Pennsylvania State Epidemiology Profile
On Substance Use & Consequences
Strategic Prevention Framework – State Incentive Grant (SPF-SIG)
SPF – SIG Statewide Epidemiological Outcomes Workgroup
Winter 2010
SPF-SIG STATEWIDE EPIDEMIOLOGY WORKGROUP
The SPF-SIG State Epidemiology Outcomes Workgroup (SEOW) is a group of twenty
three 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
Bureau of Drug and Alcohol Programs
Robin Rothermel
Daniel Miller
Terry Matulevich
Division of Prevention
Garrison Gladfelter
Lonnie Barnes
Jacqueline Spaid
Annette Williams (CSAP Fellow)
Hector Gonzalez
Bureau of Epidemiology
Division of Community Epidemiology
Ronald Tringali
Bureau of Health Statistics
Alden Small
Zachary Runkle
Bureau of Health Promotion and Risk
Reduction
Carol Thornton
PA Commission on Crime and
Delinquency
Office of Research, Evaluation, and
Strategic Policy Development
Staci Fehr
Deborah Almoney
PA Department of Education
Bureau of Community & Student
Services
Myrna Delgado
Department of Transportation
Bureau of Highway Safety and Traffic
Engineering
Ryan McNary
Temple University
School of Social Administration
Marsha Zibalese-Crawford
Institute for Survey Research
Peter Mulcahy
Emergency Medical Services Office
Robert D Cooney
Bloomsburg University
University of Pittsburgh
Drug, Alcohol & Wellness Network
Barry L. Jackson
School of Pharmacy
Michael Melczak
Janice Pringle
Penn State University
Prevention Research Center
Louis Brown
Mark Greenberg
ACKNOWLEDGEMENTS
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). The authors wish to thank Garrison Gladfelter, who directs
BDAP‘s Prevention Division, and Jacqueline Spaid, the Division‘s Program Supervisor,
for their guidance, support, and encouragement in compiling this profile as well as the
SPF-SIG Advisory Council for its concrete suggestions.
Mark Greenberg Ph.D.
Director
Prevention Research Center
Pennsylvania State University
Louis Brown Ph.D.
Research Associate
Prevention Research Center
Pennsylvania State University
TABLE OF CONTENTS
I. Executive Summary..........................................................................................................1
II. Introduction
A. About the SPF-SIG ..............................................................................................5
B. About Pennsylvania.................................................................................... .........6
C. Goals ....................................................................................................................7
D. Understanding the Profile ....................................................................................8
III. Data Sources ....................................................................................................................9
IV. Data Limitations ..............................................................................................................12
V. Data Processes
A. Choosing Indicators .............................................................................................14
B. Indicators Chosen .................................................................................................15
VI. Consumption & Consequences
A. Alcohol
1. Indicator Definitions ................................................................................16
2. Adult & Youth Consumption ...................................................................17
3. Adult & Youth Consequences .................................................................28
4. Alcohol Summary ....................................................................................40
B. Tobacco
1. Indicator Definitions ................................................................................42
2. Adult & Youth Consumption ...................................................................43
3. Adult & Youth Consequences .................................................................55
4. Tobacco Summary ...................................................................................59
C. Illicit Drugs
1. Indicator Definitions ................................................................................61
2. Adult & Youth Consumption ...................................................................62
3. Adult & Youth Consequences .................................................................67
4. Illicit Drugs Summary..............................................................................73
VII. Appendix
A. SEOW & Advisory Council Member List ...........................................................76
B. Acronyms in Profile .............................................................................................81
C. Detailed Tables
1. NSDUH Substate Data Tables Used ........................................................82
2. FARS Calculated Crash Data Tables Used ..............................................88
D. Other Pennsylvania Drug & Alcohol Resources..................................................90
I. EXECUTIVE SUMMARY
GOALS OF THIS REPORT
This report of 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 to improve
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 will
provide 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);
and
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;
Be available with a limited burden; and
Can be disaggregated geographically, by age, gender and/or race/ethnicity.
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This is the second report of the SEOW and captures data available through December
2009. The report updates the previous epidemiological profile completed in 2007.
FINDINGS OF THIS REPORT
For each type of substance (alcohol, tobacco, and illicit/other drugs (ATOD)) 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 16% 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 36% of all fatal crashes in 2007. 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
both 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 18-34. Evidence-based
prevention programs and policies prior to this age (early and middle adolescence) are an
important component in a plan to reduce heavy use in the late teen age years and early
adulthood.
Geographically, it appears that the certain substate regions show higher rates of
consumption & consequences for both adults and youth. Higher rates are seen in
Allegheny County, the northwest corner (Erie and Crawford counties), and the northcentral area of the state. Perhaps surprisingly for the largest urban area, Philadelphia has
lower rates than many other areas of the state. There is a need for further data that can
permit better assessment of regional rates for youth in urban, suburban, and rural areas of
Pennsylvania.
From 2003 to 2007, rates of ―problem drinking‖ in adults (binge & heavy drinking) are
relatively steady. A small downward trend exists in past 30-day use and binge drinking
among 10th and 12th grade youth.
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.
2
Tobacco Consumption and Consequences. Tobacco use affects many Pennsylvanians.
21.3% of adults are current smokers and about 16% smoke daily. A substantial public
health concern is that 18% of new mothers voluntarily reported that they smoked during
their pregnancy during 2007. 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 tripled for those with less than a high
school education compared to those who graduate from college.
Adults between the ages of 18-34 have the highest smoking prevalence rates, with males
smoking more than 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 that are
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 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.
Adult and Youth Illicit Drug Use and Consequences.
There is substantial use of illicit drugs in Pennsylvania among youth and adults. The 1825 year old age group stands out with regard to all types of self-reported illicit drug use—
both marijuana and other illicit drug use rates are much higher than the other age groups.
Correspondingly, the percent of 18-25 year olds meeting DSM-IV (Diagnostic and
Statistical Manual of Mental Disorders, 4th edition) criteria for illicit drug abuse or
dependence is much higher than the other age groups, with 8% meeting criteria for drug
abuse or dependence. These rates then decline as young adults move further into the
roles and responsibilities of adulthood.
There were 39,761 treatment admissions in Pennsylvania (based on 2007 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, cocaine,
and marijuana. This data is limited, however, to federal block grant/state funded
services, plus available Medicaid information, and does not reflect all treatment services
provided in Pennsylvania.
Among youth, current marijuana use increases dramatically by grade: there is almost no
reported use in 6th graders, 3% among 8th graders, 12% among 10th graders, and a jump to
19% in 12th graders. 36% of 12th graders reported that they had tried marijuana in their
lifetime. While marijuana shows the highest 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 7% of 12th graders reported substantial
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non-medical use of prescription drugs including amphetamines, sedatives, tranquilizers
and over 12% reported use of narcotic pain medications. For youth under 18, marijuana
use was most often identified as the illicit drug of choice at admission to treatment.
The use of marijuana and other illicit drugs among adults (other than non-medical use of
prescription drugs) appears relatively stable the past few years. For youth, it appears
marijuana and other illicit drug use is declining. Compared with the rest of the nation,
Pennsylvania is slightly below average for consumption and consequence rates for illicit
drugs; however, current marijuana use for 18-25 years old is slightly above the national
level.
Cross-Substance Summary
Alcohol, tobacco and illicit drugs 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 schools
years and these activities continue at high rates through the young adult years (ages 1825). Reported smoking during pregnancy also affects many people (25,155 live births in
2007). For consequences, the largest number of people are affected by: DUI arrests
(48,698 persons in 2006), admissions to treatment (75,749 admissions in 2007), lung
cancer deaths (7,969 deaths in 2006), and the percent of people in Pennsylvania meeting
DSM-IV criteria for abuse or dependence (6.4% for alcohol and 2.3% illicit drugs, 20062007). All of these issues are considered serious and may be amenable to some
intervention models. In order to make changes in these indicators, intervening variables
(risk and protective factors) may be targets for intervention and thus 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, illicit drug use) and
consequences (e.g., motor-vehicle crashes, school failure) 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
5
The SPF-SIG strives to use data across all steps of the Strategic Prevention
Framework (SPF). There is a well-structured process 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 86% White, 11% Black, 2% Asian, and 4%
Hispanic/Latino. Economically, the median household income is approximately $44,000,
with 11% of the population living in poverty.
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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 for selecting indicators. These indicators should:
Reflect critical substance use related problem or consumption pattern;
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 was focused on utilizing existing data sources and should
establish baseline levels, trends over time, and, when available, patterns by age, gender,
race/ethnicity, and geography.
7
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 is 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 forms 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 the indicator. Is the indicator getting better or
worse 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 national one 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: Lakins, N.E., LaVallee, R.A., Williams, G.D., and Yi, H., 2007.
Surveillance Report #82: Apparent Per Capita Alcohol Consumption: National, State, and
Regional Trends, 1977-2006. Bethesda, MD: NIAAA, Alcohol Epidemiologic Data
System.
Behavioral Risk Factor Surveillance System (BRFSS) Survey: Centers for Disease
Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data.
Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease
Control and Prevention, 1999-2008. 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: United States resident population by county, single-year of age, sex, race, and
Hispanic origin, prepared by the U.S. Census Bureau, 2000-2009. Data were downloaded
from the Census website at www.census.gov.
Court Convictions: Administrative Office of the Pennsylvania Courts (AOPC) provided
data on the outcomes of criminal court cases for drug and alcohol related offenses in
2008. 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 maintaining separate databases.
Fatality Analysis Reporting System (FARS): National Highway Traffic Safety
Administration, Department of Transportation, 2007. 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, and Subramanian, 1998).
National Survey on Drug Use and Health (NSDUH): Hughes, A., Sathe, N., &
Spagnola, K. (2008). State Estimates of Substance Use from the 2005-2006 National
Surveys on Drug Use and Health (DHHS Publication No. SMA 08-4311, NSDUH Series
H-33). Rockville, MD: Substance Abuse and Mental Health Services Administration,
Office of Applied Studies.
Some figures, numbers, and regional break-downs obtained online from website. State
estimates are calculated by combining two years of data and substate estimates combine 3
years of data. All estimates are based on a survey-weighted hierarchical Bayesian
approach. Annual updates and state estimates are available at: http://oas.samhsa.gov/.
Publication used for substate estimates (http://oas.samhsa.gov/substate2k8/substate.pdf):
Substate Estimates from the 2004-2006 National Survey on Drug Use and Health.
9
Pennsylvania EpiQMS (Epidemiologic Query and Mapping System): Pennsylvania
Department of Health website: http://www.dsf.health.state.pa.us. EpiQMS includes data
from Pennsylvania‘s death and birth certificates across years and by demographics and
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 PCCD (PA
Commission on Crime and Delinquency), Center for Research, Evaluation, and Statistical
Analysis as ‗DUI Fact Sheets‘ downloaded from:
http://www.pccd.state.pa.us/pccd/cwp/view.asp?a=3&Q=571189
Pennsylvania Youth Survey (PAYS): 2007 PA Youth Survey Report (Statewide)
obtainable online (http://www.pccd.state.pa.us) 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 the changes in patterns of the
use and abuse of these harmful substances and behaviors. Second, the survey assesses
risk factors that are 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): 2006 PA Youth Tobacco Survey
statewide report is available online
(http://www.dsf.health.state.pa.us/health/cwp/view.asp?A=174&Q=246221) 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 2006 during the fall
and winter of the 2006-2007 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://www.drugabusestatistics.samhsa.gov).
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
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
10
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.
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IV. DATA LIMITATIONS
There are a number of data limitations that 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)) provides 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.
Concerns About PAYS Data:
Although of great value, there are a number of issues to be considered in the
Pennsylvania Youth Survey (PAYS). The overall school response rate for the 2007
survey was 34%. Fifty-one percent of schools in the original sample did not participate.
While appropriate weighting was conducted to minimize the 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, there was no participation
from either the Philadelphia or Pittsburgh school districts; hence the estimates do not
allow for estimates of Pennsylvania‘s two large urban areas and thus may provide
unreliable estimates regarding differences by ethnicity. Third, 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. Fourth, 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). This data is 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 is 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 don‘t represent the entire scope of those admitted for treatment in
12
Pennsylvania. Finally, it is unknown as to what extent the treatment admissions data
submitted by Pennsylvania to TEDS is edited by SAMHSA's contractor (Synectics).
Concerns About DUI Arrest Data:
Although included in this profile, DUI arrest data must be used with caution as it may not
accurately reflect consumption patterns in Pennsylvania. Instead, this arrest data is 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 is 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). Where possible (in order to
compare with the national rate), we also report the applicable rates for youths from the
National Survey on Drug Use and Health (NSDUH).
