Utah Health Status Update: Current Marijuana Use in Utah January 2019 Since 2001, marijuana use data for Utah (7.7%) had higher rates than females (4.6%). Among youth in grades 8, adolescents has been collected using the 10, and 12, 8.2% reported marijuana use within the past 30 days. Adults Prevention Needs Assessment (PNA) survey; in Summit County (10.5%) and Salt Lake County (8.2%) local health however, data regarding adult marijuana use districts had 30-day use rates higher than the state rate. Adults in Utah has never been collected until 2017. During County Health District (2.6%) had rates lower than the state rate. Current 2017, the Utah Department of Health and the use was higher among adults reporting seven or more poor mental health Utah Department of Human Services Divi- days during the past month (11.3%) and those with chronic pain (9.4%). sion of Substance Abuse and Mental Health Current use was lower among veterans (3.8%). There were no differences (DSAMH) partnered to collect the first state- in 30-day use by race, ethnicity, education, or income. wide adult marijuana use data using the Behav- Reasons for Use ior Risk Factor Surveillance Survey (BRFSS). Among adults who used marijuana during the past 30 days, 42.3% used Below, are the preliminary findings for these only for non-medical reasons, while 30.8% used for both medical and data that will help establish baseline use rates non-medical reasons, and 26.9% used marijuana only for medical rea- and patterns for public health surveillance, sons. There were no statistical differences in reason for use by age or sex, policy impact, and policy analysis. although the percentage reporting medical use only was 34.2% among Past 30-day Use adult females compared with 22.4% among adult males. However, the Overall, 6.1% of Utah adults reported current reason for using marijuana varied distinctly for those who also reported use of marijuana. Current use is defined as use chronic pain, arthritis, or 7+ days of poor mental health within the past within the past 30 days. The age group with month. Users who reported chronic pain and users with arthritis mostly the highest rate of current use (10.2%) was used marijuana only for medical reasons (56.2% and 48.0%). Users who adults aged 18–34. Adult use rates for aged reported seven or more poor mental health days during the past month 35+ ranged between 5% to 1% of users. Males reported use more evenly across all categories. Perception of Risk of Harm KEY FINDINGS Utah adults had varying rates of perceived risk of harming themselves • During 2017, 6.1% of Utah adults physically and in other ways when they smoked marijuana 1–2 times per reported current use of marijuana. • Marijuana usage rates were high for Past 30-day Use Figure 1. Percentage of adolescents, adults, veterans, and those reporting adults aged 18–34 (10.2%) and among chronic pain and poor mental health who reported using marijuana one or high school students (8.2%). Rates more times in the past 30 days, Utah, 2017 were also higher for males (7.7%). 16 • Adults in Summit County (10.5%) and Salt Lake County (8.2%) had 14 higher rates of current marijuana use; Utah County (2.6%) had a lower rate. 12 • Adults reporting poor mental health ents nd10 and chronic pain had higher rates of o p current marijuana use. Res of 8 • Most adults used marijuana for rec- e g a reational purposes, but of those with nt 6 e poor mental health and chronic pain, erc P 4 more users reported medical reasons for using marijuana. 