annual Average (2007-2009) PA Rates of Drug-Induced Death
CATEGORY
COUNT POPULATION
Total
4,549
37,485,838
Gender
Male
3,090
18,216,527
Female
1,459
19,269,311
Race
White
3,930
32,105,032
Black
596
4,030,002
Asian
9
880,131
Hispanic
144
1,796,642
Age
15-19
117
2,786,303
20-24
413
2,670,959
25-29
531
2,227,167
30-34
476
2,240,595
35-39
479
2,413,507
40-44
621
2,635,390
45-49
760
2,753,602
50-54
593
2,671,678
55-59
309
2,412,022
60-64
107
2,028,090
65-69
38
1,596,250
70-74
20
1,335,044
75-79
28
1,113,143
80-84
19
847,369
85+
29
854,759
Source: Pennsylvania Certificates of Death
ND=Not Determined due to small cell size
1
Per 100,000 People
RATE1
12.4
95% CI
12.1-12.8
17.1
7.8
16.5-17.7
7.4-8.2
12.7
15.9
ND
9.1
12.3-13.1
14.7-17.3
ND
7.7-10.9
4.2
15.5
23.8
21.2
19.8
23.6
27.6
22.2
12.8
5.3
2.4
1.5
2.5
2.2
3.4
3.5-5
14-17
21.9-26
19.4-23.2
18.1-21.7
21.7-25.5
25.7-29.6
20.4-24.1
11.4-14.3
4.3-6.4
1.7-3.3
.9-2.3
1.7-3.6
1.3-3.5
2.3-4.9
The total count for drug-induced deaths was 4,549
people during 2007–2009 in Pennsylvania as
reported in Table 24. Men and Blacks have
substantially higher prevalence rates of such
deaths, whereas Hispanics have substantially lower
rates. The highest death rate was in the age range
of 45–49—27.6/100,000 persons died on average
each year. Overall, there was a small decrease in
rate from 13.7 in 2004–2006 to 12.4 in 2007–2009.
Figure 22 shows drug-induced death rates by
county. A large southwest and northeastern portion
of Pennsylvania had the highest drug-related death
rates. Due to very low prevalence, rates cannot be
estimated in the Northern Tier counties. The
counties in orange in Figure 22, Philadelphia and
Cambria, had the highest rates in the state.
Figure 22.
NA=not available
ND=not displayed
if count < 10
Source: PA
Department of
Health, EPIQMS,
PA Certificates of
Death
47
DRUG-RELATED CONVICTIONS IN PENNSYLVANIA
Table 25.
Table 25 shows that in 2008,
there were 277 drug
possession convictions per
100,000 people. Rates for
Single County Authorities
(SCA) ranged from 96 in
Franklin/Fulton to 763 in
Philadelphia. There were 199
illegal alcohol and drug sales
convictions per 100,000
Pennsylvania residents in
2008. When broken out by
SCA, this number ranged from
29 convictions per 100,000 for
Franklin/Fulton to 386
convictions per 100,000 in
Blair.
Drug Convictions per 100,000 people in 2008
Illegal
Drug
Alcohol/Drug
SCA Name
Possession
Sales
Pennsylvania
277
119
Allegheny
392
159
Armstrong/Indiana
194
70
Beaver
279
105
Bedford
153
113
Berks
368
133
Blair
578
386
Bradford/Sullivan
178
61
Bucks
262
95
Butler
352
84
Cambria
275
142
Cameron/Elk/McKean
258
123
Carbon/Monroe/Pike
177
63
Centre
271
153
Chester
171
78
Clarion
293
195
Clearfield/Jefferson
128
74
Columbia/Montour/Snyder/Union
164
89
Crawford
221
104
Cumberland/Perry
204
67
Dauphin
696
204
Delaware
509
173
Erie
169
60
Fayette
254
110
Forest/Warren
214
109
Franklin/Fulton
96
29
Greene
173
71
Huntingdon/Mifflin/Juniata
193
110
Lackawanna/Susquehanna
356
154
Lancaster
178
55
Lawrence
199
84
Lebanon
359
140
Lehigh
424
131
Luzerne/Wyoming
330
141
Lycoming/Clinton
303
128
Mercer
291
66
Montgomery
302
104
Northampton
265
90
Northumberland
263
165
Philadelphia
763
309
Potter
167
144
Schuylkill
289
149
Somerset
117
37
Tioga
113
76
Venango
360
162
Washington
248
75
Wayne
186
50
Westmoreland
268
128
York/Adams
304
156
Note: 2008 Data was the latest available at the time of this report.
