South Carolina Profile on Alcohol, Tobacco, and Other Substance Related Indicators

South Carolina Profile on Alcohol, Tobacco,
and Other Substance Related Indicators
Prepared by
South Carolina Department of Alcohol and
Other Drug Abuse Services (DAODAS)
State Epidemiological Outcomes Workgroup (SEOW)
Pacific Institute for Research and Evaluation (PIRE)
March 2009 DRAFT
This document was made possible by the South Carolina Department of Alcohol and Other
Drug Abuse Services (DAODAS) and the Center for Substance Abuse Prevention,
Substance Abuse and Mental Health Services Administration (CSAP-SAMHSA).
ii
State Epidemiological Outcomes Workgroup (SEOW)
MEMBERS
Cheryl Addy, Ph.D, Chief SEOW Committee Chairperson, Senior Associate Dean for Academic
Affairs, Associate Professor of Biostatistics
Norman J. Arnold School of Public Health, University of South Carolina
Sarah Crawford, Program Coordinator
Office of Research and Statistics, Budget Control Board
Melissa English, Surveillance and Evaluation Coordinator
Division of Oral Health, SC DHEC
David Forrester, Executive Director
Spartanburg Alcohol and Drug Abuse Commission
Wesley J. Gravelle, II, Director of Research and Planning
Maternal and Child Health Bureau, SC DHEC
Khosrow Heidari, State Epidemiologist (Chronic)
SC Department of Health and Environmental Control (DHEC)
Baron Holmes, KIDS COUNT Director
Office of Research and Statistics, Budget Control Board
Ann Maletic, Program Manager
Evaluation, Training, and Research, SC Department of Mental Health
Robert McManus, Coordinator of Planning and Research
Office of Justice Programs, SC Department of Public Safety
Delores Pluto, YRBS Coordinator
Office of Youth Services, Healthy Schools, SC Department of Education
Brenda Powell, Prevention Consultant
Division of Program Accountability, DAODAS
Camelia Vitoc, Surveillance and Evaluation Coordinator
Division of Tobacco Prevention and Control, SC DHEC
Dan Walker, Research and Statistical Analyst
Management Information and Research Section, DAODAS
James Wilson, Treatment Consultant
Division of Program Accountability, DAODAS
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SUPPORT STAFF
SEOW Project Director: Michelle Nienhius, M.P.H., Prevention Consultant (NPN), DAODAS
Lead SEOW Epidemiologist: Robert Flewelling, Ph.D., Senior Research Scientist, PIRE
PIRE Project Director: Steven C. Burritt, M.P.H., Senior Program Manager, PIRE
SEOW Manager: Crystal Gordon, M.S.W., Program Associate, PIRE
SEOW Research Assistant: Chris Paget, B.A., Research Assistant, PIRE
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SEOW MISSION
The mission of the South Carolina State Epidemiological Outcomes Workgroup is to create a
highly effective statewide comprehensive substance abuse prevention data system that will
support and enhance efforts to reduce alcohol, tobacco and other drug use across the lifespan of
people living in South Carolina communities through the development and implementation of a
comprehensive statewide prevention strategy at the state and local levels.
SEOW OBJECTIVES
1. DAODAS will establish a State Epidemiological Outcomes Workgroup (SEOW) to examine
alcohol-, tobacco-, and other drug-related archival data, including the National Outcome
Measures (NOMs), in order to determine the scope and extent of substance abuse and its
related problems with in the state.
The major roles of the SEOW are a) supporting the Governor’s Council on Substance Abuse
with respect to data-based decision making, b) supporting needs assessment at state and local
levels, c) supporting capacity-building at the state and local level, d) supporting the use of
data-driven planning , and e) supporting development of a statewide strategic plan for
substance abuse prevention. The SEOW has recruited members and will establish
procedures, is meeting regularly, and will make significant contributions to the development
of this Strategic Plan.
2. Through its data-collection efforts, the established South Carolina SEOW will support
ongoing monitoring and evaluation.
The SEOW, with support from the Pacific Institute for Research and Evaluation (PIRE) staff,
will 1) conduct a thorough review of relevant archive data sets in the state of South Carolina;
2) design an analysis of state data sets to document a) the substance abuse patterns that pose
the greatest harm for South Carolina citizens, and b) widespread problems in the state
associated with these substance use patterns; 3) review these analyses and make
recommendations to the Governor’s Council concerning evidence-based problems in the
state. Systems assessment will be ongoing through SEOW identification of data system needs
and gaps and ongoing assessment of local systems.
3. To produce a Statewide Epidemiological Profile that will drive strategic and operational
planning and budgeting processes.
South Carolina will have a highly effective substance abuse prevention system both at the
State level and in targeted counties of the state. Stakeholder readiness, involvement,
organizational expertise, system capacity and infrastructure will be substantially enhanced.
The work of the SEOW will provide a critically important role in these enhancements. We
envision this strengthened infrastructure will facilitate data-driven planning decisions that
will measurably contribute to a significant reduction in ATOD abuse or dependence and
related consequences.
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LIST OF ACRONYMS
ACS
ATOD
AIDS
BRFS
BRFSS
CDC
CI
CSAP
DHEC
DHHS
DAODAS
DSM
FARS
FBI
HIV
ICD
MDMA
NIAAA
NOMS
NSDUH
NVSS
PIRE
SAAMIS
SAMHSA
SC
SEDS
SEOW
SIG
SPF
STD
UCR
US
YRBS
YRBSS
YTS
American Community Survey
Alcohol, Tobacco, and Other Drugs
Acquired Immune Deficiency Syndrome
Behavioral Risk Factor Surveillance
Behavioral Risk Factor Surveillance System
Centers for Disease Control and Prevention
Confidence Interval
Center for Substance Abuse Prevention
Department of Health and Environmental Control
Department of Health and Human Services
Department of Alcohol and Other Drug Abuse Services
Diagnostic and Statistical Manual of Mental Disorders
Fatality Analysis Reporting Systems
Federal Bureau of Investigation
Human Immunodeficiency Virus
International Classification of Diseases
3,4-methylenedioxymethamphetamine (a.k.a. Ecstasy)
National Institute on Alcohol Abuse and Alcoholism
National Outcomes Measures
National Survey on Drug Use and Health
National Vital Statistics System
Pacific Institute for Research and Evaluation
Substance Abuse Agencies Management Information System
Substance Abuse and Mental Health Services Administration
South Carolina
State Epidemiological Data System
State Epidemiological Outcomes Workgroup
State Incentive Grant
State Prevention Framework
Sexually Transmitted Disease
Uniform Crime Reports
United States
Youth Risk Behavior Surveillance
Youth Risk Behavior Surveillance System
Youth Tobacco Survey
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TABLE OF CONTENTS
EXECUTIVE SUMMARY ............................................................................................................ 9
Tobacco..................................................................................................................................... 12
Marijuana and Other Illicit Drugs............................................................................................. 14
INTRODUCTION ........................................................................................................................ 16
METHODS ................................................................................................................................... 20
RESULTS ..................................................................................................................................... 22
Alcohol Use .............................................................................................................................. 22
Availability/Consumption..................................................................................................... 22
Current Use ........................................................................................................................... 23
Early onset use ...................................................................................................................... 27
Binge use............................................................................................................................... 28
Heavy use.............................................................................................................................. 33
Drinking and driving............................................................................................................. 35
Alcohol use during pregnancy .............................................................................................. 38
Consequences of Alcohol Use .................................................................................................. 39
Mortality ............................................................................................................................... 39
Dependence or Abuse ........................................................................................................... 42
ATOD Services Utilization................................................................................................... 43
Violent crime ........................................................................................................................ 47
Motor Vehicle Crashes ......................................................................................................... 48
Sexual activity....................................................................................................................... 52
Teen births ............................................................................................................................ 53
HIV/AIDS ............................................................................................................................. 53
Summary of Alcohol Consumption and Consequences............................................................ 54
Tobacco Use.............................................................................................................................. 56
Availability/Consumption..................................................................................................... 56
Current use ............................................................................................................................ 58
Daily use ............................................................................................................................... 63
Age of first use...................................................................................................................... 66
Smokeless tobacco ................................................................................................................ 67
Tobacco use during pregnancy ............................................................................................. 69
Consequences of Tobacco Use ................................................................................................. 71
Mortality ............................................................................................................................... 71
Summary of Tobacco Use and Consequences .......................................................................... 78
Marijuana and Other Illicit Drug Use ....................................................................................... 79
Current marijuana use ........................................................................................................... 79
Age of first marijuana use..................................................................................................... 82
Other illicit substance use ..................................................................................................... 83
Consequences of Illicit Drug Use ............................................................................................. 86
Morbidity………………………………………………………………………….………...86
Mortality ............................................................................................................................... 86
Dependence or Abuse ........................................................................................................... 88
Methamphetamine Laboratory Incidents……………………………………………….…...89
Property crime....................................................................................................................... 89
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Summary of Illicit Drug Use and Consequences...................................................................... 91
General Causal Factors ............................................................................................................. 92
Community ........................................................................................................................... 92
Family ................................................................................................................................... 95
Summary of General Causal Factors ........................................................................................ 98
CONCLUSIONS......................................................................................................................... 100
Summary of Findings on Indicators........................................................................................ 100
Data Limitations...................................................................................................................... 103
APPENDIX................................................................................................................................. 105
Constructs and Indicators........................................................................................................ 105
Data Sources ........................................................................................................................... 110
Attributable Fractions ............................................................................................................. 113
Attributable Fractions Tables.............................................................................................. 113
Number of Deaths in South Carolina Attributable to Alcohol, Tobacco, and Drug Use ... 125
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EXECUTIVE SUMMARY
In the spring of 2006 the South Carolina Department of Alcohol and Other Drug Abuse Services
(DAODAS) convened the South Carolina State Epidemiological Outcomes Workgroup (SEOW),
funded through the Substance Abuse and Mental Health Services Administration’s Center for
Substance Abuse Prevention (SAMHSA/CSAP). The SEOW was tasked with examining alcohol,
tobacco, and other drug (ATOD)-related archival data in order to determine the scope and extent
of substance abuse and its related problems in South Carolina; and supporting ongoing statelevel monitoring and evaluation through its data collection, assimilation, and reporting efforts.
The goal for SEOWs was to develop a data-driven planning and resource allocation model—a
deliberate strategy for interpreting, comparing, and synthesizing multiple health-related
indicators in order to translate information into good planning around the identified needs of the
state, territory, or community. The SEOW’s tasks included production of a Statewide
Epidemiological Profile as a key deliverable which organizes, summarizes, and presents these
archival data for use in prevention planning and decision making. These data were measures or
“indicators” of ATOD consumption and consequences primarily from periodic national surveys,
which allowed us to report trends over multiple years and to compare to national rates. These
indicators were carefully selected (most are from the State Epidemiological Data System or
SEDS, developed by SAMHSA/CSAP) and met criteria for availability, validity, consistency,
periodic collection, and sensitivity. In addition, national sources were supplemented with state
data sources, keeping in mind these selective criteria. Below we summarize our findings first by
major substance and second by consumption, consequences, and selected indicators for that
substance.
Alcohol
Consumption
Alcohol is the most commonly abused
substance nationally and state-wide.
According to the 2007 BRFS survey, 47.5%
of people age 18 or older in the South
Carolina (an estimated 1,559,000 persons)
were current users of alcohol. The State’s
rate was 9% lower than the national average
(45.2%). Data from the 2007 BRFS survey
showed that current use of alcohol among
adults has remained constant since 2001.
However, consumption of alcohol in South
Carolina, as measured by sales per capita
aged 14 and over, has trended upward since
1995 and has been about 10% higher than in
the U.S.
Roughly 18% of South Carolina adults
would be classified as risky drinkers based
on reports of engaging in binge and/or heavy
drinking. Adult binge use rates are slightly
lower compared to US rates, while heavy
use rates are about the same. Males and
younger adult age groups have higher rates
of current, binge, and heavy use, while
African Americans have lower rates.
Among pregnant women in South Carolina,
use during the last trimester of pregnancy
from 1995 to 2005 has ranged from a low of
3.2% to a high of 6.2% (in 2004), which
exceeded the Healthy People 2010
benchmark of 6 percent or less.
9
Alcohol Use, Ages 18 and Older, South Carolina and United
States, 2007
•
60
50
40
Current Use
30
Binge Use
Heavy Use
20
10
0
SC
US
G eo g r ap hi c A r ea
•
Source: 2007 Behavioral Risk Factor Surveillance System
Most adults begin using alcohol in
adolescence. Youth data from the YRBS
indicate that South Carolina rates of current,
early-onset, and binge use, and rates of
drinking and driving are all very similar to
national rates and have trended slightly
downward (though South Carolina YRBS
data were absent for 2001 and 2003). Data
from the 2007 SC YRBS indicate that 36.8%
of 9th-12th grade public high school students
are current drinkers and 20.1% had engaged
in binge drinking during the past month.
Almost 10% percent of students said that
they had driven a car while under the
influence of alcohol, and 26.3% reported
being a passenger in a car with a driver who
had been drinking. Males, upper classmen,
and Whites were at higher risk for drinking
and driving, while African Americans were
at lower risk on all YRBS alcohol
consumption indicators.
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Consequences
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•
Nearly 100,000 deaths each year in the
U.S. are attributed to alcohol use.
In 2004 in South Carolina there were
roughly 454 deaths from cirrhosis, 483
from suicide, and 323 from homicides,
some of which were alcohol-related
and all of which were preventable.
There were roughly 460 deaths from
•
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motor vehicle crashes in which alcohol
was a factor.
Risky sexual behavior is another
consequence of alcohol abuse. Rates
on teen sexual behavior indicators in
South Carolina exceed national
averages. Similarly, HIV and AIDS
rates among adults and adolescents are
higher in South Carolina compared to
the national average.
Binge drinking, as indicated by
consumption of five or more drinks on
a single occasion, is strongly
associated with injuries, motor vehicle
crashes, violence, fetal alcohol
syndrome, chronic liver disease, and
other chronic and acute conditions.
Initiation of alcohol use at young ages
has been linked to more problematic
levels of use in adolescence and
adulthood. Young people who drink
are more likely than adults to be binge
drinkers.
Heavy drinkers are at increased risk
for alcohol abuse and dependence.
People who begin drinking before the
age of 15 are four times more likely to
develop alcohol dependence than those
who wait until age 21. Each additional
year of delayed drinking onset reduces
the probability of alcohol dependence
by 14%.
Studies have shown that long-term
alcohol abuse produces serious, harmful
effects on a variety of the body’s organ
systems, especially the liver and the
immune, cardiovascular and skeletal
systems.
Immediate adverse effects of alcohol can
include: impaired judgment, reduced
reaction time, slurred speech, and
unsteady gate. When consumed rapidly
and in large amounts, alcohol can result
in coma and death.
Excessive drinking, including binge and
heavy drinking, has numerous chronic
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and acute health effects. Chronic health
consequences include: liver cirrhosis,
pancreatitis, various cancers, including
cancer of the liver, mouth, throat, larynx,
and esophagus, high blood pressure, and
psychological disorders. Acute health
consequences of excessive drinking can
include motor vehicle injuries, falls,
domestic violence, rape, and child abuse.
Mortality from causes associated with
alcohol use is generally higher in South
Carolina compared to the US. Violent
crime rates in South Carolina have
remained about 1.5 times higher
compared to US rates. All FARS motor
vehicle accident indicators show a spike
in rates from 1999 to 2001, but declining
trends thereafter, with rates higher than
those in the US. The most recent data for
two of the three FARS indicators show
upward spikes for the US and especially
for South Carolina. Nighttime single
vehicle crashes seem to be trending
downward. There are no national data on
this indicator for comparison.
•
Hospital discharge rate for alcoholrelated conditions+
• Alcohol treatment admissions#
____________________________________
__
*CSAP/SEDS current recommended indicator
+CSAP/SEDS indicator currently under consideration
#Useful indicator for which no national data source has
been identified
Selected Indicators 1
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•
Chronic liver disease/cirrhosis death
rate*
Suicide death rate*
Homicide death rate*
Alcohol-related fatal motor vehicle
crashes*
Alcohol-related vehicle death rate*
Alcohol-involved drivers of all drivers in
fatal crashes*
Single-vehicle nighttime crash rate#
Violent crime rate*
Alcohol abuse or dependence*
Ethanol sales per capita*
Alcohol-related mortality+
1
Indicators are specific data measures that quantify
different types of consumption patterns or different
consequences of use.
11
Consumption
Rates of adult cigarette consumption in
South Carolina and the US as measured by
pack sales per adult age 18 and over have
declined since the late 1990s. However,
from 2004 to 2006 South Carolina sales
increased from 92 to 96 packs per capita,
while US sales continued on a decline to 85
packs per capita. This difference might be
anticipated given that South Carolina is a
tobacco-producing state.
Despite this standing, youth current cigarette
use rates have declined and are on par with
those in the US (at approximately 25%),
while adult rates have also declined. The
2007 BRFS survey found that 21.9% of the
state’s population age 18 and over were
current cigarette smokers (approximately
718,800 people), including 16.2% who were
daily smokers. Data over time from the
BRFS suggest both current and daily adult
cigarette use have gradually declined since
2002, although current and daily use rates
have remained higher in South Carolina
compared to the US.
Current Cigarette Use, Ages 18 and Older, South Carolina and
United States, 1999-2007
50
45
40
35
Percent
30
SC
25
US
20
15
The 2007 South Carolina YRBS showed
rates of current cigarette use (17.8%), daily
use (13.1%), and smokeless tobacco use
(7.9%) among 9th-12th grade public school
students, which were similar to national
rates in 2005 (23.0%, 9.4%, and 8.0%,
respectively), and are equally likely to begin
smoking before age 13.
Current Cigarette Use, Grades 9-12, South Carolina
and United States, 1995-2007
50
40
Percent
Tobacco
30
SC
US
20
10
0
1995
1997
1999
Source: Youth Risk Behavior Surveillance System
2001
2003
2005
2007
Year
Higher risk youth subgroups included 12th
graders, males, and whites (though 9th and
10th graders also have higher smokeless use
rates).
Rates of smoking during the last trimester of
pregnancy among women in South Carolina
have ranged from 12% to 15%, far
exceeding the Healthy People 2010 goal of
1%. Rates of smoking at any time during
pregnancy have exceeded national rates
since 1995 and are increasing, while US
rates are sharply decreasing.
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Consequences
5
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Source: 2007 Behavioral Risk Factor Surveillance System
The highest rates of current and daily adult
smoking were found among those ages 25 to
34 and males.
•
More than 400,000 deaths in the U.S.
each year are attributed to cigarette
smoking, making it the leading
preventable cause of death. In South
Carolina, nearly 17,000 people annually
die from smoking-related diseases.
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Smoking increases the risk of heart
disease, cancer, stroke, and chronic lung
disease. Heart disease is the leading
cause of death in the U.S. and South
Carolina, and the leading cause of heart
disease is smoking. In 2004 some 8,287
deaths were attributed to cardiovascular
disease in South Carolina, with the
mortality rate from this cause being
comparable to the national rate.
In 2004 there were 3,482 deaths from
ischemic cerebrovascular disease in
South Carolina. Being in the “stroke
belt,” the state suffers from about 20%
higher mortality rates from ischemic
cerebrovascular disease compared to the
US national average.
Approximately 80% of chronic
obstructive pulmonary (COPD) and
emphysema deaths are attributable to
smoking. In 2004 1,721deaths were due
to lung diseases in South Carolina, and
the death rate for this cause was higher
than the national average.
Lung cancer results from long-term
tobacco use and it is the most common
form of cancer mortality in the U.S.,
accounting for 80-90% of all cancer
deaths. In 2004 some 2,496 deaths were
due to lung cancer in South Carolina.
The mortality rate from lung cancer is
10% to 20% higher in South Carolina
compared to the US.
Environmental tobacco smoke increases
the risk for heart disease and lung cancer
among nonsmokers.
Careless smoking is the leading cause of
fatal fires in the U.S.
The social costs per year of tobacco use
in the U.S. were estimated to be $177.2
billion in 2001, including those
attributed to lost productivity and
medical expenditures.
