2013 Comparison of Maine Public Health Districts

Snapshots and Trends:

Hornby Zeller Associates, Inc.

Presented By Tim Diomede September 2013

Goals for the Presentation

Introduce SEOW and the Community Profiles

Review basic demographic information

Highlight comparative snapshots and trends

for key indicators

Questions and comments

Purposes of State Epidemiological Outcomes Workgroup (SEOW)

Promote data-driven decision-making

Guide use of prevention resources

Identify substance abuse patterns

Establish and track substance abuse trends

Detect emerging substances

Characteristics of the Community Profiles

Consumption

Consequences

Contributing Factors

Mental Health

Treatment

Reports for eight Maine Public Health Districts (PHDs) include:

Each indicator includes:

a description of the indicator

a justification (e.g., why it is important)

a chart or graph

and bulleted key findings

Reports can be found at the following link:

www.maine.gov/dhhs/samhs/osa/data/profiles.htm

Characteristics of the Community Profiles

Demographics – Quick Facts

5% 13%

21%

7%

11% 13%

15%

15%

Highest rate

Lowest rate

10.8 36.3

337.2

21.0

81.9

23.2

76.9

199.0

43.1

Aroostook

Central

Cumberland

Downeast

Midcoast

Penquis

Western

York

Maine

Highest rate

Lowest rate

Higher than average

Average/lower than average

Percent of State Population and People Per Square Mile

(U.S. Census, 2012 Estimate)

Majority of Mainers reside in the

southern half of the state.

0%

5%

10%

15%

20%

25%

30%

35%

18 to 24 years 25 to 44 years 45 to 64 years 65 years and over

Aroostook

Central

Cumberland

Downeast

Midcoast

Penquis

Western

York

Maine

Population by Age Group as a Proportion of PHD (U.S. Census, 2012 Estimate)

Percent Below Poverty (U.S. Census, 2012 estimate)

About one in six residents in Aroostook

and Penquis live below the poverty level.

Highest rate

Lowest rate

Higher than average

Average/lower than average

16% 14%

11%

15%

11%

16%

12%

9%

13%

Consumption

Alcohol Use Among High School Students (MIYHS, 2011)

*Binge Drinking is defined as consuming five or more drinks in a row.

27%

16%

26%

16%

29%

17%

24%

15%

30%

18%

30%

19%

27%

16%

29%

17%

28%

17%

0%

5%

10%

15%

20%

25%

30%

35%

Any Alcohol Use (past 30 days) Binge Drinking* (past 30 days)

Aroostook

Central

Cumberland

Downeast

Midcoast

Penquis

Western

York

Maine

Percent of adults who reported drinking during past 30 days (BRFSS, 2011)

50% 55%

69% 60% 62%

56% 57% 64% 60%

Highest rate

Lowest rate

Almost seven in ten adults in

Cumberland drank in the past month. Nine percentage points higher

than the state rate

Highest rate

Lowest rate

Higher than average (4+ points)

Average/lower than average

65% - 69%

50% - 54%

60% - 64%

55% - 59%

Highest rate

Lowest rate

Higher than average

Average/lower than average

Binge Drinking Among Adults in Past 30 days By Age Group (BRFSS, 2011)

0%

10%

20%

30%

40%

50%

18+ 18-25 26-35

Aroostook

Central

Cumberland

Downeast

Midcoast

Penquis

Western

York

Maine

Nearly half of the 18 to 25 year olds in Cumberland engaged in binge drinking within the past month.

Adults at Risk from Heavy Drinking* During Past 30 Days (BRFSS, 2011)

6% 7%

9% 9%

7%

6% 6%

8% 7%

Almost one in ten adults in

Cumberland and Downeast were at risk for heavy drinking.

*At risk from heavy drinking = consuming two drinks per day for a man or one drink per day for a woman.

Highest rate

Lowest rate

Higher than average

Average/lower than average

High School Cigarette Use Past 30 Days (MIYHS, 2011)

Highest rate

Lowest rate

Highest rate

Lowest rate

Higher than average

Average/lower than average

Nearly one in six students in Maine had smoked cigarettes in the past 30 days.

