Healthy People: American Indians - Essay Example

Healthy People: American Indians Question1: Describe your population and the top issue or problem for both males and females in the 25-34age range. Answer: Population description: American Indians including Alaska Natives have population of over 4 million in the United States (U.S. Bureau of the Census 2000). American Indians are characterized by their heterogeneity rather than its homogeneity, with over 500 tribes, are bound together by core values such as an emphasis on spirituality, recognition of the sacredness of all living things, and respect for the land and the natural world (Federal Register 2000). Their subpopulations are culturally distinctive, diverse, and complex; live on nearly 300 locations in the lower 48 states, speaking more than 300 different languages (National Archives 2011). Top issue or problem: Alcohol takes a substantial toll among American Indians. They have a higher rate of alcohol-related death than the general U.S. population (May 1989). In every 100000 population covering both genders of American Indians in the age group of 25-34 years, 62.5 die from accident, 13.7 from homicide, 7.2 from heart disease and 6.4 from liver diseases (Healthy People 2011). A general observation is that alcohol abuse plays a significant role in these problems as it is a major factor in five of the 10 leading causes of mortality for American Indians (IHS, 1992). It is further corroborate by the fact that American Indian men die 2.8 times more frequently than non-Indian men from motor vehicle crashes, 2.7 times more from other accidents, 2.0 times more from suicide, 1.9 times more from homicide, and 6.8 times more frequently from alcoholism (alcohol dependence syndrome, alcoholic psychosis, and chronic liver disease and alcoholic cirrhosis) (May, 1996). For 19, 86­1,988, motor vehicle crashes, other accidents, suicide, homicide, and alcoholism caused a total of 5,781 American Indian deaths. 3,656 of these deaths are estimated to have involved alcohol (May 1989).There is the common view that Leland (1976) described in her book Firewater Myths, that American Indians have an excessive craving for alcohol and to lose control of their behavior when they drink. Interventions that address the social and physical factors that influence alcohol abuse have the potential to prevent unintentional injuries and violence. Although, public health interventions are quite different in scope and application, however, most interventions share a similar path to success, the frame work: Mobilize Assess, Plan, Implement, and Track and SMART (objectives and guidelines CDC 2008) may also be utilized in prevention of alcohol abuse in American Indians. Determinants (factors):Many determinants affect the risk of unintentional injury and violence: Individual behaviors: The choices people make about individual behaviors, such as alcohol use or risk-taking, can increase injuries (CDC 2001); Physical environment: Both in the home and community, can affect the rate of injuries related to falls, fires and burns, road traffic injuries, drowning, and violence (Runyan et al. 2005and Doll et al. 2007); Social Environment: It has a influence on the risk for injury and violence through: Individual social experiences (for example, social norms, education, victimization history);Social relationships (for example, parental monitoring and supervision of youth, peer group associations, family interactions); Community environment (for example, cohesion in schools, neighborhoods, and communities);Societal-level factors (for example, cultural beliefs, attitudes, incentives and disincentives, laws and regulations) ( Mercy et al. 2007). Question: Develop a plan for MOBILIZING your community. Which people/groups would you want to bring together? How will you mobilize these people/groups? What theory will you choose to help guide you in the mobilization process? Answer: No two public health interventions are exactly alike. But most interventions share a similar path to success: Mobilize Assess, Plan, Implement, and Track. Otherwise known as MAP-IT (Healthy People 2011), this framework can be used to plan and evaluate public health interventions to achieve the objectives of prevention of alcohol abuse in the American Indians. Mobilization of the community is the first step in effecting any health intervention. According to the Healthy People (2011), the process of mobilization should start by mobilizing key individuals and organizations into a coalition. One should look for partners who have a stake in creating healthy communities and who will contribute to the process. Broader representation has to be aimed. Ferguson (1976) elaborates on "stake theory" to the Navajo subjects in the chronic alcoholic study. Stake theory holds that those who have a stake in society will conform to society's norms and demonstrate less deviance such as alcohol abuse. Applying this lens to the subjects who chronically abuse alcohol produced the following results: those with a stake in the Navajo society or a stake in Western society responded better than those with a stake in neither (Ferguson 1976). Once that is formalized, next is to identify roles for partners and assign responsibilities. This will help to keep partners engaged in the coalition. For