Selected Indicators
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•
Lung cancer deaths*
Chronic obstructive pulmonary disease
and emphysema deaths*
• Cardiovascular disease deaths*
• Wholesale number of cigarettes taxed*
• Hospital discharge rate for tobaccorelated conditions+
• Tobacco-related mortality+
• Persons smoking a pack per day or
more#
____________________________________
__
*CSAP/SEDS current recommended indicator
+CSAP/SEDS indicator currently under consideration
#Useful indicator for which no national data source has
been identified
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Marijuana and Other Illicit Drugs
Consumption
Marijuana is the nation’s most commonlyused illicit drug and is the illicit drug of
choice in South Carolina. Marijuana use is
widespread among young adults and
adolescents. It accounts for the majority of
adolescent substance abuse treatment
admissions.
Youth (grades 9-12) current marijuana use
has been gradually declining in both South
Carolina and the US since 1999, with rates
equivalent in the two regions at around 20%.
the two regions and have remained stable
during the three reporting periods other than
a possible decrease in 18- to 25-year old
cocaine use rates. Nonmedical pain reliever
use rates among South Carolina and US 12to 17-year-olds and 18- to 25-year-olds from
2003 to 2005 were comparable in the two
regions.
Consequences
•
Current Marijuana Use, Grades 9-12, South Carolina and
United States, 1995-2007
50
•
Percent
40
30
SC
US
20
10
•
0
1995
1997
1999
Source: Youth Risk Behavior Surveillance System
2001
2003
2005
2007
Year
Males are at much higher risk compared to
females, and upper classmen at slightly
higher risk compared to lower classmen.
NSDUH survey data indicate that South
Carolina and US current marijuana use rates
in the 12- to 17- -year-old age group are
gradually declining and are similar in both
regions. The South Carolina 18- to 25-yearold rate increased in 2005-2006 and came
close to the national rate where the state had
been lower in previous years. Rates of first
use before age 13 are similar in both South
Carolina and the US.
Rates of using other illicit substances and
using cocaine in particular are also similar in
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Smoking marijuana frequently has been
associated with increased reporting of
health problems and more days of
missed employment than nonsmokers.
In the short-term, marijuana use may
cause adverse physical, mental,
emotional, and behavioral changes such
as problems with memory and learning,
distorted perceptions, difficulty in
thinking and problem solving, loss of
coordination, and increased heart rate.
Longer term adverse health effects
include respiratory illnesses, memory
impairment, and weakening of the
immune system. Long-term marijuana
use causes changes in the brain similar
to those seen after long-term use of other
major drugs.
Marijuana has been shown to
compromise the ability to learn and
remember information, often leading to
deficits in accumulating intellectual, job
or social skills.
Depression, anxiety, and personality
disturbances have been associated with
marijuana use.
Babies born to women who used
marijuana during their pregnancies
display altered responses to visual
stimuli, increased tremulousness, and
potential neurological problems. Risk of
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heat attack more than quadruples in the
first hour after smoking marijuana.
Initiation of marijuana use at younger
ages has been linked to higher and more
severe patterns of use of marijuana and
other substances in adolescence and
adulthood.
Although marijuana abusers generally do
not commit violent crimes, some illicit
drug use may be associated with violent
crime and risky sexual behavior.
Death rates from drug use, abuse, or
dependence have been higher in the US
compared to South Carolina since 1990,
though low use rates make it difficult to
make definitive statements. Dependence
and abuse rates by age match
consumption patterns by age, and there
were no differences across reporting
years or between South Carolina and the
US as a whole in reported rates of illicit
drug dependency in the past year among
persons ages 12 to 17 and 18 to 25 years
old. Property crime rates have
consistently remained about 20% higher
in South Carolina compared to the US
from 1995 to 2006.
The social costs of marijuana use in the
U.S. were estimated at $9.1 billion in
2001.
*CSAP/SEDS current recommended indicator
+CSAP/SEDS indicator currently under consideration
#Useful indicator-- no national data source has been
identified
Selected Indicators
•
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•
•
Illicit drug use death rate*
Property crime rate*
Illicit drug abuse or dependence*
Hospital discharge rate for illicit drugrelated conditions+
• Drug-related treatment admissions rate#
• Daily use of marijuana or other illicit
drugs rate#
• Adults reporting injection drug use#
• Women reporting illicit drug use during
pregnancy#
____________________________________
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INTRODUCTION
In the spring of 2006 the South Carolina Department of Alcohol and Other Drug Abuse Services
(DAODAS) convened the South Carolina State Epidemiological Outcomes Workgroup (SEOW),
funded through the Substance Abuse and Mental Health Services Administration’s Center for
Substance Abuse Prevention (SAMHSA/CSAP). The SEOW was assigned two primary tasks: to
examine alcohol-, tobacco-, and other drug-related archival data, including the National Outcome
Measures (NOMs), in order to determine the scope and extent of substance abuse and its related
problems in South Carolina; and to support ongoing state-level monitoring and evaluation
through its data collection, assimilation, and reporting efforts, including the production of a
Statewide Epidemiological Profile that will drive strategic and operational planning and
budgeting processes. This profile would be produced in two phases: phase 1 would be a
statewide assessment, and phase 2 (in year 2) would be sub-state assessment (at the county
level). This document is the first phase of the South Carolina Epidemiological Profile.
SEOW members were invited to be a part of the statewide needs assessment process based upon
their knowledge of and ability to work with data. Membership was also chosen to reflect as many
State agencies as possible, while keeping the group relatively small. The SEOW achieved a
working membership as of May 17, 2006. It meets bi-monthly and works closely with Pacific
Institute for Research and Evaluation (PIRE) to complete the assessment activities. Additionally,
the SEOW will make the many decisions necessary to develop the needs assessment and make
recommendations to the Governor’s Council, which meets quarterly. The SEOW is a
subcommittee of the Governor’s Council for Substance Abuse and reports to both the full
Council and its Executive Steering Committee.
State Epidemiological Outcomes Workgroups (SEOWs) operate within the Strategic Prevention
Framework (SPF), which closely parallels the Institute of Medicine’s Core Functions of Public
Health (Assessment, Policy Development, and Assurance) and includes five critical steps that
support effective planning and decision making (Figure 1).
16
Figure 1. SAMHSA’s Strategic Prevention Framework
1. Assess
5. Monitor,
evaluate
2. Build
Capacity
Profile population
needs, resources, and
readiness to address
needs and gaps
Monitor, evaluate,
sustain, and improve
or replace those that
fail
Cultural Competence
Sustainability
Implement evidencebased prevention
programs and
activities
4. Implement
Mobilize and/or build
capacity to address needs
Develop a
Comprehensive
Strategic Plan
3. Plan
The goal for SEOWs is to develop a data-driven planning and resource allocation model like the
one pictured above—a deliberate strategy for interpreting, comparing, and synthesizing multiple
health-related indicators in order to translate information into good planning around the
identified needs of the state, territory, or community.
With this goal in mind, the Center for Substance Abuse Prevention (CSAP) recommends that
states include a set of key indicators of substance use (consumption) and consequences resulting
from substance use in state epidemiological profiles. Consumption refers to patterns of alcohol,
tobacco, and/or illicit drug use, such as initiation of use, regular or typical use, and high-risk use.
Consequences include morbidity and mortality and other undesired events for which these
substances are clearly and consistently involved. Scientific evidence must support a link to one
or more of these substances as a contributing factor to the consequence. In other words, it must
establish a sufficient degree of association (or attribution) of the consequence to substance abuse.
Within each of the two major groupings (consumption and consequences), identifying a set of
prevention-related constructs for each of three major substance types—alcohol, tobacco, and
illicit drugs is the next step. The constructs provide a way to conceptualize and organize key
types of consumption patterns and consequences. For example, current use of alcohol is one
construct pertaining to consumption of alcohol. Binge drinking (i.e., drinking large quantities of
alcohol on a single occasion) and driving after drinking alcohol are two additional conceptually
meaningful patterns of consumption for which it is useful to have valid and reliable data.
Alcohol-, tobacco-, and illicit drug-related mortality are three of the constructs pertaining to
consequences. Some things to consider when deciding on constructs include the extent to which
the outcome is attributable to substance use and abuse. For example, alcohol-related motor
vehicle fatalities are 100% attributable to alcohol use. On the other hand, homicide is only 30%
17
attributable to alcohol use. Another aspect to consider is whether the construct has short-term or
long-term relevance. Cirrhosis of the liver is the result of many years of problem drinking so
examining changes in the rate of cirrhosis over a five-year period is not likely to show much
change if prevention efforts are focused on reducing problem drinking. However, the prevalence
of binge drinking among young people is more likely to show changes in the short term.
Prevention-related constructs for each of the three major substance types are provided in Table 1.
Table 1. Alcohol, Tobacco, and Other Drug Consumption and Consequences and Associated PreventionRelated Constructs
Consumption
Consequences
Alcohol
Current alcohol use
Current binge drinking
Heavy drinking
Age of initial alcohol
use
Drinking and driving
Per capita alcohol
consumption
Alcohol-related
morbidity and
mortality
Motor vehicle crashes
Violence
Dependence or abuse
Decreased school
connectedness
Risky sexual activity
Increased teen births
Increased HIV/AIDS
cases
Tobacco
Current tobacco use
Daily cigarette use
Age of initial tobacco
use
Per capita cigarette
consumption
Illicit Drugs
Current illicit drug use
Lifetime illicit drug
use
Age of first illicit drug
use
Tobacco-related
mortality
Drug-related
morbidity and
mortality
Crime
Dependence or abuse
Decreased school
connectedness
Risky sexual activity
Increased teen births
Increased HIV/AIDS
cases
For each construct, one or more specific measures (or “indicators”) are needed to identify the
specific data elements that will be incorporated into the profile. Unlike the underlying constructs,
indicators have specific data sources and precise definitions. Indicators are used to specify the
data elements and quantify the constructs. Thus, while “alcohol-related mortality” is a relevant
construct for monitoring trends of an important consequence of use, it does not provide a precise
definition of how this construct can be measured. There are several indicators available,
however, that provide specific measures of this construct, e.g., the annual incidence rate of
deaths determined to be attributable to chronic liver disease, suicide, homicide, or alcoholinvolved crash fatalities.
There are several criteria for selecting consequence and consumption constructs and indicators to
monitor and evaluate, including the availability/accessibility, validity, timeliness, consistency,
and sensitivity of the data.
18
1. Availability. The data should be readily available and accessible. Ideally it could be
analyzed at the subgroup level (i.e., by age, sex, race/ethnicity, etc.) and by location (i.e.,
county, region, state) if necessary.
2. Validity. The measure must meet basic criteria for validity. That is, there must be
research-based evidence that the data accurately measure the specific construct and yield
a true snapshot of the phenomenon at the time of assessment. These criteria are used to
eliminate measures that, while they may look at face value as if they assess a particular
construct, are in fact poor or unproven proxy measures and thus do not accurately reflect
the construct.
3. Periodic collection over at least 3 to 5 past years. The measure should be available for
the past 3 to 5 past years, preferably on an annual or least biennial basis. This enables the
State to determine not only the level of an indicator but also its trends.
4. Consistency. The measure must be consistent, i.e., the method or means of collecting and
organizing data should be relatively unchanged over time, such that the method of
measurement is the same from time i to time i+1. Alternatively, if the method of
measurement has changed, sound studies or data should exist that determine and allow
adjustment for differences resulting from data collection changes.
5. Sensitivity. For monitoring, the measure must be sufficiently sensitive to detect change
over time that might be associated with changes in alcohol, tobacco, or illicit drug use.
As part of its data collection effort, each SEOW is required by CSAP to collect data for the
National Outcome Measures (NOMs) initiative. CSAP’s parent agency, the Substance Abuse and
Mental Health Services Administration (SAMHSA), developed the NOMs to establish a
mechanism by which all states and territories can consistently monitor their substance abuse and
mental health services systems. There are eight prevention-related NOMs domains, five of which
include epidemiological constructs (and are identified with asterisks below):
•
•
•
•
•
•
•
•
Reduced Morbidity [30-day substance use (non-use, reduction in use); perceived
risk/harm of use; age of first use; perception of disapproval/attitude]*
Employment/Education (Perception of workplace policy; ATOD-related suspensions and
expulsions; attendance and enrollment)*
Crime and Criminal Justice (Alcohol-related car crashes and injuries; alcohol and drugrelated crime)*
Social Connectedness (Family communication around drug use)*
Access/Capacity(Number of persons served by age, gender, race and ethnicity)
Retention (Total number of evidence-based programs and strategies; percent youth
seeing, reading, watching, or listening to a prevention message)*
Cost Effectiveness (Services provided within cost bands)
Use of Evidence-Based Practices (Total number of evidence-based programs and
strategies)
Although South Carolina data are available for all five of the epidemiologically-oriented NOMs
prevention domains, data are not available for all constructs or indicators within the domains.
During the next two years, the SC SEOW will work to establish mechanisms to obtain all NOMs
data.
19
METHODS
Given that prevention resources are limited and priorities must therefore be identified and
targeted, prevention planners require a mechanism for identifying priority problems. Once data
are obtained on these indicators, there are several different criteria that are useful for identifying
substance abuse consumption and consequences patterns that are problematic for a particular
state and therefore warrant close attention. A primary function of the epidemiological profile is
to allow ready comparisons of the different consumption patterns and consequences in order to
identify those that are most important from a purely epidemiological perspective (other
perspectives will come into play later in the prevention planning and implementation process).
Three key criteria or “dimensions” for identifying priority problems include:
1. Direct comparison across different indicators based on magnitude or level of burden
2. Comparisons based on where indicators stand in relation to a reference population (or to
other similar populations as defined geographically or demographically)
3. Comparisons based on trends in indicator values over time
To the extent that all three dimensions are assessed in the profile, an accurate assessment of
priority areas is possible. However, States’ past experiences with empirically-based prevention
needs assessments indicate that having data does not necessarily lead to maximally effective
prevention planning. States need to use deliberate strategies for presenting, interpreting,
comparing, and synthesizing multiple indicators from different perspectives in order to translate
empirical information into justifiable prioritization of needs and sound planning decisions. In
order to synthesize the data, states will need additional expertise in epidemiological methods,
including age-adjustment or adjustment on other demographic characteristics to allow accurate
extrapolations to the state population, as well as other adjustments needed to weight indicators
according to some measure of burden, cost, or severity. Although the initial focus of the profile
should be the state population as a whole, the data obtained may indicate that it is necessary or
desirable to examine substance use and or consequence indicators in smaller geographical areas,
such as regions, counties or cities.
Data were graphed to show annual trends from the mid 1990s to the present. Subgroup analyses
were presented where interesting and informative. Where possible, data from different sources
on the same indicators are presented in order to highlight any discrepancies among sources.
Data on demographic characteristics and pertinent social and substance use indicators were
collected and summarized in tables and graphs. We used the US population as a standard for
comparison on indicators where possible. Survey data for Asian/Pacific Islander and American
Indian/Alaskan Native students are not provided in the graphs by race/ethnicity because the
numbers of these students in the sample was too low to generate reliable population estimates.
Substance use indicators were organized by type (i.e., most commonly-used substances, followed
by less commonly-used substances), and within type by more common use patterns (e.g., past
30-day use) and then less common but more dangerous use patterns (heavy use, binge use, daily
use). Where possible, indicators were graphed using the same scale ranges (0 to 50 percent, for
example) to allow for easier comparisons across indicators. However, in cases where prevalence
rates were very low or very high, scales had to be adjusted to a more appropriate range to
visualize small group differences or to accommodate the full range of data.
20
All of the substance use data in this report are drawn from surveys. In survey research, samples
are drawn from a larger population of individuals because we are rarely able to survey all
members of the population. Measurements of the sample characteristics are used to estimate the
same characteristics in the population. It is assumed that if the sample is large enough and
obtained randomly, then what we find to be true for the sample will also be true for the
population as a whole.
Despite the best efforts of the researchers, however, sample data are never completely accurate
reflections of the population. The precision of our estimate is based on a number of factors,
including the measurement techniques, the size of the sample, and the proportion of the
population that demonstrates the characteristic being measured. Thus, depending on these
factors, some estimates of the population are more precise than others. We express this level of
precision, or the confidence we have that our estimate is the true value in the population from
which the sample was drawn, as a confidence interval (CI). Wider CIs indicate lesser precision,
and narrower CIs indicate greater precision. The true population is likely to lie anywhere
between the low and high confidence limits. 2 For all the substance use graphs in this report, we
include CIs (the vertical lines at the tops of the bars bounded by the low and high limits) to show
how precise our estimates are. (An exception is for data from the U.S. BRFS— the SEDS data
did not include CIs, which were nevertheless extremely small due to the extremely large sample
size).
In addition to showing how precise sample estimates are, CIs can be used to determine whether
there are differences between groups. If the CIs for two groups (e.g., males and females) are
overlapping, it generally means that there is no difference between the groups—even if the
estimate itself appears to be different. If, on the other hand, the CIs do not overlap, or only
overlap slightly, it means that the two groups are likely to be different from one another.
The reader will note that because CIs depend in part on sample size and on the number of
persons reporting the particular characteristic being measured, when the characteristic is rare
(e.g., very low rates of use) or in subgroups with fewer members (e.g., Hispanics), these CIs are
very wide. Such data should be interpreted with caution because the estimates are clearly
imprecise.
2
In fact, our analyses allow us to say that we are 95% sure that the true population value lies between the CIs.
21
RESULTS
Alcohol Use
Availability/Consumption
Figure 2 shows total sales of ethanol (in gallons) in the form of beer, wine and spirits per capita
aged 14 and over from 1995 to 2006. Alcohol sales in both South Carolina and the US have
remained consistently between 2.1 and 2.5 gallons per capita over this time period with an
upward trend. South Carolina sales ranged from 2.23 to 2.46 gallons per capita and have been
about 10% higher than per capita sales in the US.
Figure 2. Total Sales of Ethanol per Capita Aged 14 and Over, South Carolina and US, 1995 to
2006
2.5
G allo n s per Cap ita
2.4
2.3
SC
2.2
US
2.1
2.0
1.9
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Source: NIAAA
According to data from the Tax Foundation (http://www.taxfoundation.org) the South Carolina
alcohol sales tax rates (per gallon) as of January 2009 were as follows: spirits tax = $5.42; table
wine tax = $1.08; and beer tax = $0.77. These rates compared to average rates for the U.S. as a
whole of $5.94, $0.79, and $0.27, respectively. South Carolina ranked 21st (2 states had no spirits
tax), 11th (wine sales in 4 states made through state-run stores ), and 4th in the nation for sales tax
rates on each of these substances, respectively, meaning that South Carolina had close to an
average sales tax on spirits, a high tax on wine, and a very high tax on beer.
22
Current Use
Rates of current (past 30-day) alcohol use among youths in grades 9 through 12 have remained
consistent over multiple years of reporting, with a subtle declining trend since 1999 (Figure 3).
In three of the four years for which there were South Carolina YRBS data, 1995, 1997, and 1999,
use rates were slightly lower in South Carolina compared to the US, with overlapping confidence
bands in 1997 and 1999. In 2005 current alcohol use rates in the two geographic regions were
indistinguishable. In 2007 the South Carolina rate declined to 36.8 percent (US data for 2007
were not yet available). Since there were approximately 204,000 students in grades 9-12 in South
Carolina public schools in 2007-2008 (Source: SC Department of Education, Office of Research,
Average Daily Membership files, Available:
http://ed.sc.gov/agency/offices/research/DailyMembership.html), this translates to 75,072
students who were current alcohol users.
Figure 3. Current (Past 30-Day) Alcohol Use among Youths in Grades 9 through 12,
South Carolina and US, 1995 to 2007
60
50
Percent
40
SC
US
30
20
10
0
1995
1997
Source: Youth Risk Behavior Surveillance System
1999
2001
2003
2005
2007
Year
South Carolina current alcohol use rates by demographic groups in 2007 are shown in Figure 4.
Although confidence bands are overlapping, there was a gradual increase across grade levels
with highest use rates among 12th graders. African Americans reported lower use rates compared
to whites.
