youth substance abuse issues: making alcohol, …r e p o r t a c r d 2 0 0 8 making alcohol,...

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Making alcohol, tobacco, and other drugs

irrelevant in the lives of youth.

Making alcohol, tobacco, and other drugs

irrelevant in the lives of youth.

Youth Substance Abuse Issues: Research and Legislation

Youth Substance Abuse Issues: Research and Legislation

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C O N T E N T S

IntRoduCtIon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 1

texAnS StAndIng tALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PubLIC HeALtH & SAfetY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 6

envIRonmentAL PReventIon StRAtegIeS . . . . . . . . . . . . . . Page28

80tH texAS LegISLAtuRe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page38

CReAtIng CommunItY CHAnge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page46

About the cover: In January of 2008, texans Standing tall updated

its mission and vision statements and launched a new logo that

we believe speaks more clearly to the comprehensive and

collaborative nature of the work we do throughout the state.

© Te x a n s S t a n d i n g Ta l l I n c . R E P O RT C A R D 2 0 0 8 w w w. Te x a n s S t a n d i n g Ta l l . o r g

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© Te x a n s S t a n d i n g Ta l l I n c . R E P O RT C A R D 2 0 0 8 w w w. Te x a n s S t a n d i n g Ta l l . o r g 1

This year, 2008, marks the third year for Texans Standing Tall

Statewide Coalition to release an annual Report Card and host a

series of Regional Policy Forums across Texas. In that time, Texans Standing Tall (TST)

has increased the number of Regional Policy Forums held and distributed more than

1,000 Report Cards each year.

The Report Card has been met with overwhelming support and utilized as a prevention

resource by people from all sectors of the community. Based on feedback from community

members, TST developed a presentation of the Report Card 2007 that was presented

during the 2008 Regional Policy Forums. Additionally, community members and leaders

were trained on how to utilize the presentation and Report Card to educate and engage

people in efforts to prevent underage alcohol, tobacco, and other drug use.

The Report Card 2008 includes information on current research including the Surgeon

General’s report, The Health Consequences of Involuntary Exposure to Tobacco Smoke,

and a report from the Institute of Alcohol Studies in London on binge drinking in

European countries. It also provides an overview of the Regional Policy Forums,

statewide youth and college-aged substance use and consequence trends, information

on how Texas compares with other states on implementation of evidence-based

environmental prevention strategies for public health and safety issues, and reports

on Texas Legislature Interim Studies that relate to youth substance use and safety issues.

It concludes with highlights on two success stories of population-based, environmental

change.

The Regional Policy Forums and Report Card are made possible through federal grant

funding from the Drug Free Communities (DFC) Support Program of the Substance

Abuse and Mental Health Services Administration (SAMHSA), support from regional

partners throughout Texas, and Texans Standing Tall.

Please note that throughout this Report Card the words “youth” and “underage” are

used interchangeably because junior high students, not only high school seniors and college

freshman, use alcohol – the average age for a student to first use alcohol in Texas is 12.2.

Report on Regional forums

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In 2006, Texans Standing Tall (TST) organized Regional Policy Forums throughout the

state, in partnership with local community coalitions. Forums were originally held in

Houston, Dallas, San Antonio, Midland, and El Paso. In 2007, Forums were again held in

those five cities, with an additional Forum in Lufkin. This year a location was added in

Austin, making the total number of Regional Policy Forums seven in 2008, three of which

are self-sustaining.

The Forums bring together local and state level participants to mobilize them in a

coordinated, strategic way to effect change at local and state levels on youth prevention

issues. At each Forum, community members learn about evidence-based environmental

prevention strategies as well as local and statewide substance abuse issues, participate in

strategic planning activities, and are mobilized to take action on different statewide and

local strategies each year. Because alcohol is the substance most used by youth in Texas,

the Regional Policy Forums give particular attention to preventing youth alcohol use.

Feedback from the 2007 Forums indicated a desire by participants to be trained in

utilizing the TST Report Card as a community advocacy tool. TST integrated

presentations based around the Report Card into the Regional Forums, not only as an

education piece for participants, but as a model of how to best utilize the Report Card

locally. State-level speakers presented on each section of the Report Card 2007:

Surgeon General’s Call to Action on Underage Drinking, Report on Regional Forums,

Statistics and Trends on Youth Substance Use, Drug Demand Reduction Advisory

Counsel (DDRAC) Policy Recommendations, Environmental Prevention Strategies, and

the Overview of the 80th Legislative Session as it related to youth substance use.

Additionally, a breakout session was provided to teach interested participants how

to present the Report Card 2007. Each participant received a CD with the Report Card

2007 PowerPoint presentation and a script.

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Creating Community Change: Surgeon general’s Call to Action on underage drinking

In January 2007, the Acting Surgeon General Kenneth Moritsugu, M.D., M.P.H., issued

a Call to Action to Prevent and Reduce Underage Drinking asking all Americans to

take action to reduce underage drinking. The Call to Action laid out six general goals,

developed in cooperation with the National Institute on Alcoholism (NIAAA) and the

Substance Abuse Mental Health Services Administration (SAMHSA). They are:

1. Foster changes in society that facilitate healthy adolescent development and that help

prevent and reduce underage drinking.

2. Engage parents, schools, communities, all levels of government, all social systems that

interface with youth, and youth themselves in a coordinated national effort to prevent

and reduce underage drinking and its consequences.

3. Promote an understanding of underage alcohol consumption in the context of

human development and maturation that takes into account individual adolescent

characteristics as well as environmental, ethnic, cultural, and gender differences.

4. Conduct additional research on adolescent alcohol use and its relationship to development.

5. Work to improve public health surveillance on underage drinking and on

population-based risk factors for this behavior.

6. Work to ensure that policies at all levels are consistent with the national goal of

preventing and reducing underage alcohol consumption.

The first Forum of 2008 was held in Houston on January 24th, and Dr. Hamilton Beazley,

Scholar-in-Residence at St. Edward’s University and Science Writer for the Surgeon

General’s Report, gave a “Call to Action” presentation about the research and

community solutions in the report. Nicole Holt, Executive Director of Texans Standing

Tall, gave the presentation at each of the remaining Forums.

The Surgeon General’s Call to Action can be viewed at:

http://www.surgeongeneral.gov/topics/underagedrinking/.

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focus on an environmental Strategy:Alcoholic energy drinks

Another highlighted issue was alcoholic energy drinks - prepackaged, sweet beverages

containing alcohol, caffeine, and other stimulants. The drinks are built on the popularity of

non-alcoholic energy drinks, and because they are categorized as malt beverages they

can be purchased anywhere beer is sold. This creates an easier to get and cheaper

alternative to buying the products separately and creating a mixed drink. The marketing

tactics employed for alcoholic energy drinks appeal largely to the youth market. They are

heavily advertised through viral marketing and on the Internet with flashy, youthful-

looking websites.

The packaging of alcoholic energy drinks looks very similar to those that contain no

alcohol. This packaging makes it more difficult for retailers, clerks, and parents to tell the

difference between the alcoholic energy drinks and the nonalcoholic versions. Underage

use of these drinks leads to many dangerous consequences. One of the most notable

is the creation of the “wide-awake drunk.” Youth do not feel the sedating effects of

alcohol the same as adults; the addition of a stimulant only makes that worse, masking

the sensation of drunkenness. This can lead to dangerous behaviors such as alcohol

poisoning, drunk driving, and other risky behaviors.

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SUBSTANCE EASY/FAirlY EASY HArD/VErY HArD

Alcohol 75% 4.7%

Tobacco 63.9% 6.9%

Other Drugs 67.2% 1.8%

Participant Perceptions of Youth Access to Drugs

evaluation of Region forums

TST conducts a comprehensive evaluation of the Forums to gauge the impact, knowledge

transfer, participant demographics, and perceptions and attitudes regarding alcohol,

tobacco, and other drug issues in the participant’s community. Research and Educational

Services (REdS) of Houston professionally administers all evaluation tools, which include:

Pre/Post Tests, Training Evaluation Survey, and a Community Assessment Survey.

TST is proud to report that the Regional Policy Forum model has proven successful in

educating and mobilizing Texans for community-level and statewide change. Results from

evaluations indicate that people leave the Forums more knowledgeable about youth

substance abuse issues and prevention strategies that can best address them. Results

from the 2008 Training Evaluation Survey of all Forum participants indicated the following:

• 91% of participants reported increased understanding of environmental strategies;

• 92% of participants reported increased understanding of advocacy; and

• 92% of participants reported increased understanding of how to achieve social change.

The Community Assessment Survey measures adult perception and behavior around

alcohol, tobacco, and other drug use in their community, and it is administered to each

Forum participant. In 2008, 93.9% of respondents stated that they believe there is an

alcohol or drug problem in their city. This is compared to 95% in 2007. Other results from

this year include: 74.8% believed that not enough attention was being given to the

alcohol or other drug problem in their community, and only 25.2% believed sufficient

attention was being given to the problem. The following chart indicates Community

Assessment Survey results on perception of availability of alcohol, tobacco, and other

drugs to youth in the participant’s community.

