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Appendix E: Other Sources of State-Level Data

A variety of surveys and data systems other than the National Survey on Drug Use and Health (NSDUH) collect data on substance use and mental health problems. It is useful to consider the results of these other studies when discussing NSDUH data. This appendix briefly describes one of these other data systems that publish State estimates, presenting selected comparisons with NSDUH results. The State-level survey that collects data on substance use discussed in this appendix is the Behavioral Risk Factor Surveillance System (BRFSS), sponsored by the Centers for Disease Control and Prevention (CDC). Another CDC data system that provides State-level substance use estimates for most but not all States is the Youth Risk Behavior Survey (YRBS). Differences between the YRBS and NSDUH sampling designs, and age groups used in NSDUH small area estimates, imply that comparisons of prevalence rates are not straightforward. However, ignoring these differences and examining estimates at a national level, the YRBS has generally shown to have higher prevalence rates but similar long-term trends compared with NSDUH (Office of Applied Studies [OAS], 2010a). For further details about the YRBS, see the CDC Web site at http://www.cdc.gov/HealthyYouth/yrbs/index.htm.

When considering the information presented here, it is important to understand the methodological differences between these surveys and the impact that these differences could have on estimates of substance use. Several studies have compared NSDUH estimates with estimates from other studies and have evaluated how differences may have been affected by differences in survey methodology (Brener et al., 2006; Gfroerer, Wright, & Kopstein, 1997; Grucza, Abbacchi, Przybeck, & Gfroerer, 2007; Hennessy & Ginsberg, 2001; Miller et al., 2004). These studies suggest that the goals and approaches of surveys are often different, making comparisons between them difficult. Some methodological differences that have been identified as affecting comparisons include populations covered, sampling methods, mode of data collection, survey setting, questionnaires, and estimation methods.

BRFSS is a State-based system of health surveys that collect information on health risk behaviors (including cigarette and alcohol use), preventive health practices, and health care access primarily related to chronic disease and injury. BRFSS is an annual, State-based telephone (landline only) survey of the civilian, noninstitutionalized adult population aged 18 or older and is sponsored by the CDC. In 2009, BRFSS collected data from all 50 States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam using a computer-assisted telephone interviewing (CATI) design. More than 350,000 adults are interviewed each year. State estimates are presented on a yearly basis. BRFSS data are weighted based on the probability of selection of a telephone number, the number of adults in a household, and the number of telephones in a household. A final poststratification adjustment is made for nonresponse and noncoverage of households without telephones. The BRFSS State prevalence rates and confidence intervals presented in this report (in Tables E.1 and E.2 at the end of this appendix) are weighted design-based estimates (i.e., each respondent is weighted, and the survey design is accounted for in the estimates) from the 2009 survey. For more details about BRFSS, see the CDC Web site at http://www.cdc.gov/brfss.

There are three measures for which State estimates are produced for both BRFSS and NSDUH: past month alcohol use, past month binge alcohol use, and cigarette use ("past month" use for NSDUH and "current" use for BRFSS). Past month alcohol use is defined consistently in both BRFSS and NSDUH as having an alcoholic beverage in the past month. In NSDUH, past month cigarette use is defined as having smoked part or all of a cigarette during the past 30 days. In BRFSS, the cigarette use measure reported is current cigarette use, which is defined as having smoked at least 100 cigarettes during the lifetime and indicating smoking every day or some days at the time of the survey. Because of these subtle but present differences in definitions, the NSDUH estimates tend to be higher in that they catch 2 groups of people that the BRFSS estimates would not: (1) respondents who have not smoked 100 cigarettes in their lifetime but had smoked in the past month, and (2) respondents who had smoked a cigarette earlier in the month but were not smoking at the time of the survey. Lastly, both surveys ask about binge alcohol use in the past month. The definition for binge alcohol use in NSDUH is having had five or more drinks of an alcoholic beverage on the same occasion (i.e., at the same time or within a couple hours of each other) on at least 1 day in the past 30 days. In BRFSS, women are asked about drinking four or more drinks on one occasion, whereas men are asked about drinking five or more drinks on one occasion.

