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Section A: Overview and Findings

A.1. Introduction

This report presents estimates of the prevalence of substance use or mental health problems in substate regions based on data from the combined 2004-2006 National Surveys on Drug Use and Health (NSDUHs). An annual survey of the civilian, noninstitutionalized population aged 12 or older, NSDUH is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). It collects information from persons residing in households, noninstitutionalized group quarters (e.g., shelters, rooming houses, dormitories), and civilians living on military bases. In 2004-2006, NSDUH collected data from 203,870 respondents aged 12 or older and was designed to obtain representative samples from all 50 States and the District of Columbia. The survey was planned and managed by SAMHSA's Office of Applied Studies (OAS), and data collection was conducted under contract with RTI International.1

This report marks the third time that detailed estimates for substate regions (also referred to as planning regions, substate areas, or regions) in all 50 States and the District of Columbia have been presented by SAMHSA. The first report to provide such estimates used data from the 1999-2001 surveys (OAS, 2005b). The second report presented estimates for 22 measures or outcomes based on the 2002-2004 NSDUHs (OAS, 2006). This report presents estimates for 23 measures of substance use or mental health problems based on the 2004-2006 NSDUHs. In addition to the 22 measures reported in the 2002-2004 substate report, a past year major depressive episode (MDE) measure was added to this report. These reports provide a more detailed perspective on the variations in substance use rates both within and across States than was possible with prior State reports (e.g., Hughes, Sathe, & Spagnola, 2008; Wright, Sathe, & Spagnola, 2007).

Estimates were generated for 363 substate regions representing collectively the 50 States and the District of Columbia. These regions were defined by officials from each State and were typically based on the substance abuse treatment planning regions specified by the States in their applications for the Substance Abuse Prevention and Treatment (SAPT) Block Grant administered by SAMHSA.

A.2. Format of the Report

Section A provides a brief background on the survey, how substate regions were formed, the general methodological approach, and a brief discussion of selected findings. A complete list of the 23 substance use measures presented in this report is given in Section B, which also provides further information on the small area estimation methodology used to develop substate estimates. Section C includes tables with estimates for each of the 23 measures and the corresponding prediction intervals for all substate regions. It also contains a set of national maps that show the prevalence of each outcome measure for each substate region. The substate regions in the tables in Section C have been ordered alphabetically within each State. There are 10 separate tables, each having two or three related substance use or mental health measures. Estimates for aggregate regions (also specified by certain States) also are included in these tables. Section D contains definitions of the substate regions. Section E includes the population counts for persons aged 12 or older and the combined 2004, 2005, and 2006 NSDUH sample sizes and response rates for each substate region. Users may find the population counts helpful in calculating the weighted average prevalence estimate for any combination of substate regions or to determine the number of people using a particular substance in a substate region. For example, the number of persons aged 12 or older who used marijuana in the past month in Alabama's Region 1 (41,956 persons) could be obtained by multiplying the prevalence rate from Table C2 (4.0 percent—shown as 3.96 percent in the table) and the population estimate from Table E1 (1,059,503). Section F lists the references.

A.3. Overview: Substate Regions, Ranking Regions, and Small Area Estimation Methods

The substate regions for each State were developed in a series of communications between SAMHSA staff and State treatment representatives in late 2007. The goal of the project was to provide substate-level estimates showing the geographic distribution of substance use prevalence for regions that States would find useful for treatment planning purposes.2The final substate region boundaries were based on the State's recommendations assuming that the NSDUH sample sizes were large enough to provide estimates with adequate precision. Most States defined regions in terms of counties or groups of counties. A few States defined the regions in terms of census tracts. Several States also requested estimates for aggregate planning regions along with the estimates for their substate planning regions. An aggregate planning region is made up of two or more substate planning regions. A few of these States wanted the maps to be produced for the aggregate regions instead of their substate planning regions. For example, New York has 15 substate regions, and those 15 regions were combined to create 4 aggregate regions that are used in the maps. Hence, for each measure in this report, maps were produced for 345 planning regions and not for 363 regions. The discussion of findings in this chapter (Section A.5) also is restricted to these 345 planning regions.