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Surgeon general’s Report: Health Consequences of Involuntary exposure to tobacco Smoke

In June of 2006, the United States Department of Health and Humans Services (DHHS)

led by the Surgeon General, Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS,

released a comprehensive scientific report on the dangers of involuntary exposure to

secondhand smoke.

The Health Consequences of Involuntary Exposure to Tobacco Smoke estimates that

126 million children and adults are exposed to secondhand smoke each year. Through

scientific studies led by the DHHS, this report outlines the negative effects secondhand

smoke has on the natural environment, pregnant mothers, infants, children, and adults.

The report also notes the direct relationship between secondhand smoke and the

increased risk of cancer and coronary heart disease. From the data collected, the report

summarizes six major conclusions:

1. Secondhand smoke causes premature death and disease in children and in adults

who do not smoke.

2. Children exposed to secondhand smoke are at an increased risk for sudden infant

death syndrome (SIDS), acute respiratory infections, ear problems, and more severe

asthma. Smoking by parents causes respiratory symptoms and slows lung growth in

their children.

3. Exposure of adults to secondhand smoke has immediate adverse effects on the

cardiovascular system, causes coronary heart disease and lung cancer.

4. The scientific evidence indicates that there is no risk-free level of exposure to

secondhand smoke.

5. Many millions of Americans, both children and adults, are still exposed to

secondhand smoke in their homes and workplaces despite substantial progress

in tobacco control.

6. Eliminating smoking in indoor spaces is the only way to fully protect nonsmokers from

exposure to secondhand smoke. Separating smokers from nonsmokers, cleaning

the air, and ventilating buildings does not eliminate exposure of nonsmokers to

secondhand smoke.

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The future of protecting ourselves from secondhand smoke can be best summarized

from a statement issued by Surgeon General Vice Admiral Carmona:

An important new conclusion of this Report is that smoke-free environments are the ONLY approach that effectively protects nonsmokers from the dangers of second-hand smoke. The 1986 Surgeon General’s Report concluded that the simple separa-tion of smokers and nonsmokers within the same air space may reduce, but does not eliminate, secondhand smoke exposure among nonsmokers. The current Report expands on that finding by concluding that even sophisticated ventilation approaches cannot completely remove secondhand smoke from an indoor space. Because there is no risk-free level of secondhand smoke exposure, anything less cannot ensure that nonsmokers are fully protected from the dangers of exposure to secondhand smoke.

A Comparison of european Countries and the united States: Youth drinking Rates

The legal age to purchase alcohol varies across Europe. According to the International

Center for Alcohol Policies, the legal age to purchase alcohol is 16 in France, Belgium,

and Spain and 18 in the United Kingdom, Switzerland, and Ireland. In Germany, wine and

beer can be purchased at age 16, but the minimum age to purchase distilled spirits is 18.

There is a perception among some people that American youth engage in high-risk drinking

and experience more alcohol-related problems than do their European counterparts. This

perception is often mentioned by supporters of changing the U.S. minimum legal drinking

age. Prevailing research does not demonstrate that lowering the drinking age results in less

youth alcohol consumption, risky drinking, or associated negative consequences.

The U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention

(OJJDP), produced a report in 2005 that compared American youth with their European

counterparts. The OJJDP report compared results from the European School Survey

Project on Alcohol and Other Drugs (ESSPAOD) with the annual Monitoring the Future

Survey (MTF) from the United States. Among the findings were:

• Young people from nearly all European countries report a greater percentage

of drinking in the past 30 days than American youth. In the Monitoring the Future

survey, 35% of U.S. 10th Graders report drinking in the past 30 days. Among their

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European counterparts, 74% of 15-16-year olds in the United Kingdom report drinking

over the previous 30 days, according to the ESSPAOD survey. In France, the past-month

drinking rate among 15-16-year olds was 58%, while in Germany it was 78%.

• In many European countries, a greater percentage of young people report having

five or more drinks in a row, meeting the criteria for binge drinking. In the MTF

Survey, 22% of U.S. 10th graders report binge drinking on one occasion in the past

month. In France, the rate of binge drinking among 15-16-year olds was reported to be

28%, while in the United Kingdom it was 54%.

• A majority of European countries have higher intoxication rates than the United

States; less than a quarter have intoxication rates lower or equivalent to the U.S. In the

MTF survey, American 10th graders reported drinking to an intoxication level in the past

30 days at a rate of 18%. In the ESSPAOD survey, the United Kingdom rate for self-reported

intoxication among 15-16-year olds was 46%, while it was 35% in Germany.

In early 2008, a report was released on behalf of the Institute of Alcohol Studies in

London entitled Binge Drinking and Europe. The report was an in-depth look at the

scale of binge drinking in Europe and the harm it causes. For this study binge drinking

was defined at 5 or more drinks on a single occasion. The report identified:

• 24% of Europeans age 15-24 reported binge drinking at least once a week.

• 18% of youth age 15-16 reported having had 5+ drinks on a single occasion three times

or more in the last month.

• Across the European Union, more than 1 in 8 (13%) of 15-16-year-old students have

been drunk more than 20 times in their life.

Health and Safety Consequences of underage drinking

The previous consumption data illustrate that a lower legal drinking age does not always

correlate with a decrease in high-risk drinking among underage youth. It is commonly

known that underage alcohol use contributes to unintentional death, suicide, and injury,

but the Surgeon General’s Call to Action identifies other consequences of underage

drinking. These include:

• Risky sexual behavior, including unwanted, unintended, and unprotected sexual activity

and sex with multiple partners, which increases the risk for unplanned pregnancy and

for contracting STDs.

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• Increased risk of physical and sexual assault.

• Increased risk of academic failure.

• Increased risk of alcoholism and heavy drinking later in life.

• Correlated incidence of tobacco and illicit drug use.

• Physical consequences from hangovers to death by alcohol poisoning.

• Secondhand effects that put others who are not drinking at risk. Examples include

unruly behavior, property destruction, unintentional injuries, violence, and death.

According to Binge Drinking and Europe: Recommendations and Conclusions, a 2008

report by the German Centre for Disease Addiction Issues, each year in the European

Union alcohol consumption, particularly binge drinking, is related to:

• 2,000 homicides (4 in 10 of all murders).

• 17,000 alcohol-related motor vehicle fatalities (1 in 3 of all traffic fatalities), including

10,000 deaths of people other than the impaired driver.

• 27,000 accidental deaths.

• 10,000 suicides (1 in 6 of all suicides).

• 16% of all child abuse/neglect.

• 5-9 million children living in families adversely affected by alcohol.

In the RAND Corporation’s publication Preventing Underage Drinking: Using Getting

to Outcomes™ with the SAMHSA Strategic Prevention Framework to Achieve Results, they

note a study from New Zealand, where in 1999 the legal age to purchase alcohol was

lowered from age 20 to age 18. The study noted that since that time, the rate of alcohol-

related traffic crashes among 18-19-year-old males increased by 12%, and the rate among

15-17-year-old males increased by 15%. Even more disturbing, alcohol-related crash

rates among females rose even more sharply with a 51% increase among those

age 18 and 19 and by 24% among 15-17-year-olds.

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TY overview of Substance Abuse in texas: Secondary School

© Te x a n s S t a n d i n g Ta l l I n c . R E P O RT C A R D 2 0 0 8 w w w. Te x a n s S t a n d i n g Ta l l . o r g 1 0

A key purpose of the TST annual Report Card is to document the current

state of youth substance abuse in Texas, focusing on key factors and analyzing specific trends.

Underage drinking costs the state of Texas more than $5.2 billion a year. This

number includes, but is not limited to, such expenses as uninsured medical costs,

property damage, loss of life, fetal alcohol syndrome as well as the cost of treatment for

alcohol-related medical problems (Pacific Institute of Research & Evaluation, 2005).

According to the latest research from the Center For Disease Control (CDC), 21.1% of

Texas youth are smoking today. It is estimated that 35,900 more youth will take up

smoking in 2008, and that eventually 503,000 Texas youth alive today will die from smoking.

The following section of the Report Card 2008 will take a look at secondary school and collegiate

data reflecting trends in substance use, as well as comparing DPS arrest data from 2000 to

2007 to look at other trends involving male-female use of alcohol and its consequences.

middle School/High School Students The latest Texas School Survey on Substance Abuse Among Students Grades 7-12 (2006)

from the Department of State Health Services (DSHS) offers insight into the scope of the

problem of youth substance abuse in Texas.

Alcohol and tobacco are considered “gateway” drugs because their early use is a

predictor that an adolescent will try other substances. It stands to reason, therefore,

that strategies that change the community environment to reduce underage alcohol

and tobacco use will therefore reduce the use of other drugs as well. The following chart

shows the average age of first use for alcohol, tobacco, and marijuana, comparing data

from 2004 with data from 2006.

SUBSTANCE 2004 2006

Alcohol 12.4 years of age 12.2 years of age

Tobacco 12.5 years of age 12.7 years of age

Marijuana 13.5 years of age 13.5 years of age

Comparison of Average Age of First Use by Substance

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Long-Term Trends of Use

Alcohol continues to be the most widely abused substance among students, with 65.9%

of Texas secondary students reporting that they had used alcohol at some point in their

lives, while 31.5% reporting that they used alcohol in the last month.

