2016-2018 National Surveys on Drug Use and Health:
Guide to Substate Tables and Summary of Small Area Estimation Methodology

Section A: Overview

A.1. Introduction

This document provides information on the model-based small area estimates of substance use and mental disorders in substate regions based on data from the combined 2016-2018 National Surveys on Drug Use and Health (NSDUHs). The estimates along with other related information are available at https://www.samhsa.gov/data/.

NSDUH is an annual survey conducted from January through December of the civilian, noninstitutionalized population aged 12 or older and is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services. NSDUH is planned and managed by SAMHSA's Center for Behavioral Health Statistics and Quality (CBHSQ). Data collection and analysis are conducted under contract with RTI International.1

NSDUH is the primary source of statistical information on the use of illicit drugs, alcohol, and tobacco by the U.S. civilian, noninstitutionalized population aged 12 or older. The survey also includes several series of questions focusing on mental health issues. Conducted by the federal government since 1971, NSDUH collects data through face-to-face interviews with a representative sample of the population at the respondent's place of residence.

In 2016-2018, the survey collected data from 203,765 respondents aged 12 or older and was designed to obtain representative samples from the 50 states and the District of Columbia. It covers residents of households and noninstitutional group quarters (e.g., shelters, rooming houses, dormitories) and from civilians living on military bases. NSDUH excludes homeless people who do not use shelters, military personnel on active duty, and residents of institutional group quarters, such as jails and hospitals.

The 1999 survey marked the first year in which the national sample was interviewed using a computer-assisted interviewing (CAI) method. The survey used a combination of computer-assisted personal interviewing (CAPI) conducted by an interviewer and audio computer-assisted self-interviewing (ACASI). Use of ACASI is designed to provide the respondent with a highly private and confidential means of responding to questions and increases the level of honest reporting of illicit drug use and other sensitive behaviors. For further details on the development of the CAI procedures for the 1999 National Household Survey on Drug Abuse (NHSDA),2 see the Office of Applied Studies (OAS, 2001).3

The 1999 through 2001 NHSDAs and the 2002 through 2013 NSDUHs employed an independent, multistage area probability sample for each of the 50 states and the District of Columbia. For this design, eight states were designated as large sample states (California, Florida, Illinois, Michigan, New York, Ohio, Pennsylvania, and Texas) with target sample sizes of 3,600 per year. For the remaining 42 states and the District of Columbia, the target sample size was 900 per year. This approach ensured there was sufficient sample in every state to support small area estimation (SAE) production at the state and substate level, while at the same time maintaining efficiency for national estimates. The design also oversampled youths aged 12 to 17 and young adults aged 18 to 25 so that each state's sample was approximately equally distributed among three major age groups: 12 to 17 years, 18 to 25 years, and 26 years or older.

A coordinated design was developed for the 2014 through 2017 NSDUHs. A large reserve sample was selected at the time the 2014 through 2017 NSDUH sample was selected. This reserve sample was (or will be) used to field the 2018 through 2022 NSDUHs. Thus, the 2018 through 2022 NSDUHs simply continue the coordinated design. Similar to the 1999 through 2013 surveys, the coordinated 4-year design (2014 through 2017) is state-based with an independent, multistage area probability sample within each state and the District of Columbia. This design designates 12 states as large sample states that have the following target sample sizes per year: 4,560 completed interviews in California; 3,300 completed interviews each in Florida, New York, and Texas; 2,400 completed interviews each in Illinois, Michigan, Ohio, and Pennsylvania; and 1,500 completed interviews each in Georgia, New Jersey, North Carolina, and Virginia. Making the sample sizes more proportional to the state population sizes improves the precision of national NSDUH estimates. This change also allows for a more cost-efficient sample allocation to the 12 large sample states while slightly increasing the sample sizes in the 38 remaining smaller states and the District of Columbia to improve the precision of state and substate estimates.4

Starting in 2014, the allocation of the NSDUH sample is 25 percent for adolescents aged 12 to 17, 25 percent for adults aged 18 to 25, and 50 percent for adults aged 26 or older. The sample of adults aged 26 or older is further divided into three subgroups: aged 26 to 34 (15 percent), aged 35 to 49 (20 percent), and aged 50 or older (15 percent). For more information on the 2014 through the 2017 NSDUH sample design and for differences between the 2013 and 2014 surveys, refer to the 2014 NSDUH sample design report (CBHSQ, 2015a).

This marks the ninth time5 that estimates for substate regions (also referred to as planning regions or substate areas) in all 50 states and the District of Columbia have been presented by SAMHSA. Here, substate-level small area estimates are provided for 30 binary (0, 1) substance use or mental health measures using combined data from the 2016-2018 NSDUHs for individuals aged 12 or older (or adults 18 or older for the five mental health outcomes, and individuals aged 12 to 20 for underage alcohol use and underage binge alcohol use). For a list of outcomes for which substate-level estimates are available, refer to Table A1 at the end of this section. These substate estimates are available at https://www.samhsa.gov/data/. The list of products (e.g., tables, maps, substate region definitions) related to the 2016-2018 substate estimates is provided in Section A.2.

Estimates for 406 substate regions were generated using the 2016-2018 NSDUH data. These substate regions are the same as the ones used in the production of the 2014-2016 substate estimates and were defined at that time by government officials from each of the 50 states and the District of Columbia. The substate regions were typically based on the substance abuse treatment planning regions specified by the states in their applications for the Substance Abuse Prevention and Treatment Block Grant (SABG) administered by SAMHSA. The SABG program provides financial and technical assistance to the 50 states, the District of Columbia, and other jurisdictions to support substance abuse prevention and treatment programs and to promote public health. States use NSDUH substate estimates for a variety of purposes, including strategic planning and program development, production of epidemiological profiles for briefing state legislatures and informing the public, allocating funds to substate areas based on the need for services, and other uses. More information on defining these regions is available in Section A.3.

Section A.4 discusses the methodological changes introduced in the 2002 NSDUH. An unanticipated result of these changes was that the prevalence rates for 2002 were in general substantially higher than those for 2001. As a result, the 1999-2001 substate estimates are not comparable with the other substate estimates. Additionally, this section discusses NSDUH questionnaire changes from 2015 and how these changes affect the small area estimates. Section A.5 discussed related substance use measures and warns users about not drawing conclusions by subtracting small area estimates from two different measures.

Section B provides information on the SAE methodology used to produce substate estimates. Section C includes the population estimates and the combined 2016, 2017, and 2018 NSDUH sample sizes and response rates for each substate region. Users may find the population estimates helpful in calculating the 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 individuals aged 12 or older who used marijuana in the past month in Alabama's Region 1 (78,975 individuals) can be obtained by multiplying the prevalence rate (6.88 percent) from Table 3 in the "2016-2018 NSDUH Substate Regions: Excel Tables" (see https://www.samhsa.gov/data/) and the population estimate from Table C1 (1,147,891) in this document. Section D lists the references cited in this document, and Section E provides a list of contributors to the production of the 2016-2018 substate estimates.

A.2. Presentation of Findings

In addition to this methodology document for the 2016-2018 substate SAE results, the following files are available at https://www.samhsa.gov/data/:

Note that other products may be added at a later date to the 2016-2018 NSDUH substate homepage at https://www.samhsa.gov/data/.

A.3. Formation and Ranking of Substate Regions

The substate regions for each state are the same as the ones used in the production of the 2014-2016 substate estimates. These substate regions vary in size, and their use varies across states. In some states, the substate regions are used more for administrative purposes rather than for planning purposes. 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 planning and reporting purposes.

Most states defined their regions in terms of counties or groups of counties. A few states defined their regions in terms of census tracts. Several states also requested estimates for aggregate substate regions, along with the estimates for their substate regions. An aggregate substate region is made up of two or more substate regions. These substate region definitions are available in a document titled "2016-2018 NSDUH Substate Region Definitions" (see https://www.samhsa.gov/data/, as listed in Section A.2). For the 2014-2016 substate estimates, some of the states (specifically, New Hampshire, Texas, and Washington) wanted maps to be produced only for the aggregate regions. For example, Washington has eight substate regions, and those eight regions were combined to create three aggregate regions used in the maps. The other states with aggregate regions wanted their maps to be produced at the substate level (i.e., Arizona, California, Florida, Illinois, Louisiana, Maine, Minnesota, Missouri, Nebraska, Nevada, New Mexico, New York, North Dakota, and Utah). As a result, across all states, maps were produced for 395 regions (individual substate regions and aggregate regions) based on the 2014-2016 substate estimates. For the 2016-2018 substate estimates, maps have been produced for the same 395 regions and not for 406 regions.

The 395 substate regions used in the maps were ranked from lowest to highest for each measure and were divided into seven categories (based on estimates rounded to two decimals) designed to represent somewhat symmetric distributions, as in a normal distribution. Colors were assigned to all substate regions such that the third having the lowest prevalence are in shades of blue (132 substate regions), the middle third are in white (131 substate regions), and the third with the highest prevalence are in shades of yellow (132 substate regions). The only exceptions are the five perception-of-risk outcomes, which have the highest estimates represented in blue and the lowest estimates represented in shades of yellow to reflect the inverse relationship between substance use and the perception of risk from using that substance. To further distinguish among the substate regions displaying relatively higher prevalence, the "highest" third has been subdivided into (a) orangish-yellow for the 18 substate regions with the highest estimates, (b) dark yellow for the 37 substate regions with the next highest estimates, and (c) light yellow for the 77 substate regions in the third highest group. The "lowest" third is categorized in a similar way using three distinct shades of blue. In some cases, a group (or category) could have more or fewer substate regions because two (or more) substate regions have the same estimate (to two decimal places). When such ties occurred at the "boundary" between two groups, all substate regions with the same estimate (to two decimal places) were assigned to the lower group. The upper and lower limits of each of the seven categories shown in the map legend collectively define a continuum and are not necessarily the actual values of a particular substate region. Note that the rankings used to create these maps do not account for the standard errors of the estimates (i.e., just because two regions are in different map groups does not imply that they are significantly different from each other). Tables containing p values for comparing two substate regions can be found at the same webpage. Specifically, see the "2016-2018 NSDUH: Comparison of Population Percentages from the United States, Census Regions, States, District of Columbia, and Substate Regions."

For example, in Figure 13 (a national map showing alcohol use in the past month among persons aged 12 or older) (see the "2016-2018 NSDUH National Maps of Prevalence Estimates, by Substate Region" at https://www.samhsa.gov/data/ as listed in Section A.2), the values on the boundary in the lowest category (group 1) correspond to Utah County in Utah (19.56 percent) and Catchment Area 3 in Arkansas (35.60 percent) and are displayed in the legend. In the next to lowest category, Catchment Area 4 in Arkansas (35.80 percent) and the Southeast region in Oklahoma (42.52 percent) are the regions with the lowest and highest values; however, in the continuum of the legend, the lower limit for group 2 was assigned a value of 35.61 percent because the upper limit of group 1 is 35.60 percent.

The 2016-2018 substate estimates and corresponding Bayesian CIs are available in the "2016-2018 NSDUH Substate Region Estimates: Excel Tables and CSV Files" (as mentioned in Section A.2, see https://www.samhsa.gov/data/). These tables also contain a sort order number and a map group indicator. The map indicator = 1 for the national estimate, = 2 for census region estimates, = 3 for state-level estimates, = 4 if a region is part of the 395 substate/aggregate region-level estimates included in the maps, and = 5 for all other substate/aggregate region-level estimates not included in the maps. The order number takes on values of 1 to 497 and can be used to re-sort the file to the original order.

In addition to the substate region estimates, estimates are provided for the 50 states and the District of Columbia and also for the four census regions. These estimates are produced using the SAE methodology described in Section B. The national estimates and associated CIs are design-based estimates and are also included. Because these estimates are based on 3 consecutive years of data, they are not directly comparable with the annually published state, census region, or national estimates based on only 2 consecutive years of NSDUH data. The U.S. Census Bureau defines the census regions 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.

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 sample selection, weighting, and estimation. Additional information on these methodological changes is available in a report by the OAS (2005). An unanticipated result of these changes was that the prevalence rates for 2002 were in general substantially higher than the 2001 prevalence rates. The jump in the prevalence rates between 2001 and 2002 was more than the usual year-to-year change. Because of the changes in the survey in 2002, substate estimates for 1999-2001 are not comparable with the other substate estimates. It is not possible to separate the effect of the methodological changes from the true trends in substance use.

However, estimates from 2002-2004, 2004-2006, 2006-2008, 2008-2010, 2010-2012, 2012-2014, 2014-2016, and 2016-2018 are comparable for outcome measures defined in a similar manner and for substate regions defined consistently across these time periods. Table A1 at the end of this section lists the outcome measures for which substate estimates were produced using 2016-2018 NSDUH data and shows the outcome measures that remained comparable over time (indicated with an "X" in the table) since 2002-2004.

It is useful to note that the 2002-2004 to 2008-2010 substate estimates were produced using predictors from the 2000 census; also, the survey weights used population projections from the 2000 census. The 2010-2012, 2012-2014, 2014-2016, and 2016-2018 estimates, on the other hand, were produced using 2010 census data. Hence, when reviewing changes between 2008-2010 and 2016-2018, it is important to note that they may be confounded with changes due to differences in the source of the predictors and the population projections (referred to as "census effects"). The impact of such census effects on national and state estimates is discussed in Section B.4.3 in Appendix B of the 2011 NSDUH national findings report (CBHSQ, 2012) and the "2011-2012 NSDUH: Impact of Using 2010 Census Data on 2010-2011 Small Area Estimates" at https://www.samhsa.gov/data/.

During regular data collection and processing checks for the 2011 NSDUH, data errors were identified. These errors were falsified cases submitted by field interviewers that affected the data for Pennsylvania (2006 to 2010) and Maryland (2008 and 2009). Cases with erroneous data were removed from the data files, and the remaining cases were reweighted to provide representative estimates (for more details on this data error, refer to Section A.7 of the "2011-2012 NSDUH: Guide to State Tables and Summary of Small Area Estimation Methodology" at https://www.samhsa.gov/data/). The 2006-2008, 2008-2010, and the 2010-2012 substate estimates exclude data based on falsified cases.

In 2015, a number of changes were made to the NSDUH questionnaire and data collection procedures. These changes were intended to improve the quality of the data that were collected and to address the changing needs of substance use and mental health policy and research.7 Discussed here briefly is the effect of the redesign on the comparability between the 2015 NSDUH and earlier NSDUHs, specifically related to the SAE outcomes. For a more detailed discussion of the questionnaire redesign and its effect, see Section C of the 2015 NSDUH's methodological summary and definitions report (CBHSQ, 2016a) and a brief report summarizing the implications of the changes for data users (CBHSQ, 2016b).

In the alcohol section of the questionnaire, the threshold for defining binge alcohol use among females was revised from five or more drinks on an occasion to four or more drinks on an occasion to ensure consistency with federal definitions.8 The threshold for males in 2015 remained at five or more drinks on an occasion. Consequently, a new baseline was established in 2015 for estimates of binge alcohol for the overall population. Substate small area estimates for past month binge alcohol use using combined 2016, 2017, and 2018 were produced to create a new baseline. Because estimates using combined 2014, 2015, and 2016 data were not produced, no comparison was done between the two sets of years (i.e., 2014-2016 vs. 2016-2018) for past month binge alcohol use. Note that this change did not affect estimates for alcohol use or alcohol use disorder.

Several changes were made to the various illicit drug sections of the NSDUH questionnaire in 2015. Specifically, changes were made to the hallucinogen, inhalant, methamphetamine, and prescription psychotherapeutic sections. For details on these specific changes, see Section C.1 of the 2015 NSDUH methodological summary and definitions report (CBHSQ, 2016a). These changes resulted in establishing a new baseline based on 2016-2018 NSDUH data for several small area estimates showing overall illicit drug use (including use disorder and treatment) and pain reliever misuse.9

Additionally, changes to some of the drug modules might have affected the set of respondents in 2015 who were eligible to be asked questions about treatment for substance use. Hence, SAE outcomes on needing but not receiving treatment (for illicit drugs and alcohol) were potentially affected. Thus, substance use treatment estimates were produced using combined 2016, 2017, and 2018 NSDUH data as a new baseline. Because estimates for these treatment outcomes using combined 2014, 2015, and 2016 data were not produced, no comparison between the two sets of years was done.

Finally, although questions on the perceptions of risk of harm from using different substances did not change in 2015, data quality checks on preliminary data and the full 2015 data showed deviations from the expected trends for these measures. A survey redesign carries the risk that preceding changes to the questionnaire will affect how respondents answer later questions (e.g., context effects). A context effect may be said to take place when the response to a question is affected by information that is not part of the question itself. For example, the content of a preceding question may affect the interpretation of a subsequent question. Or a respondent may answer a subsequent question in a manner that is consistent with responses to a preceding question if the two questions are closely related to each other. The set of questions preceding the risk and availability section in the 2015 questionnaire had undergone a number of significant changes that could have affected the way in which respondents answered the perceived risk and availability questions. Because of these deviations, the perception of risk estimates were not produced using the combined 2014, 2015, and 2016 NSDUH data. Estimates were produced using combined 2016, 2017, and 2018 data, establishing a new baseline.

