2017 EPIDEMIOLOGICAL REPORT Delaware State Epidemiological Outcomes Workgroup

2017 EPIDEMIOLOGICAL REPORT Delaware State Epidemiological Outcomes Workgroup Strategic Prevention Framework- Partners for Success

This year the 2017 Epi. Report incorporated feed from our SEOW Members Major changes include: Introductory Narratives Local and National context New Sections That addresses specific issues Website now includes subsection for easier navigation Data in Action How to apply data to inform policy and practice CHANGES IN THE EPIDEMIOLOGICAL REPORT

This year there are 11 subsections; 9 The of which have their own narratives provide the user: Local and national contexts of the topic Policy implications Health Impacts NARRATIVE

Opioids This section focuses on the use and abuse of opioids both locally and nationally Prescription Monitoring Program Mental Health Adverse Childhood Experiences Explores mental health issues in Delaware How these experience effect both mental health and substance use Protective Factors What steps parents and communities can take to protect adolescents from poor mental health and substance use NEW SECTIONS

Breaks down the epi report into individual chapters Each chapter focuses on a different topic Allows users to hone in on data pertinent to their mission Available online at: https: //www. cdhs. udel. edu/seow/reports-and-products SUBSECTIONS FOR EASIER NAVIGATION

DATA IN ACTION Using Delaware data to inform policy and practice

One of the prevention interventions supported by the Strategic Prevention Framework are environmental strategies. Changes in policy or practice are environmental strategies. POLICY AS PREVENTION

Trends in Delaware students’ cigarette use by grade self-reported regular use, 1989 -present 11 th 8 th 33% 31% 31% 5 th 28% 26% 24% 22% 22% 25% 26% 25% 23% 22% 20% 19% 17% 14% 16% 15% 2% 1989 4% 4% 1991 3% 3% 1993 1995 4% 1997 3% 2% 2% 1999 18% 16% 15% 12% 3% 19% 11% 17% 16% 15% 14% 12% 10% 11% 9% 8% 8% 8% 9% 7% 1% 1% 1% 2001 2003 2005 13% 2007 Source: 2016 Delaware School Survey KEEP UP THE GOOD WORK! REDUCE YOUTH TOBACCO USE 2009 6% 0% 2011 7% 5% 1% 4% 3% 6% 2% 2% 0% 0% 2013 2015

Targeting youth about tobacco should continue to be a focus of prevention work. Avg. age of onset is 14. 3 for 11 th graders, 12. 5 for 8 th 88% of smokers report smoking before age 18; 99% before age 26 (CDC) Raise the cost of cigarettes: Raising the cost estimated to reduce smoking between 3 -5% People under the age of 26 between 2 -3 times more likely to be deterred from smoking due to higher prices of cigarettes (CDC). Raise the purchase age to 21: Delaware law preempts attempts by municipalities to raise the purchase age. TARGET YOUTH USE WHEN CONSIDERING INTERVENTIONS

Past Year Cigarette use vs Ecig/Vaping Device Use 20 18 16 14 12 10 8 6 4 2 0 11 Past Month Cigarette use vs Ecig/Vaping Device Use 19 10 4 1 1 5 th Grade 8 th Grade Cigarette Use 20 18 16 14 12 10 8 6 4 2 0 11 th Grade 8 5 2 0 0 5 th Grade 8 th Grade Cigarette Use E-cig/Vaping use 6 11 th Grade E-Cig/Vaping Use Source: 2016 Delaware School Survey • Nationwide, there was a 900% increase in youth use of e-cigarettes between 2011 - 2015 (Surgeon’s General Office, 2016). • Data from the Youth Tobacco Survey in Delaware also shows an increase in youth use of e-cigarettes. • Less than 15% of eleventh graders and eighth graders reported “great risk” in the use of ecigarettes/vaping devices EDUCATE YOUTH ON THE RISKS OF ECIGARETTES

Trends in Delaware 11 th graders' reporting drinking and driving in the past 12% month, 1990 -2016 11% 10% 8% 12% 11% 10% 9% 8% 12% 9% 8% 8% 7% 8% 8% 8% 7% 6% 6% 6% 5% 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 5% 6% Source: 2016 Delaware School Survey ALCOHOL USE

Social host laws hold adults accountable for underage drinking that occurs on their property, even if they did not provide the alcohol to the youth. Of youth who reported past month drinking: • Nearly 1/3 of 11 th graders and 1/5 of eighth graders, attended a party where parents bought alcohol within the past year (DSS). Evaluations of the implementation of social host laws have found evidence for: • A reduction in drinking and driving • Decrease in number of large gatherings where underage drinking occurs (University of Wisconsin, Population Health Institute, n. d. ). SOCIAL HOST LAWS SHOW EVIDENCE OF REDUCTION IN UNDERAGE DRINKING AND DRIVING