17% 16%

13%

17% 19% 17% 15% 16% 16%

Past Month Cigarette Use Among Adults (BRFSS, 2011)

27% 27%

18%

24%

19%

25% 25%

21% 23%

Highest rate

Lowest rate

Highest rate

Lowest rate

Higher than average

Average/lower than average

More than one in four adults in Aroostook and Central PHD had smoked cigarettes in the

past 30 days.

High School Prescription Drug Misuse Past 30 Days (MIYHS, 2011)

Highest rate

Lowest rate

Highest rate

Lowest rate

Higher than average

Average/lower than average

7% of Maine students had reported misusing Rx drugs. Rates ranged from 5% in Downeast to 9% in Midcoast.

5%

7% 7%

5%

9%

8%

7%

8% 7%

Non-medical Pain Reliever Use Within Past Year Among 18 to 25 Year Olds (NSDUH, 2008-10)

13%

12%

13%

12%

13%

14%

13%

12%

Maine

York

Western

Penquis

Midcoast

Cumberland

Central

Aroostook/Downeast*

Highest rate

Lowest rate

Average/lower than average

*Because of small sample sizes, survey data from Aroostook and Downeast have been combined

Almost one in seven 18 to 25 year olds in Maine had misused Pain Relievers within the year. Rates ranged from 12% to 14%.

High School Marijuana Use Past 30 Days (MIYHS, 2011)

One in Four students in Midcoast had used

marijuana within the past month.

Highest rate

Lowest rate

Higher than average

Average/lower than average

17% 21%

23% 20%

25% 21% 22%

24% 22% 15% - 19%

25% - 29%

20% - 24%

Percent of adults (18+) who have used marijuana

during the past 30 days (BRFSS, 2011)

3% 5%

7%

12%

7%

10% 7%

11%

8% 1%

4% 1%

2%

4%

1%

2%

2%

2%

Recreational use

Medical use

Downeast had the highest rate of recreational use.

Central and Midcoast had the highest rate of Medical use.

*

*Medical use of marijuana is expected to increase with the inception of medical marijuana laws.

Consumption Summary Drinking among adults is more prevalent among southern regions

along the coast and use (including binge drinking) among high school students is more common in Midcoast and Penquis.

Binge drinking among adults is highest among Mainers 18 to 35, particularly in Maine’s more populated Regions. Adults at risk from heavy drinking tend to be along the coastal regions of Maine.

Cigarette smoking among adults and youth is more common among Northern and Central regions.

Pain reliever misuse is most common among 18 to 25 year olds.

High school marijuana use is most prevalent along the southern coastal regions of Maine.

Adult recreational marijuana use is most prevalent along the coast. Medical use of marijuana is more common among the Central and Midcoast PHDs.

Consequences

Drinking and Driving Among High School Students (MIYHS, 2011)

6%

4% 5%

4%

5% 6%

5% 5% 5%

Highest rate

Lowest rate

Highest rate

Lowest rate

Higher than average

Average/lower than average

One in twenty students in Maine had reported drinking and

driving within the past month. Rates ranged from 4% to 6%.

Alcohol-Related* Arrest Rate Per 10,000 Residents (DPS-UCR, 2006-2011)

50.0

80.0

110.0

140.0

2006 2007 2008 2009 2010 2011

Aroostook

Central

Cumberland

Downeast

Midcoast

Penquis

Western

York

Maine

In 2011, York had the highest alcohol-related arrest rate (89.5 per 10,000 residents).

*Alcohol-related arrests include Operating Under the Influence (OUI), liquor law violations, and drunkenness.

Drug-Related* Arrest Rate Per 10,000 Residents (DPS-UCR, 2006-2011)

30.0

40.0

50.0

60.0

2006 2007 2008 2009 2010 2011

Aroostook

Central

Cumberland

Downeast

Midcoast

Penquis

Western

York

Maine

In 2011, Penquis had the highest Drug-related arrest rate

(49.4 per 10,000 residents).

*Drug-related arrests include manufacturing, sales, and possession.

Alcohol/Drug-related* motor vehicle crash rate per 10,000 (MDOT/MBHS, 2008-2012)

4.0

8.0

12.0

16.0

2008 2009 2010 2011 2012

Aroostook

Central

Cumber.

Downeast

Midcoast

Penquis

Western

York

Maine

*In 2009, alcohol was attributed to 96 percent of the alcohol/drug-related crashes statewide.

