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HEALTH GUIDE

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Group moves forward with Hill County Health Improvement Plan Sets reducing alcohol abuse, teen pregnancy and helping with mental health problems as first priorities Tim Leeds tleeds@havredailynews.com With a comprehensive health assessment and a planning meeting under its belt, a group comprising local health care organizations is moving forward with plans to address three main health problems in the county. At a planning meeting in August sponsored by Northern Montana Health Care, Hill County Health Department and Bullhook Community Health Center, a group narrowed down a lengthy list of health concerns to three top priorities to address first: alcohol abuse, teen pregnancies and mental illness. Hill County Public Health Director Danielle Golie said she expects those topics to be a main part of the agenda at the Hill County Health Consortium’s meeting Nov. 19. Golie said she expects the consortium to set task forces to work on those issues along with the committees that were formed at the August planning meeting.

A new focus on a local strategy Havre Daily News/Lindsay Brown, file Desiree Norden, case manager for the Montana Medicaid Health Improvement Plan, from left, Hill County Extension Agent Lea Ann Larson and Bullhook Community Health Center Executive Director Cindy Smith discuss Hill County health issues at a meeting Aug. 29. The group at the meeting set reducing alcohol abuse and teen pregnancies and addressing mental health issues as the top three priorities on which to focus in a Health Improvement Plan being drafted for Hill County.

The 2103 health assessment used in the planning meeting, available online at the Northern Montana Health Care website at http://www.nmhcare.org/?id=950, is the latest in efforts to assess the health of Hill County, started by the county Health Department a decade ago.

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federal taxes and $17 million was state and local taxes. Another factor linked to the issue of teen pregnancy, and a big part of why it is one of the three health issues for the improvement plan, is the remarkably high incidence of sexually transmitted disease in Hill County. Montana has a higher than national average percentage of teens of both genders having sex by ninth grade, said Meredith, and a rate of sexual experience by 12th grade that is equivalent to the national percentage — in the mid-60 percent range for both genders. If they’re having sex, they are at risk for sexually transmitted infection, Meredith added, and Hill County’s rate of STIs is more than 12 times higher than the rest of the nation’s.

What is being done in Hill County Part of what the committees for the three focus areas will be doing for the Community Health Improvement Plan is to look at what systems and programs are in place in the county already. Everyone is working with a minimal budget and personnel, Meredith said, and this is an opportunity for them to get together to fulfill their needs with pooled resources. For the issue of teen pregnancy, the preventative systems in place include sex ed at the schools and Hill County Family Planning, which work to prevent pregnancy through education and access to contraception. Once a teen becomes pregnant, other systems and programs in the community help to ensure the health and success of both the teen mother and the baby. These include the Health Department programs like the home visiting nurse program and WIC, support and education programs through Early Head Start, n o n p r o f i t g r o u p s, s u c h a s H i - L i n e Pregnancy Resource Center, and Family Planning. Meredith said that the programs in place now and the entities working on the improvement plan are “just trying to help people be more successful in life,” and that they work to “help keep the life picture in mind of having a future and finishing school and doing all of that. "If that person at 15 has a baby," she added, “how can we help keep her in school and not have another unplanned pregnancy?”

What will be done in Hill County Another component of the work to be done by the action committees is to create and implement a plan of action, determined with input from as many different

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We need a lot more community staeholders to come and be a part of our task groups. Danielle Golie Hill County Public Health Director