In this appendix, the findings of the 2009 BRFSS State estimates and the combined 2008-2009 NSDUH State estimates for past month alcohol use and cigarette use ("past month" use for NSDUH and "current" use for BRFSS) are presented. In Tables E.1 and E.2, the 2009 BRFSS State estimates for adults aged 18 or older are shown alongside the pooled 2008-2009 NSDUH small area estimates for the same age group (by combining the 18 to 25 and 26 or older age groups). Table E.1 also includes p values that indicate whether the BRFSS and NSDUH estimates are significantly different from each other for a given State using an exact test described in Section E.1. As can be seen in Table E.2, the NSDUH past month cigarette use estimates tend to be higher than the current cigarette use estimates from BRFSS; no p values of differences are shown. Because the definitions for binge alcohol use in the two surveys are different for women, no comparison of binge alcohol use was done.

E.1 Methodology for Comparing BRFSS and NSDUH Estimates

The method for comparing the two estimates is similar to what is described in Section A.12 of Appendix A. Here, the null hypothesis of no difference is tested, that is, Pi sub b = Pi sub n (where Pi sub b is a State-specific BRFSS prevalence rate and Pi sub n is a State-specific NSDUH prevalence rate) or equivalently that the logs-odds ratio is zero, that is, Log-odds ratio lor = 0, where Log-odds ratio lor is defined as The log-odds ratio, lor, is defined as the natural logarithm of the ratio of two quantities. The numerator of the ratio is Pi sub b, divided by 1 minus Pi sub b. The denominator of the ratio is Pi sub n, divided by 1 minus Pi sub n., where ln denotes the natural logarithm. An estimate of Log-odds ratio lor is given by The estimate of the log-odds ratio, lor hat, is defined as the natural logarithm of the ratio of two quantities. The numerator of the ratio is p sub b, divided by 1 minus p sub b. The denominator of the ratio is p sub n, divided by 1 minus p sub n., where p sub b and  p sub n are the 2009 BRFSS State estimates and the 2008-2009 NSDUH State estimates, respectively (as given in Tables E.1 and E.2). To compute the variance of estimate of the log-odds ratio, lor hat, that is, variance of the estimate of the log-odds ratio, lor hat, let Theta sub b hat is defined as the ratio of p sub b and 1 minus p sub b. and Theta sub n hat is defined as the ratio of p sub n and 1 minus p sub n.,

then Variance v of the estimate of the log-odds ratio, lor hat, is a function of three quantities: q1, q2, and q3. It is expressed as the sum of q1 and q2 minus q3. Quantity q1 is the variance of the natural logarithm of Theta sub b hat, quantity q2 is the variance of the natural logarithm of Theta sub n hat, and quantity q3 is 2 times the covariance between the natural logarithm of Theta sub b hat and the natural logarithm of Theta sub n hat.. The covariance term can be assumed to be zero because the BRFSS and NSDUH samples are independent.

The quantity variance of the natural logarithm of Theta sub n hat can be obtained by using the 95 percent Bayesian confidence intervals in Tables E.1 and E.2. For this purpose, let (Lower sub n and upper sub n represent the 95 percent prediction interval for a State estimate from NSDUH.) denote the 95 percent Bayesian confidence interval for a given State-s:

Equation E1     D

where U sub n is the natural logarithm of upper sub n, divided by 1 minus upper sub n. and L sub n is the natural logarithm of lower sub n, divided by 1 minus lower sub n.


The quantity variance of the natural logarithm of Theta sub b can be obtained by using the 95 percent confidence intervals in Tables E.1 and E.2. For this purpose, let (Lower sub b and upper sub b represent the 95 percent confidence interval for a State estimate from BRFSS.) denote the 95 percent confidence intervals for a given State-s. Using the first-order Taylor series approximation, the variance can be calculated as follows:

Equation E2     D



The p value (given in Table E.1) for testing the null hypothesis of no difference (Log-odds ratio lor = 0) is given by The p value is equal to 2 times the probability of realizing a standard normal variate greater than or equal to the absolute value of a quantity z., where Zeta is a standard normal random variate, Quantity z is the estimate of the log-odds ratio, lor hat, divided by the square root of the sum of the variance of the natural logarithm of Theta sub b hat and the variance of the natural logarithm of Theta sub n hat., and absolute value of quantity z denotes the absolute value of quantity z.

