regional needs assessment - prevention resource center region 4 · 2019. 7. 22. · 2019 regional...

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2020

East Texas Council On Alcoholim And Drug Abuse

Regional Needs Assessment

2020 Regional Needs Assessment Region 4

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Linda Oyer, BS, RN, MBA, PRSS,

RSPS, PSS, ICPR, APS

Chief Executive Officer

[email protected]

Nathaniel Olson, IACPS

PRC Program Director

[email protected]

Mindy Robertson, BA, IACPS

PRC Data Coordinator

[email protected]

Theresa Horn, BS

PRC Public Relations Coordinator

[email protected]

Christopher Dolph

PRC Tobacco Prevention

Coordinator

[email protected]

East Texas Council On Alcoholim And Drug Abuse

708 Glencrest Lane Longview, Texas 75601

903-753-7633

800-441-8639

www.prcfour.org

www.etcada.com

http://www.prcfour.org/


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Contents Executive Summary ....................................................................................................................... 1

Prevention Resource Centers .......................................................................................................... 3

Introduction ................................................................................................................................ 10

Methodology .............................................................................................................................. 11

Regional Demographics ............................................................................................................... 14

Environmental Risk Factors .......................................................................................................... 34

Regional Consumption ................................................................................................................. 46

Consequences ............................................................................................................................ 54

Emerging Trends ............................................................................................................................. 86 Special Topic: Opioids ..................................................................................................................... 93 Environmental Protective Factors ...................................................................................................... 96 Region in Focus ............................................................................................................................ 102 Conclusion ................................................................................................................................... 104 References ................................................................................................................................105

Data Source Tables .....................................................................................................................111

Glossary of Terms ......................................................................................................................351

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Executive Summary

What is the RNA

The Regional Needs Assessment (RNA) is a document created by the Prevention Resource Center (PRC) in Region 4 along with Data Coordinators from PRCs across the State of Texas and supported by the East Texas Council On Alcoholism And Drug Abuse and the Texas Health and Human Services Commission (HHSC). The PRC 4 serves a total of 23 counties throughout Region 4. This assessment was designed to aid PRC’s, HHSC, and community stakeholders in long-term strategic prevention planning based on the most current information relative to the unique needs of the diverse communities in the State of Texas. This document will present a summary of statistics relevant to risk and protective factors associated with drug use, consumption patterns and consequences data, and it will offer insight related to gaps in services and data availability challenges.

Who writes the RNA

A team of Data Coordinators has procured national, state, regional, and local data through partnerships of collaboration with diverse agencies in sectors such as law enforcement, public health, and education, among others.

How the RNA is informed (data collections)

Qualitative data collection has been conducted in the form of surveys, focus groups, and interviews with key informants. The information obtained through these partnerships has been analyzed and synthesized in the form of this Regional Needs Assessment. PRC 4 recognizes those collaborators who contributed to the creation of this RNA. Quantitative data has been extrapolated from federal and state agencies to ensure reliability and accuracy.


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Key Findings

Demographics: Region 4 is primarily populated by individuals 25-44 years of age followed closely by individuals 45–64 years of age. Race for Region 4 is predominantly White with Hispanic ethnicity steadily on the rise. Socioeconomics: Region 4 per capita income remains lower than the state, and unemployment continues to be higher in Region 4 compared to the state. Single-parent households remains equal to the state percentage, and 11% of Region 4’s children are uninsured. Environmental Risk Factors: Region 4 has an Alcohol Permit Density Rate per 100k population of 166.8 and a Tobacco Permit Density Rate per 100k population of 1.3. The rate for prescriptions per 100k population in Region 4 is 191,665 with 651,891 of those prescriptions being Schedule ll drugs. Consumption: Marijuana and Prescription Drugs are the most seized substances by law enforcement in our region. Alcohol and marijuana are the most consumed substances among high school and college aged students. Consequences: Alcohol violations for sales to minors has decreased while tobacco violations for sales to minors has increased. The TDCJ populations have stayed consistent while juvenile justice referrals have decreased. Environmental Protective Factors: Our region has numerous non-profits and social service agencies within our counties. Many of these services provide basic needs; others provide treatment for mental health; others provide counseling inpatient/outpatient services; intervention services include drug and alcohol referrals and counseling, peer recovery coaching, pregnancy intervention for new and expecting mothers at-risk, and the numerous coalitions and community groups all willing to assist client and community members in needs.


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Prevention Resource Centers Our Purpose

There are eleven regional Prevention Resource Centers (PRCs) servicing the State of Texas. Each PRC acts as the central data repository and substance misuse prevention training liaison for their region. Data collection efforts carried out by PRCs are focused on the state’s prevention priorities of alcohol (underage drinking), marijuana, and prescription drug use, as well as other illicit drugs.

Prevention Resource Centers (PRCs) are a program funded by the Texas Health and Human Services Commission (HHSC) to provide data and information related to substance use and misuse, and to support prevention collaboration efforts in the community. There is one PRC located in each of the eleven Texas Health Service Regions to provide support to prevention providers located in their region with substance use data, trainings, media activities, and regional workgroups. Prevention Resource Centers have four fundamental objectives related to services provided to partner agencies and the community in general:

(1) Collect data relevant to the state’s prevention priorities and share findings with community partners and stakeholders;

(2) Ensure the sustainability of a Regional Epidemiological Workgroup focused on identifying strategies related to data collection, gaps in data, and prevention needs;

(3) Coordinate regional prevention trainings and conduct media awareness activities related to risks and consequences of alcohol, tobacco, and other drugs (ATOD) use;

(4) Conduct voluntary compliance checks and education on state tobacco laws to retailers.

Public Health Regions

Region 1 Panhandle and South Plains

Region 2 Northwest Texas Region 3 Dallas/Fort Worth Metroplex Region 4 Upper East Texas Region 5 Southeast Texas Region 6 Gulf Coast Region 7 Central Texas Region 8 Upper South Texas Region 9 West Texas Region 10 Upper Rio Grande Region 11 Rio Grande Valley/Lower South Texas

Department of State Health Services https://www.dshs.state.tx.us/IDCU/data/annual/2016-Texas-Annual-Report/2016-Annual-Report/ Accessed April 17, 2020.

https://www.dshs.state.tx.us/IDCU/data/annual/2016-Texas-Annual-Report/2016-Annual-Report/


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What Evaluators Do

Regional PRCs are tasked with compiling and synthesizing data and disseminating findings to the community. Data collection strategies are organized around risk and protective factors, consumption data, and related consequences associated with substance use and misuse. PRCs engage in building collaborative partnerships with key community members who aid in securing access to information. How We Help the Community

PRCs provide technical assistance and consultation to providers, community groups, and other stakeholders in identifying data and data resources related to substance use or other behavioral health indicators. PRCs work to promote and educate the community on substance use and misuse and associated consequences through various data products, media awareness activities, and an annual Regional Needs Assessment. These resources and information provide stakeholders with knowledge and understanding of the local populations they serve, help guide programmatic decision making, and provide community awareness and education related to substance use and misuse. Additionally, the program provides a way to identify community strengths as well as gaps in services and areas of improvement.


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Conceptual Framework of This Report .

Key Concepts

As one reads through this needs assessment, two guiding concepts will appear throughout the report:

• a focus on the youth population

• the use of an empirical approach from a public health framework For the purpose of strategic prevention planning related to drug and alcohol use among youth populations, this report is based on three main aspects:

• risk and protective factors

• consumption patterns

• consequences of substance misuse and substance use disorders (SUDs)

Adolescence The World Health Organization (WHO) identifies adolescence as a critical transition in the life span characterized by tremendous growth and change, second only to infancy. This period of mental and physical development poses a critical point of vulnerability where the use and misuse of substances, or other risky behaviors, can have long-lasting negative effects on future health and well-being. This focus of prevention efforts on adolescence is particularly important since approximately 90 percent of adults who are clinically diagnosed with SUDs, began misusing substances before the age of 18. 1 The information presented in this document is compiled from multiple data sources and will therefore consist of varying demographic subsets of age which generally define adolescence as ages 10 through 17-19. Some domains of youth data conclude with ages 17, 18 or 19, while others combine “adolescent” and “young adult” to conclude with age 21.

Epidemiology The WHO describes epidemiology as the “study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems.” This definition provides the theoretical framework through which this assessment discusses the overall impact of substance use and misuse. Epidemiology frames substance use and misuse as a preventable and treatable public health concern. The Substance Abuse and Mental Health Services Administration (SAMHSA) establishes epidemiology to identify and analyze community patterns of substance misuse and the contributing factors influencing this behavior. SAMHSA adopted an epidemiology-based framework on a national level while this needs assessment establishes this framework on a regional level.