Within the State 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, the percent
of persons over 12 meeting DSM-IV criteria for alcohol/drug 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. As there are no other
14
available consequence indicators specific to the use of illegal drugs, we include the
percent of admissions to treatment centers across the state for alcohol or other substances,
detailed by each substance (see ‗Data Limitations‘ for cautions in interpreting this
indicator).
V. B. Chosen Indicators
Table 1.
Construct
ALCOHOL
TOBACCO
Alcoholic Liver Disease Death
Rate
Lung Cancer Death
Percent Fatal Motor Vehicle
Rate
Crashes Involving Alcohol
Emphysema Death
Mortality
Fatal Motor Vehicle Death Rate
Rate
Involving Alcohol
Percent Drinking Drivers of Total
Drivers in Fatal Crashes
DUI Arrest Rate
Public Drunkenness Conviction
Rate
Crime
Underage Purchase of
Alcohol/Tobacco Conviction rate
DUI Conviction Rate
Percent Persons 12+ Meeting
DSM-IV Criteria for Alcohol
Other
Abuse/Dependence
Consequences Treatment Admissions (%) for
Alcohol Use
Current Use
Current Use (youth only)
Lifetime Use (youth
Binge Drinking
only)
Lifetime Use (youth only)
Daily Smokers (adults
Consumption
Heavy Drinking (adults only)
only)
Drinking & Driving
Smoking During
Alcohol Sales
Pregnancy
ILLICIT DRUGS
Drug Death Rate
Percent Persons 12+
Meeting DSM-IV
Criteria for Illicit Drug
Abuse/Dependence
Drug Possession
Conviction Rate
Illegal Alcohol/Drug
Sales Conviction Rate
Treatment Admissions
(%) for Illicit Drug Use
Current Use
Lifetime Use (youth
only)
15
VI. CONSUMPTION & CONSEQUENCE INDICATORS
VI. A. Alcohol
VI. A. 1. Alcohol Indicators Defined
Consumption
Binge Drinking—defined as drinking 5 or more drinks on at least one occasion (i.e., at
the same time or within a couple of hours of each other) usually 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 for youth under 18 and for persons 18 or older as
driving one or more times in the past 30-days when they ―have perhaps had too much to
drink‖.
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, and Subramanian, 1998).
Alcohol-Related Fatal Motor Vehicle Death Rate—defined as the number of deaths
resulting from fatal motor vehicle crashes involving alcohol per 100,000 persons in
census population.
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.
16
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 edition [DSMIV) (American Psychiatric Association, 1994)].
VI. A. 2. Adult & Youth Alcohol Consumption
BINGE DRINKING
Table 2 displays adult binge drinking trends as reported from the Behavioral Risk Factor
Surveillance System (BRFSS) survey data from 2004 to 2008 as well as patterns by age,
gender, race/ethnicity, and education level. Nationally, 15.6% of adults reported binge
drinking (males having five or more drinks on one occasion, females having four or more
drinks on one occasion) in 2008. In Pennsylvania, in 2008, the estimate is 16.7% (95%
CI: 15.5-18.0%). The most substantial difference occurs in rates by gender. For
example, in 2008, 22.6% of men reported binge drinking compared to only 11.4% of
women. This difference is also depicted in Figure 1. Figure 1 also illustrates that there is
a small reduction in binge drinking in men between 2002 and 2008.
In addition, binge drinking shows a decline with increasing age. In 2008 binge drinking
percentages were 32.5% in the 18-24 age range, compared to 16.0% of those aged 45-54
and only 3.6% of those aged 65 or older. Findings indicate lower rates of binge drinking
for Blacks (13.7%) as compared to Whites (17.3%) in 2008. Educational level does not
appear to have a consistent influence on the rate of binge drinking.
Figure 1.
Source: BRFSS, Center for Disease Control (CDC) (State Prevalence).
17
Table 2.
PA Adult Binge Drinking
All Adults
2004 (N=6,026)
2005 (N=13,245)
2006 (N=12,882)
2007 (N=13,007)
2008 (N=12,921)
n (yes) % yes
CI
n (yes) % yes
CI
n (yes) % yes
CI
n (yes) % yes
CI
n (yes) % yes
CI
798 17.6 16.3-18.9 1647 16.0 14.9-17.1
1664 16.6 15.2-18.0 1579 16.2 14.8-17.6 1579
16.7 15.5-18.0
Male
Female
490
308
25.5 23.2-27.8
10.5 9.2-11.8
1033
614
18-24
25-34
35-44
45-54
55-64
65+
145
145
145
145
145
145
42.9
25.9
19.9
14.7
7.0
3.5
37.0-48.8
21.9-29.3
17.0-22.8
12.0-17.4
5.1-8.9
2.4-4.6
204
364
401
396
177
105
White
Black
Other
692
44
23
17.1 15.8-18.4
18.5 11.9-25.1
20.8 12.3-29.3
1391
156
41
23.7 21.8-25.6
9.0 7.9-10.1
928
736
22.3 19.8-24.8
11.5 10.0-13.0
899
680
22.7 20.3-25.1
10.3 8.9-11.7
869
710
22.6 20.4-24.7
11.4 10.0-12.8
31.2
24.1
18.8
15.8
8.5
3.2
25.9-36.5
20.7-27.5
16.5-21.1
13.7-17.9
6.7-10.3
2.4-4.0
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
16.2 15.0-17.4
14.0 9.3-18.9
24.2 15.3-33.1
1445
122
23
17.4 15.9-18.9
9.9 3.6-16.2
7.1 1.4-12.8
1363
130
26
16.4 15.0-17.8
10.5 6.6-14.4
19.5 9.5-29.5
1363
143
NA
25.9-39.2
21.3-28.9
18.3-23.5
14.0-18.1
7.2-10.3
2.8-4.5
17.3 16.0-18.6
13.7 9.2-18.2
NA
NA
<HS
59 18.4 13.1-23.7
145 15.3 11.4-19.2
125 12.8 8.2-17.4
114 14.1 8.6-19.6
128
15.1 10.5-19.7
HS
299 16.1 14.1-18.1
642 15.4 13.7-17.1
664 16.4 14.0-18.8
663
16 14.0-18.0
579
15.4 13.4-17.5
Some College
200 20.1 17.2-23.0
408 17.9 15.4-20.4
400 17.8 14.5-21.1
368 18.9 15.6-22.2
387
19.2 16.4-22.1
College Grad
240 17.5 15.1-19.9
451 15.4 13.5-17.3
475 17.2 14.8-19.6
433 15.1 12.9-17.3
485
16.8 14.8-18.9
% = 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
Figure 2 displays regional rates of binge drinking among all persons aged 12 or older in
Pennsylvania, according to the National Survey on Drug Use and Health (NSDUH)
(2004-2006, see Appendix for data table). The Allegheny region (includes Pittsburgh),
northwest region, and the north-central region have the highest overall binge drinking
rates, whereas the south central regions have the lowest rates.
Figure 2. Binge Alcohol Use in Past Month by Persons Aged 12 or Older by PA
Substate Region
Note: Substate regions are delineated by thick black lines whereas counties are delineated by
thin black lines.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004,
2005, and 2006.
19
Figure 3 represents underage (aged 12-20) substate data from the NSDUH (see Appendix
for data table). Substate estimates based on the 2004-2006 NSDUH indicate substantial
differences within Pennsylvania regions in underage binge drinking. The north-central
region with a rate of 25.9% (which includes Bradford, Sullivan, Centre, Columbia,
Montour, Snyder, Union, Clinton, Lycoming, Northumberland, Potter, Susquehanna, and
Tioga counties) show the highest rates and are substantially higher than the statewide
average estimate of 20.5%. Philadelphia County shows the lowest rate at 14.4% and is
significantly lower than the statewide average.
Figure 3. Binge Alcohol Use in Past Month by Persons aged 12-20 by PA Substate
Region
Note: Substate regions are delineated by thick black lines whereas counties are delineated by
thin black lines.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004,
2005, and 2006.
20
Figure 4 depicts 2001-2007 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 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). There was also a trend towards a decline among 10th graders. Overall, from
the 2007 PAYS, 14.9% (15.3% in 2003) of students in these grades report binge drinking
in the two weeks before the survey. In comparison, the NSDUH estimates 11.1% of
Pennsylvania youth aged 12-17 reported binge drinking in the 30-days prior to the survey
in 2003-2004 and 9.8% in 2006-2007. Nationally, from NSDUH, the median estimate
was 10.9% in 2003-2004 and 10.0% in 2006-2007.
Figure 4.
2-Week % Binge Drinking
40%
35%
30%
25%
20%
15%
10%
5%
0%
2001
6th
8th
2003
10th
2005
12th
2007
All Grades
Source: Pennsylvania Youth Survey Report (PAYS)
21
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). Results indicate a significant reduction among all adults between 2002 and
2005, from 6.1% down to 4.6% but then increased to 5.5% by 2008. Nationally, in 2008, adult heavy drinking prevalence was 5.2%.
Similar to binge drinking, younger adults show higher rates of heavy drinking than do older adults. A greater percentage of men (7%)
compared to women (4%) report that they are heavy drinkers.
Table 3.
PA Adult Heavy Drinking
All Adults
2002 (N=13,386)
n (yes) % yes
CI
730
6.1 5.5-6.7
Male
Female
404
326
18-24
25-34
35-44
45-54
55-64
65+
107
127
163
158
93
82
White
Black
Hispanic
665
24
7
8.2
4.1
7.2-9.2
3.5-4.7
13.4 10.4-16.4
7.1 5.5-8.7
5.9 4.8-7.0
5.4 4.3-6.5
4.5 3.3-5.7
2.6 1.8-3.3
6.3
3.7
2.4
5.7-6.9
1.9-5.5
0.3-4.5
2005 (N=13,124)
n (yes) % yes
CI
573
4.6 4.0-5.2
2006 (12,879)
2007 (12,861)
2008 (12,820)
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
287
286
5.8
3.5
4.8-6.8
2.9-4.1
264
288
61
95
111
132
82
92
8.4 5.6-11.2
6.0 3.9-8.1
3.9 2.8-5.0
4.5 3.4-5.6
3.6 2.6-4.6
2.5 1.8-3.2
62
68
135
108
98
81
485
50
15
4.7 4.1-5.3
3.5 1.3-5.7
4.8 0.0-10.1
473
52
ND
3.9-6.9
3.4-5.4
285
275
6.9
3.7
5.3-8.5
2.9-4.5
308
294
12.6 7.1-18.1
3.8
2.2-5.4
4.7
3.3-6.1
4.8
3.4-6.2
3.7
2.3-5.1
2.1
1.3-2.9
31
69
113
157
104
86
9.6 5.1-14.1
5.2
2.3-8.1
5.5
3.9-7.1
6
4.6-7.4
3.6
2.4-4.8
2.7
1.9-3.5
28
61
126
161
124
102
8.1 4.3-11.9
6.2 4.1-8.3
6.8 5.2-8.5
5.7 4.4-7.0
4.6 3.5-5.8
2.4 1.8-3.1
485
49
ND
5.3
2.9
ND
520
55
10
5.7
4.7
3.7
5.4
4.4
4.9
3.2
ND
4.0-5.8
1.4-5.0
ND
4.5-6.1
0.7-5.1
ND
7
4
<HS
63
5.8 4.0-7.6
57
4.4 2.2-6.6
46
4.2
1.7-6.7
47
7.3 2.2-12.4
42
5
HS or GED
307
6.2 5.3-7.1
205
4.4 3.4-5.4
218
4
2.9-5.1
226
5.3
3.9-6.7
234
5.4
Some College
181
7.2 5.8-8.6
139
5.0 3.7-6.3
131
6.9
4.2-9.6
125
5.2
3.4-7.0
138
5.6
College Grad
178
5.0 4.1-5.9
172
4.5 3.5-5.5
157
4.6
3.3-5.9
161
4.6
3.2-6.0
188
5.5
Heavy drinking is definied 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 Prevalences).
22
5.7-8.3
3.3-4.7
4.9-6.5
2.2-7.2
0.7-6.8
2.0-8.0
4.2-6.7
4.0-7.2
4.4-6.5
Table 4 and Figure 5 present regional rates of adult heavy drinking from the BRFSS
survey. Regional estimates were created by aggregating all data collected in 2005, 2006
& 2007. Results indicate that rates of heavy drinking range from 3 to 7 percent across the
state, with no particular region demonstrating rates that are significantly different from
the statewide average.
Table 4.