E.2 Alcohol Use

As can be seen in Table E.1, for past month alcohol use, the NSDUH and the BRFSS estimates for more than half of the States are similar (i.e., at the 5 percent level of significance, only 23 of 51 States, including the District of Columbia, are different). These estimates are also highly correlated (correlation coefficient = 0.95). Figures E.1 and E.2 were created by using the BRFSS State estimates and the NSDUH State estimates and categorizing the States into five quintiles similar to the process described in Section 1.2 of Chapter 1. Note that the BRFSS estimates and corresponding confidence intervals are rounded to one decimal place, whereas the NSDUH small area estimates and Bayesian confidence intervals are rounded to two decimal places. Therefore, all of the Tables and maps included in this appendix use that approximation.

As can be seen in Figures E.1 and E.2, 9 out of 10 States with the highest rates of alcohol use (States shown in red) were the same in the two surveys: Colorado, Connecticut, District of Columbia, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont, and Wisconsin. The lowest rate of past month alcohol use was in Tennessee for the BRFSS survey and in Utah for NSDUH; both of these States were in the bottom 10 in both surveys (see Table E.1 and Figures E.1 and E.2).

E.3 Cigarette Use

As can be seen in Table E.2, the NSDUH estimates of past month cigarette use are always larger than the BRFSS estimates of current cigarette use. Some of this difference is the result of the differences in definitions as discussed earlier in this appendix; thus, exact tests to see significant differences between the NSDUH and BRFSS cigarette use estimates are not included. Although the NSDUH estimates are consistently larger for all 50 States and the District of Columbia, these 2 set of estimates are correlated (correlation coefficient = 0.88).

Figures E.3 and E.4 were created using the same method used to produce Figures E.1 and E.2. As can be seen in Figures E.3 and E.4, 7 out of 10 States with the highest rates of cigarette use (States shown in red) were the same in the 2 surveys: Alabama, Indiana, Kentucky, Louisiana, Oklahoma, Tennessee, and West Virginia. The lowest rate of cigarette use for both surveys occurred in Utah (see Table E.2).

E.4 Sample Size Comparisons

The BRFSS estimates are design based; however, the NSDUH estimates are model based. Also, the NSDUH estimates are based on the pooled 2008 and 2009 NSDUHs (two years of data), whereas the BRFSS estimates are based on the 2009 BRFSS survey (one year of data). Although the BRFSS estimates are only based on one year of data, the BRFSS sample sizes for a given State are in general much larger than the sample sizes for NSDUH over two years. The eight "large" States14 (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas) have a sample size of approximately 7,200 respondents each for the 2008-2009 combined NSDUH data. For the 2009 BRFSS, two States (Illinois and New York) had a slightly smaller sample size as compared with the NSDUH data, but the other six States had larger sample sizes. Overall, the BRFSS sample sizes for the 8 "large" States varied from a low of 5,845 respondents in Illinois to a high of 17,392 respondents in California, with a median sample size of 9,515. For the remaining 43 small sample States, the NSDUH sample size for the combined 2008-2009 data were approximately 1,800 respondents for each State. The BRFSS sample sizes for the small sample States were much larger (they varied from a low of 2,432 respondents in Alaska to a high of 20,294 respondents in Washington, with a median sample size of 6,664). Sample size differences of this magnitude explain why the NSDUH Bayesian confidence intervals are generally wider than the corresponding BRFSS design-based confidence intervals.