Downeast had the highest alcohol/drug related crash rate

since 2009. In 2012, Downeast’s rate was 13 per 10,000 residents)

Outpatient* Hospital Admissions Related to Substance Use** Per 10,000 Residents (MHDO, 2011)

708.7

667.0

557.1

716.5

389.3

681.6

1094.6

751.2

284.6

Maine

York

Western

Penquis

Midcoast

Downeast

Cumberland

Central

Aroostook

**Visits may involve multiple substances

Lowest rate Highest rate

Highest rate

Lowest rate

Higher than average

Average/lower than average

*“Outpatient” refers to patients who receive treatment at a hospital or clinic but are not admitted overnight.

Outpatient Hospital Admissions Related to Substance Use* Per 10,000 Residents, by Drug Type (MHDO, 2011)

155

48

186

408

560

359

177

435

153 168

225

382

248

194

302 288 291 300

Alcohol Opiate**

Aroostook

Central

Cumberland

Downeast

Midcoast

Penquis

Western

York

Maine

*Visits may involve multiple substances

**Includes prescription narcotics, methadone, and heroin.

Outpatient Hospital Admissions Related to Substance Use* Per 10,000 Residents, by Drug Type (MHDO, 2011)

*Visits may involve multiple substances

28

82

41

163

126

305

32

91

26

81

58

132

38

131

66

131

62

161

Marijuana Other Drugs

Aroostook

Central

Cumberland

Downeast

Midcoast

Penquis

Western

York

Maine

Emergency Medical Services Overdose Responses Per 10,000 Residents, by Primary Type of Substance Involved

(EMS, 2012)

Highest rate

Lowest rate

Higher than average

Average/lower than average

17.9 19.2

16.3

9.0

13.4

20.9

17.9

12.2

14.0

17.1

9.7

15.8

21.2 20.5

14.5

11.4

15.3 16.0

Medication Alcohol

Aroostook

Central

Cumber.

Downeast

Midcoast

Penquis

Western

York

Maine

Drug-related Death Rate Per 100,000 (OCME, 2000-02 to 2009-11)

0.0

10.0

20.0

30.0

40.0

50.0

2000-02 2003-05 2006-08 2009-11

Aroostook

Central

Cumber.

Downeast

Midcoast

Penquis

Western

York

Maine

Consequence Summary

One in twenty students reported drinking and driving – Rates among PHDs did not vary much.

Overall, alcohol-related arrests have been declining among PHDs since 2006 and more common among more populated regions.

Recently, drug related arrest rates have increased among the Penquis, Aroostook, and Cumberland PHDs.

All PHDs, with the exception of Downeast, have seen a decrease in the rate of alcohol/drug related crashes since 2008. Rates were highest among the Downeast and Midcoast.

Consequence Summary (cont.)

Outpatient hospital admissions rates are highest among the Cumberland, Central, and Penquis PHDs. Alcohol-related admission rates were highest in densely populated areas, particularly Cumberland. Opiate related rates were higher in southern, central, and eastern Maine.

Rates for EMS medication-related overdose responses were highest in more rural/isolated regions. Alcohol-related overdose calls were highest among the Cumberland, Western, and Aroostook PHDs.

Drug related death rates were highest among southern, central, and eastern regions. Overall, death rates have been rising steadily since 2000.

Contributing Factors

Number of Liquor Licensees Per 1,000 Residents (DPS and U.S. Census, 2013)

3.1

3.1

2.1

2.7

3.5

4.8

3.2

2.5

3.8

Maine

York

Western

Penquis

Midcoast

Downeast

Cumberland

Central

Arroostook

Lowest rate Highest rate

Highest rate

Lowest rate

Higher than average

Average/lower than average

The dispensed quantity of narcotics per capita (PMP, 2008 -2012)

40.0

60.0

80.0

100.0

2008 2009 2010 2011 2012

Aroostook

Central

Cumber.

Downeast

Midcoast

Penquis

Western

York

Maine

Dispensed Quantity of Stimulants Per Capita (PMP, 2008-2012)

5.0

10.0

15.0

20.0

2008 2009 2010 2011 2012

Aroostook

Central

Cumber.