PA Adult Heavy Drinking by Region 2005-2007
County/Region
Pennsylvania
Philadelphia
Bucks
Montgomery
Chester
Delaware
Lancaster
Berks, Schuylkill
Carbon, Lehigh, Northampton
Pike, Monroe, Susquehanna, Wayne
Lackawanna, Luzerne, Wyoming
Adams, Franklin, Fulton
York
Cumberland, Perry
Dauphin, Lebanon
Bedford, Blair, Huntingdon, Juniata, Mifflin
Cntr, Colmbia, Montr, Nrthumbrlnd, Snyder, Union
Bradford, Sullivan, Tioga, Lycoming, Clinton, Potter
Erie
Crawford, Lawrence, Mercer, Venango
Forst, Elk, Camrn, Clrfd, Jefrsn, Clarn, McKn, Wrrn
Allegheny
Westmoreland
Indiana, Cambria, Somerset, Armstrong
Beaver, Butler
Fayette, Greene, Washington
CI = 95% Confidence Interval
*Source: BRFSS, PA Dept. of Health EpiQMS.
Percent
5
4
5
5
6
6
5
6
5
6
6
5
3
7
4
3
7
4
5
5
7
6
5
6
5
5
CI
(5-6)
(3-6)
(3-7)
(4-8)
(5-7)
(4-11)
(4-7)
(4-8)
(3-9)
(4-9)
(5-8)
(3-9)
(2-5)
(4-11)
(3-6)
(2-5)
(5-10)
(3-6)
(3-8)
(4-7)
(5-11)
(4-8)
(3-7)
(4-9)
(3-8)
(4-7)
23
Figure 5. PA Adult Heavy Drinking by Region (2005-2007).
Source: BRFSS, PA Dept of Health, EpiQMS.
24
CURRENT USE
As illustrated in Figure 6, youth current use (one or more drinks in the last 30-days) from
the PAYS indicates that a very large percentage of 10th and 12th graders are consuming
alcohol. Twelfth-graders 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, 23.2% of students
in 6, 8, 10, and 12 grades report past 30-day use in the 2007 PAYS. In comparison, the
2005-2006 Pennsylvania specific NSDUH estimate for current alcohol use for youth aged
12-17 was 16.3%, which declined from 17.8% in 2003-2004. National rates are nearly
identical according to NSDUH data, with 16.3% of youth aged 12-17 reporting part 30day alcohol use in 2005-2006 and 17.7% of youth in 2003-2004.
Figure 6.
% Past 30-Day Alcohol Use
60%
50%
40%
30%
20%
10%
0%
2001
6th
8th
2003
10th
2005
12th
2007
All Grades
Source: Pennsylvania Youth Survey Report (PAYS)
25
Figure 7 presents substate data from the NSDUH for youth aged 12-20 (see Appendix for
data table). Substate estimates based on the 2004-2006 NSDUH indicate substantial
differences within Pennsylvania regions in youth current use of alcohol. These findings
are similar to those reported for binge drinking. Both the Allegheny County region
(33.8%) and the north-central region (33.1%) showed higher rates than the state average
of 29.5%. Philadelphia County again showed the lowest underage 30-day alcohol
consumption rate at 22.9%.
Figure 7. Alcohol Use in Past 30-days by Persons Aged 12-20 by PA Substate Region
Note: Substate regions are delineated by thick black lines whereas counties are delineated by
thin black lines.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004,
2005, and 2006.
LIFETIME USE
In 2007, 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 12.8. In 2007,
on average, 23.9% of 6th graders, 51% of 8th graders, 70% of 10th graders, and 78.4% of
12th graders sampled reported that they had used alcohol in their lifetime.
26
ALCOHOL SALES
Table 5 displays data on alcohol sales between 1990 and 2006. The data indicate that there was
a decrease in Pennsylvania from 1990 to 1995, and then an increasing trend since 1995. All
sales rates are highest in 2006 (most recent data). 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 2006 was 2.27, while in Pennsylvania it was 2.12.
Table 5.
PA Sales of Ethanol in Gallons per 10,000 Persons (14 years or
older)
Beverage Type
Spirits
Wine
Beer
All beverages
1990
0.55
0.18
1.42
2.15
1995
0.45
0.18
1.23
1.86
2000
0.47
0.21
1.21
1.90
2005
0.55
0.24
1.29
2.08
2006
0.57
0.24
1.30
2.12
Source: Surveillance Report #82: Apparent Per Capita Alcohol
Consumption: National, State, and Regional Trends, 1977-2006.
Bethesda, MD: NIAAA, Alcohol Epidemiologic Data System.
27
VI. A. 3. Adult & Youth Alcohol Consequences
DUI ARREST RATES
Table 6 displays DUI arrests by year from 1990 through 2006. It is important to point out that
this data should be considered an indicator of amount of enforcement and is not an indicator of
consumption. DUI arrests are driven by many forces and are likely to reflect local priorities and
concerns and 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
1990. As in previous years, in 2006 DUI arrest rates for juveniles are much lower than that for
adults. For example, in 2006, the adult arrest rate per 100,000 persons in Pennsylvania was 499
and for juveniles (under 18) it was 21.8. DUI arrests in Pennsylvania overwhelmingly include
White males (see Table 7; arrests are 79% (although female DUI arrest rates are increasing over
the years). Figure 8 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
1990
44,284
367.7
718.8
483.1
15.7
1991
40,143
337.9
678.5
435.7
13.8
1992
37,535
313.8
618.4
408.6
8.1
1993
35,857
298.6
574.5
389.8
7.2
1994
37,172
308.5
519.9
403.5
8.5
1995
36,758
305.0
526.0
398.9
8.4
1996
35,098
290.7
533.9
378.8
13.8
1997
37,073
307.5
538.3
398.7
21.5
1998
40,704
338.6
521.0
437.5
24.7
1999
39,696
330.8
551.0
427.2
22.6
2000
41,058
342.3
508.6
431.4
23.5
2001
40,011
325.8
491.6
414.0
20.6
2002
41,284
336.0
497.4
429.0
22.3
2003
41,613
337.4
492.9
430.9
21.1
2004
43,699
352.2
482.3
450.3
21.3
2005
44,722
359.8
458.1
459.1
20.9
2006
48,698
391.4
479.3
499.0
21.8
*Juveniles are persons 17 years of age or younger. Rates computed using US Census population
numbers.
Source: PA State Police, Uniform Crime Report
28
Table 7.
Percent of DUI Arrest Offenders by Gender and
Race/Ethnicity
Year
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Male
88%
87%
87%
87%
87%
86%
85%
85%
84%
84%
84%
83%
82%
81%
81%
81%
79%
Female
12%
13%
13%
13%
13%
14%
15%
15%
16%
16%
16%
17%
18%
19%
19%
19%
21%
White
93%
92%
93%
92%
92%
91%
92%
91%
91%
92%
90%
88%
91%
92%
91%
90%
90%
Minority
7%
8%
7%
8%
8%
9%
8%
9%
9%
8%
10%
12%
9%
8%
9%
10%
10%
Source: Pennsylvania State Police, Uniform Crime
Report.
Figure 8.
29
SELF-REPORTED DRIVING UNDER THE INFLUENCE (OF ALCOHOL)
For youth, Figure 9 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 2007 in self-reported DUI.
Figure 9.
% Past 30-Day Self-Reported DUI (of
Alcohol)
30%
25%
20%
15%
10%
5%
0%
2001
2003
10th
2005
2007
12th
Source: 2001-2007 Pennsylvania Youth Survey Report (PAYS)
ALCOHOL-RELATED CONVICTIONS IN PENNSYLVANIA
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 purchase 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.
30
Table 8.
Alcohol-Related Convictions per 100,000 people in 2008
Underage
Public
Purchase of DUI - Alcohol or
Drunkeness
Alcohol/Tob.
Drug Related
SCA
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
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
31
PERCENT FATAL MOTOR VEHICLE CRASHES INVOLVING ALCOHOL
Table 9 shows the percent of alcohol related motor vehicle crashes in Pennsylvania from years
2003-2007. The percent of alcohol-related fatal crashes in Pennsylvania has remained relatively
constant from 2003 to 2007. In 2007, 36% of all crash deaths were alcohol related. The
comparable national rate in 2007 was 37%. Figure 10 combines five years of crash data (20032007) to obtain county level alcohol-related traffic fatalities adjusted for population size.
Sullivan and Forest counties have the highest rates at 22.5 and 19.9 deaths per 100,000
respectively. Philadelphia and Delaware counties have the lowest rates at 2.2 deaths per 100,000
each.
Table 9.
Alcohol Related Crashes in PA - Five Year Trends
2003
2004
2005
2006
All Crashes
140,207 137,410 132,829 128,342
All Injuries
106,372 105,222 100,381
96,597
All Deaths
1,577
1,490
1,616
1,525
Alcohol Related Crashes
13,689
13,624
13,179
13,616
Alcohol Related Injuries
11,274
10,822
10,423
10,529
Alcohol Related Deaths
558
541
580
545
% Crashes Alcohol Related
10%
10%
10%
11%
% Injuries Alcohol Related
11%
10%
10%
11%
% Deaths Alcohol Related
35%
36%
36%
36%
Source: Fatality Analysis Reporting System (FARS)
32
2007
130,675
94,633
1,491
12,867
9,825
535
10%
10%
36%
Figure 10. Five Year Averages of the Total Number of Alcohol-Related Traffic Fatalities
per 100,000 by County in Pennsylvania (2003-2007).
Source: Fatality Analysis Reporting System (FARS); Calculated by averaging the total number
of alcohol related traffic deaths from 2003 to 2007.
33
FATAL MOTOR VEHICLE DEATH RATE INVOLVING ALCOHOL
Figure 11 shows the alcohol-related motor vehicle death rate (per 100,000 licensed persons) in
Pennsylvania by year. This rate appears to be fairly stable from 2003 to 2007. In 2003, there
were 6.6 deaths per 100,000 licensed drivers from alcohol-related motor vehicle crashes and in
2007 there were 6.2 deaths; there were a total of 535 alcohol-related deaths in 2007. Nationally,
in 2007, there were about 6.3 deaths per 100,000 licensed drivers from alcohol-related motor
vehicle crashes.
Figure 11.
Alcohol-Related Crash Deaths per
100,000 Licensed Drivers
10
8
6
4
2
0
2003
2004
2005
2006
2007
Source: FARS PA Crash Data.
PERCENT DRINKING DRIVERS (AMONG ALL DRIVERS) IN CRASHES
Age related differences for this indicator are shown in Figure 12. There are substantial agerelated changes with the highest rates (10.5%) at ages 21-25. Rates gradually decrease among
older adults. In addition, males account for 77% of alcohol-related crashes.
Figure 12.
Percentage of Alcohol Related Crashes
by Age and Gender in 2007
12.00%
10.00%
8.00%
6.00%
4.00%
2.00%
% Female
% Male
0.00%
Source: FARS PA Crash Data.
34
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 2004-2006, 2.1 persons died each year per 100,000
(95% CI: 2.0-2.3). For comparison purposes, the US rate in 2005 was 4.4 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.
Annual Average (2004-2006) PA Rates of Death from Alcoholic
Liver Disease
1
CATEGORY
COUNT POPULATION RATE
95% CI
Total
883
37,276,529
2.1
2.0-2.3
Gender
Male
666
18,069,907
3.4
3.2-3.7
Female
217
19,206,622
1
0.9-1.2
Race
White
819
32,161,085
2.2
2.1-2.4
Black
59
3,933,633
1.6
1.2-2.1
Hispanic
23
1,508,612
2.5
1.5-4.0
Source: Pennsylvania Certificates of Death
1
Per 100,000 People
35
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 don‘t 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 there are thousands of Pennsylvania treatment admissions related to alcohol
use every year. Between 1995 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 in 2004 and 2005.
The number of admissions for alcohol plus another drug also showed a steady decline until 2004.
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 53.1% in 1995 and 38.6% in 2005
(however, the absolute total number of admission increased over this period). Table 12 shows
that clients are largely male, White, and between 21-50 years old.
Table 11.
Percent and Number of Treatment Admissions for Alcohol
Use
Pennsylvania
Pennsylvania
National
National
Alcohol Only
Alcohol +
Year
Alcohol Only
Alcohol +
1992 12,845 (38.1%)
37.2%
8,256 (24.6%)
22.6%
1993 16,583 (31.7%)
34.5%
12,162 (23.2%)
23.0%
1994 17,375 (29.1%)
31.1%
14,120 (23.6%)
22.3%
1995 17,977 (28.5%)
29.4%
15,507 (24.5%)
22.2%
1996 16,378 (27.7%)
28.8%
14,012 (23.6%)
22.4%
1997 14,478 (25.9%)
27.7%
12,912 (23.1%)
22.4%
1998 12,460 (24.4%)
27.0%
11,737 (23.1%)
22.3%
1999 13,642 (25.0%)
26.7%
12,844 (23.6%)
21.9%
2000 15,615 (24.4%)
25.8%
14,002 (21.8%)
21.2%
2001 14,817 (24.2%)
24.4%
12,430 (20.3%)
20.6%
2002 14,573 (23.9%)
23.7%
11,721 (19.2%)
20.1%
2003 14,525 (22.5%)
23.1%
10,926 (16.9%)
19.2%
2004 19,536 (22.5%)
22.2%
14,500 (16.7%)
18.8%
2005 16,785 (21.9%)
21.7%
12,738 (16.6%)
17.9%
2006 15,880 (22.2%)
21.9%
11,810 (16.5%)
18.2%
2007 16,621 (23.9%)
22.3%
11,188 (16.2%)
18.3%
Note: Alcohol + refers to admissions for alcohol along with a secondary drug
Source: Office of Applied Studies, Substance Abuse and Mental Health
Services Administration, Treatment Episode Data Set (TEDS)
36
Table 12.
