Why Prepare a City Profile?

Drug abuse is a nationwide problem. Alcohol, tobacco and other drugs cost Americans an estimated $400 billion a year in health care, welfare, crime, automobile accidents and lost productivity.(5) The consequences of drug abuse, however, are felt most acutely in individual neighborhoods, and policy responses play out in local settings that vary enormously.

Location Matters. Drug popularity varies substantially across the country. For example, beginning in 1990, cocaine use declined rapidly among arrestees in Washington, D.C., plateaued at a high rate in Atlanta, and rose gradually in Denver. In Omaha and San Antonio, however, cocaine use has never become a significant epidemic.(6) In many western cities methamphetamine use has steadily increased among arrestees since 1990, while eastern and southern cities register very little methamphetamine use.(7)

States Can Set the Tone. States have broad discretion in setting and implementing policy. The wide range of penalties for drug offenses is a case in point. While cocaine use trends may have been similar in Omaha and San Antonio, their state drug laws differ significantly. In Nebraska, cocaine possession carries a maximum penalty of five years in prison, while in Texas the same offense could bring a life sentence.(8)

State policies can also diverge widely with respect to legal drugs, as in the arena of excise taxation. Research has shown that raising the price of alcohol and tobacco through excise tax increases can be an effective prevention strategy, especially with respect to youth, who are more sensitive to price increases.(9) But excise tax rates vary considerably by state -- and therefore by city as well. For example, a six-pack of beer sold in Honolulu is subject to Hawaii's excise tax of 52¢; the same beer sold in St. Louis, Missouri (home of Anheuser-Busch) would be subject to only 3¢ in state excise taxation.(10) And a pack of cigarettes sold in Detroit is subject to Michigan's excise tax of 75¢, compared to only 2.5¢ per pack in Richmond, Virginia (home of Phillip Morris).(11) Clearly, even cities that may otherwise seem very similar may face quite different situations in confronting substance abuse, depending on the policies adopted by their states.(12)

The Urban-Suburban Divide. The contemporary United States is the product of decades of public policies promoting suburban prosperity at the expense of the central city. Shrinking core cities, economically and politically weakened, are surrounded by comparatively affluent -- and politically potent -- independent suburbs. Strapped for resources, the cities nevertheless bear the brunt of social burdens in their metropolitan regions. Washington, D.C., for example, is home to just 10 percent of the Washington metropolitan area's population, but accounts for about two-thirds of the region's expenditures for social services such as Medicaid, housing assistance, and drug abuse treatment.(13)

The greater reliance on public programs in cities (as opposed to purchasing services with private resources or through private insurance coverage) feeds the misconception that drug abuse is essentially an inner-city, minority problem confined to people on the margins of society. In fact, the 1998 National Household Survey on Drug Abuse found virtually no difference between metropolitan and non-metropolitan areas with respect to past month cocaine use and past month heavy alcohol use.(14) Nor is alcohol and other drug abuse relegated to an "underclass" of impoverished, unemployed Americans. Although those who are unemployed have higher rates of heavy smoking, drinking and illicit drug use, most Americans who smoke heavily, abuse alcohol or who use illicit drugs are employed, according to the National Household Survey on Drug Abuse.(15) In 1998, for example, 87 percent of the 9.7 million adults in the labor force who reported current (past month) use of illicit drugs held full- or part-time employment. With respect to current heavy alcohol use, the 1998 survey findings are even more pronounced: 92 percent of 10.3 million heavy drinking adults in the labor force were working, meaning that for every heavy drinker without a job, there are a dozen heavy drinkers who are employed.

Cities differ from their suburban neighbors, and can also find themselves in widely divergent contexts, depending on the political culture of their states and the state laws that are brought to bear. Perhaps most important, cities also differ remarkably from one another, each with its own particular history and spirit. In the words of Kenneth T. Jackson, a leading historian of American cities: "Unlike the mass-produced suburbs, no intelligent observer could mistake Baltimore for Chicago, Minneapolis for Milwaukee, Los Angeles for Houston, or Portland for Memphis. The old downtown can give metropolitan residents, including suburbanites, a sense of place, a sense of uniqueness, and a sense of belonging."(16)

Clearly, national and even state-level data are inadequate to capture the crucial distinctions required to shape local drug strategies. Strategies well-suited to a certain city at a certain time may be less effective in other locales or at other phases of a drug's popularity.(17) Also, success in one aspect of drug control may not alleviate the need for emphasis in other areas. For example, the decline in new, young crack users in many cities since the early 1990s does not change the fact that numerous older users have already become addicted; they need drug treatment, not prevention programs.

In recognition of the need to illuminate local drug trends and to fashion responses suited to local realities, Drug Strategies produced Lessons from the Field: Profiling City Alcohol, Tobacco and Other Drug Problems. City profiles are valuable because they can help catalyze government and community action against drug abuse; provide a blueprint for specific policies and initiatives; and serve as report card or baseline for monitoring policy changes and drug abuse trends. The guidance offered in Lessons from the Field reflects Drug Strategies' experience in producing three city profiles (Washington, D.C., Detroit, and Santa Barbara) and seven state profiles, but also draws on the expertise of those who have prepared profiles in other cities. Five years of city and state profile work has allowed Drug Strategies to develop and to test a reliable methodology. Using examples from profile projects in different cities, the goals of this guide are to:

An important caveat: because no two cities are exactly alike, no single set of guidelines will apply in all cases. The goal, rather, is to establish a framework for asking the right questions, even though the answers are bound to differ.