Downeast

Midcoast

Penquis

Western

York

Maine

Perception of Risk From Binge Drinking By Age Group Among (NSDUH, 2008-10)

Lowest rate Highest rate

Highest rate

Lowest rate

Higher than average

Average/lower than average

0%

10%

20%

30%

40%

50%

12 to 17 18 to 25 26+

29%

40%

27%

39%

29%

41%

26%

38%

27%

38%

27%

41%

25%

38%

27%

39%

18 to 25 26+

Aroostook/Downeast

Central

Cumberland

Midcoast

Penquis

Western

York

Maine

Risk and Protective Factors (MIYHS, 2011)

State Rate

Lowest Rate

Highest Rate

Ease of access to alcohol 67% 65% (Downeast, Western)

69% (Cumberland)

Ease of access to marijuana 58% 50% (Aroostook) 61% (York)

Perception of harm from misusing Rx drugs

85% 84% (Western) 87% (Aroostook)

Perception of harm from binge drinking (1-2 times/wk)

78% 77% (Downeast, Midcoast, Penquis)

80% (Aroostook, Cumberland, York)

Perception of harm from smoking marijuana on a regular basis

56% 53% (Midcoast) 64% (Aroostook)

Perception of parent’s feelings of wrongness for child smoking marijuana

86% 83% (Midcoast) 90% (Aroostook)

Contributing Factors Summary

The highest rates of liquor licensees are in Northern and Coastal Maine.

Dispensed quantity of narcotics per capita has been gradually decreasing (highest rate in Central and Penquis) while quantity of stimulants has been increasing (highest rates in Penquis and Cumb.).

One in four 18 to 25 year olds perceive a risk from binge drinking.

Well over half of students felt alcohol and marijuana were easy to get. Cumberland held the highest rate of accessibility for alcohol and York had the highest rate for marijuana.

Perception of getting caught by parents for drinking was lowest among the Midcoast and York PHDs and highest in Aroostook.

Contributing Factors Summary (cont.)

Almost nine out of ten students felt their parents would think it was wrong for them to smoke marijuana. Rates were lowest in the southern half of Maine.

Over three quarters of students felt misusing prescriptions drugs as well as binge drinking is harmful while only half of students felt smoking marijuana on a regular basis was harmful.

Mental Health

Diagnosed Depression Among Adults (BRFSS, 2011)

24% 26%

23% 23% 24% 27%

25% 22%

24%

Highest rate

Lowest rate

Highest rate

Lowest rate

Higher than average

Average/lower than average

More than one in four adults in Penquis

have been diagnosed with depression.

18%

23%

18% 18% 19%

23% 20% 20% 20%

Diagnosed Anxiety Among Adults (BRFSS, 2011)

Highest rate

Lowest rate

Highest rate

Lowest rate

Higher than average

Average/lower than average

Almost one in four adults in Penquis and

Central have been diagnosed with depression.

Depression* Among High School Students (MIYHS, 2011)

23% 22% 21%

23% 25%

22% 24% 24% 23%

*Felt sad or hopeless almost every day for two weeks or more in a row during the past year.

Highest rate

Lowest rate

Highest rate

Lowest rate

Higher than average

Average/lower than average

Almost one in four students in Maine have experienced

symptoms of depression. Rates ranged from 21% to 25%.

Suicide Ideation* Among High School Students (MIYHS, 2011)

12% 13% 11% 11%

15%

12% 14% 14%

13%

Highest rate

Lowest rate

Highest rate

Lowest rate

Higher than average

Average/lower than average

More than one in ten students in Maine have seriously

considered suicide. Rates ranged from 11% to 15%.

*students who reported that they seriously considered attempting suicide during the past year

Co-occurring* Mental Health and Substance Abuse (TDS, 2008-2012)

30%

40%

50%

60%

70%

2008 2009 2010 2011 2012

Aroostook

Central

Cumberland

Downeast

Midcoast

Penquis

Western

York

Maine

*Individuals admitted for substance abuse treatment that also had a mental health diagnosis

Mental Health Summary More than one in four adults have been diagnosed with depression.

Rates are highest among the central and western regions in Maine.

One in five adults have been diagnosed with anxiety. Rates were highest among the Central and Penquis PHDs.