stakeholders in the community as possible, said Golie. Participants at the Aug. 29 meeting brainstormed possible measurable objective and strategies to meet the objectives. The group meeting on teen pregnancy came up with nine possible objectives, including lowering the teen pregnancy rate over the next three years; school completion for pregnant teens and adolescent parents; parent education opportunities; and risk management assessments for teens at Havre Middle School. The objectives will be pared down to about six measurable, attainable goals, s a i d C h r i s t e n O b r e s l ey, d i r e c t o r o f Northern Montana Health Care Foundation. Once the Community Health Improvement Plan is written the consortium will meet with its members and anyone in the community to come in to review it and see where and how they can contribute to the objectives. “We need a lot more community stakeholders to come and be a part of our task groups,” Golie said, people with a passion to address these issues. With Montana Department of Health and Human Services statistics showing that more than twice as many births are to Native American teens than white teens, it is important to have good representation of Native Americans in the action committee to provide a cultural perspective that will help the group be more effective, Meredith said. “The more voices we have, the better outcomes we’ll have, also,” said Obresley, who also pointed out that one of the proposed objectives was to get teen parents, both fathers and mothers, to participate in the teen-pregnancy action group to provide their unique perspective. “Once the Community Health Improvement Plan is done,” Obresley said, “it’s up to the entities involved to say where they can make a difference and work with the members of the committee. In the end, the teen pregnancy action committee will work on the objectives for the next three years then reassess what is working or not. At that point, the stakeholders will decide whether or not to continue or abandon each objective, she said. “As organizations,” she added, “we need to look at the Community Health Improvement Plan and say this is how we can have an impact.”

Statistics on Risky Behaviors Teens who engaged in risky behavior also engaged in other behaviors that increase risk for teen pregnancy. • Rarely or never wore seatbelt. • Rode with a driver who had been drinking • Drove when drinking • In a physical fight one or more times in last year • Smoked cigarettes in last 30 days • Smokeless tobacco use • Drank alcohol in last 30 days • Used marijuana during last 30 days Source: Montana Youth Risk Behavior Survey, 2011

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Pregnancy on the Hi-Line: Sexually transmitted disease also high ■ Continued from page 11 “We really try in everything that we do, we do it in a very clinical, factual method, and we coach our folks, and our folks do a wonderful job on this of not bringing in opinion,” he said about the teachers and school nurse who present information in the classrooms. “We try to be very honest with the kids but do it from a very clinical and factual way.” One of the important components of the schools sex ed curriculum is to have teachers and staff meet with parents before the first sex ed class to tell them about what the kids will be taught that year, and how, and to suggest ways that these conversations can be furthered at home. “We get a very small amount of time that we can provide students with factual information,” he said, especially compared to the amount of time they can get information elsewhere. “We have really tried to focus on bridging that gap between here’s the factual information they’re getting in school and saying, OK, mom, dad, we’re going to give you a conversation starter. We’re hoping that this talk continues at home,” he said. “There are homes … where these conversations are not occurring,” he added, “and we would hope that we can provide maybe a little bit of a window to make that happen.” Wanda Meredith, Hill County Family Planning coordinator, said that today the subject of teen pregnancy and sexual activity is much more transparent than in was in generations past when pregnant girls were “just sent to Aunt Tilly’s house.” Still, she said, when the conversation turns to teens, sex and sexually transmitted infections, it can quickly turn into a moral issue because people are uncomfortable with the topic as if “we can’t talk about it because then people will do it.” When families feel that these conversations are best kept in the home, she doesn’t disagree, but she has seen in the community a wide variety of family situations that don’t fit that ideal of the parents taking on that responsibility. “I don’t argue that a bit,” she said. “But, you know, some kids don’t necessarily have a place to sleep or parents who will do this. ... Then you can have the other side of it — the so-oppressive type of a parent that it’s not a safe place for them to have that discussion either.” That’s where education from outside, neutral sources, like the school classroom, the confidential office of Family Planning, or some other safe place, is so important,

There are homes where these conversations are not occurring. Andy Carlson Havre Public Schools Superintendent

she said.