The National Center on Addiction and Substance Abuse at Columbia University. 2011. CASA analysis of the National Survey on Drug Use and Health, 2009 [Data file]. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.


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Socio-Ecological Model The Socio-Ecological Model (SEM) is a conceptual framework developed to better understand the multidimensional factors that influence health behavior and to categorize health intervention strategies.2

• Intrapersonal factors are the internal characteristics of the individual of focus and include knowledge, skills, attitudes, and beliefs.

• Interpersonal factors include social norms and interactions with significant others, such as family, friends, and teachers.

• Organizational/institutional factors are social and physical factors that indirectly impact the individual of focus (e.g., zero tolerance school policies, classroom size, mandatory workplace drug testing).

• Community/societal factors include neighborhood connectedness, collaboration between organizations, and policy.

The SEM proposes that behavior is impacted by all levels of influence, from the intrapersonal to the societal, and that the effectiveness of health promotion programs is significantly enhanced through the coordination of interventions targeting multiple levels. For example, changes at the community level will create change in individuals and support of individuals in the population is essential for implementing environmental change.

Socio- Ecological Model https://www.acha.org/HealthyCampus/HealthyCampus/Ecological_Model.aspx Accessed April 16, 2020

https://www.acha.org/HealthyCampus/HealthyCampus/Ecological_Model.aspx


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Risk and Protective Factors Researchers have examined the characteristics of effective prevention programs for more than 20 years. One component shared by effective programs is a focus on risk and protective factors that influence substance misuse among adolescents. Protective factors are characteristics that decrease an individual’s risk for a SUD. Examples may include factors such as strong and positive family bonds, parental monitoring of children's activities, and access to mentoring. Risk factors are characteristics that increase the likelihood of substance use behaviors. Examples may include unstable home environments, parental use of alcohol or drugs, parental mental illnesses, poverty levels, and failure in school performance. Risk and protective factors are classified under four main domains: societal, community, relationship, and individual.3

.

2 McLeroy, KR, Bibeau, D, Steckler, A, Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education & Behavior, 15(4), 351-377. 3 The SBCC Capacity; Health Communication Capacity Collaborative. https://healthcommcapacity.org/sbcc-capacity-ecosystem/ Accessed April 16, 2020

Health Community Capacity Collaborative https://healthcommcapacity.org/sbcc-capacity-ecosystem/ Accessed April 16, 2020

https://healthcommcapacity.org/sbcc-capacity-ecosystem/


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Consumption Patterns For the purpose of this needs assessment and following operational definitions included in widely used measures of substance consumption, such as the Texas School Survey of Drug and Alcohol Use (TSS)4, the Texas Youth Risk Surveillance System (YRBSS)5, and the National Survey on Drug Use and Health (NSDUH)6, consumption patterns are generally operationalized into three categories:

• Lifetime use (ever tried a substance, even once)

• School year use (past year use when surveying outside of a school setting)

• Current use (use within the past 30 days)

These three categories of consumption patterns are used in the TSS to elicit self-reports from adolescents on their use and misuse of tobacco, alcohol (underage drinking), marijuana, prescription drugs, and illicit drugs. The TSS, in turn, is used as the primary outcome measure in reporting on Texas youth substance use and misuse in this needs assessment.

Due to its overarching and historical hold on the United States, there exists a plethora of information on the evaluation of risk factors that contribute to Alcohol Use Disorder (AUD). According to SAMHSA, AUD is ranked as the most wide-reaching SUD in the United States, for people ages 12 and older, followed by Tobacco Use Disorder, Cannabis Use Disorder, Stimulant Use Disorder, Hallucinogen Use Disorder, and Opioid Use Disorder (presented in descending order by prevalence rates).7

When evaluating alcohol consumption patterns in adolescents, more descriptive information beyond the aforementioned three general consumption categories is often desired and can be tapped by adding specific quantifiers (i.e., per capita sales, frequency and trends of consumption, and definitions of binge drinking and heavy drinking), and qualifiers (i.e., consequential behaviors, drinking and driving, alcohol consumption during pregnancy) to the operationalization process.

Some alcoholic drinks contain more alcohol than others. As with all matter’s nutritional, you need to consider the portion size.

For example, some cocktails may contain an alcohol "dose" equivalent to three standard drinks. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has created guidelines that are used in the in quantitative measurement of alcohol consumption.8

4Texas A&M University. Texas School Survey of Drug and Alcohol Use: 2016 State Report. 2016. http://www.texasschoolsurvey.org/Documents/Reports/State/16State712.pdf. Accessed May 30, 2018. 5 Texas Department of State Health Services. 2001-2017 High School Youth Risk Behavior Surveillance System Data. 2017. http://healthdata.dshs.texas.gov/HealthRisks/YRBS. Accessed April 27, 2018. 6 Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health. 2016. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf. Accessed May 30, 2018. 7 Substance Abuse and Mental Health Services Administration. Substance use disorders. https://www.samhsa.gov/disorders/substance-use. Updated October 27, 2015. Accessed May 29, 2018. 8 National Institute for Alcohol Abuse and Alcoholism. What is a “standard” drink? https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/What-counts-as-a-drink/Whats-A-Standard-Drink.aspx. Accessed May 24, 2018.

National Institute on Alcohol Abuse and Alcoholism https://www.niaaa.nih.gov/ Accessed April 16, 2020

Percentage of alcohol and standardized portions

http://www.texasschoolsurvey.org/Documents/Reports/State/16State712.pdfhttp://healthdata.dshs.texas.gov/HealthRisks/YRBShttps://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdfhttps://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/What-counts-as-a-drink/Whats-A-Standard-Drink.aspxhttps://www.niaaa.nih.gov/


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Consequences One of the hallmarks of SUDs is the continued use of a substance despite harmful or negative consequences. The types of consequences most commonly associated with SUDs, the most severe of SUDs being addiction, typically fall under the categories of health consequences, physical consequences, social consequences, and consequences for adolescents. The prevention of such consequences has received priority attention as Goal 2 (out of four goals) on the 2016-2020 NIDA Strategic Plan. Goal 2 of the NIDA Strategic Plan is:

Goal 2: Develop new and improved strategies to prevent drug use and its consequences.9 The consequences associated with SUDs tend to be developmentally, culturally, and contextually dependent and the measurement and conceptualization of such associations has proven to be quite difficult for various reasons, including the fact that consequences are not always caused or worsened by substance use or misuse.10

Therefore, caution should be taken in the interpretation of the data presented in this needs assessment. Caution in inferring relationships or direction of causality should be taken, also, because only secondary data is reported out and no sophisticated analytic procedures are involved once that secondary data is obtained by the PRCs and reported out in this needs assessment, which is intended to be used as a resource.

Stakeholder/Audience Potential readers of this document include stakeholders from a variety of disciplines: substance use prevention and treatment providers; medical providers; school districts and higher education; substance use prevention community coalitions; city, county, and state leaders; and community members interested in increasing their knowledge of public health factors related to drug consumption. The information presented in this report aims to contribute to program planning, evidence-based decision making, and community education. The executive summary found at the beginning of this report will provide highlights of the report for those seeking a brief overview. Since readers of this report will come from a variety of professional fields, each yielding specialized genres of professional terms and concepts related to substance misuse and substance use disorders prevention, a glossary of key concepts can be found in the back of this needs assessment.

The core of the report focuses on risk factors, consumption patterns, consequences, and protective factors.

A list of tables can also be found in the back of this needs assessment.

9 National Institute on Drug Abuse. 2016-2020 NIDA Strategic Plan. 2016. https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/nida_2016strategicplan_032316.pdf. Accessed May 29, 2018. 10 Martin, CS., Langenbucher, JW, Chung, Sher, KJ. Truth or consequences in the diagnosis of substance use disorders. Addiction. 2014. 109(11): 1773-1778.

https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/nida_2016strategicplan_032316.pdf


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Introduction

The Texas Health and Human Services Commission (HHSC) administers approximately 225 school and community-based prevention programs across 72 providers with federal funding from the Substance Abuse Prevention and Treatment Block Grant to prevent the use and consequences of alcohol, tobacco, and other drugs (ATOD) among Texas youth and families. These programs provide evidence-based curricula and effective prevention strategies identified by SAMHSA’s Center for Substance Abuse Prevention (CSAP). The Strategic Prevention Framework (SPF) provided by CSAP guides prevention activities in Texas.

In 2004, Texas received a state incentive grant from CSAP to implement the Strategic Prevention Framework in close collaboration with local communities in order to tailor services to meet local needs for substance abuse prevention.