To summarize, several changes in the 2015 questionnaire affected the comparability of the 2014 and 2015 NSDUH data. It was decided, therefore, that for those measures data across those 2 years could not be pooled, and estimates for those measures could not be produced using 2014-2016 NSDUH data. Estimates for these measures are included using the 2016, 2017, and 2018 data, establishing new baselines. Note that because 2014-2016 estimates were not produced for some outcomes, change estimates between 2014-2016 and 2016-2018 were not produced. For a complete list of outcomes for which substate small area estimates are available, refer to Table A1.

A.5. Related Substance Use Measures

Small area estimates are produced for a number of related drug measures, such as marijuana use and illicit drug use or alcohol use disorder and needing but not receiving treatment at a specialty facility for alcohol use. It might appear that one could draw conclusions by subtracting one from the other (e.g., subtracting the percentage who used illicit drugs other than marijuana in the past month from the percentage who used illicit drugs in the past month to find the percentage who used only marijuana in the past month). Because related measures have been estimated with different models (i.e., separate models by age group and outcome), subtracting one measure from another related measure at the subnational level (i.e., substate region or state) can give misleading results, perhaps even a "negative" estimate, and should be avoided. However, these comparisons can be made at the national level because these estimates are design-based estimates. For example, at the national level, subtracting cigarette use estimates from tobacco use estimates will give the estimate of individuals who did not use cigarettes, but used other forms of tobacco, such as cigars, pipes, or smokeless tobacco.

Table A1. – Outcomes, by Survey Year, for Which Substate Small Area Estimates Are Available
Measure 2002-2004 2004-2006 2006-2008 2008-2010 2010-2012 2012-2014 2014-2016 2016-2018
Illicit Drug Use in the Past Month1 X X X X X X -- X
Marijuana Use in the Past Year X X X X X X X X
Marijuana Use in the Past Month X X X X X X X X
Perceptions of Great Risk from Smoking Marijuana Once a Month1 X X X X X X -- X
First Use of Marijuana (Marijuana Initiation) X X X X X X X X
Illicit Drug Use Other Than Marijuana in the Past Month1 X X X X X X -- X
Cocaine Use in the Past Year X X X X X X X X
Perceptions of Great Risk from Using Cocaine Once a Month -- -- -- -- -- -- -- X
Heroin Use in the Past Year -- -- -- -- -- -- X X
Perceptions of Great Risk from Trying Heroin Once or Twice -- -- -- -- -- -- -- X
Methamphetamine Use in the Past Year -- -- -- -- -- -- -- X
Pain Reliever Misuse in the Past Year1 X X X X X X -- X
Alcohol Use in the Past Month X X X X X X X X
Underage Past Month Use of Alcohol (among Individuals Aged 12 to 20) X X X X X X X X
Binge Alcohol Use in the Past Month1 X X X X X X -- X
Underage Past Month Binge Alcohol Use (among Individuals Aged 12 to 20)1 X X X X X X -- X
Perceptions of Great Risk from Having Five or More Drinks of an Alcoholic
   Beverage Once or Twice a Week1
X X X X X X -- X
Tobacco Product Use in the Past Month X X X X X X X X
Cigarette Use in the Past Month X X X X X X X X
Perceptions of Great Risk from Smoking One or More Packs of Cigarettes
   per Day1
X X X X X X -- X
Alcohol Use Disorder in the Past Year X X X X X X X X
Alcohol Dependence in the Past Year X X X X X X -- --
Illicit Drug Use Disorder in the Past Year1 X X X X X X -- X
Illicit Drug Dependence in the Past Year X X X X X X -- --
Pain Reliever Use Disorder in the Past Year -- -- -- -- -- -- -- X
Substance Use Disorder in the Past Year1 X X X X X X -- X
Needing But Not Receiving Treatment at a Specialty Facility for Illicit
   Drug Use in the Past Year1
X X X X X X -- X
Needing But Not Receiving Treatment at a Specialty Facility for Alcohol
   Use in the Past Year1
X X X X X X -- X
Needing But Not Receiving Treatment at a Specialty Facility for Substance
   Use in the Past Year1
-- -- -- -- -- -- -- X
Serious Psychological Distress (SPD) in the Past Year2 X X -- -- -- -- -- --
Had at Least One Major Depressive Episode (MDE) in the Past Year3 -- X X X X X X X
Serious Mental Illness (SMI) in the Past Year -- -- -- X X X X X
Any Mental Illness (AMI) in the Past Year -- -- -- X X X X X
Received Mental Health Services in the Past Year -- -- -- -- -- -- X X
Had Serious Thoughts of Suicide in the Past Year -- -- -- X X X X X
X = available; -- = not available.
NOTE: The measures included in the 1999-2001 substate small area estimation (SAE) report are not included here. Because of the changes in the survey that took place in 2002, the 1999-2001 estimates are not comparable with the 2002-2004 or subsequent year estimates. SAE estimates using the combined 2002-2004, 2004-2006, 2006-2008, 2008-2010, 2010-2012, 2012-2014, and 2014-2016 data can be found at https://www.samhsa.gov/data/.
1 For these outcomes, the 2016-2018 small area estimates are not comparable with the 2012-2014 estimates or the estimates from prior years. Because of comparability issues, 2014-2016 small area estimates were not produced for these outcomes. Prior to 2016-2018, "misuse of pain relievers" was referred to as "nonmedical use of pain relievers."
2 Because of questionnaire changes, SPD estimates in 2002-2004 are not comparable with the 2004-2006 SPD estimates. For details, see Section B.7 of the report on Substate Estimates from the 2004-2006 National Surveys on Drug Use and Health (Office of Applied Studies, 2008). Additional questionnaire changes were made in 2008 that affected past year SPD trends. However, revised past year SPD measures were created for 2005 through 2007 that are comparable with the 2008 through 2016 past year SPD measure. Substate small area estimates for 2006-2008, 2008-2010, 2010-2012, 2012-2014, 2014-2016, and 2016-2018 were not created for this measure.
3 Questions used to determine MDE were added in 2004. The 2004-2006 MDE estimates are not comparable with the 2006-2008 and subsequent year estimates. For details on MDE, see Sections B.4.2 and B.4.4 in Appendix B of the 2012 NSDUH mental health findings report (CBHSQ, 2013).
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health, 2002-2018.
Table A2. – NSDUH Substate Region Counts and Overlap, by State and Estimation Period
State 2008-2010 2016-20181
Number of
Substate
Regions2
Number of
Map Regions3
Number of
Substate
Regions2
Number of Map
Regions3
Number of
Substate
Regions
Overlapping
with 2008-20104
Total U.S. 383 362 406 395 304
Alabama 4 4 4 4 4
Alaska 4 4 4 4 4
Arizona 4 4 4 4 2
Arkansas 8 8 8 8 8
California 27 27 26 26 25
Colorado 5 5 7 7 0
Connecticut 5 5 5 5 5
Delaware 4 4 4 4 4
District of Columbia 8 8 8 8 8
Florida 18 18 18 18 16
Georgia 6 6 6 6 6
Hawaii 4 4 4 4 4
Idaho 7 7 7 7 5
Illinois 5 5 17 17 0
Indiana 8 8 8 8 8
Iowa 6 6 6 6 6
Kansas 6 6 5 5 0
Kentucky 6 6 6 6 6
Louisiana 5 5 6 6 4
Maine 7 7 8 8 6
Maryland 9 9 9 9 9
Massachusetts 6 6 6 6 6
Michigan 15 15 10 10 3
Minnesota 6 6 9 9 3
Mississippi 7 7 7 7 7
Missouri 7 7 7 7 7
Montana 5 5 5 5 5
Nebraska 6 6 6 6 6
Nevada 3 3 4 4 2
New Hampshire 5 3 5 3 5
New Jersey 4 4 4 4 4
New Mexico 5 5 6 6 4
New York 15 4 15 15 4
North Carolina 12 11 14 14 10
North Dakota 5 5 8 8 2
Ohio 21 21 21 21 21
Oklahoma 7 7 7 7 7
Oregon 6 6 6 6 6
Pennsylvania 13 13 13 13 13
Rhode Island 4 4 7 7 0
South Carolina 4 4 4 4 2
South Dakota 7 7 5 5 0
Tennessee 7 7 7 7 5
Texas 15 11 15 11 15
Utah 6 6 7 7 5
Vermont 4 4 4 4 4
Virginia 5 5 5 5 5
Washington 6 3 8 3 2
West Virginia 6 6 6 6 6
Wisconsin 6 6 6 6 6
Wyoming 9 9 9 9 9
1 Substate regions for 2016-2018 are the same as the substate regions for 2014-2016 (see Section A.3).
2 Number of regions includes only the main substate regions and not the aggregate regions.
3 More information on the map regions can be found in Section A.3.
4 The names of some of the substate regions have changed across the time periods. However, as long as the two regions are made of the same counties or tracts, they are included in the count of overlapping regions.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health, 2008-2010 and 2014-2018.

Section B: Substate Region Estimation Methodology

The survey-weighted hierarchical Bayes (SWHB) methodology used in the production of state and substate estimates from the 1999 to 2018 National Surveys on Drug Use and Health (NSDUHs) also was used in the production of the 2016-2018 substate estimates. The SWHB methodology is described by Folsom, Shah, and Vaish (1999). A general model description is given in Section B.1. A brief discussion of the precision of the estimates and interpretation of the Bayesian confidence intervals (CIs) is given in Section B.2. The goals of the small area estimation (SAE) modeling, the general model description, and the implementation of SAE modeling remain the same and are described in Appendix E of the 2001 state report (Wright, 2003).

Small area estimates obtained using the SWHB methodology are design consistent (i.e., for states or substate areas with large sample sizes, the small area estimates are close to the corresponding robust design-based estimates). The substate small area estimates when aggregated by using the appropriate population totals result in national small area estimates that are very close to the national design-based estimates. However, for many reasons, including internal consistency, it is desirable to have the national small area estimates exactly match the national design-based estimates. Beginning in 2002, exact benchmarking was introduced (see Appendix A, Section A.4, in Wright & Sathe, 2005). The 2016-2018 substate small area estimates have been benchmarked to the national design-based estimates.

B.1. General SAE Model Description

The model can be characterized as a complex mixed10 model (including both fixed and random effects) of the following form:

Equation 1,     D

where pi sub a, i, j, k is the probability of engaging in the behavior of interest (e.g., using marijuana in the past month) for person-k belonging to age group-a in substate region-j of state-i.

Let x sub a, i, j, k denote a  p sub a times 1 vector of the auxiliary (predictor) variables associated with age group-a (12 to 17, 18 to 25, 26 to 34, and 35 or older), and let beta sub a denote the associated vector of the regression parameters. The age group-specific vectors of the auxiliary variables are defined for every block group in the nation and also include person-level demographic variables, such as race/ethnicity and gender. The auxiliary variables include block group, census tract, county, and state-level data. These predictor variables include demographic and socioeconomic data from the American Community Survey (ACS), population projections obtained from Claritas,11 food stamp participation rates from the U.S. Census Bureau, Uniform Crime Report (UCR) arrest totals from the Federal Bureau of Investigation (FBI), per capita income from the Bureau of Economic Analysis (BEA), unemployment rates from the Bureau of Labor Statistics (BLS), mortality rates from the National Center for Health Statistics (NCHS), treatment rates from the National Survey of Substance Abuse Treatment Services (N-SSATS), and Block Grant awards, cost of services, and total taxable resources from the Substance Abuse and Mental Health Services Administration (SAMHSA). For a complete list of predictors, refer to Section B of the "2017-2018 NSDUH Guide to State Tables and Summary of Small Area Estimation Methodology" at https://www.samhsa.gov/data/.

The vectors An eta sub i is a transposed vector of values eta sub 1, i and so on until eta sub capital A, i. and A nu sub i, j is a vector of transposed values nu sub 1, i, j and so on until nu sub capital A, i, j., defined as state- and substate-level random effects, respectively, are assumed to be mutually independent with An eta sub i is normally distributed with mean 0 and variance denoted by matrix capital D sub eta. and A nu sub i, j is normally distributed with mean 0 and variance denoted by matrix capital D sub nu., where A is the total number of individual age groups modeled (generally, Capital A equals 4.). For hierarchical Bayes (HB) estimation purposes, an improper uniform prior distribution12 is assumed for beta sub a, and proper Wishart prior distributions are assumed for inverse of capital D sub eta and inverse of capital D sub nu. The HB solution for pi sub a, i, j, k involves a series of complex Markov Chain Monte Carlo (MCMC) steps to generate values of the desired fixed and random effects from the underlying joint distribution. The basic process is described in Folsom et al. (1999), Shah, Barnwell, Folsom, and Vaish (2000), and Wright (2003). Once the required number of MCMC samples for the parameters of interest are generated and tested for convergence properties (see Raftery & Lewis, 1992), the small area estimates for each age group × race/ethnicity × gender cell within a block group can be obtained. These block group-level small area estimates then can be aggregated using the appropriate population projections to form substate- and state-level small area estimates for the desired age group(s). These small area estimates then are benchmarked to the national design-based estimates (for details on exact benchmarking, see Section B.4 of the "2017-2018 NSDUH Guide to State Tables and Summary of Small Area Estimation Methodology" at https://www.samhsa.gov/data/).

Because the objective here was to produce small area estimates for substate regions, it was decided to ratio adjust the person-level sampling weights to match population projections available from Claritas at the substate × age group × gender level. Note that these population projections from Claritas were adjusted to match the NSDUH analysis weight at the state × age group × race × gender level, taking into account the NSDUH population, which is made up of U.S. civilian, noninstitutionalized individuals. These adjusted sampling weights are used in the estimation because they reflect the demography of the substate regions better than the unadjusted weights. This ratio adjustment was done at the substate region (406 regions) × age group (12 to 17, 18 to 25, 26 to 34, and 35 or older) × gender (male and female) level collectively over 3 years (2016, 2017, and 2018) of data.

The SAE methodology used here tends to borrow strength from both the national model and the state-level random effects. Estimates for substate regions with smaller sample sizes tend to be shrunk more toward the corresponding state and national prevalence estimates than substate regions with larger sample sizes. This methodology tends to cluster the small sample substate estimates around their state prevalence estimates. Thus, relatively high estimates for substate regions with small sample sizes tend to shrink toward the state prevalence estimates, while relatively low estimates tend to increase toward the state prevalence estimates. On the other hand, for substate regions with large sample sizes, the methodology produces estimates that are close to the weighted average of the sample data in that substate region. In addition, these estimates are design consistent so that, as the sample size for a substate region increases, the estimate approaches the corresponding design-based estimate.

B.2. Precision Validation of the Estimates

The primary purpose of producing substate estimates is to give policy officials and data users a better perspective on the range of prevalence estimates within and across states. Because the data were collected in a consistent manner by field interviewers who adhered to the same procedures and administered the same questions across all states and substate regions, the results are comparable within and across the 50 states and the District of Columbia.

The 95 percent Bayesian CI associated with each estimate defines the range that contains the true parameter value with 95 percent probability. For example, the estimated prevalence of past month use of marijuana in Region 1 in Alabama is 6.9 percent, and the 95 percent CI ranges from 5.5 to 8.7 percent.13 Therefore, the probability is 0.95 that the true value is within that range. The CI indicates the uncertainty due to both sampling variability and model bias. The key assumption underlying the validity of the CIs is that the state- and substate-level error (or bias correction) terms in the models behave like random effects with zero means and common variance components.

A comparison of the standard errors (SEs) among substate regions with small (n ≤ 500), medium (500 < n ≤ 1,000), and large (n > 1,000) sample sizes for certain measures shows that the small area estimates behave in predictable ways. Regardless of whether the substate region is from a state with a larger annual sample size or one of the other states, the sizes of the CIs are very similar and are primarily a function of the sample size of the substate region and the prevalence estimate of the measure. Substate regions with large sample sizes had the smallest SEs. For past month use of alcohol, where the national prevalence for all individuals aged 12 or older was 51.2 percent (for 2016-2018), the average relative standard error (RSE)14 was about 4.8 percent, and the RSE for substate regions with a large sample size was about 3.1 percent. For substate regions with a medium sample size, the average RSE was 4.0 percent; for small sample sizes, the average RSE was 5.4 percent. For past month use of marijuana (with a national prevalence of 9.5 percent), the average RSE was 9.0 percent for substate regions with large samples. For medium sample sizes, the average RSE was 11.1 percent, and for small samples, the RSE was 14.0 percent, whereas the overall national average RSE was 12.7 percent. Substance use measures with lower prevalence rates, such as past year use of cocaine (2.0 percent nationally), displayed larger average RSEs. For substate regions with large sample sizes, the average RSE was 16.7 percent. For those with medium sample sizes, the average RSE was 20.2 percent, and for those with small sample sizes, the average RSE was 23.9 percent. The overall national RSE for past year use of cocaine was 22.2 percent.