These 345 substate regions used in the maps were ranked from lowest to highest for each measure and were divided into seven categories designed to represent distributions that are somewhat symmetric, like a normal distribution. Colors were assigned to all regions such that the third having the lowest prevalence are in blue, the middle third are in white, and the third with the highest prevalence are in red. The only exceptions were the three perception-of-risk outcomes, which have the highest estimates represented in blue and the lowest represented in red. To further discriminate among the regions that display relatively higher prevalence, the "highest" third has been further divided into three categories: dark red for the 15 substate regions with the highest estimates, medium red for the 31 substate regions with the next highest, and light red for the 69 substate regions in the third highest group. The "lowest" third is categorized in a similar way using three distinct shades of blue. Due to tied values of prevalence, the number of substate regions in each category may vary a little.

In addition to this report, the following substate region tables will be available on SAMHSA's website:

These additional tables will be posted at http://samhsa.gov/data/substate.cfm as they become available.

Estimates in this report are based on hierarchical Bayes estimation methods that combine survey data with a national model. Applying this methodology to the State substance use measures has been shown to result in more precise estimates than using the sample-based results alone (Wright, 2002). The methodology used to produce estimates in this report is the same as that used to produce State estimates from the NSDUH data since 1999 and has been used for prior substate reports (see OAS, 2005b, 2006). Sample data have been combined across 3 years (2004-2006) in this report to improve the precision of substate region estimates. The estimate for each region is accompanied by a 95 percent prediction interval (for more details, see Section B, Substate Region Estimation Methodology).

In addition to the substate region estimates, comparable estimates are provided for the 50 States and the District of Columbia using the same methodology. Because these estimates are based on 3 consecutive years of data, they are not directly comparable with the State estimates in earlier reports that are based on only 2 consecutive years. Estimates for the Nation and the four census regions also are presented. These regions, defined by the U.S. Census Bureau, are defined as follows:

Northeast Region - Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.

Midwest Region - Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin.

South Region - Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.

West Region - Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.

Because the small area estimation methods used here tend to borrow strength from both the national model and the State-level random effects, estimates for substate regions with sample sizes that were closer to the minimum (200) tend to be shrunk more toward the corresponding State prevalence estimate than substate regions with large sample sizes. This methodology tends to cluster the small sample substate estimates around their State means. Thus, relatively high estimates for small substate regions tend to shrink toward the State mean, while relatively low estimates tend to increase toward the State mean. On the other hand, for regions with large sample sizes, the methodology produces estimates that are close to the weighted average of the sample data. In addition, these estimates are design consistent so that as the sample size for a substate region increases, the estimate approaches the true population value.

A.4. Comparability with Past Estimates

For the 2002 NSDUH, a number of methodological changes were introduced, including a $30 incentive for participating in the survey, additional training for interviewers to encourage adherence to survey protocols, a change in the survey name, and a shift to the 2000 decennial census (from the 1990 census) as a basis for population counts used in estimation. An unanticipated result of these changes was that the prevalence rates for 2002 were in general substantially higher than those for 2001. These rates were substantially higher than could be attributable to the usual year-to-year trend. Additional information on these methodological changes is available in OAS (2005a).

Because of the changes in the survey that took place in 2002, estimates for 2004-2006 are not comparable with estimates for 1999-2001, and it is not possible to separate the effect of the methodological changes from the true trends in substance use. Therefore, one should not conclude that any differences between estimates from 1999-2001 and 2004-2006 represent true changes. However, estimates from 2002-2004 and 2004-2006 are comparable for outcomes that were defined in a similar manner and for substate regions defined consistently across these time periods. Such estimates of change will be posted at http://samhsa.gov/data/substate.cfm as they become available.