example, partners can: Facilitate community input through meetings, events, or advisory groups; Develop and present education and training programs; Lead fundraising and policy initiatives; Provide technical assistance in planning (Healthy People 2011). The age group involvement with alcohol is younger. An attempt has to be made to promote health in the face of the problem of alcohol abuse among 25- 34 years American Indians. Prevention programs must also consider the young age composition of the American Indian population as their stakes are high. The approach that should be implemented in a collaborative manner from within the community rather than from the top down, however, prevention programs can be initiated by outside experts working with tribal leaders, but the continuation and entrenchment of the activities must be carried on by individuals in the local community (Moran, 1995; Office of Substance Abuse and Prevention, 1990). Programs should be made relevant to local norms, values, and conditions through sensitive adaptations. Getting to know a community entails getting to know the people there, the activities they engage in, and where these activities take place. Knowing these basic bits of information can tell a lot about who connects with each other, the types of relationships people have, and the types of material resources people have or need. (Community Tool Box, Healthy People 2011). By asking questions of people about these situations, one can begin to understand the feelings, attitudes, and values people have towards each other, and why understanding feelings, attitudes, and values are key to any community building effort (Community Tool Box, Healthy People 2011). Question: Develop a plan for ASSESSING the needs of your community regarding the issue/problem. What will you assess? What framework or theory will you use and the steps you will take to guide you in the assessment process? Answer: According to Healthy People (2011), by assessing the needs one gets a sense of what one can do, versus what one would like to do, to know as what community members and key stakeholders see as the most important issues. This way, it will be easy to consider feasibility, effectiveness, and measurability while priorities are set for any health interventions. The data collected during the assessment phase will serve as baseline data as every target needs a baseline. Baseline data provide information, before starting a program or intervention. Not only that, it allows to track progress (CDC 2008). Data collection is more flexible than in surveillance as it allows program areas to be assessed in greater depth. For example, any community can use detailed surveys to evaluate how well a program was implemented and the impact of a program on participants’ knowledge, attitudes, and behavior (CDC 2008). Use of qualitative methods (e.g., focus groups, feedback from program participants, and semi structured or open-ended interviews with program participants) to gain insight into the strengths and weaknesses of a particular program activity is also a means to collect data (CDC 2008). To assess alcohol-use prevention and control efforts adequately, the American Indians will usually need to supplement surveillance data with data collected to answer specific evaluation questions. The community can collect data on, for example, behaviors, and environmental indicators (e.g., local legislative information, public opinion/poll data, and data on community norms). They can also collect program planning and implementation information to document and measure the effectiveness of a program, including its policy and publicity (CDC 2008). Stakeholders should be involved in the evaluation at various levels. It is desirable to include coalition members in an evaluation team and engage them in question development, data collection, and analysis (CDC 2008). This will give an opportunity to assess stakeholders’ needs and interests besides integrating their ideas into evaluation activities. A larger network of stakeholders has the opportunity to provide input into designing evaluation questions and is kept informed of the progress of the evaluation. So that stakeholders are more likely to support the evaluation and act on results and recommendations if they are involved in the evaluation process (CDC 2008). Even engaging program’s critics in the evaluation is beneficial. At times, these critics can help identify issues around program strategies and evaluation information that could be attacked or discredited, thus helping you strengthen the evaluation process (CDC 2008). This information might also help understand the opposition’s rationale and could help one engage potential agents of change within the opposition. However, caution is desirable when interacting with the alcohol industry. It is important to understand the motives of the opposition before engaging them in any meaningful way. The whole process can be mapped and corrective measures can be employed for efficient and effective out come. Process evaluations can also assess issues related to program services. For example, they can determine the number of people abstaining from alcohol, or avoiding alcohol while driving. So to say, it should be continuously be used even to assess the outcome. That