23
Figure 4. Current (Past 30-Day) Alcohol Use among Youths in Grades 9 through 12,
By Gender, Grade, and Race/Ethnicity, South Carolina and US, 2007
60
50
Percent
40
30
20
10
0
Male
Female
Grade 9
Grade 10
Grade 11
Grade 12
White
Black
Total
Source: 2007 Youth Risk Behavior Surveillance System
Among persons age 12 to 17, current alcohol use rates remained essentially unchanged between
2002 and 2006 in both South Carolina and the US (Figure 5). Current alcohol use rates among 12
to 17 year olds have been consistently lower in South Carolina compared to the US (e.g., 14.2%
versus 16.6% in 2005-2006). Using 2006 US Census population estimates for this age group in
South Carolina (approximately 365,963) this translates into approximately 51,967 persons age 12
to 17 who were current alcohol users. Among those ages 18 to 25, current use rates in the US
have remained constant at about 61%, while South Carolina rates declined from 61% in 20022003 to 55% in 2005-2006 and are now significantly below the US rate. Using the US Census
South Carolina population estimates for this age group (approximately 483,962), this translates
into approximately 266,179 persons age 18 to 25 who were current alcohol users.
24
Figure 5. Current (Past 30-Day) Alcohol Use among Persons Age 12 to 17 and 18 to 25,
South Carolina and US, 2002-2006
70
60
Percent
50
A ge 18 to 25
40
SC
US
30
20
10
A ge 12 to 17
0
2002-2003
2003-2004
2004-2005
2005-2006
Year
Source: SAMHSA Office of Applied Studies, National Survey on Drug Abuse and Health
These data are further supported by the BRFS data for adults aged 18 and over presented in
Figure 6. This figure shows that current (past 30-day) alcohol use rates have remained higher in
the US (at roughly 55%-56%) compared to South Carolina (at roughly 46%-49%) for all years,
and that South Carolina rates declined very gradually from 2003 to 2006 with a slight increase in
2007, while US rates appear to have risen slightly from 1999 to 2007. In 2007, 47.5% of South
Carolina adults age 18 and over were current alcohol users, which (using US Census data
indicating an 18 and over South Carolina population of 3,282,036 in 2007) represents
approximately 1,559,000 persons age 18 and over who were current alcohol users.
25
Figure 6. Current (Past 30-Day) Alcohol Use among Persons Age 18 and Over,
South Carolina and US, 1999-2007
60
50
Percent
40
SC
30
US
20
10
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Source: 2007 Behavioral Risk Factor Surveillance System
Subgroup analysis of BRFS data indicates that the highest rates of current alcohol use are among
those ages 18 to 44 and steady decline afterwards (Figure 7). African Americans show lower
current use rates. Males report higher use rates compared to females.
Figure7. Current (Past 30-Day) Alcohol Use among Persons Age 18 and Over,
by Age, Race, and Gender, South Carolina, 2007
70
60
Percent
50
40
30
20
10
0
Ages 18 Ages 25 Ages 35 Ages 45 Ages 54 Ages 65
thru 24 thru 34 thru 44 thru 54 thru 64 and over
White
Black
Male
Female
Total
Source: 2007 Behavioral Risk Factor Surveillance System
26
Early onset use
First use of alcohol before age 13 is declining in both South Carolina and the US as a whole,
from a higher 1995 starting point of roughly 40% in South Carolina and 33% in the US as a
whole (Figure 8). Rates in the two regions were indistinguishable in 2005 at roughly 26%. The
2007 rate in South Carolina remained essentially unchanged at approximately 25% (US data for
2007 were not yet available), or roughly 51,000 students in grades 9 through 12.
Figure 8. First Alcohol Use before Age 13, South Carolina and US, 1995-2007
45
40
35
Percent
30
25
SC
US
20
15
10
5
0
1995
1997
Source: Youth Risk Behavior Surveillance System
1999
2001
2003
2005
2007
Year
27
Binge use
Binge alcohol use, defined as five or more drinks on a single occasion, has remained fairly
constant across reporting years among youths in grades 9 through 12, with the suggestion of a
recent decline in the US to about 28% (Figure 9). Rates have remained lower in South Carolina
compared to the US as a whole, though by 2005, SC rates (at 25%) were not statistically
different from US rates. South Carolina rates declined slightly in 2007 (US data for 2007 were
not yet available). This rate (25%) translates to approximately 51,000 students in grades 9-12
who were binge drinkers.
Figure 9. Binge Alcohol Use* in the Past 30 Days among Youths in Grades 9 through 12,
South Carolina and US, 1995-2007
50
40
Percent
30
US
SC
20
10
0
1995
1997
Source: Youth Risk Behavior Surveillance System
1999
2001
Year
2003
2005
2007
*Defined as five or more drinks on a single occasion
28
Subgroup analysis shows overlapping confidence bands for all groups except African Americans,
who again report much lower rates of use—less than 10% of African Americans reported binge
alcohol use (Figure 10).
Figure 10. Binge Alcohol Use* in the Past 30 Days among Youths in Grades 9 through 12, By
Gender, Grade, and Race/Ethnicity, South Carolina, 2007
50
40
Percent
30
20
10
0
Male
Female
Grade 9
Source: 2007 Youth Risk Behavior Surveillance System
Grade 10
Grade 11
Grade 12
White
Black
Total
*Defined as five or more drinks on a single occasion
29
Among persons age 12 to 17, binge alcohol use rates have remained relatively constant between
2002 and 2006 in both South Carolina and the US, with the US rate being slightly higher (8.3%
in South Carolina vs. 10.5% in the US) (Figure 11). The 8.3% rate in 2005-2006 translates to
about 30,375 persons ages 12 to 17 in South Carolina who were binge alcohol users. Among
those ages 18 to 25, binge alcohol use rates remained at about 41% in the US but declined in
South Carolina from 42% to 35.7% and were significantly below US rates in 2005-2006. The
South Carolina rate of 35.7% in 2005-2006 translates to approximately 172,774 persons aged 18
to 25 who binge drink.
Figure 11. Binge Alcohol Use* in the Past 30 Days among Persons Age 12 to 17 and 18 to 25,
South Carolina and US, 2002-2006
50
45
40
35
Ages 18 to 25
Percent
30
SC
25
US
20
15
10
5
Ages 12 to 17
0
2002-2003
2003-2004
2004-2005
2005-2006
Year
Source: SAMHSA Office of Applied Studies, National Survey on Drug Abuse and Health
30
The BRFS data shown in Figure 12 lend support to the above data on this indicator. For all
reporting years South Carolina adults have reported slightly lower rates of binge drinking
compared to adults in the US as a whole. The most recent percentages were 13.9% for South
Carolina and 15.8% for the US. The South Carolina rate translates to roughly 456,200 persons.
Both South Carolina and US rates have been increasing since 2005.
Figure 12. Binge Alcohol Use* in the Past 30 Days among Persons Age 18 and Over,
South Carolina and US, 1999-2007
25
20
Percent
15
SC
US
10
5
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Source: 2007 Behavioral Risk Factor Surveillance System
Subgroup analysis shows highest binge use rates in the ages from 18 to 34 and a stepwise decline
in rates with age (Figure 13). African Americans again report lower use rates, though the
difference with Whites was not statistically significant in 2007 as it was in 2006.. Binge alcohol
use rates are more than 2.5 times higher among South Carolina males compared to females.
31
Figure 13. Binge Alcohol Use* among Persons Age 18 and Over, by Age, Race, and Gender,
South Carolina, 2007
50
45
40
35
Percent
30
25
20
15
10
5
0
Ages 18
thru 24
Ages 25
thru 34
Ages 35
thru 44
Ages 45
thru 54
Ages 54 Ages 65
thru 64 and over
White
Black
Male
Female
Total
Source: 2007 Behavioral Risk Factor Surveillance System
32
Heavy use
Rates of heavy alcohol use, defined as having more than two drinks per day for adult men and
more than one drink per day for adult women, have been very similar between South Carolina
and the US over the years (Figure 14). The 2007 South Carolina rate of 5.6% translates to
roughly 183,800 persons.
Figure 14. Heavy Alcohol Use* in the Past 30 Days among Persons Age 18 and Over,
South Carolina and US, 2001-2007
25
Percent
20
15
SC
US
10
5
0
2001
2002
2003
2004
2005
2006
2007
Year
Source: 2007 Behavioral Risk Factor Surveillance System
33
Heavy alcohol use is highest among 18-44 year olds at about 7%, but then drops to around 5%
for ages 45 and over (Figure 15). Again, African Americans report lower rates of heavy alcohol
use compared to other races, with Hispanics being the highest, and males having higher rates
compared to females.
Figure 15. Heavy Alcohol Use* among Persons Age 18 and Over,
by Age, Race/Ethnicity, and Gender, South Carolina, 2007
12
10
Percent
8
6
4
2
0
Ages 18 Ages 25 Ages 35 Ages 45 Ages 54 Ages 65
thru 24 thru 34 thru 44 thru 54 thru 64 and over
White
Black
Hispanic
Male
Female
Total
Source: 2007 Behavioral Risk Factor Surveillance System
34
Drinking and driving
Rates of past 30-day drinking and driving among youths in grades 9-12 declined over multiple
reporting years in both South Carolina and the US, although South Carolina YRBS data are
absent for 2001 and 2003, so whether the downward trend continued through those years is
unknown (Figure 16). Drinking and driving rates in 2005 were roughly equivalent in South
Carolina and the US as a whole at about 10-12%. In 2007 the South Carolina rate declined
slightly to approximately 10% (US data for 2007 were not yet available). The South Carolina
rate translates to roughly 20,400 persons.
Figure 16. Drinking and Driving among Youths in Grades 9 through 12,
South Carolina and US, 1995-2007
25
20
Percent
15
SC
US
10
5
0
1995
1997
Source: Youth Risk Behavior Surveillance System
1999
2001
2003
2005
2007
Year
35
Drinking and driving rates tended to be higher among males compared to females, and lower
among 9th and 10th graders (who are barely of driving age) and African Americans (Figure 17).
Figure 17. Drinking and Driving among Youths in Grades 9 through 12, By Gender, Grade, and
Race/Ethnicity, South Carolina and US, 2007
30
25
Percent
20
15
10
5
0
Male
Female
Grade 9
Grade 10
Grade 11
Grade 12
White
Black
Total
Source: 2007 Youth Risk Behavior Surveillance System
36
Rates of being a passenger in a car with a drinking driver during the past 30-days among youths
in grades 9-12 have also declined slightly over multiple reporting years in both South Carolina
and the US (Figure 18). In 2005 rates were roughly equivalent in South Carolina and the US as a
whole at about 30-32%. The South Carolina rate declined in 2007 to 26.3% (US data for 2007
were not yet available). The South Carolina rate translates to roughly 54,000 persons.
Figure 18. Youths in Grades 9 through 12 Reporting Being a Passenger in a Car with a Drinking
Driver, South Carolina and US, 1995-2007
50
40
Percent
30
SC
US
20
10
0
1995
1997
Source: Youth Risk Behavior Surveillance System
1999
2001
2003
2005
2007
Year
37
Alcohol use during pregnancy
Rates of alcohol use during the last three months of pregnancy remained constant at 3.5% to
3.7% from 1996 to 1999 and reached a low of 3.2% in 2000, but have since increased (Figure
19). The rate peaked at 7.7% in 2006, well above the Healthy People 2010 benchmark of 6
percent or less. This rate of 7.7% represents 4,392 pregnant women in South Carolina.
Figure 19. Percent of Pregnant Women Reporting Any Use of Alcohol
During the Last Three Months of Pregnancy, South Carolina, 1995-2006
10
9
7.7
8
7
6.2
Healthy People 2010 GOAL = 6.0
Percent
6
5.0
5
4.5
4.4
4.2
4
3.6
3.6
3.7
3.8
3.7
3.2
3
2
1
0
1995
1996
1997
1998
Source: Pregnancy Risk Assessment Monitoring System
1999
2000
2001
2002
2003
2004
2005
2006
Year
38
Consequences of Alcohol Use
Mortality
Alcohol abuse is associated with deaths from chronic liver disease, homicide, and suicide. Since
1996, death rates from chronic liver disease have been higher in South Carolina compared to the
US, with a larger spread (roughly 10% difference) from 1999 to 2004 (excluding 2002, when
rates were nearly identical) (Figure 20). The 2004 death rate represents 454 persons in South
Carolina. Mortality from chronic liver disease peaks in the 55- to 64-year-old age group in South
Carolina but in the 75- to 84-year-old age group in the US (Figure 21).
Figure 20. Number of Deaths from Chronic Liver Disease per 1000 Population,
South Carolina and US, 1990-2004
Rate (per 1000 population)
0.15
0.10
SC
US
0.05
0.00
1990
1991
1992
1993
Source: National Vital Statistics System
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
39
Figure 21. Number of Deaths from Chronic Liver Disease per 100,000 Population,
By Age Group, South Carolina and US, 2004
40
Rate (per 100,000 population)
30
SC
20
US
10
0
5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
Age Group
Source: National Vital Statistics System
Although somewhat variable, death rates from homicide have been about 20% to 30% higher in
South Carolina compared to the US since at least 1996 (Figure 22). The 2004 death rate
represents 323 persons in South Carolina.
Figure 22. Number of Deaths from Homicide per 1000 Population,
South Carolina and US, 1990-2004
Rate (per 1000 population)
0.15
0.10
SC
US
0.05
0.00
1990
1991
1992
1993
Source: National Vital Statistics System
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
South Carolina death rates from homicide exceed national averages for all age groups and peak
in the 25- to 34-year-old age group (Figure 23). South Carolina rates among 35- to 44-year-olds
and among those 85 years and older are much higher than US rates.
40
Figure 23. Number of Deaths from Homicide per 100,000 Population,
By Age Group, South Carolina and US, 2004
Rate (per 100,000 population)
15
10
SC
US
5
0
5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
Age Group
Source: National Vital Statistics System
Death rates from suicide have been similar in South Carolina and the US between 1990 and
2004, although for most years South Carolina rates have been slightly higher (Figure 24). The
2004 death rate represents 483 persons in South Carolina.
Figure 24. Number of Deaths from Suicide per 1000 Population,
South Carolina and US, 1990-2004
Rate (per 1000 population)
0.15
0.10
SC
US
0.05
0.00
1990
1991
1992
1993
Source: National Vital Statistics System
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
41
Death rates from suicide appear to increase through age 54, decline in the 55- to 64-year-old
group, and then increase among those aged 75 to 84 (Figure 25). Compared to national rates,
South Carolina rates are higher in the age groups 15-34, 45-54, and 65-84, but lower in the age
groups 35-44 and 85 and over.
Figure 25. Number of Deaths from Suicide per 100,000 Population,
By Age Group, South Carolina and US, 2004
20
Rate (per 100,000 population)
15
SC
10
US
5
0
5-14
15-24
Source: National Vital Statistics System
25-34
35-44
45-54
55-64
65-74
75-84
85+
Age Group
These data all lend support to the contention that alcohol abuse is more of a problem in South
Carolina than in the US as a whole, which agrees with the per capita sales data presented in
Figure 2, but not with the self-reported consumption data from the BRFS and the NSDUH
surveys, which indicate slightly lower use rates in South Carolina compared to the US.
Dependence or Abuse
Among persons age 12 to 17, alcohol dependence or abuse rates have remained relatively
constant between 2002 and 2004 in both South Carolina and the US as a whole, with the
suggestion of a slight decline starting in 2004-2005 (Figure 26). Among persons age 18 to 25,
alcohol dependence or abuse rates have remained stable in the US but declined to 13.6% in
2004-2005 in South Carolina then increased to 14.8% in 2005-2006. The 2004-2005 death rate in
this age group represents approximately 71,626 persons.
42
Figure 26. Percent of Persons Age 12 to 17 and 18 to 25 Meeting DSM-IV Criteria
For Alcohol Dependence or Abuse in the Past Year,
South Carolina and US, 2002-2006
25
Percent
20
15
Ages 18 to 25
SC
US
10
5
Ages 12 to 17
0
2002-2003
2003-2004
2004-2005
2005-2006
Year
Source: SAMHSA Office of Applied Studies, National Survey on Drug Abuse and Health
ATOD Services Utilization
The indicators in this section, while not meeting SEDS inclusion criteria set forth in the
Introduction, nevertheless provide an indication of the types of ATOD services being provided to
subpopulations of the state, and the numbers and demographic characteristics of the clients
served. Limitations of these data are noted later in the Data Limitations section of this document.
Suffice it to say, these data should be interpreted with caution.
Figure 27 shows the number of Medicaid visits per 1000 gender-, age- and race-specific South
Carolina population for ATOD-related reasons, by gender, race, and age group, in 2005. This
graph indicates that far and away the largest client base served by the South Carolina Medicaid
payor for ATOD-related services is non-white, non-black persons, and that these clients tend to
be younger females.
43
Figure 27. ATOD-Related Medicaid Visits per 1000 Population,
By Gender, Race, and Age Group, 2005
120
Visits per 1000 Population
100
80
60
40
20
0
Total
Female
Male
White
Black
Other
0-4
5-9
10 - 24
25-34
35 - 44
45 - 54
55 - 64
65+
Source: South Carolina Medicaid Paid Claims Database, SCDHHS
ATOD-related Medicaid visits tend to be for alcohol, tobacco, marijuana, and cocaine use and
abuse, with alcohol-related visits in recent decline and tobacco-related visits on the rise (Figure
28). These trends may be most closely associated with changed in reimbursement legislation or
regulations, with tobacco abuse becoming a more readily reimbursed diagnostic code, which may
also have prompted substitution of a tobacco abuse code for an alcohol abuse code among those
with both diagnoses.
Figure 28. Percent of Total Medicaid Visits by Substance and Year, 2001-2005
35
30
Percent of Total Visits
25
20
alcohol
tobacco
marijuana
cocaine
15
other drugs
opioids
10
5
0
2001
2002
Source: South Carolina Medicaid Paid Claims Database, SCDHHS
2003
2004
2005
Year
44
Figure 29 shows unduplicated client admissions among those persons receiving SC DAODAS
patient services for AOD problems, per 1000 population, for 2004 to 2008. Intake rates have
very consistent at about 6.7 per 1,000 in the South Carolina population. “Treatment Needs
Assessment Estimates” (DAODAS, 2003) estimated that 7.1% of the population was in need of
treatment services, so these data suggest that perhaps there are more South Carolinians in need of
these services but not receiving them.
Figure 29. Number of Unduplicated DAODAS Admissions (Primary, Secondary, and Tertiary)
for AOD-Related Reasons per 1000 Population, 2004-2008
Rate per 1,000 Population
7
6.5
6
5.5
5
2004
2005
2006
2007
2008
Year
Source: South Carolina DAODAS, SAAMIS
Figure 30 indicates that the demographic served by this system is primarily males between the
ages of 25 and 64 years old.
45
Figure 30. Number of Unduplicated DAODAS Admissions (Primary, Secondary, and Tertiary)
Presenting for AOD-Related Reasons per 1000 Population, By Gender and Age Group, 2008
3.5
Number per 1,000 Population
3
2.5
2
1.5
1
0.5
0
Male
Female
Age 11 Age 12 to Age 18and Under
17
24
Age 25 to Age 35 to Age 45 to Age 65
34
44
64
and Over
Source: South Carolina DAODAS, SAAMIS
46
Violent crime
Violent crime, including aggravated assaults, sexual assaults, and robberies, is one consequence
of alcohol abuse. Figure 31 shows that the violent crime rate in both South Carolina and the US
has clearly declined in the latter half of the 1990’s but has remained relatively stable since that
time, with the suggestion of slight declines. The absolute rates for South Carolina have
consistently remained about 1.5 times those for the US as a whole. The 2006 rate in South
Carolina represents 32,719 violent crimes.
Figure 31. Number of Violent Crimes Reported to Police per 1000 Population, 1995-2006
12
Rate (per 1000 population)
10
8
SC
6
US
4
2
0
1995
1996
1997
Source: Uniform Crime Reporting Program
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
47
Motor Vehicle Crashes
Figure 32 shows the percent of fatal motor vehicle crashes in which at least one driver,
pedestrian, or cyclist had been drinking, in South Carolina and the US, from 1995 to 2006, using
data from the national Fatality Analysis Reporting System (FARS). This graph indicates a sharp
increase in rates between 1999 and 2001, but a gradual decline back to a rate comparable to that
for the US as a whole in 2005, rising sharply again in 2006 in the US and especially in South
Carolina. It is remarkable that almost half of all fatal motor vehicle accidents involve use of
alcohol. The 2006 rate in South Carolina represents 486 fatal motor vehicle crashes involving
alcohol.