There were 10 States that made changes to their 2002-2004 substate regions for producing the 2004-2006 estimates: Arkansas, Florida, Hawaii, Maine, Maryland, Michigan, New York (made changes to aggregate regions only), North Carolina, South Dakota, and Wisconsin. Except for South Dakota, all of these States had at least one substate region definition that was the same as the 2002-2004 definition. The remaining 40 States and the District of Columbia did not change their definitions of substate regions or aggregate regions. Pennsylvania, however, renamed its substate regions, but the definitions (based on counties) did not change from those shown in the 2002-2004 report.

A.5. Discussion of Findings

A.5.1. Illicit Drug Use

Based on NSDUH data from the 2004-2006 surveys combined, 8.1 percent of persons in the United States aged 12 or older had used an illicit drug in the past month. Northwest Iowa reported the lowest rate at 4.8 percent, and Region 5 in Montana had the highest rate at 13.8 percent. The 15 substate regions with the highest rates were dispersed among 10 States, with Alaska (Rural and Urban), California (Region 1 and Region 4), the District of Columbia (Ward 1 and Ward 2), Massachusetts (Boston and Western), and Rhode Island (Providence and Washington) each accounting for 2 regions. Of the 15 substate regions with the lowest rates of illicit drug use in the past month, 8 regions were from five Midwestern States: Iowa, Kansas, Nebraska, North Dakota, and Ohio. Moreover, Maryland had 3 regions (North Central, Prince George's, and West) and Texas had 2 regions (Region 10 and Region 11) that were among the 15 with the lowest rates of past month illicit drug use.

Marijuana is the most commonly used illicit drug, and many of the substate regions having a high rate of illicit drug use reported similarly high rates of marijuana use. The national rate of past month marijuana use was 6.1 percent in 2004-2006. The lowest rate occurred in Utah's Central, Four Corners, San Juan, and Southwest region (3.0 percent). The highest rate was found in Montana's Region 5 (12.1 percent). The lowest group for past month marijuana use had 9 regions that were the same as those for past month illicit drug use, and 11 of the highest 15 substate regions for past month marijuana use were the same as for past month illicit drug use.

In 2004-2006, 39.2 percent of persons aged 12 or older in the Nation perceived a great risk in smoking marijuana once a month. Substate regions with low rates suggest that a larger percentage of the population do not think that smoking marijuana once a month is a great risk compared with regions with higher rates. The lowest rate was in District of Columbia's Ward 3 (17.9 percent), which was 1 of 2 substate regions in the District of Columbia that were among the regions with the 15 lowest rates. Other States with more than 1 region in the lowest 15 include Alaska and Oregon (2 regions each), New Hampshire (3 regions), and Washington (4 regions). The highest rate was in Mississippi's Region 5 (57.3 percent). Mississippi had 5 substate regions among the 15 with the highest rates. Other States with multiple substate regions in the top 15 included Alabama and Texas, each with 3 regions.

Most recent marijuana initiates were younger than 18 when they first used (OAS, 2007, p. 50). Nationwide, 1.7 percent of persons aged 12 or older had used marijuana for the first time in 2004-2006. Of the 15 regions in the highest group for first-time marijuana use, 8 regions were also in the highest group for past month marijuana use: Alaska (Southeast and Urban regions), Florida (Circuit 2), Massachusetts (Western), Montana (Region 5), Rhode Island (Bristol-Newport and Washington regions), and Vermont (Champlain Valley).