Section C: Sample Sizes, Response Rates, and Population Estimates

200125
Table C1. – Sample Sizes, Weighted Screening and Interview Response Rates, and Population Estimates, by Substate Region, for Individuals Aged 12 or Older: 2016, 2017, and 2018 NSDUHs
State/Substate Region Total
Selected DUs
Total Eligible
DUs
Total
Completed
Screeners
Weighted DU
Screening
Response
Rate
(Percentage)
Total
Selected
Total
Responded
Population
Estimate
Weighted
Interview
Response
Rate
(Percentage)
Weighted
Overall
Response
Rate
(Percentage)
Total United States 650,597 550,871 415,128 75.40% 292,385 203,765 271,818,889 67.37% 50.80%
Northeast 145,171 123,765 87,875 69.26% 58,640 38,911 47,904,221 63.66% 44.09%
Midwest 147,436 125,898 97,864 77.07% 69,134 47,877 56,998,599 67.40% 51.94%
South 212,770 177,945 137,009 78.82% 95,345 68,489 102,502,191 70.00% 55.17%
West 145,220 123,263 92,380 72.88% 69,266 48,488 64,413,879 65.89% 48.02%
Alabama 9,021 7,311 6,031 82.62% 4,028 2,882 4,078,039 67.38% 55.67%
Region 1 2,508 2,101 1,788 84.99% 1,204 862 1,147,891 66.96% 56.90%
Region 2 2,650 2,189 1,733 79.46% 1,181 821 1,300,621 65.57% 52.10%
Region 3 1,694 1,262 1,061 84.21% 700 522 731,710 71.24% 59.99%
Region 4 2,169 1,759 1,449 82.52% 943 677 897,817 67.42% 55.63%
Alaska 9,998 7,534 5,757 76.00% 4,111 2,890 585,498 68.65% 52.17%
Anchorage 3,891 3,180 2,393 75.38% 1,728 1,264 238,843 68.81% 51.87%
Northern 2,176 1,582 1,176 74.51% 885 600 129,568 68.32% 50.90%
South Central 2,754 1,915 1,473 75.55% 1,007 704 155,337 69.53% 52.53%
Southeast 1,177 857 715 81.67% 491 322 61,749 66.55% 54.35%
Arizona 8,592 6,535 5,041 76.53% 3,626 2,713 5,853,899 73.36% 56.14%
Central 5,077 4,042 3,053 74.93% 2,335 1,684 3,503,579 69.80% 52.30%
North 1,292 866 686 78.59% 430 351 701,867 80.99% 63.66%
South 2,223 1,627 1,302 79.33% 861 678 1,648,453 79.24% 62.86%
South A 1,478 1,054 828 77.95% 469 379 897,920 81.74% 63.71%
South B 745 573 474 81.88% 392 299 750,533 75.68% 61.97%
Arkansas 8,511 7,028 5,889 84.03% 4,060 2,981 2,481,911 70.21% 58.99%
Catchment Area 1 1,204 1,068 842 79.29% 648 448 414,236 69.20% 54.87%
Catchment Area 2 917 744 619 83.87% 423 303 298,928 68.31% 57.29%
Catchment Area 3 1,105 918 796 86.62% 563 414 327,236 72.23% 62.57%
Catchment Area 4 862 738 628 85.40% 425 314 217,872 68.61% 58.59%
Catchment Area 5 1,359 1,124 971 86.48% 689 529 372,204 75.25% 65.08%
Catchment Area 6 566 440 382 86.91% 252 199 170,568 71.19% 61.87%
Catchment Area 7 687 509 466 91.98% 254 197 188,904 69.31% 63.75%
Catchment Area 8 1,811 1,487 1,185 79.73% 806 577 491,964 67.45% 53.77%
California 40,179 36,793 24,848 67.60% 20,957 13,637 32,928,005 62.17% 42.03%
Region 1R 1,512 1,339 1,031 77.10% 742 564 816,595 75.78% 58.43%
Region 2R 1,204 998 697 69.36% 458 321 888,935 66.98% 46.46%
Region 3R (Sacramento) 1,873 1,704 1,185 69.31% 859 623 1,247,629 68.84% 47.71%
Region 4R 1,455 1,293 897 70.04% 546 353 1,138,140 61.19% 42.86%
Region 5R (San Francisco) 1,173 1,028 525 49.95% 352 217 779,719 60.67% 30.30%
Region 6 (Santa Clara) 2,025 1,844 1,330 72.24% 1,152 689 1,611,621 57.06% 41.22%
Region 7R (Contra Costa) 1,239 1,156 807 69.54% 603 404 949,025 66.12% 45.98%
Region 8R (Alameda) 1,568 1,453 1,021 70.91% 781 512 1,369,454 61.89% 43.88%
Region 9R (San Mateo) 925 852 636 75.06% 531 363 647,112 64.73% 48.59%
Region 10 1,224 1,154 617 54.01% 501 295 1,088,574 57.13% 30.85%
Region 11 (Los Angeles) 10,152 9,540 5,930 62.50% 5,300 3,170 8,573,274 57.18% 35.74%
LA SPA 1 and 5 1,358 1,256 743 59.70% 639 417 930,633 63.37% 37.84%
LA SPA 2 2,055 1,976 1,185 60.12% 1,071 618 1,892,712 54.70% 32.88%
LA SPA 3 1,697 1,608 1,028 64.21% 900 542 1,525,776 58.98% 37.87%
LA SPA 4 1,492 1,368 691 50.93% 542 294 1,003,214 51.53% 26.25%
LA SPA 6 826 766 579 75.72% 626 393 823,913 57.71% 43.69%
LA SPA 7 957 917 602 66.31% 650 368 1,078,359 53.90% 35.74%
LA SPA 8 1,767 1,649 1,102 67.01% 872 538 1,318,668 59.09% 39.60%
Region 12R 775 703 553 78.98% 418 294 725,161 68.76% 54.31%
Regions 13 and 19R 2,466 2,178 1,577 72.37% 1,513 1,024 2,109,431 63.75% 46.13%
Region 14 (Orange) 2,830 2,679 1,663 62.14% 1,524 949 2,728,413 57.44% 35.69%
Region 15R (Fresno) 1,046 974 730 74.94% 636 472 793,599 69.69% 52.23%
Region 16R (San Diego) 3,405 3,086 2,018 64.53% 1,690 1,103 2,790,454 62.82% 40.54%
Region 17R 1,538 1,383 1,059 76.90% 1,018 708 1,224,865 67.37% 51.81%
Region 18R (San Bernardino) 1,711 1,605 1,089 68.12% 1,073 678 1,762,209 60.97% 41.53%
Region 20R 922 854 713 83.68% 650 485 796,371 70.62% 59.09%
Region 21R 1,136 970 770 79.48% 610 413 887,425 68.82% 54.69%
Colorado 8,217 6,949 5,488 78.84% 4,141 2,878 4,692,315 67.13% 52.92%
Region 1 1,426 1,061 841 78.34% 647 442 769,225 68.29% 53.50%
Region 2 611 551 437 79.42% 345 224 362,516 61.34% 48.72%
Region 3 1,730 1,620 1,314 80.85% 1,135 782 1,227,457 66.35% 53.65%
Region 4 589 440 364 82.64% 228 180 314,956 79.42% 65.64%
Region 5 1,400 1,255 923 75.05% 613 406 598,063 64.09% 48.09%
Region 6 1,451 1,165 898 77.14% 643 443 794,164 64.88% 50.05%
Region 7 1,010 857 711 83.13% 530 401 625,935 73.56% 61.15%
Connecticut 9,631 8,429 6,081 72.32% 4,514 2,930 3,060,928 63.40% 45.85%
Eastern 1,295 1,092 824 75.67% 529 373 369,670 69.70% 52.74%
North Central 2,842 2,490 1,760 70.95% 1,203 774 855,545 62.73% 44.51%
Northwestern 1,572 1,409 1,053 74.79% 842 539 527,560 62.85% 47.00%
South Central 2,117 1,795 1,395 77.91% 1,050 689 712,353 64.46% 50.22%
Southwest 1,805 1,643 1,049 63.87% 890 555 595,799 59.53% 38.02%
Delaware 10,654 8,752 6,315 72.24% 4,243 2,863 811,077 66.12% 47.77%
Kent 1,709 1,443 1,110 77.19% 752 534 147,471 66.57% 51.39%
New Castle (excluding Wilmington City) 5,308 4,877 3,383 69.35% 2,411 1,592 414,384 65.18% 45.21%
Sussex 3,036 1,944 1,474 75.56% 857 572 184,497 66.96% 50.60%
Wilmington City 601 488 348 71.68% 223 165 64,725 71.01% 50.90%
District of Columbia 19,999 17,150 10,683 59.89% 3,865 2,917 589,214 72.91% 43.67%
Ward 1 2,460 2,101 1,313 60.61% 439 322 73,570 68.93% 41.78%
Ward 2 2,663 2,336 1,039 43.63% 320 236 77,981 70.34% 30.69%
Ward 3 2,764 2,344 1,511 62.49% 560 425 74,852 73.72% 46.07%
Ward 4 2,087 1,900 1,317 68.00% 496 364 72,772 71.12% 48.36%
Ward 5 2,710 2,202 1,410 63.79% 508 383 75,100 72.79% 46.43%
Ward 6 2,829 2,385 1,489 57.54% 478 364 76,238 74.74% 43.01%
Ward 7 2,100 1,829 1,202 65.52% 482 357 69,356 72.33% 47.39%
Ward 8 2,386 2,053 1,402 68.52% 582 466 69,346 77.86% 53.35%
Florida 34,793 28,711 21,463 74.53% 14,443 10,296 17,884,314 68.47% 51.03%
Broward (Circuit 17) 3,109 2,561 1,728 67.49% 1,188 822 1,655,538 65.73% 44.37%
Central I 4,668 4,070 3,193 78.69% 2,400 1,727 2,264,667 68.42% 53.84%
Circuit 9 2,644 2,382 1,886 79.44% 1,572 1,146 1,357,634 70.40% 55.92%
Circuit 18 2,024 1,688 1,307 77.78% 828 581 907,033 65.75% 51.14%
Central II 10,331 8,003 6,036 74.81% 3,881 2,844 5,011,862 69.97% 52.34%
Circuit 6 2,983 2,314 1,692 73.42% 998 708 1,303,238 67.84% 49.81%
Circuit 10 1,167 959 789 82.20% 539 434 671,254 78.58% 64.59%
Circuit 12 1,675 1,185 837 72.18% 431 316 716,007 72.57% 52.38%
Circuit 13 (Hillsborough) 2,256 2,031 1,557 76.61% 1,147 865 1,193,806 72.87% 55.82%
Circuit 20 2,250 1,514 1,161 72.86% 766 521 1,127,558 63.09% 45.97%
Northeast 6,678 5,603 4,303 76.42% 2,543 1,749 3,320,978 66.86% 51.10%
Circuit 4 2,044 1,781 1,378 77.35% 867 599 1,023,112 66.15% 51.16%
Circuit 5 2,028 1,641 1,276 77.06% 684 471 997,885 69.30% 53.40%
Circuit 7 1,675 1,396 1,035 73.33% 589 388 815,433 60.92% 44.67%
Circuit 8 plus Columbia, Dixie, Hamilton,
   Lafayette, and Suwannee
931 785 614 78.42% 403 291 484,548 73.31% 57.49%
Northwest 2,657 2,118 1,737 82.01% 1,140 846 1,316,227 71.88% 58.94%
Circuit 1 1,164 987 801 81.12% 504 369 646,967 70.80% 57.44%
Circuit 2 plus Madison and Taylor 936 702 566 80.56% 383 289 399,662 71.57% 57.66%
Circuit 14 557 429 370 86.26% 253 188 269,597 74.35% 64.13%
South (Circuits 11 and 16) 4,172 3,683 2,578 69.60% 2,020 1,411 2,489,580 68.59% 47.73%
Southeast 3,178 2,673 1,888 70.77% 1,271 897 1,825,463 67.38% 47.69%
Circuit 15 (Palm Beach) 2,139 1,785 1,213 68.22% 925 646 1,255,101 64.48% 43.99%
Circuit 19 1,039 888 675 75.69% 346 251 570,362 73.82% 55.88%
Georgia 12,187 10,482 7,990 76.25% 6,100 4,483 8,576,228 70.32% 53.62%
Region 1 3,072 2,663 2,161 80.67% 1,672 1,161 2,206,077 66.49% 53.64%
Region 2 1,557 1,308 992 76.75% 792 621 1,088,254 77.25% 59.29%
Region 3 3,746 3,332 2,334 69.99% 1,859 1,361 2,583,337 69.34% 48.53%
Region 4 630 482 427 88.68% 271 206 525,805 72.44% 64.24%
Region 5 1,569 1,300 1,019 78.82% 724 518 975,715 68.35% 53.88%
Region 6 1,613 1,397 1,057 75.61% 782 616 1,197,041 75.87% 57.37%
Hawaii 11,622 9,834 6,823 68.93% 4,430 3,020 1,160,319 65.40% 45.08%
Hawaii Island 1,670 1,352 1,100 82.12% 631 437 154,486 67.58% 55.49%
Honolulu 7,726 6,583 4,224 63.68% 2,893 1,982 818,512 64.97% 41.37%
Kauai 755 650 540 83.00% 309 207 56,197 64.28% 53.35%
Maui 1,471 1,249 959 76.75% 597 394 131,124 65.75% 50.46%
Idaho 7,516 6,278 5,201 82.76% 4,020 3,012 1,408,573 73.92% 61.18%
Region 1 1,148 853 637 75.23% 438 276 197,481 62.06% 46.69%
Region 2 592 527 403 76.04% 291 222 98,503 79.75% 60.65%
Region 3 1,066 976 816 82.99% 690 543 222,809 77.94% 64.68%
Region 4 2,094 1,850 1,513 81.92% 1,131 842 408,837 75.16% 61.57%
Region 5 951 722 667 92.22% 504 425 161,117 81.98% 75.60%
Region 6 466 347 301 87.07% 225 159 104,021 65.12% 56.70%
Region 7 1,199 1,003 864 86.08% 741 545 215,805 71.44% 61.49%
Illinois 23,511 20,581 13,695 66.80% 11,404 7,171 10,705,375 60.65% 40.51%
Region 1 (Cook) 9,894 8,727 4,544 52.45% 3,961 2,353 4,371,358 58.33% 30.59%
Region 1.1 (Far North Side) 863 789 381 46.70% 314 196 400,289 57.53% 26.87%
Region 1.2 (Northwest Side) 585 535 308 58.60% 305 158 225,528 49.45% 28.98%
Region 1.3 (North Central Side) 1,114 979 142 15.27% 128 75 405,543 60.33% 9.22%
Region 1.4 (West Side) 1,015 834 381 45.96% 341 198 390,700 59.53% 27.36%
Region 1.5 (South Side) 1,700 1,426 636 45.02% 534 327 548,751 62.67% 28.22%
Region 1.6 (Southwest Side) 452 348 196 56.07% 212 116 301,632 54.90% 30.78%
Region 1.7 (Suburban Cook) 4,165 3,816 2,500 65.64% 2,127 1,283 2,098,916 57.94% 38.04%
Region 2 6,707 6,131 4,443 72.73% 3,992 2,610 3,396,154 62.96% 45.79%
Region 2a (DuPage) 1,676 1,516 1,021 67.41% 872 553 785,557 62.64% 42.22%
Region 2b 3,265 3,014 2,245 75.01% 2,124 1,358 1,825,754 60.86% 45.65%
Region 2c (Winnebago) 453 410 307 75.52% 226 162 236,371 67.70% 51.12%
Region 2d 1,313 1,191 870 72.99% 770 537 548,471 68.02% 49.65%
Region 3 3,048 2,490 2,091 84.32% 1,594 1,013 1,199,804 60.70% 51.18%
Region 3a (Champaign) 475 379 289 76.48% 236 161 171,873 65.53% 50.12%
Region 3b 2,573 2,111 1,802 85.76% 1,358 852 1,027,931 59.92% 51.39%
Region 4 1,550 1,313 1,093 83.21% 786 522 747,304 65.94% 54.87%
Region 4a (Sangamon) 440 379 317 83.94% 245 162 167,953 66.30% 55.65%
Region 4b 1,110 934 776 82.94% 541 360 579,351 65.79% 54.57%
Region 5 2,312 1,920 1,524 79.42% 1,071 673 990,756 58.73% 46.64%
Region 5a 1,055 904 736 81.56% 535 366 441,546 65.33% 53.28%
Region 5b 1,257 1,016 788 77.49% 536 307 549,210 52.85% 40.96%
Indiana 8,839 7,528 5,584 74.55% 4,065 2,871 5,535,704 69.03% 51.46%
Central 2,571 2,300 1,615 70.36% 1,227 892 1,484,631 72.33% 50.90%
East 587 470 377 80.73% 305 214 459,110 72.54% 58.56%
North Central 1,364 1,139 861 75.48% 574 372 772,260 59.76% 45.11%
Northeast 815 734 561 76.61% 438 282 546,041 67.27% 51.53%
Northwest 874 766 562 74.21% 418 293 624,471 66.56% 49.39%
Southeast 933 795 650 82.03% 470 348 593,268 72.60% 59.55%
Southwest 757 637 465 73.31% 282 203 431,125 71.21% 52.21%
West 938 687 493 73.17% 351 267 624,799 68.60% 50.20%
Iowa 9,300 7,893 6,460 82.02% 4,295 2,958 2,620,272 68.53% 56.21%
Central 1,818 1,580 1,250 79.37% 898 607 480,987 66.98% 53.16%
North Central 1,142 990 813 81.98% 515 371 287,189 71.00% 58.20%
Northeast 2,142 1,801 1,480 82.42% 977 661 636,592 67.23% 55.41%
Northwest 1,408 1,137 990 87.27% 625 446 394,291 71.59% 62.47%
Southeast 2,049 1,747 1,381 79.28% 941 611 556,745 64.24% 50.93%
Southwest 741 638 546 85.95% 339 262 264,467 77.94% 66.99%
Kansas 7,779 6,677 5,379 80.61% 4,083 2,948 2,375,700 70.45% 56.79%
Northeast 3,723 3,359 2,510 74.82% 2,021 1,461 1,194,749 70.10% 52.45%
Northwest and North Central 792 670 581 86.38% 373 259 187,830 68.14% 58.86%
South Central 2,184 1,851 1,580 85.45% 1,159 853 682,128 72.98% 62.36%
Southeast 673 453 396 87.05% 261 157 173,781 58.96% 51.33%
Southwest 407 344 312 90.68% 269 218 137,212 77.91% 70.65%
Kentucky 8,617 7,101 5,720 80.45% 4,309 2,901 3,704,174 64.64% 52.00%
Adanta, Cumberland River, and Lifeskills 1,369 1,061 876 82.47% 698 439 618,455 60.62% 50.00%
Bluegrass, Comprehend, and North Key 2,329 1,957 1,557 79.51% 1,308 861 1,094,193 64.30% 51.12%
Centerstone 2,137 1,841 1,517 82.36% 1,094 839 824,704 73.78% 60.77%
Communicare and River Valley 869 727 609 83.59% 435 277 414,396 59.34% 49.60%
Four Rivers and Pennyroyal 878 741 581 77.81% 389 242 344,348 60.43% 47.02%
Kentucky River, Mountain, and Pathways 1,035 774 580 75.18% 385 243 408,078 58.62% 44.07%
Louisiana 8,605 6,990 5,825 83.40% 4,037 2,931 3,829,776 70.64% 58.91%
Regions 1 and 10 1,654 1,408 1,137 80.66% 780 542 757,676 68.88% 55.56%
Region 1 849 680 564 82.99% 391 295 404,960 76.10% 63.16%
Region 10 (Jefferson) 805 728 573 78.50% 389 247 352,716 62.12% 48.77%
Regions 2 and 9 2,239 1,802 1,508 83.84% 1,052 726 1,017,812 68.10% 57.09%
Region 3 719 605 524 86.52% 380 287 323,962 74.58% 64.53%
Regions 4, 5, and 6 2,266 1,812 1,483 82.07% 980 695 979,418 68.52% 56.23%
Regions 7 and 8 1,727 1,363 1,173 86.02% 845 681 750,908 76.81% 66.07%