2 • Women and older adults reported a higher perceived risk of harm from 0 marijuana than men and younger Grades 18-34 35-49 50-64 65+ All Adults Chronic Pain ≥ 7 Days Poor Veteran 8, 10, 12 Mental Health adults. Grades 8, 10, and 12 from the Utah Prevention Needs Assessment Survey Adult data from the Utah Behavioral Risk Factor Surveillance System week. More females (46.9%) reported moder- Reasons for Use ate to great perceived risk of harm smoking Figure 2. Percentage of adults reporting reason for using marijuana within the marijuana than males (38.1%). Younger age past 30 days by selected characteristics, Utah, 2017 groups also reported minimal perceived risk of Medical Only Non-medical Only Both 80 harm related to smoking marijuana one or two times per week. Two-thirds (68.2%) of 18- to Use70 34-year-olds reported no or slight perceived a n a risk of harm related to smoking marijuana. ariju60 The perceived risk of harm was opposite for M g 50 n adults aged 65 and older where 63.2% of these orti p adults reported moderate to great perceived e40 R risk of harm. The only age group with similar ults d30 perceived risk across both categories was adults of A ages 50 to 64. About half (51.4%) of these age 20 adults reported no or slight perceived risk of ent harm, and 48.6% reported moderate to great Perc10 perceived risk. 0 All Adults With Chronic Pain ≥7 Days Poor Have Arthritis These data are the first snapshot of adult Mental Health marijuana use in Utah and provide insights Source: Utah Behavioral Risk Factor Surveillance System into overall adult use and use by age, sex, and reasons for use by various self-reported characteristics. To better establish patterns of Perception of Risk of Harm use and how these patterns change, there is Figure 3. Percentage of adults reporting none or slight risk versus moderate or great risk of harm from using marijuana 1–2 times per week by age and sex, a need for regular data collection regarding Utah, 2017 marijuana use. As laws governing the use of None or Slight Risk Moderate or Great Risk marijuana and the state criminal penalties for 80 possession of marijuana are changing in Utah and surrounding states, these data will provide 70 insights for public health surveillance as well 60 as a baseline for measuring policy impact and analysis. ults50 d A of e 40 g a nt e erc30 P 20 UDOH ANNOUNCEMENT: 10 Many environmental health rules in Title 0 R392 have been revised this last year, includ- Male Female 18-34 35-49 50-64 65+ ing new food truck and general sanitation Source: Utah Behavioral Risk Factor Surveillance System rules. New rules were created in coopera- tion with Utah local health departments and to come into compliance with statu- tory requirements. Some rules hadn't been changed since 1990 and needed to be up- dated. The school rule had a minor update to come in line with building codes, while the pool rule was changed to accommodate For additional information about this topic, contact Mike Friedrichs, instructional pools. All of these rules can 801-538-6244, [email protected]; or the Office of Public be found at https://rules.utah.gov/publicat/ Health Assessment, Utah Department of Health, (801) 538-9191, code/r392/r392.htm. [email protected]. Spotlights for January 2019 Breaking News, January 2019 E-cigarette Use Among Pregnant Women Although research is emerging around e-cigarettes E-cigarette Use in the Three Months Before Pregnancy Among in general, there continues to be a lack of scientific Women With a Recent Live Birth, Utah, 2016 evidence regarding the safety and risks of e-ciga- 50 rette use on maternal and fetal health. A common 45 misconception is that e-cigarettes are a safer and 40 healthier alternative (for mother and baby) com- ers Us35 pared to traditional cigarettes.1 However, most e- e cigarettes contain nicotine and the adverse health arett30 g effects of nicotine on maternal and fetal outcomes E-Ci25 have been well documented. of e 20 g a In 2016, the Pregnancy Risk Assessment Monitor- nt e15 ing System (PRAMS) found 5.9% of women with a erc P 10 recent live birth reported using e-cigarettes in the three