Trends in Delaware students’ perceived “great risk” in using marijuana weekly 70% 60% 50% 40% 30% 20% 10% 0% 11 th Grade 8 th Grade 5 th Grade 1999 50% 60% 49% 2000 51% 60% 46% 2001 47% 57% 43% 2002 47% 58% 50% 2003 50% 62% 58% 2004 53% 62% 63% 2005 51% 58% 63% 2006 51% 60% 2007 49% 58% 62% 2008 56% 64% 60% 2009 53% 62% 60% 2010 51% 59% 55% 2011 49% 58% 54% 2012 45% 58% 53% 2013 38% 53% 47% Source: 2016 Delaware School Survey MARIJUANA: CHANGING PERCEPTIONS OF RISK 2014 37% 50% 49% 2015 34% 52% 48% 2016 34% 49% 51%

Trends in Delaware students’ past month marijuana use by grade self-reported regular use, 1989 -present 11 th grade 25% 27% 21% 18% 13% 12% 14% 12% 8% 3% 5% 5% 6% 5 th grade 28% 25% 25% 23% 22% 22% 23% 24% 25% 27% 26% 23% 24% 22% 19% 15% 16% 15% 14% 12% 13% 12% 8% 11% 10% 11% 12% 11% 9% 9% 7% 7% 0% 0% 0% 1% 1% 1% 0% 0% 0% 0% 19 89 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 0% 0% 17% 25% 27% 8 th grade Source: 2016 Delaware School Survey

The amount of THC in marijuana seized by the DEA has increased nearly 200 percent since 1995, with average levels of THC around 12% (El. Sohly et al. , 2016). Marijuana concentrates, can have levels of up to 75% THC (El. Sohly et al. , 2016; the Academies 2017). Numerous studies on brain development and marijuana use show differences in cognitive functioning between heavy users and abstainers (see: Lisdahl et al. , 2013 and Gruber et al. , 2017 for two reviews of the literature). It is important that we continue to keep youth informed of these risks, especially since brain development continues until the mid-20 s. CHANGING PERCEPTIONS OF RISK MAY LEAD TO INCREASED USE

Primary Drug at Admission 2015 2005 Percent 2015 Total Percent 2005 Total Alcohol 2336 28% 1093 11% Heroin 2234 26% 3723 38% Cocaine 533 6% 107 1% Crack/Cocaine 943 11% 143 1% 1801 21% 873 9% 18 0% 30 0% Other Opioids & Synthetics 286 3% 643 7% Other/Missing/Unknown/None 329 4% 3265 33% 8480 100. 0% 9877 100% Marijuana/Hashish Amphetamine State Total SOURCE: OFFICE OF CONTROLLED SUBSTANCES, DIVISION OF PROFESSIONAL REGULATION DE. OPIOIDS: INCREASE ACCESS TO TREATMENT SERVICES

Delaware is currently in need of expanded treatment options Two recent bills signed into law (SB 41 and HB 100) were created to address ongoing insurance disputes about inpatient treatment. Despite progress and ongoing efforts to address this, the needs exceed existing treatment resources. PROMISING SIGNS & ROOM FOR IMPROVEMENT

Nationally, up to 70% of women who enter treatment do have children (DHHS, 2016). Treatment programs that accommodate mothers with children have higher success rates with women with children, than those that do not (DHHS, 2016). Expanding treatment options that are responsive to the needs of caregivers may help improve treatment outcomes across the state. One promising program in the state is out of Connections, CSP which provides in-patient treatment for pregnant women who have been convicted of a crime, and would have otherwise been incarcerated. WOMEN IN TREATMENT

Family protective factors and past year mental health (in percentages) There are clear rules/consequences in my home? Depressed for two weeks at a time 21 36 41 Males 12 23 31 Females 30 47 47 11 17 22 5 12 13 16 22 Self-Harm Males Females 41 36 21 Attempt Suicide 5 Males 3 Females 7 Depressed for Two Weeks Stongly Agree/Agree 17 9 11 22 30 12 5 12 12 12 Self-Harm Unsure 5 9 12 Attempt Suicide Disagree/Strongly Disagree Source: 2015 High School Youth Risk Behavior Survey PREVENTION STARTS AT HOME

Family protective factors and past month substance use (in percentages) There are clear rules and consequences in my home? 48 22 8 28 28 14 12 Cigarettes 35 32 20 16 25 16 5 Alcohol Stongly Agree/Agree Binge Drinking* Unsure Marijuana Disagree/Strongly Disagree Source: 2015 High School Youth Risk Behavior Survey PARENTS MATTER! 9 Rx

The SEOW is currently working on providing interactive data maps Using data gathered at the Center and through Arc. GIS Online, we are able to provide easy to use data tools: http: //udel. maps. arcgis. com/apps/webappviewer/index. html? id=3 b 97 b 0 f 28 8434 e 649 da 409 c 74 fed 5600 INTERACTIVE DATA MAPS

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