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Report of the State Epidemiological Workgroup to The Advisory Council. Presented by Martin Arocena, Ph. D. Purpose of the SEW:. The Texas State Epidemiological workgroup’s purpose is to provide data and relevant information to the Advisory Council to:

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Report of the state epidemiological workgroup to the advisory council l.jpg

Report of the State Epidemiological Workgroup to The Advisory Council

Presented by Martin Arocena, Ph. D.


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Purpose of the SEW: Advisory Council

  • The Texas State Epidemiological workgroup’s purpose is to provide data and relevant information to the Advisory Council to:

    • Maintain you informed of the state’s status regarding alcohol, tobacco and other drugs;

    • Identify groups and/or areas affected the most by ATOD issues; and

    • Provide information necessary to guide the design of the Prevention Plan.


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Topics To Be Discussed Advisory Council

  • Describe the structure of the epidemiological workgroup and its role in this project;

  • Introduce one key concepts in epidemiology;

  • Present the status of substance abuse in the state;


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Topics To Be Discussed Advisory Council

  • Identify a list of the most prominent problems, and

  • Identify areas where alcohol-related problems are higher.


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Structure of the Epi Workgroup Advisory Council

  • The Epi workgroup consists of representatives from several state agencies, community organizations, and academia that have information and access to databases related to alcohol consumption, consequences, and other factors.

  • As a group, we have met 3 times so far for a total of 12 hours.


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Structure of the Epi Workgroup Advisory Council

  • The Center for Substance Abuse Prevention (CSAP), the funder of the Statewide Prevention Framework grant, is collaborating with DSHS very closely providing leadership, giving us advice, and participating in the decision-making process.


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Structure of the Epi Workgroup Advisory Council

  • We receive technical assistance from the Pacific Institute for Research and Evaluation (PIRE) hired by CSAP to provide technical assistance to the SPF grantees.

  • We also work in close collaboration with Drs. Tony Rey and Richard Cervantes from BAI, who are the project evaluators for this project.


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Structure of the Epi Workgroup Advisory Council

  • Dr. Liang Liu who is a researcher/epidemiologist with DSHS has been assigned duties in this project and acts as a co-coordinator of the Epi workgroup.

  • Liang and I are former TCADA researchers with many years of experience in the field of substance abuse research and evaluation.


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Epidemiology Advisory Council

Epidemiologists measure the magnitude and severity of a health problem and its consequences in society and the individuals through the collection and analyses of archival and survey statistics.

This type of work allows public health specialist to design interventions that help control the problem in a given area.


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Epidemiology Advisory Council

In our case, the problem is the consumption of alcohol, tobacco and drugs by the residents of Texas, and our collective goal is:

“To Move the Needle”


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Attribution is a very important concept used in epidemiology to select indicators.

Given two variables, the epidemiologist establishes the direction of the relationship and its strength.

The Concept of Attribution


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The Concept of Attribution to select indicators.

  • For example in substance abuse, while prolonged alcohol use is strongly associated with cirrhosis liver (1.0), the relationship between alcohol and diabetes is weaker (.05)

  • Attribution information was used as a criteria in selecting the substance abuse consequence variables.


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The Concept of Attribution to select indicators.

  • An example of attribution of substance abuse with a social consequence is the relationship between drugs and property crime.


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The Concept of Attribution to select indicators.

  • Surveys of inmate in prison serving time for robbery, burglary, and larceny found that approximately 30% of the property crimes (robbery, burglary, and larceny), reported that they committed the crime for which they were incarcerated to get drugs.


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Domains Selected To Measure Consequences to select indicators.

  • Alcohol and Drug Dependency

  • Alcohol-Related Fatalities

  • Crime Statistics

  • Mortality Information


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Sources of Archival Data to select indicators.

  • 2002-2003 National Survey on Drug Use and Health (NSDUH)(the national survey)

  • The 2004 Texas School Survey of Substance Use Among Students: Grades 7th – 12th (the school survey).


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Sources of Archival Data to select indicators.

  • Fatality Analysis Reporting System (FARS), National Highway Traffic Safety Administration (NHTSA),

  • D.S.H.S. Vital Statistics.

  • The F. B. I. 2003 Uniform Crime Reports


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Sources of Archival Data to select indicators.

DSHS’s Behavioral Risk Factor Surveillance System (The Risk Survey)

  • Youth Risk Behavior Surveillance System (YRBSS).


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Sources of Archival Data to select indicators.

  • National Census 2000 and estimated statistics provided by two demographers from Health and Human Service Commission, Drs. Liliana Santoyo and Edli Colberg.


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Status of Substance Use in Texas to select indicators.

  • The following charts will describe the status of substance abuse in Texas.


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Substance Abuse Dependency to select indicators.

  • The NSDUH includes questions designed to measure dependence and abuse based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).


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Substance Abuse Dependency to select indicators.

  • According to the national survey in Texas:

  • 12 to 17 group: 9 % = 184,631

  • 18 to 25 group: 20 % = 541,553

  • 26 and older: 7 % = 1,272,795

  • Were alcohol dependent or abusers.


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Substance Abuse Dependency to select indicators.

  • Alcohol is the most frequently mentioned primary drug reported by the adult population admitted to publicly-funded treatment centers in Texas.

  • About 30 % of the clients reported this substance as their primary substance at admission.


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Substance Abuse Dependency to select indicators.

  • The national survey estimated that the following percentages are dependent or abusers of any illicit drug:

  • 12 to 17 group: 5 % = 105,445

  • 18 to 25 group: 7 % = 1,811,496

  • 26 and older: 1.5 % = 280,763,


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Consequences: Alcohol-Related Fatalities to select indicators.