The following charts demonstrate both long-term (1990-2006) and short-term (2004-2006)

trends in substance abuse among Texas secondary school students.

Long-Term Trends of Use

EVEr USED 1990 2006 % oF CHANgE

Alcohol 81.0% 65.9% -18.6%

Tobacco 56.2% 35.4% -37.0%

Marijuana 22.6% 26.4% +16.8%

PAST MoNTH USE 1990 2006 % oF CHANgE

Alcohol 43.6% 31.5% -27.8%

Tobacco 22.9% 15.2% -33.6%

Marijuana 7.8% 11.0% +41.0%

Short-Term Trends of Use

EVEr USED 2004 2006 % oF CHANgE

Alcohol 67.9% 65.9% -3.0%

Tobacco 39.4% 35.4% -10.2%

Marijuana 29.8% 26.4% -11.4%

PAST MoNTH USE 2004 2006 % oF CHANgE

Alcohol 32.6% 31.5% -3.4%

Tobacco 17.0% 15.2% -10.6%

Marijuana 12.6% 11.0% -12.7%

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As can be seen from these numbers, there are many positive trends. Youth alcohol and

tobacco use has dropped significantly both in the long-term and short-term. Although

the long-term trends of marijuana use remain statistically high, the short-term numbers

reveal that this trend has been reversing. We must ensure that current positive trends

continue. Positive trends are also apparent in more specific areas:

• In 2006, 9.2 % of secondary students said they had attended class while drunk at least

once during the past school year, down from 10% in 2004.

• Binge drinking, defined as having five or more drinks in one sitting for boys and four

or more drinks in one sitting for girls, was reported by 21.9% of the students in 2006.

This is down from 23% in 2004.

• In 2006, 21.2% of high school seniors said that they had driven a car after having

several drinks at least once during the past year. This is down from 24% in 2004.

Alcohol continues to be viewed as the easiest of the substances to get, although this

perception has decreased somewhat over the past few years, as illustrated in the chart below.

Somewhat/Very Easy to Get

2004 2006 % oF CHANgE

Alcohol 67.8% 66.9% -1.3%

Tobacco 61.2% 58.4% -4.6%

Marijuana 44.3% 41.6% -6.1%

overview of Substance Abuse in texas: Secondary School

The report also sheds light on how secondary school students are obtaining alcohol,

as indicated below.

Sources of Alcohol for Secondary School Students

At Parties 65%

From Friends 58%

At Home 19%

At A Store 19%

From Another Source 38%

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These data show that efforts to reduce underage drinking have shown success in

terms of youth obtaining alcohol from stores and from home. However, there is

considerable room for improvement regarding youth obtaining alcohol socially

at parties and from friends.

The data presented in the report show that efforts to reduce youth substance abuse have

had a positive impact over the past 16 years. Still, the rates of youth substance abuse remain

unacceptably high, underlying the need for even more use of effective strategies.


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Long-term trends of Youth male-female drinking

Since its inception in 1990, the Texas School Survey on Substance Abuse Among

Students Grades 7-12 has shown a downward trend for lifetime use and past-month

use for both male and female students. However, in recent years the trend has slowed

dramatically for girls, and they now have a higher rate of alcohol use than their male

counterparts in grades 7-12.


1990 1992 1994 1996 1998 2000 2002 2004 2006

Boys 81.6% 77.5% 75.0% 73.7% 72.1% 70.9% 70.6% 66.5% 64.2%

Girls 80.5% 73.9% 73.5% 72.9% 72.2% 70.6% 71.3% 69.3% 67.5%

Texas School Survey Grades 7-12: Lifetime Alcohol Use

From 1990 to 2006, youth male lifetime use of alcohol among Texas secondary students

dropped 21.3%. Meanwhile, lifetime use of alcohol among female secondary students

dropped 16.1% from 1990 to 2006.

Percentage of Texas Secondary Students Who Used Alcohol in the Past Month, by Gender: 1990-2006

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

1990 1992 1994 1996 1998 2000 2002 2004 2006

Boys Girls

Percentage of Texas Secondary Students Who Had Ever Used Alcohol, by Gender: 1990-2006

40.0%

60.0%

80.0%

100.0%

1990 1992 1994 1996 1998 2000 2002 2004 2006

Boys Girls

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1990 1992 1994 1996 1998 2000 2002 2004 2006

Boys 45.3% 38.6% 40.8% 37.7% 39.2% 37.3% 34.9% 32.5% 31.4%

Girls 42.1% 35.6% 38.1% 37.0% 36.9% 35.0% 34.1% 32.7% 31.5%

Texas School Survey Grades 7-12: Past Month Alcohol Use

From 1990 to 2006, the Texas School Survey on Substance Abuse Among Students

Grades 7-12 reports that past-month use among Texas male secondary students

dropped 30.7%. The rate for Texas female secondary students for past-month alcohol

use dropped 25.2%, demonstrating that girls are now drinking more than boys.


This decade also saw the first time when females in grades 7-12 passed their male

counterparts in past-month use of alcohol.

Percentage of Texas Secondary Students Who Used Alcohol in the Past Month, by Gender: 1990-2006

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

1990 1992 1994 1996 1998 2000 2002 2004 2006

Boys Girls

Percentage of Texas Secondary Students Who Had Ever Used Alcohol, by Gender: 1990-2006

40.0%

60.0%

80.0%

100.0%

1990 1992 1994 1996 1998 2000 2002 2004 2006

Boys Girls

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In the spring of 1997, the Texas Commission on Alcohol and Drug

Abuse, now a part of the Texas Department of State Health Services, collaborated with

the Public Policy Research Institute (PPRI) of Texas A&M University to conduct a

telephone survey of substance use and related behaviors among full-time

undergraduate students in Texas aged 18-26.

In the spring of 2005, the Texas Department of State Health Services (DSHS), also in

conjunction with PPRI, conducted a follow-up survey of substance use and related

behaviors among full-time undergraduate students in Texas aged 18-26. The following

reviews some of the information revealed by the two studies.

Pattern of Substance use

In both surveys, alcohol was the number one substance that college students reported

using. A comparison of the two surveys also shows that lifetime use of tobacco products

increased by 15% since 1997, and lifetime use of cigarettes by Texas college students

increased by 21% between 1997 and 2005.

SUBSTANCE liFETiME USE PAST MoNTH liFETiME USE PAST MoNTH

Alcohol 88% 69% 84% 66%

Tobacco 45% 26% 52% 28%

Cigarettes 42% 24% 51% 26%

Marijuana 29% 11% 37% 11%

Cocaine/Crack 5% 1% 9% 1%

Alcohol (age 18-20) 83% 60% 78% 58%

Patterns of Use: 1997 2005

overview of Substance Abuse in texas: College

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demographic factors

Both the 1997 and the 2005 Texas Surveys of Substance Abuse Among University Students

took a look at the relationship between demographic factors and substance use.

SUBSTANCE liFETiME USE PAST YEAr PAST MoNTH MAlE / FEMAlE MAlE / FEMAlE MAlE / FEMAlE

Alcohol 88.3% / 86.6% 82.0% / 81.7% 72.5% / 66.1%

Tobacco 51.7% / 39.0% 40.8% / 29.1% 31.9% / 20.5%

Marijuana 34.0% / 24.7% 22.5% / 13.5% 14.9% / 7.1%

Prevalence and Recency of Substance Abuse Among College Students by Gender: 1997

SUBSTANCE liFETiME USE PAST YEAr PAST MoNTH MAlE / FEMAlE MAlE / FEMAlE MAlE / FEMAlE

Alcohol 85.1% / 83.6% 79.3% / 77.8% 68.3% / 63.6%

Tobacco 58.0% / 47.1% 45.1% / 33.0% 32.2% / 22.2%

Marijuana 40.6% / 33.5% 25.0% / 17.6% 15.3% / 7.4%

According to the two surveys, alcohol use among college students is down slightly

across the board. Meanwhile, the number of students who admit to trying tobacco

products and marijuana at some point in their lifetime are up substantially. Past-year and

past-month use of both substances are up as well.

SUBSTANCE liFETiME USE PAST YEAr PAST MoNTH 18-20 / 21-26 18-20 / 21-26 18-20 / 21-26

Alcohol 82.7% / 91.9% 77.3% / 86.2% 60.1% / 77.8%

Tobacco 41.0% / 49.3% 34.0% / 35.9% 24.7% / 27.5%

Marijuana 24.5% / 33.8% 17.6% / 18.4% 10.8% / 11.1%

Prevalence and Recency of Substance Abuse Among College Students by Gender: 2005

Prevalence and Recency of Substance Abuse Among College Students by Age: 1997


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SUBSTANCE liFETiME USE PAST YEAr PAST MoNTH 18-20 / 21-26 18-20 / 21-26 18-20 / 21-26

Alcohol 78.1% / 90.5% 71.7% / 85.3% 57.6% / 73.7%

Tobacco 44.2% / 59.4% 33.9% / 42.6% 23.9% / 32.4%

Marijuana 30.3% / 42.8% 20.2% / 21.3% 10.4% / 11.0%

Alcohol use by college students, both underage and those of age, is down across the

board according to the two surveys. Tobacco use is up for lifetime use for both age

groups, while past-year and past-month use are down for the18-20 age group.