Source: Court of Common Pleas and the Magistrate Courts in PA
Population estimates for 2008 provided by the U.S. Census Bureau
48
PERCENT ADMISSIONS TO TREATMENT CENTERS FOR ILLICIT DRUGS
This indicator is drawn from the TEDS (Treatment Episode Data Set) and represents the number
of admissions, not the number of people admitted. In addition, reported admissions are only to
facilities that are either state-certified for treatment and/or receive government funds; thus, these
numbers do not represent the entire scope of those admitted for treatment in Pennsylvania.
However, this indicator does provide some insight into the extent of illicit drug usage
consequences. Table 26 shows treatment admissions in Pennsylvania in 2010 in which specific
illicit drugs (cocaine, marijuana, heroin, other synthetics/opiates) were identified as the drug of
choice at admission (52.8% of all admissions). The most frequent illicit drugs of choice
identified (in order of ranking) were: heroin, marijuana, and cocaine/crack. Clients were mostly
male, 21–45 years old, and White. For national comparison purposes, 59.6% (36,867) of all
2009 treatment admissions in Pennsylvania (as reported to TEDS) were related to primary illicit
drug use, compared to 58.4% nationally. When broken down by type of illicit drug, the percent
of 2009 treatment admissions in Pennsylvania was much lower for amphetamines and much
higher for heroin. Table 26 gives the most current statistics on Pennsylvania treatment
admissions.
Table 26.
PA Admissions to Treatment Facilities by Illicit Substance and Demographics, 2010
Overall N=61,543
Cocaine (smoked)
Marijuana
Heroin
Other Opiates and Synthetics
Total N=32,677
3,679
9,389
11,300
6,725
Total %= 52.8%
6.4
16.4
19.7
11.7
Gender
Male
53
76.3
64.6
59.6
Female
47
23.7
35.4
40.4
Age at Admission
12–17 years
.5
23.6
.8
2.7
18–20 years
1.6
17.4
9.1
9.7
21–25 years
6
23.3
30.3
30.5
26–30 years
10
13.7
26.1
22.9
31–35 years
12.8
8.2
13.2
12.7
36–40 years
18.3
5.4
7.7
7.4
41–45 years
20.9
3.5
5.3
5.7
46–50 years
18.3
2.9
3.8
4.1
51–55 years
8.4
1.4
2.2
2.7
56–60 years
2.4
0.4
1.2
1.1
61–65 years
.7
0.1
0.3
0.4
66 years +
0.1
0.0
0.1
0.1
Race
White
50.5
64.9
87.8
94.1
Black
44.5
26.8
5.1
2.8
Source: Treatment Episode Data Set (TEDS), SAMHSA
Notes: Admissions to facilitates that are licensed or certified by PA to provide substance abuse treatment
49
Figure 23 compares the Pennsylvania and national rates of treatment admissions with
heroin identified as the drug of choice at admission. The percent of treatment admissions
related to heroin use in Pennsylvania was about equal to the national average in 1999
(14.4% in PA, 14.9% US) but has risen significantly in the past 10 years. The highest
rates were in 2003 at 23.4% (US 14.7%). In 2007, there was a decrease in admissions
down to18.2%, but the rate rose again in the subsequent years. In contrast, the national
percent of treatment admissions has stayed relatively stable around 14.5% during the
same timeframe. The current rates of use in are 19.4% in Pennsylvania and 14.3% in the
US.
Figure 23.
PA/U.S. Percent of Treatment Admissions
related to Heroin
25
Axis Title
20
15
US
PA
10
5
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Source: Treatment Episode Data Set (TEDS), SAMHSA.