Maine 11,239 8,626 7,085 82.29% 4,219 2,944 1,161,401 69.83% 57.46%
Aroostook/Downeast 1,423 980 863 88.28% 459 361 138,517 77.71% 68.60%
Aroostook 595 434 384 88.78% 205 174 61,720 83.25% 73.91%
Downeast 828 546 479 87.87% 254 187 76,796 73.01% 64.15%
Central 1,229 1,027 831 81.46% 519 407 150,718 77.40% 63.04%
Cumberland 2,356 1,889 1,481 78.75% 929 578 250,290 62.88% 49.52%
Midcoast 1,498 1,117 929 83.41% 495 330 128,482 68.63% 57.24%
Penquis 1,455 1,158 1,032 89.26% 572 417 149,381 74.56% 66.55%
Western 1,816 1,251 1,000 79.63% 647 457 167,603 70.26% 55.95%
York 1,462 1,204 949 78.82% 598 394 176,410 64.85% 51.11%
Maryland 8,802 7,835 5,517 70.52% 3,960 2,913 5,048,978 72.14% 50.88%
Anne Arundel 643 594 391 67.00% 273 202 476,219 74.48% 49.90%
Baltimore City 1,346 1,091 744 69.27% 521 423 514,101 78.62% 54.46%
Baltimore County 979 877 588 67.41% 368 249 700,996 69.89% 47.11%
Montgomery 1,388 1,304 931 70.36% 712 522 875,896 72.19% 50.79%
North Central 752 707 541 76.90% 386 290 408,428 74.58% 57.35%
Northeast 524 437 306 69.99% 239 158 421,097 62.66% 43.85%
Prince George's 1,438 1,315 831 63.24% 625 457 740,816 70.67% 44.69%
South 983 861 658 76.55% 448 322 485,604 70.26% 53.78%
West 749 649 527 81.17% 388 290 425,821 72.96% 59.22%
Massachusetts 10,868 9,729 6,880 70.50% 4,800 2,937 5,899,409 60.64% 42.75%
Boston 1,411 1,277 718 56.00% 501 328 751,419 66.28% 37.12%
Central 1,334 1,228 877 70.99% 610 366 757,376 58.98% 41.88%
Metrowest 2,723 2,523 1,830 72.41% 1,269 752 1,374,715 57.94% 41.96%
Northeast 1,938 1,810 1,303 71.78% 942 597 1,165,860 61.08% 43.85%
Southeast 2,088 1,711 1,314 76.26% 846 492 1,116,919 59.21% 45.15%
Western 1,374 1,180 838 71.16% 632 402 733,121 65.12% 46.34%
Michigan 22,382 18,798 14,917 79.34% 10,157 7,253 8,446,882 68.99% 54.74%
Region 1 728 521 427 82.49% 238 182 276,512 75.89% 62.60%
Region 2 1,598 1,003 852 84.34% 527 357 441,769 71.02% 59.90%
Region 3 2,375 2,125 1,764 82.97% 1,407 1,050 1,048,655 72.20% 59.91%
Region 4 2,163 1,737 1,475 84.44% 955 730 713,780 71.77% 60.61%
Region 5 4,038 3,271 2,699 82.55% 1,777 1,300 1,415,351 70.77% 58.42%
Region 6 1,644 1,469 1,181 80.45% 795 629 689,782 76.93% 61.89%
Region 7 3,854 3,219 2,225 69.36% 1,584 1,079 1,461,192 65.63% 45.52%
Region 8 2,584 2,401 1,863 77.50% 1,286 862 1,076,728 66.07% 51.21%
Region 9 1,970 1,835 1,364 74.18% 890 570 731,786 61.71% 45.77%
Region 10 1,428 1,217 1,067 87.76% 698 494 591,326 66.62% 58.46%
Minnesota 7,998 6,958 5,459 78.25% 4,046 2,858 4,650,527 69.98% 54.76%
Regions 1 and 2 1,099 743 612 82.02% 406 272 458,184 70.04% 57.45%
Region 1 552 361 302 83.49% 218 145 173,704 69.87% 58.34%
Region 2 547 382 310 80.58% 188 127 284,480 70.23% 56.60%
Regions 3 and 4 1,311 1,084 868 79.78% 645 473 786,680 71.09% 56.72%
Region 3 400 277 230 82.78% 164 113 273,652 63.73% 52.75%
Region 4 911 807 638 78.86% 481 360 513,028 73.08% 57.63%
Regions 5 and 6 1,428 1,262 1,061 83.54% 787 521 851,893 63.03% 52.66%
Region 5 642 557 473 85.02% 375 253 428,834 65.25% 55.48%
Region 6 786 705 588 82.38% 412 268 423,059 61.02% 50.27%
Region 7 4,160 3,869 2,918 75.42% 2,208 1,592 2,553,770 71.88% 54.22%
Region 7A (Hennepin) 1,773 1,649 1,207 73.28% 900 667 1,048,506 73.27% 53.70%
Region 7B (Ramsey) 867 777 617 79.81% 469 324 457,197 68.81% 54.92%
Region 7C 1,520 1,443 1,094 75.51% 839 601 1,048,068 72.03% 54.39%
Mississippi 7,365 6,116 5,121 83.68% 3,951 2,850 2,455,673 69.12% 57.84%
Region 1 1,571 1,361 1,198 88.01% 967 710 558,689 72.16% 63.51%
Region 2 879 706 599 84.90% 450 371 295,156 81.21% 68.95%
Region 3 1,154 957 772 80.39% 615 439 340,561 66.50% 53.46%
Region 4 1,467 1,283 987 76.98% 778 524 461,407 62.67% 48.24%
Region 5 378 273 233 84.97% 158 117 146,442 68.14% 57.90%
Region 6 730 572 530 92.58% 391 291 254,180 70.18% 64.97%
Region 7 1,186 964 802 83.09% 592 398 399,236 65.11% 54.10%
Missouri 8,603 7,280 6,080 83.65% 4,069 2,907 5,089,218 69.49% 58.13%
Central 1,262 1,042 914 87.64% 681 509 691,338 73.09% 64.05%
Eastern 2,994 2,615 2,122 81.48% 1,381 976 1,767,821 67.19% 54.74%
Eastern (St. Louis City and County) 1,784 1,511 1,181 78.66% 760 547 1,107,128 67.83% 53.35%
Eastern (excluding St. Louis) 1,210 1,104 941 85.29% 621 429 660,693 66.40% 56.63%
Northwest 2,279 1,950 1,624 83.06% 1,054 728 1,235,245 67.83% 56.33%
Northwest (Jackson) 1,205 1,046 848 80.97% 552 394 562,721 69.62% 56.38%
Northwest (excluding Jackson) 1,074 904 776 85.46% 502 334 672,524 65.63% 56.09%
Southeast 811 630 563 89.45% 379 297 600,117 76.72% 68.63%
Southwest 1,257 1,043 857 82.67% 574 397 794,697 69.62% 57.55%
Montana 10,613 8,632 7,110 82.76% 4,225 2,961 885,203 70.67% 58.49%
Region 1 770 556 474 85.95% 271 193 70,119 70.34% 60.46%
Region 2 1,455 1,207 884 74.70% 511 356 125,221 67.71% 50.58%
Region 3 2,159 1,877 1,549 82.54% 958 679 183,877 72.53% 59.87%
Region 4 2,931 2,400 1,969 82.37% 1,250 848 235,903 69.52% 57.26%
Region 5 3,298 2,592 2,234 86.39% 1,235 885 270,082 71.74% 61.98%
Nebraska 8,061 7,082 5,549 78.53% 4,090 2,891 1,569,575 70.11% 55.05%
Regions 1 and 2 732 606 522 85.82% 367 261 156,846 68.20% 58.53%
Region 1 323 255 227 89.00% 159 117 73,686 69.15% 61.55%
Region 2 409 351 295 83.67% 208 144 83,160 67.54% 56.51%
Region 3 1,114 956 776 81.46% 554 399 191,358 73.96% 60.24%
Region 4 913 791 674 85.53% 459 321 171,049 67.03% 57.33%
Region 5 1,812 1,614 1,301 80.88% 965 661 388,103 69.52% 56.22%
Region 6 3,490 3,115 2,276 73.20% 1,745 1,249 662,219 70.41% 51.54%
Nevada 7,743 6,965 4,798 67.92% 4,056 2,910 2,496,940 69.25% 47.04%
Clark – Region 1 5,374 4,872 3,305 68.06% 2,922 2,116 1,804,158 69.44% 47.26%
Region 3 1,021 871 638 73.14% 447 297 304,901 66.33% 48.51%
Capital District 454 429 309 71.96% 231 158 144,728 65.01% 46.78%
Rural/Frontier 567 442 329 74.17% 216 139 160,173 67.78% 50.28%
Washoe – Region 2 1,348 1,222 855 64.39% 687 497 387,880 70.55% 45.43%
New Hampshire 10,413 8,736 6,703 76.29% 4,229 2,895 1,164,925 67.43% 51.44%
Central 3,068 2,605 2,068 79.21% 1,331 949 330,730 70.00% 55.45%
Central 1 1,582 1,270 1,018 79.85% 693 512 164,197 74.11% 59.18%
Central 2 1,486 1,335 1,050 78.61% 638 437 166,533 65.53% 51.51%
Northern 1,670 1,142 947 80.81% 528 397 149,680 74.11% 59.89%
Southern 5,675 4,989 3,688 73.63% 2,370 1,549 684,515 64.49% 47.49%
Southern 1 (Rockingham) 2,125 1,908 1,408 74.28% 875 562 264,688 63.92% 47.48%
Southern 2 3,550 3,081 2,280 73.24% 1,495 987 419,827 64.84% 47.49%
New Jersey 14,598 12,947 9,065 69.10% 6,955 4,503 7,566,601 62.42% 43.13%
Central 3,178 2,887 2,013 68.55% 1,438 912 1,733,735 62.31% 42.71%
Metropolitan 3,179 2,878 2,019 70.22% 1,675 1,103 1,828,664 61.72% 43.34%
Northern 5,041 4,488 3,135 67.13% 2,366 1,506 2,441,191 60.91% 40.88%
Southern 3,200 2,694 1,898 71.83% 1,476 982 1,563,011 65.72% 47.21%
New Mexico 8,842 6,311 5,264 83.50% 3,602 2,843 1,731,228 77.02% 64.31%
Region 1 1,420 1,079 910 84.59% 663 512 358,594 73.72% 62.36%
Region 2 1,301 848 689 81.60% 402 339 248,368 83.41% 68.06%
Region 3 (Bernalillo) 2,823 2,235 1,773 79.44% 1,204 937 564,892 75.76% 60.18%
Region 4 1,194 888 755 84.97% 587 458 215,465 76.55% 65.05%
Region 5 2,104 1,261 1,137 90.02% 746 597 343,909 78.19% 70.39%
Region 5a 1,229 594 533 89.85% 309 258 161,861 84.51% 75.93%
Region 5b (Dona Ana) 875 667 604 90.19% 437 339 182,048 72.61% 65.49%
New York 40,854 35,546 21,781 60.74% 15,337 9,853 16,736,238 61.01% 37.06%
Region 1: Long Island 4,974 4,471 2,879 64.42% 2,296 1,296 2,434,284 53.21% 34.28%
Region 2: New York City 17,050 15,315 8,035 51.39% 6,021 3,531 7,233,272 54.72% 28.12%
Region 2A: Bronx 2,420 2,237 1,447 64.48% 1,170 845 1,174,724 70.26% 45.30%
Region 2B: Kings 5,284 4,685 2,720 58.41% 1,991 1,086 2,193,829 51.28% 29.96%
Region 2C: New York 4,289 3,815 1,441 35.81% 993 574 1,472,592 53.74% 19.24%
Region 2D: Queens 4,112 3,720 1,877 50.30% 1,460 793 1,990,858 52.22% 26.26%
Region 2E: Richmond 945 858 550 64.16% 407 233 401,270 53.22% 34.14%
Region 3: Mid-Hudson 4,560 3,911 2,370 60.44% 1,708 1,106 1,957,266 62.94% 38.04%
Region 4: Capital Region 2,181 1,875 1,279 68.94% 835 575 807,673 71.84% 49.53%
Region 5: Mohawk Valley 359 307 220 71.91% 148 92 218,663 60.15% 43.25%
Region 6: North Country 873 579 471 80.52% 220 174 260,857 79.51% 64.02%
Region 7: Tug Hill Seaway 546 414 344 83.05% 217 169 213,289 73.58% 61.10%
Region 8: Central 2,438 2,090 1,383 66.37% 926 709 859,336 75.81% 50.31%
Region 9: Southern Tier 1,344 992 760 76.68% 430 338 377,220 78.36% 60.08%
Region 10: Finger Lakes 3,279 2,858 2,043 71.43% 1,296 941 1,079,246 70.54% 50.39%
Region 11: Western 3,250 2,734 1,997 73.21% 1,240 922 1,295,132 72.10% 52.78%
North Carolina 12,934 10,987 8,614 78.32% 6,240 4,450 8,550,036 69.83% 54.69%
Alliance Behavioral Healthcare 1 973 813 664 81.81% 512 390 680,684 75.08% 61.43%
Alliance Behavioral Healthcare 2 1,127 1,047 749 71.52% 618 461 860,408 72.64% 51.95%
Cardinal Innovations Healthcare Solutions 1 1,029 926 716 77.20% 540 334 648,460 60.54% 46.74%
Cardinal Innovations Healthcare Solutions 2 698 596 474 79.35% 342 261 580,879 76.12% 60.40%
Cardinal Innovations Healthcare Solutions 3 1,101 967 763 78.82% 574 367 858,518 63.46% 50.02%
CenterPoint Human Services 833 678 530 78.00% 349 261 469,591 75.87% 59.18%
Eastpointe 1,173 1,023 797 78.11% 545 412 703,678 73.57% 57.46%
Partners Behavioral Health Management 1,144 1,011 819 81.04% 575 403 782,232 69.43% 56.27%
Sandhills Center 1 763 654 534 81.65% 412 305 494,208 73.01% 59.61%
Sandhills Center 2 680 606 469 77.21% 351 238 446,482 65.61% 50.66%
Smoky Mountain Center 1 1,223 918 732 79.49% 448 309 464,578 68.10% 54.13%
Smoky Mountain Center 2 526 442 358 80.86% 225 134 467,841 58.75% 47.51%
Trillium Health Resources 1 909 703 549 77.72% 419 331 534,374 72.66% 56.47%
Trillium Health Resources 2 755 603 460 76.22% 330 244 558,102 71.95% 54.84%
North Dakota 10,464 8,421 7,173 85.37% 4,240 2,906 619,356 67.73% 57.82%
Badlands and West Central 2,709 2,269 2,007 88.57% 1,209 804 166,597 64.73% 57.33%
Badlands 617 467 410 87.28% 250 168 38,048 64.67% 56.44%
West Central 2,092 1,802 1,597 88.92% 959 636 128,549 64.75% 57.58%
Lake Region 535 447 387 87.00% 201 149 34,533 72.53% 63.10%
North Central 1,302 959 778 81.25% 462 289 88,430 63.13% 51.29%
Northeast 1,177 906 789 87.73% 462 344 76,116 72.98% 64.03%
Northwest 947 608 532 87.19% 343 206 34,920 61.39% 53.53%
South Central 1,029 769 648 84.27% 325 240 48,024 73.71% 62.12%
Southeast 2,765 2,463 2,032 82.65% 1,238 874 170,735 69.53% 57.47%
Ohio 22,189 19,391 14,921 77.05% 10,501 7,260 9,780,581 67.05% 51.66%
Boards 2, 46, 55, and 68 614 549 435 79.38% 334 228 428,829 63.16% 50.14%
Boards 3, 52, and 85 772 681 564 82.71% 416 277 323,279 66.28% 54.82%
Boards 4 and 78 886 750 634 84.77% 405 305 261,280 71.25% 60.40%
Boards 5 and 60 708 605 492 81.71% 349 254 288,142 73.47% 60.03%
Boards 7, 15, 41, 79, and 84 687 594 482 80.83% 303 190 389,995 62.69% 50.67%
Boards 8, 13, and 83 716 672 499 74.20% 370 220 429,017 60.63% 44.99%
Board 9 (Butler) 723 672 530 78.66% 378 236 314,512 57.73% 45.41%
Board 12 733 610 387 63.37% 302 190 295,265 62.51% 39.61%
Boards 18 and 47 2,908 2,508 1,842 73.51% 1,258 898 1,314,788 69.06% 50.77%
Boards 20, 32, 54, and 69 826 737 659 89.54% 480 337 286,037 68.49% 61.32%
Boards 21, 39, 51, 70, and 80 1,064 900 736 81.54% 504 359 474,034 67.48% 55.02%
Boards 22, 74, and 87 851 713 613 85.99% 456 357 329,520 75.57% 64.98%
Boards 23 and 45 621 576 455 79.12% 333 217 321,414 64.75% 51.23%
Board 25 (Franklin) 2,425 2,156 1,605 74.71% 1,224 851 1,029,412 68.91% 51.48%
Boards 27, 71, and 73 1,108 913 703 77.21% 493 346 415,376 67.11% 51.82%
Boards 28, 43, and 67 790 741 605 81.57% 385 234 417,780 55.39% 45.18%
Board 31 (Hamilton) 1,739 1,509 1,115 73.93% 761 519 663,926 65.62% 48.51%
Board 48 (Lucas) 737 597 434 73.18% 304 229 363,344 74.35% 54.41%
Boards 50 and 76 1,167 1,072 864 80.75% 554 397 517,791 69.23% 55.90%
Board 57 (Montgomery) 1,134 958 635 66.58% 435 306 461,282 68.80% 45.81%
Board 77 (Summit) 980 878 632 72.07% 457 310 455,558 66.96% 48.26%
Oklahoma 8,737 7,294 5,708 78.19% 4,227 2,867 3,210,733 66.96% 52.35%
Central 1,066 953 739 77.67% 578 375 415,685 63.35% 49.21%
East Central 780 637 509 80.98% 381 264 365,733 65.66% 53.17%
Northeast 1,374 1,092 911 82.90% 618 420 404,063 66.69% 55.29%
Northwest and Southwest 1,184 913 784 86.33% 562 381 453,510 65.13% 56.23%
Oklahoma County 1,775 1,532 1,102 71.33% 760 512 626,766 67.82% 48.37%
Southeast 1,199 954 781 82.02% 633 460 430,643 73.86% 60.58%
Tulsa County 1,359 1,213 882 73.14% 695 455 514,333 65.10% 47.61%
Oregon 10,203 8,949 6,989 78.17% 4,335 2,985 3,527,514 68.11% 53.24%
Region 1 (Multnomah) 1,999 1,821 1,309 72.50% 818 573 700,007 68.67% 49.79%
Region 2 2,385 2,143 1,701 79.47% 1,116 795 842,636 71.51% 56.83%
Region 3 3,033 2,629 2,032 77.01% 1,340 896 1,092,479 67.27% 51.81%
Region 4 1,476 1,279 1,046 81.71% 539 357 493,891 62.16% 50.79%
Region 5 (Central) 489 417 345 83.00% 173 114 183,774 63.20% 52.46%
Region 6 (Eastern) 821 660 556 84.37% 349 250 214,727 72.14% 60.86%
Pennsylvania 24,845 21,168 16,344 77.37% 10,170 7,135 10,861,105 68.67% 53.12%
Region 1 (Allegheny) 2,846 2,473 1,852 74.93% 1,078 737 1,059,655 68.63% 51.42%
Regions 3, 8, 9, and 51 1,466 1,213 995 82.08% 553 397 596,374 71.55% 58.73%
Regions 4, 11, 37, and 49 1,766 1,336 1,067 79.97% 609 404 769,051 65.00% 51.98%
Regions 5, 18, 23, 24, and 46 1,523 1,342 1,122 83.78% 612 440 634,977 70.05% 58.69%
Regions 6, 12, 16, 31, 35, 45, and 47 1,353 1,064 842 79.28% 530 400 607,788 71.33% 56.55%
Regions 7, 13, 20, and 33 4,730 4,325 3,188 73.90% 2,105 1,438 2,127,061 67.09% 49.58%