Figure 32. Percent of Fatal Motor Vehicle Crashes in which at Least One
Driver, Pedestrian, or Cyclist had Been Drinking, South Carolina and the US, 1995-2006
60
50
Percent
40
SC
30
US
20
10
0
1995
1996
1997
Source: Fatality Analysis Reporting System
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
48
Similar to the graph above, South Carolina showed a sudden spike in the number of vehicle
deaths per 100,000 population from 1999 to 2001, with rates declining somewhat from 2001
onward, rising again in 2006 (Figure 33). However, rates for South Carolina remain about twice
those for the US as a whole. The 2006 rate in South Carolina represents 523 vehicle deaths
involving alcohol.
Figure 33. Number of Vehicle Deaths in which at Least One Driver, Pedestrian, or Cyclist
had been Drinking, per 100,000 Population, 1995-2006
25
Rate (per 1000 population)
20
15
SC
US
10
5
0
1995
1996
1997
Source: Fatality Analysis Reporting System
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
49
Again, Figure 34 shows that South Carolina experienced a sudden increase between 1999 and
2001 in the percent of drivers involved in fatal crashes who used alcohol, with a steady decline
after 2001. However, since 2000 South Carolina rates have remained higher than US rates on this
indicator, and in 2006 5% more drivers who used alcohol were involved in fatal crashes,
compared to the US. The 2006 rate in South Carolina represents 345 drivers involved in fatal
crashes who used alcohol.
Figure 34. Percent of Drivers Involved in Fatal Crashes Who Used Alcohol, 1995-2006
50
45
40
35
Percent
30
SC
25
US
20
15
10
5
0
1995
1996
1997
Source: Fatality Analysis Reporting System
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
50
The number of nighttime single-vehicle crashes per 1000 population aged 16 and over, while not
an official SEDS indicator because it is not available at the national level (hence there is no US
comparison), is nevertheless a good proxy for alcohol-related crashes, especially in rural areas.
These data for South Carolina indicate a fairly stable rate with possibly a slight declining trend
from 2002 onward (Figure 35). The 2005 rate in South Carolina represents a total of 11,651
nighttime single-vehicle crashes.
Figure 35. Number of Nighttime Single-Vehicle Crashes per 1000 Population Aged 16 and
Older,
South Carolina, 2001-2005
Crashes (per 1000 Population Aged 16 Years and Older)
5
4
3
2
1
0
2001
2002
Source: South Carolina Department of Public Safety
2003
2004
2005
Year
51
Alcohol-related car crash fatalities for ages 15 to 20 were higher between 2005 and 2007 than in
2003 and 2004 with a high of 74 fatalities in a year (Figure 36).
Figure 36. Total Alcohol-Related Crash Fatalities for Ages 15-20, South Carolina, 2003-2007
100
90
Number of Fatalities
80
70
60
50
40
30
20
10
0
2003
2004
2005
2006
2007
Year
Source: South Carolina Department of Transportation
Alcohol-related traffic crashes for youth increase as age increases between 15 and 20 (Figure
37).
Figure 37. Leading Age for Youth Alcohol-Related Crashes, South Carolina, 2003-2007
1400
1200
1109
Number of Crashes
1000
1000
795
800
600
495
400
222
200
55
0
15
16
17
18
19
20
Age
Source: South Carolina Department of Transportation
52
Sexual activity
According to data from the 2005 YRBS, South Carolina youth were slightly more likely than US
youth to be sexually active, to have used alcohol or drugs before last having sex, and to have
become sexually active before their teens, although the confidence bands on the rates are
overlapping, so these differences are not statistically significant. More South Carolina youth had
ever had sexual intercourse (52.3% versus 46.8%), were currently sexually active (37.5% versus
33.9%), reported having used alcohol or drugs before last having intercourse (24.8% versus
23.3%), and had had intercourse before age 13 (9.2% versus 6.2%). However, slightly more
South Carolina youth reported having used a condom before sex (67.4% versus 62.8%).
Although 2007 YRBS data for the US are not yet available, 2007 YRBS data for South Carolina
indicate that 51.5% of youth reported ever having had intercourse, 35.9% were currently sexually
active, 18.8% reported having used alcohol or drugs before last having intercourse, 9.5% had had
intercourse before age 13, and 62.4% reported having used a condom before last having sex.
Therefore, except for these last two, sexual behavior indicators are trending in a favorable
direction in South Carolina.
Teen births
Teenage pregnancies are an important potential consequence of adolescent substance abuse.
South Carolina has higher rates of teen pregnancy compared to the US as a whole. In 2004 there
were 52.1 live births per 1,000 women ages 15 to 19 in South Carolina, compared to 41.1 per
1,000 women in the US as a whole. For women ages 15 to 17 and 18 to 19 these rates were 28.8
and 87.8, respectively, in South Carolina, compared to 22.1 and 70.0 in the US.
HIV/AIDS
Like pregnancy, HIV/AIDS is an important consequence of risky sexual behavior among youths.
At the end of 2006 in South Carolina there were an estimated 176.8 adults and adolescents per
100,000 living with HIV and 195.9 per 100,000 living with AIDS (Figure 38). These rates
compare less favorably to US rates of 137.0 per 100,000 living with HIV and 174.5 per 100,000
living with AIDS. For children less than 13 years of age, prevalence rates were 6.2 per 100,000
for HIV and 3.2 per 100,000 for AIDS in South Carolina. The former is similar to the US rate of
6.5 per 100,000 for HIV but South Carolina is higher than the US rate of 2.2 per 100,000 for
AIDS. In South Carolina the leading mode of transmission for reported AIDS cases at the end of
2005 was male to male sexual contact (36% of cases), followed by heterosexual contact (24%),
unreported or unidentified means (17%), and injection drug use (16%). For the US, these
percents by mode of transmission were 45%, 23%, 2%, and 23%, respectively.
53
Figure 38. Estimated rates (per 100,000 population) for adults and adolescents living with HIV infection
(not AIDS) or with AIDS, 2006—United States and dependent areas
a Includes persons whose area of residence is unknown.
Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2006. Vol. 18. Atlanta: U.S. Department of Health
and Human Services, Centers for Disease Control and Prevention; 2008:pg. 21.
http://www.cdc.gov/hiv/topics/surveillance/resources/reports/
Summary of Alcohol Consumption and Consequences
In summary, consumption of alcohol in South Carolina, as measured by sales per capita aged 14
and over, has trended upward since 1995 and remained about 10% higher than in the U.S.
Among youth in grades 9 through 12 rates of current, early-onset, and binge use, and rates of
drinking and driving are all very similar to national rates and have trended slightly downward
(though South Carolina YRBS data were absent for 2001 and 2003). Males, upper classmen, and
whites are at higher risk for drinking and driving, while African Americans are at lower risk on
all YRBS alcohol consumption indicators.
Among adults, self-reported current alcohol use and binge alcohol use rates tend to be lower in
South Carolina compared to the US. Among young adults, current use and binge use rates are
lower than US rates, while heavy alcohol use rates are very similar to US rates. Rates of binge
use and heavy use are higher in males and people between 18 and 44 and lower among African
Americans. Use during pregnancy declined to a low of 3.2% in 2000 but has since risen to a
decade-high 7.7%, above the Healthy People 2010 benchmark of 6 percent or less.
Mortality from causes associated with alcohol use is generally higher in South Carolina
compared to the US. Higher cirrhosis death rates are concentrated among those in the 35- to 44year-old age group. Violent crime rates in South Carolina have remained about 1.5 times higher
compared to US rates. All FARS motor vehicle accident indicators show a spike in rates from
1999 to 2001, but declining trends thereafter, with rates higher than those in the US. It would be
54
valuable to try to identify the reason for this spike and subsequent decline so that the causes of
the rise can be avoided and any causes for the decline can be supported to continue this
downward trend. The most recent data for two of the three FARS indicators show upward spikes
for the US and especially for South Carolina. Nighttime single vehicle crashes seem to be
trending downward. There are no national data on this indicator for comparison. Teen sexual
behavior indicators, while only loosely associated with alcohol consumption, are nevertheless
problematic in South Carolina. Similarly, HIV rates among adults and adolescents are higher in
South Carolina compared to the national average.
55
Tobacco Use
Availability/Consumption
Figure 39 shows annual cigarette consumption per adult for South Carolina and the US from
1996 to 2006. Here consumption is defined as is the number of packs of cigarettes taxed at the
wholesale level per capita (persons aged 18 and over) and measured as the total tax paid sales
divided by the states' adult population from the US Census. Consumption in South Carolina rose
sharply between 1996 and 1997, declined steeply between 1997 and 1999, and then declined
more gradually thereafter to a low of 92 packs per adult per year in 2004. US consumption rates
have been similar but declined to 85 packs per capita in 2006, while South Carolina sales have
increased since 2004 to 96 packs per capita.
Figure 39. Annual Cigarette Pack Sales per Adult Age 18 and Over,
South Carolina and US, 1996-2006
140
120
Packs per adult
100
80
SC
US
60
40
20
0
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Sources: Office of Smoking and Health, State Tobacco Activities Tracking and Evaluation (STATE) System (Orzechowski and Walker);
USDA, Economic Research Service, Tobacco Outlook , TBS-263, October 24, 2007
To help sell this many cigarettes per person, Campaign for Tobacco-Free Kids estimates that the
tobacco industry spends $280.3 million in South Carolina annually (and $13.4 billion
nationwide) on marketing. It notes that research studies have found that kids are twice as
sensitive to tobacco advertising than adults and are more likely to be influenced to smoke by
cigarette marketing than by peer pressure, and that one-third of underage experimentation with
smoking is attributable to tobacco company advertising.
Table 2 provides state cigarette taxes, prices, and costs per pack for South Carolina and all US
states averaged. As indicated, South Carolina has much lower state taxes compared to the
average for all states. Interestingly, even with all taxes added, the CDC-estimated smoking-
56
induced costs are over twice the retail price of cigarettes for both South Carolina and the all
states combined.
Table 2. State Cigarette Prices, Taxes and Costs per Pack, South Carolina and All States
Geographic
Area
State Cigarette
Tax
Federal Cigarette
Tax
South Carolina
States Average
$0.07
$1.21
$1.0066
$1.0066
Retail Price Per
Pack With All
Taxes
$3.85
$4.97
CDC Smoking
Costs Per Pack
Sold
$7.66
$10.28
Source: Campaign for Tobacco-Free Kids, Fact Sheets #0099 and #0343 updated February 26, 2009 and February 12, 2009
The South Carolina cigarette tax rate is extraordinarily low even among tobacco-producing
states. As indicated in Figure 40, South Carolina has the lowest state cigarette tax (7 cents per
pack) among all 50 states plus the District of Columbia. The South Carolina state cigarette tax
rate was last changed July 1, 1977, far and away the oldest standing state tax rate in the country.
According the Campaign for Tobacco-Free Kids, as of February 2009, the average cigarette tax
rate for all states combined is $1.21 per pack, while the average rate for the major tobacco states
is over three times lower (38.5 cents per pack) and the average for non-tobacco producing states
is $1.32 per pack.
Figure 40. State Cigarette Tax Rates, 2009
Source: The Tax Foundation
57
According to Tobacco Free Kids documents (2008), South Carolina ranks 45th among all 50
states and the District of Columbia in allocating tobacco settlement funds to tobacco prevention
programming, spending only $2 million in FY2008, or 8.4% of the $23.9 million minimum
spending recommended by the CDC, and $0 in FY2009. None of the national tobacco settlement
funds have been allocated to tobacco prevention in South Carolina since 2003. A potential
cigarette tax increase is once again being discussed in the 2009 legislative session. According to
the Tax Foundation, South Carolina is among a minority of seven U.S. states that as of January
1, 2009 had a cigarette tax rate less than three times its rate in 1983.
Current use
Past 30-day (current) cigarette use has decreased in both South Carolina and the US from a high
of 35 to 40 percent in 1997 to just under 25% by 2005 (Figure 41). In 2005 South Carolina and
US rates were indistinguishable and were just above adult current use rates (see Figures 42 and
43). In 2007 the South Carolina rate declined further to 17.8% (US data for 2007 were not yet
available). It is possible that a new smoking law that went into effect on August 21, 2006 that
criminalized youth possession and purchase of tobacco products contributed to this most recent
decline in current cigarette use. The 2007 South Carolina rate represents approximately 36,000
youths in grades 9-12 who are current smokers.
Figure 41. Current (Past 30-day) Cigarette Use among Youths in Grades 9 through 12,
South Carolina and US, 1995-2007
50
40
Percent
30
SC
US
20
10
0
1995
1997
Source: Youth Risk Behavior Surveillance System
1999
2001
2003
2005
2007
Year
58
Figure 42 shows South Carolina data on current cigarette use among youths in grades 9 through
12, by gender, grade, and race/ethnicity. [Note: Data from the 2007 YRBS and the 2006 Youth
Tobacco Survey (YTS), another source of youth tobacco use data, were comparable]. There were
few differences among subgroups with the exception of 12th graders, who reported higher use
rates (26.7%), and African Americans, who reported lower use rates (11.2%).
Figure 42. Current (Past 30-day) Cigarette Use among Youths in Grades 9 through 12,
By Gender, Grade, and Race/Ethnicity, South Carolina, 2007
50
40
Percent
30
20
10
0
Male
Female
Grade 9
Grade 10
Grade 11
Grade 12
White
Black
Total
Sources: 2007 Youth Risk Behavior Surveillance System
59
Current cigarette use rates have remained higher among South Carolina adults compared to
adults in the US for all reporting periods, with a downward trend in use rates to the present
(Figure 43). In 2007, adult current use rates were approximately 22% in South Carolina and 20%
in the US. The 2007 South Carolina rate represents approximately 718,800 adults age 18 and
over who are current smokers.
Figure 43. Current (Past 30-day) Cigarette Use among Persons Age 18 and Over,
South Carolina and US, 1999-2007
50
45
40
35
Percent
30
SC
25
US
20
15
10
5
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Source: 2007 Behavioral Risk Factor Surveillance System
BRFS subgroup analysis shows the highest current use rates among those ages 25 to 34 (28.4%),
and lower current use rates for those ages 54 and over and females compared to males (Figure
44). There was no significant difference by race, though African Americans had lower smoking
rates in the previous survey.
60
Figure 44. Current (Past 30-day) Cigarette Use among Persons Age 18 and Over,
By Age, Race/Ethnicity and Gender, South Carolina, 2007
35
30
Percent
25
20
15
10
5
0
Ages 18 Ages 25 Ages 35 Ages 45 Ages 54 Ages 65
thru 24 thru 34 thru 44 thru 54 thru 64 and over
White
Black
Hispanic
Male
Female
Total
Source: 2007 Behavioral Risk Factor Surveillance System
Current cigarette use data from the NSDUH show slightly higher rates in the 18- to 25-year-old
age group (43% for South Carolina and 39% for the US), which are most likely attributable to
the different demographic characteristics of the BRFS vs. NSDUH survey respondents (Figure
45). The 2005-2006 South Carolina rate represents approximately 208,103 persons age 18 to 25
who are current smokers. Rates have remained relatively stable from 2002 through 2006 and
may be slightly higher in South Carolina compared to the national average in the 18- to 25-yearold age group.
61
Figure 45. Current (Past 30-day) Cigarette Use among Persons Age 12 and Over,
By Age Group, South Carolina and US, 2002-2006
50
45
40
35
Ages 18 to 25
Percent
30
SC
25
US
20
15
10
Ages 12 to 17
5
0
2002-2003
2003-2004
2004-2005
2005-2006
Year
Source: SAMHSA Office of Applied Studies, National Survey on Drug Abuse and Health
62
Daily use
Among both South Carolina and US youths in grades 9-12, daily cigarette use has declined
significantly since 1999 with some leveling off by 2005 (although, again, South Carolina YRBS
data were unavailable for 2001 and 2003) (Figure 46). Rates have remained slightly higher in
South Carolina, although not statistically different from the US as a whole. In 2007 the South
Carolina rate increased slightly to 13.1% (US data for 2007 were not yet available). The 2007
South Carolina rate represents approximately 27,000 youths in grades 9-12 who are daily
smokers, that is, about 75% of current smokers in this age group.
Figure 46. Daily Cigarette Use among Youths in Grades 9 through 12,
South Carolina and US, 1995-2007
25
20
Percent
15
SC
US
10
5
0
1995
1997
Source: Youth Risk Behavior Surveillance System
1999
2001
2003
2005
2007
Year
Daily use rates appear to be lower among 9th through 11th graders compared to 12th graders, and
African Americans compared to Whites (Figure 47).
63
Figure 47. Daily Cigarette Use among Youths in Grades 9 through 12,
By Gender, Grade, and Race/Ethnicity, South Carolina, 2007
30
25
Percent
20
15
10
5
0
Male
Female
Grade 9
Grade 10
Source: 2007 Youth Risk Behavior Surveillance System
Grade 11
Grade 12
White
Black
Total
Year
Daily cigarette use rates have remained higher among South Carolina adults compared to adults
in the US for all reporting periods (Figure 48). There has been a decline since 2002. By 2007
rates were 16.2% in South Carolina and 14.5% in the US. The 2007 South Carolina rate
represents approximately 531,700 persons age 18 and over who are daily smokers, again about
one-fourth of those in this age group.
Figure 48. Daily Cigarette Use among Persons Age 18 and Over,
South Carolina and US, 1999-2007
50
45
40
35
Percent
30
SC
25
US
20
15
10
5
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Source: 2007 Behavioral Risk Factor Surveillance System
64
As with current cigarette use, adult subgroup analysis shows the highest rates in the 25- to 54year-old age group, and lower use rates for those ages 65 and over, African Americans compared
to whites, and females compared to males (Figure 49).
Figure 49. Daily Cigarette Use among Persons Age 18 and Over,
By Age, Race/Ethnicity, and Gender, South Carolina, 2007
35
30
Percent
25
20
15
10
5
0
A ges 18
thru 24
A ges 25
thru 34
A ges 35
thru 44
A ges 45
thru 54
A ges 54
thru 64
A ges 65
and o ver
White
B lack
Hispanic
M ale
Female
To tal
Source: 2007 Behavioral Risk Factor Surveillance System
65
Age of first use
Age of first cigarette use among youths in grades 9-12 has declined in both South Carolina and
the US as a whole (to 20% and 16%, respectively, in 2005) (Figure 50). Again rates have
remained slightly higher in South Carolina, although not statistically different from the US. In
2007 the South Carolina rate declined to 15.3%, which appears to be closer to the national
average (US data for 2007 were not yet available). The 2007 South Carolina rate represents
approximately 31,000 youths in grades 9-12.
Figure 50. Youths in Grades 9 through 12 Reporting First Cigarette Use before Age 13,
South Carolina and US, 1995-2007
50
40
Percent
30
SC
US
20
10
0
1995
1997
Source: Youth Risk Behavior Surveillance System
1999
2001
2003
2005
2007
Year
66
Smokeless tobacco
Smokeless tobacco use rates among youths in grades 9-12 have remained fairly constant over
reporting years in both South Carolina and US at between 7% and 12% (Figure 51). South
Carolina youths have reported using smokeless tobacco at rates which are similar to rates for the
US as a whole, although the most recent data suggests slightly higher rates in South Carolina. In
2007 the South Carolina rate declined slightly to 7.9%, also apparently closer to the national
average (US data for 2007 were not yet available). The 2007 South Carolina rate represents
approximately 16,000 youths in grades 9-12 who are current smokeless tobacco users.
Figure 51. Current (Past 30-day) Smokeless Tobacco Use among Youths in Grades 9 through 12,
South Carolina and US, 1995-2007
25
20
Percent
15
SC
US
10
5
0
1995
1997
Source: Youth Risk Behavior Surveillance System
1999
2001
2003
2005
2007
Year
67
Subgroup analysis [Note: subgroup data from the YRBS and the YTS were again fairly
comparable] indicates females and African Americans have much lower use rates compared to
other subgroups (Figure 52).