The 21-26 age group reports a 20.5% increase in the lifetime use of tobacco products

while showing almost 20% increases in past-year and past-month use of tobacco

products. Both age groups report an increase of lifetime and past-year use of marijuana,

while past-month use is stable.

SUBSTANCE liFETiME USE PAST YEAr PAST MoNTH NoN-grEEk / grEEk NoN-grEEk / grEEk NoN-grEEk / grEEk

Alcohol 86.7% / 92.1% 80.6% / 89.3% 67.3% / 80.2%

Tobacco 43.3% / 56.5% 32.9% / 46.7% 24.8% / 33.5%

Marijuana 28.4% / 34.1% 17.4% / 21.6% 10.6% / 13.2%

SUBSTANCE liFETiME USE PAST YEAr PAST MoNTH NoN-grEEk / grEEk NoN-grEEk / grEEk NoN-grEEk / grEEk

Alcohol 83.6% / 89.6% 77.8% / 83.8% 64.8% / 71.6%

Tobacco 51.4% / 54.6% 37.7% / 42.1% 27.7% / 31.5%

Marijuana 36.2% / 39.0% 20.4% / 23.2% 10.7% / 11.4%

Prevalence and Recency of Substance Abuse Among College Students by Age: 2005

Prevalence and Recency of Substance Abuse Among College Students by Fraternity/Sorority: 1997

Prevalence and Recency of Substance Abuse Among College Students by Fraternity/Sorority: 2005


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Alcohol use among college students both within the Greek system (fraternities and

sororities) and outside the Greek system is down slightly. Meanwhile tobacco use among

Non-Greek college students increased dramatically, while students within the Greek

system saw a decline across the board. Lifetime use among college students not in the

Greek system rose 18.7%. Past-year use of tobacco products among students not in a

fraternity/sorority rose 14.6% and past month use rose 11.7%. Tobacco use among

students in the Greek system dropped in all three categories.

SUBSTANCE liFETiME USE PAST YEAr PAST MoNTH $0-20k / $20-60k / $60k+ $0-20k / $20-60k / $60k+ $0-20k / $20-60k / $60k+

Alcohol 84.0% / 86.7% / 89.0% 72.1% / 80.2% / 85.2% 57.4%/ 65.5% / 75.0%

Tobacco 35.6% / 41.2% / 51.4% 27.1% / 31.0% / 40.1% 19.8%/ 23.5%/ 30.0%

Marijuana 24.2% / 24.3% / 36.1% 14.1% / 14.6% / 22.4% 8.1%/ 9.2% / 13.3%

In comparing the two surveys, the trend of alcohol use among college students

remained fairly stable across all parental household income groups, but students with

higher parental annual incomes have a higher rate of past-month alcohol use.

For tobacco use among college students, there are dramatic increases in almost all of

the categories when broken down by parental household income but with the opposite

effect of alcohol. For instance, lifetime tobacco use among college students in the

lower income bracket (0-20K) is up 40.1%. Past year use for this category is also up

40.5%. Past month use of tobacco products for this income bracket is up 32.3% from

1997 to 2005. The middle income bracket (20-60K) shows an increase of 22.3% for

SUBSTANCE liFETiME USE PAST YEAr PAST MoNTH $0-20k / $20-60k / $60k+ $0-20k / $20-60k / $60k+ $0-20k / $20-60k / $60k+

Alcohol 77.9% / 84.8% / 88.8% 72.3% / 78.1% / 84.6% 59.3% / 63.2% / 74.6%

Tobacco 49.9% / 50.4% / 58.7% 38.1% / 34.2% / 45.0% 26.2% / 27.6% / 32.5%

Marijuana 35.7% / 37.5% / 41.0% 18.3% / 19.2% / 25.8% 10.0% / 10.9% / 13.2%

Prevalence and Recency of Substance Abuse Among College Students by Parental Annual Household Income: 1997

Prevalence and Recency of Substance Abuse Among College Students by Parental Annual Household Income: 2005


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ToTAl MAlE FEMAlE AgE 18-20

29% 40% 19% 25%

Prevalence of Binge Drinking: 1997

binge drinking Among texas College Students

Binge drinking (consuming five or more drinks in a row for men and four or more drinks

in a row for women on at least two occasions in the last month) continues to be a

problem on Texas college campuses.

ToTAl MAlE FEMAlE AgE 18-20

30% 38% 23% 27%

Prevalence of Binge Drinking: 2005

Female binge drinking on Texas college campuses showed a dramatic 22.3%

increase from 1997 to 2005. In both surveys, many of those who identified themselves

as binge drinkers did not perceive it as a problem. In the 1997 survey, 63% of the binge

drinkers considered themselves moderate drinkers, while 29% identified themselves as

light drinkers. The 2005 survey showed similar numbers, as 61% said they were moderate

drinkers, and 26% considered themselves light drinkers.

lifetime use, a 10.3% increase for past-year use, and a 17.4% increase in past-month use

of tobacco products. The upper income bracket (60K+) has an increase of 14.2% in

lifetime use from 1997-2005 and a 12.2% increase in past-year use of tobacco products.

The past-month use number stayed essentially the same between the two surveys.


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Comparisons to College Students nationwide

The findings of the 2005 DSHS survey were used for comparison with the Monitoring the

Future (MTF) study that looked at behaviors of college students on the national level.

There are a few differences in the sampling, data collection, and analytical protocols

used for the two studies, but the results are generally comparable.

For instance, Texas college students tended to binge drink less at 30% compared to the

national rate on college campuses of 40%. The national study defined binge drinking as

five or more drinks in a row in the past two weeks.

Texas college students reported a slightly higher rate of past-month use of cigarettes at

26% than their national counterparts at 24%.

College students reported a higher prevalence of use of marijuana on the national study.

For example, 17% reported past-month use of marijuana on the national study, compared to

11% among Texas college students.

Alcohol use and Risky behaviors

Another area of concern is substance use combined with dangerous behavior. The

pattern of drinking and driving has changed little for college students in the eight years

between the two surveys. The figures show that while the numbers are lower, college

students continue to drink and drive, even after binge drinking or when they are the

designated driver.

1997 2005

Drink/Drive 39% 29%

Binge/Drive 15% 11%

Designated Driver/More than 1 Drink 14% 11%

Could Have 4 Drinks/Still Drive 13% 12%

Prevalence of Drinking and Driving


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TY Consequences of underage Alcohol use


Beginning in 1976, the State of Texas, through the Department of

Public Safety (DPS), started producing a yearly Uniform Crime Report. This report

collects, tabulates, and publishes data on major crime from all jurisdictions in Texas.

The following is a look at some of the data collected this decade in relation to driving

under the influence and violations of other liquor laws by youth. From 2000 to 2007

there is a noticeable increase of female arrests for underage alcohol violations.

texas department of Public Safety – Arrest data 2000-2007

ToTAl MAlES FEMAlES

21,171 16,623 4,548

2000 Violation of Liquor Laws – Under the age of 21

L I q u o R L A w v I o L At I o n S

Underage Females made up 21% of the total number of liquor law violations

cited by the DPS for 2000.

Underage Females were 27.5% of the total number of liquor law violations cited

by the DPS for 2007.

AgE 17 AgE 18 AgE 19 AgE 20

2000 781 1,047 982 774

2007 879 1,292 1,268 944

% Increase 12.5% 23.4% 29.1% 22.9%

Female Liquor Law Violations

ToTAl MAlES FEMAlES

19,340 14,019 5,321

2007 Violation of Liquor Laws – Under the age of 21

The following chart indicates the increase in underage female liquor law violations.

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ToTAl MAlES FEMAlES

21,716 19,293 2,423

2000 Public Drunkenness Arrests – Under the age of 21

ToTAl MAlES FEMAlES

17,518 14,539 2,979

2007 Public Drunkenness Arrests – Under the age of 21

Underage Females were 17% of the total number of public drunkenness arrests

according to DPS statistics.


2000 432 508 590 536

2007 422 736 795 777

% Increase/ -0.02% +44.8% +34.7% +44.9% Decrease

Female Public Drunkenness

ToTAl MAlES FEMAlES

11,056 9,857 1,199

2000 DUI Arrests – Under the Age of 21

P u b L I C d R u n K e n e S S

Underage Females were 11.2% of the total number of public drunkenness arrests

according to DPS statistics.

Consequences of underage Alcohol use

d R I v I n g u n d e R t H e I n f L u e n C e A R R e S t S ( d u I )

Females made up 11% of the total DUI arrests under the age of 21 in 2000.

The following chart indicates the increase in underage female public drunkeness arrests.

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ToTAl MAlES FEMAlES

11,457 9,097 2,360

2007 DUI Arrests – Under the Age of 21

Females made up 21% of the total DUI arrests under the age of 21 in 2007.