Regions 10, 15, 27, 32, 43, and 44 1,186 927 768 83.30% 455 332 431,672 69.41% 57.82%
Regions 17 and 21 620 478 412 86.47% 279 196 310,722 69.38% 59.99%
Regions 19, 26, 28, and 42 2,811 2,546 2,095 82.38% 1,381 1,009 1,237,969 72.47% 59.70%
Regions 22, 38, 40, 41, and 48 1,377 1,219 1,009 83.02% 594 382 704,683 62.91% 52.23%
Regions 29 and 34 930 857 636 74.64% 411 263 563,611 64.52% 48.16%
Regions 30 and 50 1,256 1,040 815 78.46% 509 354 517,085 68.35% 53.63%
Region 36 (Philadelphia) 2,981 2,348 1,543 65.79% 1,054 783 1,300,456 70.38% 46.30%
Rhode Island 10,377 9,014 6,484 72.19% 4,230 2,869 908,479 67.26% 48.55%
Region 1: Southern Providence .County 1,734 1,589 1,124 70.74% 674 444 165,937 66.40% 46.97%
Region 2: Northern Providence County/Blackstone Valley 2,168 1,947 1,434 74.07% 947 658 182,739 67.35% 49.89%
Region 3: Providence 1,535 1,287 799 62.44% 647 477 153,606 71.47% 44.62%
Region 4: Kent County 1,759 1,607 1,200 74.74% 742 475 147,338 67.32% 50.32%
Region 5: East Bay 991 891 622 70.32% 414 281 83,680 66.97% 47.09%
Region 6: Newport County 962 737 596 81.19% 359 217 71,381 59.54% 48.34%
Region 7: South County 1,228 956 709 74.10% 447 317 103,799 70.28% 52.08%
South Carolina 8,347 6,808 5,360 78.78% 3,864 2,880 4,196,076 73.05% 57.54%
Region 1 2,788 2,281 1,807 79.18% 1,293 960 1,309,126 72.03% 57.03%
Region 2 2,029 1,770 1,430 81.10% 1,036 746 1,034,946 69.32% 56.22%
Region 3 1,289 1,032 816 79.09% 591 447 724,545 76.09% 60.18%
Region 4 2,241 1,725 1,307 75.87% 944 727 1,127,459 76.19% 57.80%
South Dakota 8,316 6,908 5,778 83.76% 4,013 2,878 708,303 71.40% 59.80%
Region 1 1,951 1,688 1,407 83.68% 912 655 175,353 71.22% 59.60%
Region 2 916 654 546 83.86% 362 273 65,276 75.84% 63.60%
Region 3 2,184 1,678 1,451 86.47% 1,012 735 166,253 71.98% 62.25%
Region 4 1,032 878 708 80.83% 474 325 98,954 66.18% 53.49%
Region 5 2,233 2,010 1,666 82.80% 1,253 890 202,467 71.81% 59.46%
Tennessee 8,524 7,009 5,764 82.27% 4,041 2,924 5,615,393 69.98% 57.57%
Region 1 650 521 462 88.57% 303 220 452,378 74.57% 66.05%
Region 2 1,627 1,306 1,100 84.18% 765 573 1,050,281 72.84% 61.32%
Region 3 1,505 1,149 1,021 88.59% 663 472 841,193 66.74% 59.13%
Region 4 (Davidson) 842 701 489 69.88% 346 221 558,141 64.10% 44.79%
Region 5 1,830 1,623 1,341 82.83% 1,021 703 1,377,511 65.65% 54.38%
Region 6 884 696 609 87.86% 406 313 539,798 72.91% 64.06%
Region 7 (Shelby) 1,186 1,013 742 73.23% 537 422 796,091 76.94% 56.34%
Texas 22,073 18,551 15,303 82.45% 13,188 9,935 22,902,252 72.82% 60.04%
Region 1 785 642 540 84.19% 401 292 738,666 73.81% 62.14%
Region 2 557 450 422 93.56% 293 229 468,724 78.31% 73.27%
Region 3 6,055 5,372 4,582 85.59% 4,082 3,201 6,202,507 76.54% 65.51%
Region 3a 3,694 3,347 2,733 82.05% 2,547 1,891 3,974,563 72.53% 59.51%
Region 3bc 2,361 2,025 1,849 91.51% 1,535 1,310 2,227,944 83.04% 75.99%
Region 4 922 698 618 88.27% 472 378 978,898 77.84% 68.71%
Region 5 765 538 462 86.76% 348 279 673,658 80.70% 70.02%
Region 6 5,099 4,437 3,288 74.37% 2,947 2,064 5,580,881 65.90% 49.01%
Region 6a 4,576 4,002 2,935 73.54% 2,583 1,814 4,999,370 66.13% 48.63%
Region 6bc 523 435 353 81.53% 364 250 581,511 64.22% 52.36%
Region 7 2,694 2,116 1,740 82.37% 1,500 1,107 2,796,069 71.40% 58.81%
Region 7a 1,563 1,207 959 79.91% 805 554 1,800,760 68.22% 54.52%
Region 7bcd 1,131 909 781 85.55% 695 553 995,309 75.71% 64.77%
Region 8 2,311 1,878 1,544 82.41% 1,281 943 2,385,533 72.23% 59.52%
Region 9 533 415 368 88.93% 282 197 508,212 67.48% 60.01%
Region 10 705 590 522 88.84% 490 391 745,497 76.83% 68.25%
Region 11 1,647 1,415 1,217 83.13% 1,092 854 1,823,607 74.85% 62.22%
Region 11abd 1,053 909 779 85.63% 703 540 1,142,451 74.44% 63.74%
Region 11c (Hidalgo) 594 506 438 79.19% 389 314 681,156 75.63% 59.89%
Utah 4,945 4,402 3,750 85.15% 3,807 2,883 2,467,283 74.25% 63.22%
Bear River, Northeastern, Summit, Tooele,
   and Wasatch
532 452 404 89.56% 373 266 297,596 68.90% 61.71%
Central, Four Corners, San Juan, and
   Southwest
748 570 472 83.65% 429 309 296,636 68.69% 57.46%
Central, Four Corners, and San Juan 340 254 205 82.36% 172 117 112,557 66.61% 54.86%
Southwest 408 316 267 84.73% 257 192 184,079 70.21% 59.49%
Davis County 444 419 364 86.50% 388 298 266,849 77.05% 66.65%
Salt Lake County 1,979 1,814 1,512 83.11% 1,535 1,173 936,240 75.51% 62.76%
Utah County 805 745 651 87.55% 736 575 457,916 76.89% 67.32%
Weber, Morgan 437 402 347 86.01% 346 262 212,045 73.13% 62.90%
Vermont 12,346 9,570 7,452 77.64% 4,186 2,845 545,133 69.34% 53.83%
Champlain Valley 4,374 3,635 2,762 75.91% 1,711 1,105 220,447 64.36% 48.86%
Rural Northeast 3,296 2,503 1,802 71.36% 999 700 128,298 73.61% 52.53%
Rural Southeast 2,794 2,019 1,698 84.08% 870 617 112,386 71.30% 59.95%
Rural Southwest 1,882 1,413 1,190 84.07% 606 423 84,002 72.41% 60.87%
Virginia 13,237 11,393 9,038 79.39% 6,372 4,530 7,017,789 68.62% 54.48%
Region 1 2,296 1,969 1,664 84.66% 1,116 820 1,090,274 71.08% 60.18%
Region 2 3,294 3,029 2,237 74.03% 1,797 1,216 2,027,323 66.02% 48.87%
Region 3 2,377 1,903 1,628 85.45% 1,016 731 1,159,736 69.01% 58.97%
Region 4 2,326 2,070 1,612 77.84% 1,135 828 1,191,126 70.22% 54.65%
Region 5 2,944 2,422 1,897 78.33% 1,308 935 1,549,330 68.39% 53.57%
Washington 8,413 7,372 5,749 78.08% 4,238 2,864 6,197,230 65.54% 51.17%
Region 1 1,866 1,502 1,223 81.74% 915 619 1,339,113 65.57% 53.60%
Greater Columbia and North Central 1,143 983 815 83.28% 635 426 801,258 65.74% 54.75%
Spokane 723 519 408 78.77% 280 193 537,855 65.25% 51.39%
Region 2 4,036 3,644 2,739 75.21% 2,047 1,342 2,864,320 63.63% 47.86%
King 2,726 2,453 1,775 72.44% 1,347 872 1,835,987 63.26% 45.82%
North Sound 1,310 1,191 964 81.01% 700 470 1,028,332 64.34% 52.12%
Region 3 2,511 2,226 1,787 80.36% 1,276 903 1,993,798 68.66% 55.18%
Pierce 1,051 919 701 76.20% 497 357 731,198 67.44% 51.39%
Salish 402 348 293 84.26% 206 135 330,878 68.02% 57.31%
SW WA and Great Rivers 814 735 608 82.80% 434 316 640,453 70.80% 58.62%
Thurston-Mason 244 224 185 82.49% 139 95 291,269 67.52% 55.69%
West Virginia 10,364 8,427 6,668 79.26% 4,417 2,886 1,550,528 63.47% 50.31%
Region I 878 720 602 83.87% 351 224 121,465 63.76% 53.48%
Region II 1,323 1,130 906 80.23% 651 448 222,380 68.20% 54.72%
Region III 1,032 831 665 80.25% 421 282 142,575 66.49% 53.36%
Region IV 2,144 1,764 1,401 79.46% 995 605 344,631 57.49% 45.68%
Region V 3,058 2,423 1,917 79.33% 1,258 807 437,954 62.42% 49.52%
Region VI 1,929 1,559 1,177 75.47% 741 520 281,523 66.75% 50.37%
Wisconsin 9,994 8,381 6,869 82.00% 4,171 2,976 4,897,105 70.08% 57.46%
Milwaukee 1,631 1,453 1,104 75.48% 659 468 793,541 72.32% 54.59%
Northeastern 1,662 1,505 1,277 84.59% 784 543 1,061,996 68.07% 57.57%
Northern 1,421 1,016 878 86.71% 452 344 418,906 72.14% 62.55%
Southeastern 1,856 1,664 1,297 78.00% 856 589 993,520 67.32% 52.51%
Southern 2,260 1,777 1,512 85.18% 924 678 961,360 72.08% 61.40%
Western 1,164 966 801 83.13% 496 354 667,782 68.89% 57.27%
Wyoming 8,337 6,709 5,562 83.02% 3,718 2,892 479,872 75.05% 62.30%
Judicial District 1 (Laramie) 1,378 1,180 903 76.78% 587 426 78,904 70.58% 54.19%
Judicial District 2 753 546 453 83.08% 365 297 45,801 78.47% 65.19%
Judicial District 3 1,165 926 786 85.07% 546 426 66,876 72.93% 62.04%
Judicial District 4 581 502 412 81.91% 220 156 31,996 71.55% 58.61%
Judicial District 5 979 793 661 83.36% 381 305 45,952 77.89% 64.93%
Judicial District 6 829 612 515 84.12% 353 291 50,041 76.36% 64.23%
Judicial District 7 (Natrona) 977 856 693 81.32% 483 387 65,385 78.55% 63.87%
Judicial District 8 672 522 454 87.18% 320 252 33,644 76.27% 66.49%
Judicial District 9 1,003 772 685 88.57% 463 352 61,272 75.10% 66.52%
DU = dwelling unit; SPA = service planning area.
NOTE: For substate region definitions, see the "2016-2018 National Survey on Drug Use and Health Substate Region Definitions" at https://www.samhsa.gov/data.
NOTE: To compute the pooled 2016-2018 weighted response rates, the three samples were combined, and the individual-year weights were used for the pooled sample. Thus, the response rates presented here are weighted across 3 years of data rather than being a simple average of the 2016, 2017, and 2018 individual response rates.
NOTE: The total responded column represents the combined sample size from the 2016, 2017, and 2018 NSDUHs.
NOTE: The population estimate is the simple average of the 2016, 2017, and 2018 population counts for individuals aged 12 or older. Because of rounding, the sum of the substate region population counts within a state may not exactly match the state population count listed in the table.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2016, 2017, and 2018.
200125
Table C2. – Sample Sizes, Weighted Interview Response Rates, and Population Estimates, by Substate Region, for Individuals Aged 12 to 20 and Adults Aged 18 or Older: 2016, 2017, and 2018 NSDUHs
State/Substate Region 12-20
Total
Selected
12-20
Total
Responded
12-20
Population
Estimate
12-20
Weighted
Interview
Response Rate
(Percentage)
18+
Total
Selected
18+
Total
Responded
18+
Population
Estimate
18+
Weighted
Interview
Response Rate
(Percentage)
Total United States 92,510 69,031 37,857,440 74.71% 224,350 152,771 246,905,278 66.57%
Northeast 18,769 13,299 6,243,027 69.99% 44,819 29,099 43,852,084 63.06%
Midwest 22,021 16,381 8,130,070 74.19% 53,009 35,817 51,692,303 66.65%
South 29,984 22,949 14,421,915 77.19% 73,296 51,542 92,913,586 69.19%
West 21,736 16,402 9,062,427 74.45% 53,226 36,313 58,447,305 64.91%
Alabama 1,290 995 597,055 77.17% 3,104 2,171 3,703,785 66.37%
Region 1 394 305 163,254 77.59% 915 640 1,040,884 65.97%
Region 2 360 270 192,089 75.14% 936 633 1,182,343 64.36%
Region 3 225 177 113,506 79.91% 557 415 667,061 70.85%
Region 4 311 243 128,206 77.14% 696 483 813,497 66.16%
Alaska 1,385 1,027 87,677 75.11% 3,061 2,117 526,974 68.00%
Anchorage 580 464 35,170 78.15% 1,283 901 215,590 67.47%
Northern 319 219 21,113 69.31% 664 457 115,873 68.82%
South Central 335 248 23,320 77.61% 743 510 139,340 68.81%
Southeast 151 96 8,074 68.33% 371 249 56,172 66.66%
Arizona 1,200 933 854,702 78.68% 2,734 2,020 5,299,849 72.77%
Central 791 603 522,384 77.80% 1,745 1,229 3,159,031 68.72%
North 140 114 97,524 81.44% 322 263 641,866 81.08%
South 269 216 234,793 80.09% 667 528 1,498,951 79.44%
South A 126 103 122,197 82.29% 380 312 822,838 82.28%
South B 143 113 112,596 78.14% 287 216 676,113 75.20%
Arkansas 1,319 1,034 358,669 78.66% 3,085 2,240 2,245,124 69.59%
Catchment Area 1 198 148 67,500 74.75% 501 344 370,060 69.02%
Catchment Area 2 152 124 38,047 81.18% 340 240 273,880 67.66%
Catchment Area 3 186 138 48,331 73.98% 409 299 295,264 71.86%
Catchment Area 4 136 110 32,235 82.84% 318 229 196,019 67.41%
Catchment Area 5 231 187 54,473 80.56% 523 399 338,976 75.02%
Catchment Area 6 80 68 23,855 83.07% 194 148 155,307 69.66%
Catchment Area 7 87 72 26,641 82.11% 188 143 170,977 68.14%
Catchment Area 8 249 187 67,585 77.24% 612 438 444,642 66.89%
California 6,295 4,626 4,655,216 73.26% 16,333 10,208 29,899,013 60.93%
Region 1R 240 181 102,310 74.83% 582 443 750,496 75.89%
Region 2R 146 116 123,959 76.58% 338 224 808,504 65.63%
Region 3R (Sacramento) 228 178 173,384 76.80% 685 484 1,130,122 67.83%
Region 4R 152 115 145,041 74.51% 424 259 1,040,432 59.75%
Region 5R (San Francisco) 60 49 56,312 77.65% 302 175 743,766 59.31%
Region 6 (Santa Clara) 317 219 214,381 70.79% 902 508 1,465,508 55.16%
Region 7R (Contra Costa) 180 142 130,455 77.28% 480 308 859,455 65.36%
Region 8R (Alameda) 213 159 173,017 74.54% 629 400 1,255,995 60.97%
Region 9R (San Mateo) 143 112 77,355 78.63% 419 274 592,284 63.38%
Region 10 142 90 161,610 61.38% 392 228 988,826 56.96%
Region 11 (Los Angeles) 1,492 1,034 1,177,373 69.93% 4,220 2,410 7,817,815 55.89%
LA SPA 1 and 5 184 138 121,197 75.49% 509 315 856,877 61.45%
LA SPA 2 332 224 244,221 69.11% 820 447 1,731,106 53.01%
LA SPA 3 246 152 205,649 62.74% 730 442 1,394,341 59.01%
LA SPA 4 92 64 107,303 65.88% 473 243 934,681 50.60%
LA SPA 6 195 148 149,208 74.04% 487 278 730,934 54.81%
LA SPA 7 203 135 172,495 69.04% 510 271 968,243 52.29%
LA SPA 8 240 173 177,300 73.47% 691 414 1,201,634 58.13%
Region 12R 142 99 112,870 69.08% 307 215 650,298 68.21%
Regions 13 and 19R 512 383 348,198 74.85% 1,125 733 1,882,937 62.33%
Region 14 (Orange) 462 340 372,895 71.82% 1,192 698 2,482,732 55.64%
Region 15R (Fresno) 225 178 135,062 76.79% 469 340 705,706 68.36%
Region 16R (San Diego) 511 386 378,661 76.63% 1,319 827 2,550,254 61.62%
Region 17R 336 256 210,584 74.57% 768 514 1,086,442 66.18%
Region 18R (San Bernardino) 361 254 299,598 69.32% 819 498 1,566,738 59.76%
Region 20R 245 201 133,375 82.77% 495 358 709,167 69.08%
Region 21R 188 134 128,775 73.27% 466 312 811,535 68.52%
Colorado 1,283 959 644,802 74.16% 3,193 2,162 4,264,119 66.24%
Region 1 184 121 100,388 61.83% 505 345 704,962 68.40%
Region 2 113 88 56,141 78.26% 259 154 325,629 58.71%
Region 3 400 297 181,638 72.63% 824 551 1,098,723 65.51%
Region 4 70 49 41,316 69.32% 181 149 288,296 80.64%
Region 5 164 116 70,024 70.24% 506 328 552,242 63.54%
Region 6 184 150 102,559 82.13% 505 329 728,929 62.96%
Region 7 168 138 92,735 84.69% 413 306 565,338 72.32%
Connecticut 1,432 1,014 424,835 71.40% 3,495 2,207 2,786,759 62.58%
Eastern 161 122 56,450 77.70% 415 290 339,679 69.15%
North Central 341 238 114,266 69.83% 947 588 779,574 61.80%
Northwestern 271 189 71,968 69.44% 629 390 478,405 62.06%
South Central 347 242 95,508 70.97% 801 515 653,232 63.76%
Southwest 312 223 86,642 71.64% 703 424 535,870 58.55%
Delaware 1,321 938 104,483 71.84% 3,281 2,180 741,661 65.64%
Kent 259 200 20,718 77.66% 562 388 133,807 65.20%
