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Reading 2015 YRBS Nicotine and Tobacco Data Highlights Compiled for Board of Health

Major youth substance use problems in Reading, MA

To understand the youth substance abuse problems and local conditions in Reading, RCASA hosted 14 community dialogues to gather substance abuse-related input including the 2012 World Café that engaged 200 residents.  The outcome summary from the World Café participants summarizes what is wrong and where change needs to occur: “We need MORE citizen involvement, communication, parental commitment, safety, school consequences, security, and healthy outlets for families.  We need LESS drugs/alcohol, families destroyed, enabling, crime, blame, fear, denial, overdoses, alcohol poisonings, perfection, shame, and loss. We must CHANGE norms that say youth substance use is just a rite of passage.  We must SHARE accountability for addressing our problem systemically and creatively.”

Local residents also shared comments through key informant interviews and online posts on alcohol enforcement.  As one parent described, “alcohol isn’t as bad as drugs and police should leave them alone”. RCASA staff interviewed a high school student that reported that their peers are less likely to be concerned “if it’s just alcohol”.  Parents also point out that state law allows them to give their child alcohol at home.  Some parents felt they should teach their teen to drink before they leave for college.  A local youth said the following about parties “alcohol is there so you want to do it even if no one asks you”.  Qualitative themes compared with Reading YRBS data indicate that youth have easy access to alcohol in Reading.  For younger youth who drank, 100% of local middle school students got alcohol from home, party, friend, or a sibling.  Police also report increases in youth intoxication and cases of alcohol poisoning. 

Teens that participated in an RCASA Underage Drinking Prevention Town Hall event said, “There’s too much media bombarding us with youth drinking, and using like it’s no big deal…it’s on TV, movies , and online”.  Youth Leaders tracked alcoholic beverages advertising and found gender-specific messaging, and underpricing targeting youth under 21.  According to Reading Police, they receive some parental complaints when they enforce the law because parents say drinking is just a rite of passage.  The Police Prosecutor reports that many parents that he interacts with appear more worried about their child’s ability to participate in extracurricular activities than court consequences.  As one resident stated, “Some parents treat underage drinking like it’s no big deal and not really against the law because they got away with it when they were young”.

For prescription drug misuse, a local teen said “pills are safer than illegal drugs; you know what’s in them. School Nurses report a large-scale increase in the number of students legally medicated, and that perhaps that lowers their inhibitions about prescription drug abuse.  Police and EMS report seeing youth and adult abuse drugs not prescribed to them to get high.  As one teen stated, “Adults still keep old meds at home, and don’t even notice when pills are missing.”  Comments at RCASA events indicated that parents and prescribers still do not closely monitor narcotics given to teens for minor injuries.  Youth reported tuning out the risks of prescription drugs because of the intense saturation of TV ads.  “They describe all the bad stuff like side effects in a really fast voice, it’s a joke”.  Youth talked about the idea that medication will help fix problems.  One teen said, “Ads are everywhere telling us pills make it all better.”

Police report increases in false prescriptions, doctor shopping, robberies, and drug dealing.  According to the New England High Intensity Drug Trafficking Area report, distributors operating from three nearby cities primarily supply Reading’s drug market.  Reading’s location at the busiest highway interchange in New England creates opportunities for transient buyers, and sellers of drugs as well as those within Reading to target customers from near, and far.  Reading Detectives began working with a regional drug task force in 2012 last year, and report ongoing problems with opioids.

Representatives of the Woburn District Court Probation Department report that more young adults are abusing prescription drugs and ultimately becoming hooked on heroin.  It's getting worse every year. We have not seen a decrease in 10 years.  Once they are hooked on the pills, very few get help until someone or something gets in the way of their use.  Psychiatric diagnosis causes more difficulty dealing with the problem (getting health insurers to pay for treatment).  Parents and families who cannot set limits become enablers.  The opioid problem is worse than people realize.”

The impact of opioid abuse on the health of local residents has been astounding.  From 2003-2005, Reading residents had one of the highest crude rates of opioid fatal overdoses in the state’s northeast region.  From 2005 to March 14, 2014, the Reading Fire Department responded to 189 overdose calls, and medically transported 20 youth for opioid overdoses.  From 2011 to March 14, 2014, they handled 37 alcohol poisonings.  A review of local death certificates from 2003-2013 revealed 23 opioid deaths, 11 substance-related deaths, and 181 tobacco-related deaths of residents.  From 2008-2012, the 3-year average for Reading was 11 opioid deaths. 

Hallmark Health System, a local health care provider in Reading offers outpatient services and operates nearby Melrose-Wakefield Hospital.  A staff liaison from Hallmark sits on the RCASA Board and described their prescribers feeling overwhelmed by prescription drug abuse amongst their patients.  Hallmark staff is also trying to meet the increasing demand for urgent substance abuse-related care by designating a private patient area and training staff on SBIRT. 