2000 124 262 360 403

2007 190 528 754 837

% Increase 53.2% 101.5% 109.4% 107.6%

Female DUI Arrests

Increases in Risky behavior Among females

Between 2000 and 2007, the number of underage male arrests for Driving Under the

Influence decreased by 7.7% (from 9,857 to 9,097). During that same time period,

the number of underage female arrests for Driving Under the Influence increased

by 96.8% (from 1,199 to 2,360) according to the Texas Department of Public Safety

arrest data.

Between 2000 and 2007, the number of underage Liquor Law violations for underage

males decreased by 15.7%. During that same time period, the number of underage

female Liquor Law violations increased by 16.9% according to the Texas Department

of Public Safety arrest data.

Between 2000 and 2007, the number of underage male arrests for Public Drunkenness

decreased by 24.6%. During that same time period, the number of underage female

Public Drunkenness arrests increased by 22.9% according to Texas Department of

Public Safety arrest data.

Consequences of underage Alcohol use

The following chart indicates the increase in underage female DUI arrests.

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other data of Interest

Driving after drinking continues to be a major problem among Texans, including youth.

According to the National Highway Traffic Safety Administration, Texas continues to lead

the nation in percentage of traffic fatalities that are alcohol-related. From 2002-2006,

the national average of alcohol-related traffic fatalities ranged from 40%-41%. For the

State of Texas alcohol-related traffic fatalities accounted for between 46%-48% of all

traffic fatalities between 2002-2006.

In 2006, 17,062 people were killed in the U.S. in alcohol-related motor vehicle traffic

crashes (41% of all traffic fatalities). Texas recorded 1,677 alcohol-related traffic fatalities

in 2006, which was 48% of all traffic fatalities. The National Transportation Safety Board

(NTSB) currently estimates the cost of each alcohol-related traffic fatality to be

approximately $977,000, thus the 2006 fatalities cost Texas $1.6 billion.

Age breakdowns are only available up to 2005, a year that saw 1,569 alcohol-related

traffic fatalities. Below is a breakdown of some key age groups for 2005.

AgE ToTAl FATAliTiES AlCoHol-rElATED FATAliTiES %

15–20 526 215 41%

21–34 988 576 58%

35+ 1,750 695 40%

Alcohol-related traffic fatalities by Age: 2005

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TY tobacco And texas: A Comparative Look

at Revenues and Costs


Tobacco use in Texas among both adults and youth, though

slightly in decline, still remains a serious public health issue for the State.

According to the Centers of Disease Control and Prevention (CDC) and the Department

of State Health Services (DSHS), 19.3% or 3,283,600 adult Texans smoke tobacco.

Meanwhile 21.1% or 294,700 Texas High School students also smoke. It is estimated that

67.7 million packs of cigarettes are bought or smoked by underage youth each year.

Nationwide, youth smoking has declined dramatically since the mid-1990s, but that

decline appears to have slowed in recent years. In Texas, 35,900 youth under the age

of 18 become daily smokers each year, and the number of adults who will die each year

from their own smoking is estimated at 24,200.

In 1999, as part of the initial tobacco settlement with the States, Texas, by law, placed

all of the tobacco settlement funds into several permanent endowments earmarked for

several purposes including: higher education, children and public health, and emergency

medical services. As Texas receives new funds as part of their settlement with the

tobacco industry, the funds are appropriated by the Legislature on a biennial basis.

The 1999 law also directed that $200 million of the $1.8 billion Texas received from its

first two tobacco settlement payments be put into a Tobacco Education Enforcement

Trust Fund, with no future payments to be placed into this fund. A maximum of 7.5% of

the annual interest generated from the trust is available to fund a tobacco prevention

and cessation program. Only the interest earned from each of the endowments is

available for expenditure and must be appropriated by the Legislature every session.

CdC Recommendations

The U.S. Center for Disease Control and Prevention recommends that Texas spend a

minimum of $103 million up to $284 million a year to have an effective, comprehensive

tobacco prevention program. Texas currently allocates $11.8 million for tobacco

prevention. This is 11.4% of the CDC’s minimum recommendation and puts Texas

42nd among all states in funding tobacco prevention programs. Texas spending on

tobacco prevention amounts to 0.6% of the $2.1 billion in tobacco-generated revenue

the state collects each year in tobacco settlement payments and tobacco taxes.

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TY tobacco And texas: A Comparative Look

at Revenues and Costs


State Comparison of tobacco-Related data

Here is a view of how Texas compares with its neighboring states as well as a few other

states of like size when looking at some state-specific tobacco-related data and costs.

ADUlT ADUlT SMokiNg YoUTH SMokiNg YoUTH WHo Will YoUTH AliVE WHo SMokiNg rATE DEATHS rATE BECoME SMokErS Will DiE FroM SMokiNg

TX 19.3% 24,200 21.1% 1,573,000 503,000

CA 14.3% 37,800 15.4% 1,862,000 596,000

FL 19.3% 28,700 14.5% 1,153,000 369,000

OK 25.8% 5,800 23.2% 273,000 87,000

NM 20.8% 2,100 24.2% 118,000 38,000

LA 22.6% 6,400 25.0% 340,000 109,000

Key State-Specific Tobacco-Related Data & Rankings*

*Campaign for Tobacco-Free Kids, www.tobaccofreekids.org

SMokiNg CigArETTE TAx CigArETTE TAx STATE ToBACCo % oF CDC CDC % HEAlTH CoSTS PEr PACk NATioNAl rANk CoNTrol SPENDiNg MiNiMUM NATioNAl rANk

TX $5.83 billion $1.41 19th $11.8 million 11.4% 42nd

CA $9.14 billion $0.87 31st $77.4 million 46.9% 25th

FL $6.32 billion $0.339 47th $58.0 million 74.0% 13th

OK $1.16 billion $1.03 26th $14.2 million 65.1% 17th

NM $461 million $0.91 30th $9.6 million 70.1% 15th

LA $1.47 million $0.36 45th $7.7 million 28.3% 35th

Key State-Specific Tobacco-Related Costs & Revenues *

*Campaign for Tobacco-Free Kids, www.tobaccofreekids.org

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s overview of environmental Strategies

Rooted in the public health model, environmental, community-based

prevention strategies act to create change and enforce policies and procedures as well

as change attitudes, behaviors, and beliefs (social norms) related to substance use.

Underage drinking, tobacco use, and their consequences have a detrimental impact on

public health and safety in Texas and across the nation. Therefore it is important that

prevention of underage use of alcohol, tobacco, and other drugs is addressed in a

comprehensive way, utilizing strategies that are research-based.

In 2003, the Institute of Medicine (IOM) released Reducing Underage Drinking:

A Collective Responsibility, laying out recommendations of several environmental

strategies that have shown effectiveness in reducing underage consumption of alcohol

whether through reducing access, changing community norms, or enforcing existing

policies. The Center for Disease Control’s Best Practices for Comprehensive Tobacco

Control Programs – 2007 provides evidence-based strategies for reduction and

prevention of tobacco use. These strategies are supported by research conducted at

a community level and intended for community implementation. Because Texas is a

preemptive state (local laws cannot be more stringent than state law unless the state law

specifies otherwise), multiple evidence-based environmental strategies, especially those

focused on alcohol, can only be implemented after policy change at the State level.

This section will discuss public health and safety issues in Texas as well as look at key

environmental strategies and how Texas compares to similar states in implementation.


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s Implementation: How texas Ranks


excise taxesIom Report Recommendation 12-7CdC Recommendation

Because youth are more price sensitive, raising excise taxes acts as a deterrent to youth

consumption of alcohol and tobacco. The taxes can also be used as a source of revenue

for funding prevention. The following information and charts show the excise taxes on

beer, wine, spirits and tobacco and how Texas compares with its neighboring states, as

well as states across the nation that are of similar size.

ExCiSE TAx Tx Ar ok NM lA

Beer (per gallon) 0.19 0.23 0.40 0.41 0.32

Wine (per gallon) 0.20 0.75 0.72 1.70 0.11

Spirits (per gallon) $2.40 $2.50 $5.56 $6.06 $2.50

Cigarettes (per pack) $1.41 0.59 $1.03 0.91 0.36

ExCiSE TAx Tx CA Fl oH NY U.S MEDiAN

Beer (per gallon) 0.19 0.20 0.48 0.18 0.11 0.188

Wine (per gallon) 0.20 0.20 $2.25 0.30 0.19 0.69

Spirits (per gallon) $2.40 $3.30 $6.50 N/A* $6.44 $3.75

Cigarettes (per pack) $1.41 0.87 0.34 0.44 $1.50 $1.00

Excise Tax Rates on Beer, Wine and Spirits for Texas and its Neighboring States

Excise Tax Rates on Beer, Wine and Spirits for Texas and States of Similar Size

*In 18 states, the state government directly controls the sale of distilled spirits. Revenue in these states is generated by various taxes, fees, and net liquor profits.