Nationally, 3.7 percent of persons aged 12 or older had used an illicit drug other than marijuana in 2004-2006 in the past month. Illicit drugs other than marijuana include cocaine (and crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutics used nonmedically. The nonmedical use of prescription-type psychotherapeutics includes the nonmedical use of pain relievers, tranquilizers, stimulants, or sedatives and does not include over-the-counter drugs. Past month use of these substances ranged from a low of 2.3 percent in Region 6 of South Dakota to a high of 5.6 percent in the Northern C and D region of West Virginia. In the Midwest, 12 regions (5 in South Dakota, 4 in North Dakota, 2 in Iowa, and 1 in Minnesota) collectively accounted for 80 percent of the 15 regions in the country with the lowest rates of use of an illicit drug other than marijuana in the past month. Of the 15 substate regions with the highest rates, 11 regions were in the South (1 each in Arkansas, the District of Columbia, Louisiana, and Oklahoma; 2 each in Tennessee and West Virginia; and 3 in Florida).

The national prevalence rate for the use of cocaine in the past year among persons aged 12 or older was 2.4 percent in 2004-2006 and ranged from 1.3 percent in Region 6 of South Dakota to 5.2 percent in District of Columbia's Ward 2. Among the 15 substate regions with the highest rate of past year cocaine use, 5 were in the District of Columbia (Ward 1, Ward 2, Ward 3, Ward 5, and Ward 6), 3 were in Rhode Island (Bristol-Newport, Providence, and Washington), and 2 were in Florida (Circuit 2 and Circuit 14). Regions with the lowest rates of past year cocaine use included three regions each from North Dakota, Oklahoma, Oregon, and South Dakota.

During 2004-2006, 4.9 percent of all persons aged 12 or older had used a pain reliever for nonmedical use within the past year. Estimates ranged from 2.5 percent in District of Columbia's Ward 7 to 7.9 percent in Florida's Circuit 1. Oklahoma (Oklahoma County and Tulsa County), Tennessee (Region 1 and Region 4 [Davidson]), Utah (Salt Lake County and Weber-Morgan), and West Virginia (Northern C and D and South Central II) had more than one substate region among the regions with the highest 15 prevalence rates. Regions with the 15 lowest rates included 5 in the District of Columbia (Wards 4 through 8), 3 in South Dakota (Region 2, Region 3, and Region 6), 2 in Maryland (Montgomery and Prince George's Counties), and 2 in Pennsylvania (Regions 19, 26, 28, and 42 and Regions 5, 18, 23, 24, and 46).

A.5.2. Alcohol Use

Alcohol is the most commonly used substance in the United States. Nationally, about half (51.0 percent) of Americans aged 12 or older reported past month use of alcohol in 2004-2006. Utah County, Utah, had the lowest rate of any region in the Nation (21.0 percent). The District of Columbia (Ward 3) had the highest rate (78.7 percent). Among the 15 substate regions with the highest rates, five States each had 2 regions in this group: Connecticut (South Central and Southwest), District of Columbia (Ward 2 and Ward 3), Minnesota (Region 7A [Hennepin] and Region 7C), Rhode Island (Bristol-Newport and Washington), and Wisconsin (Northeastern and Southeastern). The 15 substate regions with the lowest rates of past month alcohol use were distributed across just four States: Kentucky (1 region), Mississippi (5 regions), Utah (5 regions), and West Virginia (4 regions).

Binge alcohol use is defined as drinking five or more drinks 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 30 days prior to the survey. Nationally, past month binge alcohol use was reported by 22.8 percent of persons aged 12 or older during 2004-2006. Utah County, Utah, once again had the lowest rate (12.7 percent), while the highest rate was in Ward 2 in the District of Columbia (38.9 percent). Of the 15 substate regions with the lowest rates of past month binge alcohol use, 12 were distributed across three States: Utah (all 6 regions), West Virginia (4 regions), and Mississippi (2 regions). Of the 15 substate regions with the highest rates of binge drinking, 11 were distributed across four States: District of Columbia (3 regions), North Dakota (2 regions), South Dakota (2 regions), and Wisconsin (4 regions).