Figure 52. (Past 30-day) Smokeless Tobacco Use among Youths in Grades 9 through 12,
By Gender, Grade, and Race/Ethnicity, South Carolina, 2007
30
25
Percent
20
15
10
5
0
Male
Female
Grade 9
Grade 10
Grade 11
Grade 12
White
Black
Total
Source: 2007 Youth Risk Behavior Surveillance System
68
Tobacco use during pregnancy
Rates of tobacco use during the last three months of pregnancy has remained fairly constant from
1995 to 2006, with between 12% and 15% of South Carolina pregnant women reporting smoking
during the last three months of their pregnancy (Figure 53). These percents are much higher than
the Healthy People 2010 goal of 1% of pregnant women smoking in their last trimester. The rate
of 12.1% represents 6,907 pregnant women in South Carolina.
Figure 53. Percent of Pregnant Women Reporting Smoking During the
Last Three Months of Pregnancy, South Carolina, 1995-2006
25
20
15.4
15.1
14.9
13.9
13.8
Percent
15
13
12.5
12.1
13.1
12.4
12.1
11.4
10
5
Healthy People 2010 GOAL = 1.0
0
1995
1996
1997
1998
Source: Pregnancy Risk Assessment Monitoring System
1999
2000
2001
2002
2003
2004
2005
2006
Year
69
The number of pregnant women per 1,000 live births reporting smoking at any time during their
pregnancy has declined in the US from 1995 to 2005, most rapidly since 2001 (Figure 54).
However, in South Carolina, the rate has remained above the national average for every year
since 1995 and has increased since 2000 such that the gap between the South Carolina and US
rate in 2005 is very large. The 2005 rate of 139.1 per 1,000 represents 8,001 live births in South
Carolina.
Figure 54. Rate (Per 1,000 Live Births) of Women Reporting Smoking at Any Time during
Pregnancy,
South Carolina and US, 1995-2005
200
Rate (per 1,000 live births)
150
SC
100
US
50
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year
Sources: South Carolina Community Assessment Network; National Vital Statistics System
70
Consequences of Tobacco Use
Mortality
Tobacco use is associated with deaths from lung cancer, other lung diseases, cardiovascular
disease, and ischemic cerebrovascular disease. Figure 55 shows an increasing separation in the
trend lines for death rates from lung cancer in South Carolina versus the US in 1996, with rates
in South Carolina about 10% higher than those in the US since then, increasing to about 20%
higher by 2003. However, the 2004 rate in South Carolina showed a decline toward prior years’
levels. The South Carolina rate of approximately 0.60 per 1,000 in 2004 represents 2,498
persons.
Figure 55. Number of Deaths from Lung Cancer per 1000 Population,
By Age Group, South Carolina and US, 1990-2004
1.0
0.9
0.8
Rate (per 1000 population)
0.7
0.6
SC
US
0.5
0.4
0.3
0.2
0.1
0.0
1990
1991
1992
1993
Source: National Vital Statistics System
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
Among all age groups South Carolina death rates exceed national averages, but especially among
those aged 55 to 64, again reflecting a burden of premature mortality from this cause (Figure 56).
71
Figure 56. Number of Deaths from Lung Cancer per 100,000 Population,
By Age Group, South Carolina and US, 2004
400
Rate (per 100,000 population)
300
SC
200
US
100
0
5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
Age Group
Source: National Vital Statistics System
Death rates from other lung diseases have remained very similar in South Carolina and the US
since 1992 (Figure 57). South Carolina mortality rates for this cause were higher than US rates in
2002 and 2003 but then declined in 2004 to equal US rates. The South Carolina rate of
approximately 0.41 per 1,000 in 2004 represents 1,722 persons.
Figure 57. Number of Deaths from Lung Disease per 1000 Population,
South Carolina and US, 1990-2004
1.0
0.9
0.8
Rate (per 1000 population)
0.7
0.6
SC
US
0.5
0.4
0.3
0.2
0.1
0.0
1990
1991
1992
1993
Source: National Vital Statistics System
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
72
Again, South Carolina death rates from this cause exceed national averages in all age groups
except those ages 85 and over (Figure 58).
Figure 58. Number of Deaths from Lung Disease per 100,000 Population,
By Age Group, South Carolina and US, 2004
700
600
Rate (per 100,000 population)
500
400
SC
US
300
200
100
0
5-14
15-24
Source: National Vital Statistics System
25-34
35-44
45-54
55-64
65-74
75-84
85+
Age Group
73
Death rates from ischemic cerebrovascular disease have been about 15% to 20% higher in South
Carolina) versus the US since 1999, when the change to the ICD-10 coding system caused the
apparent large spike in the mortality rate for this cause (Figure 59). Because it is in the “stroke
belt,” South Carolina is expected to have higher ischemic cerebrovascular death rates compared
to the US average, and the ICD-10 coding system appears to capture this discrepancy in rates. As
with death rates for lung cancer and lung disease, death rates for ischemic cerebrovascular
disease in South Carolina exceed national averages for all age groups except those ages 85 and
over (Figure 60). The South Carolina rate of approximately 0.83 per 1,000 in 2004 represents
3,485 persons.
Figure 59. Number of Deaths from Ischemic Cerebrovascular Disease per 1000 Population,
South Carolina and US, 1990-2004
1.0
0.9
0.8
Rate (per 1000 population)
0.7
0.6
SC
US
0.5
0.4
0.3
0.2
0.1
0.0
1990
1991
1992
1993
Source: National Vital Statistics System
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
74
Figure 60. Number of Deaths from Ischemic Cerebrovascular Disease per 100,000 of Population,
by Age Group, South Carolina and US, 2004
5000
Rate (per 100,000 population)
4000
3000
SC
US
2000
1000
0
5-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
Age Group
Source: National Vital Statistics System
Death rates from cardiovascular disease (CVD) have remained nearly identical in South Carolina
and the US between 1990 and 2004 (Figure 61). The South Carolina rate of approximately 1.98
per 1,000 in 2004 represents 8,294 persons.
Figure 61. Number of Deaths from Cardiovascular Disease per 1000 Population,
South Carolina and US, 1990-2004
5.0
4.5
4.0
Rate (per 1000 population)
3.5
3.0
SC
US
2.5
2.0
1.5
1.0
0.5
0.0
1990
1991
1992
1993
Source: National Vital Statistics System
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
75
South Carolina CVD death rates are slightly higher in every age group compared to national
rates (Figure 62).
Figure 62. Number of Deaths from Cardiovascular Disease per 100,000 Population,
by Age Group, South Carolina and US, 2004
2000
Rate (per 100,000 population)
1500
SC
US
1000
500
0
5-14
15-24
Source: National Vital Statistics System
25-34
35-44
45-54
55-64
65-74
75-84
85+
Age Group
In 2004 the age-adjusted death rate for all causes was 898.0 deaths per 100,000 in South Carolina
and 800.8 per 100,000 in the United States as a whole. Of these deaths, the overwhelming
majority were due to diseases of the heart and malignant neoplasms (Figure 63). It is interesting
that in all cases South Carolina rates exceed those for the US. Also note that while the difference
for malignant neoplasms, for example, is only + 5%, this difference translates into an additional
9.7 deaths per 100,000 persons, or 97 per million, or about 388 per 4 million (the approximate
population of South Carolina). A significant contributor to deaths from this cause, and the
leading preventable cause of death in the US, is chronic tobacco use.
76
Figure 63. Age-adjusted Deaths from Several Leading Causes Related to ATOD Use,
South Carolina and US, 2004
222.0
217.0
Diseases of the heart
195.5
185.8
Malignant neoplasms
65.2
Cerebrovascular diseases
50.0
49.9
Accidents
37.7
43.1
41.1
Chronic lower respiratory diseases
SC
US
24.4
15.2
Motor vehicle accidents
13.6
10.0
Injury by firearms
Intentional self-harm
11.3
10.9
Chronic liver disease and cirrhosis
10.4
9.0
Homicide
7.7
5.9
HIV
6.4
4.5
0
50
100
150
200
250
Rate (per 100,000 population)
77
Summary of Tobacco Use and Consequences
In summary, rates of adult cigarette consumption in South Carolina as measured by pack sales
per adult age 18 and over remained similar to national consumption rates since 2000, but
increased well above national rates in 2005 and 2006. Youth current cigarette use rates declined
to about 18% in 2007 and appear to be below national rates, although 2007 national YRBS data
were not yet available. South Carolina adult current use rates are approximately 22%, with rates
highest among those aged 25 to 34 (between 25% and 30%). Adult current and daily use rates
have remained higher compared to the national average. Higher risk youth subgroups include
high school upper classmen, males, and whites (for smokeless tobacco, lower classmen also have
high use rates). High risk adult subgroups include those ages 25 to 44 and males. Rates of
smoking during the last trimester of pregnancy among women in South Carolina have ranged
from 11% to 16%, far exceeding the Healthy People 2010 goal of 1%. Rates of South Carolina
pregnant women smoking at any time during their pregnancy have exceeded national rates for all
years and had been increasing until a favorable decrease in 2006.
The mortality rate from lung cancer is 10% to 20% higher in South Carolina compared to the US,
and the mortality rate from lung diseases is also higher. Being in the “stroke belt,” South
Carolina also suffers from about 20% higher morality rates from ischemic cerebrovascular
disease compared to the US national average. However, the mortality rate from CVD is
comparable in the two regions. Age-adjusted death rates for several leading causes of death
related to ATOD use in 2004 were all higher in South Carolina compared to the US.
78
Marijuana and Other Illicit Drug Use
Current marijuana use
South Carolina and US youth as a whole consistently report similar rates of past 30-day
marijuana use, ranging from 20% to 25% (Figure 64. There has been a gradual decline in rates
from 1999 to 2005. In 2007 the South Carolina rate was unchanged at 18.6% (US data for 2007
were not yet available). The 2007 rate of 18.6% represents about 38,000 youths in grades 9
through 12.
Figure 64. Current (Past 30-day) Marijuana Use among Youths in Grades 9 through 12,
South Carolina and US, 1995-2007
50
40
Percent
30
SC
US
20
10
0
1995
1997
Source: Youth Risk Behavior Surveillance System
1999
2001
2003
2005
2007
Year
79
YRBS subgroup data suggest that males have higher rates of current use compared to females,
and an upward trend in use across grade levels (Figure 65).
Figure 65. Current (Past 30-day) Marijuana Use among Youths in Grades 9 through 12, By
Gender, Grade, and Race/Ethnicity, South Carolina, 2007
50
40
Percent
30
20
10
0
Male
Female
Grade 9
Grade 10
Grade 11
Grade 12
White
Black
Total
Source: 2007 Youth Risk Behavior Surveillance System
80
Looking at age groups in the NSDUH survey data, South Carolina and US current marijuana use
rates in the 12- to 17 -year-old age group are gradually declining and are similar in South
Carolina and the US (Figure 66). For 18- to 25-year-olds, the South Carolina use rate increased
to 15.8% in 2005-2006, similar to the US rate, after declining the past three periods. The South
Carolina 2005-2006 rates of 6.1 and 15.8 percent represent approximately 22,323 and 76,466
persons in these two age groups, respectively.
Figure 66. Current (Past 30-day) Marijuana Use among Persons Age 12 and Over,
By Age Group, South Carolina and US, 2002-2006
25
20
Ages 18 to 25
Percent
15
SC
US
10
Ages 12 to 17
5
0
2002-2003
2003-2004
2004-2005
2005-2006
Year
Source: SAMHSA Office of Applied Studies, National Survey on Drug Abuse and Health
81
Age of first marijuana use
South Carolina and US youth report similar rates of first marijuana use before age 13 for all
reporting periods (Figure 67). As with current use rates, early use rates have declined since 1999.
In 2007 the South Carolina rate was essentially unchanged at 9.7% (US data for 2007 were not
yet available). The 2007 rate represents about 20,000 youths in grades 9 through 12.
Figure 67. Youths in Grades 9 through 12 Reporting First Marijuana Use before Age 13,
South Carolina and US, 1995-2007
25
20
Percent
15
SC
US
10
5
0
1995
1997
Source: Youth Risk Behavior Surveillance System
1999
2001
2003
2005
2007
Year
82
Other illicit substance use
Looking again at the same two age subgroups in the NSDUH survey data, there was no change in
self-reported past month illicit substance use other than marijuana among these subgroups across
the three reporting years, both in South Carolina and nationally (Figure 68). South Carolina and
US rates were comparable. The South Carolina 2005-2006 rates of 4.9 and 8.6 percent represent
approximately 17,932 and 41,621 persons in these two age groups, respectively.
Figure 68. Other Illicit Drug Use in the Past Month among Persons Age 12 to 17 and 18 to 25,
South Carolina and US, 2002-2006
12
10
Percent
8
Ages 18 to 25
SC
6
4
US
Ages 12 to 17
2
0
2002-2003
2003-2004
2004-2005
2005-2006
Year
Source: SAMHSA Office of Applied Studies, National Survey on Drug Abuse and Health
83
Figure 69 shows past year cocaine use among persons age 12 to 17 years and 18 to 25 years from
2002 to 2005 for South Carolina and the US. Use rates in South Carolina and the US were very
similar for 12- to 17-year-olds but the 18- to 25-year-old rate for South Carolina may have
decreased from 2004-2005 to 2005-2006. Cocaine use appears to be a concern among 18- to 25year olds, with use rates of about 5.9 percent, representing approximately 28,554 persons.
Figure 69. Cocaine Use in Past Year among Persons Age 12 to 17 and 18 to 25,
South Carolina and US, 2002-2006
10
9
8
Percent
7
Ages 18 to 25
6
SC
5
US
4
3
2
Ages 12 to 17
1
0
2002-2003
2003-2004
2004-2005
2005-2006
Year
Source: SAMHSA Office of Applied Studies, National Survey on Drug Abuse and Health
84
Figure 70 shows past year nonmedical use of pain relievers among persons age 12 to 17 and 18
to 25 for South Carolina and the US from 2003 to 2005. Rates have decreased very slightly in the
former group and increased slightly in the latter, and rates in South Carolina and the US have
been similar. The South Carolina 2005-2006 rates represent approximately 24,885 and 63,883
persons in these two age groups, respectively.
Figure 70. Nonmedical Use of Pain Relievers in Past Year among Persons Age 12 to 17 and 18
to 25, South Carolina and US, 2003-2005
18
16
14
Percent
12
Ages 18 to 25
10
SC
8
US
6
Ages 12 to 17
4
2
0
2003-2004
2004-2005
2005-2006
Year
Source: SAMHSA Office of Applied Studies, National Survey on Drug Abuse and Health
85
Consequences of Illicit Drug Use
Morbidity
Since 2003, there has been a sizable annual increase in the number of persons per 1,000
population admitted to a hospital ER for a drug-related diagnosis, from 9.14 to 21.11 (Figure 71).
The number of alcohol only and alcohol and drug-related admissions have been far smaller and
have remained consistent since 2003.
Figure 71. Number of Persons Admitted to Hospital ER for Drug-related Diagnoses per 1,000 of
Population, South Carolina, 2003-2007
25
Rater per 1,000 Population
20
15
Alcohol & Drug
Alcohol Only
Drug Only
10
5
0
2003
2004
2005
2006
2007
Year
Source: Office of Research and Statistics, SC Budget and Control Board
Mortality
Figure 72 shows death rates from drug use, abuse, or dependence in South Carolina and the US
from 1990 to 2003. Although rates across all years appear to be higher in the US compared to
South Carolina, these data should be interpreted with caution because the absolute rates are
extremely low (less than 0.01 per 1000, of 1 in 100,000). The 2003 South Carolina rate
represents only about 15 people. The attributable fractions tables in the Appendix of this report,
and recent modifications to the way in which SEDS calculates these rates suggest that this value
severely underestimates the actual numbers of deaths associated with drug abuse.
86
Figure 72. Number of Deaths from Drug Use, Abuse, or Dependence per 1000 Population,
South Carolina and US, 1990-2003
0.010
0.009
0.008
Rate (per 1000 population)
0.007
0.006
SC
US
0.005
0.004
0.003
0.002
0.001
0.000
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Year
Source: National Vital Statistics System
Death rates appear to increase with age to age 54 and then decrease (Figure 73). South Carolina
death rates are lower than national rates for all ages, though again, rates are extremely small and
should be interpreted with caution.
Figure 73. Number of Deaths from Drug Use, Abuse, or Dependence per 100,000 Population,
by Age Group, South Carolina and US, 2003
2.0
Rate (per 100,000 population)
1.5
SC
1.0
US
0.5
0.0
0-11
12-17
Source: National Vital Statistics System
18-20
21-29
30-34
35-54
55-64
65+
Age Group
87
Dependence or Abuse
There were no differences across reporting years or between South Carolina and the US as a
whole in reported rates of illicit drug dependency in the past year among persons ages 12 to 17
and 18 to 25 years old (Figure 74). The South Carolina 2005-2006 rates represent approximately
16,834 and 38,233 persons in these two age groups, respectively.
Figure 74. Illicit Drug Dependency or Abuse in Past Year among Persons Age 12 to 17 and 18 to
25, South Carolina and US, 2002-2006
12
10
8
Percent
Ages 18 to 25
SC
6
4
US
Ages 12 to 17
2
0
2002-2003
2003-2004
2004-2005
2005-2006
Year
Source: SAMHSA Office of Applied Studies, National Survey on Drug Abuse and Health
88
Methamphetamine Laboratory Incidents
Figure 75 shows total of all meth clandestine laboratory incidents from 2003 to 2007. Included
in the number of incidents or seizures of meth labs, dumpsites, and chemical/glass/equipment use
in the manufacture of the drug. These data show a sharp decrease in lab incidents beginning in
2004 down to a low of just 26 in 2007.
Figure 75. Number of Methamphetamine Clandestine Laboratory Incidents, South Carolina,
2003-2007
180
160
Number of Incidents
140
120
100
80
60
40
20
0
2003
2004
2005
2006
2007
Year
Source: National Clandestine Laboratory Database, US Drug Enforcement Administration
Property crime
Property crime, including larceny, burglary, and motor vehicle theft, is one consequence of illicit
drug use and abuse. Figure 76 shows that property crime rates in the both South Carolina and the
US as a whole have shown parallel trends with declines in the latter half of the 1990’s (with a lag
noted for the South Carolina rate), but have remained relatively stable since that time, with the
suggestion of slight declines from 2004 to 2006. The absolute rates for South Carolina have
remained about 20% higher than those for the US as a whole. The 2006 rate represented 183,322
property crimes in South Carolina.
89
Figure 76. Number of Property Crimes Reported to Police per 1000 Population, 1995-2006
60
Rate (per 1000 population)
50
40
SC
US
30
20
10
0
1995
1996
1997
Source: Uniform Crime Reporting Program
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
90
Summary of Illicit Drug Use and Consequences
In summary, YRBS data indicated that current marijuana use has been gradually declining in
both South Carolina and the US since 1999 with rates equivalent in the two regions. Males are at
higher risk compared to females, and upper classmen are at higher risk than lower classmen.
NSDUH survey data indicate that South Carolina and US current marijuana use rates in the 12to 17- -year-old age group are gradually declining and are similar in both regions. There was an
increase in the South Carolina marijuana use rate for 18- to 25-year-olds in 2005-2006. Rates of
first use before age 13 are similar in both South Carolina and the US. Rates of using other illicit
substances and using cocaine in particular are also similar in the two regions and have remained
stable during the three reporting periods. Nonmedical pain reliever use rates among South
Carolina and US 12- to 17-year-olds and 18- to 25-year-olds from 2003 to 2006 were
comparable in the two regions. Death rates from drug use, abuse, or dependence have been
higher in the US compared to South Carolina since 1990, though low rates make it difficult to
make definitive statements. The 2003 rate is substantially lower than the high in 2000.
Dependence and abuse rates by age match consumption patterns by age, and there were no
differences across reporting years or between South Carolina and the US as a whole in reported
rates of illicit drug dependency in the past year among persons ages 12 to 17 and 18 to 25 years
old. Property crime rates have consistently remained about 20% higher in South Carolina
compared to the US from 1995 to 2006.
91
General Causal Factors
Most data in this assessment is organized by alcohol, tobacco, or marijuana and other drugs.
However, some risk and protective factors (causal factors) for the state apply equally to
substance use and other behaviors. We describe these factors below, organized by “domains,” the
parts of an individual’s everyday environment (community, family, school, peers, and the
individuals themselves).