Why curbing teen pregnancy is important Teen pregnancy was identified as a key area of concern for the Community Health Improvement Plan through the 2013 Hill County Needs Assessment and the 2012 community assessment by the Early Childhood Investment Team, an independent group which began as a committee of the community health consortium. “It is such a larger creature in the fact th at w h e n p e o p l e h ave c h i l d re n younger, they don’t finish school, they don’t go to college, they end up being on more of the welfare system, at the lower s o c i o - e c o n o m i c e n d, a n d we h ave s o many kids that are being raised in poverty — and we keep repeating that cycle,” said Meredith, a member of the planning group. The U.S. Department of Health and Human Resources website cites reports that the economic and social costs of teenagers giving birth is that the mothers tend not to finish school or go on to college, the children are most likely to be raised in poverty in single-parent households, to have poorer health than the average child and to have a high likelihood of ending up in the justice system. Multiplying the problem, all these factors are listed as contributing to a child’s likelihood of growing up to be a teenager who gets pregnant or fathers a child. “Teen pregnancies are your highest risk because they’re young, they don’t have income and … statistically it shows that once they’ve had one pregnancy they’re likely to have a second one within a year to two years after that first teen pregnancy, so then that’s a huge impact on our society as well,” said Danielle Golie, Hill County Public Health Director. The nonprofit group National Campaign to Prevent Teen and Unplanned Pregnancy compiled statistics from 2008 and found that the cost of teen pregnancies to Montana taxpayers was $29 million — of that $12 was

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Bullhook Community Health Center Executive Director Cindy Smith, then county health director, spearheaded an effort to create the Hill County Consortium. The consortium, which included health and social service providers, faith-based representatives, educational consultants and representatives of the Hutterite community, did its own health assessment of the county to determine the top priorities it should address then. The top need identified by the consortium was to increase health care access in the county, which led to the creation in 2005 of the Bullhook Community Health Center, which now is erecting a new facility across from City Hall on 4th Street and 5th Ave. in which to house its services, including in medical, dental and mental health. The consortium continued its work, including in 2011 released a health assessment and health improvement plan that focused on reducing obesity and increasing physical activity for Hill County residents; increasing awareness of health care resources available in the county, and increasing awareness of the dangers of unsafe sex. Another assessment looking at issues in maternity and in families with young children was adopted by the Hill County Early Childhood Investment Team in 2012.

Another health assessment conducted The latest health assessment of the county, released this year, had its origins in the national health care reform, the Affordable Care Act. That act requires certain organizations, including community health centers and nonprofit hospitals, as well as accredited health departments, to conduct periodic health assessments in their region. Benefis Healthcare began preparing a health assessment for its region, including Hill County, and the Havre hospital, community health center and county health department partnered with the Great Falls hospital in developing the health assessment for Hill County. The health assessment used data both from a survey sent out to residents as well as statistics from a variety of sources to provide a snapshot of health issues in the county. More of the respondents felt that the overall health of the county was not good, with 30 percent responding that they believed the county was healthy and 42 responding that they did not. Another 22 percent did not respond to that question. The most serious concern for the Hill County residents who participated was alcohol abuse, followed by cancer, illegal drug abuse, weight and obesity, and dental care. Binge drinking and tobacco use both were listed in the report at a higher rate

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A look at three three major health problems in Hill County

The Community Needs Assessment conducted for Hill County selected three major areas that should be the focus of activities for area health care professionals. The three problems involved alcohol abuse, mental disorders and teen pregnancy. The Havre Daily News in this special section will look at each of these areas in depth. Staff writers Pam Burke, Tim Leeds and John Paul Schmidt have talked to professionals in the area and, defining what services are available in these areas and what can be done to help people with these problems.

than for the state overall. The Early Childhood assessment noted that Hill County has a much higher rate of teen pregnancy than the state, and also that 26 percent of families with children younger than 18 live on incomes below the federal poverty level.

Developing a plan At a meeting Aug. 29, about 30 people representing a variety of health care and governmental organizations spent five or so hours reviewing the 2012 and 2013 assessments, then narrowing down local concerns and issues to items on which the group could set goals with measurable results. The final vote brought dealing with alcohol abuse, teen pregnancy and mental health issues to the top of the list, followed by nutrition. The group agreed to forward the nutrition issue to the OPEN GYM group that developed as a result of the 2011 health improvement plan to address obesity, exercise and nutrition, allowing the new Health Improvement Plan to focus specifically on the top three. The people at the meeting then split into three groups to start developing specific objectives regarding those three priorities, and set strategies —  and measurements — for meeting those goals. A common thread in the three groups was to try to hook up with other groups already working on those issues in the community, and to find — locally and nationally — proven strategies already in use. Part of the next step is to develop focus groups to continue developing, and implementing, the strategies to address the issues selected.