Table E.1 Alcohol Use in Past Month among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2009 BRFSS and 2008-2009 NSDUHs
State 2009 BRFSS
(Estimate)
2009 BRFSS
(95% Confidence
Interval)
2008-2009
NSDUH
(Estimate)
2008-2009 NSDUH
(95% Confidence Interval)
p value
NOTE: NSDUH estimates along with the 95 percent Bayesian confidence (credible) intervals are based on a survey-weighted hierarchical Bayes estimation approach and are generated by Markov Chain Monte Carlo techniques.
BRFSS estimates are based on a survey-weighted direct estimation approach.
NOTE: p value: Probability of no difference between the BRFSS and NSDUH estimates.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies), National Survey on Drug Use and Health, 2008-2009; CDC, Behavioral Risk Factor Surveillance System, 2009.
Alabama 37.1 (35.3 - 39.0) 46.24 (42.82 - 49.70) 0.000
Alaska 55.2 (52.0 - 58.4) 59.45 (55.93 - 62.87) 0.079
Arizona 52.4 (49.6 - 55.3) 55.42 (51.83 - 58.96) 0.196
Arkansas 40.8 (38.5 - 43.2) 46.34 (42.82 - 49.91) 0.010
California 52.9 (51.8 - 54.1) 54.93 (52.95 - 56.90) 0.082
Colorado 60.4 (59.0 - 61.8) 66.52 (63.04 - 69.83) 0.002
Connecticut 67.0 (65.3 - 68.7) 63.72 (60.17 - 67.12) 0.092
Delaware 57.8 (55.6 - 60.1) 60.52 (56.72 - 64.21) 0.225
District of Columbia 68.1 (66.2 - 70.1) 65.08 (61.70 - 68.32) 0.120
Florida 51.3 (49.5 - 53.1) 54.92 (52.90 - 56.93) 0.009
Georgia 45.4 (43.4 - 47.5) 53.18 (49.58 - 56.74) 0.000
Hawaii 50.5 (48.8 - 52.3) 51.80 (48.14 - 55.45) 0.529
Idaho 44.6 (42.6 - 46.5) 49.61 (46.29 - 52.93) 0.011
Illinois 56.5 (54.8 - 58.3) 58.66 (56.70 - 60.58) 0.106
Indiana 47.5 (45.9 - 49.1) 51.74 (48.34 - 55.12) 0.027
Iowa 57.4 (55.7 - 59.1) 60.83 (57.52 - 64.04) 0.070
Kansas 50.0 (49.0 - 51.0) 58.19 (54.57 - 61.72) 0.000
Kentucky 39.2 (37.2 - 41.1) 41.50 (38.22 - 44.86) 0.240
Louisiana 48.1 (46.5 - 49.6) 52.13 (48.67 - 55.57) 0.037
Maine 57.9 (56.5 - 59.4) 59.04 (55.42 - 62.57) 0.564
Maryland 56.1 (54.5 - 57.7) 58.44 (54.65 - 62.13) 0.264
Massachusetts 63.0 (61.7 - 64.3) 66.05 (62.63 - 69.31) 0.101
Michigan 55.4 (53.9 - 56.9) 59.15 (57.22 - 61.05) 0.003
Minnesota 61.5 (59.6 - 63.4) 65.98 (62.51 - 69.29) 0.026
Mississippi 36.7 (35.3 - 38.1) 43.63 (40.32 - 46.99) 0.000
Missouri 50.1 (48.0 - 52.3) 53.92 (50.39 - 57.41) 0.070
Montana 58.5 (56.8 - 60.3) 62.84 (59.21 - 66.32) 0.035
Nebraska 59.1 (57.5 - 60.8) 58.09 (54.47 - 61.63) 0.616
Nevada 54.0 (51.2 - 56.8) 58.85 (54.83 - 62.75) 0.052
New Hampshire 64.7 (62.8 - 66.5) 68.84 (65.38 - 72.11) 0.038
New Jersey 57.6 (56.2 - 59.0) 58.49 (54.50 - 62.37) 0.678
New Mexico 49.5 (47.9 - 51.2) 51.17 (47.52 - 54.82) 0.413
New York 55.8 (54.1 - 57.6) 59.74 (57.68 - 61.77) 0.004
North Carolina 45.5 (44.0 - 47.1) 51.17 (47.70 - 54.62) 0.003
North Dakota 60.5 (58.5 - 62.5) 61.70 (58.25 - 65.03) 0.553
Ohio 53.7 (52.2 - 55.2) 55.61 (53.57 - 57.64) 0.139