50
VI. C. 4. Illicit/Prescription Drug Summary
The results of the data on illicit and prescription drug indicators are summarized in Table
27. This table summarizes key indicators by comparing across three data dimensions:
magnitude, time trends, and comparisons to national rates as described in the earlier
section, “Understanding the Data.” This summary can be a useful tool in determining
problem areas.
Table 27.
Illicit Drug Indicators Compared by:
Magnitude, Time Trends, and National Comparisons
CONSEQUENCES
PA Magnitude
Time Trend
National Rate
Ratio (RR)
Number and % Admissions to
Treatment Centers for Illicit Drugs
36,867 (59.6%)
6.8
1.02
(2009, TEDS)
Note: ‘Other Illicit Drug’ includes all illicit drugs other than marijuana—including non-medical use of
prescription drugs.
RR=1, no difference; RR>1, PA higher than US; RR<1, PA lower than US.
Magnitude.
There were 36,867 treatment admissions related to illicit drug use reported to TEDS in
2009. These data are largely limited to block grant/state-funded services, plus available
Medicaid information, and do not represent all treatment services provided in
Pennsylvania. The most frequent illicit drugs of choice identified at treatment admission
(in order of ranking) were: heroin, marijuana, and cocaine/crack. The drug-induced death
rate in Pennsylvania (includes non-illicit drugs) affected 4,549 people during the years
2007–2009 and the rates are highest for those between 25 and 54 years of age. Men and
Blacks are disproportionately affected.
Among youth, current marijuana use increases dramatically by grade: there is almost no
reported use among 6th graders, 5.4% among 8th graders, 14.2% among 10th graders, and
a jump to 23.7% among 12th graders. 41.1% of 12th graders reported that they had tried
marijuana in their lifetime. There has been an increase in reported marijuana use since
2007 by approximately 2% for 8th, 10th and 12th graders. While marijuana shows the
greatest prevalence, there is substantial use of inhalants among all grades (6th, 8th, 10th,
12th) and non-medical use of prescription drugs as reported by 10th and 12th graders. In
2007, over 10% of 12th graders reported non-medical use of prescription drugs, including
stimulants and tranquilizers, and almost 15% reported use of narcotic pain medications.
51
VII. APPENDIX
52
VII. A. SEOW & Advisory Council Member List
*Indicates a member of the State Epidemiology Outcomes Workgroup (SEOW).
*Kim Nelson
PA Commission on Crime and Delinquency
3101 N. Front Street
Harrisburg, PA 17110
717-265- 8458
knelson@state.pa.us
Center for Juvenile Justice Training & Research
Shippensburg University
1871 Old Main Drive
Shippensburg, PA 17257-2299
717-477-1188
jcookusl@state.pa.us
Doris Arena
Office of Mental Health and Substance Abuse
Services
PA Department of Public Welfare
2nd Floor, Beechmont Building
Harrisburg, PA 17105
717-772-7685
darena@state.pa.us
Julia Cox
Executive Director
American Trauma Society
2 Flowers Drive
Mechanicsburg, PA 17050
717-766-1616
atspa@atspa.org
*Lonnie Barnes
Program Analyst
Bureau of Drug & Alcohol Programs
PA Department of Health
2 Kline Plaza
Harrisburg, PA 17104
717-783-8200
lobarnes@state.pa.us
*Louis Brown
Research Associate
Prevention Research Center
Penn State University
135 E. Nittany, Suite 402
State College, PA 16801
814-865-4122
ldb12@psu.edu
Leslie Coombe
Acting Director
Bureau of Alcohol Education
PA Liquor Control Board
Room 602 Northwest Office Building
Harrisburg, PA 17124
717-772-3902
lecoombe@state.pa.us
*Robert D Cooney
EMS Program Manager
Emergency Medical Services Office
PA Department of Health
Health and Welfare Bldg., Room 606
Harrisburg Pa 17120-0701
cooney@state.pa.us
John Cookus
Director
Michele Denk
Director
PA Association of County Drug & Alcohol
Administrators
17 N. Front Street
Harrisburg, PA 17101-1624
717-232-7554 x3132
mdenk@pacounties.org
Peg Dierkers
PA Coaltion Against Domestic Violence
6400 Flank Drive, #1300
Harrisburg, PA 17112
717-545-6400
pdierkers@pcadv.org
Nora Drexler
President
Drexler Associates
5639 Mill Street
Erie, PA 16509
814-864-9986
ndrexler@drexlerassociates.com
Major Gilbert Durand
Drug Demand Reduction Administrator
Counterdrug Progam
PA National Guard
Fort Indiantown Gap
Annville, PA 17003
717-861-2319
c-gidurand@state.pa.us
E. Shaye Erhard
Services Program Specialist
Division of Planning, Policy, & Program
Development
53
Office of Mental Health and Substance Abuse
Services
PA Department of Public Welfare
DGS Annex Complex, Beechmont #32
Harrisburg, PA 17105
717-705-9709
eerhard@state.pa.us
Debra Fye
President
Commonwealth Prevention Alliance
Mercer County Behavioral Health Commission
8406 Sharon Mercer Road
Mercer, PA 17137
724-662-1550
debby.fye@mercercountybhc.org
Carl D. Giardinelli
DRC, Philadelphia FD
Drug Enforcement Administration
William J. Green Federal Building
600 Arch Street, Suite 10224
Philadelphia, PA 19106
215- 861-3288
Carl.D.Giardinelli@usdoj.gov
*Garrison Gladfelter
Prevention Division Director
Bureau of Drug & Alcohol Programs
PA Department of Health
2 Kline Plaza
Harrisburg, PA 17104
717-783-8200
ggladfelte@state.pa.us
Donna Gority
Blair County Commissioner
Suite 142, Courthouse
423 Allegheny Street
Hollidaysburg, PA 16648
814-693-3112
dgority@blairco.org
*Mark Greenberg
Director
Prevention Research Center
Pennsylvania State University
S112B Henderson Building
University Park, PA 16802
814-863-0112
mxg47@psu.edu
Eileen Grenell
Prevention Specialist
Adams County Substance Abuse Prevention
Program
It Takes A Village, Inc.