This prevention framework provides a continuum of services that target the three classifications of prevention activities under the Institute of Medicine (IOM), which are universal, selective, and indicated.11

The Health and Human Services Commission Substance Abuse Services funds Prevention Resource Centers (PRCs) across the state of Texas. These centers are part of a larger network of youth prevention programs providing direct prevention education to youth in schools and the community, as well as community coalitions that focus on implementing effective environmental strategies. This network of substance abuse prevention services work to improve the welfare of Texans by the reduction of substance use and misuse.

Our Audience

Readers of this document include stakeholders from a variety of disciplines such as substance use prevention and treatment providers; medical providers; school districts and higher education; substance use prevention community coalitions; city, county, and state leaders; and community members interested in increasing their knowledge of public health factors related to drug consumption. The information presented in this report aims to contribute to program planning, evidence-based decision making, and community education.

11 SAMHSA. Strategic Prevention Framework. https://avpride.com/ Accessed April 29, 2020.

Sustainability & Cultural Competence. 2020. AVPRIDE. https://avpride.com/ Accessed April 29, 2020

Assessment Profile population needs, resources, and readiness to address needs and gaps

Capacity Mobilize and/or build capacity to address needs

Planning Develop a Comprehensive Strategic Plan

Implementation Implement the Strategic Plan and corresponding evidence-based prevention strategies

Evaluation Monitor, evaluate, sustain, and improve or replace those that fail

Strategic Prevention Framework

https://avpride.com/https://avpride.com/


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Methodology Relevance of the RNA

This needs assessment is a review of data on substance misuse, substance use disorders, and related variables that will aid in substance misuse prevention decision making at the county, regional, and state level. In this needs assessment, the reader will find the following:

• Primary focus on the state-delineated prevention priorities of alcohol, tobacco, marijuana, prescription drugs, and other drug use among adolescents;

• Exploration of drug consumption trends and consequences, particularly where adolescents are concerned;

• An exploration of related risk and protective factors as operationalized by the Center of Substance Abuse Prevention (CSAP).

Purpose of the RNA

The regional needs assessment can serve in the following capacities:

• To determine patterns of substance use among adolescents and monitor changes in substance use trends over time;

• To identify gaps in data where critical substance misuse information is missing;

• To determine county-level differences and disparities;

• To identify substance use issues that are unique to specific communities;

• To provide a comprehensive resource tool for local providers to design relevant, data-driven prevention and intervention programs targeted to needs;

• To provide data to local providers to support their grant-writing activities and provide justification for funding requests;

• To assist policy-makers in program planning and policy decisions regarding substance misuse prevention, intervention, and treatment at the region and state level.


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Process

The State Evaluator and the Data Coordinators collected primary and secondary data at the county, regional, and state levels between September 1, 2019 and May 30, 2020. Between September and July, the State Evaluator meets with the Data Coordinators via bi-weekly conference calls to discuss the criteria for processing and collecting data. The information is primarily gathered through established secondary sources including federal and state government agencies. In addition, region-specific data collected through local law enforcement, community coalitions, school districts and local-level governments are included to address the unique regional needs of the community. Qualitative data is collected through primary sources such as surveys and focus groups conducted with stakeholders and participants at the regional level. Primary and secondary data sources are identified when developing the methodology behind this document. Readers can expect to find information from the American Community Survey, Texas Department of Public Safety, Texas School Survey of Drug and Alcohol Use, and the Community Commons, among others. For the purpose of this needs assessment, adults and youth in the region were selected as primary sources. Quantitative Data Selection

Relevant data elements were determined, and reliable data sources were identified through a collaborative process among the team of Data Coordinators.

Identification of Variables: The data collected is the most recent data available within the last five years. However, older data might be provided for comparison purposes.

Key Data Sources: For the purpose of this Regional Needs Assessment, data sources were chosen based on specific criteria. The data provided is a measure of substance use consumption, consequence, and related risk and protective factors. Data reflects the target population in Texas and across the eleven public health regions.

Criterion for Selection: The criterion used for this document is, relevance, timeliness, methodologically sound, representative, and accuracy. The data consists of well-documented methodology and valid or reliable data collection tools.


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Qualitative Data Selection

During the year, focus groups, surveys and interviews are conducted by the Data Coordinator to better understand what members of the communities believe their greatest need to be. The information collected by this research serves to identify avenues for further research and provide access to any quantitative data that each participant may have access to.

Key Informant Interviews Interviews are conducted primarily with school officials and law enforcement officers. Participants are randomly selected by city and then approached to participate in an interview with the Data Coordinator. Each participant is asked the following questions:

• What problems do you see in your community?

• What is the greatest problem you see in your community?

• What hard evidence do you have to support this as the greatest problem?

• What services do you lack in your community?

Other questions inevitably arise during the interviews, but these four are asked of each participant.

Focus Groups Participants for the focus groups are invited from a wide selection of professionals including, but not limited to, law enforcement, health workers, community leaders, clergy, high school educators, town councils, state representatives, university professors, and local business owners. In these sessions, participants discuss their perceptions of how their communities are affected by alcohol, tobacco, marijuana, prescription drugs, and other drugs.

Longitudinally Presented Data In an attempt to capture a richer depiction of possible trends in the data presented in this needs

assessment, data collection and reporting efforts consist of multi-year data when it is available from respective sources.

Most longitudinal presentations of data in this needs assessment consist of, but are not limited to, the

most recently-available data collected over three years in one-year intervals of data-collection, or the most recently-available data collected over three data-collection intervals of more than one year (e.g. data collection for the TSS is done in two-year intervals).

Efforts are also made in presenting state-and national-level data

with county-level data for comparison purposes. However, where it is the case that neither state-level nor national-level date are included in tables and figures, the assumption can be made by the reader that this data is not made available at the time of the data request. Such requests are made to numerous counties, state, and national-level agencies in the development of this needs assessment.


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Regional Demographics

Overview of Region

At the regional and county level, demographics are the basic building blocks that form the places in which we live and work. Via the Prevention Resource Centers, the driving force behind the regional evaluation initiative is to ultimately gain a better understanding of the factors that influence risk and protection from substance abuse on a more localized level. These indicators will reflect the conditions of the individual counties that comprise Region 4 in Northeast Texas. Where applicable, counties with substantially higher or lower rates than the overall region, state, or country will be highlighted. Full rankings tables comparing all 23 counties in Region 4 will be placed in the Appendix and referenced in the text.

Geographic Boundaries

Region 4 consists of 23 counties in Northeast Texas often referred to as the Upper East Texas Region.

Region 4 spans from the eastern edge of the Dallas-Fort Worth Metroplex and the Trinity River to the Piney Woods bordering Louisiana.

Oklahoma and Louisiana border the northern and eastern edges of Region 4 respectively.

The Red River, the political and geographical border between Texas and Oklahoma, is the northern dividing line while the southern border of Region 4 consists of mostly governmental county lines instead of geographical land boundaries.

Region 4 and Arkansas share a metropolitan area known as the Texarkana Metropolitan Statistical Area, formed by Texarkana, Texas in Bowie County and its twin city of Texarkana, Arkansas.

See the full listing of counties regarding physical environment ranking for Region 4 in Tables 1 - 3 in the Data Source Tables section of this needs assessment.

Map developed for ETCADA. In house developed. 2020


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.Table 4 - Region 4 ZIP Codes by County .

