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Health PromotionHS 490

Amy E. Kaucic
Need Assessment Assignment 2
March 24, 2016

The Idaho Youth Risk Behavior Survey 2015 estimates that one in six
Americans ages 12 to 17, and individuals, aged 18 to 24, have used
marijuana. Substance abuse has a major impact on the individual, the
families, and the community. The effects of using a substance are
cumulative. Significant costs are social, physical, mental, and are a public
health problem. The HP 2020 goal and objective closely aligned to this
project is SA2.2. The goal/objective is to increase the proportion of atrisk
adolescents, aged 1217 years, who in the past year refrained from using
marijuana for the first time.
Quality of Life and Social Assessment
Demographic Data

Coeur dAlene


Median Age


Language other than English spoken

at home

High school graduation

Coeur dAlene Spanish,

French, SerbCroatian,
Asian, Pacific

Bachelors degree



Median household income



Persons below poverty

20%Benewah 15.6

Housing renteroccupied
Single mother household
TANF recipients (2010) rate
per 1,000 population
No leisure time physical activityDistrict 1
Health Data







The health of the Coeur dAlene Tribal community is impacted by

diverse quality of life factors, and are known as the social determinants of
health. Access to healthy food, physical activity, and safe, affordable housing
is an important determinant of health. Environmental contamination from
secondhand smoke, leadbased paint, and others can lead to poor health
American Indians were more likely to be renters than own their own
homes. Education, healthcare, and social assistance are the dominant
industries, and the other employment is
art, entertainment, recreation, accommodation and food service. Spring
time sees the highest rates of unemployment for forest products. The 3rd
highest unemployment rate in Idaho was Benewah County (2012). Tribal
poverty levels were highest in the Benewah County tract. Femaleheaded
households, with children under five, were a full 100% in poverty compared
70.4% in Benewah and 50.7% in Idaho. The nearest supermarket is 10 miles
away. The
Benewah Tract is low access and low income.
Epidemiological Assessment
The Coeur dAlene Reservation mortality death rates are not currently
available. CDC
reports crude death rates from 19992010 for American Indian/American
Native in Idaho at
478.9 per 100,000 population. The ageadjusted death rate was 913 per
100,000 population which is the highest among Idahoans.


County ageadjusted death rate was 1,194.5 compared to 765.5 in Idaho.

Mortality causes are diabetes, chronic liver disease,

cerebrovascular disease, and chronic lower respiratory diseases are two to

four times the state rate. An important note is the data is from Benewah
County not the Reservation (Chart 35)
Unintentional and Intentional death rates are caused by motor vehicle,
total accidents, suicide and homicide, and are higher than the rest of Idaho.
Cancer mortality rates per 100,000 population numbers are 66 for the
Reservation and 113 for the state of Idaho. The two highest cancers for the
Coeur dAlene Reservation are breast cancer (20.6%) for females and
esophageal cancer (15.6%) for men. According to the, Community Health
Needs & Strengths Assessment December 2013, Benewah County is a
healthchallenge among the 44 counties in Idaho.


Health Behavior Data

Youth, male and female, use illegal substance(s) in Idaho. One in three
high school students have used marijuana one or more times during his or
her lifetime. Hispanics were twice as likely as White students to have tried
marijuana for their first time before age 13. Twelfth grade students lifetime
use is significantly higher than ninth graders. Academic achievement is
directly associated with substance abuse. Students grades reflect more Ds
and Fs.
Substance abuse services at the Benewah Medical Wellness Center
were 3.1%. The Behavioral Risk Factor Surveillance Survey (BRFSS) does not
include American Indian/Alaskan Native data. The reality of substance abuse,
i.e. marijuana, is youth dont usually just use one substance. There are other
abuses such as alcohol. Intentional and unintentional injuries are a result of
addictions. Suicides are a sad fact for individuals ages 13 to 38 (National
Institute of Health (NIH). According to the NIH, marijuana affects the brain in
shortterm and longterm losses. Impaired memory is one result.
Environmental Data
The environmental factor most important is changing the education
policy. A solid policy at school is important as youth spend a large part of
their day in the system. Services available for youth could be available
through the school, counseling and the public health sector. Primary data
from the Reservation is needed from youth and adults working/living with
youth. Surveys, interviews and town hall meetings are needed to obtain
the information.
It is a matter of providing protective youth factors, and changing the
educational environment at the school to include addictions programs, peer
support, mentors, families, the community and health sectors.
Five behavioral and environmental factors are behavior use of
addictions, making educational programs available, what are perceptions of
marijuana, belief that changes can be made, integrate the community by
having active and healthy events for all ages, and lower the use of
marijuana usage.