% Pennsylvania Treatment Admissions for Alcohol Use by
Demographics, 2007
Alcohol only
(n=16,621;
24%)
Alcohol with
secondary drug
(n=11,188; 16.2%)
Total N=75,749
Gender
72.6
Male
27.4
Female
Age at admission
12-14 years
0.5
15-17 years
2.5
18-20 years
4.8
21-24 years
9.7
25-29 years
11.7
30-34 years
10.4
35-39 years
13.3
40-44 years
16.0
45-49 years
14.5
50-54 years
9.3
7.3
55 and over
Race
White
88.1
Black
9.8
Ethnicity
4.5
Hispanic or Latino
N=All admissions, n=admissions for substance.
72.2
27.8
0.7
5.1
6.5
13.3
14.8
11.3
13.0
14.6
12.1
5.8
2.7
77.7
19.9
5.5
Source: Office of Applied Studies, Substance Abuse and
Mental Health Services Administration, Treatment Episode
Data Set (TEDS).
37
PERCENT MEETING DSM-IV FOR ALCOHOL ABUSE OR DEPENDENCE
The NSDUH includes a series of questions to assess the prevalence of substance use disorders (i.e., dependence on or abuse of a
substance) in the past 12 months. These questions are used to classify persons as being dependent on or abusing specific substances
based on criteria specified in the DSM-IV manual. The questions on dependence concern health and emotional problems, attempts to
cut down on use, tolerance, withdrawal, and other symptoms associated with substances used. The questions on abuse assess problems
at work, home, and school; problems with family or friends; physical danger; and trouble with the law due to substance use. Across
the nation, 7.7% of the population aged 12 or older was classified in 2006-2007 as being dependent on or having had an alcohol abuse
disorder in the past year. In Pennsylvania, 6.4% of persons 12 or older met the DSM-IV criteria in 2006-2007 (Table 13). Age
disaggregation indicates that people aged 18-25 showed significantly higher rates than other age groups with 16.8% categorized as
dependent on or abusing alcohol in 2006-2007. Figure 13 shows substance abuse/dependence rates by substate NSDUH regions: the
north-central region shows the highest rate at 8.6%.
Table 13.
% PA Meeting DSM-IV Alcohol Abuse/Dependence in Past Year by Age Group
2002-2003
2003-2004
2004-2005
2005-2006
2006-2007
Estimate
95% CI
Estimate
95 % CI
Estimate
95 % CI
Estimate
95 % CI
Estimate
95 % CI
All Ages
6.93
(6.26 - 7.67)
7.56
(6.86 - 8.33)
7.57
(6.87 - 8.33)
6.75
(6.08 - 7.48)
6.36 (5.72 - 7.06)
5.34
(4.57 - 6.24)
5.63
(4.83 - 6.57)
5.65
(4.84 - 6.57)
5.08
(4.35 - 5.93)
4.67 (3.99 - 5.46)
12-17
18-25
18.08 (16.53 - 19.75) 19.07 (17.48 - 20.77) 19.03 (17.48 - 20.68) 17.58 (16.07 - 19.20)
16.8 (15.39 - 18.32)
5.33
(4.56 - 6.23)
5.92
(5.10 - 6.86)
5.93
(5.09 - 6.89)
5.18
(4.41 - 6.08)
4.86 (4.12 - 5.71)
26+
CI = Confidence Interval
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health.
38
Figure 13. Percent Meeting DSM-IV Alcohol Abuse/Dependence in Past Year by
Persons Aged 12+ by PA Substate Region
Note: Substate regions are delineated by thick black lines whereas counties are delineated by
thin black lines.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004,
2005, and 2006.
39
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 17% of
Pennsylvania adults and similar rates are reported by high school students. 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. 36% of all traffic deaths are
alcohol related. Further, 6.4% of PA residents age 12 and older meet DSM-IV alcohol
abuse or dependence criteria. 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. For youth, it appears that girls show similar
rates of 30-day alcohol use, but lower rates of binge drinking than teen boys. 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.
On the PAYS Survey, 12th graders showed a substantial drop between 2005 and 2007.
However, they had risen in the 2005 data while rates at other grades levels had decreased
or remained stable. Thus, in the 2005 data it was unclear whether these increases were
―real‖ or statistical artifacts. The fact they have now declined below previous rates (e.g.
2003) may support the concern that (1) 2005 data was problematic, and (2) indicate a true
drop in the last two years.
Geographically, it appears that the certain substate regions show higher rates of
consumption & consequences for both adults and youth. Higher rates are seen in
Allegheny County, the northwest corner (regions 19 and 23 in the NSDUH), and the
north-central area of the state. Perhaps surprisingly for the largest urban area,
Philadelphia has lower rates than many other areas of the state.
Time Trends. During the past three years, the rates of ―problem drinking‖ in adults
appear to be relatively stable. From 2005 to 2007 there appears to be a decrease in
drinking among high school students according to the PAYS data. This trend is also
reflected in NSDUH data, which indicates a small decrease in the past 30-day use of
alcohol for youth ages 12-20 between 2002-2004 and 2004-2006. Over the past decade
there have been some increases in DUI arrests and in 2006, 48,698 people were arrested
for driving under the influence, which is more than any previous year.
National Comparisons. On most indicators, comparisons with the 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,
40
Pennsylvania has slightly lower rates of alcohol abuse/dependence and fewer DUI arrests
per 100,000 persons.
Table 14.
Alcohol Indicators Compared by: Magnitude, Time Trends, and National Comparisons
CONSUMPTION
30-Day Adult Binge Drinking (2008, BRFSS)
30-Day Youth Binge Drinking (2006-2007, NSDUH)
30-Day Adult Heavy Drinking (2008, BRFSS)
30-Day Youth Alcohol Use (2006-2007, NSDUH)
Alcohol Sales per Capita (all beverages) (2006)
PA Magnitude
16.7%
20.4%
5.5%
29.5%
2.1
Trend
Stable
Stable
Stable
Down
Stable
Rate
Ratio
(RR)
1.03
1.08
1.00
1.04
1.00
CONSEQUENCES
DUI Arrests & Rate per 100,000 Persons (2006)
Number & % Alcohol-Related Crash Deaths (2007)
Alcohol-Related Deaths per 100,000 Licensed Drivers (2007)
Alcoholic liver Disease Deaths & Rate per 100,000 Persons (2004-2006)
Number & % Admissions to Treatment Centers for Alcohol (2004)
% Persons Meeting DSM-IV Alcohol Abuse or Dependence (2006-2007)
48,698 (391.4)
535 (36%)
6.2
883 (2.1)
16,621 (23.9%)
6.4%
Up
Stable
Stable
Stable
Stable
Stable
0.81
0.97
0.98
0.48
1.07
.88
Note: This table does not include youth lifetime alcohol use nor youth self-reported DUI as there weren't
comparable national rates. RR=1, no difference; RR>1, PA higher than US; RR<1, PA lower than US
41
VI. B. Tobacco
VI. B. 1. Tobacco Indicators Defined
Consumption
Current use—defined for youth (under 18) as using a tobacco product (smoking and
smoke-less) 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 whom had a
live birth and who reported smoking at least one cigarette during pregnancy out of all
mothers whom had 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 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 is then age-specific) death rate per 100,000 persons due to an
underlying cause of death specified as ICD-10 code: J43.
42
VI. B. 2. Adult & Youth Tobacco Consumption
CURRENT USE
As shown in Figure 14, Pennsylvania has been above the national median for the
prevalence of adult current smoking for the past decade. Specifically, in 2007, the
Pennsylvania adult current smoking prevalence was 21.0% (95% CI: 19.6-22.4%) while
nationally it was 19.8%. Smoking rates in both the US and Pennsylvania show declines
in 2006-2007, as compared earlier years. However, between 2005 and 2008 PA rates
appear to have declined more rapidly and to now be closer to the national average.
Figure 14.
Source: BRFSS, CDC (State Prevalence & US Median Prevalence)
43
Table 15 contrasts rates of adult current smoking in Pennsylvania between 1995, 2005, 2007, and
2008, disaggregating by age, gender, race/ethnicity, and educational level. The prevalence of
smoking has significantly declined over this time-period. Men show slightly higher rates of
current smoking. The smoking prevalence begins to decline substantially after age 55. In 2008,
Blacks (26.8%) have a higher rate of current smoking than Whites (20.2%). Educational
attainment is related to substantial differences in smoking rates, with lower smoking rates
associated with higher educational attainment in all years. For example, respondents with less
than a high school education have a smoking rate of 34.5% while respondents who are college
graduates have a smoking rate of 10.6%.
Table 15. % Adult Current Smoking Prevalence by Smokers’ Characteristics
PA Adult Current Smoking
All Adults
1995 (N=3,591)
2005 (N=13,314)
2007 (N=13,163)
2008 (N=13,133)
n (yes) % yes
CI
n (yes) % yes
CI
n (yes) % yes
CI
n (yes) % yes
CI
866 24.2 22.4-26.1 3011 23.6 22.4-24.8 2834
21 19.6-22.4 2646 21.3 20.0-22.6
Male
Female
400
466
26.1 23.4-28.8
22.6 20.1-25.1
1138
1873
18-24
25-34
35-44
45-54
55-64
65+
68
219
237
158
89
88
28.6
32.0
29.4
23.8
21.1
11.4
21.5-35.7
26.8-37.2
25.8-33.0
20.2-27.4
16.7-25.5
8.6-14.3
243
473
703
767
506
319
White
Black
Hispanic
749
87
12
23.9 21.9-25.9
32.4 25.5-39.2
13.2 4.7-21.7
2428
376
71
25.0 23.0-27.0
22.4 21.0-23.8
35.0
27.8
28.8
25.5
19.8
9.4
984
1850
29.5-40.5
24.4-31.2
26.2-31.4
23.1-27.9
17.5-22.1
8.0-10.8
143
401
607
703
583
397
22.4 21.2-23.6
30.8 25.2-36.4
31.1 22.2-40.0
2279
385
48
20.8 18.6-23.0
21.1 19.5-22.7
26.8
28.6
25
22.7
18.1
8.4
20.3-33.3
24.5-32.7
22.1-27.9
20.2-25.2
15.7-20.5
7.0-9.8
20.4 19.0-21.8
27.5 21.6-33.4
15.1 7.5-22.7
1029 23.4 21.2-25.5
1617 19.4 18.0-20.9
131
336
534
727
554
364
28.6
28.6
25.3
23.9
17.8
7.7
22.3-34.8
24.6-32.7
22.6-28.1
21.6-26.3
15.6-20.0
6.6-8.9
2083 20.2 18.9-21.4
383 26.8 21.0-32.5
59 26.5 17.3-35.8
<HS
148 29.6 24.7-34.6
447 38.6 33.9-43.3
401 33.3 27.8-38.8
356 34.5 28.6-40.4
HS or GED
379 27.3 24.2-30.3 1432 28.3 26.3-30.3 1326 25.9 23.5-28.3 1254 26.7 24.4-28.9
Some College
194 26.4 21.8-31.1
703 24.3 21.7-26.9
683 23.7 20.8-26.6
627 22.5 19.7-25.2
College Grad
144 13.9 11.5-16.4
425 11.7 10.2-13.2
420 10.5 8.7-12.3
406 10.6 9.2-12.1
% = 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).
44
Table 16 and Figure 15 combine several years (2005-2007) of BRFSS data collection to
produce more accurate county/regional estimates of current smoking. Findings indicate
that Philadelphia county and the Lackawanna, Luzerne, Wyoming region have higher
rates of adult smoking than Pennsylvania as a whole. Montgomery and Chester counties
both have lower rates of smoking as compared to Pennsylvania as a whole.
Table 16.