months before pregnancy. Additionally, sig- 5 nificantly higher rates of e-cigarette use were found 5.9 37.1 20.7 14.9 15.6 0 among specific groups of women when compared All Women Smoked Age < 20 <=100% Poverty Less than High Cigarettes in the School Education to the rate of e-cigarette use by all women just 3 Months Before prior to pregnancy (see figure). Preconception and Pregnancy prenatal screening for tobacco use should address Source: Pregnancy Risk Assessment Monitoring System (PRAMS) e-cigarette use, and healthcare providers should refer women using these products to the Utah Tobacco Quit Line https://www.quitnow.net/Utah/. 1. McCubbin, A.; Fallin-Bennett, A. et al. Perceptions and use of electronic cigarettes in pregnancy. Health Education Research 2017; 32:22-32. Community Health Spotlight, January 2019 Trend in Overall Cesarean Rate In 2017, close to one-third of all births in the U.S. were from Cesarean deliveries (C-section). Although C-sections can be a valuable intervention, overuse of this procedure is associated with excess health problems. For more than 13 consecutive years (1996–2009), the C-section rate in the U.S. has increased, topping out at 32.9%; following a plateau, the national rate has con- tinued to decline since 2013 (32.0% in 2017). While the C-section rate in Utah is consistently lower than the rate in the U.S. as a whole, the rate increased from 1997 to 2010, maxing at 23.0%, and remaining stable since 2011 at 22.7%. Rate of Cesarean Deliveries, Utah and U.S., 1996–2017 C-section rates include all C-section deliveries: pri- Utah US 35 mary C-sections (C-sections among women whom 32.9 32.0 this is their first C-section) and women with repeat 30 C-sections. However, an important rate to consider is the number of women with a vaginal birth after cesarean (VBAC). Unfortunately, data have not been eries 25 23.0 22.7 v available for comparison of national rates of primary eli D 20 C-section and VBAC. Although there is a national 00 1 recommendation for VBAC reporting on birth cer- er p 15 e tificates, this recommendation was not adopted by at R all states until 2016. In 2017, however,the primary 10 C-section rate in Utah (11.9%) was well below the national rate of 21.9%. Compared to 22.5% in Utah, 5 nationally, only 12.8% of deliveries were VBAC. This high rate of VBAC in Utah may be a contributing 0 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 9 9 9 9 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 factor to the state’s ranking for the last three years 9 9 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 as the lowest in the nation for C-sections. Sources: Utah Birth Certificate Database and National Center for Health Statistics Monthly Health Indicators Report (Data Through November 2018) MDiosnetahsleys R, eNpoovret mofb Nero 2ti0fi1a8ble Current Month# Cases Current Month# Expected Cases (5-yr average) # Cases YTD # Expected YTD (5-yr average) YTD Standard Morbidity Ratio (obs/exp) PNCMProCHeovNdIgePi cr(m aaP(Cimrbdihme iErlad nr2ryre0 onC1’ls8al mHreee Nanlettht wf oIonrrs k.t h)Pela nM)onth of 2611Current 968,,,383Month808878 2Previous 711158Month,,,315846494 % **Change From +1--Previous 000...997Month%%% 28111 Year 039,,,Ago273073294 % **+Change 2--243From 1 ...099Year Ago%%% Campylobacteriosis (Campylobacter) 28 33 509 498 1.0 Annual Visits Annual Charges SHHInheeflippguaaaet ttiniottizxissa iB n*A,- p a(rcioundtfeeu cicntiinfoeguc Etsi sohcnhesep r(aisctehirtiiuasm )co hlie (pEa.t citoilsi)) Weekl1y 211updates at h771ttp://health11.u833ta941h.gov/epi/di93se409ases/influe243n...z053a Health Care System Measures (Year) Numberof Events Visits per 1,000 Utahns **% Change From Previous Year Total Charges in Millions **% Change From Previous Year Meningococcal Disease 0 0 3 3 1.0 Overall Hospitalizations (2016) 297,106 