Oklahoma 42.7 (41.1 - 44.2) 49.17 (45.41 - 52.93) 0.002
Oregon 58.8 (56.7 - 61.0) 64.07 (60.50 - 67.50) 0.013
Pennsylvania 54.6 (53.0 - 56.1) 59.56 (57.57 - 61.52) 0.000
Rhode Island 64.0 (62.2 - 65.7) 64.19 (60.55 - 67.67) 0.926
South Carolina 43.4 (41.6 - 45.1) 49.54 (45.94 - 53.15) 0.003
South Dakota 59.6 (57.7 - 61.4) 62.48 (59.00 - 65.84) 0.150
Tennessee 25.1 (23.2 - 27.0) 44.22 (40.58 - 47.92) 0.000
Texas 51.3 (49.6 - 53.0) 52.70 (50.73 - 54.66) 0.292
Utah 25.8 (24.5 - 27.0) 30.92 (27.95 - 34.06) 0.002
Vermont 64.5 (63.0 - 66.1) 64.27 (60.67 - 67.73) 0.909
Virginia 52.0 (49.6 - 54.4) 54.74 (51.13 - 58.31) 0.215
Washington 59.1 (58.1 - 60.1) 60.49 (57.09 - 63.78) 0.439
West Virginia 28.3 (26.6 - 29.9) 40.49 (36.89 - 44.20) 0.000
Wisconsin 66.8 (64.5 - 69.0) 66.30 (62.81 - 69.61) 0.809
Wyoming 54.4 (52.6 - 56.2) 58.02 (54.38 - 61.58) 0.080
Table E.2 Cigarette Use among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2009 BRFSS and 2008-2009 NSDUHs
State 2008 BRFSS1
(Estimate)
2008 BRFSS1
(95% Confidence
Interval)
2007-2008
NSDUH2
(Estimate)
2007-2008 NSDUH2
(95% Prediction
Interval)
1 BRFSS respondents were classified as current smokers if they reported having smoked at least 100 cigarettes during their lifetime and indicated that they smoked every day or some days at the time of the survey.
2 NSDUH respondents were classified as past month cigarette users if they smoked all or part of a cigarette during the past 30 days.
NOTE: NSDUH estimates along with the 95 percent Bayesian confidence (credible) intervals are based on a survey-weighted hierarchical Bayes estimation approach and are generated by Markov Chain Monte Carlo techniques.
BRFSS estimates are based on a survey-weighted direct estimation approach.
Sources: SAMHSA, Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies), National Survey on Drug Use and Health, 2008-2009; CDC, Behavioral Risk Factor Surveillance System, 2009.
Alabama 22.5 (20.9 - 24.1) 28.54 (26.02 - 31.20)
Alaska 20.6 (18.2 - 23.0) 26.04 (23.48 - 28.77)
Arizona 16.1 (14.2 - 18.1) 23.47 (21.06 - 26.07)
Arkansas 21.5 (19.4 - 23.5) 32.30 (29.43 - 35.31)
California 12.9 (12.1 - 13.6) 20.73 (19.34 - 22.19)
Colorado 17.1 (15.9 - 18.2) 23.67 (21.30 - 26.21)
Connecticut 15.4 (13.9 - 17.0) 22.88 (20.43 - 25.53)
Delaware 18.3 (16.5 - 20.1) 27.16 (24.51 - 29.97)
District of Columbia 15.3 (13.6 - 16.9) 25.32 (22.76 - 28.06)
Florida 17.1 (15.8 - 18.4) 24.04 (22.53 - 25.62)
Georgia 17.7 (16.1 - 19.3) 26.24 (23.64 - 29.01)
Hawaii 15.4 (14.0 - 16.7) 21.44 (18.98 - 24.13)
Idaho 16.3 (14.8 - 17.8) 24.81 (22.54 - 27.22)
Illinois 18.6 (17.1 - 20.1) 26.59 (25.09 - 28.15)
Indiana 23.1 (21.7 - 24.5) 28.58 (26.01 - 31.29)
Iowa 17.2 (15.8 - 18.6) 26.47 (24.18 - 28.90)
Kansas 17.8 (17.0 - 18.7) 26.59 (24.19 - 29.13)
Kentucky 25.6 (23.9 - 27.3) 34.02 (31.06 - 37.13)