Lessons from the Field is a guide to producing city profiles of alcohol, tobacco and other drug problems. Each city — and therefore each profile — is unique, reflecting local trends, policies and programs, power structures, funding streams and agency priorities. Nonetheless, the steps required to produce a profile are predictable. Lessons from the Field anticipates the decisions and challenges faced at each phase of the profile process. The guide also offers strategies for increasing the likelihood that legislators, officials and the public will embrace the profile and its recommendations.

Project Phases. This guide describes five essential phases for producing city profiles of alcohol, tobacco and other drugs. It connects the goals for each project phase to specific steps, including key decisions, challenges and strategies related to each goal.

For each project phase, the guide provides a task list with specific goals. This method can be applied in any city. However, the challenges will be unique in each location; it is not possible to anticipate all potential obstacles. Rather, based on past profile work, each chapter provides examples of challenges faced to help researchers identify solutions to difficulties that may arise.

The guide also includes examples of standard forms that Drug Strategies has found useful in conducting profile research. Some researchers may want to replicate these forms, while others may choose to modify them or to reject them altogether.

The Economic Costs of Drug and Alcohol Abuse in the United States, 1992. Washington, DC: NIDA and National Institute on Alcohol Abuse and Alcoholism (NIAAA), 1998.

Leonard S. Miller, Xiulan Zhang, Dorothy P. Rice & Wendy Max. "State Estimates of Total Medical Expenditures Attributable to Cigarette Smoking, 1993." Public Health Reports, September/October 1998, 113:447-458.

Smoking Cessation: A Systems Approach. Rockville, MD: Agency for Health Care Policy and Research, April 1997.

6. Crack's Decline: Some Surprises Across U.S. Cities. Washington, DC: NIJ, 1997.

7. Arrestee Drug Abuse Monitoring Program (ADAM): 1998 Annual Report on Drug Use Among Adult and Juvenile Arrestees. Washington, DC: NIJ, 1999.

8. A Guide to State Controlled Substances Acts. Prepared in cooperation with the U.S. Department of Justice. Washington, DC: National Criminal Justice Association, 1999.

9. District of Columbia: Taxes and Other Strategies to Reduce Alcohol Abuse. Washington, DC: U.S. General Accounting Office (GAO), 1998.

Henry Saffer & Frank Chaloupka. Demographic Differentials in the Demand for Alcohol and Illicit Drugs. Cambridge, MA: National Bureau of Economic Research (NBER) Working Paper No. 6432, 1998.

10. District of Columbia: Taxes and Other Strategies to Reduce Alcohol Abuse. Washington, D.C.: GAO, 1998. Alcohol excise tax rates are levied on the gallon, but are more readily understood when converted to a per drink rate. Hawaii's beer excise tax of 92¢ per gallon translates to 8.6¢ per 12-ounce beer (based on 10.66 drinks per gallon). Hawaii's excise tax on a six-pack is therefore 51.6¢.

11. U.S. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health at www.cdc.gov/nccdphp/osh/statehi/pdf/tobactax.pdf

12. How Do We Know We Are Making A Difference? A Community Substance Abuse Indicators Handbook. Boston, MA: Join Together and the Brandeis University Institute for Health Policy, 1995. Some cities and counties also impose their own sales taxes (as distinct from excise taxes) on alcohol and tobacco: in 15 states, communities impose local alcohol sales taxes, and in eight states, communities impose local cigarette sales taxes. Illinois, Louisiana, Ohio and Tennessee are the four states with local communities that impose both alcohol and tobacco sales taxes.

13. Edward M. Meyers. Public Opinion and the Future of the Nation's Capital. Washington, DC: Georgetown University Press, 1996.

The State of the Nation's Housing 1999. Cambridge, MA: Joint Center for Housing Studies of Harvard University, 1999. p. 33, Table A-5: "Population Growth in Large Cities and Their Surrounding Areas: 1990-1996."

14. Summary of Findings from the 1998 National Household Survey on Drug Abuse. Rockville, MD: Substance Abuse and Mental Health Services Administration (SAMHSA), 1999. Tables 34 and 36.

15. M. Bartley. "Unemployment and Ill Health: Understanding the Relationship." Journal of Epidemiology and Community Health. August 1994. 48(4): 333-337.

Summary of Findings from the 1998 National Household Survey on Drug Abuse. Rockville, MD: Substance Abuse and Mental Health Services Administration (SAMHSA), 1999. Tables 2A, 19 and 24. In 1998, the proportion of unemployed adults who reported current illicit drug use (18.2 percent) was significantly higher than the rate among adults employed full time (6.4 percent) or part time (7.4 percent). Similarly, the proportion of unemployed adults who reported current heavy alcohol use (10.6) was higher than the rate among adults with full-time (7.9 percent) or part-time (5.5 percent) employment. However, because adults with full-time or part-time jobs outnumbered jobless adults by a 25-to-1 margin, employed drug users outnumbered unemployed drug users by a more than 6-to-1 margin, and employed heavy drinkers outnumbered unemployed heavy drinkers by a more than 12-to-1 margin.

16. Kenneth T. Jackson cited by Rhodes Cook. "Cities: Decidedly Democratic, Declining in Population." Congressional Quarterly Weekly Report, July 12, 1997, 55:1593-1664.

17. Crack's Decline: Some Surprises Across U.S. Cities. Washington, DC: NIJ, 1997.