PA Adult Current Smoking (2005-2007)
County/Region
Percent
CI
Pennsylvania
22
(22-23)
Philadelphia
28
(25-31)
Bucks
20
(16-23)
Montgomery
16
(13-19)
Chester
15
(13-17)
Delaware
25
(21-30)
Lancaster
18
(15-22)
Berks, Schuylkill
20
(17-23)
Carbon, Lehigh, Northampton
21
(18-25)
Pike, Monroe, Susquehanna, Wayne
25
(21-29)
Lackawanna, Luzerne, Wyoming
29
(26-32)
Adams, Franklin, Fulton
21
(17-27)
York
22
(19-26)
Cumberland, Perry
19
(15-24)
Dauphin, Lebanon
21
(17-25)
Bedford, Blair, Huntingdon, Juniata, Mifflin
27
(23-33)
Cntr, Colmbia, Montr, Nrthumbrlnd, Snyder, Union
24
(19-29)
Bradford, Sullivan, Tioga, Lycoming, Clinton, Potter
23
(20-27)
Erie
27
(22-31)
Crawford, Lawrence, Mercer, Venango
21
(17-24)
Forst, Elk, Camrn, Clrfd, Jefrsn, Clarn, McKn, Wrrn
23
(19-27)
Allegheny
22
(19-25)
Westmoreland
20
(16-25)
Indiana, Cambria, Somerset, Armstrong
20
(17-23)
Beaver, Butler
23
(19-28)
Fayette, Greene, Washington
25
(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.
45
Figure 15. PA Adult Current Smoking (2005-2007).
Source: BRFSS, PA Dept. of Health EpiQMS.
46
For youth, Table 17 and Figure 16 show results from the PAYS survey in 2001-2007.
Results for 6th and 8th graders indicate that both cigarette use and smokeless tobacco have
declined since 2001. 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 possibly higher cigarette smoking rates in girls, but much
higher rates of smokeless tobacco use for boys: 8.5% of males versus only 1.7% of
females in 2007.
Table 17.
% PA Youth Tobacco Use by Year
Cigarettes
Past 30 Day Use
2001 2003 2005 2007
Grade
6th
2.2
2.1
1.0
8th
10.6
10.9
6.4
10th
20.2
19.0
18.4
12th
31.9
25.8
28.5
All Grades
15.4
14.1
13.3
Gender
Females
16.0
14.9
14.3
Males
14.9
13.1
12.4
Source: PAYS Statewide Report.
Smokeless Tobacco
Past 30 Day Use
2001 2003 2005 2007
1.3
5.5
13.7
20.6
10.2
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
10.6
9.9
2.2
8.7
1.7
8.5
1.9
9.1
1.7
8.5
Figure 16.
Source: Pennsylvania Youth Survey Report
47
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 17, current cigarette use among middle
school students in Pennsylvania has dropped by nearly half, from an estimate of eight
percent in 2002 to nearly four percent in 2006. With respect to high school students
(grades nine through 12), cigarette use has fallen (see Figure 18), from an estimate of
23% in 2002 to an estimate of 18% in 2006. Survey data from 2006 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 19). Figure 20
illustrates the steady increase in rates of tobacco use from grade 6 (5%) to grade 12
(35%). Figure 21 illustrates age of onset data, indicating that 13-14 years old is the most
common age to first smoke a whole cigarette.
Figure 17. Current Cigarette Use among PA Middle School Students
20
Percent
15
10
5
0
YTS 2002
YTS 2006
Figure 18. Current Cigarette Use among PA High School Students
30
Percent
25
20
15
10
5
0
YTS 2002
YTS 2006
48
Figure 19.
Percent of Pennsylvania Students Who Used Any
Tobacco Product in the Past 30 Days, by Race/Ethnicity and Sex
50
Percent
40
30
High
School
20
Middle
School
10
0
Black
Figure 20.
Hispanic
White
Female
Male
Total
Percent of Pennsylvania Students Who Used
Any Tobacco Products in the Past 30 Days, by Grade
50
30
t
Percent
40
20
10
0
6th grade 7th grade 8th grade 9th grade 10th grade 11th grade 12th grade
Figure 21. Age High School Students Smoked a Whole Cigarette for
the First Time
50
Percent
40
30
20
10
0
8 years
old or
younger
9 or 10 11 or 12 13 or 14 15 or 16
years old years old years old years old
17 or
older
49
NSDUH survey data from 2005-2006 permits comparison of youth smoking rates in
Pennsylvania compared to national youth rates. The 2005-2006 surveys estimated that
15.0% of Pennsylvania youth aged 12-17 currently use tobacco products. This can be
compared with the US prevalence rate from the 2005-2006 NSDUHs for youth aged 1217: 12.9%.
Figures 22 and 23 display regional data from the NSDUHs (2004-2006) for all persons in
Pennsylvania aged 12 or older. Most regions of Pennsylvania have higher current
smoking use (Figure 22) and current tobacco use (any tobacco product – Figure 23) than
the rest of the nation (please see Appendix for data tables).
Figure 22. PA Cigarette Use in Past Month Among Persons 12 or Older
Note: Substate regions are delineated by thick black lines whereas counties are delineated by
thin black lines.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004,
2005, and 2006.
50
Figure 23. PA Tobacco Use in Past Month Among Persons 12 or Older
Note: Substate regions are delineated by thick black lines whereas counties are delineated by
thin black lines.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004,
2005, and 2006.
51
DAILY SMOKING
As seen in Table 18, in 2008, Pennsylvania adult daily smoking prevalence is lower (15.6%) than in 2002 (19.5%). However, the
2008 estimate is above the national median rate of 13.4%. As with current smoking, educational attainment plays a substantial role in
adult daily smoking; rates decline with greater educational attainment at both assessments (see Figure 24). Additionally, daily
smoking rates decline with age. However, there are no significant differences by gender or ethnicity.
Table 18. % PA Adult Daily Cigarette Use by Smokers’ Demographics
PA Adult Daily Smoking
All Adults
Male
Female
18-24
25-34
35-44
45-54
55-64
65+
White
Black
Hispanic
2002 (N=13,464)
2005 (N=13,314)
2007 (N=13,163)
2008 (N=13,163)
n (yes) % yes
CI
n (yes) % yes
CI
n (yes) % yes
CI
n (yes) % yes
CI
2502 19.5 18.5-20.5
2295 17.9 16.8-19.0
2186 15.1 13.9-16.3
1986 15.6 14.5-16.7
1061 20.9 19.3-22.5
1441 18.2 17.1-19.3
203
451
644
611
350
243
24.0
23.5
24.4
21.5
17.8
7.8
19.7-28.3
21.0-26.0
22.2-26.6
19.5-23.5
15.6-20.0
6.6-9.0
2191 19.0 18.0-20.0
144 20.4 16.7-24.1
53 19.1 13.2-25.0
849 18.8 17.0-20.6
1446 17.2 15.9-18.5
183
360
560
591
380
221
27.0
20.5
22.8
19.4
15.3
6.2
750
1436
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
1887 17.2 16.1-18.3
266 21.9 16.6-27.2
50 22.4 14.1-30.7
1781
269
33
14.4 12.6-16.2
15.8 14.4-17.2
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
15.1 13.9-16.3
15.3 11.2-19.4
12.5 5.2-19.8
771 17.2 15.3-19.1
1215 14.2 13.0-15.4
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
1611 15.2 14.1-16.3
244 17.5 12.6-22.4
44 20.4 11.8-29.0
<HS
367 28.9 25.5-32.3
369 31.5 27.0-36.0
310 24.6 19.5-29.7
264 27.4 21.6-33.2
HS or GED
1262 24.6 23.0-26.2
1120 22.4 20.5-24.3
1065 19.5 17.5-21.5
999 21.1 19.0-23.1
Some College
541 19.2 16.9-21.5
511 17.3 15.0-19.6
520 17.6 15.1-20.1
441 14.1 12.1-16.2
College Grad
331
8.9 7.7-10.1
292
7.7 6.5-8.9
288
6.4
5.2-7.6
279
7.2
6.0-8.4
% = 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).
52
Figure 24.
2008 Smoking Prevalence
of PA Everyday Smokers by
Education
30
25
20
15
10
5
0
Less
H.S. or Some College
than H.S. G.E.D. post-H.S. graduate
Source: BRFSS, CDC (State Prevalence)
LIFETIME USE
In 2007, Pennsylvania youth (6th, 8th, 10th, and 12th graders), on average, reported using
cigarettes for the first time at age 12.7. In 2007, on average, 5.6% of 6th graders, 16.2%
of 8th graders, 32.3% of 10th graders, and 42.1% of 12th graders reported that they had
tried smoking cigarettes in their lifetime.
53
PERCENT SMOKING DURING PREGNANCY
Table 19 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 2007 (17.5% or 25,155 live births).
Pennsylvania rates were substantially higher than the national rates. Nationally, in 2006,
10% of mothers whom gave a live birth reported smoking while pregnant (CDC National
Vital Statistics System). Ethnicity/race comparisons indicate possible lower rates for
pregnant women of Hispanic origin.
Table 19.
% PA Mothers Who Smoked During Pregnancy
by Age and Race/Ethnicity
1996
2002
2004
Total
18.2
15.8
17.9
Age
<20
24.2
23.9
28.9
20-24
25.3
24.8
29.4
25-29
17.1
13.9
16.6
30-34
13.6
10.1
10.1
35-39
14.3
10.6
10.4
40+
12.3
11.4
12.2
Race/Ethnicity
White
18.3
16.5
19.2
Black
20.4
14.5
17.6
Hispanic
13.9
11.2
12.4
Note: Unknowns excluded in calculations.
Source: Pennsylvania Vital Statistics, PA Department of Health
2007
17.5
24.8
27.8
17.2
10.2
9.6
10.7
19.3
15.6
10.6
54
VI. B. 3. Adult & Youth Tobacco Consequences
LUNG CANCER DEATH RATE
Almost 24,000 deaths were directly attributed to lung cancer during the three years 20042006 in Pennsylvania (Table 20). On average, annually, the rate of death was 53.2
persons per 100,000 (PA Department of Health data). For comparison purposes, rates
were calculated from US Department of Health data provided (same ICD-10 code).
According to this data, in 2005, the rate was 53.7 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
2006 (see Figure 25). Figure 26 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: Philadelphia, Forest, Potter, and Venango.
Table 20.
Annual Average (2004-2006) PA Rates of Death from Lung
Cancer
1
CATEGORY
COUNT POPULATION RATE
95% CI
Total 23,906
37,276,529
53.2
52.6-53.9
Gender
Male 13,494
18,069,907
71.0-73.5
72.3
Female 10,412
19,206,622
39.5-41.0
40.2
Race
White 21,524
32,161,085
51.6-53.0
52.3
Black
3,933,633
67.9-73.8
2,264
70.8
Hispanic
1,508,612
14.5-21.7
118
17.8
Source: Pennsylvania Certificates of Death
1
Per 100,000 People
55
Figure 25.
Lung Cancer Death Rates per 100,000
Persons in PA by Gender 1990-2006
100
90
80
70
60
50
40
30
Male
Female
20
10
0
Source: PA Department of Health, EPIQMS, PA Certificates of Death
Figure 26.
*NA=not available, ND=not displayed if count less than 10
Source: PA Department of Health, EPIQMS, PA Certificates of Death
56
EMPHYSEMA DEATH RATE
1,788 deaths were attributed to emphysema during the three years 2004-2006 in
Pennsylvania (Table 21). On average, annually, 3.9 people died per 100,000 persons (PA
Department of Health data). For comparison purposes, in 2005 the US rate was 4.7
deaths per 100,000 persons (CDC, National Center for Health Statistics,
http://www.cdc.gov/nchs/fastats/emphsema.htm); compared to 4.2 (95% CI: 3.9-4.6) in
Pennsylvania.
The death rate for men was disproportionately higher than for women. However,
between 1990-2006 (Figure 27), the gender gap has declined, with female rates staying
fairly stable over the years while male rates decreased. In Figure 28, it can be seen that
the southeast and western regions of the state are more affected by this condition. The
counties with the highest rates are in orange: Crawford, Warren, McKean, & Tioga.
Table 21.
Annual Average (2004-2006) PA Rates of Death from
Emphysema
1
CATEGORY
COUNT POPULATION RATE
95% CI
Total
1,788
37,276,529
3.9
3.7-4.1
Gender
Male
864
18,069,907
4.9
4.6-5.2
Female
924
19,206,622
3.4
3.1-3.6
Race
White
1,644
32,161,085
3.9
3.7-4.1
Black
138
3,933,633
4.5
3.8-5.4
Hispanic
8
1,508,612
ND
ND
Source: Pennsylvania Certificates of Death
1
Per 100,000 People
ND = Data not displayed because estimates are unreliable.
57
Figure 27.
Emphysema Death Rates per 100,000 Persons
in PA by Gender 1990-2006
Deaths per 100,000 people
9
8
7
6
5
4
Male
3
Female
2
1
0
Year
Source: PA Department of Health, EPIQMS, PA Certificates of Death
Figure 28.