In 2004-2006, 41.5 percent of persons aged 12 or older in the Nation perceived a great risk in having five or more drinks of an alcoholic beverage once or twice a week. Substate regions with low rates suggest that a larger percentage of the population do not think that this pattern of drinking is a great risk compared with regions with higher rates. The lowest rate was in Wisconsin's Northeastern region (28.5 percent), which was 1 of 5 Wisconsin regions among the 15 with the lowest rates. North Dakota had 3 regions and Massachusetts had 2 regions among the 15 substate regions with the lowest rates. The highest rate was in Florida's Circuits 11 and 16 substate region, with a rate of 53.0 percent. Substate regions in the top 15 with the highest rates included 3 in Mississippi and 2 each in the District of Columbia, Maryland, and Texas.

The national rate of underage alcohol use in the past month (i.e., past month use of alcohol among persons aged 12 to 20) was 28.3 percent in 2004-2006. The lowest rate occurred in Utah County, Utah (14.5 percent), while the highest rate occurred in the District of Columbia's Ward 2 (53.2 percent). Of the 15 substate regions with the lowest rates of past month underage alcohol use, 9 were in the South (2 in the District of Columbia, 1 in Maryland, 3 in Mississippi, 2 in South Carolina, and 1 in Tennessee). Among the 15 substate regions with the highest rates of past month underage alcohol use, 9 were in the Midwest (1 in Iowa, 3 in North Dakota, 2 in South Dakota, and 3 in Wisconsin).

Nationally, the rate of underage binge drinking during the past month was 19.0 percent in 2004-2006. The highest and lowest rates of past month underage binge alcohol use occurred in the District of Columbia: Ward 2 had the highest rate (39.0 percent), while Ward 7 had the lowest rate (8.7 percent). Of the 15 substate regions with the lowest rates of underage binge drinking, 8 were in four States: District of Columbia (Ward 7 and Ward 8), Maryland (Baltimore City and Prince George's), Mississippi (Region 2 and Region 5), and Tennessee (Region 4 [Davidson] and Region 7 [Shelby]). Of the 15 substate regions with the highest rates of underage binge drinking, 10 were in four States: District of Columbia (Ward 2 and Ward 3), North Dakota (Badlands and West Central, North Central and Northwest, Northeast, and Southeast), Rhode Island (Bristol-Newport and Washington), and Wisconsin (Southeastern and Western).

A.5.3. Tobacco Use

In 2004-2006, 29.5 percent of all persons aged 12 or older used a tobacco product in the past month. Tobacco products include cigarettes, smokeless tobacco (i.e., chewing tobacco or snuff), cigars, or pipe tobacco. Tobacco is the second most commonly used substance in the United States next to alcohol. The lowest rate of past month tobacco use occurred in Utah County, Utah (17.3 percent). The highest rate was in West Virginia's South Central II region (43.1 percent). Of the 15 substate regions with the lowest rates of past month tobacco use, 13 regions were in California (9 regions) and Utah (4 regions); the other 2 regions in this group were Honolulu, Hawaii, and Montgomery County, Maryland. Among the 15 substate regions with the highest rates of past month tobacco use, 4 were in Kentucky and 7 were in West Virginia.

During 2004-2006, the national rate of past month cigarette use among persons aged 12 or older was 25.0 percent. As with past month use of tobacco, the highest rate of past month cigarette use was in West Virginia's South Central II region (35.4 percent), and the lowest rate was in Utah County, Utah (15.9 percent). The majority of the 15 substate regions with the highest rates of past month cigarette use were in Kentucky (3 regions) and West Virginia (6 regions). Of the 15 substate regions with the lowest rates of past month cigarette use, 9 were in California and 4 were in Utah; these are the same regions that were among the 15 with the lowest rates of past month tobacco use.