will ensure that the project is implemented as planned and is reaching the intended target. Question: Develop a PLAN to address your population's needs. Describe one theory that you will use in the planning process. Your plan will usually include objectives and evaluation components. What would you consider in developing your objectives/evaluation measures? What steps will this include? Answer: A good plan includes clear objectives and concrete steps to achieve them. The objectives set will be specific to ones issue or community (Healthy People 2011). Although objectives are specific to one community/region/ reservation, it’s important as one community/group is part of a larger movement to create a healthier Nation (Healthy People 2011).Bottom of Form The objective of this study is to prevent abuse of alcohol in American Indians in Long Beech that will have long term bearing in alcohol related disease, accidents and violence. In a public health approach, the goal is to apply comprehensive strategies and programs to reduce the rates of affliction and early death among total groups and aggregates of individuals (Beauchamp, 1980). The focus should be on communities and particular geographic areas and not on individuals. No single type of alcohol abuse prevention should be championed, but rather various programs and approaches should be compatible or bound together in a mutually supportive and beneficial manner (May, 1992). May et al. (1993) describe seven steps that are useful in developing appropriate community-based prevention programs: (1) listen; (2) develop a relationship and rapport; (3) promote dialogue; (4) avoid polarization; (5) maintain ongoing dialogue and roll with any resistance; (6) provide a menu of options; and (7) help the community initiate options on its own. Therefore, these programs must also affect the social and cultural aspects of life and mitigate the effects. Beauvais (1992) pinpoints socioeconomic conditions as the major factors that have contributed greatly to alcohol abuse among the youths of most American Indian communities. He therefore proposes a four-level integrated model of prevention. True prevention of many problems will come from improvement in social structure (economic, family structure, and cultural integrity), socialization (family caring, sanctions, and religiosity), psychological factors (self-esteem and reduced alienation), and peer clusters (peer encouragement and sanctions against promoting alcohol). Maynard and Twiss (1970) advocate a major social and economic development program that eliminates dependent poverty through providing culturally approved employment opportunities on the reservation, upgrading the educational system, and fostering leadership through strengthening the authority and dignity of the tribal leadership and tribal council. The May (1989) article is a literature review that documents the close tie between alcohol and deaths and injuries, and outlines a variety of suggestions for prevention. He advocates the following primary prevention efforts: social and economic improvement; traffic safety education and highway improvement; public education; and new tribal alcohol policies, laws, norms, and values. The IHS (1990) emphasizes surveillance to pinpoint problem topics and environments in need of prevention, as well as increased community awareness of injuries and their alcohol-related nature. Recommended prevention activities include multiple-media "None for the Road" campaigns, training of local community experts and advocates, and infant car seat and adult safety belt usage programs to prevent serious injury and death despite alcohol-related crashes. Question: Develop an implementation plan that targets at the problem within the chosen racial/ethnic group. The implementation plan should include: a description of at least one or more theories related to implementation, and a rationale for choosing these theories. What steps will be taken to ensure proper implementation? Answer: First, create a detailed work plan that lays out concrete action steps, identifies who is responsible for completing them, and sets a timeline and/or deadlines. Make sure all partners are on board with the work plan (Healthy People 2011). Accordingly, once a definite plan with a road map and deadline is ready, it has to be implemented, and it is the most important step of the path of success. However, implementing any plan or program is not easy especially when that concerns the social habit or addiction of American Indians. This is particularly true with the implementation plan of prevention of alcohol abuse amongst them as discussed below. As Gordis (1991) has pointed out, going from science to social policy is an "uncertain road," highly affected by the type of scientific evidence, cultural and social influences, timing, and many other factors. Similar, or even greater, pitfalls have been recorded in many American Indian and Alaskan native communities (Foulks, 1989; Moran, 1995). One edition of the journal American Indian and Alaska Native Mental Health Research (May 1996) was devoted to the pitfalls of an alcohol research and prevention initiative in an Alaskan community. In this community, research on alcohol use patterns and plans for prevention created tremendous misunderstanding