Louisiana 22.1 (20.7 - 23.4) 28.57 (26.04 - 31.25)
Maine 17.3 (16.1 - 18.5) 27.15 (24.56 - 29.91)
Maryland 15.2 (14.0 - 16.4) 21.51 (19.10 - 24.13)
Massachusetts 15.0 (14.0 - 16.0) 22.39 (20.06 - 24.91)
Michigan 19.6 (18.4 - 20.8) 27.95 (26.38 - 29.58)
Minnesota 16.8 (15.2 - 18.3) 24.94 (22.58 - 27.45)
Mississippi 23.3 (22.0 - 24.6) 28.34 (25.78 - 31.06)
Missouri 23.1 (21.2 - 25.0) 28.06 (25.42 - 30.87)
Montana 16.8 (15.5 - 18.2) 26.08 (23.54 - 28.79)
Nebraska 16.7 (15.3 - 18.1) 25.94 (23.41 - 28.65)
Nevada 22.0 (19.6 - 24.5) 26.24 (23.38 - 29.32)
New Hampshire 15.8 (14.2 - 17.3) 24.69 (22.32 - 27.22)
New Jersey 15.8 (14.7 - 16.9) 22.45 (19.87 - 25.26)
New Mexico 17.9 (16.6 - 19.3) 24.11 (21.68 - 26.72)
New York 18.0 (16.6 - 19.4) 22.68 (21.21 - 24.23)
North Carolina 20.3 (19.0 - 21.6) 28.29 (25.67 - 31.07)
North Dakota 18.6 (16.9 - 20.3) 26.06 (23.56 - 28.71)
Ohio 20.3 (19.1 - 21.6) 28.43 (26.81 - 30.10)
Oklahoma 25.5 (24.1 - 26.9) 30.09 (27.25 - 33.08)
Oregon 17.9 (16.0 - 19.7) 26.46 (23.81 - 29.30)
Pennsylvania 20.2 (18.9 - 21.6) 26.42 (24.84 - 28.06)
Rhode Island 15.1 (13.7 - 16.5) 23.99 (21.44 - 26.75)
South Carolina 20.4 (18.9 - 21.8) 28.72 (26.08 - 31.52)
South Dakota 17.5 (16.0 - 19.0) 26.48 (24.02 - 29.10)
Tennessee 22.0 (20.2 - 23.9) 30.24 (27.52 - 33.11)
Texas 17.9 (16.4 - 19.4) 24.29 (22.81 - 25.83)
Utah 9.8 (8.9 - 10.7) 17.84 (15.51 - 20.42)
Vermont 17.1 (15.8 - 18.5) 23.59 (21.06 - 26.32)
Virginia 19.0 (16.8 - 21.2) 24.73 (22.26 - 27.39)
Washington 14.9 (14.2 - 15.7) 24.37 (22.00 - 26.90)
West Virginia 25.6 (24.0 - 27.2) 32.37 (29.53 - 35.35)
Wisconsin 18.8 (16.7 - 20.8) 27.34 (24.76 - 30.07)
Wyoming 19.9 (18.4 - 21.5) 27.98 (25.32 - 30.81)

Below is a map; click here for the text describing this map.

Figure E.1 Alcohol Use in Past Month among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2009 BRFSS

Figure E.1

Source: Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey, 2009.

Below is a map; click here for the text describing this map.

Figure E.2 Alcohol Use in Past Month among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2008-2009 NSDUHs

Figure E.2

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.

Below is a map; click here for the text describing this map.

Figure E.3 Current Cigarette Use among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2009 BRFSS

Figure E.3

Source: Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey, 2009.

Below is a map; click here for the text describing this map.

Figure E.4 Cigarette Use in Past Month among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2008-2009 NSDUHs

Figure E.4

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, NSDUH, 2008 and 2009.


End Notes

14 The eight most populous States are referenced as the "large" States in this report.

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