AboutZipCode. http://www.aboutzipcode.com/zip-code-map-Texas.html Accessed June 1, 2020

ZIP Codes

ZIP Codes, previously known as US postal codes, are used by the United States Postal Service (USPS) to process and deliver mail quickly and efficiently. The term ZIP Code is an acronym for Zone Improvement Plan Code. ZIP Codes are numbered as follows:

1st Digit: designates a broad area that ranges from zero for the Northeast to nine for the far West

2nd and 3rd Digit: the code of a central post office facility in that region

4th and 5th Digit: designate small post offices or postal zone

County Zip Codes

Anderson 75751, 75832, 75839, 75763, 75844, 75853, 75779, 75801, 75803, 75861

Bowie 75554, 75559, 75561, 75567, 75569, 75570, 75573, 75574, 75501, 75503

Camp 75686, 75451

Cass 75551, 75630, 75555, 75556, 75638, 75560, 75656, 75657, 75562, 75563, 75566,

75565, 75568, 75572

Cherokee 75925, 75757, 75759, 75764, 75654, 75766, 75780, 75969, 75784, 75785, 75789, 75976

Delta 75415, 75428, 75432, 75441, 75448, 75450, 75469

Franklin 75455, 75457, 75478, 75480, 75481, 75487, 75494

Gregg 75641, 75645, 75647, 75662, 75601, 75602, 75603, 75604, 75605, 75693

Harrison 75640, 75642, 75650, 75651, 75657, 75661, 75601, 75602, 75605, 75670, 75672, 75692

Henderson 75751, 75752, 75756, 75758, 75124, 75763, 75143, 75770, 75147, 75156, 75148,

75778, 75163

Hopkins 75420, 75431, 75433, 75437, 75453, 75471, 75472, 75478, 75481, 75482, 75494, 75497

Lamar 75411, 75416, 75421, 75435, 75436, 75446, 75460, 75462, 75468, 75470, 75473,

75477, 75486

Marion 75630, 75555, 75640, 75651, 75657, 75668, 75683

Morris 75638, 75656, 75668, 75568, 75571, 75686

Panola 75631, 75633, 75639, 75643, 75954, 75669, 75691, 75974, 75975

Rains 75410, 75440, 75453, 75472

Red River 75550, 75554, 75412, 75417, 75426, 75435, 75436

Rusk 75760, 75641, 75946, 75652, 75654, 75662, 75667, 75669, 75603, 75681, 75682,

75684, 75691, 75975, 75789

Smith 75750, 75757, 75762, 75647, 75662, 75771, 75773, 75684, 75789, 75701, 75702,

75704, 75705, 75706, 75707, 75708, 75709, 75790, 75791, 75792

Titus 75558, 75455, 75571, 75686, 75487, 75493

Upshur 75755, 75640, 75644, 75645, 75647, 75765, 75604, 75605, 75683, 75686, 75494

Van Zandt 75752, 75754, 75756, 75103, 75758, 75117, 75124, 75127, 75140, 75147, 75778,

75790, 75169

Wood 75410, 75755, 75431, 75440, 75765, 75451, 75773, 75471, 75783, 75494, 75497

http://www.aboutzipcode.com/zip-code-map-Texas.html


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.Table 5 - Region 4 Metropolitan Areas .

Metropolitan and Micropolitan. https://www.census.gov/programs-surveys/metro-micro/about.html Accessed June 1, 2020

Metropolitan/Micropolitan/Combined Statistical Areas

The United State Office of Management and Budget (OMB)12 defines statistical areas of the Unites States of America in three categories:

• Metropolitan statistical areas (MSAs) – Has a large population nucleus and adjacent communities that have a high degree of socioeconomic interaction with the core

• Metro Area – Any county that is part of an MSA is classified as a metro area regardless of its own size. A number of low population counties in Texas are considered metro area because they are adjacent to larger population cores and share social and economic interaction with the core.

• NCHS Urban-Rural Classification – An urban designation developed by the Nation Center for Health Statistics.

• Micropolitan statistical areas (µSAs) - One or more adjacent counties or county equivalents that have at least one urban core area with a population of at least 10,000 but less than 50,000.

12 Office of Management and Budget. https://www.whitehouse.gov/omb/ Accessed June 1, 2020

Area Metropolitan Statistical

Area Metro Area

NCHS Urban Rural Classification

Anderson -- Non-Metro Micropolitan

Bowie Texarkana Metro Small Metro

Camp -- Non-Metro Non-core

Cass -- Non-Metro Non-core

Cherokee -- Non-Metro Micropolitan

Delta -- Non-Metro Non-core

Franklin -- Non-Metro Non-core

Gregg Longview Metro Small Metro

Harrison -- Non-Metro Micropolitan

Henderson -- Non-Metro Micropolitan

Hopkins -- Non-Metro Micropolitan

Lamar -- Non-Metro Micropolitan

Marion -- Non-Metro Non-core

Morris -- Non-Metro Non-core

Panola -- Non-Metro Non-core

Rains -- Non-Metro Non-core

Red River -- Non-Metro Non-core

Rusk Longview Metro Small Metro

Smith Tyler Metro Small Metro

Titus -- Non-Metro Micropolitan

Upshur Longview Metro Small Metro

Van Zandt -- Non-Metro Non-core

Wood -- Non-Metro Non-core

https://www.census.gov/programs-surveys/metro-micro/about.htmlhttps://www.whitehouse.gov/omb/


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.Table 6 - Region 4 Counties, County Seats, and County Websites.

Texas Association of Counties. https://www.county.org/About-Texas-Counties/Texas-County-Websites Accessed May 1, 2020

Counties

Region 4 is comprised of 23 counties in Upper East Texas.

County County Seat County Website

Anderson Palestine co.anderson.tx.us

Bowie New Boston co.bowie.tx.us

Camp Pittsburg co.camp.tx.us

Cass Linden co.cass.tx.us

Cherokee Rusk co.cherokee.tx.us

Delta Cooper deltacountytx.com

Franklin Mt. Vernon co.franklin.tx.us

Gregg Longview co.gregg.tx.us

Harrison Marshall harrisoncountytexas.org

Henderson Athens henderson-county.com

Hopkins Sulphur Springs hopkinscountytx.org

Lamar Paris co.lamar.tx.us

Marion Jefferson co.marion.tx.us

Morris Daingerfield co.morris.tx.us

Panola Carthage co.panola.tx.us

Rains Emory co.rains.tx.us

Red River Clarksville co.red-river.tx.us

Rusk Henderson co.rusk.tx.us

Smith Tyler smith-county.com

Titus Mt. Pleasant co.titus.tx.us

Upshur Gilmer countyofupshur.com

Van Zandt Canton vanzandtcounty.org

Wood Quitman mywoodcounty.com

https://www.county.org/About-Texas-Counties/Texas-County-Websiteshttp://www.co.anderson.tx.us/


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Texas Demographics. https://demographics.texas.gov/Data/TPEPP/Projections/Tool?fid=E78EA7AF7FA040DEA6D207B2F706C607 Accessed May 1, 2020

.Table 8 - Region 4 2020 Population Projection Percent Change.

Demographic Information

Demographics is the study of a population based on factors such as age, gender, race, and number of populates. Demographic data also refers to socio-economic information expressed statistically including employment, education, income, marriage rates, housing, languages, birth and death rates, and more. Governments, corporations, schools, religious groups, social campaigns, and nongovernment groups use demographic data to learn more about a population’s characteristics for many purposes.

Total Population

Texas is a state of vast land area with a rapid growing population. The state of Texas’ 2020 population projection of 29,677,668 people ranks it as the second-most populous state. Region 4 is estimated to have a total of 1,159,682 persons.13 See Table 4 under Data Source Tables for population totals. The total percent change from the 2010 Census to the 2020 Census projection for Region 4 is 4.32%. Region 4’s growth rate, 4.32%, was significantly lower than the state’s growth rate of 18.02%.

See the full listing of counties regarding population projection for Region 4 in Table 7 and population projections percent change in Table 8 in the Data Source Tables section of this needs assessment.

13 Texas Demographic Center. https://demographics.texas.gov/Data/TPEPP/Projections/Tool?fid=E78EA7AF7FA040DEA6D207B2F706C607 Accessed May 26, 2020

Area 2020 Census Population Projection

2010 Census Population

2020 Percent Change (+/-) from 2010

Census

Texas 29,677,668 25,145,561 18.02%

Region 4 1,159,652 1,111,696 4.32%

Higher Population Growth Counties in Region 4

Smith 235,143 209,714 12.13%

Wood 45,292 41,964 7.93%

Camp 13,322 12,401 7.43%

Lowest Population Growth Counties in Region 4

Morris 12,448 12,934 -3.76%

Marion 10,294 10,546 -2.39%

Red River 12,610 12,860 -1.94%

https://demographics.texas.gov/Data/TPEPP/Projections/Tool?fid=E78EA7AF7FA040DEA6D207B2F706C607https://demographics.texas.gov/Data/TPEPP/Projections/Tool?fid=E78EA7AF7FA040DEA6D207B2F706C607


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Population Density

Population density is a number showing how populated or crowded an area happens to be. Many factors, such as climate, natural resources, economy, politics, and societal boundaries can affect population density. For this needs assessment, population density will be shown as the number of people per square mile.

Due to its large surface area, Texas has a high population density of 113.6 persons per square mile. However, Region 4 is substantially less dense at 75.2 persons per square mile. For the last three years, Gregg, Smith, and Bowie counties have had the top three highest population densities for Region 4. Red River, Delta, and Marion counties have consistently had the lowest population densities in the region during this same time.