Identifying the Program Purpose

Predisposing Factors according to an integrated analysis the variables are
the personality domain which is a reflection of adolescents conventionality
and intrapsychic functioning; the familys parent-child relationship and if the
parents use substances, the peer domain that reflects the substance abuse,
and if the adolescent uses legal drugs. Marijuana use by the adolescent was
a dependent variable. Gender, time, location, and ethnic/cultural
background are risk and protective factors for later marijuana use. The
results of the analysis have importance for designing intervention programs.
Program(s) targeting preventing adolescent marijuana use can incorporate
universal features and still address specifics that address adolescents from
different ethnic/culture.
I believe that to be successful we need to look at not only the school,
but the community at-large. How does housing affect the issues? Is there a
program currently in place at the school? There is usually more than one
substance being used.

FIG 1: Hypothesized model. Separate pathways of tobacco, alcohol, and marijuana

use considered simultaneously (not pictured). Unique influences of parental
monitoring and family relationship quality considered simultaneously (not
pictured). Intervention condition, socioeconomic status (SES), and grade-point
average (GPA) controlled throughout the model (not pictured). All measures
allowed to correlate within each time point (VanRyzin et al)

For collection tools, I would use the successful Communites-that-CareProgram which is a grassroots organization aimed at helping connect-thedots with the school, community and resources. Providing education is one
part of the key to substance abuse issues, and the tools that are available
through their organization are cost effective.
Enabling Factors consistent in the literature are daily activities, low level of
engagement in prosocial activities, psychological health as marijuana users
experience intrapersonal difficulty, poor emotional control, depression and
anxiety; personalities that have limited resources to cope with stress and
poor self-image, school situation associated with poor academic
achievement, dont connect to school or dont finish school and drop out,
family environment is poor, family conflicts, bonding issues with family, and
little structure or rules. Neighborhoods are disadvantaged.
Reinforcing Factors are a low perception of marijuana risks, poorly
educated regarding risks, conduct disorder at grade 6 for females,
impulsivity, abandoned structures in the neighborhoods, and high sensation
with low harm avoidance. Peers may be using marijuana and be an enabler
for the students. Students may have nothing to occupy their time after
school which may cause an individual to smoke marijuana. Research
suggests that it is linked to other substances including nicotine. Also, the
brain receives pleasure from the THC in marijuana.

Validating needs and conclusion

The most important target is the students. The youth are with teachers,
staff, mentors, culture assistants (Families in Four Seasons), visitors from the
community, and elders. A majority of the day is spent at the school.
Marijuana abuse education is needed at the school whether it is addressed by
the teachers or a counselor. Students need risk and protective factors so they
can be knowledgeable, and have strategies in place.
The belief that marijuana causes no harm needs changed. Marijuana
harms the body which includes the brain. Developing bodies need protection,
and prevention education is needed.
The school and community can address the marijuana issue by
providing a program is cost efficient and has been shown to work.
Communities that Care program is highly successful. White Bison is another
nationwide substance abuse program.
Education is very important. Information about programs and tools can
be provided at either a town hall meeting or at a religious facility or the
Benewah Health and Wellness Center. Educate not only the students, but
the school, the families, and all who care about their youth. Youth are the
future, and we want them to lead healthy and productive lives so they can
pass on their love of culture.
Brooks JS et al. Risk factors for adolescent marijuana use across cultures and
across time. J Genet Psychology. 2001 Sep; 162(3):357-74
VanRyzin MJ et al. Family and peer predictors of substance use from early
adolescence to early adulthood: an 11-year prospective analysis. Addict
Behav.2012 Dec;37(12):1314-24. doi: 10.1016/j.addbeh.2012.06.020.Epub
2012 Jul 6
Van den Bree MM, Pickworth WB. Risk Factors Predicting Changes in Marijuana
Involvement in Teenagers. Arch Gen Psychiatry. 2005;62(3):311-319.