New Castle (excluding Wilmington City) 747 523 56,141 70.74% 1,858 1,202 378,242 64.65%
Sussex 240 161 19,584 67.87% 686 457 170,532 66.92%
Wilmington City 75 54 8,040 74.18% 175 133 59,080 71.71%
District of Columbia 1,192 956 54,088 81.77% 2,857 2,114 557,854 72.45%
Ward 1 73 59 5,994 83.99% 376 271 70,687 68.57%
Ward 2 86 72 6,984 85.40% 289 210 76,699 70.03%
Ward 3 176 144 6,574 81.99% 402 296 71,167 73.20%
Ward 4 145 105 6,602 74.28% 367 272 67,791 71.12%
Ward 5 165 132 6,772 79.34% 360 265 71,166 72.36%
Ward 6 101 81 4,506 80.70% 389 293 72,911 74.58%
Ward 7 181 140 7,708 77.78% 324 235 64,127 71.80%
Ward 8 265 223 8,949 86.42% 350 272 63,306 76.89%
Florida 4,537 3,497 2,200,195 77.10% 11,104 7,703 16,461,513 67.69%
Broward (Circuit 17) 375 295 204,055 78.99% 904 602 1,516,919 64.75%
Central I 776 611 303,239 78.93% 1,864 1,299 2,072,084 67.43%
Circuit 9 519 407 193,590 78.32% 1,225 873 1,237,374 69.69%
Circuit 18 257 204 109,649 80.10% 639 426 834,710 64.43%
Central II 1,186 929 590,315 77.64% 2,997 2,146 4,621,482 69.31%
Circuit 6 276 205 139,833 73.91% 785 549 1,209,708 67.33%
Circuit 10 195 166 89,180 86.47% 381 300 612,547 77.62%
Circuit 12 127 101 73,698 78.30% 337 242 666,468 72.37%
Circuit 13 (Hillsborough) 355 286 165,604 80.74% 901 663 1,086,319 72.06%
Circuit 20 233 171 122,001 70.57% 593 392 1,046,440 62.49%
Northeast 743 539 407,320 73.18% 1,977 1,333 3,061,929 66.30%
Circuit 4 292 218 138,137 73.83% 627 417 931,736 65.08%
Circuit 5 152 102 103,042 71.03% 569 394 928,614 69.26%
Circuit 7 181 128 97,861 69.82% 453 288 752,086 60.04%
Circuit 8 plus Columbia, Dixie, Hamilton,
   Lafayette, and Suwannee
118 91 68,281 79.51% 328 234 449,493 72.83%
Northwest 418 328 179,243 78.90% 849 623 1,210,885 71.29%
Circuit 1 181 144 87,500 80.17% 370 264 592,228 69.88%
Circuit 2 plus Madison and Taylor 143 110 59,267 77.32% 289 220 370,571 71.35%
Circuit 14 94 74 32,476 79.04% 190 139 248,086 73.87%
South (Circuits 11 and 16) 630 469 305,265 75.38% 1,567 1,070 2,293,453 67.92%
Southeast 409 326 210,758 78.14% 946 630 1,684,762 66.07%
Circuit 15 (Palm Beach) 300 238 144,638 77.27% 695 457 1,158,916 62.89%
Circuit 19 109 88 66,120 80.71% 251 173 525,846 73.07%
Georgia 1,854 1,462 1,268,988 78.86% 4,726 3,416 7,712,367 69.52%
Region 1 522 391 329,750 76.27% 1,262 861 1,971,947 65.55%
Region 2 273 220 162,400 80.93% 627 491 984,586 77.22%
Region 3 491 397 372,857 78.86% 1,501 1,071 2,323,055 68.40%
Region 4 87 66 79,784 73.09% 196 149 474,744 72.17%
Region 5 223 174 143,653 78.22% 548 381 883,809 67.29%
Region 6 258 214 180,543 84.06% 592 463 1,074,226 75.13%
Hawaii 1,430 1,044 138,954 73.58% 3,333 2,216 1,064,678 64.57%
Hawaii Island 215 156 18,748 75.51% 448 309 141,308 67.14%
Honolulu 950 707 98,052 74.74% 2,193 1,451 752,120 63.85%
Kauai 92 63 6,548 66.04% 235 156 51,443 64.21%
Maui 173 118 15,605 67.79% 457 300 119,807 65.65%
Idaho 1,258 990 216,232 78.46% 3,073 2,262 1,256,899 73.23%
Region 1 117 77 26,531 67.22% 349 217 178,686 61.62%
Region 2 83 62 13,698 76.71% 239 185 90,893 80.52%
Region 3 231 192 36,741 84.75% 503 385 196,552 76.79%
Region 4 346 272 60,351 77.88% 875 638 365,015 74.46%
Region 5 165 150 25,031 90.63% 391 323 143,067 80.96%
Region 6 73 58 16,760 76.28% 168 113 92,257 63.58%
Region 7 243 179 37,120 73.20% 548 401 190,431 70.98%
Illinois 3,463 2,443 1,511,837 70.59% 8,860 5,363 9,704,395 59.61%
Region 1 (Cook) 1,114 756 579,365 68.43% 3,170 1,812 3,982,249 57.45%
Region 1.1 (Far North Side) 80 56 44,120 64.19% 264 160 371,462 57.02%
Region 1.2 (Northwest Side) 101 63 31,600 66.34% 242 115 203,995 46.90%
Region 1.3 (North Central Side) 10 7 30,542 67.80% 124 73 387,953 60.50%
Region 1.4 (West Side) 66 48 54,618 75.47% 300 171 355,596 59.06%
Region 1.5 (South Side) 151 101 77,383 62.84% 426 254 498,671 62.65%
Region 1.6 (Southwest Side) 64 37 53,212 63.05% 162 85 265,349 53.29%
Region 1.7 (Suburban Cook) 642 444 287,891 70.67% 1,652 954 1,899,223 56.71%
Region 2 1,326 959 524,306 71.86% 2,997 1,886 3,037,213 61.79%
Region 2a (DuPage) 287 207 109,677 73.41% 648 391 709,052 61.29%
Region 2b 724 509 298,134 69.36% 1,579 976 1,619,786 59.85%
Region 2c (Winnebago) 68 57 33,017 83.26% 177 118 213,820 65.57%
Region 2d 247 186 83,478 74.75% 593 401 494,555 66.86%
Region 3 492 349 176,716 70.88% 1,242 759 1,096,955 59.57%
Region 3a (Champaign) 63 52 31,243 78.96% 203 131 159,770 63.88%
Region 3b 429 297 145,473 69.35% 1,039 628 937,184 58.85%
Region 4 224 163 100,757 74.32% 613 398 682,184 65.31%
Region 4a (Sangamon) 71 49 22,428 72.28% 190 125 152,561 66.11%
Region 4b 153 114 78,329 75.25% 423 273 529,623 64.97%
Region 5 307 216 130,694 72.05% 838 508 905,794 57.48%
Region 5a 167 126 59,604 76.61% 410 270 401,560 63.92%
Region 5b 140 90 71,090 66.19% 428 238 504,235 51.90%
Indiana 1,247 939 818,824 74.90% 3,139 2,166 4,997,784 68.30%
Central 377 290 217,806 77.25% 940 671 1,331,208 71.81%
East 99 73 66,936 76.57% 244 167 418,826 71.63%
North Central 177 127 115,995 67.63% 430 264 694,642 58.38%
Northeast 147 96 84,056 66.02% 324 207 487,799 67.46%
Northwest 124 96 91,143 75.61% 324 222 563,191 65.85%
Southeast 152 122 81,392 79.44% 363 262 536,304 71.92%
Southwest 72 56 60,625 79.94% 237 168 391,075 70.46%
West 99 79 100,870 79.10% 277 205 574,738 67.16%
Iowa 1,351 987 377,130 73.38% 3,291 2,222 2,375,777 67.98%
Central 286 206 70,024 73.25% 678 448 433,095 66.21%
North Central 146 115 44,080 80.83% 404 283 262,883 70.09%
Northeast 326 229 90,460 68.96% 752 504 578,505 67.08%
Northwest 211 157 56,532 77.09% 464 328 356,453 71.20%
Southeast 280 197 78,869 70.71% 727 456 506,635 63.37%
Southwest 102 83 37,165 76.08% 266 203 238,205 77.92%
Kansas 1,374 1,046 368,757 75.26% 3,093 2,200 2,138,502 70.01%
Northeast 682 521 186,716 75.76% 1,531 1,097 1,076,524 69.82%
Northwest and North Central 101 79 25,905 78.63% 291 194 170,831 67.06%
South Central 394 300 106,297 75.20% 862 621 611,959 72.37%
Southeast 92 56 25,883 58.92% 196 119 157,824 59.58%
Southwest 105 90 23,956 85.05% 213 169 121,364 76.91%
Kentucky 1,348 982 526,354 73.30% 3,331 2,190 3,363,945 63.79%
Adanta, Cumberland River, and Lifeskills 212 150 88,904 71.58% 558 338 562,344 59.55%
Bluegrass, Comprehend, and North Key 416 294 161,366 72.51% 998 643 991,757 63.44%
Centerstone 338 280 112,815 82.57% 838 625 748,769 72.83%
Communicare and River Valley 146 101 61,000 67.23% 324 200 373,718 58.15%
Four Rivers and Pennyroyal 112 74 47,957 65.33% 306 186 314,211 59.96%
Kentucky River, Mountain, and Pathways 124 83 54,312 69.77% 307 198 373,147 58.60%
Louisiana 1,298 977 544,148 74.42% 3,081 2,211 3,466,043 70.20%
Regions 1 and 10 245 176 97,719 70.97% 600 413 692,600 68.54%
Region 1 131 99 52,344 78.23% 298 227 371,409 76.06%
Region 10 (Jefferson) 114 77 45,375 63.23% 302 186 321,191 61.63%
Regions 2 and 9 309 216 148,187 68.76% 811 556 919,560 67.95%
Region 3 138 107 47,176 78.28% 277 206 291,661 73.93%
Regions 4, 5, and 6 301 220 141,855 72.50% 752 529 882,658 68.16%
Regions 7 and 8 305 258 109,211 83.18% 641 507 679,564 75.97%
Maine 1,404 1,010 140,644 73.09% 3,210 2,226 1,071,266 69.69%
Aroostook/Downeast 149 117 15,524 79.09% 352 279 128,455 77.84%
Aroostook 67 57 7,171 85.99% 161 137 57,065 83.25%
Downeast 82 60 8,353 72.40% 191 142 71,390 73.22%
Central 171 147 18,142 88.05% 391 294 138,876 76.13%
Cumberland 291 190 31,245 67.51% 700 428 230,401 62.48%
Midcoast 149 86 14,030 57.06% 379 256 118,725 69.01%
Penquis 176 127 19,468 73.69% 449 332 138,570 74.94%
Western 268 198 21,305 76.71% 480 341 154,031 70.22%
York 200 145 20,931 71.22% 459 296 162,208 64.55%
Maryland 1,203 921 660,889 76.52% 3,075 2,220 4,596,124 71.42%
Anne Arundel 75 57 60,848 74.78% 210 152 433,909 73.95%
Baltimore City 141 119 61,563 85.70% 426 340 475,444 77.82%
Baltimore County 108 71 87,682 63.46% 286 191 642,689 69.67%
Montgomery 198 154 114,317 79.97% 557 403 790,417 71.61%
North Central 119 93 56,620 78.68% 295 219 366,876 73.90%
Northeast 83 59 54,778 68.66% 175 113 382,743 61.83%
Prince George's 173 133 102,172 75.18% 515 369 675,099 69.84%
South 149 114 66,714 76.89% 333 230 441,385 68.92%
West 157 121 56,195 78.29% 278 203 387,563 72.14%
Massachusetts 1,584 1,046 858,668 67.49% 3,714 2,216 5,415,955 60.07%
Boston 162 112 107,280 69.34% 418 265 706,204 65.55%
Central 190 113 117,048 60.36% 467 280 689,006 58.82%
Metrowest 392 264 196,226 66.45% 967 546 1,257,105 57.05%
Northeast 281 201 164,635 71.88% 729 442 1,064,425 60.02%
Southeast 276 164 154,619 62.12% 644 364 1,024,791 58.47%
Western 283 192 118,860 72.79% 489 319 674,424 65.83%
Michigan 3,244 2,505 1,202,884 76.80% 7,805 5,426 7,680,398 68.16%
Region 1 72 55 35,755 72.91% 189 142 255,692 75.31%
Region 2 156 106 53,168 67.04% 407 273 405,956 71.24%
Region 3 509 422 164,551 82.25% 1,062 764 943,302 70.95%
Region 4 299 251 104,204 83.00% 728 538 648,052 70.74%
Region 5 555 442 215,827 78.92% 1,396 991 1,292,960 69.86%
Region 6 243 198 104,605 82.23% 605 476 628,770 76.65%
Region 7 508 362 204,305 71.61% 1,218 813 1,324,416 64.82%
Region 8 412 301 141,953 73.86% 962 629 978,078 65.39%
Region 9 238 170 94,702 70.53% 724 450 667,588 60.97%
Region 10 252 198 83,814 79.69% 514 350 535,585 65.06%
Minnesota 1,289 969 647,949 74.09% 3,113 2,138 4,217,608 69.26%
Regions 1 and 2 121 90 60,016 73.08% 315 202 419,894 69.37%
Region 1 73 50 24,642 65.27% 164 106 157,221 69.72%
Region 2 48 40 35,374 84.82% 151 96 262,672 69.00%
Regions 3 and 4 222 174 113,288 75.78% 472 334 712,230 70.05%
Region 3 59 44 36,956 72.65% 114 73 250,182 61.31%
Region 4 163 130 76,333 76.68% 358 261 462,048 72.36%
Regions 5 and 6 244 174 121,988 71.52% 625 409 773,769 62.39%
Region 5 126 93 60,499 73.77% 296 197 390,286 64.55%
Region 6 118 81 61,489 68.79% 329 212 383,483 60.44%
Region 7 702 531 352,656 74.52% 1,701 1,193 2,311,715 71.26%
Region 7A (Hennepin) 271 205 135,271 74.54% 710 519 957,489 73.18%
Region 7B (Ramsey) 141 102 64,423 70.70% 366 245 416,708 67.89%
Region 7C 290 224 152,962 76.44% 625 429 937,518 70.99%
Mississippi 1,275 989 366,409 77.92% 3,015 2,123 2,213,025 68.20%
Region 1 310 236 85,693 77.52% 747 544 502,349 71.79%
Region 2 129 116 42,816 88.87% 361 290 266,386 80.37%
Region 3 204 162 52,917 78.85% 470 325 307,406 65.29%
Region 4 263 191 68,810 72.42% 580 378 414,462 61.45%
Region 5 58 47 20,376 77.54% 112 80 132,527 67.18%
Region 6 129 104 37,291 82.32% 291 211 229,715 68.65%
Region 7 182 133 58,506 74.51% 454 295 360,181 64.00%
Missouri 1,292 970 729,779 75.63% 3,119 2,200 4,622,126 69.02%
Central 237 182 108,498 75.50% 509 376 630,613 72.77%
Eastern 419 317 244,846 76.00% 1,067 739 1,604,721 66.43%
Eastern (St. Louis City and County) 218 169 147,693 78.31% 596 424 1,009,348 67.25%
Eastern (excluding St. Louis) 201 148 97,153 73.47% 471 315 595,372 65.42%
Northwest 322 232 178,766 73.83% 820 563 1,117,763 67.59%
Northwest (Jackson) 161 116 78,664 75.74% 443 319 509,598 69.65%
Northwest (excluding Jackson) 161 116 100,102 71.60% 377 244 608,165 65.00%
Southeast 135 108 84,261 81.48% 286 226 546,634 76.80%
Southwest 179 131 113,408 73.89% 437 296 722,395 69.07%
Montana 1,329 974 115,902 73.10% 3,245 2,236 809,957 70.40%
Region 1 99 73 9,264 69.85% 194 135 63,680 70.42%
Region 2 167 120 17,357 73.11% 371 255 113,643 67.11%
Region 3 289 202 24,223 69.78% 741 519 167,208 72.35%
Region 4 398 292 30,601 74.12% 988 656 217,226 69.16%
Region 5 376 287 34,457 75.25% 951 671 248,200 71.53%
Nebraska 1,315 965 236,531 74.16% 3,132 2,181 1,414,491 69.65%
Regions 1 and 2 131 98 22,944 71.27% 276 192 141,483 67.81%
Region 1 52 41 10,777 77.20% 124 92 66,680 69.15%
Region 2 79 57 12,167 67.51% 152 100 74,803 66.87%
Region 3 183 128 28,779 71.58% 427 306 172,263 74.03%
Region 4 158 119 25,913 74.95% 339 233 153,671 66.42%
Region 5 284 195 57,818 68.86% 772 531 353,418 69.80%
Region 6 559 425 101,077 78.02% 1,318 919 593,657 69.40%
Nevada 1,221 952 337,080 77.64% 3,179 2,214 2,269,280 68.26%
Clark – Region 1 904 715 246,705 78.17% 2,286 1,602 1,636,776 68.35%
Region 3 127 86 38,993 69.54% 348 230 277,962 66.11%
Capital District 63 47 17,549 71.59% 185 123 132,673 64.38%
Rural/Frontier 64 39 21,443 67.21% 163 107 145,288 68.04%
Washoe – Region 2 190 151 51,383 80.40% 545 382 354,543 69.41%
New Hampshire 1,401 999 146,406 70.68% 3,182 2,128 1,069,364 66.90%
Central 474 341 42,441 71.21% 980 691 304,667 69.75%
Central 1 264 188 22,185 71.35% 511 380 151,673 74.29%
Central 2 210 153 20,256 71.00% 469 311 152,994 64.82%
Northern 166 122 18,048 73.54% 411 309 139,265 73.90%
Southern 761 536 85,917 69.69% 1,791 1,128 625,432 63.75%
Southern 1 (Rockingham) 303 201 31,506 64.72% 642 402 241,772 63.44%
Southern 2 458 335 54,411 73.05% 1,149 726 383,660 63.93%
New Jersey 2,173 1,546 1,017,149 70.74% 5,348 3,356 6,879,394 61.54%
Central 447 300 236,015 65.94% 1,077 664 1,571,925 61.81%
Metropolitan 522 378 256,451 72.37% 1,306 830 1,659,823 60.45%
Northern 726 520 316,091 71.09% 1,833 1,130 2,225,017 59.94%
Southern 478 348 208,591 72.87% 1,132 732 1,422,630 65.05%
New Mexico 1,162 972 244,873 83.62% 2,725 2,102 1,565,363 76.20%
Region 1 222 185 54,131 84.10% 490 367 320,309 72.30%
Region 2 130 118 30,117 92.76% 297 243 227,666 82.35%
Region 3 (Bernalillo) 330 276 76,207 83.01% 957 727 513,440 75.01%
Region 4 212 175 34,033 80.11% 439 331 192,769 75.59%
Region 5 268 218 50,385 82.00% 542 434 311,178 77.98%
Region 5a 102 83 21,237 84.35% 232 198 147,356 84.84%
Region 5b (Dona Ana) 166 135 29,148 80.49% 310 236 163,822 71.71%
New York 4,865 3,358 2,071,701 67.15% 11,653 7,301 15,348,822 60.44%
Region 1: Long Island 779 493 314,013 61.86% 1,689 906 2,211,858 52.09%