In 2004-2006, 74.1 percent of persons aged 12 or older in the Nation perceived a great risk in smoking one or more packs of cigarettes per day. Substate regions with low rates suggest that a larger percentage of the population do not think that smoking one more packs of cigarettes is a great risk compared with regions with higher rates. The lowest rate was in Kentucky's Kentucky River, Mountain, and Pathways region (62.7 percent), which was 1 of 5 Kentucky regions among the 15 with the lowest rates. Ohio and Missouri each had 3 substate regions among the 15 with the lowest rates. The highest rate was in District of Columbia's Ward 3 and Florida's Circuits 11 and 16, each with a rate of 80.7 percent. States with multiple regions in the top 15 include California (6 regions), the District of Columbia (4 regions), and Utah (2 regions).

A.5.4. Substance Dependence, Abuse, and Treatment Need

Several series of questions to assess the prevalence of substance use disorders (i.e., dependence on or abuse of a substance) in the past 12 months are included in NSDUH each year. Substances include alcohol and illicit drugs, such as marijuana, cocaine, heroin, hallucinogens, and inhalants, and the nonmedical use of prescription-type psychotherapeutic drugs. These series of questions are used to classify persons as being dependent on or abusing specific substances based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association [APA], 1994). The questions on dependence ask about health and emotional problems, attempts to cut down on use, tolerance, withdrawal, and other symptoms associated with substances used. The questions on abuse ask about problems at work, home, and school; problems with family or friends; physical danger; and trouble with the law due to substance use. Dependence reflects a more severe substance problem than abuse, and persons are classified with abuse of a particular substance only if they are not dependent on that substance.

Nationally, 7.7 percent of the population aged 12 or older was classified with being dependent on or having abused alcohol in the past year in 2004-2006. Past year alcohol dependence or abuse varied from a low of 5.6 percent in Delaware (Sussex County), in Georgia (Region 5), in Mississippi (Region 5), and in southern Utah (Central, Four Corners, San Juan, and Southwest) to a high of 14.0 percent in the District of Columbia (Ward 2). The District of Columbia, Montana, North Dakota, South Dakota, and Wisconsin all had more than one of its substate regions in the highest 15.

In 2004-2006, 2.9 percent of persons aged 12 or older were dependent on or had abused illicit drugs in the past year. The rates among substate regions ranged from a low of 1.8 percent in Pennsylvania's Regions 5, 18, 23, 24, and 46 to 5.9 percent in the District of Columbia's Ward 5. The District of Columbia accounted for 5 of the top 15 substate regions with dependence on or abuse of illicit drugs in the past year. Only 3 of the top 15 substate regions for alcohol dependence or abuse were also in the top 15 for illicit drug dependence or abuse: the District of Columbia's Ward 1, Circuit 2 in Florida, and Region 5 in Montana.

The national rate in 2004-2006 for past year dependence on or abuse of illicit drugs or alcohol among persons aged 12 or older was 9.2 percent. Substate regions that were ranked high for past year dependence on or abuse of alcohol also tended to be ranked high for dependence on or abuse of illicit drugs or alcohol because alcohol accounts for most of the substance dependence or abuse. For example, 10 of the top 15 substate regions for alcohol dependence or abuse were in the top 15 for illicit drug or alcohol dependence or abuse. The substate region with the highest rate of illicit drug or alcohol dependence or abuse (15.4 percent) was Ward 2 in the District of Columbia, and Regions 5, 18, 23, 24, and 46 in Pennsylvania had the lowest rate in the Nation (6.5 percent).

The definition of a person needing but not receiving treatment for an illicit drug use problem is that the person meets the criteria for abuse of or dependence on illicit drugs according to the DSM-IV, but has not received specialty treatment for an illicit drug problem in the past year. Specialty treatment is treatment received at a drug or alcohol rehabilitation facility (inpatient or outpatient), hospital (inpatient only), or mental health center. In 2004-2006, 2.6 percent of persons aged 12 or older needed treatment for an illicit drug use problem in the past year, but did not receive it. The lowest rate in the Nation (1.5 percent) occurred in Pennsylvania's Regions 5, 18, 23, 24, and 46. The region with the highest rate in the Nation (4.8 percent) was Detroit City in Michigan.