  • The statistics presented in the NHTSA’s State Alcohol Related Fatality Rates, 2003 revealed that from 1982 to 2003:

  • The percent of alcohol-related fatalities has been decreasing for the nation and Texas. For the United States, the decline went from 60 % to 40%, and for Texas the corresponding percentages were 66 % to 47 %.


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Alcohol-Related Fatalities to select indicators.

  • In 2003, the statistics showed that of the 4,916 drivers in crashes in which at least one person died, 1,443 (29.3%) were intoxicated with alcohol.


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Alcohol-Related Fatalities to select indicators.

  • The 35 to 54 years old group had the highest number of drivers involved in fatalities, 1,724 drivers.

  • However, of these 1,724, only 504 (29 %) were intoxicated.


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Alcohol-Related Fatalities to select indicators.(drivers)

  • The 21 to 29 years old age group had the highest percentage of intoxicated drivers.

  • Within this group, of the 1,102 drivers involved in an accident, 415 (38 %) were intoxicated.

  • 38 % vs. 29%


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Alcohol-Related Fatalities to select indicators.(drivers)

  • The 10 counties that contributed the most to the total number of drunk drivers were: Collin, Smith, El Paso, Montgomery, Hidalgo, Travis, Tarrant, Bexar, Dallas and Harris.


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Alcohol-Related Fatalities (Crashes) to select indicators.

  • In 2003, of the 3,675 vehicle deaths sustained in crashes, 1,709 (46%) involved alcohol in 2003.

  • The counties with the greatest number of fatal crashes where alcohol was a factor were: Cameron, Nueces, Collin, Denton, Smith, Montgomery, El Paso, Hidalgo, Travis, Tarrant, Bexar, Dallas, and Harris.


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Crime-Related Statistics to select indicators.

Violence rate includes aggravated assault, rape, and robbery. It is associated with alcohol abuse.

The crime reports shows that Texas’ violence rate per population is higher than the national rate.


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Crime-Related Statistics to select indicators.

  • The counties with the highest violence rates per population were: Victoria, Kleberg, Lamar, Potter, Nueces, Dallas, Wichita, Harris, Lubbock, and Jim Wells.


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Crime-Related Statistics to select indicators.

  • The counties with the higher number of reported violent offenses were: Jefferson, Lubbock, Nueces, Hidalgo, Travis, El Paso, Tarrant, Bexar, Dallas, and Harris.


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Crime-Related Statistics to select indicators.

  • Drug-related property crimes include burglary, larceny and motor vehicle theft.

  • The property crime rate in Texas is higher than the rate for the United Sates


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Crime-Related Statistics to select indicators.

  • The counties with the highest number of property crime reports were: Harris, Dallas, Bexar, Tarrant, Travis, Hidalgo, and El Paso.


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Crime-Related Statistics to select indicators.

  • However, when we take into consideration, property crime rates per 1,000 population, we found that among the top 20 counties, 6 were in the Rio Grande Valley (Cameron, Hidalgo, Kleberg, Webb, and Nueces).


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Mortality: Leading Causes of Death to select indicators.

  • Alcohol or other drugs are known to play a contributing factors in suicide, homicides, injuries, and motor vehicle crashes. These are among the leading causes of deaths for Youth aged 10 to 24.


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Mortality: Suicide to select indicators.

  • It is estimated that in approximately 20 % of suicides alcohol is a contributing factor.

  • In 2003, 2,355 individuals committed suicide in Texas. The greater number of suicides occurred among the 35 to 54 years old age group (1,030).

  • Harris and Tarrant were the counties with the greatest number of suicides, 296 and 166 respectively.


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Mortality: Homicides to select indicators.

  • It is estimated that approximately 30 percent of homicides are attributable to alcohol.

  • In 2003,the cause of death for 1,516 individuals was homicide.


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Mortality: Homicides to select indicators.

  • Unlike the case with suicides, there is not a single age-group with a higher proportion of the deaths due to homicide.

  • The age-groups with over 20% of homicide deaths were the 0 to 20 (328), 21 to 29 (427) and the 35 to 54 (448).


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Mortality: Leading Causes of Death to select indicators.

  • Tobacco is a contributing factor to chronic obstructive pulmonary and emphysema deaths, lung cancer and cardiovascular diseases.

  • These diseases were identified as leading causes of deaths in Texas.


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Tobacco-Related Deaths to select indicators.

  • 7,299 individuals died of COPD in Texas.

  • 51,940 died of cardiovascular complications, and

  • 9,697 died of lung cancer

  • The great majority of these preventable deaths occurred among the 65 yrs. old and older population


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Problems Statement in Texas to select indicators.

  • The list of Problem Statement in Texas is a summary of the major findings found regarding prevalence and consequence. This list is included in your packet of materials.


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Target Areas: to select indicators.

  • Based on crime and fatal accidents, these are some of the areas in the state that emerged as the most at risk due to high number and/or rates of fatalities, violent and property offenses:


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Target Areas: to select indicators.

  • Harris, Montgomery and Fort Bend counties,

  • Dallas, Collin, Tarrant and Denton,

  • And the Rio Grande Valley including the following counties: Cameron, Hidalgo, Jim Wells, Kleberg, Webb, and Nueces, and El Paso.


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Target Areas: to select indicators.

  • The identification of these areas was based thinking that in order to “move the needle,” these areas will be the ones that will produce the greater change on the overall statistics.


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