*NA=not available, ND=not displayed if count less than 10
Source: PA Department of Health, EPIQMS, PA Certificates of Death
58
VI. B. 4. Tobacco Summary
The results of the data on key tobacco indicators are summarized in Table 22. 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 22.
Tobacco Indicators Compared by:
Magnitude, Time Trends, and National Comparisons
CONSUMPTION
Current Adult Smoking Prevalence (2008, BRFSS)
30-Day Youth Cigarette Use (2005-2006, NSDUH)
Daily Adult Smoking Prevalence (2008, BRFSS)
Smoking While Pregnant Births and Percent (2007)
CONSEQUENCES
Lung Cancer Deaths & Rate per 100,000 Persons (2006)
Emphysema Deaths & Rate per 100,000 Persons (2006)
PA Magnitude
21.3%
12.5%
15.6%
25,155 17.5%
Trend
Down
Down
Down
Stable
Rate
Ratio
(RR)
1.16
1.18
1.16
1.75
7,969 (53.2)
596 (3.9)
Down
Down
0.99
0.83
Note: Table does not include 30-Day Youth Smokeless Tobacco Use nor Youth Lifetime Use as
there weren't comparable national rates. RR=1, no difference; RR>1, PA higher than US; RR<1,
PA lower than US.
Magnitude. Tobacco use affects many Pennsylvanians. 21.3% of adults are current
smokers and 15.6% smoke daily. Of substantial public health concern is that 18% of
mothers report that they smoked during their pregnancy in 2007. 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 is 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 than women that are attributable
to tobacco use. Geographically, there is no clear pattern of ―hot spots.‖
59
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 stable and alarmingly high at 18%.
National Comparisons. Pennsylvania is above the national median levels with regard to
all consumption indicators for tobacco as shown in Table 22. Rates of smoking while
pregnant are 75% higher in Pennsylvania than in the US as a whole. Pennsylvania is
below the national median levels with regard to the consequence indicators, lung cancer
death and emphysema death.
60
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 edition (DSM-IV)
(American Psychiatric Association [APA], 1994)).
61
VI. C. 2. Adult & Youth Other Drug Consumption
CURRENT MARIJUANA USE
Table 23 displays current estimates of 30-day marijuana use from the NSDUH for different age groups. Rates increase substantially
from 6.4% for youth aged 12-17 to 16.9% for young adults aged 18-25. Pennsylvania rates are similar to the national rates for 20052006: 6.7% (12-17), 16.4% (18-25), 4.1% (>25), and overall 6.0%.
Table 23.
% PA Marijuana Use in Past Month by Age Group
2002-2003
2003-2004
2004-2005
2005-2006
2006-2007
95% CI
95% CI
95% CI
95% CI
95% CI
Estimate
Estimate
Estimate
Estimate
Estimate
6.11 (5.52 - 6.75)
5.8 (5.23 - 6.43)
5.08 (4.57 - 5.64)
All Ages
5.64 (5.07-6.28)
6.02 (5.47-6.62)
6.88 (5.98 - 7.90)
6.37 (5.50 - 7.36)
6.42 (5.63 - 7.31)
12-17
8.18 (7.20-9.28)
7.75 (6.81-8.82)
18.02 (16.56 - 19.59)
16.92 (15.37 - 18.60)
14.9 (13.47 - 16.46)
18-25
17.66 (16.14-19.29)
17.74 (16.24-19.36)
4.04 (3.38 - 4.83)
3.9 (3.26 - 4.66)
3.3 (2.76 - 3.95)
26+
3.37 (2.75-4.14)
3.87 (3.27-4.57)
Note: CI=Confidence Interval
Source: SAMHSA, Office of Applied Statistics, NSDUH
More detailed data by grade and gender for Pennsylvania students are provided by the PAYS data (Table 24 and Figure 29). There
appear to be substantial increases in 30-day use in each grade, beginning in 8th grade. 19.2% of 12th graders report current marijuana
use which is somewhat higher than the rates discussed above for young adults. There do not appear to be large differences as a result
of gender. Rates by grade have remained stable except for 12th graders where there was decline between 2005 and 2007.
62
Table 24.
% PA Youth Current Marijuana Use
2001
Grade
6th
8th
10th
12th
All Grades
Gender
Females
Males
Past 30-Day Use
2003
2005
2007
0.6
5.3
17.0
25.6
11.4
0.5
5.2
14.5
21.4
10.0
0.3
3.5
12.0
22.9
9.4
0.2
2.8
12.0
19.2
8.5
10.2
12.9
9.1
10.9
8.0
10.7
7.2
9.8
Source: PAYS Statewide Report.
Figure 29.
% Marijuana Current Use by Grade
30.0
25.0
20.0
15.0
10.0
5.0
0.0
6th
8th
10th
12th
2001
2003
2005
2007
Year
Source: PAYS 2005 Statewide Report.
LIFETIME MARIJUANA USE
In 2007, Pennsylvania youth, on average, reported using marijuana for the first time
around age 14 (average of grades 6, 8, 10, and 12). In 2007, 0.9% of 6th graders, 6.5% of
8th graders, 23.5% of 10th graders, and 35.7% of 12th graders reported that they had used
marijuana in their lifetime.
63
CURRENT OTHER ILLICIT DRUG USE
Illicit drug use as assessed in the NSDUH includes all drugs other than alcohol and marijuana/hashish. As displayed in Table 25, the
highest illicit drug use is among 18-25 year olds, who report that about 8% used illicit drugs 30-days before the survey. Youth under
18 years old show a lower rate at 4.2%. Pennsylvania rates are slightly lower compared to the national rates from the 2006-2007
NSDUHs, which are 4.9% (aged 12-17), 8.8% (aged 18-25), 2.8% (adults >25), and overall 3.8%. There has been a small nonsignificant decline in illicit drug use rates in PA between 2002-2003 and 2006-2007. Rates of nonmedical pain reliever use also show
small non-significant declines, with rates of use higher than those of illicit drugs other than marijuana. As displayed in Table 26,
youth 18-25 show the highest rates of pain reliever use at 10.6%. Pennsylvania rates are slightly lower compared to the national rates
from the 2006-2007 NSDUHs, which are 6.9% (aged 12-17), 12.3% (aged 18-25), 3.6% (adults >25), and overall 5.1%.
Table 25.
% PA Other Illicit Drug Use in Past Month by Age Group
2002-2003
2003-2004
95% CI
95% CI
Estimate
Estimate
All Ages
3.44 (3.03-3.92)
3.42 (3.02-3.87)
12-17
5.51 (4.75-6.39)
5.47 (4.72-6.33)
18-25
8.04 (7.05-9.15)
8.55 (7.53-9.69)
26+
2.43 (1.96-3.01)
2.31 (1.87-2.86)
Note: CI=Confidence Interval
Source: SAMHSA, Office of Applied Statistics, NSDUH
2004-2005
95% CI
Estimate
3.25 (2.85 - 3.70)
4.78 (4.08 - 5.59)
8.72 (7.64 - 9.94)
2.15 (1.72 - 2.68)
2005-2006
95% CI
Estimate
3.19 (2.78 - 3.66)
4.46 (3.78 - 5.24)
8.12 (7.05 - 9.34)
2.22 (1.77 - 2.79)
Table 26.
% PA Nonmedical Use of Pain Relievers in Past Year by Age Group
2003-2004
2004-2005
2005-2006
2006-2007
95% CI
95% CI
95% CI
95% CI
Estimate
Estimate
Estimate
Estimate
4.28 (3.84 - 4.77)
4.1 (3.62 - 4.65)
4.03 (3.56 - 4.56)
All Ages
4.13 (3.69 – 4.62)
6.16 (5.30 - 7.14)
5.91 (5.08 - 6.88)
5.94 (5.16 - 6.83)
12-17
6.71 (5.84 – 7.69)
12.63 (11.36 - 14.01)
11.12 (9.89 - 12.47)
10.62 (9.44 - 11.93)
18-25
12.13 (10.87 – 13.51)
2.66 (2.18 - 3.25)
2.72 (2.19 - 3.38)
2.71 (2.22 - 3.31)
26+
2.48 (2.01 – 3.06)
Note: CI=Confidence Interval
Source: SAMHSA, Office of Applied Statistics, NSDUH
64
2006-2007
95% CI
Estimate
3.11 (2.70 - 3.58)
4.18 (3.55 - 4.91)
7.67 (6.71 - 8.76)
2.23 (1.78 - 2.78)
Table 27 shows the youth estimates for other illicit drug use from the PAYS (does not include
non-medical use of prescription drugs), broken down by grade and gender. As in other areas of
drug and alcohol use, there was a substantial decrease in use in 12th graders.
Table 27.
% PA Youth Current Other Illicit
Drug Use*
Past 30-Day Use
2003
2005
2007
Grade
6th
8th
10th
12th
All Grades
Gender
Females
Males
3.1
6.7
6.8
7.9
6.1
2.7
4.7
6.9
8.5
5.6
2.9
4.6
6.1
4.9
4.7
5.2
6.9
5.2
6.1
4.5
5.1
2001 Data Not Available
* In PAYS, 'Other Illicit Drug Use' does NOT
include non-medical use of prescription drugs.
Source: PAYS Statewide Report.
Figure 30 shows the breakdown of 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 prescription drugs.
Figure 30.
Source: PAYS Report.
65
LIFETIME OTHER ILLICIT DRUG USE
Table 28 displays 2007 youth rates of lifetime use of illicit substances from the PAYS survey.
12th graders reported substantial non-medical use of prescription drugs including amphetamines,
sedatives, tranquilizers, and narcotic pain medications. 10th graders also show 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 28.
% Lifetime Prevalence of Other Illicit Substance Use by Substance by Grade
Substance
Inhalants
Cocaine
Heroin
Hallucinogens
Methamphetamines
Ecstasy
Steroids
Prescription Amphetamines
Prescription Sedatives
Prescription Tranquilizers
Prescription Other Narcotics
6th
7.0
0.3
0.2
0.2
0.2
0.1
0.7
1.7
2.0
0.6
0.7
8th
9.4
0.9
0.3
0.9
0.6
0.7
1.3
3.3
4.4
1.8
1.8
10th
11.0
3.1
1.3
5.0
1.6
3.5
1.6
6.6
6.7
5.6
8.3
12th All Grades
6.6
8.6
5.7
2.5
1.5
0.8
7.3
3.4
1.2
1.0
4.1
2.2
1.5
1.3
7.8
4.9
7.5
5.2
7.4
3.9
12.1
5.7
Source: 2007 PAYS Report. Prescription drugs here are reported used non-medically.
66
VI. C. 3. Adult & Youth Illicit Drug Consequences
DRUG (INCLUDING NON-ILLICIT)-INDUCED DEATH RATE
The drug-induced death count was 5,008 people during 2004-2006 in Pennsylvania as reported in
Table 29. Men and Blacks have substantially higher prevalence rates of such deaths, whereas
Asians have substantially lower rates. The highest death rate was in the age range of 40-44, for
whom 29.9 out of 100,000 persons died on average each year. Overall the rate was 11.3 in 20022004 and showed a small increase to 13.7 in 2004-2006.
Table 29.
Annual Average (2004-2006) PA Rates of Drug-Induced
Death
CATEGORY
COUNT
POPULATION
Total
5,008
37,276,529
Gender
Male
3,394
18,069,907
Female
1,614
19,206,622
Race
White
4,322
32,161,085
Black
663
3,933,633
Asian
16
771,030
Hispanic
185
1,508,612
Age
15-19
135
2,771,312
20-24
509
2,565,100
25-29
501
2,147,273
30-34
454
2,276,110
35-39
633
2,543,652
40-44
831
2,776,251
45-49
798
2,810,815
50-54
528
2,617,932
55-59
248
2,261,759
60-64
89
1,841,751
65-69
69
1,533,243
70-74
55
1,354,929
75-79
50
1,178,874
80-84
44
867,235
85+
51
751,187
Source: Pennsylvania Certificates of Death
1
Per 100,000 People
RATE
13.7
1
95% CI
13.3-14.1
19
8.6
18.3-19.6
8.2-9.0
13.8
18.2
2.4
13.3
13.4-14.2
16.9-19.7
1.3-4.5
11.4-15.6
4.9
19.8
23.3
19.9
24.9
29.9
28.4
20.2
11
4.8
4.5
4.1
4.2
5.1
6.8
4.1-5.8
18.2-21.6
21.3-25.5
18.2-21.9
23.0-26.9
27.9-32.0
26.5-30.4
18.5-22.0
9.6-12.4
3.9-5.9
3.5-5.7
3.1-5.3
3.1-5.6
3.7-6.8
5.1-8.9
DRUG-RELATED CONVICTIONS IN PENNSYLVANIA
Table 30 show 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.