Arkansas, California, the District of Columbia, Florida, and Rhode Island each had more than one substate region among those with the highest rates of needing but not receiving treatment for illicit drug use problems. The top 15 substate regions were not very clustered and represented 10 different States.

In 2004-2006, the percentage of persons aged 12 or older who needed but did not receive treatment for alcohol use problems was more than twice as large (7.3 percent) as the percentage for illicit drug use problems. Generally, the substate regions with the highest rates of untreated alcohol use problems were not the same as those regions with the highest rates of untreated illicit drug use problems. Only Circuit 2 of Florida and Region 5 of Montana were among the top 15 for both measures. The District of Columbia's Ward 2 had a rate of 13.8 percent, the highest in the Nation, and Sussex County in Delaware had the lowest rate (5.1 percent).

A.5.5. Serious Psychological Distress and Major Depressive Episode among Adults

In 2004-2006, past year serious psychological distress (SPD) was present in 11.5 percent of adults aged 18 or older in the Nation. The 15 substate regions with the highest rates of SPD included 6 in West Virginia and 2 each in Kentucky, Missouri, and Utah. Southern II region in West Virginia had the highest rate of past year SPD (16.5 percent). Montgomery County, Maryland, had the lowest rate (8.7 percent). Of the 15 substate regions with the lowest rates of SPD, Florida and Maryland each had 4 regions and Hawaii had 2 regions.

This report marks the first time that estimates of the prevalence of a major depressive episode (MDE) are being reported at the substate level. Nationally, 7.6 percent of adults aged 18 or older experienced having MDE in the past year. Salt Lake County, Utah, had the highest rate (11.1 percent), while Circuits 11 and 16 in Florida had the lowest rate (5.7 percent). Of the 15 substate regions with the highest rates, the District of Columbia and Wyoming each had 3 regions, and Nevada and Utah each had 2 regions. Regions with the lowest estimates of MDE included California and Florida (3 regions each) and Hawaii and Texas (2 regions each).

For details on how SPD and MDE were measured, refer to Section B.7 of this report and Sections A.8 and A.9 in Appendix A of the 2005-2006 NSDUH State report (Hughes et al., 2008).

A.6. Caveats

In Section A.5, a discussion covering most of the 23 substance use measures shown in Section C was presented. This discussion was primarily limited to providing the range of rates from lowest to highest in the Nation and any State-level clustering of substate regions in the lowest 15 or the highest 15 group of substate regions. It is important to note that these estimates are based on a sample, and that different samples could result in slightly different high and low regions. For example, Montana's Region 5 had the highest rate of past month illicit drug use (13.8 percent) of any substate region in the Nation. It can be stated with 95 percent confidence that the true value for Region 5 falls between 11.4 and 16.8 percent (see Table C1). Estimates in the highest group ranged from 11.7 in Providence, Rhode Island, to 13.8 in Montana's Region 5; therefore, Montana's Region 5 estimate of past month illicit drug use may not be any different from estimates shown in the other regions in the highest group.

The tables presented in Section C contain estimates for 363 substate regions, 21 aggregated substate regions, 50 States and the District of Columbia, 4 census regions, and the total United States. The national maps included in that section display 345 substate regions (a combination of substate regions and aggregate substate regions) to satisfy requests made by some States to only show aggregate substate regions (see Section D). The discussion in Section A.5 above is based only on these 345 substate or aggregate substate regions.


End Notes

1 RTI International is a trade name of Research Triangle Institute.

2 These regions were defined by officials from each State, typically based on the substance abuse treatment planning regions specified by States in their applications for a SAPT Block Grant administered by SAMHSA. There is extensive variation in treatment planning regions across States. In some States, the planning regions are used more for administrative purposes rather than for planning purposes. Because the estimation method required a minimum NSDUH sample size of approximately 200 to provide adequate precision, planning regions with sample sizes that were much smaller than that were collapsed with adjacent regions until an adequate sample size was obtained.

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