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Sobriety CheckpointsIom Report Recommendation 9-11

Sobriety Checkpoints are recognized as an efficient law enforcement tool and a sound,

science-based environmental strategy to help reduce and prevent alcohol-related

crashes. Sobriety checkpoints are stops where law enforcement systematically check

drivers to assess alcohol impairment. Sobriety checkpoints are not only about identifying and

punishing those who break the law; they’re also about convincing people not to break

the law in the first place. They are most effective when well publicized, which increases

the perception of risk of arrest. Public opinion rests in favor of sobriety checkpoints.

The Scripps Research Center’s 2005 Winter Texas Poll showed 67% of Texans favor a law

that would allow sobriety checkpoints.

The U.S. Supreme Court upheld the constitutionality of sobriety checkpoints in 1990.

The Court held that the interest in reducing alcohol-impaired driving was sufficient to

justify the brief intrusion of a sobriety checkpoint.

The National Transportation Safety Board (NTSB) currently estimates the cost of each

alcohol-related traffic fatality to be approximately $977,000, thus the 2006 traffic fatalities

cost the state of Texas more than $1.6 billion. Sobriety checkpoints can result in

substantial savings to a community in relation to the financial costs of alcohol-related

traffic fatalities.

A systematic review of published studies, conducted by a team of experts on behalf of

the Task Force on Community Preventive Services, found that sobriety checkpoints were

effective in reducing crashes, injuries and deaths. The studies found that after

implementation of sobriety checkpoints:

• Crashes thought to involve alcohol dropped a median of 20%, and

• Fatal crashes thought to involve alcohol dropped a median of 23%.

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How they work

There are two types of sobriety checkpoints in use: Random Breath Testing and Selective

Breath Testing. In Random Breath Testing (RBT) checkpoints, police test all drivers for

blood alcohol levels. This system is used in several European countries and in Australia.

Selective Breath Testing (SBT) checkpoints call for a specific pre-selected number of cars

to be stopped, and police must have a reason to suspect that the driver has been drinking in

order to test. This is the only type of sobriety checkpoint system used in the United States.

traditional Sobriety Checkpoints

A key factor in the effectiveness of any sobriety checkpoint is that they be well publicized

to create a highly visible enforcement tactic and, as a result, increase the perception

of risk of being caught driving under the influence. A similar public safety enforcement

program with a public awareness campaign is “Click it or Ticket” for seatbelt

enforcement. Preventing impaired driving is the goal of sobriety checkpoints. Signs

clearly mark the upcoming checkpoint well in advance, and vehicles are stopped in a

predetermined sequence, such as every third or fourth vehicle.

Staffing requirements for checkpoints may vary, depending on several factors, such as location

and traffic volume of the selected site. The traditional sobriety checkpoint is human-resource

intensive in both uniform and support personnel. They can generally involve as many as 15

to 20 officers who stop traffic in both directions. Cars are stopped using a pre-determined

mathematical formula – not by how they look or drive; for example,every 11th car is stopped.

During the stop, if a driver exhibits signs of impairment then a sobriety test is performed. In

a study conducted earlier this decade, it was determined that when a community runs an

intensive sobriety checkpoint program each checkpoint costs about $9,600.

Low-Staffing Sobriety Checkpoints

While sobriety checkpoints can lead to substantial financial savings for communities,

it can be costly on a local basis to initiate and maintain checkpoint programs, especially

for rural communities. This has led to a trend of small-scale sobriety checkpoints that

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do not involve large numbers of personnel. This results in a more efficient use of limited

resources and a deterrence capability, without conducting a large scale sobriety

checkpoint operation.

The Pacific Institute for Research and Evaluation and the Insurance Institute for Highway

Safety conducted a study of two West Virginia counties that ran small-scale sobriety

checkpoints. During the study, 48 low-staffing checkpoints (3-5 officers) took place in the

two counties in both municipal and rural areas. The study’s findings showed that

low-staffing checkpoints, at a cost of $350-$400 per site, can be expected to result in

reductions in drivers operating at high blood alcohol content levels (BAC). Relative to

two comparison counties, the proportion of drivers with BAC’s of 0.08 percent or more

was 64% lower.

Another example saw the Brevard County (Florida) Sheriff’s Office initiate a small-scale

sobriety checkpoint program that used 10-12 officers as opposed to the usual 35-40.

The program used some officers from other jurisdictions and combined this with media

events and rotating checkpoints to high crash locations. Operation Checkpoint Brevard

made 163 impaired driving arrests over a two-year period. Checkpoint Brevard produced

a significant decrease in alcohol-related traffic fatalities (38%) and a decrease in

alcohol-related crashes with injury (9.3%)

The experiences in states with small-scale checkpoints demonstrate that they can result

in a more efficient use of human resources with lower operational costs. With the proper

use of media and collaboration between smaller agencies, they also can increase the

visibility and general deterrence through greater mobility.

texas and Sobriety Checkpoints

In 1994, a State Appeals Court ruled that without statewide guidelines, checkpoints

are unconstitutional in Texas, which means a community cannot implement sobriety

checkpoints. Establishing statewide guidelines requires policy by the Texas Legislature,

and to date, the Texas Legislature has not established such guidelines. Since 1994,

legislation has been filed in every session in the Texas Legislature.

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Keg RegistrationIom Report Recommendation 9-8

Beer kegs are a relatively cheap source of alcohol – an appealing factor for a price-

sensitive youth. With an average keg holding approximately 165 servings, rented at $75

a filling, that equals just 45 cents a beer. This makes beer kegs a popular and relatively

inexpensive source of alcohol at underage drinking parties where large numbers of

people gather. The kegs are often purchased by friends, relatives, or other adults over

the age of 21. When police arrive at these parties, some of which are referred to as

“pasture,” “desert,” or “house” parties, people scatter, making it difficult for law

enforcement to identify who purchased the kegs and hold them accountable for

providing them. Keg registration is a tool for police to identify the purchaser and aids

them in prosecuting that person for supplying alcohol to minors.

When a person rents a keg, they complete a form for their deposit. Through a number

on the keg and the registration form, the identity of the renter and the specific keg

would be linked. The registration is then kept on hand by the retailer and readily

available for law enforcement to review. Currently Texas has no statewide law requiring

retailers to use keg registration.

texas and Keg Registration

In the 79th Texas Legislature, Rep. Craig Eissler (R) of The Woodlands introduced a bill

requiring keg registration labels for kegs being used for off-premise consumption.

However it died in committee. Reintroduced in the 80th Legislature, the keg registration

bill made it out of committee but too late for a vote on the House floor. At the time of

this writing, 31 states and the District of Columbia have keg registration laws, and Utah

bans kegs altogether.

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Alcohol exclusion Law (uPPL)Iom Report Recommendation 10-5

The Uniform Accident and Sickness Policy Provision Law (UPPL) was designed as a “model”

law by the National Association of Insurance Commissioners (NAIC) in 1947 and can be

found in the Texas Insurance Code. The law allows health insurers to deny payment for

health costs relating to injuries when any type of alcohol or narcotic is found in the patient’s

system. It was originally designed to deter drunk driving. The unintended consequence has

been a reluctance of emergency rooms (ER) to document verifiable evidence of a patient’s

toxicology. This allows hospitals to recoup their costs and continue to provide care to the

patient, but it results in gross under reporting of injuries related to alcohol and substance use

and missed opportunities for early detection and intervention of alcohol and other substance

abuse problems.

Scope of the Problem

In their public policy statement on alcohol exclusion laws, the American Society of

Addiction Medicine notes that national studies indicate that 35-50% of injured patients

treated in ERs and trauma centers are under the influence of alcohol or other intoxicants.

They also note that injuries are the leading cause of death in individuals less than 40

years of age, the fourth leading cause of overall mortality, and the number one cause

of ER visits, with alcohol use being the leading contributing factor to injuries. In states

where alcohol exclusion laws are in effect, patients do not receive adequate screening

or early intervention for alcohol and drug abuse. A national survey found that 27.7% of

trauma surgeons felt that screening would threaten reimbursement of medical costs

(The National Institute on Alcohol Abuse and Alcoholism).

Cost of Alcohol exclusion Laws

In 2006, Ensuring Solutions to Alcohol Problems, a project at The George Washington

University Medical Center, conducted a national and state-by-state analysis of the costs

of unidentified alcohol problems and the savings that would result from screening and

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brief intervention. They found that the failure to identify and treat substance use in

emergencies services may cost Texas businesses and residents $889 million in health

care expenses each year. Additionally, Texas could save more than $175 million per year

if ER patients were routinely screened for alcohol and drugs and received treatment

when necessary.

In 2001, NAIC formally changed its position to support the repeal of alcohol exclusion

laws (UPPL legislation). Other groups that support the repeal of this language include:

the National Conference of Insurance Legislators, American Medical Association,

Mothers Against Drunk Driving, National Commission Against Drunk Driving, American

College of Emergency Physicians, and the American Public Health Association.

In recent years, twelve states have prohibited the use of alcohol exclusions: Colorado,

Connecticut, Illinois, Indiana, Iowa, Maryland, Nevada, North Carolina, Oregon, Rhode

Island, South Dakota, and Washington.

texas and Alcohol exclusion Laws

In the past two cycles of the Texas Legislature, Rep. Craig Eiland (D) of Galveston has

been an advocate for the removal of the alcohol exclusion law (UPPL). In the 80th Session,

he drafted HB 634 that would have removed the alcohol exclusion law from the state’s

insurance code. The last action on this bill was left pending in the House Committee on

Insurance on April 17, 2008.