Community
One measure of risk in a community is the general economic situation. Data from the US Census
Bureau indicate that median household income in South Carolina, from 1997 to 2005, remained
about 10% to lower than median household income for the US as a whole, and significantly
lower for all time points (non-overlapping confidence bands in Figure 77 below).
Figure 77. South Carolina and US Median Household Income, 1997-2007
Median household income (dollars)
60000
50000
40000
US
30000
South Carolina
20000
10000
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Source: U.S. Census Bureau, Small Area Income and Poverty Estimates
Census Bureau data also indicate that, from 1997 to 2007, a significantly higher percent of South
Carolina households were considered in poverty, compared to US households. According to the
U.S. Census Bureau, in 2005 the poverty level for a family of four was $18,850. This is a
national figure and does not take into account geographical location (Figure 78).
92
Figure 78. Percent of South Carolina and US Households Living Below Poverty Level, 19972007
25
20
Percent
15
South Carolina
US
10
5
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Source: U.S. Census Bureau, Small Area Income and Poverty Estimates
93
From 1999 to 2006, a higher percentage of students in South Carolina have qualified for the
federal Free and Reduced Price Lunch Program, compared to students living in the US as a
whole. There was a sharp decrease in 2006 in the US, but this was not seen in the South Carolina
rate. According to the U.S. Department of Agriculture, for a family of four their annual income
could be no more than $35,798 to qualify for reduced price meals in 2005. The annual income
for free meals was $25,155 (Figure 79).
Figure 79. Percent of South Carolina and US Students Eligible for the Free and
Reduced-Price Lunch Program, 1998-2006
60
50
Percent
40
SC
30
US
20
10
0
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Source: National Center for Education Statistics
94
Fluctuations in South Carolina’s average unemployment rates have mirrored those of the state as
a whole, but the state rate has been consistently above the national average since 2003 (Figure
80). The average unemployment rate in South Carolina, currently 6.1%, has remained above six
percent since 2003 but is trending downward, while the national rate peaked at 6.0% in 2003 and
declined more rapidly afterward to 4.6% in 2006 and 2007.
Figure 80. Average South Carolina and US Unemployment Rates, 1997-2007
10
9
8
7
Percent
6
South Carolina
5
US
4
3
2
1
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Source: U.S. Bureau of Labor Statistics
Family
Undoubtedly, characteristics of the family greatly influence the behaviors of both the adults and
youth within that family. One of those characteristics, family disorganization, can be measured in
several ways, including percent of households with a single head of household, percent of live
births to unmarried mothers, and percent of households headed by a grandparent.
Data from the 2000 US Census indicate that South Carolina had 2.7% more of its households
headed by a single parent, when compared to the national average (Figure 81).
95
Figure 81. Percent of South Carolina and US Households with a Single (Unmarried) Head of
Household, 2000
50
40
30
Percent
26.0
23.3
20
10
0
South Carolina
US
Source: U.S. Census 2000
From 1997 to 2005, rates of live births to unmarried mothers have been about 15% to 20%
higher in South Carolina compared to the US as a whole, with both rates trending upward
(Figure 82).
Figure 82. Percent of South Carolina and US Live Births to Unmarried Mothers, 1997-2005
50
40
Percent
30
SC
US
20
10
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year
Source: National Center for Health Statistics, National Vital Statistics System
96
According to 2000 US Census data, 4.4% of South Carolina households are headed by a
grandparent, compared to 3.4% for the US as a whole (Figure 83).
Figure 83. Percent of South Carolina and US Households with Grandparent
as Head of Household, 2000
10
9
8
7
Percent
6
5
4.4
4
3.4
3
2
1
0
South Carolina
US
Source: U.S. Census 2000
97
Family conflict is also a risk factor. In 2004 there were 24% fewer family assaults per 10,000
residents in South Carolina compared to the state as a whole (Figure 84).
Figure 84. Number of Family Assaults per 10,000 Residents,
South Carolina (2004) and US (1998-2002)
150
Assaults per 10,000 residents
126.8
100
80.5
50
0
South Carolina
US
Sources: State Law Enforcement Division, SC Incident-Based Reporting System, 2005; US Department of Justice, Office
of Justice Programs, 2005
Summary of General Causal Factors
General causal factors for the use and abuse of alcohol, tobacco and other drugs range from the
characteristics of the community and home, to the impacts of school and peers. In particular,
youth are more likely to use alcohol, tobacco, or other drugs if they do not perceive much harm
from use, and do not believe that it is wrong for people their age to drink, smoke, or use other
drugs; associate with peers who use or value alcohol; family and community attitudes do not
discourage early use behavior; and substances are readily available.
The economic health of a community is a strong contributing factor to the use of alcohol,
tobacco, and other drugs. From 1997 to 2007 the annual median household income for South
Carolina was lower than the national average. In 2007, the median household income for South
Carolina was $43,508, compared to a national average of $50,740. Between 1997 and 2007, a
higher percent of households in South Carolina were considered to be in poverty, compared to
the national average. In 2007, 15.1% of South Carolina households were in poverty, compared to
13.0% of US households. Related to this finding is the percent of South Carolina and US
students qualifying for the Free and Reduced Price Lunch Program. In 2006, over half (51%) of
South Carolina students qualified for this program, while 41% of students qualified nationally.
For a family of four, annual income could be no more than $35,798 to qualify for reduced price
meals in 2005. The annual income for free meals was $25,155. Unemployment is also a measure
of statewide and national economic health. South Carolina’s 2007 average unemployment rate
98
was 6.1 percent and peaked at 6.8 percent in 2004, while the national rate peaked at 6.0 percent
in 2003 and was at 4.6 percent in 2007.
The makeup and dynamics of individual families play a significant role in both adult and youth
behavior. Family disorganization is a leading cause of youths’ unhealthy habits regarding
alcohol, tobacco and other drug use. Specifically, disruptive family characteristics include single
parent families, births to unmarried mothers, households headed by a grandparent, and family
conflict. According to Census 2000 data, 2.7% more South Carolina households headed by a
single parent compared to US households. Likewise, the rate of births to unmarried mothers from
1997 to 2005 has been about 15% to 20% higher in South Carolina compared to the state.
Households headed by a grandparent are not considered to be the ideal family environment.
Census 2000 data indicate that 4.4% of South Carolina households were headed by a
grandparent, compared to 3.4 percent for the US as a whole. Finally, family conflict is a risk
factor for inappropriate behavior among the community’s youth. South Carolina reported 37%
fewer family assaults per 10,000 residents compared to the national rate.
99
CONCLUSIONS
Summary of Findings on Indicators
Tables 3, 4, and 5 summarize findings regarding trends across recent years, rate ratios comparing
rates for South Carolina and US populations, and high risk groups for each of the indicators
examined in this report. Indicator characteristics of greater immediate concern to the South
Carolina SEOW are indicated in red (upwardly trending rates and/or high rate ratios). In
addition, high risk groups indicate which groups are particularly vulnerable and could be targeted
for preventive interventions.
As indicated in the tables below, youth current alcohol use in South Carolina is trending
downward and identical (rate ratio=1.00) to that for the US as a whole, with highest use rates
among whites, other races, and 11th and 12th graders. Early use (before age 13) rates are also
identical to those for the US as a whole, with other races having higher risk of early use. Youth
binge use rates are lower compared to national rates, with higher risk among males, whites, and
other races. Drinking and driving remains a problem in South Carolina despite a downward trend
in the rate and is especially prevalent among males, whites, and 11th and 12th graders. Being a
passenger in a car with a drinking driver is also problematic despite downward trending rates,
with highest risk noted among whites and other races. Adult rates of current and binge alcohol
use are below national averages. Males, whites, and those aged 18 to 44 are at highest risk for
current alcohol use; Males and whites are also at highest risk for binge and heavy use.
As mentioned in the body of this report, tobacco use and consequence rates were all higher than
national averages, even though use rates were by and large trending downward. Rate ratios for
youth smokeless tobacco use, early cigarette use, and daily cigarette use all exceeded 1.2,
meaning that use rates were much higher compared to the national average. Among adults, the
rates of 30-day and daily cigarette use are also elevated compared to national rates. As smoking
is the leading preventable cause of death and disability in the US and in South Carolina, tobacco
use and its consequences deserve continued close monitoring in the South Carolina population.
Current youth marijuana use rates are trending downward and just under the national average,
but the early use rate is higher than the national average.
Almost all of the alcohol-, tobacco-, and drug-related consequences occur at higher rates in
South Carolina compared to the US. Although trending downward, rates of risky sexual behavior
among youths in grades 9-12 are especially high in South Carolina, particularly for early
initiation of sex, ever having had sex, sex with four or more partners, and sex in the past three
months. The SEOW will strongly consider as a high priority those indicators which are both
trending upward and have rate ratios much greater than 1.0. However, nearly all of the indicators
listed warrant close attention, since rate ratios are all greater than 1.0, and attention should be
paid to those far exceeding 1.0. For example, the rate ratio for mortality from motor vehicle
crashes (1.61) and for deaths attributable to HIV (1.42) are both indicators of great concern.
100
Table 3. Summary of Consumption Indicators
Population
Substance
Indicator
Trend1
Rate
(%)2
Rate High Risk Groups
Ratio
3
Youths in grades 9-12
alcohol
Adults (> age 18)
Youths in grades 9-12
cigarettes
Adults (> age 18)
smokeless
tobacco
cigarettes
Youths in grades 9-12
marijuana
30-day use
↓
43.2
first use before age 13
binge use
drinking and driving
↓
↓
↓
25.6
23.6
11.5
passenger with drinking
driver
↓
30.0
1.00 whites, other races, 11th and 12th
graders
1.00 other races
0.93 males, whites, other races
1.16 males, whites, 11th and 12th
graders
1.05 whites, other races
30-day use
binge use
heavy use
↑
−
↑
47.5
13.9
5.6
0.87 males, whites, ages 18-44
0.88 males, whites, ages 25-34
1.08 males, whites, ages 18-24, 35-44
30-day use
↓
23.5
first use before age 13
daily use
↓
↓
19.6
11.4
30-day use
↑
10.7
1.02 whites, other races, 11th and 12th
graders
1.23 whites
1.21 whites, other races, 11th and 12th
graders
1.34
30-day use
daily use
↓
↓
21.9
16.2
1.11 males, whites, ages 25-34
1.12 males, whites, blacks, ages 25-34
30-day use
↓
19.0
0.94 males, other races
first use before age 13
↓
9.5
1.09 males, other races
1 Trends are for the years 1996 to 2005 for youths in grades 9-12 but omit years 2001 and 2003 because the YRBS was not conducted
in South Carolina during those years, and are for the years 1999 to 2006 for adults (≥ age 18). Arrows indicate trend direction.
2 Rate is for 2005 since US data for 2007 are not yet available for direct rate comparisons.
3 Rate Ratio = SC rate/US rate. A ratio > 1 indicates that the SC rate is higher than the US rate.
101
Table 4. Summary of Consequences Indicators
Population
Youths in grades 912
Substance
Alcohol &
Other
Drugs
Women (ages 15-19)
All ages
Ages 12-17
Ages 18-25
All ages
Ages 16 and older
All ages
Tobacco
Indicator
Sexual Activity (% reporting)
sex before age 13
ever had sex
sex with 4 or more people in lifetime
alcohol/drugs before last sex
90 day sex
90 day condom before sex*
90 day BCP before sex*
Teen births (live births per 1,000)
HIV (cases per 100,000)
AIDS (cases per 100,000)
Dependence/Abuse (% reporting)
alcohol
illicit drugs
alcohol
illicit drugs
Motor vehicle accidents
fatal accidents involving alcohol (%)
vehicle deaths involving alcohol (per
100,000)
drivers involved in fatal crashes who
used alcohol (%)
nighttime single-vehicle crashes (per
1,000)
Property crime (offenses per 1,000)
Violent crime (offenses per 1,000)
Age-adjusted mortality (per 100,000)4
chronic liver disease and cirrhosis
unintentional injuries
motor vehicle crashes
firearm-related
suicides
homicides
HIV
Mortality (per 100,000)
ischemic cerebrovascular disease
lung diseases
lung cancer
cardiovascular disease
Rate
(%)2
Rate
Ratio3
↓
9.2
1.48
↓
↓
↓
↓
↑
↑
↓
↓
↑
52.3
18.8
24.8
37.5
67.4
17.9
52.1
176.8
195.9
1.12
1.31
1.06
1.11
1.07
0.98
1.27
1.23
1.10
−
−
↑
↓
4.5
4.56
14.84
7.92
0.83
0.98
0.84
0.97
↑
↑
50.3
12.1
1.22
2.06
↓
24.8
1.23
↓
3.48
NA
↓
↓
42.4
7.7
1.27
1.64
↑
↑
↑
↓
−
↓
↓
10.4
49.9
24.4
13.6
11.3
7.7
6.4
1.16
1.27
1.61
1.36
1.04
1.31
1.42
↑
↑
↑
↓
83.0
41.0
59.5
222.0
1.23
1.02
1.01
1.02
Trend1
1 Trends are for the years 1996 to 2005 for youths in grades 9-12 but omit years 2001 and 2003 because the YRBS was not conducted in
South Carolina during those years; for the years 1999 to 2007 for adults (≥ age 18) (BRFS); for the years 2002 to 2006 for persons
102
ages 12 to 17 and 18 to 25 (NSDUH); for the years 1995 to 2006 for motor vehicle accidents (FARS); for 1995 to 2006 for crimes
(UCR); and for 1990 to 2004 for mortality rates. Arrows indicate trend direction.
2 Rates for youths in grades 9-12 are for 2005 since US data for 2007 are not yet available for direct rate
comparisons.
3 Rate Ratio = SC rate/US rate. A ratio > 1 indicates that the SC rate is higher than the US rate.
4 Source for 2004 age-adjusted death rates was the National Vital Statistics Reports, 55(19), Table 29
http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_19.pdf
* Decreasing trends and lower rate ratios are worse for these indicators.
NA = Not available.
Table 5. Summary of Causal Factors
Population
Indicator
General
Median household income*
Households living below poverty level
Students on free and reduced lunch
Unemployment rates
Households with single head of households
Live births to unmarried mothers
Households with grandparent as head of
household
Family assaults per 10,000 residents
Trend1
↑
↓
NA
↑
NA
Value/
Rate
(%)
$43,508
15.1
51.3
6.1
26.0
43.3
4.4
NA
80.5
Rate
Ratio2
0.86
1.16
1.24
1.33
1.12
1.17
1.29
0.63
1 Arrows indicate general trend direction for years of data available.
2 Rate Ratio = SC rate/US rate. A ratio > 1 indicates that the state value or rate is higher than the US value or rate.
* Decreasing trends and lower rate ratios are worse for these indicators.
Data Limitations
Where available, this document utilized data from national standardized surveys with wellestablished, proven, and sound methodologies. Despite efforts directed at ensuring the quality of
data collection and analyses, measures are often subject to limitations of availability (e.g., gaps
in survey administration in certain years), time lag (between administration, data processing, and
analysis on the one hand and important environmental inputs such as policy or program
initiatives on the other hand), error (sampling, measurement, etc.), bias (e.g., reporting), and
other shortcomings. It is important to acknowledge these methodological and reporting issues in
order to exclude from consideration those data sets that have too many weaknesses to be
informative and to attach less importance to those data sets that have several limitations but still
some usefulness. Additionally, identifying and understanding the limitations in the data are
important to guide data analyses and interpretation of findings. Failure to consider the
weaknesses in data sets can lead to inaccurate assessments of the problem and the adoption of
erroneous conclusions. Limitations of the data in this profile include:
•
Age-adjustment: not age-adjusting the consequences data could lead one to
misinterpretations due to differing age structures of US and South Carolina populations.
For example, the mortality rates in this profile were not age-adjusted. If there are
significantly higher proportions of older or younger adults in South Carolina compared
103
to the US, some of the differences in mortality rates could be attributed to this age
distribution difference, rather than to an actual difference in mortality rates.
•
Small numbers: as mentioned above, estimates derived from small numbers are likely to
be imprecise estimates of the actual population value of an indicator.
•
Identifying meaningful differences: we chose to use CIs where possible to identify
between-group differences. It should be acknowledged that there are different methods
to calculate the CI which would obviously affect CI values and hence interpretations of
between-group differences.
•
Use of response indicators for assessment: certain indicators (e.g., arrest, treatment data,
school suspensions) are typically influenced by a variety of factors in addition to the
underlying substance use patterns (e.g., funding, personnel/staff resources, and
institutional priorities). As a result, they may reflect a ‘response’ to the problem rather
than the underlying pattern of substance use or negative consequences. For example, a
zero tolerance policy implemented by law enforcement may result in increased DUI
arrests without an actual increase in the percent of people drinking and driving. Caution
should be exercised while using and drawing conclusions from such ‘response’
indicators. As another example, the indicators related to sexual activity, teen births, and
HIV/AIDS do not meet criteria for inclusion in the SEDS indicators, primarily because
their attribution to alcohol is not well-defined, and there are no known data sources for
identifying incidents that are alcohol-attributable.
•
‘Short’- vs. ‘long’-term consequences: some long-term consequences indicators (e.g.,
alcoholic cirrhosis deaths) may not be useful for short-term evaluation as they may not
change within a short frame of time. However, these consequences may indicate an
underlying consumption pattern noteworthy of attention (chronic heavy use of alcohol),
which may not be picked up by existing population surveys.
•
Attributable fractions: These fractions are inexact and may be subject to reporting bias,
among other problems. However, in theory they allow attribution to the substance
(alcohol, tobacco, or drugs) rather than to broad categories of disease that may be only
partially attributable to the substance, so in that respect provide a more accurate picture
of numbers of deaths due to substance use.
104
APPENDIX
Constructs and Indicators
Table A1 lists the indicators of ATOD consumption and consequences, data sources, geographic
levels, and associated National Outcome Measures (NOMS) for which data are available in
South Carolina.