and turmoil perceived as frustrating, painful, and destructive. The general guidelines for professionals working in alcohol problem prevention in American Indian communities is to be patient, culturally sensitive, and responsive to local leaders and citizens alike (Beauchamp, 1980; Beauvais & Trimble, 1992). Programs implemented in American Indian communities must be designed to allow the content to be shaped and molded to fit the local culture. Furthermore, programs must assist people in their efforts at empowerment (Beauvais & LaBoueff, 1985). There are no uniform implementation policies, as still research is going on to come out with a kind of toolkit to implement prevention in American Indian community. Different levels and strategies of prevention dealing with alcohol-involved behaviors should be used. For example, prevention efforts must have plans to involve and strengthen the community and family. American Indian families that are strong and well integrated produce children with better indicators of adjustment and, in most cases, fewer indicators of deviance (Jensen et al .1977). Conversely, disorganized, multi problem families have higher alcohol use and more health and deviance problems (Lujan et al. 1989; Spivey 1977). Any community will have to have prevention programs and standard health and alcohol prevention programs. Though the problems have been evidence based and documented by many, as far as the problems encountered while a plan/ program is implemented, however, priorities of a community are yet to be identified. As per the tool kit presented in the Healthy people (2011) for problem solving can be tried as, we will always be confronted with problems, so the importance of problem solving can't be overstated. That's why this Tool Box can be tried, that is focused wholly on the subject. Question: The final step is TRACKING or evaluation. How will you evaluate the program? What questions need to be considered in evaluation? What evaluation processes will be used? Describe methods or theories that you will use as a basis for evaluation, and the steps you will take to conduct the evaluation process. Answer: As recommended by Healthy people (2011), it is worth considering partnering with a local university or State center for health statistics to help with data tracking. According to (CDC 2008), evaluation provides tailored information to answer specific questions about a program. Data collection in evaluation is more flexible than in surveillance and may allow program areas to be assessed in greater depth. It further elaborates that Surveillance and evaluation can and should be conducted simultaneously. To assess any prevention and control efforts adequately, states will usually need to supplement surveillance data with data collected to answer specific evaluation questions. States can collect data on, for example, knowledge, attitudes, behaviors, and environmental indicators (e.g., local legislative information, public opinion/poll data, and data on community norms). They can also collect program planning and implementation information to document and measure the effectiveness of a program, including its policy and media efforts (CDC 2008). It is important that any evaluation is developed using the SMART approach and indeed, it is also intended. Such objectives offer specific, relevant, and measurable benchmarks to measure achievement of any program goals and will serve as the foundation for program activities. Resources necessary to conduct alcohol control program, like any other prevention and control program, include money, staff, time, materials, and equipment. Program evaluation activities often include accountability for resources to funding agencies and stakeholders. This strategy of adhering to CDC’s (2008), SMART objectives should be chosen because the American Indian population requires, prevention of alcohol abuse, it is desirable to explore the best plan and strategies, keeping in view of the nature of problem and ethos. Literature on this purpose is also lacking, and there is no convergence of opinion of experts towards having uniform guidelines. However, the experts believe that social work professionals explore many options and tailor their prevention approaches to specific communities. Thus, a broad review covering many approaches is more useful than an in-depth critical review of fewer strategies. It should be noted that although this study focuses on preventing alcohol abuse. However, drugs other than alcohol also present problems in American Indian communities, the CDC’s (2008) prevention of drugs, tobacco and other relevant guidelines should be handy in making community based, and problem based approach. Conclusion American Indians experience many health problems that are related to alcohol abuse. The age of first involvement with alcohol is younger, the frequency and amount of drinking is greater, and negative consequences are more common for American Indian than non-Indian youths. Programs that address these issues must consider American Indian heterogeneity as it is reflected in tribal affiliation, cultural groups, language, and ethos. Socio economic perspective is also important, as the problems faced by under privileged and poor is more. 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