Implementation: How texas Ranks

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Statewide Smoking banCdC Recommendation Surgeon general’s Report Recommendation

According to the Surgeon General’s Report The Health Consequences of Involuntary

Exposure to Tobacco Smoke, secondhand tobacco smoke can be just as harmful as

firsthand smoke.

Because of growing health concerns in regards to secondhand smoke, many cities,

counties, and states across the nation have established various forms of smoking bans

or limitations. The Center for Disease Control established a task force to examine the

effects of tobacco smoke on all levels of society. Their findings from several systematic

reviews of smoking bans and ordinances can be outlined in four points:

1. Studies that evaluated the effect of smoking bans in workplaces observed an average

reduction of 74% in exposure to components of secondhand smoke (e.g., nicotine

vapor).

2. Smoking bans were more effective in reducing secondhand smoke exposures than

were smoking restrictions.

3. Smoking bans were effective in a wide variety of public and private workplaces and

healthcare settings. Their effectiveness should extend to most indoor workplaces in

the United States.

4. Studies evaluating smoking bans also observed reductions in the amount smoked.

Smoking bans and Restrictions in texas Cities

The 76th Legislature appropriated funding for the Texas Department of State Health

Services (DSHS) to establish a research team of eight universities to prevent tobacco

use and promote cessation. As part of that team, the University of Houston created the

Texas Smoke-Free Ordinance Database for DSHS. This database is a collection of

smoking ordinances from municipalities across the state.

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The researchers also developed a system of ranking each city and county on the

effectiveness of their smoking ordinance. It is based on a one to five scale and broken

down into five categories. Listed below are the cities and municipalities that received

the highest ranking for their secondhand smoke ordinances that include municipal workplaces,

private workplaces, restaurants, bars outside restaurants, bars inside restaurants.

Abilene Copperas Cove Marshall Southlake

Austin El Paso Pearland Tyler

Baytown Houston Plano Vernon

Beaumont Laredo Socorro Victoria

texas and Statewide Smoking bans

In the 80th Texas Legislature, two pieces of legislation would have banned smoking in

most workplaces and indoor public places in Texas, including restaurants and bars.

The penalty for violating this law would have been a fine to the establishment of $100

per cigarette. SB 368 authored by Sen. Rodney Ellis (D) of Houston and HB 9 authored

by Rep. Myra Crownover (R) of Lake Dallas were both left pending.

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Re Interim Study Charges


Texas maintains a “Citizen-Legislator” system of government where

the Legislature only meets every other year. This leaves a limited amount of time for

legislators to study important issues in-session. Therefore during the interim between

sessions, both the Speaker of the House and the Lieutenant Governor will call for specific

issues to be studied by committees in both the House and the Senate. These “Interim

Charges” are the topics that the committees are directed to study in the months leading

up to the regular session of the Texas Legislature. These committees will produce Interim

Studies, reports to the House or the Senate containing the committee’s findings and

recommendations for the upcoming Legislative Session.

Interim Studies serve several purposes. They provide an opportunity for legislators to

learn more about issues they may choose to address with new legislation in the coming

session. They also provide a forum for examining the implementation of legislation

passed in previous sessions. Interim Studies give legislators the chance to monitor and

provide oversight of the state agencies within the jurisdiction of respective committees.

Interim Studies are also unique opportunities for the citizens of Texas, either as individuals

or as members of grassroots organizations or agencies, to be heard on vital issues

through submission of research and testimony during public comment periods and

public hearings. The 81st Session of the Texas Legislature will begin on January 13, 2009,

and the final gavel for the session is set to fall on May 28, 2009.

The following Interim Charges (assigned in the House by Speaker Tom Craddick and in

the Senate by Lieutenant Governor David Dewhurst) are related to substance abuse and

organized by committee. For each hearing held on Interim Charges, Texans Standing Tall

has witness lists available for your viewing.

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House Committee on Appropriations Subcommittee on Criminal JusticeChair: representative Sylvester Turner (D-Houston)

Vice Chair: representative Corbin Van Arsdale (r-Houston)

Members: representative Alma Allen (D-Houston)

representative kirk England (D-grand Prairie)

representative Jim Mcreynolds (D-lufkin)

representative Debbie riddle (r-Houston)

House Committee on CorrectionsSubcommittee on Substance Abuse and Mental IllnessChair: representative Jerry Madden (r-Plano)

Vice Chair: representative Scott Hochberg (D-Houston)

Members: representative Jim Mcreynolds (D-lufkin)

representative Jim Dunnam (D-Waco)

representative Pat Haggerty (r-El Paso)

representative Delwin Jones (r-lubbock)

representative rene oliveira (D-Brownsville)

Interim Charge 18 & 19 (Appropriations) and Interim Charge 6 (Corrections)

Assess the relationship between mental illness and criminal behavior, offer reforms

needed to address the proliferation of mental illness in the adult and juvenile criminal

justice systems. This review should include an examination of data sharing between

criminal justice and health and human services agencies, proper screening, assessments,

treatment, discharge planning, post-release supervision, and community services.

Review and research the availability, coordination, efficiency, and allocation of substance

abuse treatment resources for probationers, pretrial defendants, people in the custody

of the Texas Department of Criminal Justice (TDCJ), and parolees. This review should

include methods to reduce and improve current assessments, training, and referring

protocols and the identification of any barriers that may be impeding all of the above.

A joint hearing was held on May 29, 2008.

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House Committee on Criminal JurisprudenceChair: representative Aaron Peña (D-Edinburg)

Vice Chair: representative Allen Vaught (D-Dallas)

Members: representative Debbie riddle (r-Houston)

representative Terri Hodge (D-Dallas)

representative Juan Escobar (D-kingsville)

representative Barbara Mallory Caraway (D-Dallas)

representative Paula Pierson (D-Arlington)

representative robert Talton (r-Pasadena)

representative Paul Moreno (D-El Paso)

Interim Charge 4

Study the prosecution and effectiveness of current drunk driving laws in Texas and

recommend any legislative changes needed to further combat the problem.

A hearing was held on January 31, 2008.

House Committee on Licensing and Administrative ProceduresChair: representative ismael “kino” Flores (D-Mission)

Vice Chair: representative Charlie geren (r-river oaks)

Members: representative Tony J. goolsby (r-Dallas)

representative Mike Hamilton (r-Mauriceville)

representative Delwin Jones (r-lubbock)

representative Borris Miles (D-Houston)

representative Chente Quintanilla (D-El Paso)

representative Senfronia Thompson (D-Houston)

representative Carl isett (r-lubbock)

Interim Charge 3

Study current distance requirement provisions in the Alcoholic Beverage Code and

recommend any changes needed to promote clarity and uniformity.

At the time of publication of the Report Card 2008, a hearing had yet to be scheduled.

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House Committee on Public Health

Chair: representative Dianne White Delisi (r-Temple)*

Vice Chair: representative Jodie laubenberg (r-rockwall)*

Members: representative Ellen Cohen (D-Houston)

representative garnet Coleman (D-Houston)

representative Veronica gonzales (D-McAllen)

representative Susan king (r-Abilene)

representative Dora olivo (D-Missouri City)

representative Vicki Truitt (r-Southlake)

representative Jim Jackson (r-Carrollton)

* During the writing of this Report Card, Rep. Dianne White Delisi retired, and Rep. Jodie

Laubenberg was appointed Chair of the Committee on Public Health, leaving the

position of Vice Chair vacant.

Interim Charge 1

Monitor and evaluate the full array of wellness initiatives undertaken by the State of

Texas to include the newly adopted state employee wellness and prevention legislation

(HB 1297*, 80th Legislature, Regular Session) and a pilot program to encourage healthy

lifestyles, such as smoking cessation within the Medicaid program (SB 10, 80th

Legislature, Regular Session) for state employees. Develop strategies for maximizing

potential health benefits and optimizing the return on the State of Texas’ investments in

wellness. Include a review of other state and private sector programs for employee

wellness that result in prevention cost savings.

*In the 80th Legislative session both the House and the Senate passed bills that

addressed wellness and prevention. As stated in the authors’ statement of intent of the

bill, current state employee wellness programs do not include the components necessary to

reduce health care related costs and encourage healthy behavior. The legislature was

especially concerned about the cost of such illnesses as diabetes, congestive heart

failure, and hypertension that often result from unhealthy behaviors such as smoking,

overeating, and physical inactivity. H.B. 1297 required the Department of State Health

Services to designate a wellness coordinator to develop a model wellness program and

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to assist state agencies with wellness initiatives.

On the Senate side of the aisle, S.B. 10 enacted the recommendations of the Senate

Committee on Health and Human Services with the goal of improving the Texas

Medicaid program by focusing on prevention, individual choice, better planning,

modernizing services, as well as reducing Texas’ rate of uninsured. Interim Charge 1

calls for the Committee to evaluate the progress of prevention through these two bills.

A hearing was held on January 17, 2008.