97.4 +3.0% $ 8,638.0 +8.4% Pertussis (Whooping Cough) 7 50 291 650 0.4 Non-maternity Hospitalizations (2016) 198,257 65.0 +2.0% $ 7,466.1 +9.2% Salmonellosis (Salmonella) 23 25 336 353 1.0 Emergency Department Encounters†† (2016) 756,376 247.9 +7.6% $ 2,286.3 +21.7% Shigellosis (Shigella) 4 5 57 42 1.4 Outpatient Surgery (2016) 491,566 161.1 +4.9% $ 3,000.6 -0.3% QDViausraeicraetesllarel s(yC, Rh3iercdpk eoQnrtptr oo 2xf)0 N1o8tifiable Current Quarter# Cases9 Current Quarter# Expected Cases1(5-yr average)9 # Cases YTD141 # Expected YTD(5-yr average)210 YTD Standard Morbidity Ratio 0(obs/exp).7 AICOnnibflgneuasureietnatyztl e (aC A SIomdmummoltkmsui nn1ug8inz +(aiA)ttiydo unHl t(esAa 1dl8tuh+lt )sM 6e5a+s)ures Current 222000Data Year111777 115Number 894738Affected,,,961000000 Percent/Rate52658...029%%% **% Change From ++-201Previous ...041%%%Year 4State 017 (((‡‡ Rank222000(1 is best)111777))) HIV/AIDS† 35 30 99 91 1.1 Health Insurance Coverage (Uninsured) 2017 304,000 9.8% +12.6% n/a Chlamydia 2,688 2,099 7,905 4,354 1.8 Motor Vehicle Traffic Crash Injury Deaths 2017 280 9.0 / 100,000 +6.9% 16 (2016) Gonorrhea 764 387 2,169 770 2.8 Poisoning Deaths 2017 714 23.0 / 100,000 -0.3% 33 (2016) Syphilis 46 22 111 42 2.7 Suicide Deaths 2017 663 21.4 / 100,000 +6.3% 47 (2016) Tuberculosis 5 8 15 22 0.7 Diabetes Prevalence (Adults 18+) 2017 154,400 7.1% -1.4% 6 (2017) Mfoer dthicea Mido Enxthp eonfd Nitouvreems (biner M 2i0ll1io8n‡s) Current Month Expected/Budgeted for Month Fiscal YTD BudgetedFiscal YTD Variance - over (under) budget SACPtoolrloor Cork naeMn aDrecynee ratHa tDhle Hsearaetta hDlstihs e(aAsde uDltesa 1th8+s) 2222000011117777 39531,,,981608690802 1250841...659 /// 11100010008,,,.0002000%000 ++--6017....0481%%%% 221215 ((((2222000011117777)))) Mental Health Services§ $ 7.4 $ 7.6 $ 64.4 $ 65.6 $ (1.2) Births to Adolescents (Ages 15-17) 2017 420 5.8 / 1,000 -7.6% 13 (2017) Inpatient Hospital Services $ 25.8 $ 26.1 $ 72.6 $ 74.6 $ (2.1) Early Prenatal Care 2017 37,395 77.0% +2.3% n/a Outpatient Hospital Services $ 5.0 $ 5.0 $ 16.1 $ 16.9 $ (0.8) Infant Mortality 2017 282 5.8 / 1,000 +7.0% 15 (2016) Nursing Home Services $ 32.8 $ 32.8 $ 97.2 $ 98.5 $ (1.3) Childhood Immunization (4:3:1:3:3:1) 2017 35,600 70.2% -4.6% 46 (2017) Pharmacy Services $ 10.1 $ 9.9 $ 51.8 $ 53.4 $ (1.6) ‡ This state fiscal year (SFY) 2018 report includes supplemental payments to better match the SFY 2018 Medicaid Forecast Physician/Osteo Services $ 3.9 $ 3.9 $ 22.9 $ 23.2 $ (0.3) Budget which costs have not been included in previous years. § The SFY 2018 Medicaid Forecast Budget includes Mental Health and Substance Abuse services together while this report Medicaid Expansion Services $ 8.2 $ 8.2 $ 37.0 $ 38.8 $ (1.9) only accounts for Mental Health services. This is to stay consistent with the previous years reports. TOTAL MEDICAID# $ 168.3 $ 168.1 $ 953.5 $ 958.5 $ (5.0) # Medicaid Espansion Services was added to the Medicaid program in SFY 2018. Total Medicaid costs exclude the Prism Project. ** Relative percent change. Percent change could be due to random variation. * Influenza activity was low in November 2018. 18 influenza-associated hospitalizations have been †† Treat and release only. confirmed from September 30, 2018 to November 30, 2018. Active influenza surveillance has ‡‡ State rank based on age-adjusted rates where applicable. begun for the 2018/19 influrenza season. More information and weekly reports can be found at Notes: Data for notifiable diseases are preliminary and subject to change upon the completion of ongoing disease investiga- http://health.utah.gov/epi/diseases/influenza/surveillance/2018-2019/Utah_Weekly_Influenza_Report.html. tions. Active surveillance for West Nile Virus will start in June for the 2019 season. † Diagnosed HIV infections, regardless of AIDS diagnosis.