111-117 Baltimore Street, Room 201-B
Gettysburg, PA 17325
717-337-5827
egrenell@adamscounty.us
Cheryl Guthier
Executive Director
Community Prevention Partnership of Berks
County
227 N. 5th Street
Reading, PA 19601
610 376-6988 ext. 203
guthierc@enter.net
Lieutenant Colonel Robert Hepner
Counterdrug Coordinator
PA Dept of Military & Veteran's Affairs
NCTC Building 8-65
Fort Indiantown Gap
Annville, PA 17003
717-861-2302
c-rhepner@state.pa.us
*Mike Kozup
Safe Schools Supervisor
PA Department of Education
Bureau of Community & Student Services
333 Market Street
Harrisburg, PA 17126-0333
717-705-0353
mkozup@pa.gov
*Barry L. Jackson
Director
Drug, Alcohol & Wellness Network
253 SSC Bloomsburg University
Bloomsburg, PA 17815
570-389-4977
bjackson@bloomu.edu
Lieutenant Douglas Martin
Central Section Commander
Bureau of Liquor Control Enforcement
PA State Police
3655 Vartan Way
Harrisburg, PA 17110
717-540-7443
doumartin@state.pa.us
*Terry Matulevich
Budget Analyst
Bureau of Drug & Alcohol Programs
PA Department of Health
2 Kline Plaza
Harrisburg, PA 17104
54
717-783-8200
tmatulevic@state.pa.us
Judy May-Bennett
Assistant Director
American Trauma Society
PA Division
2 Flowers Drive
Mechanisburg, PA 17050
717-766-1616
judymaybennett@yahoo.com
*Michael Melczak
Research Specialist
University of Pittsburgh
School of Pharmacy
Department of Pharmacy & Therapeutics
456 Falk Clinic, 3601 Fifth Avenue
Pittsburgh, PA 15213
412- 647-4295
mam142@pitt.edu
*Ryan W. McNary
Department of Transportation
Bureau of Highway Safety and Traffic
Engineering
P.O. Box 2047 | Harrisburg, PA 17105-2047
Phone: 717.787.3656 | Fax: 717.783.8012
www.dot.state.pa.us
*Daniel Miller
Chief, Data Section
Bureau of Drug & Alcohol Programs
Pennsylvania Department of Health
02 Kline Plaza
Harrisburg, PA 17104
Phone: 717.783.8200
*Peter D. Mulcahy
72 Fairview Avenue
Morrisville, PA 19067
215-736-3167
peterdmulcahy@comcast.net
Beata Peck-Little
PA Coalition Against Rape
125 North Enola Drive
Enola, PA 17025
717-728-9740 x115
bpecklittle@pcar.org
Michael Pennington
Director
PA Commission on Crime and Delinquency
Office of Juvenile Justice & Delinquency
Prevention
3101 N. Front Street
Harrisburg, PA 17110
717-265-8461
mpenningto@state.pa.us
Sherry Peters
Chief, Division of Planning, Policy, & Program
Development
Office of Mental Health and Substance Abuse
Services
PA Department of Public Welfare
2nd Floor, Beechmont Building
Harrisburg, PA 17105
717-772-7855
shepeters@state.pa.us
*Janice Pringle
Research Assistant Professor
University of Pittsburgh
School of Pharmacy
2100 Wharton St.
7th Floor, Suite 720-C
Pittsburgh, PA 15203, 412-904-6127
*Robin Rothermel
Director
Bureau of Drug & Alcohol Programs
PA Department of Health
2 Kline Plaza
Harrisburg, PA 17104
717-783-8200