Interim Charge 8 (Public Health) & Interim Charge 7 (transportation)

For information on this Joint Interim Charge with the House Committee on

Transportation please see below.

House Committee on Transportation

Chair: Representative Mike Krusee (R-Taylor) Vice Chair: Representative Larry Phillips (R-Sherman)Members: Representative Joe Deshotel (D-Port Arthur) Representative Pat Haggerty (R-El Paso) Representative Patricia Harless (R-Spring) Representative Fred Hill (R-Richardson) Representative Nathan Macias (R-Bulverde) Representative Jim Murphy (R-Houston)

Representative Linda Harper-Brown (R-Irving)

Interim Charge 1

Research and make recommendations to the legislature on programs to improve safety

for teen drivers.

A hearing was held on April 30, 2008.

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Interim Charge 7 (transportation) and Interim Charge 8 (Public Health)

Review the effectiveness of the Driver Responsibility Program and provide recommendations

for increasing the collection rate of assessed penalties. Provide recommendations for

amnesty and incentive programs established by the passage of SB 1723*, 80th Legislature,

Regular Session. Examine the status of Texas’ current statewide trauma system infrastructure

and how the system may be optimized to meet future trauma care needs in a rapidly

growing state with overburdened emergency rooms. (Joint Interim Charge for the House

Committee on Public Health and the House Committee on Transportation.)

*Senate Bill 1723 addressed issues with the Texas Driver Responsibility Program. Passed

by the 78th Legislature, the Driver Responsibility Law established a system that assigns points

to moving violations classified as Class C misdemeanors and applies surcharges to offenders,

based upon the type of offense and the time period in which the citation was received. SB

1723 allowed the Texas Department of Public Safety to set up a collections system for

surcharges, as well as authorizes an amnesty program for some cases.

A joint hearing was held on March 27, 2008.

Senate Committee on Criminal Justice

Chair: Senator John Whitmire (D-Houston)

Vice Chair: Senator kel Seliger (r-Amarillo)

Members: Senator John Carona (r-Dallas)

Senator Bob Deuell (r-greenville)

Senator rodney Ellis (D-Houston)

Senator glenn Hegar (r-katy)

Senator Juan “Chuy” Hinojosa (D-McAllen)

Interim Charge 3

Study the impact of laws designed to reduce illegal drug use and make recommendations

for reducing access to illegal drugs and for developing best practices for preventative

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Re

Interim Study Charges


programs, focusing on drugs targeted for the younger population, such as cheese heroin.

Assess the impact of limiting access to pseudoephedrine; including the impact restrictions

have had on illegal manufacturers’ methods for producing methamphetamine.

A hearing was held on July 9, 2008.

Senate Committee on Health and Human Services

Chair: Senator Jane Nelson (r-grapevine)

Vice Chair: Senator Bob Deuell (r-greenville)

Members: Senator robert Nichols (r-Jacksonville)

Senator Dan Patrick (r- Houston)

Senator Eliot Shapleigh (D- El Paso)

Senator Carlos Uresti (D-San Antonio)

Senator royce West (D-Dallas)

Senator Judith Zaffirini (D-laredo)

Interim Charge 7

Study the changes in statute contained in SB 10*, 80th Legislature, Regular Session, as

well as the State’s current prevention and wellness efforts and chronic care management

efforts, and identify opportunities for improvement in state policies and programs.

Examine options for expanding and optimizing the State’s current investment in wellness

programs and management tools for individuals with chronic care conditions, including

options that address childhood asthma. Review partnerships with the private sector that

specifically address the following:

• Tobacco cessation, including the evaluation of a statewide smoking ban in public

places;

• Reducing obesity;

• Availability and effectiveness of childhood and adult vaccines, including public

education programs to promote the use of vaccines; and

• More effective management of chronic care conditions.

*SB 10 addressed issues of improving the Texas Medicaid program by focusing on

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prevention, individual choice, better planning, modernizing services, and reducing Texas’

rate of uninsured. For instance, a part of the bill called for a pilot program to be

instituted in one region of the state. Recipients are provided positive incentives to lead

healthy lifestyles. The program would offer expanded health care benefits or

value-added services for Medicaid recipients who participate in certain programs,

such as specified weight loss or smoking cessation programs.

Another portion of the bill allowed the creation of the Texas Health Opportunity Pool.

This provision uses Medicaid dollars as a financing tool to expand private health

insurance to low-income Texans. SB 10 also allows individuals to opt out of Medicaid

and into employer health insurance if financially beneficial.

At the time of publication of the Report Card 2008, a hearing had yet to be scheduled.

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e Highlighting Success


It is possible to create population-based change through implementing

strategies that effect the lives of many. Here are two examples from the higher education

sector, obtained through interviews with involved parties and from articles published

about the subjects.

Certified Prevention Specialist Certificate Program at Lee College

The field of substance abuse prevention is rapidly growing. Since 2005, all prevention

grants from the Texas Department of State Health Services require at least one staff

person to be a Certified Prevention Specialist. The Texas Certification Board of

Addiction Professionals (TCBAP) offers a Certified Prevention Specialist (CPS) credential

that is reciprocal across the states and countries in the International Certification and

Reciprocity Consortium (ICRC). The certification requires 100 hours of prevention

education, a 120-hour supervised practicum, 2,000 hours (approximately one year) of

work experience in alcohol, tobacco, and other drug prevention, and a passing score on

the ICRC International Written Prevention Specialist Examination. According to TCBAP,

the number of people testing for certification each year has more than quadrupled in the

past three years, with approximately 200 people testing in 2007. Although the credential

is used throughout the country, there are few degree programs that are specifically for

substance abuse prevention.

Howard Bushart, Lead Instructor in the Allied Health Division, Mental Health Services

Program at Lee College in Baytown, Texas, has designed a curriculum for a level one

Substance Abuse Prevention Certificate. Pending the posting of newly adopted Work-

force Education Curriculum Manual courses in Substance Abuse Prevention, Lee College

will offer the first class in this new certificate program in Fall 2008. The certificate will

require six courses for 270 contact hours, 135 of which will be prevention-specific plus a

128-hour practicum in prevention. Students in this program will be qualified for careers in

the field of substance abuse prevention and prepared to sit for the certification exam.

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mcCombs School of business at the university of texas Says no to tobacco donations

The McCombs School of Business enjoys a reputation as the highest-ranked business

school in Texas and the Southwest and is one of only a few in the nation to be ranked in

the Top 20 in nearly all business specialty areas according to U.S. News & World Report.

McCombs currently boasts the number 14 MBA program in the Forbes Magazine U.S.

business school rankings.

It is also a national leader in putting ethics at the core of its mission as an educational

institution. In November of 2007, the McCombs School of Business at the University of

Texas instituted a new policy to no longer accept contributions from tobacco companies.

The ban covers contributions to student organizations, career fairs, faculty research

projects, and research centers.

McCombs School Dean George Gau stated that it was not ethical for the school to

continue to accept donations from tobacco companies since those gifts come from revenue

generated through the sale of a product that has damaging health consequences for its

consumers.

The McCombs School Associate Dean, Paula C. Murray, became concerned when the

parent company of the tobacco maker Philip Morris – the Altria Group Inc. – wanted

more face time with more than their 6,000 undergraduate students. Since 1989, Philip

Morris has donated over $300,000 to the business school.

As far as can be determined, the McCombs School of Business at the University of Texas

is the first of its kind to put an end to tobacco donations. According to the New York

Times, over the past few years 15 public health and medical schools have turned away

donations from the tobacco industry. The list includes the medical school at Emory

University and the public health schools at Harvard, Johns Hopkins, Ohio State,

Louisiana State, and the Universities of Arizona, Iowa, and North Carolina.

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In September of 2007, the regents of the University of California rejected a proposal to

ban university researchers from accepting tobacco money but adopted a policy that calls

for special reviews of any studies to be conducted with such funds. The reviews must

verify that a proposed study “uses sound methodology and appears designed to allow

the researcher to reach objective and scientifically valid conclusions.”

What makes the McCombs decision unique is that, as a business school, it obviously has

strong connections with a variety of corporations. But department chairs and deans at

the business school had become uncomfortable with the tobacco company’s role, along

with their desire to become more involved with undergraduates. There was a concern

that if the tobacco company’s presence on campus became more noticeable that it

could be seen as somewhat of an endorsement of the product.

Paula Murray, the associate dean for undergraduate programs at McCombs, was

especially concerned about the donations. She told the New York Times, “We know the

product is deadly. We know it causes cancer. And we know that the younger you start

smoking, the more likely you will find it hard to quit. With two-thirds of our undergraduates

under 21, to me it’s a no-brainer.”

In the end the decision came down to what fit the McCombs School of Business mission.

For Dean Gau, it was a clear choice.

“At McCombs, we have put ethics at the core of our mission in educating

the next generation of business leaders,” stated Gau. “In the final analysis,

I simply felt that accepting money from an industry that has caused so

much harm to so many without any redeeming qualities was incompatible

with this mission.”

youth substance abuse issues: making alcohol, …r e p o r t a c r d 2 0 0 8 making alcohol,...

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