Region 2: New York City 1,727 1,125 826,262 63.50% 4,791 2,744 6,680,349 54.20%
Region 2A: Bronx 425 322 167,272 73.62% 870 610 1,064,423 69.47%
Region 2B: Kings 591 354 269,356 59.15% 1,581 851 2,008,592 51.01%
Region 2C: New York 247 160 122,360 59.96% 812 456 1,396,337 53.33%
Region 2D: Queens 340 202 217,291 60.67% 1,217 660 1,844,566 52.00%
Region 2E: Richmond 124 87 49,983 73.29% 311 167 366,431 51.38%
Region 3: Mid-Hudson 624 415 269,805 62.45% 1,213 774 1,768,860 62.93%
Region 4: Capital Region 261 179 101,729 66.87% 633 431 741,578 71.93%
Region 5: Mohawk Valley 48 27 28,387 54.24% 109 69 200,795 60.41%
Region 6: North Country 61 53 30,139 89.37% 173 133 240,795 78.83%
Region 7: Tug Hill Seaway 70 59 30,157 87.48% 159 122 194,423 72.86%
Region 8: Central 324 250 116,511 75.70% 676 510 785,769 75.39%
Region 9: Southern Tier 133 105 52,962 79.97% 323 252 349,102 78.07%
Region 10: Finger Lakes 412 318 140,697 78.07% 980 696 986,294 69.84%
Region 11: Western 426 334 161,039 79.71% 907 664 1,188,997 71.48%
North Carolina 1,950 1,490 1,179,279 75.80% 4,833 3,353 7,759,846 68.98%
Alliance Behavioral Healthcare 1 158 130 99,336 81.78% 402 297 615,179 74.25%
Alliance Behavioral Healthcare 2 173 144 128,566 84.88% 490 352 770,451 70.92%
Cardinal Innovations Healthcare Solutions 1 184 126 95,826 66.36% 395 232 579,813 59.40%
Cardinal Innovations Healthcare Solutions 2 112 90 81,177 81.54% 258 194 529,727 75.72%
Cardinal Innovations Healthcare Solutions 3 152 103 119,859 66.29% 475 299 774,936 63.08%
CenterPoint Human Services 109 84 65,046 78.78% 265 196 425,950 75.49%
Eastpointe 176 141 97,111 80.18% 416 308 637,715 72.92%
Partners Behavioral Health Management 188 138 104,457 72.34% 434 296 709,615 68.75%
Sandhills Center 1 139 112 69,175 79.11% 316 227 445,872 72.10%
Sandhills Center 2 95 71 63,351 73.11% 278 180 406,745 64.32%
Smoky Mountain Center 1 140 95 58,093 65.08% 345 234 428,827 67.73%
Smoky Mountain Center 2 56 36 54,164 66.83% 188 112 430,236 58.59%
Trillium Health Resources 1 164 139 71,398 85.65% 326 250 490,461 71.00%
Trillium Health Resources 2 104 81 71,722 78.03% 245 176 514,320 71.07%
North Dakota 1,432 1,051 92,979 74.44% 3,168 2,136 566,470 67.30%
Badlands and West Central 424 317 23,414 75.94% 872 556 151,981 63.72%
Badlands 80 62 5,017 79.70% 190 124 34,957 63.85%
West Central 344 255 18,396 75.04% 682 432 117,024 63.67%
Lake Region 72 57 5,906 79.73% 142 104 30,651 72.05%
North Central 166 105 13,390 63.85% 329 203 80,770 62.69%
Northeast 174 143 12,611 84.65% 364 268 70,509 72.62%
Northwest 93 55 4,933 60.56% 267 163 31,717 62.12%
South Central 108 87 6,428 80.37% 235 169 44,138 73.47%
Southeast 395 287 26,298 72.60% 959 673 156,704 69.22%
Ohio 3,303 2,437 1,366,539 73.29% 8,117 5,481 8,881,486 66.36%
Boards 2, 46, 55, and 68 108 84 62,218 77.67% 251 165 387,256 61.81%
Boards 3, 52, and 85 143 98 49,320 67.03% 315 205 289,559 66.03%
Boards 4 and 78 101 82 33,312 82.07% 329 244 238,353 70.54%
Boards 5 and 60 122 86 44,526 70.54% 268 196 263,194 73.87%
Boards 7, 15, 41, 79, and 84 97 66 48,833 64.53% 229 135 357,089 61.42%
Boards 8, 13, and 83 126 82 63,855 66.43% 280 155 383,730 59.03%
Board 9 (Butler) 124 86 49,847 70.15% 300 181 283,328 56.48%
Board 12 100 62 42,738 58.49% 237 151 269,318 63.01%
Boards 18 and 47 367 278 173,730 75.07% 1,000 701 1,199,146 68.54%
Boards 20, 32, 54, and 69 163 121 41,225 73.82% 354 243 257,579 67.82%
Boards 21, 39, 51, 70, and 80 176 135 69,312 75.55% 360 245 425,441 66.10%
Boards 22, 74, and 87 178 148 47,194 84.60% 366 285 300,211 75.24%
Boards 23 and 45 106 73 48,395 66.20% 250 161 289,356 64.71%
Board 25 (Franklin) 347 266 144,010 77.38% 959 646 936,226 68.02%
Boards 27, 71, and 73 174 125 56,633 70.40% 364 253 376,931 66.60%
Boards 28, 43, and 67 122 85 58,578 64.24% 297 171 380,651 54.03%
Board 31 (Hamilton) 226 162 91,170 71.86% 593 400 604,546 65.24%
Board 48 (Lucas) 104 81 51,457 81.87% 229 169 330,388 73.37%
Boards 50 and 76 156 126 68,055 79.58% 435 300 472,897 68.37%
Board 57 (Montgomery) 132 99 62,179 74.43% 338 232 420,809 68.20%
Board 77 (Summit) 131 92 59,951 72.03% 363 243 415,480 66.43%
Oklahoma 1,339 954 446,767 70.99% 3,199 2,121 2,894,147 66.35%
Central 197 138 58,808 71.34% 423 268 374,774 62.57%
East Central 127 95 51,012 75.09% 275 183 329,032 64.27%
Northeast 184 136 56,346 73.11% 482 318 365,936 65.86%
Northwest and Southwest 184 131 64,433 69.10% 419 277 408,571 64.32%
Oklahoma County 227 164 86,185 70.56% 594 391 564,635 67.53%
Southeast 202 146 58,282 71.34% 467 335 388,994 73.66%
Tulsa County 218 144 71,703 68.44% 539 349 462,205 64.66%
Oregon 1,439 1,000 444,348 69.72% 3,280 2,241 3,234,220 67.89%
Region 1 (Multnomah) 218 156 78,209 69.65% 656 449 648,494 68.07%
Region 2 391 274 111,694 72.79% 802 575 764,250 71.40%
Region 3 484 328 146,680 68.78% 1,033 690 1,002,020 67.33%
Region 4 179 116 55,876 62.75% 403 268 456,271 62.13%
Region 5 (Central) 46 35 22,756 70.79% 139 88 167,777 62.73%
Region 6 (Eastern) 121 91 29,133 74.46% 247 171 195,408 71.63%
Pennsylvania 3,233 2,387 1,392,691 73.89% 7,772 5,359 9,942,088 68.16%
Region 1 (Allegheny) 283 192 120,306 68.03% 875 599 980,269 68.67%
Regions 3, 8, 9, and 51 193 142 74,089 74.13% 410 294 549,652 71.57%
Regions 4, 11, 37, and 49 210 145 101,256 67.96% 449 291 701,250 64.47%
Regions 5, 18, 23, 24, and 46 202 153 80,724 74.07% 453 319 581,321 69.73%
Regions 6, 12, 16, 31, 35, 45, and 47 164 129 84,679 80.19% 437 329 562,641 70.94%
Regions 7, 13, 20, and 33 721 524 282,899 71.93% 1,565 1,043 1,929,265 66.53%
Regions 10, 15, 27, 32, 43, and 44 135 109 50,816 82.77% 352 248 396,681 68.22%
Regions 17 and 21 89 66 42,755 74.19% 211 146 283,627 68.85%
Regions 19, 26, 28, and 42 448 333 165,501 74.25% 1,040 754 1,122,167 72.25%
Regions 22, 38, 40, 41, and 48 175 126 78,451 72.89% 458 284 650,450 62.08%
Regions 29 and 34 127 86 76,148 69.44% 313 191 512,623 63.55%
Regions 30 and 50 146 104 61,033 70.76% 392 270 476,665 68.15%
Region 36 (Philadelphia) 340 278 174,035 81.26% 817 591 1,195,476 69.16%
Rhode Island 1,325 970 122,660 74.94% 3,275 2,182 835,168 66.81%
Region 1: Southern Providence County 216 156 19,571 73.32% 515 332 153,662 66.32%
Region 2: Northern Providence County/Blackstone Valley 304 233 23,484 78.57% 714 479 166,271 66.17%
Region 3: Providence 172 143 29,317 81.21% 534 386 140,250 70.96%
Region 4: Kent County 234 153 16,180 66.96% 564 360 135,951 67.48%
Region 5: East Bay 120 85 10,252 74.38% 314 206 77,215 65.65%
Region 6: Newport County 108 74 8,717 69.78% 277 161 65,906 58.74%
Region 7: South County 171 126 15,140 78.10% 357 258 95,913 70.79%
South Carolina 1,234 986 580,721 78.68% 3,007 2,188 3,824,084 72.50%
Region 1 413 321 184,384 76.29% 1,010 738 1,190,738 71.84%
Region 2 345 271 150,033 77.67% 799 559 940,138 68.48%
Region 3 186 153 93,719 83.25% 464 342 663,675 75.39%
Region 4 290 241 152,585 80.64% 734 549 1,029,533 75.51%
South Dakota 1,321 1,005 101,966 76.41% 3,047 2,142 640,367 70.83%
Region 1 289 225 25,061 76.27% 684 473 158,354 70.33%
Region 2 114 86 9,681 78.33% 264 201 58,332 75.89%
Region 3 363 274 24,260 76.47% 805 584 151,527 71.81%
Region 4 167 126 14,340 73.75% 335 218 89,908 65.04%
Region 5 388 294 28,625 76.95% 959 666 182,246 71.18%
Tennessee 1,334 1,013 770,091 74.42% 3,060 2,173 5,104,891 69.47%
Region 1 85 58 54,268 70.63% 246 184 416,596 75.29%
Region 2 241 188 135,003 77.28% 575 420 960,783 72.10%
Region 3 226 168 110,250 73.58% 503 352 769,638 65.84%
Region 4 (Davidson) 80 58 74,099 74.07% 285 178 511,882 63.73%
Region 5 382 277 200,121 70.38% 742 497 1,239,604 64.92%
Region 6 139 113 74,748 80.33% 299 228 490,950 72.44%
Region 7 (Shelby) 181 151 121,601 78.08% 410 314 715,438 76.59%
Texas 4,164 3,356 3,648,618 80.13% 10,210 7,525 20,456,318 71.87%
Region 1 117 94 120,352 82.36% 319 223 663,385 72.62%
Region 2 110 84 71,218 76.24% 220 174 425,186 78.64%
Region 3 1,279 1,058 978,020 82.20% 3,159 2,432 5,527,687 75.67%
Region 3a 795 632 627,349 79.48% 1,981 1,438 3,539,487 71.51%
Region 3bc 484 426 350,672 86.89% 1,178 994 1,988,201 82.45%
Region 4 140 112 141,358 80.80% 384 311 885,313 78.01%
Region 5 96 79 97,510 82.58% 280 226 611,076 81.03%
Region 6 924 721 875,482 77.01% 2,266 1,525 4,979,768 64.48%
Region 6a 798 629 786,974 77.74% 1,995 1,341 4,459,220 64.60%
Region 6bc 126 92 88,508 72.51% 271 184 520,548 63.62%
Region 7 483 380 436,458 79.33% 1,190 865 2,523,767 70.50%
Region 7a 234 172 272,836 75.16% 647 438 1,621,997 67.27%
Region 7bcd 249 208 163,622 84.20% 543 427 901,770 74.89%
Region 8 403 320 378,361 78.45% 994 712 2,133,752 71.22%
Region 9 74 58 79,931 78.07% 223 149 456,101 65.97%
Region 10 170 141 133,669 83.33% 356 281 655,590 75.99%
Region 11 368 309 336,258 83.05% 819 627 1,594,692 73.83%
Region 11abd 229 193 202,327 83.03% 535 401 1,005,709 73.49%
Region 11c (Hidalgo) 139 116 133,931 83.09% 284 226 588,982 74.48%
Utah 1,140 911 440,369 78.75% 2,945 2,193 2,163,014 73.58%
Bear River, Northeastern, Summit, Tooele,
   and Wasatch
110 85 54,780 75.98% 287 197 259,321 67.44%
Central, Four Corners, San Juan, and
   Southwest
116 90 54,453 77.90% 339 241 259,854 67.75%
Central, Four Corners, and San Juan 46 30 21,349 62.81% 132 92 98,134 67.41%
Southwest 70 60 33,104 88.05% 207 149 161,719 68.00%
Davis County 142 111 49,402 78.00% 277 207 231,005 76.15%
Salt Lake County 445 355 152,825 77.54% 1,206 910 828,392 75.23%
Utah County 219 176 92,888 80.34% 569 442 397,661 76.28%
Weber, Morgan 108 94 36,021 86.06% 267 196 186,782 71.98%
Vermont 1,352 969 68,271 72.29% 3,170 2,124 503,268 69.16%
Champlain Valley 565 404 30,176 73.61% 1,315 832 203,342 63.77%
Rural Northeast 316 224 15,836 66.34% 744 512 118,083 73.84%
Rural Southeast 281 199 12,260 71.78% 654 464 103,989 71.33%
Rural Southwest 190 142 9,999 78.41% 457 316 77,854 72.31%
Virginia 1,932 1,454 919,846 75.39% 4,933 3,421 6,388,815 67.71%
Region 1 313 232 153,813 73.45% 877 639 990,046 70.64%
Region 2 550 408 260,618 74.82% 1,356 881 1,829,456 64.73%
Region 3 330 238 146,272 71.28% 790 558 1,068,361 68.20%
Region 4 332 257 155,202 78.06% 892 635 1,086,731 69.31%
Region 5 407 319 203,940 78.67% 1,018 708 1,414,220 67.45%
Washington 1,297 956 812,394 72.01% 3,299 2,170 5,658,537 64.84%
Region 1 275 206 203,787 72.04% 710 464 1,210,193 64.59%
Greater Columbia and North Central 192 144 131,921 74.02% 497 322 719,498 64.68%
Spokane 83 62 71,867 67.77% 213 142 490,695 64.42%
Region 2 601 432 348,106 70.37% 1,623 1,038 2,631,266 63.01%
King 388 275 215,953 69.24% 1,082 683 1,691,554 62.66%
North Sound 213 157 132,152 72.59% 541 355 939,711 63.67%
Region 3 421 318 260,500 74.50% 966 668 1,817,078 68.05%
Pierce 159 125 99,903 76.96% 375 260 664,302 66.43%
Salish 74 50 38,308 68.73% 149 96 305,415 67.67%
SW WA and Great Rivers 142 109 86,382 76.04% 335 241 580,534 70.54%
Thurston-Mason 46 34 35,908 71.13% 107 71 266,827 66.88%
West Virginia 1,394 945 195,318 67.78% 3,395 2,193 1,424,044 63.07%
Region I 107 69 14,623 64.98% 277 176 112,135 63.57%
Region II 211 153 31,249 72.90% 486 329 201,314 67.82%
Region III 147 97 17,179 64.82% 306 208 130,473 66.83%
Region IV 308 202 45,457 65.02% 789 462 319,183 56.43%
Region V 383 252 54,016 66.56% 966 618 401,736 62.21%
Region VI 238 172 32,795 71.90% 571 400 259,203 66.42%
Wisconsin 1,390 1,064 674,893 76.55% 3,125 2,162 4,452,899 69.21%
Milwaukee 230 174 116,620 77.39% 492 336 718,984 71.44%
Northeastern 233 165 142,197 68.55% 605 410 966,231 67.47%
Northern 150 125 53,135 85.34% 335 245 383,560 70.83%
Southeastern 324 243 140,750 75.65% 609 400 897,869 65.96%
Southern 279 222 128,227 78.18% 721 519 877,472 71.54%
Western 174 135 93,964 76.73% 363 252 608,784 68.19%
Wyoming 1,297 1,058 69,879 80.67% 2,826 2,172 435,402 74.53%
Judicial District 1 (Laramie) 177 124 11,454 68.62% 446 328 71,478 70.87%
Judicial District 2 139 121 7,722 85.25% 329 266 42,739 77.96%
Judicial District 3 208 169 10,690 79.29% 382 288 59,517 71.85%
Judicial District 4 65 45 4,340 71.76% 169 122 29,127 71.91%
Judicial District 5 137 111 6,467 81.39% 284 227 41,739 77.61%
Judicial District 6 125 110 7,457 87.07% 273 223 44,886 75.71%
Judicial District 7 (Natrona) 190 162 9,277 84.36% 349 276 59,375 77.88%
Judicial District 8 110 95 4,527 86.53% 230 174 30,730 75.08%
Judicial District 9 146 121 7,946 81.84% 364 268 55,811 74.08%
SPA = service planning area.
NOTE: For substate region definitions, see the "2016-2018 National Survey on Drug Use and Health Substate Region Definitions" at https://www.samhsa.gov/data.
NOTE: Computations in this table are based on a respondent's age at screening. Thus, the data in the Total Responded column(s) could differ from data in other NSDUH tables that use the respondent's age recorded during the interview.
NOTE: To compute the pooled 2016-2018 weighted response rates, the three samples were combined, and the individual-year weights were used for the pooled sample. Thus, the response rates presented here are weighted across 3 years of data rather than being a simple average of the 2016, 2017, and 2018 individual response rates.
NOTE: The total responded column represents the combined sample size from the 2016, 2017, and 2018 NSDUHs.
NOTE: The population estimate is the simple average of the 2016, 2017, and 2018 population counts for individuals aged 12 to 20 and adults aged 18 or older. Because of rounding, the sum of the substate region population counts within a state may not exactly match the state population count listed in the table.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2016, 2017, and 2018.