rrothermel@state.pa.us
Kathy Schmick
Executive Secretary
Office of Administrative Law Judge
PA Liquor Control Board
Brandywine Plaza
2221 Paxton Church Rd.
Harrisburg, PA 17110-9661
717-540-5037
kschmick@state.pa.us
*Kimberly Fitzpatrick
Drug & Alcohol Program Supervisor
Bureau of Drug & Alcohol Programs
PA Department of Health
2 Kline Plaza
Harrisburg, PA 17104
717-783-8200
kfitzpatri@pa.gov
*Carol E. Thornton
Section Chief
Violence and Injury Prevention Program
Pennsylvania Department of Health
Bureau of Health Promotion and Risk Reduction
55
Room 1008, Health & Welfare Building
Harrisburg, PA 17120
717-787-5900
cathornton@state.pa.us
*Ronald Tringali
Epidemiologist
Bureau of Epidemiology, Family Health
PA Department of Health
Room 925 Health & Welfare Building
Harrisburg, PA 17120
717-346-3283
rtringali@state.pa.us
*Gene Weinberg
Epidemiologist Director
Division of Community Epidemiology
Room 925 Health & Welfare Building
Harrisburg, PA 17100
717-783-4677
gweinberg@state.pa.us
Lenore Wyant
Program Director, Communities that Care
Center for Juvenile Justice Training & Research
1871 Old Main Drive
Shippensburg, PA 17257
717-477-1187
ldwyant@ship.edu
*Marsha Zibalese-Crawford
Chair, Social Work Department
Temple University School of Social
Administration
1301 Cecil B. Moore Avenue
Ritter Avenue
Room 587
Philadelphia, PA 19122
215-204-3760
mcrawfor@temple.edu
56
VII. B. Acronyms in Profile
ATOD
BAC
BDAP
BRFSS
CDC
CIS
COPD
CSAP
DOH
DSM-IV
DUI
FARS
ICD
NCHS
NHTSA
NIAAA
NSDUH
PA ATS
PA EpiQMS
PAYS
PCCD
SAMHSA
SCA
SEDS
SEOW
SPF-SIG
TEDS
YRBSS
Alcohol, Tobacco, and Other/Illicit Drugs
Blood Alcohol Content
Bureau of Drug and Alcohol Programs
Behavioral Risk Factor Surveillance System
Centers for Disease Control and Prevention
Client Information System
Chronic Obstructive Pulmonary Disease
Center for Substance Abuse Prevention
Department of Health
Diagnostic and Statistical Manual of Mental Disorders, 4th edition
Driving under the influence of alcohol or drugs
Fatality Analysis Reporting System
International Classification of Diseases
National Center for Health Statistics
National Highway Traffic Safety Administration
National Institute on Alcohol Abuse and Alcoholism
National Survey on Drug Use and Health
Pennsylvania Adult Tobacco Survey
Epidemiologic Query and Mapping System
Pennsylvania Youth Survey
PA Commission on Crime and Delinquency
Substance Abuse and Mental Health Administration
Single County Authorities
State Epidemiological Data Systems
State Epidemiology Outcomes Workgroup
Strategic Prevention Framework State Incentive Grant
Treatment Episode Data
Youth Risk Behavioral Surveillance Survey
57
VII. C. 2. FARS Calculated Crash Data Tables Used
Total Number of Alcohol-related Traffic Deaths and
Population-adjusted Rate of Traffic Deaths by County in