Table A1. Indicators of Alcohol, Tobacco, and Other Drug Consumption and Consequences, Data Sources and Geographic Levels,
and Associated National Outcome Measures
Construct
Apparent per
capita ethanol
consumption
Current
alcohol use
Current binge
drinking
Heavy
drinking
Age of initial
alcohol use
Drinking and
driving
Consumption of Alcohol, Tobacco, and Other Drugs (ATOD)
Indicator
Data
Geographic
Source
Levels
Total sales of ethanol (as estimated in gallons) in beer,
wine and spirits per capita aged 14 and over
AEDS
National,
State
Percent of persons aged 12 and older reporting any use
of alcohol in the past 30 days
Percent of students in grades 9 through 12 reporting any
use of alcohol in the past 30 days
Percent of persons aged 18 and over reporting any use of
alcohol in the past 30 days
Percent of persons aged 12 and older reporting having
five or more drinks on at least one occasion in the past
30 days
Percent of students in grades 9 through 12 reporting
having 5 or more drinks on at least one occasion in the
past 30 days
Percent of persons aged 18 and older reporting having 5
or more drinks on at least one occasion in the past 30
days
Percent of adults aged 18 and older reporting average
daily alcohol consumption greater than 2 (male) drinks
or greater than 1 drink (female) per day
Percent of students in grades 9 through 12 who report
first use of alcohol before age 13
Percent of students in grades 9 through 12 reporting
driving in the past 30 days when they had been drinking
alcohol
Percent of students in grades 9 through 12 who report
riding in a car driven by someone who has been drinking
Percent of adults aged 18 and older reporting driving
after having “perhaps too much to drink” in past 30 days
NSDUH
National,
State
National,
State
National,
State
National,
State
YRBS
BRFS
NSDUH
YRBS
National,
State
BRFS
National,
State
BRFS
National,
State
YRBS
National,
State
National,
State
YRBS
YRBS
BRFSS
SAMHSA
NOM
Domain
Reduced
Morbidity
Reduced
Morbidity
Reduced
Morbidity
Reduced
Morbidity
National,
State
National,
State
105
Total cigarette
consumption
per capita
Current
tobacco use
Daily cigarette
use
Age of initial
tobacco use
Current illicit
drug use
Lifetime illicit
drug use
Age of initial
marijuana use
Number of packs of cigarettes taxed at the wholesale
level per capita aged 18 and older
State excise
tax data
National,
State
Percent of persons aged 12 and older reporting any use
of smokeless tobacco in the past 30 days
Percent of students in grades 9 through 12 reporting any
use of smokeless tobacco in the past 30 days
Percent of students in grades 9 through 12 reporting any
use of cigarettes in the past 30 days
Percent of persons aged 18 and older who report
smoking 100 or more cigarettes in their lifetime and now
smoke cigarettes either every day or on some days
Percent of students in grades 9 through 12 who report
smoking cigarettes on 20 or more days within the past
30 days
Percent of adults aged 18 and older who report smoking
100 cigarettes in their lifetime and now smoke every day
Percent of students in grades 9 through 12 initiating
tobacco use before age 13
NSDUH
National,
State
National,
State
National,
State
National,
State
Percent of persons aged 12 and older reporting any use
of marijuana in the past 30 days
Percent of students in grades 9 through 12 reporting any
use of marijuana in the past 30 days
Percent of persons aged 12 and older reporting use of
any illicit drug other than marijuana, or an abusable
product that an be obtained legally, in the past 30 days
Percent of students in grades 9 through 12 reporting the
use of cocaine in the past 30 days
Percent of students in grades 9 through 12 reporting any
use of specific classes of illicit drugs in their lifetime
Percent of students in grades 9 through 12 reporting first
use of marijuana before age 13
YRBSS
YRBSS
BRFSS
Reduced
Morbidity
Reduced
Morbidity
Reduced
Morbidity
Reduced
Morbidity
YRBSS
National,
State
BRFSS
National,
State
National,
State
Reduced
Morbidity
National,
State
National,
State
National,
State
Reduced
Morbidity
Reduced
Morbidity
Reduced
Morbidity
National,
State
National,
State
National,
State
Reduced
Morbidity
YRBSS
NSDUH
YRBSS
NSDUH
YRBSS
YRBSS
YRBSS
Reduced
Morbidity
Consequences of Alcohol, Tobacco, and Other Drugs (ATOD)
Construct
Indicator
Data
Source
Alcoholrelated
mortality
Number of deaths from cirrhosis per 1000 population
NVSS
Number of deaths from suicide per 1000 population
NVSS
Number of deaths from homicide per 1000 population
NVSS
Geographic
Levels
SAMHSA
NOM
Domain
National,
State,
County
National,
State,
County
National,
106
Alcoholrelated motor
vehicle crashes
Alcoholrelated crime
Dependence or
abuse
Tobaccorelated
mortality
Percent of fatal motor vehicle crashes for which at least
one driver, pedestrian, or cyclist had been drinking
FARS
Number of vehicle deaths in which at least one driver,
pedestrian, or cyclist had been drinking per 1000
population
Percent of drivers involved in fatal crashes who used
alcohol
FARS
FARS
Number of single vehicle nighttime crashes per 1000 SC Dept. of
population aged 16 and older
Transportat
ion
Total Alcohol-Related Crash Fatalities for Ages 15-20, SC Dept. of
South Carolina
Transportat
ion
Leading Age for Youth Alcohol Related Crashes, South SC Dept. of
Carolina
Transportat
ion
UCR
Number of violent crimes (aggravated assaults, sexual
assaults, and robberies) reported to police per 1000
population
Percent of population aged 12 and older meeting DSMNSDUH
IV criteria for alcohol abuse or dependence
Number of deaths from lung cancer and oropharyngeal
NVSS
cancer per 1000 population
Number of deaths from COPD and emphysema per 1000 NVSS
population
Number of deaths from cardiovascular disease per 1000
population
NVSS
Drug-related
morbidity
Number of persons admitted to hospital ER for alcoholand drug-related diagnoses (as per ICD-10 codes) per
1000 population
Drug-related
mortality
Number of deaths from illicit drug use per 1000
population
SC Office
of Research
and
Statistics
NVSS
Drug-related
crime
Number of property crimes (larceny, burglary, MV
theft) reported to police per 1000 population
UCR
State,
County
National,
State,
County
National,
State,
County
National,
State,
County
State,
County
State
State
National,
State,
County
National,
State
National,
State,
County
National,
State,
County
National,
State,
County
Crime and
Criminal
Justice
Crime and
Criminal
Justice
Crime and
Criminal
Justice
Crime and
Criminal
Justice
Crime and
Criminal
Justice
Crime and
Criminal
Justice
Crime and
Criminal
Justice
State
National,
State,
County
National,
State,
County
Crime and
Criminal
Justice
107
Number of Methamphetamine Clandestine Laboratory
Incidents
Illicit drug
dependence or
abuse
Percent of persons aged 12 and older meeting DSM-IV
criteria for drug abuse or dependence
School
connectedness
Number of ATOD-related suspensions and expulsions
Attendance and enrollment
Early,
increased, or
risky sexual
activity
Increased teen
births
Increased
HIV/AIDS
cases
Percent of students in grades 9 through 12 reporting
having sexual intercourse before age 13
Percent of students in grades 9 through 12 reporting ever
having had sexual intercourse
Percent of students in grades 9 through 12 reporting
having had sexual intercourse in the past three months
Percent of students in grades 9 through 12 reporting
having used alcohol or drugs before last sexual
intercourse
Percent of students in grades 9 through 12 reporting
having used a condom before last sexual intercourse
Number of live births per 1000 women ages 15-19, 1517, and 18-19
Number of HIV cases per 100,000 population
Number of AIDS cases by method of transmission
Construct
Social norms
regarding use
Work and
school norms
US Drug
Enforceme
nt Agency
NSDUH
National,
State
NCES, SC
Dept. of
Education
NCES, SC
Dept. of
Education
YRBSS
National,
State
Education/
Employment
National,
State
Education/
Employment
YRBSS
YRBSS
YRBSS
YRBSS
NVSS
HIV/AIDS
Surveillanc
e Report
HIV/AIDS
Surveillanc
e Report
National,
State
National,
State
National,
State
National,
State
National,
State
National,
State
National,
State
National,
State
National,
State
Additional Substance Abuse Prevention National Outcome Measures
Not Falling under the Categories of Consumption or Consequences
Indicator
Data
Geographic
Source
Levels
Survey questions on perceived risk/ harm from use of
NSDUH
National,
ATOD
State
Survey questions on perception of disapproval/ attitudes NSDUH
National,
towards ATOD
State
Survey question of attitude towards employers who
NSDUH
National,
randomly test employees for drug or alcohol use
State
SAMHSA
NOM
Reduced
Morbidity
Reduced
Morbidity
Reduced
Morbidity
108
regarding use
Number of school ATOD-related suspensions and
expulsions
School attendance and enrollment data
Social Support/ Survey questions on family communication around drug
connectedness use
Increased
access to
prevention
services
Number of persons served by age, gender, race and
ethnicity
Increased
retention in
treatment for
substance
abuse
Total number of evidence-based programs and strategies
Cost
effectiveness
Percent of youth seeing (reading, watching, listening to)
a prevention message
Services provided within cost bands (under
development)
NCES, SC
Dept. of
Education
NCES, SC
Dept. of
Education
NSDUH
MDS/
Prevention
Database
Builder; SC
DAODAS
and SC
DHHS
MDS/
Prevention
Database
Builder; SC
DAODAS
and SC
DHHS
NSDUH
CSAP/
Prevention
Template
Use of
To be collected from CSAP records and/or as reported in MDS/
evidence-based MDS, Database Builder, and the Prevention Platform
Prevention
practices
Database
Builder
Note: Sources for this information include the SAMHSA SEDS and NOMS websites
(http://www.epidcc.samhsa.gov/, http://www.nationaloutcomemeasures.samhsa.gov/).
National,
State
Employment/
Education
National,
State
Employment/
Education
National,
State
Social
Connectedness
Access/
Service
Capacity
National,
State
National,
State
Retention
National,
State
National,
State
Retention
National,
State
Cost
Effectiveness
Use of
Evidence
Based
Practices
109
Data Sources
Background information on the Strategic Prevention Framework and the National Outcomes
Measures (NOMS) came from the US Department of Health and Human Services (USDHHS),
Substance Abuse and Mental Health Services Administration (SAMHSA) website
(http://www.nationaloutcomemeasures.samhsa.gov/./outcome/index.asp;
http://www.nationaloutcomemeasures.samhsa.gov/./outcome/Accessible/NOMsSPF2k6.asp?CD
DID=1), and from the USDHHS, SAMHSA, Center for Substance Abuse Prevention (CSAP),
Data Coordinating Center (DCC), State Epidemiological Data System (SEDS) website
(http://www.epidcc.samhsa.gov/). In addition, the CSAP DCC SEDS provided data on ATOD
consumption and consequences. The primary sources for these data are noted below.
Much of the data summarized in the body of this report came from publicly available sources,
including NIH-sponsored US national and state surveys on substance use among youths and
adults in South Carolina and the United States. Data on per capita ethanol consumption (gallons
of ethanol, based on population age 14 and older) for States, census regions, and the United
States, 1970-2003 came from the National Institute on Alcohol Abuse and Alcoholism (NIAAA)
http://www.niaaa.nih.gov/Resources/DatabaseResources/QuickFacts/AlcoholSales/consum03.ht
m. Data on alcohol sales tax rates came from the Tax Foundation
(http://www.taxfoundation.org).
Data on youth and adult ATOD consumption indicators and on additional NOMS came from the
USDHHS, SAMHSA, Office of Applied Studies (OAS), National Survey on Drug Use and
Health (NSDUH) https://nsduhweb.rti.org/ The NSDUH has been used consistently for many
years by many different surveillance systems. It is the only national source currently providing
prevalence estimates for both adolescents and adults for every state. However, it does not capture
the frequency of drug use, and State-level estimates for most states are based on relatively small
samples. Although augmented by model-based estimation procedures, estimates for specific age
groups have relatively low precision (i.e., large confidence intervals). The estimates are provided
directly by SAMHSA and raw data that could be used for alternative calculations (e.g.,
demographic subgroups) are not available. The estimates are subject to bias due to self-report
and non-response (refusal/no answer). More localized versions of the survey are not conducted.
Data on youth ATOD consumption indicators came from the Centers for Disease Control and
Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion
(NCCDPHP), Youth Risk Behavior Surveillance System (YRBSS)
http://www.cdc.gov/HealthyYouth/data/index.htm. The YRBSS has been used consistently for
many years by many different surveillance systems. YRBSS estimates are typically based on
larger samples that the NSDUH and can be further disaggregated by grade level, gender, and
race/ethnicity. Some states also collect YRBSS data for individual communities or school
districts, which can be compared to state-level data. However, this survey does not capture the
frequency of drug use on any one occasion. Not all states participate, and some participating
states do not provide representative samples. YRBSS is a school-based survey, so students who
have dropped out of school are not captured. It is also subject to bias due to self-report, noncoverage (refusal by selected school to participate) and non-response (refusal/no answer).
Estimates for subgroups may have relatively low precision (i.e., large confidence intervals).
110
(Note: The YRBSS did not achieve an adequate number of respondents in South Carolina in
2001 and 2003 to have representative data. Data for years 1995 through 1999 were obtained from
the State Epidemiological Data System (SEDS) website http://www.epidcc.samhsa.gov/).
Additional state-level data on youth tobacco consumption came from the South Carolina
Department of Health and Environmental Control, Division of Tobacco Prevention and Control,
South Carolina Youth Tobacco Survey (YTS), 2006 www.dhec.sc.gov/health/chcdp/tobacco.
Data on average daily membership in South Carolina public high schools came from the South
Carolina Department of Education, Office of Research average daily membership files
http://ed.sc.gov/agency/offices/research/DailyMembership.html.
Data on adult ATOD consumption came from the CDC, NCCDPHP, Behavioral Risk Factor
Surveillance System (BRFSS)
http://www.cdc.gov/brfss/technical_infodata/surveydata/2005.htm. The BRFSS provides
prevalence estimates of adult use for every state. State-level estimates are typically based on
larger samples than the National Survey on Drug Use and Health and may be further
disaggregated by age, gender, and race/ethnicity. The BRFSS is a telephone survey subject to
potential bias due to self-report, non-coverage (households without phones), and non-response
(refusal/no answer). Estimates for subgroups may have relatively low precision (i.e., large
confidence intervals). Survey data may be accurate to eight health service regions, but not to the
county, although the survey does exceed a minimum sample size. (Note: data for years 1999
through 2003 were obtained from the State Epidemiological Data System (SEDS) website
http://www.epidcc.samhsa.gov/).
Substance Abuse Treatment Services data (unduplicated clients) for FY2000 – FY2005 came
from the South Carolina Department of Alcohol and Other Drug Abuse Services (SCDAODAS).
Data on Medicaid claims related to substance abuse for FY2000 – FY2005 came from the South
Carolina Department of Health and Human Services (SCDHHS). Data on teen birth rates per
1,000 females aged 15 to 19 years came from the CDC National Vital Statistics Reports
(http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_06.pdf).
Data on alcohol use during the last trimester of pregnancy came from the South Carolina
Pregnancy Risk Assessment Monitoring System (PRAMS) at the South Carolina Department of
Health and Environmental Control website:
http://www.scdhec.gov/co/phsis/biostatistics/index.asp?page=prams.
Data on HIV/AIDS cases came from the CDC HIV/AIDS Surveillance Reports
(http://www.cdc.gov/hiv/topics/surveillance/resources/reports/index.htm) and from a file
available at the South Carolina Department of Health and Environmental Control website
(http://www.dhec.sc.gov/health/disease/stdhiv/docs/HIVSTD%20Surveillance%20Report_12312
006.pdf)
Mortality data came from the SEDS website (http://www.epidcc.samhsa.gov/), and from
National Vital Statistics System (http://www.cdc.gov/nchs/deaths.htm). Updated (2004 & 2005)
South Carolina mortality data were obtained from a mortality file available from the South
Carolina Department of Health and Environmental Control website:
111
(http://www.scdhec.gov/co/phsis/biostatistics/an_pubs%5C2004DMS.pdf and
http://www.scdhec.gov/co/phsis/biostatistics/an_pubs/2005DMS.pdf.
State and national census data came from the SEDS website (http://www.epidcc.samhsa.gov/),
from US Census Bureau files http://www.census.gov/, and from the South Carolina Office of
Research and Statistics (http://www.sccommunityprofiles.org/census/scpop06.php).
Data on teen births came from the National Center for Health Statistics National Vital Statistics
System (http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_1_table11.pdf).
Data on alcohol tax rates by state came from The Tax Foundation website:
http://www.taxfoundation.org/taxdata/show/245.html. Data on cigarette tax rates by state came
from reports available at the Campaign for Tobacco-Free Kids website:
http://www.tobaccofreekids.org/research/.
Data on youth alcohol-related car crashes came from the South Carolina Department of
Transportation.
Hospital emergency room visits for alcohol- and drug-related diagnoses data comes from the SC
Budget and Control Board Office of Research and Statistics.
Data on methamphetamine clandestine incidents reported came from the National Clandestine
Laboratory Database at the U.S. Drug Enforcement Administration website:
http://www.usdoj.gov/dea/concern/map_lab_seizures.html.
112
Attributable Fractions
Attributable Fractions Tables
Tables A2 – A4 list attributable mortality fractions for alcohol use, drug use, and smoking, as well as the sources for this information.
Table A2. ICD 9/10 Codes for Alcohol-Attributable Mortality Fractions
ICD-9 Diagnosis
Category
CHRONIC
CONDITIONS
100%
ATTRIBUTABLE
TO ALCOHOL
USE
Alcoholic liver
disease/cirrhosis
CHRONIC
CONDITIONS
PARTIALLY
ATTRIBUTABLE
TO ALCOHOL
USE
Liver cirrhosis,
unspecified
Percent Age
ICD-9
Code1
ICD-9CM
Diagnosis
Category2
ICD9CM
Code3
ICD-10 Diagnosis
Category
ICD-10 Code
100
>20
571.0571.3
Alcoholic liver
disease/cirrhosis
571.0571.3
Alcoholic liver disease
K70.0-K70.9
40
>20
571.5571.9
Liver cirrhosis,
unspecified
571.5571.9
Liver cirrhosis,
unspecified
K74.3-K74.6,
K76.0, K76.9
ACUTE
CONDITIONS
100%
ATTRIBUTABLE
TO ALCOHOL
113
USE
Unintentional
poisoning by
alcoholic beverages
100
>15
E860.0
Accidental poisoning E860.0
by alcoholic
beverages
Unintentional
poisoning by other
and unspecified
ethyl alcohol and its
products and methyl
alcohol
Suicide by alcohol
100
>15
E860.1
E860.2
Unintentional
E860.1
poisoning by other
E860.2
and unspecified ethyl
and methyl alcohol
and its products
100
>15
--
Suicide by alcohol
Homicide and injury
purposely inflicted
by other persons
Hypothermia
ACUTE
CONDITIONS
PARTIALLY
ATTRIBUTABLE
TO ALCOHOL
USE
Homicide and injury
purposely inflicted
by other persons
Hypothermia
47
>15
E960E969
42
>15
E901
Unintentional falls
32
>15
Accidents caused by
42
>15
E880E888,
E848
E890-
Unintentional falls
Accidents caused by
Unintentional
poisoning by and
exposure to Ethyl or
Methyl alcohol
X45 (with T51.0
Ethyl Alcohol or
T51.1 Methyl
Alcohol
diagnosis codes
only)
--
Suicide by alcohol
X65
E960E969
All injury, homicide
X85-Y09, Y87.1
E901
Hypothermia
E880E888,
E848
E890-
Fall unintentional
W93
(manmade), X31
(natural)
W00-W19
Fire/flame
X00-X09
114
fires and flames
E899
fires and flames
E899
unintentional
Unintentional
drowning and
submersion
Non-(ethyl)alcohol
poisoning
E910
Drowning
unintentional
E830E838
E840E845
E911
Water transport
accidents
Air and space transport
accidents
Aspiration
Unintentional
drowning and
submersion
Non-(ethyl)alcohol
poisoning
34
>15
E910
29
>15
E850E858,
E860.3E869
Water transport
accidents
Air and space
transport accidents
Aspiration
18
>15
18
>15
Water transport
accidents
Air and space
transport
18
>15
E830E838
E840E845
E911
Firearm injuries
18
>15
E922
E922
Firearm injuries
Occupational and
machine injuries
18
>15
E917E920
Firearm injuries
(includes new codes
for air guns E922.4
and paintball guns
E922.5)
Occupational and
machine injuries
E917E920
Occupational and
machine injuries
Suicide and selfinflicted injury
23
>15
E950E959
Suicide and selfinflicted injury
(includes new codes
E950E959
Suicide, not by alcohol
specifically
E850Non-(ethyl)alcohol
E858,
poisoning
E860.3E869
W65-W74
X40-X44, X46X49
Y10-Y14, Y16Y19
(poisoning
undetermined
intent, nonalcohol)
V90-V94
V95-V97
W78 (inhalation
of gastric
contents)-W79
W32-W34
W20-W23
(struck by
objects), W24W31 (machinery
piercing)
X60-X64, X66X84, Y87.0
115
for air guns E955.6
and paintball guns
E955.7)
Child maltreatment
(overlaps with
homicide/assault so
need age group)
Motor-vehicle non
traffic crashes
16
<15
E960E968
18
>15
E820E825
Child maltreatment
(overlaps with
homicide/assault so
need age group)
Motor-vehicle non
traffic crashes
E960E968
E820E825
Child maltreatment
(overlaps with
homicide/assault so
need age group)
Motor-vehicle non
traffic crashes
X85-Y09, Y87.1
V02.0, V03.0,
V04.0, V09.0,
V12-V14(.0-.2),
V19.0-V19.3,
V20-V28(.0-.2),
V29.0-V29.3,
V30-V39(.0.3),V40-V49(.0.3), V50-V59(.0.3), V60-V69(.0.3), V70-V79(.0.3), V81.0,
V82.0,
V83-V86(.4-.9),
V88.0-V88.8,
V89.0
116
Other road vehicle
crashes
18
>15
E800E807,
E826E829
Other road vehicle
crashes
E800E807,
E826E829
Other road vehicle
crashes
V01, V05-V06,
V09.1, V09.3,
V09.9, V10V11, V15-V18,
V19.3, V19.8V19.9, V80.0V80.2, V80.6V80.9, V81.2V81.9, V82.2V82.9, V87.9,
V88.9, V89.1,
V89.3, V89.9
1 From http://www.cdc.gov/nchs/data/statab/gmwki_98.pdf
2 Yellow highlights indicate that ICD-9CM codes are more detailed than ICD-9 codes.
3 From http://www.cdc.gov/nchs/icd9.htm#RTF
-- No corresponding ICD-9 or ICD-10 code available for that particular condition.