67
Table 30.
Drug Convictions per 100,000 people in 2008
Illegal
Drug
Alcohol/Drug
Possession
Sales
SCA Name
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
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
68
Figure 31 shows drug-induced death rates by county. It can be seen that a large southwest and
eastern portion of Pennsylvania have the highest drug-related death rates. Due to the very low
prevalence, rates cannot be estimated in the Northern Tier counties. The counties in orange have
the highest rates, which are Philadelphia and Cambria.
Figure 31.
*NA=not available, ND=not displayed if count less than 10
Source: PA Department of Health, EPIQMS, PA Certificates of Death
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, the reported admissions are only
to facilities that are either state-certified for treatment and/or receive government funds; thus,
these numbers don‘t 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 31 shows that there were 39,761 treatment admissions in Pennsylvania (in
2007) where illicit drugs were identified as the drug of choice at admission (57% of all
admissions). The most frequent illicit drugs of choice identified (in order of ranking) were:
heroin, cocaine/crack, and marijuana. Clients were mostly male, 21-45 years old, and White.
For national comparison purposes, 57% (39,761) of all 2007 treatment admissions in
Pennsylvania (as reported to TEDS) were related to illicit drug use, compared to 57% nationally.
When broken down by type of illicit drug, the percent of 2007 treatment admissions in
69
Pennsylvania were much lower for methamphetamine and higher for heroin and cocaine/crack
compared to the nation.
Table 31.
2007 Pennsylvania Percent Admissions* to Treatment Facilities by Illicit
Substance and Demographics
N=69,435
Total n=39,761
Total %=57%
Gender
Male
Female
Age at admission
12-14 years
15-17 years
18-20 years
21-24 years
25-29 years
30-34 years
35-39 years
40-44 years
45-49 years
50-54 years
55 years and over
Race
White
Black
Ethnicity
Hispanic or Latino
Cocaine/
Crack
Marijuana
Heroin
Other Opiates
and
Synthetics
11,815
17.0
10,309
14.8
12,706
18.3
4,931
7.1
57.3
42.7
76.1
23.9
65.9
34.1
57.3
42.7
0.1
1.3
3.7
8.8
14.3
14.4
18.5
18
13.6
5.2
2.1
4.4
26.6
16.5
18.6
13.8
7.2
5.3
3.8
2.2
1.2
0.4
0
0.8
7.7
23.4
24.9
13.3
9.9
7.9
6.2
3.7
2.1
0.2
2.6
9.7
23
24.2
13
8.7
6.7
6.6
3
2.2
62.6
34.6
69
27
86.5
9
95.7
3.4
6.8
8.7
12.1
1.8
Source: Treatment Episode Data Set, SAMHSA.
Note: N=Total Admissions, n=Admissions for substance.
*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).
70
Figure 32 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 tripled in Pennsylvania from 1992 (7.1%) to 2004 (22.2%), but
declined to 18.3% in 2007. In contrast, the national percent of treatment admissions for
heroin use rose from 11.0% in 1992 to 13.7% in 2007.
Figure 32.
% Admissions for Heroin, 1992-2007
25
20
15
10
5
0
Pennsylvania
National
Source: Treatment Episode Data Set (TEDS), SAMHSA.
71
PERCENT MEETING DSM-IV FOR ILLICIT DRUG ABUSE OR DEPENDENCE
Table 32 presents the NSDUH data on the percent of people who meet criteria for illicit drug abuse or dependence (see corresponding
section in alcohol consequences for more description of this assessment technique). Overall, an estimated 2.3% of Pennsylvanians
over age 12 meet DSM-IV criteria for illicit drug abuse or dependence in 2006-2007. The age group of 18-25 year olds has the
highest prevalence rate with 7% meeting the criteria for illicit drug abuse or dependence. Over 4% of youth under 18 met the criteria.
Pennsylvania rates are quite similar to national rates. Nationally in 2006-2007, 4.5% (aged 12-17), 7.9% (aged 18-25), 1.7% (over age
25), and 2.8% overall met criteria for illicit drug abuse or dependence.
Table 32.
% PA Meeting DSM-IV Illicit Drug Abuse/Dependence in Past Year by Age Group
2002-2003
2003-2004
2004-2005
Estimate
95% CI
Estimate
95 % CI
Estimate
95 % CI
All Ages
2.70
(2.39 - 3.05)
2.60
(2.28 - 2.97)
2.69
(2.37 - 3.05)
4.54
(3.84 - 5.36)
5.11
(4.36 - 5.97)
4.73
(4.03 - 5.54)
12-17
8.70
(7.69 - 9.83)
7.76
(6.76 - 8.88)
7.96
(6.97 - 9.09)
18-25
1.48
(1.15 - 1.90)
1.44
(1.11 - 1.87)
1.56
(1.23 - 1.98)
26+
CI = Confidence Interval
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health.
2005-2006
Estimate
95 % CI
2.46
(2.14 - 2.83)
3.96
(3.32 - 4.73)
8.00
(6.99 - 9.14)
1.36
(1.03 - 1.81)
72
2006-2007
Estimate
95 % CI
2.25 (1.94 - 2.62)
4.03 (3.43 - 4.74)
7.06 (6.14 - 8.11)
1.24 (0.93 - 1.65)
VI. C. 4. Illicit/Prescription Drug Summary
The results of the data on illicit and prescription drug indicators are summarized in Table 33. 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 33.
Illicit Drug Indicators Compared by: Magnitude, Time Trends, and National Comparisons
CONSUMPTION
Marijuana Use in Past Month, Adults >25 (2006-2007, NSDUH)
Marijuana Use in Past Month, Adults 18-25 (2006-2007, NSDUH)
Marijuana Use in Past Month, Youth <18 (2006-2007, NSDUH)
Other Illicit Drug Use in Past Month, Adults >25 (2006-2007, NSDUH)
Other Illicit Drug Use in Past Month, Adults 18-25 (2006-2007, NSDUH)
Other Illicit Drug Use in Past Month, Youth <18 (2006-2007, NSDUH)
Nonmedical Use of Pain Relievers in Past Year, Adults >25 (2006-2007, NSDUH)
Nonmedical Use of Pain Relievers in Past Year, Adults 18-25 (2006-2007, NSDUH)
Nonmedical Use of Pain Relievers in Past Year, Youth <18 (2006-2007, NSDUH)
CONSEQUENCES
Number and % Admissions to Treatment Centers for Illicit Drugs (2007)
Adults >25 Meeting DSM-IV for Illicit Drug Abuse or Dependence (2006-2007)
Adults 18-25 Meeting DSM-IV for Illicit Drug Abuse or Dependence (2006-2007)
Youth <18 Meeting DSM-IV for Illicit Drug Abuse or Dependence (2006-2007)
Magnitude
3.3%
14.9%
6.4%
2.2%
7.7%
4.2%
2.7%
10.6%
5.9%
Trend
Down
Down
Down
Stable
Stable
Down
Stable
Stable
Stable
Rate
Ratio
(RR)
0.95
1.03
0.96
0.79
0.92
0.92
0.75
0.86
0.86
39,761 (57%)
1.2%
7.1%
4.0%
Stable
Stable
Stable
Stable
1.00
0.73
0.89
0.88
Note: Here, ‘Other Illicit Drug’ includes all illicit drugs reported other than marijuana—including non-medical use of
prescription drugs. Also, this table did not include Youth Lifetime Use or Drug-Induced Death Rate as there weren't
comparable national rates. RR=1, no difference; RR>1, PA higher than US; RR<1, PA lower than US.
73
Magnitude. There is substantial illicit and nonmedical prescription drug use in
Pennsylvania among youth and adults. For adults, the age group of 18-25 year olds stands
out with regard to all self-reported drug use---marijuana and other illicit drug use rates,
along with nonmedical use of pain relievers are much higher than the other age groups
(NSDUH data). Correspondingly, the percent of 18-25 year olds meeting DSM-IV
criteria for illicit drug abuse or dependence is much higher than the other age groups at
7%. There were 39,761 treatment admissions related to illicit drug use reported to TEDS
in 2007. This data is largely limited to block grant/state funded services, plus available
Medicaid information, and does 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, cocaine/crack, and marijuana. The drug-induced death
rate in Pennsylvania (includes non-illicit drugs) affected 5,008 people during the years
2004-2006 and the rates are highest for those between 20 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 in 6th graders, 2.8% among 8th graders, 12% among 10th graders, and a jump
to 19.2% among 12th graders. 35.7% of 12th graders reported that they had tried
marijuana in their lifetime. While marijuana shows the highest 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 7% of 12th graders
reported non-medical use of prescription drugs including amphetamines, sedatives,
tranquilizers and over 12% reported use of narcotic pain medications. Philadelphia and
Cambria counties are higher than the rest of the state with regard to the rate of druginduced deaths.
Time Trends. Marijuana use among all age groups appears to be decreasing; however this
trend is not significant. The current use of other illicit drugs for adults over 18 appears to
be stable, whereas current use of other illicit drugs for youth under age 18 appears to be
decreasing. Although non-medical use of amphetamines, sedatives, tranquilizers, and
narcotic drugs are of substantial concern in 10th and 12th graders, their use decreased from
2005 to 2007 according to the Pennsylvania Youth Survey (PAYS). NSDUH data
indicates nonmedical pain reliever use among all ages is relatively stable.
National Comparisons. Compared with the rest of the nation, Pennsylvania is slightly
below average for most consumption and consequence rates (see rate ratio summary in
Table 33).
74
VII. APPENDIX
75
VII. A. SEOW & Advisory Council Member List
*Indicates a member of the State Epidemiology Outcomes Workgroup (SEOW).
*Deborah E. Almoney
Senior Evaluation Analyst
Office of Research, Evaluation, and Strategic
Policy Development
PA Commission on Crime and Delinquency
3101 N. Front Street
Harrisburg, PA 17110
717-265-8526
dalmoney@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
*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
Center for Juvenile Justice Training & Research
Shippensburg University
1871 Old Main Drive
Shippensburg, PA 17257-2299
717-477-1188
jcookusl@state.pa.us
Julia Cox
Executive Director
American Trauma Society
2 Flowers Drive
Mechanicsburg, PA 17050
717-766-1616
atspa@atspa.org
Myrna Delgado
Division Chief
Bureau of Student & Community Services
PA Department of Education
5th Floor
333 Market Street
Harrisburg, PA 17126-0333
717-772-2813
mdelgado@state.pa.us
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
76
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
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
*Staci Fehr
Program Analyst
Office of Research, Evaluation, and Strategic
Policy Development
PA Commission on Crime and Delinquency
3101 N. Front Street
Harrisburg, PA 17110
717-265-8521
sfehr@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
77
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
*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
*Dan Iser
Drug & Alcoh Ed Specialist
PA Department of Education
Bureau of Community & Student Services
333 Market Street
Harrisburg, PA 17126-0333
717-787-6406
diser@state.pa.us
*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
*Barry L. Jackson
Director
Drug, Alcohol & Wellness Network
253 SSC Bloomsburg University
Bloomsburg, PA 17815
570-389-4977
bjackson@bloomu.edu
*Daniel Miller
Chief, Data Section
Bureau of Drug & Alcohol Programs
Pennsylvania Department of Health
02 Kline Plaza
Harrisburg, PA 17104
Phone: 717.783.8200
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
*Peter D. Mulcahy
72 Fairview Avenue
Morrisville, PA 19067
215-736-3167
peterdmulcahy@comcast.net
*Terry Matulevich
Budget Analyst
Bureau of Drug & Alcohol Programs
PA Department of Health
2 Kline Plaza
Harrisburg, PA 17104
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
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
78
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
*Jacqueline Spaid
Drug & Alcohol Program Supervisor
Bureau of Drug & Alcohol Programs
PA Department of Health
2 Kline Plaza
Harrisburg, PA 17104
717-783-8200
jspaid@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
*Carol E. Thornton
Section Chief
Violence and Injury Prevention Program
Pennsylvania Department of Health
Bureau of Health Promotion and Risk Reduction
Room 1008, Health & Welfare Building
Harrisburg, PA 17120
717-787-5900
cathornton@state.pa.us
*Robin Rothermel
Acting Director
Bureau of Drug & Alcohol Programs
PA Department of Health
2 Kline Plaza
Harrisburg, PA 17104
717-783-8200
rrothermel@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
*Zachary Runkle
Bureau of Health Statistics & Research
Forum Place, 6th Floor
555 Walnut Street
Harrisburg, PA 17101-1900
717-783-2548
zrunkle@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
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
*Annette L Williams
CSAP Fellow
Bureau of Drug & Alcohol Programs
PA Department of Health
2 Kline Plaza
Harrisburg, PA 17104
717-783-8200
c-anwillia@state.pa.us
*Alden Small
Statistical Analyst Supervisor
Bureau of Health Statistics
Forum Place, 6th Floor
555 Walnut Street
Harrisburg, PA 17101-1900
717-783-2548
asmall@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
79
*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
80
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
81
VII. C. 1. NSDUH Pennsylvania Substate Data Tables (2004-2006)
Binge alcohol use in past month ages 12 and older
Region
Estimate
95% CI
Pennsylvania
24.1 (23.04 - 25.18)
Allegheny
28.04 (24.98 - 31.32)
Beaver, Butler, Armstrong, Indiana, Cambria
24.99 (21.75 - 28.55)
Wayne, Pike, Monroe, Carbon, Schuylkill, Berks
23.9 (20.94 - 27.14)
Blair, Huntingdon, Mifflin, Juniata, Perry, Cumberland, Franklin,
Fulton,
Bedford
19.96 (17.29 - 22.93)
Potter, Tioga,
Bradford, Susquehanna, Clinton, Lycoming,
Sullivan, Centre, Union, Snyder, Montour, Columbia,
Northumberland
26.25 (23.43 - 29.28)
Chester, Delaware, Montgomery, Bucks
25.23 (23.09 - 27.50)
Warren, McKean, Mercer, Lawrence, Venango, Forest, Elk,
Cameron, Clarion, Jefferson, Clearfield
22.45 (19.31 - 25.94)
Erie, Crawford
27.13 (23.41 - 31.19)
Dauphin, Lebanon, Lancaster, York, Adams
20.59 (18.26 - 23.13)
Washington, Westmoreland, Greene, Fayette, Somerset
22.13 (19.18 - 25.39)
Wyoming, Lackawanna, Luzerne
25.97 (22.52 - 29.74)
Northampton, Leigh
22.51 (19.37 - 26.00)
Philadelphia
23.65 (20.97 - 26.56)
Estimates are based on a survey-weighted hierarchical Bayes estimation approach, and 95% prediction
intervals were generated by Markov Chain Monte Carlo techniques.