About one in four students in Maine have experienced depression within the past year. Rates did not vary much among PHDs.

More than one in ten students had seriously considered attempting suicide within the past year. Rates were slightly higher among the Midcoast, Western, and York PHDs.

Co-occurring mental health and substance abuse treatment rates have been gradually increasing among all PHDs since 2008. In recent years, rates were highest among the Central and Cumberland PHDs.

Treatment

Primary Treatment Admissions Related to Alcohol (18+) (TDS, 2008-2012)

30%

35%

40%

45%

50%

55%

60%

65%

2007 2008 2009 2010 2011 2012

Aroostook

Central

Cumberland

Downeast

Midcoast

Penquis

Western

York

Maine

Primary Treatment Admissions Related to Synthetic Opioids (18+)

(TDS, 2007-2012)

0%

10%

20%

30%

40%

50%

60%

2007 2008 2009 2010 2011 2012

Aroostook

Central

Cumberland

Downeast

Midcoast

Penquis

Western

York

Maine

Primary Drug Treatment Admissions per 10,000 Residents by Substance (18+)

(TDS, 2011)

47.0

33.0 31.4 35.5

23.9 19.0

38.5

50.7

26.3 28.4 24.1

31.2

37.0 39.5

33.9

13.9

31.1 28.9

0.0

20.0

40.0

60.0

Alcohol Synthetic Opioids

Aroostook

Central

Cumber.

Downeast

Midcoast

Penquis

Western

York

Maine

Aroostook and Downeast had the highest rate of alcohol related primary treatment admissions

Downeast and Western had the highest rate of synthetic opioid

related primary treatment admissions

Heroin/Morphine Marijuana Methadone Cocaine/Crack

Aroostook 2.4 13.5 6.2 1.3

Central 10.6 6.8 5.0 3.7

Cumber. 13.3 5.5 3.8 3.7

Downeast 7.7 8.7 6.3 0.9

Midcoast 5.8 5.8 5.2 1.0

Penquis 7.2 3.4 4.3 2.1

Western 10.3 13.2 2.2 4.5

York 11.4 8.5 1.9 3.5

Maine 9.7 7.7 4.0 3.0

0.0

5.0

10.0

15.0

20.0

Primary Drug Admissions Per 10,000 Residents, by Substance (18+)

(TDS, 2012)

Treatment Summary

Alcohol continues to be the most common substance sought for treatment. Synthetic Opioids are the second most common substance for primary treatment admissions, followed by heroin/morphine, marijuana, methadone, and cocaine/crack.

With the exception of Downeast, the proportions of adult primary treatment admissions due to alcohol have been decreasing since 2007. Recently, rates have been highest among the Western, Downeast, and Aroostook PHDs.

All PHDs have seen an increase in the proportion of adult primary treatment admissions related to synthetic opioids since 2007. These rates have been led by the Downeast and Penquis PHDs.

Treatment Summary (cont.)

Aroostook and Downeast had the highest rate per 10,000 residents concerning primary treatment admissions for alcohol.

Downeast and Western had the highest rate per 10,000 residents involving primary treatment admissions for synthetic opioids.

Heroin/morphine primary treatment admission rates per 10,000 were highest among Maine’s most populated regions.

Marijuana rates were highest among the Aroostook and Western PHDs, Methadone rates were highest among Downeast and Aroostook PHDs, and cocaine/crack rates were highest among Maine’s more densely populated PHDs.

Conclusion Alcohol and Marijuana are most commonly used as well as perceived accessible

in southern and coastal regions – especially younger generations (~14 to 35)

Consequence data seems to correlate with regions where substance use is

most common.

Cigarette use is most prevalent in the Northern half of Maine.

Rx misuse is most common among 18 to 25 year olds.

Alcohol is most available across southern and coastal regions of Maine.

Availability of opiates is decreasing but treatment admissions are still rising.

Perceptions of harm from substances are down among young adults,

particularly those regarding marijuana.

Depression and Anxiety among adults are more common in central and

western regions of Maine.

Questions/Comments?

Timothy Diomede SEOW Coordinator/Data Analyst Office of Substance Abuse Timothy.Diomede@maine.gov

Reports can be found at the following link:

www.maine.gov/dhhs/samhs/osa/data/profiles.htm