Attributable Fraction Source: Alcohol-Related Disease Impact (ARDI) software –
http://apps.nccd.cdc.gov/ARDI/HomePage.aspx
117
Table A3. ICD 9/10 Codes for Smoking-Attributable Mortality Fractions
Disease Category
ICD 10
Codes
ICD 9 Codes
MALIGNANT
NEOPLASMS
Trachea, Lung, Bronchus
C33-C34
162
89%
87%
77%
67%
CARDIOVASCULAR
DISEASES
Ischemic Heart Disease
I20-I25
40%
15%
35%
10%
21%
18%
12%
8%
38%
9%
43%
5%
89%
81%
91%
81%
83%
80%
80%
73%
Other Heart Disease
I00-I09, I26I51
Cerebrovascular Disease
I60-I69
410-414,
429.2
390-398,
415-417,
420-429.1,
429.3-429.9
430-438
RESPIRATORY
DISEASES
Bronchitis, Emphysema
Chronic Airway Obstruction
J40-J42
J44
490-492
496
35-64
(%)
65 +
(%)
35-64
(%)
65 +
(%)
Source: Smoking Attributable Mortality, Morbidity and Economic Costs (SAMMEC): http://apps.nccd.cdc.gov/sammec/saf_reports.asp
118
Table A4. ICD 9/10 Codes for Drug-Attributable Mortality Fractions
Percent1
ICD-9
Code1,2
ICD-9CM Diagnosis
Category3
ICD9CM
Code4
ICD-10 Diagnosis
Category
CHRONIC
CONDITIONS 100%
ATTRIBUTABLE TO
DRUG USE
Drug psychosis
100
292
Drug psychosis
[includes 5th digit
codes with more
specific drug induced
mental disorders]
292
Mental and behavioral
disorders due to
psychoactive substance use
(excluding alcohol and
tobacco). [includes 4th
characters: .0 acute
intoxication, .1 harmful use,
.2 dependence syndrome, .3
withdrawal state, .4
withdrawal state with
delirium, .5 psychotic
disorder, .6 amnesic
syndrome, .7 residual and
late-onset psychotic
disorder, .8 other mental
and behavioral disorders, .9
unspecified mental and
behavioral disorder]
Drug dependence
100
304
Drug dependence
[includes 5th digit
codes 0 unspecified, 1
continuous, 2
episodic, 3 in
remission]
304
ICD-9 Diagnosis
Category1
ICD-10
Code5
F11-F-16,
F18
--
119
Nondependent use of drugs
100
305.2305.9
Nondependent use of
drugs [includes 5th
digit codes 0
unspecified, 1
continuous, 2
episodic, 3 in
remission]
305.2305.9
100
CHRONIC
CONDITIONS
PARTIALLY
ATTRIBUTABLE TO
DRUG USE
AIDS
ACUTE CONDITIONS
100% ATTRIBUTABLE
TO DRUG USE
Accidental poisoning by
psychoactive drugs
286
AIDS (HIV-1 and
HIV-2)
042,
079.53
--
Mental and behavioral
disorders due to multiple
drug use and use of other
psychoactive substances
[same 4th characters as F11F18]
F19
AIDS
B20-B24
Note: ICD-10 drug
poisoning categories are
not organized the same
way
as ICD-9. Overall should
include X40-X44, X46.
120
Opiates and related
narcotics
100
E850.0
Heroin, methadone,
other opiates, and
related narcotics
Aromatic analgesics, not
elsewhere classified
100
E850.2
Other non-narcotic
analgesics
100
E850.5
Aromatic analgesics,
not elsewhere
classified
Other non-narcotic
analgesics
Other
100
E850.8
Unspecified analgesics and
antipyretics
100
E850.9
Barbituates
100
E851
Other sedatives and
hypnotics
Tranquilizers
Other psychotropic agents
(including antidepressants)
100
E852
100
100
E853
E854
Other drugs acting on the
central and autonomic
nervous system
100
E855
Other specified
analgesics and
antipyretics
Unspecified
analgesics and
antipyretics
Barbituates
Other sedatives and
hypnotics
Tranquilizers
Other psychotropic
agents (including
antidepressants)
Other drugs acting on
the central and
autonomic nervous
E850.0- Accidental poisoning by
E850.2 and exposure to narcotics
and psychodysleptics
[hallucinogens], not
elsewhere classified
E850.4
E850.7
Accidental poisoning by
and exposure to nonopioid
analgesics, antipyretics and
antirheumatics
E850.8
E850.9
E851
Accidental poisoning by
and exposure to
antiepileptic, sedativehypnotic, antiparkinsonism
and psychotropic drugs, not
elsewhere classified
E852
--
E853
E854
---
E855
Accidental poisoning by
and exposure to other drugs
acting on the autonomic
X43, X46
121
system
Accidental poisoning by
drugs and medicaments
Salicylates
nervous system
100
E850.1
Salicylates
E850.3
Pyrazole derivatives
Antirheumatics
Antibiotics
Other anti-infectives
Other and unspecified
drugs, medicaments and
biological substances
100
100
100
100
100
E850.3
E850.4
E856
E857
E858
Pyrazole derivatives
Antirheumatics
Antibiotics
Other anti-infectives
Other and unspecified
drugs, medicaments
and biological
substances
E850.5
E850.6
E856
E857
E858
Heroin, methadone, other
opiates and related
narcotics, and other drugs
causing adverse effects in
therapeutic use
Self Inflicted
Suicides with drugs and
medicine
Poisoning, Undetermined
Intent
Analgesics, antipyretics,
and antirheumatics
100
E935.0935.2,
E937E940
E935.0935.2,
E937E940
--
100
E950.0- Suicides with drugs
.5
and medicine
E950.0- Suicides with drugs and
.5
medicine
X60-X64
100
E980.0
E980.0
Y10
Analgesics,
antipyretics, and
antirheumatics
(In ICD-10 these
categories are already
covered in X40-X43)
Accidental poisoning by
and exposure to other and
unspecified drugs,
medicaments and biological
substances
Nonopioid analgesics,
antipyretics and
antirheumatics
----X44
122
Barbituates
100
E980.1
Barbituates
E980.1
Other sedatives and
hypnotics
Tranquilizers and other
psychoactive agents
100
E980.2
E980.2
100
E980.3
Other sedatives and
hypnotics
Tranquilizers and
other psychoactive
agents
Other specified drugs and
medicinal agents
100
Unspecified drug or
medicinal substance
Other and unspecified solid
and liquid substances
ACUTE CONDITIONS
PARTIALLY
ATTRIBUTABLE TO
DRUG USE
Homicide and injury
purposely inflicted by other
persons
E980.3
Other specified drugs
and medicinal agents
100
100
E980.4
E980.5
100
E980.9
Other and unspecified
solid and liquid
E980.9
10
E960E969
Homicide and injury
purposely inflicted by
other persons
E960E969
Unspecified drug or
medicinal substance
E980.4
E980.5
Antiepileptic, sedativehypnotic, antiparkinsonism
and psychotropic drugs, not
elsewhere classified
(includes barbituates,
tranquilizers)
Y11
-Narcotics and
psychodysleptics
[hallucinogens], not
elsewhere classified
(includes most illicit
narcotics, drugs acting on
autonomic nervous system
Y12
Other drugs acting on the
autonomic nervous system
Y13
Unspecified drugs,
medicaments, biological
substances
Organic solvents and
halogenated hydrocarbons
and their vapors
Y14
All injury, homicide
Y16
X85-Y09,
Y87.1
123
1 From Source: National Institute on Drug Abuse. The economic costs of alcohol and drug abuse in the United States 1992, Tables 5.5, 5.6, 6.8.
http://www.drugabuse.gov/EconomicCosts/Index.html
2 From http://www.cdc.gov/nchs/data/statab/gmwki_98.pdf
3 Yellow highlights indicate that ICD-9CM codes are more detailed than ICD-9 codes.
4 From http://www.cdc.gov/nchs/icd9.htm#RTF
5 From http://www3.who.int/icd/vol1htm2003/fr-icd.htm
6 28% of AIDS cases were attributed to IV drug use in 2000 versus 36% of cases overall according to CDC ( http://www.cdc.gov/hiv/pubs/facts/idu.htm). The 1992 NIDA report
attributed 32% of AIDS cases to IV drug use based on 1992 National Death Certificate data.
-- No corresponding ICD-9 or ICD-10 code available for that particular condition.
124
Number of Deaths in South Carolina Attributable to Alcohol, Tobacco, and Drug Use
Using the attributable fractions and ICD-10 codes listed in the tables above and 2005 mortality data from the SC DHEC, Tables A5 –
A7 indicate the number of deaths in South Carolina in 2005 that can be attributed to alcohol, tobacco, or drug use, by diagnosis
category.
Table A5. Number of Deaths Attributable to Alcohol Use in South Carolina by ICD-10 Diagnosis Category, 2005
ICD-10 Diagnosis Category
CHRONIC CONDITIONS 100%
ATTRIBUTABLE TO ALCOHOL USE
Mental and behavioral disorders due to use of
alcohol
Alcohol dependence syndrome
Nondependent abuse of alcohol
Degeneration of nervous system due to alcohol
Alcoholic polyneuropathy
Alcoholic cardiomyopathy
Alcoholic myopathy
Alcoholic gastritis
Alcoholic liver disease
Alcohol-induced chronic pancreatitis
Fetal alcohol syndrome
Alcohol affecting fetus
Total
CHRONIC CONDITIONS PARTIALLY
ATTRIBUTABLE TO ALCOHOL USE
Portal hypertension
Acute pancreatitis
Other pancreatitis (not alcohol induced)
ICD-10 Code
Percent
Attributable
to ETOH
Age
SC Deaths
Above or
Below Age
(2005)
SC ETOH
Attributable
Deaths
(2005)
F10.0-F10.1, F10.3-F10.9
100
>20
68
68
F10.2
-G31.2
G62.1
I42.6
G72.1
K29.2
K70.0-K70.9
K86.0
Q86.0
P04.3, O35.4
100
100
100
100
100
100
100
100
100
100
100
>20
>20
>20
>20
>20
>20
>20
>20
>20
<15
<15
30
NA
1
0
5
0
0
251
14
0
0
369
30
1
0
5
0
0
251
14
0
0
369
K76.6
K85
K86.1
40
24
84
>20
>20
>20
2
57
8
1
14
7
125
Gastroesophageal hemorrhage
Liver cirrhosis, unspecified
Esophageal varicies
Epilepsy
Spontaneous abortion (female only)
Total
CHRONIC CONDITIONS PARTIALLY
ATTRIBUTABLE TO ALCOHOL USE
Liver cancer (male)
Liver cancer (female)
Oropharyngeal cancer (male)
Oropharyngeal cancer (female)
Esophageal cancer (male)
Esophageal cancer (female)
Laryngeal cancer (male)
Laryngeal cancer (female)
Chronic hepatitis (male)
Chronic hepatitis (female)
Superventricular cardiac dysrhythmia (male)
Superventricular cardiac dysrhythmia (female)
Stroke, ishemic (male)
Stroke, ishemic (female)
Stroke, hemorrhagic (male)
Stroke, hemorrhagic (female)
Breast cancer (female)
Hypertension (male)
Hypertension (female)
Psoriasis (male only)
K22.6
K74.3-K74.6, K76.0,
K76.9
I85, I98.20, I98.21
G40, G41
O03
C22
C22
C01-C06, C09-C10, C12C14
C01-C06, C09-C10, C12C14
C15
C15
C32
C32
K73
K73
I47.1, I47.9, I48
I47.1, I47.9, I48
G45, I63, I65-I67, I69.3
G45, I63, I65-I67, I69.3
I60-I62, I69.0-I69.2
I60-I62, I69.0-I69.2
C50
I10-I15
I10-I15
L40.0-L40.4, L40.8,
L40.9
47
40
>20
>20
2
282
1
113
40
15
4
>20
>20
>20
1
24
0
376
0
4
0
140
6
3
0.07
>20
>20
>20
157
63
79
9
2
0
0.03
>20
40
0
0.04
0.02
0.07
0.03
2
1
2
1
6
1
10
2
1
3
2
1
>20
>20
>20
>20
>20
>20
>20
>20
>20
>20
>20
>20
>20
>20
>20
>20
174
38
56
8
1
1
67
119
107
219
299
323
654
349
486
0
0
0
0
0
0
0
1
1
6
2
30
6
7
10
10
0
126
Low birthweight, prematurity, IUGR, death
(male)
Low birthweight, prematurity, IUGR, death
(female)
Total
ACUTE CONDITIONS 100%
ATTRIBUTABLE TO ALCOHOL USE
Finding of alcohol in blood
Toxic effect of ethyl and methyl alcohol
Unintentional poisoning by and exposure to ethyl
or methyl alcohol
Alcohol poisoning undetermined intent
Suicide by alcohol
Total
ACUTE CONDITIONS PARTIALLY
ATTRIBUTABLE TO ALCOHOL USE
All injury, homicide
Hypothermia
Fall unintentional
Fire/flame unintentional
Drowning unintentional
Non-(ethyl)alcohol poisoning
Water transport accidents
O36.4, O36.5, P05, P07
4
<15
49
2
O36.4, O36.5, P05, P07
3
<15
34
1
3323
66
R78.0
T51.0-T51.1
X45 (with T51.0 ethyl
alcohol or T51.1 methyl
alcohol diagnosis codes
only)
Y15
X65
100
100
100
>15
>15
>15
0
0
0
0
0
0
100
100
>15
>15
0
0
0
0
0
0
X85-Y09, Y87.1
W93 (manmade), X31
(natural)
W00-W19
X00-X09
W65-W74
X40-X44, X46-X49
Y10-Y14, Y16-Y19
(poisoning
undetermined
intent, non-alcohol)
V90-V94
47
42
>15
>15
593
9
279
4
32
42
34
29
>15
>15
>15
>15
207
67
57
394
66
28
19
114
18
>15
12
2
127
Air and space transport accidents
Aspiration
Firearm injuries
Occupational and machine injuries
Suicide, not by alcohol specifically
Child maltreatment (overlaps with
homicide/assault so need age group)
Motor-vehicle non traffic crashes
Other road vehicle crashes
V95-V97
W78 (inhalation of gastric
contents)-W79
W32-W34
W20-W23 (struck by
objects), W24-W31
(machinery piercing)
X60-X64, X66-X84,
Y87.0
X85-Y09, Y87.1
V02.0, V03.0, V04.0,
V09.0, V12-V14(.0-.2),
V19.0-V19.3, V20V28(.0-.2),
V29.0-V29.3,
V30-V39(.0.3),V40-V49(.0.3), V50-V59(.0.3), V60-V69(.0.3), V70-V79(.0.3), V81.0, V82.0,
V83-V86(.4-.9),
V88.0-V88.8,
V89.0
V01, V05-V06, V09.1,
V09.3, V09.9, V10-V11,
V15-V18, V19.3, V19.8V19.9, V80.0-V80.2,
V80.6-V80.9, V81.2V81.9, V82.2-V82.9,
V87.9, V88.9, V89.1,
V89.3, V89.9
18
18
>15
>15
15
17
3
3
18
18
>15
>15
33
36
6
6
23
>15
449
103
16
<15
10
2
18
>15
254
46
18
>15
4
1
128
Total
GRAND TOTAL
2157
682
1257
Table A6. Number of Deaths Attributable to Tobacco Use in South Carolina by ICD-10 Diagnosis Category, 2005
Age 35-64
Age 65+
SC Tobacco
SC Tobacco
SC
Attributable
Attributable
Deaths
Deaths
SC Deaths
Deaths
ICD-10 Diagnosis Category
ICD-10 Code
Percent
(2005)
(2005)
Percent
(2005)
(2005)
MALIGNANT
NEOPLASMS
Lip, oral cavity, pharynx
C00-C14
77
63
49
71
72
51
Esophagus
C15
72
84
60
72
128
92
Stomach
C16
28
75
21
27
100
27
Pancreas
C25
28
145
41
19
324
62
Larynx
C32
84
28
24
82
35
29
Trachea, lung, bronchus
C33-C34
89
889
791
87
1811
1576
Cervix uteri
C53
31
27
Kidney and renal pelvis
C64-C65
40
54
22
38
140
53
Urinary bladder
C67
48
31
15
46
145
67
Acute myeloid leukemia
C92.0
24
22
5
22
72
16
Total
1422
1028
2854
1973
CARDIOVASCULAR
DISEASES
Ischemic heart disease
Other heart disease
Cerebrovascular disease
Atherosclerosis
Aortic aneurysm
Other arterial disease
Total
I20-I25
I00-I09, I26-I51
I60-I69
I70
I71
I72-I78
40
21
38
32
66
22
1461
729
394
5
42
24
2655
584
153
150
2
28
5
922
15
18
9
26
64
11
2305
2482
2034
64
182
165
7232
346
447
183
17
116
18
1127
129
RESPIRATORY DISEASES
Pneumonia, influenza
Bronchitis, emphysema
Chronic airway obstruction
Total
GRAND TOTAL
J10-J18
J40-J42
J44
23
89
81
102
1
264
23
1
214
22
91
81
642
11
1374
2027
12113
141
10
1113
1264
4364
Table A7. Number of Deaths Attributable to Drug Use in South Carolina by ICD-10 Diagnosis Category, 2005
ICD-10 Diagnosis Category
CHRONIC CONDITIONS 100% ATTRIBUTABLE TO
DRUG USE
Mental and behavioral disorders due to psychoactive substance
use (excluding alcohol and tobacco)
Mental and behavioral disorders due to multiple drug use and use
of other psychoactive substances
Neonatal withdrawal symptoms from maternal use of drugs of
addiction
Total
CHRONIC CONDITIONS PARTIALLY ATTRIBUTABLE
TO DRUG USE
Tuberculosis
Hepatitis C
Hepatitis B
AIDS
Total
Percent
SC Deaths
(2005)
SC Drug
Attributable
Deaths
(2005)
F11-F16, F18
100
8
8
F19
100
13
13
P96.1
100
0
0
21
21
4.5
20
30
9
60
15
0
12
5
28
249
333
70
87
ICD-10 Code
A15-A19
B17.1, B18.2
B16, B17.0, B18.0,
B18.1
B20-B24
130
ACUTE CONDITIONS 100% ATTRIBUTABLE TO DRUG
USE
Acidental Poisoning by Psychoactive Drugs
Accidental poisoning by and exposure to narcotics and
psychodysleptics [hallucinogens], not elsewhere classified
Accidental poisoning by and exposure to nonopioid analgesics,
antipyretics and antirheumatics
Accidental poisoning by and exposure to antiepileptic, sedativehypnotic, antiparkinsonism and psychotropic drugs, not elsewhere
classified
Accidental poisoning by and exposure to other drugs acting on the
autonomic nervous system
Accidental Poisoning by Drugs and Medicaments
Accidental poisoning by and exposure to other and unspecified
drugs, medicaments and biological substances
Self Inflicted
Suicides with drugs and medicine
Poisoning, Undetermined Intent
Nonopioid analgesics, antipyretics and antirheumatics
Antiepileptic, sedative-hypnotic, antiparkinsonism and
psychotropic drugs, not elsewhere classified (includes barbituates,
tranquilizers)
Narcotics and psychodysleptics [hallucinogens], not elsewhere
classified (includes most illicit narcotics, drugs acting on
autonomic nervous system
Other drugs acting on the autonomic nervous system
Unspecified drugs, medicaments, biological substances
Organic solvents and halogenated hydrocarbons and their vapors
Total
ACUTE CONDITIONS PARTIALLY ATTRIBUTABLE TO
DRUG USE
All injury, homicide
X42
100
140
140
X40
100
5
5
X41
100
11
11
X43, X46
100
1
1
X44
100
199
199
X60-X64
100
50
50
Y10
Y11
100
100
1
4
1
4
Y12
100
1
1
Y13
Y14
Y16
100
100
100
0
7
1
420
0
7
1
420
X85-Y09, Y87.1
10
672
67
131
Total
GRAND TOTAL
672
1446
67
595
132