Source: Substate Estimates from the 2004-2006 NSDUHs
82
Alcohol use past month among persons aged 12 to 20
Region
Estimate
95% CI
Pennsylvania
29.51 (28.31 - 30.73)
Allegheny
33.86 (30.56 - 37.32)
Beaver, Butler, Armstrong, Indiana, Cambria
32.04 (28.27 - 36.06)
Wayne, Pike, Monroe, Carbon, Schuylkill, Berks
29.57 (26.22 - 33.16)
Blair, Huntingdon, Mifflin, Juniata, Perry, Cumberland, Franklin, Fulton,
Bedford
25.21 (21.69 - 29.10)
Potter, Tioga, Bradford, Susquehanna, Clinton, Lycoming, Sullivan, Centre,
Union, Snyder, Montour, Columbia, Northumberland
33.6 (30.46 - 36.89)
Chester, Delaware, Montgomery, Bucks
32.28 (29.76 - 34.92)
Warren, McKean, Mercer, Lawrence, Venango, Forest, Elk, Cameron,
Clarion, Jefferson, Clearfield
27.94 (24.18 - 32.04)
Erie, Crawford
33.07 (28.86 - 37.58)
Dauphin, Lebanon, Lancaster, York, Adams
27.86 (25.14 - 30.75)
Washington, Westmoreland, Greene, Fayette, Somerset
28.3 (24.76 - 32.12)
Wyoming, Lackawanna, Luzerne
30.32 (26.26 - 34.72)
Northampton, Leigh
28.33 (24.22 - 32.83)
Philadelphia
22.9 (20.06 - 26.01)
Estimates are based on a survey-weighted hierarchical Bayes estimation approach, and 95% prediction intervals
were generated by Markov Chain Monte Carlo techniques.
Source: Substate Estimates from the 2004-2006 NSDUHs
83
Cigarette use past month aged 12+
Region
Pennsylvania
Allegheny
Beaver, Butler, Armstrong, Indiana, Cambria
Wayne, Pike, Monroe, Carbon, Schuylkill, Berks
Blair, Huntingdon, Mifflin, Juniata, Perry, Cumberland, Franklin, Fulton,
Bedford
Potter, Tioga, Bradford, Susquehanna, Clinton, Lycoming, Sullivan, Centre,
Union, Snyder, Montour, Columbia, Northumberland
Chester, Delaware, Montgomery, Bucks
Warren, McKean, Mercer, Lawrence, Venango, Forest, Elk, Cameron,
Clarion, Jefferson, Clearfield
Erie, Crawford
Dauphin, Lebanon, Lancaster, York, Adams
Washington, Westmoreland, Greene, Fayette, Somerset
Wyoming, Lackawanna, Luzerne
Northampton, Leigh
Philadelphia
Estimate
26.68
27.5
29.11
27.28
95% CI
(25.48 - 27.93)
(24.53 - 30.70)
(25.73 - 32.74)
(24.29 - 30.49)
26.97 (23.93 - 30.25)
24.9 (22.10 - 27.93)
23.67 (21.57 - 25.90)
29.18
26.21
25.86
28.23
27.5
26.4
28.97
(25.83 - 32.78)
(22.90 - 29.81)
(23.24 - 28.67)
(24.98 - 31.72)
(24.32 - 30.93)
(23.00 - 30.10)
(25.96 - 32.18)
Estimates are based on a survey-weighted hierarchical Bayes estimation approach, and 95% prediction intervals were
generated by Markov Chain Monte Carlo techniques.
Source: Substate Estimates from the 2004-2006 NSDUHs
84
Alcohol dependence or abuse in past year
Region
Estimate
95% CI
Pennsylvania
7.13 (6.57 - 7.74)
Allegheny
8.03 (6.68 - 9.63)
Beaver, Butler, Armstrong, Indiana, Cambria
7.4 (5.92 - 9.22)
Wayne, Pike, Monroe, Carbon, Schuylkill, Berks
6.89 (5.62 - 8.43)
Blair, Huntingdon, Mifflin, Juniata, Perry, Cumberland, Franklin, Fulton,
Bedford
5.75 (4.61 - 7.14)
Potter, Tioga, Bradford, Susquehanna, Clinton, Lycoming, Sullivan, Centre,
Union, Snyder, Montour, Columbia, Northumberland
8.6 (7.25 - 10.18)
Chester, Delaware, Montgomery, Bucks
7.25 (6.17 - 8.50)
Warren, McKean, Mercer, Lawrence, Venango, Forest, Elk, Cameron,
Clarion, Jefferson, Clearfield
6.67 (5.33 - 8.31)
Erie, Crawford
8.32 (6.67 - 10.33)
Dauphin, Lebanon, Lancaster, York, Adams
6.15 (5.08 - 7.44)
Washington, Westmoreland, Greene, Fayette, Somerset
6.26 (5.05 - 7.72)
Wyoming, Lackawanna, Luzerne
7.25 (5.88 - 8.92)
Northampton, Leigh
6.09 (4.71 - 7.85)
Philadelphia
7.77 (6.45 - 9.32)
Estimates are based on a survey-weighted hierarchical Bayes estimation approach, and 95% prediction intervals
were generated by Markov Chain Monte Carlo techniques.
Source: Substate Estimates from the 2004-2006 NSDUHs
85
Binge alcohol use past month among persons aged 12 to 20
Region
Estimate
95% CI
Pennsylvania
20.46 (19.36- 21.60)
Allegheny
22.74 (19.88- 25.88)
Beaver, Butler, Armstrong, Indiana, Cambria
23.62 (20.36- 27.22)
Wayne, Pike, Monroe, Carbon, Schuylkill, Berks
20.21 (17.14- 23.69)
Blair, Huntingdon, Mifflin, Juniata, Perry, Cumberland, Franklin, Fulton,
Bedford
16.88 (13.91- 20.34)
Potter, Tioga, Bradford, Susquehanna, Clinton, Lycoming, Sullivan, Centre,
Union, Snyder, Montour, Columbia, Northumberland
25.86 (22.83- 29.13)
Chester, Delaware, Montgomery, Bucks
23.07 (20.73- 25.58)
Warren, McKean, Mercer, Lawrence, Venango, Forest, Elk, Cameron,
Clarion, Jefferson, Clearfield
19.81 (16.37- 23.77)
Erie, Crawford
23.72 (20.07- 27.81)
Dauphin, Lebanon, Lancaster, York, Adams
17.84 (15.54- 20.40)
Washington, Westmoreland, Greene, Fayette, Somerset
19.97 (16.88- 23.46)
Wyoming, Lackawanna, Luzerne
22.22 (18.77- 26.11)
Northampton, Leigh
19.43 (15.84- 23.60)
Philadelphia
14.35 (12.16- 16.87)
Estimates are based on a survey-weighted hierarchical Bayes estimation approach, and 95% prediction intervals
were generated by Markov Chain Monte Carlo techniques.
Source: Substate Estimates from the 2004-2006 NSDUHs
86
Tobacco use past month aged 12+
Region
Pennsylvania
Allegheny
Beaver, Butler, Armstrong, Indiana, Cambria
Wayne, Pike, Monroe, Carbon, Schuylkill, Berks
Blair, Huntingdon, Mifflin, Juniata, Perry, Cumberland, Franklin, Fulton,
Bedford
Potter, Tioga, Bradford, Susquehanna, Clinton, Lycoming, Sullivan, Centre,
Union, Snyder, Montour, Columbia, Northumberland
Chester, Delaware, Montgomery, Bucks
Warren, McKean, Mercer, Lawrence, Venango, Forest, Elk, Cameron,
Clarion, Jefferson, Clearfield
Erie, Crawford
Dauphin, Lebanon, Lancaster, York, Adams
Washington, Westmoreland, Greene, Fayette, Somerset
Wyoming, Lackawanna, Luzerne
Northampton, Leigh
Philadelphia
Estimate
31.57
32.59
35.79
32.64
95% CI
(30.31 - 32.85)
(29.50 - 35.83)
(31.97 - 39.79)
(29.37 - 36.08)
33.05 (29.92 - 36.34)
30.48 (27.52 - 33.62)
27.98 (25.62 - 30.47)
35.38
31.1
30.32
33.95
32.63
30.59
32.09
(31.74 - 39.20)
(27.33 - 35.14)
(27.52 - 33.28)
(30.54 - 37.54)
(29.07 - 36.41)
(27.07 - 34.34)
(29.04 - 35.31)
Estimates are based on a survey-weighted hierarchical Bayes estimation approach, and 95% prediction intervals were
generated by Markov Chain Monte Carlo techniques.
Source: Substate Estimates from the 2004-2006 NSDUHs
87
VII. C. 2. FARS Calculated Crash Data Tables Used
Five Year Averages of the Total Number of Alcohol-Related
Traffic Deaths and the Percentage Relative to All Traffic
Deaths by County in Pennsylvania (2003-2007)
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
Alcohol related
deaths per year
9
31.2
4.8
5.6
6.6
18
5.2
4.2
22.2
10.6
6.4
0.2
5.2
7.4
20.8
3.6
5.2
3.2
5.4
8
10.2
9.4
12.4
3.4
12.4
12.2
1.4
9.4
1.6
5
3
6.4
1.4
% Alcohol related
deaths relative to
all traffic deaths
43%
38%
38%
33%
36%
33%
27%
42%
33%
38%
35%
33%
37%
35%
39%
31%
27%
32%
38%
41%
34%
32%
38%
38%
42%
47%
64%
35%
24%
49%
38%
39%
18%
88
Juniata
1.4
23%
Lackawanna
7.2
32%
Lancaster
19.4
31%
Lawrence
3.2
27%
Lebanon
6.6
35%
Lehigh
11.8
30%
Luzerne
21.4
49%
Lycoming
7
32%
McKean
2.6
48%
Mercer
7.6
31%
Mifflin
3
48%
Monroe
11.2
32%
Montgomery
21.2
37%
Montour
1.2
29%
Northampton
8.6
30%
Northumberland
5.8
34%
Perry
4
34%
Philadelphia
32.6
29%
Pike
2.8
29%
Potter
2.2
58%
Schuylkill
10
32%
Snyder
2
26%
Somerset
9.8
49%
Sullivan
1.4
58%
Susquehanna
4.4
41%
Tioga
1.6
17%
Union
3.2
40%
Venango
4
36%
Warren
4.8
50%
Washington
12.4
47%
Wayne
3.6
33%
Westmoreland
20
43%
Wyoming
2
36%
York
20.8
42%
Total
552
37%
Source: FARS; Calculated by averaging the total number
of alcohol related traffic deaths from 2003 to 2007.
89
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.
2) Some additional PA Department of Health website 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.
90