See the full listing of counties regarding Region 4 population density for Region 4 in Table 9 in the Data Source Tables section of this needs assessment.

https://demographics.texas.gov/Data/TPEPP/Projections/Tool?fid=E78EA7AF7FA040DEA6D207B2F706C607


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Age

The age structure of a population is the distribution of people of various ages. It is a useful tool for social scientists, public health and health care experts, policy analysts, and policy-makers because it illustrates population trends like rates of births and deaths. Region 4 age demographics are broken down into the following categories: 0 – 17 years old, 18 – 24 years old, 25 – 44 years old, 45 – 64 years old, and 65 years old and older.

In Region 4, there is a slightly lower percentage of youth age 0-17 (23.0%) compared to the state (25.3%); however, Region 4 has a higher percentage of populants 65 and above (19.0%) than the state (13.2%). The top three counties in Region 4 with the highest concentrations of younger residents are Titus, Gregg, and Harrison counties. The top three counties in Region 4 with the highest concentrations of older residents are Rain, Red River, and Wood counties. See the full listing of counties regarding Region 4 population projection by age category in Tables 10 - 12 in the Data Source Tables section of this needs assessment.



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Race/Ethnicity

Region 4 has a significantly higher percentage of White population by race (65.4%) compared to Texas (40.9%). Region 4’s Black population (15.1%) is also higher than the state average (12.0%). However, while the Hispanic population for Region 4 has grown annually, both the Hispanic, Texas at 39.8% and Region 4 at 16.2%, and Asian, Texas at 5.1% and Region 4 at 0.9%, categories in Texas are more than twice that of Region 4. Texas and Region 4 are almost even under the ‘Other” category with the state at 2.2% and Region 4 at 2.4%. Rains County has the highest percentage of White race population projection (84.9%), Bowie County has the highest percentage of Black race population projection (24.3%), Titus County has the highest percentage of Hispanic ethnicity population projection (43.5%), Smith County has the highest percentage of Asian race population projection (1.7%), and Lamar County has the highest percentage of Other race population projection (4.2%).

See the full listing of counties regarding Region 4 population projection by race and ethnicity category in Tables 13 - 15 in the Data Source Tables section of this needs assessment.



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Gender Marker

The state of Texas currently recognizes the gender markers male (M) and female (F). The gender markers are indicated on a birth certificate, ID or passport that shows an individuals biological gender at birth. Region 4’s percentages closely match those of the state on male verses female gender markers. Region 4’s 2020 population projection for female gender markers is 49.9% with male gender markers at 50.1%. The state of Texas’ population projection for female gender markders is 49.7% with male gender markers at 50.3%.

See the full listing of counties regarding Region 4 population projection by gender category in Tables 16 - 18 in the Data Source Tables section of this needs assessment.



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Population Ages 0 – 17 Years

This focus of prevention efforts on children and adolescents is particularly important since approximately 90 percent of adults who are clinically diagnosed with SUDs, began misusing substances before the age of 18. The Region 4 and the state of Texas is demographically similar to the national average. The United States Census Bureau (USCB) has the 2020 population projection for age 0 – 17 years old for the United States as 22.3% of the total population. Comparably, Texas has the 2020 population projection for ages 0 – 17 years old of 25.3%. Region 4 has the 2020 population projection for age 0 – 17 years old of 23.0%. The same is true for the 2020 population projection for age 0 – 17 gender markers with the United States at 50.8% female and 49.2% male, Texas at 49.0% female and 51.0% male, and Region 4 at 48.9% female and 51.1% male. See the full listing of counties regarding Region 4 population projection for the population ages 0 - 17 in Tables 19 - 25 in the Data Source Tables section of this needs assessment.



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County Health Rankings and Roadmaps. https://www.countyhealthrankings.org/app/texas/2020/downloads Accessed July 1, 2020

Children in Poverty In Region 4, 26%, or 69,489 children aged 0 - 17 are living in households with income below the Federal Poverty Level (FPL). This indicator is relevant because poverty limits access to health services, healthy food, and other health necessities that promote an overall healthy lifestyle. The Region 4 counties with the highest percentages for age 0 – 17 population living in poverty are Marion with 34%, Cass with 32%, and Camp and Morris both with 31%. It is interesting to note that 25% of Camp County’s population is made up of age 0 – 17 population. See the full listing of counties regarding Region 4 population ages 0 - 17 living in poverty in Table 26 in the Data Source Tables section of this needs assessment.

https://www.countyhealthrankings.org/app/texas/2020/downloads


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U.S. Census Bureau. https://data.census.gov/cedsci/ Accessed April 1, 2020

Language and Language Proficiency

According to the U.S. Census American Community Survey, English is the primary language and Spanich is the secondary language spoken within in Region 4. Indo-European, Asian and Pacific Islander, and other undefined languages are used in a few counties throughout Region 4.14

Language barriers pose problems in mental health and substance use care and prevention for foreign-born

individuals in the United States. A "Limited English-Speaking Household" is one in

which no member 14 years old and over speaks only English or speaks a non-English language and speaks English "very well." In other words, all members 14 years old and over have at least some difficulty with English. 15 The percent of Limited English Speaking Households for 2013 - 2018 is lower in Region 4, 3.39%, than in Texas, 7.89%. Six counties in Region 4 have percentages above the Region 4 average. These counties are Titus with 6.94%, Marion with 6.24%, Lamar with 5.95%, Cherokee with 5.09%, Anderson with 3.60%, and Smith with 3.99%.

See the full listing of Region 4 counties Limited English-Speaking Households in Table 27 in the Data Source Tables section of this needs assessment.

14 American Community Survey. https://www.census.gov/programs-surveys/acs Accessed May 21,2020 15 U.S. Census Bureau, 2014-2018 American Community Survey 5-Year Estimates. https://data.census.gov/cedsci/ Accessed April 1, 2020

https://data.census.gov/cedsci/https://www.census.gov/programs-surveys/acshttps://data.census.gov/cedsci/


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Per Capita Income by Texas County and Region, 5-year Estimates. 2016-2018. U.S. Census Bureau. https://data.census.gov/cedsci/. Accessed June 19, 2020

.Table - PHRs of Texas 2016 - 2018 Per Capita Income.

Socio-Economic Data

Socio-economic data is comprised of data about humans, human activities, and the space and/or structures used to conduct human activities. For the purposes of this report, socioeconomics will be examined by reporting data regarding total and per capita income, employment and unemployment rates, household composition, TANF and SNAP recipients, children receiving free or reduced school lunches, and uninsured children. These indicators will assist with communities understanding the social and economic factors influencing the population living in Region 4.

Total Income and Per Capita Income

The U.S. Census Bureau collects information regarding a county’s average rate of income. Per capita income measures the resident’s average amount of income for a particular year. It is calculated by dividing the area’s total income by its population. Region 4’s average, $24,357, though not the lowest in the state, is significantly lower than the state average, $30,143.

See the full listing of counties regarding Region 4 total income and per capita income in Table 28 in the Data Source Tables section of this needs assessment.

.

Area

2018

Per Capita Income

2017 Per Capita Income

2016 Per Capita Income

Texas $30,143 $28,985 $27,828

PHR 1 $25,375 $24,104 $23,227

PHR 2 $25,108 $24,330 $23,593

PHR 3 $30,184 $28,739 $26,101

PHR 4 $24,357 $23,402 $22,678

PHR 5 $23,343 $22,477 $22,1633

PHR 6 $29,906 $28,977 $27,621

PHR 7 $26,934 $26,252 $24,850

PHR 8 $26,552 $26,228 $24,792

PHR 9 $26,437 $26,399 $26,307

PHR 10 $20,029 $20,748 $20,293

PHR 11 $20,335 $18,923 $19,244


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Region 4 2019 Unemployed

U.S. Bureau of Labor Statistics. https://www.bls.gov/lau/#tables Accessed March 3, 2020

Employment

Full-time employment is one of the greatest protections against risk for substance use, misuse and abuse behaviors. The U.S. Department of Labor keeps record of local area labor force statistics and defines labor force as the total number of people able to work, employed as the total number of people having a paid job, and unemployed as the total number of people without a paid job but availavle to work. Region 4’s unemployment rate of 4.2% is slightly higher than the state’s rate of 3.9%. The counties in Region 4 with the highest unemployment rates are Morris at 6.6%, Red River with 5.4%, Cass with 5.1%, and Titus with 5.0%. the counties with the lowest unemployment rates are Anderson with 3.1%, Delta and Hopkins both with 3.4%, Rains and Van Zandt with 3.5%.