Pennsylvania (2009)
County
Adams
Allegheny
Armstrong
Beaver
Bedford
Berks
Blair
Bradford
Bucks
Butler
Cambria
Cameron
Carbon
Centre
Chester
Clarion
Clearfield
Clinton
Columbia
Crawford
Cumberland
Dauphin
Delaware
Elk
Erie
Fayette
Forest
Franklin
Fulton
Greene
Huntingdon
Indiana
Jefferson
# of Alcoholrelated Deaths
per Year
9
22
2
4
2
18
1
0
17
8
9
1
4
4
8
4
5
2
2
4
5
10
6
0
9
13
3
7
0
2
5
6
4
Fatalities
per 100,000
Population
8.8
1.81
2.95
2.33
4.03
4.42
.079
0
2.72
4.33
4.86
0
6.26
2.74
1.6
10.13
6.07
5.44
3.07
4.52
2.15
3.86
1.08
0
3.21
9.12
44.28
4.83
0
5.10
11.01
6.86
8.96
58
Juniata
Lackawanna
Lancaster
Lawrence
Lebanon
Lehigh
Luzerne
Lycoming
McKean
Mercer
Mifflin
Monroe
Montgomery
Montour
Northampton
Northumberland
Perry
Philadelphia
Pike
Potter
Schuylkill
Snyder
Somerset
Sullivan
Susquehanna
Tioga
Union
Venango
Warren
Washington
Wayne
Westmoreland
Wyoming
York
3
6
13
2
5
16
13
4
0
7
4
9
15
0
9
1
3
27
2
0
10
2
4
1
0
4
3
1
1
13
3
14
6
11
12.98
2.87
2.56
2.22
3.83
4.66
4.16
3.42
0
6.03
8.71
5.41
1.92
0
3.01
1.10
6.59
1.74
3.3
0
6.80
5.19
5.2
16.29
0
9.79
6.89
1.85
2.46
6.27
5.84
3.86
21.58
2.56
Source: National Highway Traffic and Safety
Administration- FARS Crash data.
59
VII. D. Other Pennsylvania Drug & Alcohol Data Resources
1) Annually published statewide report, Adult Behavioral Health Risks of Pennsylvania
by PA Department of Health, Bureau of Health Statistics and Research, available on PA
Department of Health website. Some PA community-level (communities vary each year)
reports are available to supplement. This report can be found online at
http://www.portal.state.pa.us/portal/server.pt?open=514&objID=615148&mode=2
2) Additional PA Department of Health website (www.health.state.pa.us/) resources
available include: PA Vital Statistics Reports, County Health Profiles, PA Healthy
People 2010 information, and an annually published ‘Pennsylvania Tobacco Facts’.
3) PennDOT (Pennsylvania Department of Transportation) annually publishes a ‘Crash
Facts and Statistics’ book providing detailed information on crash data including alcoholinvolved crashes. Most years can be found online using http://www.dot.state.pa.us.
4) PA State Police publish a ‘Crime in Pennsylvania, Annual Uniform Crime Report’
available online using http://ucr.psp.state.pa.us. In addition, crime (arrests/reported)
queries and maps can be done online.
5) The Drug Abuse Warning Network (DAWN) is a public health surveillance system
that monitors drug-related hospital emergency department (ED) visits and drug-related
deaths to track the impact of drug use, misuse, and abuse in the U.S. A report on
Philadelphia county is available online (Metropolitan Area Profiles Part 2)
https://dawninfo.samhsa.gov/pubs/mepubs/default.asp.
60