Section D: References

Box, G. E. P., & Tiao, G. C. (1992). Bayesian inference in statistical analysis (Wiley Classics Library). Hoboken, NJ: John Wiley & Sons.

Center for Behavioral Health Statistics and Quality. (2012). Results from the 2011 National Survey on Drug Use and Health: Summary of national findings (HHS Publication No. SMA 12-4713, NSDUH Series H-44). Retrieved from https://www.samhsa.gov/data/

Center for Behavioral Health Statistics and Quality. (2013). Results from the 2012 National Survey on Drug Use and Health: Mental health findings (HHS Publication No. SMA 13-4805, NSDUH Series H-47). Retrieved from https://www.samhsa.gov/data/

Center for Behavioral Health Statistics and Quality. (2015a). 2014 National Survey on Drug Use and Health: Methodological resource book (Section 2, Sample design report). Retrieved from https://www.samhsa.gov/data/

Center for Behavioral Health Statistics and Quality. (2015b, August). National Survey on Drug Use and Health: 2014 and 2015 redesign changes. Retrieved from https://www.samhsa.gov/data/

Center for Behavioral Health Statistics and Quality. (2016a). 2015 National Survey on Drug Use and Health: Methodological summary and definitions. Retrieved from https://www.samhsa.gov/data/

Center for Behavioral Health Statistics and Quality. (2016b). 2015 National Survey on Drug Use and Health: Summary of the effects of the 2015 NSDUH questionnaire redesign: Implications for data users. Retrieved from https://www.samhsa.gov/data/

Folsom, R. E., Shah, B., & Vaish, A. (1999). Substance abuse in states: A methodological report on model based estimates from the 1994-1996 National Household Surveys on Drug Abuse. In Proceedings of the 1999 Joint Statistical Meetings, American Statistical Association, Survey Research Methods Section, Baltimore, MD (pp. 371-375). Alexandria, VA: American Statistical Association.

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Wright, D. (2003, July). State estimates of substance use from the 2001 National Household Survey on Drug Abuse: Volume II. Individual state tables and technical appendices (HHS Publication No. SMA 03-3826, NHSDA Series H-20). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Wright, D., & Sathe, N. (2005, January). State estimates of substance use from the 2002-2003 National Surveys on Drug Use and Health (HHS Publication No. SMA 05-3989, NSDUH Series H-26). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Section E: List of Contributors

This National Survey on Drug Use and Health (NSDUH) document was prepared by the Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), and by RTI International (a registered trademark and a trade name of Research Triangle Institute), Research Triangle Park, North Carolina. Work by RTI was performed under Contract No. HHSS283201700002C.

At RTI, Neeraja S. Sathe and Kathryn Spagnola were responsible for the writing of the document, and Akhil K. Vaish was responsible for the overall methodology and estimation for the model-based Bayes estimates and confidence intervals. At SAMHSA, Xingyou Zhang and Yang Cheng reviewed the document and provided substantive revisions.

The following staff were responsible for generating the estimates: Akhil K. Vaish, Neeraja S. Sathe, and Kathryn Spagnola. The following staff provided other support: Brenda K. Porter and Amber McDonald. Ms. Spagnola also provided oversight for production of the document. Richard S. Straw edited it, and Teresa F. Bass, Kimberly Cone, and Pamela Tuck prepared the web versions. Justine L. Allpress prepared the maps used in the associated files.

End Notes

1 RTI International is a registered trademark and a trade name of Research Triangle Institute, Research Triangle Park, North Carolina.

2 In 2002, the survey's name changed from the National Household Survey on Drug Abuse (NHSDA) to the National Survey on Drug Use and Health (NSDUH).

3 The Office of Applied Studies (OAS) is the former name of the Center for Behavioral Health Statistics and Quality (CBHSQ).

4 The target sample size per year in each of the small sample states is 960 completed interviews, with the exception of Hawaii where the target sample size is 967 completed interviews.

5 Prior to this effort, substate small area estimates using combined 1999-2001, 2002-2004, 2004-2006, 2006-2008, 2008-2010, 2010-2012, 2012-2014, and 2014-2016 data have been produced by SAMHSA. Estimates from recent combined datasets, starting with the 2008-2010 dataset going forward, can be found at https://www.samhsa.gov/data/.

6 Files with a comma separated value (*.csv) extension are in plain text. They contain characters stored in a flat, nonproprietary format and can be opened by most computer programs. Computers with Microsoft Excel installed open *.csv files in Excel by default, with the fields automatically arranged appropriately in columns. Other database programs also open *.csv files with the fields appropriately arranged.

7 The exact changes are documented in the 2015 NSDUH's Office of Management and Budget (OMB) clearance package and in a summary report (CBHSQ, 2015b). The summary report and the 2015 NSDUH questionnaire are available on the SAMHSA website at https://www.samhsa.gov/data/.

8 The National Institute on Alcohol Abuse and Alcoholism (NIAAA, 2016) defines binge drinking as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 grams per deciliter (g/dL). This typically occurs after four drinks for women and five drinks for men in about 2 hours.

9 Prior to 2015, NSDUH referred to "nonmedical" use of prescription drugs. See Section C of the 2015 NSDUH methodological summary and definitions report (CBHSQ, 2016a) for further discussion about the change in terminology from nonmedical use to misuse of prescription drugs in 2015. Specifically, the approach and definition for measuring the misuse of prescription drugs were revised to include questions about any use of prescription drugs in addition to questions about misuse (previously called "nonmedical use"). Also, the definition for misuse was revised to focus on specific behaviors that indicate misuse (i.e., use in any way a doctor did not direct respondents to use prescription drugs, including use without a prescription of one's own; use in greater amounts, more often, or longer than told to take a drug; and use in any other way not directed by a doctor). Moreover, questions pertaining to specific prescription drugs focused on the past 12 months instead of the lifetime period that was used in the 2014 and prior questionnaires.

10 The use of mixed models (fixed and random effects) allows additional error components (random effects) to be included. These account for differences between states and within-state variations that are not taken into account by the predictor variables (fixed effects) alone. It is also difficult (if not impossible) to produce valid mean squared errors (MSEs) for small area estimates based solely on a fixed-effect national regression model (i.e., synthetic estimation) (Rao, 2003, p. 52). The mixed models produce estimates that are approximately represented by a weighted combination of the direct estimate from the substate data and a regression estimate from the national model. The regression coefficients of the national model are estimated using data from all of the substate areas (i.e., borrowing strength), and the regression estimate for a particular substate area is obtained by applying the national model to the substate-specific predictor data. The regression estimate for the substate area is then combined with the direct estimate from the substate data in a weighted combination where the weights are obtained by minimizing the MSE (variance + squared bias) of the small area estimate.

11 Claritas is a market research firm headquartered in Ithaca, New York (see https://www.claritas.com/ exit icon). When the Claritas data were obtained for the 2016-2018 NSDUHs, Claritas was affiliated with Nielsen Holdings, from which they became independent in January 2017.

12 Improper noninformative priors were used for the fixed regression coefficients. Because NSDUH's sample size is very large (approximately 200,000 observations across 3 years), it can be said with certainty that the posterior distribution for the fixed regression coefficients will be proper. For the Capital D sub eta and Capital D sub nu matrices, noninformative proper inverse Wishart prior distributions were used so that proper posterior distributions are guaranteed. Noninformative priors are used so that the data speak for themselves and inferences are unaffected by information external to the current data. For further information on Bayesian inference and analysis, see Box and Tiao (1992) and Gelman, Carlin, Stern, and Rubin (2003).

13 See Table 3 in the "2016-2018 NSDUH Substate Region Estimates: Excel Tables and CSV Files" at https://www.samhsa.gov/data/.

14 The RSE of an estimate is the posterior SE divided by the estimate itself. Note that the RSEs have been calculated based on the unbenchmarked small area estimates.

Long Description

Long description, Equation 1: The model is given by the following equation: log of pi sub a, i, j, k divided by 1 minus pi sub a, i, j, k is equal to the sum of three terms. The first term is given by x transpose sub a, i, j, k times beta sub a. The second term is eta sub a, i. And the third term is nu sub a, i, j. Long description end. Return to Equation 1.

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