See the full listing of counties regarding Region 4 labor force, employed, unemployed, and unemployment rate in Tables 29 - 30 in the Data Source Tables section of this needs assessment.

https://www.bls.gov/lau/#tables


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County Health Rankings and Roadmaps. https://www.countyhealthrankings.org/app/texas/2020/downloads Accessed July 1, 2020

Single-parent Households

Living in a single-parent household has been identified as a potential risk factor for substance abuse and victimization of child abuse/neglect. Region 4 has a slightly lower percentage of single-parent households, 32%, in comparison to the state, 33%. The same is true for 2019, and Region 4 and the state were even at 33% in 2018. A few counties in Region 4 have had significant changes in the number of single-parent households in the past three years. Franklin County has had the largest decline with 38% in 2018 to 25% in 2020. Delta County had the second largest drop from 2018 with 40% to 2020 with 33%. The largest increase from 2018 at 28% to 2020 at 32% is Camp County. The second largest increase was Wood County from 2018 with 33% to 2020 with 36%. See the full listing of counties regarding Region 4 single-parent households in Tables 31 - 32 in the Data Source Tables section of this needs assessment.

https://www.countyhealthrankings.org/app/texas/2020/downloads


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Texas Education Agency. https://rptsvr1.tea.texas.gov/adhocrpt/adspr.html. Accessed July 1, 2020

Homelessness Students

The homeless student population has climbed in recent years according to the National Center for Homeless Education (NCHE).16 As defined by the McKinney-Vento Act., a homeless student is an individual who lacks a “fixed, regular, and adequate nighttime residence.” 17 This includes students who are sharing accommodations (doubling up), staying at hotels, or sleeping in any public space. 74% of students experiencing homelessness shared housing with others (doubling up). English language learners make up only 10% of the total student population; however, they are 17% of the homeless student population. Thirty-one states reported that at least 20% of their homeless students had a disability. Only 29% of homeless students achieved academic proficiency in reading/language arts. 24% in mathematics, and 26% in science. 18 In addition to triggering insecurity, unstable living arrangements also create a crucial risk factor for substance abuse. Careful attention to this very vulnerable population should be given. For the 2019 -20 school year, Region 4 has a lower rate of homeless students per 100k, 922, than the state rate of 1,425. See the full listing of counties regarding Region 4 homeless students in Table 33 in the Data Source Tables section of this needs assessment.

16 The National Center fo Homeless Education. https://nche.ed.gov/ Accessed June 16, 2020 17 The National Center for Homeless Education. https://nche.ed.gov/mckinney-vento-definition/ Accessed June 16, 2020

18 The national center for Homeless Education. https://nche.ed.gov/wp-content/uploads/2019/02/Federal-Data-Summary-SY-14.15-to-16.17-Final-Published-2.12.19.pdf Accessed Accessed June 16,2020

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2019 - 2020 Homeless Students 2018 - 2019 Homeless Students 2017 - 2018 Homeless Students

https://nche.ed.gov/mckinney-vento-definition/https://nche.ed.gov/mckinney-vento-definition/https://nche.ed.gov/https://nche.ed.gov/mckinney-vento-definition/https://nche.ed.gov/wp-content/uploads/2019/02/Federal-Data-Summary-SY-14.15-to-16.17-Final-Published-2.12.19.pdf%20Accessed


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Texas Education Agency. https://rptsvr1.tea.texas.gov/adhocrpt/adspr.html. Accessed July 1, 2020

TANF recipients

The Texas Temporary Assistance for Needy Families, or TANF, program is a support service for Texas families to provide financial and medical assistance to children in need and/or for the parents or relatives of whom they reside. TANF programs provide cash for monthly household expenses. Food, clothing, housing, utilities, furniture, transportation, phone, and laundry services are all items that TANF can supply for individuals. TANF is further broken down into the TANF Basic Program, which assists single parents and children who may be wards of the state, and the TANF State Program. TANF Basic is funded by federal money and the TANF State Program is specific to two-parent households and funded with state general revenue dollars. These funds are generally reserved for when there is an emergency in the family and the family will be short on funds for the month. The Region 4 counties with the most TANF recipients per 100k population are Lamar with 225.39, Red River with 212.24, and Camp with 185.55. The Region 4 counties with the least amount of TANF recipients per 100k population are Rains with 47.84, Wood with 68.31, and Van Zandt with 72.43.

See the full listing of counties regarding Region 4 TANF recipients in Table 34 in the Data Source Tables section of this needs assessment.


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Texas Health and Human Services. https://hhs.texas.gov/about-hhs/records-statistics/data-statistics/supplemental-nutritional-assistance-program-snap-statistics Accessed May 10, 2020

SNAP receipients

The Texas Supplemental Nutrition Assistance Program (SNAP) provides multiple benefits to needy families living in the state of Texas. In addition to purchasing food, families can also pay utilities and pay for public transportation. SNAP benefits cannot be used to buy tobacco, alcoholic drinks, things you cannot eat or drink, or pay for food bills that have already been incurred.

In Texas, 3,725,683 individuals received SNAP benefits. Comparably, the 23 counties that make up Region 4 had 150,199 recipients. The majority of Region 4’s SNAP recipients, 58,879, fall in the age range of 18 to 59 years of age. The counties with the highest number of reciepients are Smith with 25,156, Gregg with 18,383, and Bowie with 15,034. The counties with the lowest number of recipients are Delta with 619, Franklin with 1,228, and Rains with 1,320.

See the full listing of counties regarding Region 4 SNAP recipients in Tables 35 - 38 in the Data Source Tables section of this needs assessment.

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National Center for Education Statistics. https://nces.ed.gov/ccd/elsi/ Accessed April 22, 2020

Free and Reduced School Lunch Recipients

The National School Lunch Program is a federally assisted meal program operating in public and nonprofit private schools and residential child care institutions. Children from families with incomes at or below 130 percent of the poverty level are eligible for free meals. Those with incomes between 130 percent and 185 percent of the poverty level are eligible for reduced-price meals, for which studnts can be charged no more than 40 cents. A measure of possible food insecurity is the percentage of children who are eligible for free or reduced-price school meals. Region 4’s percentage of students on free and reduced lunch, 63%, is slightly higher than the state rate, 61%. The greatest percentages of students with meal assistance are in Morris at 79%, Camp at 78%, Marion at 74%, and Titus at 73%. The only counties in Region 4 that fall below the state percentage of 61% are Franklin, Upshur, and Wood all with 60%, Van Zandt with 54%, and Harrison and Panola both at 53%. See the full listing of counties regarding Region 4 free and reduced lunch students in Tables 39 - 42 in the Data Source Tables section of this needs assessment.

https://nces.ed.gov/ccd/elsi/


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County Health Rankings. http://www.countyhealthrankings.org/ Accessed May 4, 2020

Uninsured Children

According to a press release by Health Resources & Services Administration (HRSA), ‘Compared to children who were consistently and adequately insured throughout the year, uninsured or underinsured children were more likely to have difficulty obtaining referrals for needed care, lacked a usual source of care, delayed or did not get needed care and had problems getting care from specialists when needed.” Uninsured children are quantified as the percentage of children under the age of 19 without health insurance. Lack of health insurance coverage is a significant barrier to accessing needed health care and “going without coverage can have serious health consequences for the uninsured”.

Compared to the state rate of 10% uninsured children, Region 4 is slightly higher at 11% or 29,489 total uninsured children. With the exception of Smith at 9%, Cass at 9%, and Bowie at 8%, all other counties in Region 4 have uninsured children rates that exceed the state rate.

See the full listing of counties regarding Region 4 uninsured children in Table 43 in the Data Source Tables section of this needs assessment.


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Environmental Risk Factors

The more risk factors one has while using drugs, the more likely that person is to abuse drugs or become addicted. Risk factors may be either environmental or biological. Biological risk factors may be one’s genetics, the stage of development they are in, or even their gender or ethnicity. Environmental risk factors include, but are not limited to: retail access, social access, perceived risk of harm, and social norms. This is the area preventionists can focus on altering. A person may have many environments or domains of influence such as community, family, school, and friends. An individual’s risk of addiction can develop in any of these domains.

In evaluating the risk of substance use in congruence with the risk factor model, accessibility should be considered as a risk factor in the perceptions one has in obtaining alcohol, marijuana, tobacco, and other drugs. Social hosting by family is an example of an accessibility increased risk factor of substance use, e.g., when a parent hosts a party and allows substance use on their property. Another example is the acceptability of drugs and/or alcohol in a school environment and among peers. The more accepted and common ATOD are, the more accessible they are. The community also contributes to the accessibility risk factor if businesses do not follow state licensing and regulations in alcohol sales. The information addresses assessing accessibility in Region 4.