Residents are increasingly seeking publicly funded treatment for alcohol and opioid abuse.  According to the MA Department of Public Health, 77 of the 551 admissions of Reading residents in state-funded treatment programs (2012) were for young adults under 21.  Alcohol and opioids were the most frequently reported substances used upon treatment entry. 

To gather quantitative data on youth substance abuse,RCASA collaborated with the Reading Public Schools to administer the 2013 Reading Youth Risk Behavior Survey (YRBS) to grades 6-12.  The middle school sample is comprised of 874 student surveys from grades 6-8.  Eighty-two percent of the sample are White/Non-Hispanic, 4% Multi-ethnic, 3% Black/African-American, 5% Asian/Pacific-Islander, 3% Hispanic/Latino, and 3% did not disclose.  The high school sample is comprised of 1,169 student surveys from grades 9-12.  Eighty-one percent of the sample reported their ethnicity as White/Non-Hispanic, 4% Multi-ethnic, 4% Black/African-American, 4% Asian/Pacific-Islander, 2% Hispanic/Latino, and 4% did not disclose.

  • Current use (past 30 days prior to survey):The middle school results indicated seven percent of students reported current alcohol use.  Fifteen percent used tobacco—six percent used cigars, six percent used cigarettes, and three percent used loose tobacco.  Six percent used marijuana.  Seven percent used prescription drugs compared to four percent in 2011, and higher than the MA 2011 rate of four percent, and U.S. rate of six percent.  Males were three percent more likely than females to report current alcohol use, and one percent more likely to report prescription drug use.  The high school results indicated 41% of students reported current alcohol use at a rate slightly higher than the state (40%), and national results (39%).  Fourteen percent used cigars, 11% used cigarettes, and nine percent used loose tobacco. Twenty-four percent used marijuana.  Eleven percent used prescription drugs compared to eight percent in 2011, and higher than the state rate of six percent.  Females were three percent more likely to report current alcohol use compared to male peers.  While males were eight percent more likely to report current non-prescribed drug use compared to female peers.  The current binge-drinking rate was higher than state and national rates (27% for Reading, 22% for MA, 22% for U.S.). 
  • Perception of Parental Disapproval:  Seventy-eight percent of middle school students perceived their parents would find their alcohol use as “very wrong”, 83% for smoking tobacco, 91% for smoking marijuana, and 83% for prescription drugs.  Males were five percent less likely to perceive their parents would find their alcohol or prescription drug use as “very wrong” compared to females.  Sixty-eight percent of high school students perceived their parents would find their alcohol use as “very wrong”, 72% for smoking tobacco, 73% for smoking marijuana, and 80% for prescription drugs.  Males were six percent less likely to perceive their parents would find their alcohol use as “very wrong” compared to females.  Males were nine percent less likely to perceive their parents would find their prescription drug misuse as “very wrong”.
  • Perception of Peer Disapproval: Fifty-eight percent of middle school students perceived their peers would find their alcohol use as “very wrong”, 58% for smoking tobacco, 70% for smoking marijuana, and 67% for prescription drugs.  Males were 19% less likely to perceive their peers would find their alcohol use as “very wrong” compared to females.  Males were 13% less likely to perceive their peers would find their prescription drug misuse as “very wrong”.  Thirty-one percent of high school students perceived their peers would find their alcohol use as “very wrong”, 41% for smoking tobacco, 35% for smoking marijuana, and 57% for prescription drugs.  Males were five percent less likely to perceive their peers would find their alcohol use as “very wrong” compared to females.  Males were 16% less likely to perceive their peers would find their prescription drug misuse as “very wrong”. 
  • Perception of Risk of Harm: Forty-three percent of middle school students reported great risk of harm from alcohol use, 71% for smoking tobacco, 58% for smoking marijuana, and 64% for prescription drugs.  Males were 13% less likely to perceive “great risk” from alcohol use, and eight percent less likely to perceive “great risk” from prescription drugs compared to female peers.  Forty-five percent of high school students reported great risk of harm from alcohol use, 70% for smoking tobacco, 27% for smoking marijuana, and 67% for prescription drugs.  Perceived risk for marijuana use has declined as laws in Massachusetts changed.  Marijuana possession (1 oz. or less) was decriminalized down to a civil citation in 2009, and medical marijuana was passed in 2013.  Males were eight percent less likely to perceive “great risk” from alcohol use, and 15% less likely to perceive “great risk” from prescription drugs compared to female peers. 

 

To gather qualitative data on youth substance abuse, we hosted bi-annual community dialogues, educational film screenings, board meetings, and youth crew sessions.  We reviewed themes from youth/parent events, feedback from our sector leaders, youth statements from diversion programming, and held meetings with key stakeholders.  Drawing on this data, youth leaders developed a list of social norms in Reading that illustrate our challenges. 