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Texas Alcoholic Beverage Commission. www.tabc.texas.gov Accessed March 17, 2020

Retail Access

Drug availability is contingent upon social policies. Some major policies address legal measures to: control supply and demand, control access, by age, location, and time, and provide public education and treatment for those who need assistance. Perceptions of access can represent both a risk and a protective factor.

Alcohol

The number of licensed establishments that sell alcohol in an area is also related to accessibility. For example, areas with greater numbers of licensed establishments have a greater statistical likelihood for higher consumption rates. Furthermore, outlet density is closely tied to a community’s rate of consumption. Greater density creates more “opportunities” for purchase. This information becomes most useful in analyzing those areas of concentration (of both types), the transportation system from lower permit areas to the higher ones, and the socio-economics of those areas of highest concentration. The counties in Region 4 with a higher denisty rates per 100k population for number of alcohol permits than the state’s rate of 200.9 are Marion at 301.1, Gregg at 283.9, Rains at 241.0, Morris at 241.0, Camp at 240.2, and Henderson at 234.1.

See the full listing of counties regarding Region 4 alcohol permits in Table 44 in the Data Source Tables section of this needs assessment.

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Texas Comptroller referred to Data.texas.gov. https://data.texas.gov/Government-and-Taxes/Active-Cigarette-Tobacco-Retailers/u5nd-4vpg/data Accessed March 23, 2020

Tobacco and other Nicotine Products

The same is true for tobacco liscenced merchants as that of alcohol lisecenced merchants. The increased number of establishments to purchase tobacco and other nicotine products has a direct corelation with the increased amount of the community purchasing and using harmful substances.

The increase in use of e-cigarettes by teens has increased the demand for nicotine products and the paraphanalia that accompanies those products. There has also been an expansion from nicotine to THC vaping. This makes the detection of the illicit substance more difficult due to the lack of pungent odor associated with smoking marijuana. While the age required for the purchase of vape products has increased in Texas from 18 to 21 it is still commonly found on high schoolers.

The Region 4 counties with the highest tobacco permit density per 100k population are Marion at 2.5, Morris at 2.0, Rains and Gregg at 1.7, and Henderson at 1.6. The counties with the lowest rates are Delta and Franklin at 0.9 and Rusk and Smith at 1.0.

See the full listing of counties regarding Region 4 tobacco permits in Table 45 in the Data Source Tables section of this needs assessment.

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https://data.texas.gov/Government-and-Taxes/Active-Cigarette-Tobacco-Retailers/u5nd-4vpg/data


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Marijuana

With legalization efforts happening across the United States, the political and discursive landscape of marijuana has been filled with significant amounts of misinformation, so it is important that PRCs share scientifically-backed facts about the drug. Below are a series of misunderstandings about marijuana that are corrected by science-based research.

• Misconception: Marijuana is legal in Texas.

Fact: Marijuana is not legal in Texas. Marijuana (cannabis) is a Schedule I drug, defined as a drug with no currently accepted medical use and a high potential for abuse.19

• Misconception: “CBD is legal in Texas… doesn’t that mean marijuana is legal?”

Fact: No, marijuana is illegal in Texas; CBD is not marijuana. Cannabidiol, aka CBD, is a pharmacologically relevant constituent of the Cannabis plant.20 Those who smoke cannabis may do so for the intoxicating effects of tetrahydrocannabinol (THC) that is present in cannabis.

• Misconception: Marijuana is not harmful.

Fact: Marijuana can cause both mental and physical harm to the user. Marijuana affects brain development and may impair thinking, memory, and learning functions as well as affect how the brain builds connections.21 Marijuana smoke affects the lungs and causes chronic bronchitis, chronic cough, phlegm production, wheeze, acute bronchitis, and has been linked to causing air pockets in the chest cavity.22 Marijuana can increase the chance for heart attacks, as it raises the heart rate for some time after being smoked, and can lead to Cannabinoid Hyperemesis Syndrome, where the user experiences cycles of severe nausea, vomiting, and dehydration. Long-term marijuana use has been linked to mental health conditions in some users, such as temporary hallucinations, temporary paranoia, and worsening symptoms of existing schizophrenia.

• Misconception: Marijuana is not addictive.

Fact: According to the Diagnostic and Statistical Manual-V (DSM-5), “Cannabis Addiction is a highly prevalent public health issue and common clinical problem”.23 Moreover, adults seeking treatment for marijuana use disorders have, on average, attempted to quit more than 6 times.24.

• Misconception: Marijuana is not a gateway drug.

Fact: In order to be a gateway drug, the use of marijuana must be prior to the use of other drugs. In 2013, nearly three-quarters of adult illicit-drug users reported that marijuana was their first illicit drug of choice. Marijuana is highly correlated with alcohol, opioid, and cocaine use disorders.25

19 United States Drug Enforcement Administration. DEA / Drug Scheduling. https://www.dea.gov/druginfo/ds.shtml. Accessed July 2020 20 Iffland K, Grotenhermen F. An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies. Cannabis Cannabinoid Res. 2017;2(1):139-154. doi:10.1089/can.2016.0034 21 National Institute on Drug Abuse. Marijuana. https://www.drugabuse.gov/publications/drugfacts/marijuana. Accessed July 10, 2019. 22 Moir D, Rickert WS, Levasseur G, et al. A Comparison of Mainstream and Sidestream Marijuana and Tobacco Cigarette Smoke Produced under Two Machine Smoking Conditions. Chemical Research in Toxicology. 2008;21(2):494-502. doi:10.1021/tx700275p 23 Miller NS, Oberbarnscheidt T, Gold MS. Marijuana Addictive Disorders: DSM-5 Substance-Related Disorders. Journal of Addiction Research & Therapy. 2017;8(1):1-8. doi:10.4172/2155-6105.S11-013 24 National Institute on Drug Abuse. Available Treatments for Marijuana Use Disorders. https://www.drugabuse.gov/publications/research-reports/marijuana/availabletreatments-marijuana-use-disorders. Accessed July 2020 25 Miller NS, Guttman JC, Chawla S. Integration of generalized vulnerability to drug and alcohol addiction. Journal of Addictive Diseases. 1997;16:7-22. doi:10.1080/10550889709511140


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National Conference of State Legislatures. https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx Accessed August 24, 2020

State Cannabis Programs

https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx


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PDMP Dispensations. Request from The Texas State Board of Pharmacy. Accessed July 17, 2020

Prescription Drugs

In the 1990s, there were dramatic increases in opioid prescriptions in response to chronic pain symptoms reported by U.S. patients. This marked the beginning of the current opioid epidemic. The year of 2010 marked the second wave of opioid overdose deaths via the drug heroin. The third wave of this epidemic was in 2013 which then involved synthetic opioids, particularly fentanyl, which increased opioid overdose deaths even more. Measures were, and still, are being taken at the national, state, and regional levels to combat the drug overdose epidemic. In 2017, the U.S. Department of Health and Human Services (HHS) declared the opioid epidemic a public health emergency. Illicit use of prescription drugs remains one of the top three prevention priority areas for the nation and state of Texas.

The Texas Prescription Monitoring Program (PMP) collects and monitors prescription data for all Schedule II, III, IV, and V controlled substances dispensed by licensed pharmacies located throughout Texas. The purpose of the PMP is to inform prescribers and pharmacists of a patient’s history with controlled or scheduled substances.

Schedule II drugs (usually prescribed for pain management) are defined as those with a high potential for abuse and use can potentially lead to severe psychological or physical dependence. Most opioids, such as hydrocodone, methadone, oxycodone, hydromorphone, and fentanyl, fall into this category of Schedule II drugs.

See the full listing of counties regarding Region 4 prescriptions in Tables 46 - 48 in the Data Source Tables section of this needs assessment.

https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx


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Social Access

While parents may provide the first form of protection against risk for substance abuse, it’s not long before they compete for a young person’s attention from a variety of societal influences. Thrust into unfamiliar conditions, the desire for companionship can lead to poor decision-making. The process of self-discovery changes dramatically during formative years. Media messages also continue to portray drugs and alcohol as acceptable, enjoyable ways to relate to others and have a good time. Peer pressure can make even the most steadfast young adult submit to experimentation and a “just this once” mindset. Even with no other risk factors present, peer pressure can be one of the most influential forces in an individual’s life. Add to all the above the desire for stress relief, and social factors present a strong influence on teen substance abuse. Access involves multiple potential sources of ATOD for minors, including friends, siblings, and parents, either with or without their permission, and therefore presents a more defuse target for intervention activities, including media advocacy. Family associations may influence the risk of abuse if parents are social hosts for adolescent parties, and the risk of abuse is influenced if drugs are allowed or are normally found on school campuses. A community may contribute to a perceived risk if businesses do not follow state licensing and regulations in alcohol sales. Data reported for youth in Texas is researched and collected by the Public Policy Research Institute, PPRI, at Texas A&M University through participation in the Texas School Survey, TSS. This survey is conducted every two years on students in grades 7-12. The TSS was scheduled to collect data during the 2019 – 2020 school year. However, because of the global pandemic and public schools closing for most of the spring semester, the survey was not completed. The Texas School Survey addresses a teenager’s perception of how difficult it would be for them to acquire alcohol, tobacco, and other drugs.


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.Table 50 - Region 4 2018 TSS: If you wanted some,

how difficult would it be to get tobacco? .

.Table 51 - Region 4 2018 TSS: If you wanted some,

how difficult would it be to get marijuana? .

Percieved Access

Ease of access to substances has been shown to have a direct and significant relationship with substance use for school-aged children. Perceived access to substances is a strong predictor of use and is an important risk factor. The TSS addresses a teenager’s perception of how difficult it would be for them to acquire alcohol, tobacco/other nicotine products, marijuana, and illicit drugs.

See the full listing of responses regarding Region 4 perceived access in Tables 49 - 52 in the Data Source Tables section of this needs assessment.

Region 4 Never

Heard of It Impossible

Very Difficult

Somewhat Difficult

Somewhat Easy

Very Easy

All 23.8% 20.9% 6.9% 8.7% 14.0% 25.7%

Grade 7 28.5% 36.8% 6.6% 9.3% 10.8% 8.1%

Grade 8 24.6% 31.3% 8.1% 10.9% 12.8% 12.2%

Grade 9 28.8% 19.6% 6.4% 9.3% 15.2% 20.7%

Grade 10 22.2% 14.0% 8.6% 9.6% 15.6% 30.1%

Grade 11 17.1% 10.9% 6.5% 8.8% 16.4% 40.3%

Grade 12 19.7% 8.1% 4.6% 3.2% 13.4% 51.1%

Region 4 Never

Heard of It Impossible

Very Difficult

Somewhat Difficult

Somewhat Easy

Very Easy

All 25.6% 26.4% 8.7% 8.6% 12.5% 18.4%

Grade 7 32.5% 47.8% 7.6% 4.8% 4.3% 3.1%

Grade 8 29.0% 40.2% 9.8% 7.3% 6.4% 7.2%

Grade 9 30.3% 21.4% 8.9% 10.8% 11.5% 17.0%

Grade 10 20.7% 16.6% 8.6% 9.4% 16.2% 28.5%

Grade 11 17.9% 16.4% 9.0% 9.9% 17.4% 29.4%

Grade 12 20.4% 10.5% 8.0% 9.6% 22.2% 29.3%


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.Table 54 - Region 4 2018 TSS: Thinking of parties you attended this school

year, how often were. marijuana and/or other drugs used? .

Source of Access

There are many ways that teenagers can get their hands on drugs or alcohol without having to buy them from a store. The high prevalence of illicit substances in most communities gives teens easy access to drugs, both at school and in other places. Groups of teens can develop specific ways to find drugs and distribute them to each other without adults figuring out what’s going on. Many drug transactions occur on school grounds, where teens sell drugs to their peers. At school, teens have access to a larger pool of drugs than what they would be accustomed to seeing in their own social groups. Teenage drug dealers operate in shrouds of secrecy around campus, potentially making deals on a regular basis. Nearly 20%, 1 in 5, of all high school students in the United States say that they have been sold, given, or offered drugs on school property.

Teenagers can often find substances they can use to get high right in their own homes. The medicine and liquor cabinets at home are frequently the targets of teens who either abuse drugs or alcohol themselves or sell them to other students at school. Prescription drug abuse by teenagers is high, especially with regard to performance-enhancing drugs like Adderall or Ritalin, and even opiate painkillers. Therefore, it is very important for parents to get rid of any unused medications as soon as possible, and to pay attention to whether any prescriptions are running out faster than expected. Non-prescription drug use in the home is also a major factor that influences teen substance abuse. If parents, older siblings or other relatives or housemates use illicit drugs, teenagers likely have easy access to them. Further, witnessing parents and family members do drugs can legitimize or validate a teen’s own drug use. Knowing about these drug sources is important for parents/guardians, schools, and communities who want to protect their children from illicit drug use and addiction.

See the full listing of responses regarding Region 4 source of access in Tables 53 - 54 in the Data Source Tables section of this needs assessment.

Region 4 Never Seldom Half the

Time Most of

the Time Always

Do Not Know

Did Not Attend

All 59.7% 5.2% 3.5% 5.1% 5.6% 1.7% 19.2%

Grade 7 81.3% 2.7% 1.3% 0.7% 0.7% 1.1% 12.2%

Grade 8 74.8% 2.9% 1.8% 1.8% 2.7% 1.8% 14.3%

Grade 9 59.4% 7.2% 2.8% 3.4% 4.4% 1.9% 20.9%

Grade 10 49.9% 6.9% 4.5% 7.4% 7.9% 2.3% 21.1%

Grade 11 4000.0% 5.7% 4.7% 9.4% 9.9% 2.4% 27.8%

Grade 12 45.9% 6.7% 6.8% 9.7% 9.7% 1.0% 20.3%

https://www.therecoveryvillage.com/drug-addiction/https://www.therecoveryvillage.com/teen-addiction/drug/high-school-drug-use/https://www.therecoveryvillage.com/teen-addiction/drug/high-school-drug-use/https://nccd.cdc.gov/youthonline/App/Results.aspx?TT=B&OUT=0&SID=HS&QID=H58&LID=LL&YID=RY&LID2=&YID2=&COL=&ROW1=&ROW2=&HT=&LCT=&FS=&FR=&FG=&FA=&FI=&FP=&FSL=&FRL=&FGL=&FAL=&FIL=&FPL=&PV=&TST=&C1=&C2=&QP=&DP=&VA=CI&CS=Y&SYID=&EYID=&SC=&SO=https://www.therecoveryvillage.com/adderall-addiction/https://www.therecoveryvillage.com/ritalin-addiction/https://www.therecoveryvillage.com/opiate-addiction/https://www.therecoveryvillage.com/drug-addiction/related-topics/america-addiction-familiar-familial/https://www.therecoveryvillage.com/drug-addiction/related-topics/america-addiction-familiar-familial/https://www.therecoveryvillage.com/illicit-drugs/


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.Table 55 - Region 4 2018 TSS: How dangerous do you

think it is for kids your age to use alcohol? .

.Table 57 - Region 4 2018 TSS: How dangerous do you think it is for

kids your age to use electronic cigarettes or vapes? .

Perceived Risk of Harm

An adolescent’s perception of the risks associated with substance use is an important determinant of whether or not he or she engages in substance use. For example, youth who perceive high risk of harm are less likely to use drugs than youth who perceive low risk of harm.

See the full listing of responses regarding Region 4 perceived risk of harm in Tables 55 - 59 in the Data Source Tables section of this needs assessment.

Region 4 Very

Dangerous Somewhat Dangerous

Not Very Dangerous

Not at All Dangerous

Do Not Know

All 52.8% 30.0% 11.4% 2.5% 3.3%

Grade 7 64.5% 19.8% 9.2% 2.2% 4.3%

Grade 8 54.7% 29.1% 11.7% 2.2% 2.2%

Grade 9 51.1% 28.0% 13.1% 2.0% 5.8%

Grade 10 47.3% 36.8% 10.4% 3.0% 2.5%

Grade 11 47.7% 35.2% 12.1% 2.2% 2.8%

Grade 12 49.6% 33.4% 12.1% 3.4% 1.5%

Region 4 Very

Dangerous Somewhat Dangerous

Not Very Dangerous

Not at All Dangerous

Do Not Know

All 57.2% 13.2% 13.2% 11.2% 5.2%

Grade 7 70.7% 12.9% 5.3% 5.5% 5.6%

Grade 8 62.4% 14.8% 10.2% 7.8% 4.8%

Grade 9 53.0% 14.0% 13.5% 10.7% 8.7%

Grade 10 52.5% 11.6% 15.5% 16.3% 4.0%

Grade 11 49.9% 14.5% 20.0% 11.2% 4.4%

Grade 12 52.2% 11.0% 16.5% 17.4% 2.9%


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.Table 60 - Region 4 2018 TSS: How do your parents feel about kids your age drinking alcohol? .

.Table 62 - Region 4 2018 TSS: How do your parents feel about kids your age using marijuana? .

Social Norms

Numerous surveys have shown that young people tend to overestimate the prevalence and acceptance of substance use among their peers. It is assumed that young people