 

Positive Local Norms

Negative Local Norms

OPPORTUNITY- Teens have access to great schools, quality athletics, and dramatic arts.

ACCESS- Local youth can easily access alcohol or prescription drugs at home/in town.

MOST- The majority of teens does not use alcohol or misuse prescription drugs. 

GENERATIONAL AMNESIA- Adults forget, underplay or overlook youth substance abuse. 

CONNECTED- Many teens care what their family, teachers, and coaches think of them.

FALSE SENSE OF PROTECTION- Some adults and teens think bad things cannot happen because of where they live or what they have. 

PAUSE- Many teens consider what can happen if they abuse substances. 

SUBSTANCE ABUSE STYLE- Too many teens start young, use a lot, and are in deep.  

 

Our media, educational, enforcement, and policy development activities have tried to address the negative norms, but despite progress, they remain challenging, require more coordinated action, and continued analysis.  We have also worked diligently to reinforce the positive norms. 

RCASA used data, information on existing challenges and analysis of current community conditions to prioritize the specific youth substance abuse problems in Reading.  Over the past seven years, we surveyed 8000 students, met with hundreds of youth, parents, faculty, residents, and key stakeholders in bi-annual community dialogues to build the needs assessment.  The RCASA-sponsored Pride Faculty and Parent Surveys revealed gaps in adult perception of youth substance use compared to actual rates of use reported by students. 

Based on community input, data and actual harm caused in Reading, underage drinking and prescription drug use emerged as the two RCASA prevention priorities for our Drug Free Communities funded project.  Local youth reported a higher rate of binge drinking and prescription drug misuse compared to state results.  

Alcohol is the most commonly abused substance in our community, and is our first priority. The 2013 Reading YRBS revealed 109 seniors reported binge drinking compared to 45 freshmen.  Twenty-seven percent of students reported getting a ride from an alcohol-impaired driver, an increase compared to 2011 local rates, and higher than both the state rate (24%) and national rate (23%).  Thirteen percent drove impaired by alcohol compared to the state rate (eight percent) and national rate (seven percent).  All alcohol use data for middle school students showed decreased rates compared to 2011 data except for binge drinking which stayed the same (four percent).  Overall, alcohol use indicators for 6th – 8th graders were consistent with state rates.  Fifteen percent of middle school youth reported getting into a car with an alcohol-impaired driver.  Younger youth were more likely to access alcohol at home compared to older youth that used fake ids or paid someone to buy for them.  Targeted coalition activities resulted in some underage drinking reductions but we must intensify efforts to reduce youth binge drinking, address current use, limit alcohol access, reduce impaired driving, and youth riding in a car with an impaired driver.

Prescription drugs are our second priority due to their devastating impact on our town from opioid-related deaths.  Fourteen percent of all students reported being ‘offered, sold or given prescription drugs not prescribed to them on school property’.  Twenty-nine youth under age 21 overdosed in the last five years.  Twelve percent of local high school students misused prescription drugs to get high.  Seven percent of the high school youth that reported heroin use also reported prescription drug misuse at a rate of 50% compared to non-heroin users (12%).  Youth that abused heroin also had lower perceptions of prescription drug risk, 17% (heroin users) compared to 67% (non-heroin users).  Middle school students reported misuse of over the counter (OTC) and prescription drugs to get high.  Forty-seven local youth reported using OTC meds to get high and 25 youth reported using prescription drugs to get high, one or more times in the past month.  Forty-six middle school youth reported there was ‘no risk’ in using non-prescribed drugs.  We need to further reduce access to prescription drugs through better monitoring, improve perception of risk, and increase awareness about their addictive potential.

Local data is critical to the work of the coalition.  RCASA staff and the Data Workgroup manage the data collection and analysis processes.  The workgroup is comprised of representatives from law enforcement, school, and health partners.  They established priority data points, support access to critical data and guide dissemination. 

The RCASA Director works with the Reading Public Schools to collect local Youth Risk Behavior Survey Data every two years. The Director develops the questionnaires for the high school and middle schools, defines survey protocols per CDC guidance, develops Parent materials, consent forms, trains school staff to administer the survey in wellness classes and monitors the process.  An independent consultant processes the survey data.  The Director analyzes the results and compares them to state and national averages.  The Detectives Unit provides police log data weekly to the Director to analyze cases involving underage drinking, prescription drug misuse, marijuana civil citations, and mental health crises. 

2016 Data Visualization of the Massachusetts Opioid Epidemic

"Massachusetts is currently experiencing an epidemic of opioid-related overdose and death. These overdoses are driven by the underlying chronic disease of opioid addiction or opioid use disorders. People with opioid addiction are at high risk of overdose and death."

Learn more at http://www.mass.gov/chapter55/#top

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