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Group planning to fight alcohol abuse in Hill County Tim Leeds tleeds@havredailynews.com

Illinois Liquor Control Commission

A group of health care providers and local officials is moving forward with plans to fight a perennial problem in Havre and Hill County — alcohol abuse. Some 30 representatives of local government and health care organizations met Aug. 29 to sift through results of a Hill County Health Assessment, released in 2013 in a collaborative effort spearheaded by Benefis Healthcare of Great Falls and Havre’s Northern Montana Health Care, the Hill County Health Department and Bullhook Community Health Center. After reviewing the data from the 2013 health assessment and a 2012 early childhood health assessment, and spending nearly five hours discussing the contents, the group narrowed down its focus to three top priorities on which to focus in the health improvement plan being drafted: mental illness, reducing teen pregnancy and reducing alcohol abuse. Alcohol abuse was a top concern in the survey of the Hill County residents released in the assessment, as well as data cited in the survey. It also was a top concern for each of the five groups that brainstormed Aug. 29 about what to prioritize in the assessment.

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More or Less likely to have or father a child as a teen Less likely

More likely

Enrolled in school

Mother was a teen-mom

Participating in activities

Mother has high school or less education

Has good grades

Has a positive attitude toward school

Single parent household Live in low-income neighborhood with limited employment

Source: Office of Adolescent Health, www.hhs.gov

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It’s so normal for people to drink at every activity around here. People don’t see it as a problem. Danielle Golie Hill County Public Health Director

Lowering the risks This month is National Breast Cancer Awareness Month. Various organizations partner at this time of year to remind women of the importance of breast cancer prevention and mammograms. The American Cancer Society, one of the NBCAM partners, reports that after skin cancer, breast cancer is the most pervasive cancer among American women. Improvements in screening and early diagnosis, as well as better public education about prevention, have contributed to a slight decline in breast cancer rates over the last 20 years. The best chances of surviving breast cancer come with early detection through regular screen-

ing. Getting annual mammograms after the age of 40 is one of the recommendations made by the ACS. Clinical breast exams and selfbreast exams every two to three years are recommended for women in their 20s and 30s. There are some lifestyle related risk factors for breast cancer. These are unlike the unchangeable risk factors that women can do nothing to alter, such as genetic predisposition, dense breast tissue, and having had previous chest radiation treatments. Women can take some steps to improve their chances of staying free from this disease by keeping a moderate body weight, getting plenty of physical exercise, eating a healthy diet, and giving up tobacco use. Post-menopausal women considering hormone replacement therapy should discuss with their doctors the risks involved with that kind of treatment, as should women using oral contraceptives. Research has also shown a link between alcohol consumption and breast cancer. The ACA reports that women who consume one drink per day have a “very small” increase in risk, while those who consume two to five drinks a day are one-and-ahalf times more likely to contract a form of breast cancer.

What others can do to help A woman who is in the process of fighting breast cancer needs a great deal of support. Some days can be hard to get through, and a well-organized support network can make all the difference. Who will do the shopping and the housework? Who will come with me to my treatments? How can I find the time to rest? Many women have difficulty asking for help. Shyness, pride, or the fear of disturbing others prevails. And yet, being given a helping hand can facilitate adaptation to the changes caused by the cancer. When a woman accepts help from others, she is giving herself extra resources in order to fight this disease. These other people will include members of the family, of course, but also friends, co-workers, volunteers, neighbors, or someone who has lived through a similar experience. As well as providing support for the woman living with cancer, this network can give valuable help to her partner and children. Even under the best of circumstances, cancer can put a great deal of stress on family life. Everyone’s roles and responsibilities can change, and children and spouse alike are exposed to feelings of insecurity. On those more difficult days, it is reassuring to be able to count on someone, even if it’s only to walk the dog, prepare a hot meal, or take the children to the movies. A woman living with breast cancer also needs someone to talk to. She needs to be able to talk when she feels the need, or to be quiet without being questioned. Supporters and friends can be a big help with this as well.

Debby Knudson, licensed addiction counselor at Bullhook Community Health Center, said in a recent interview that the problem is widespread and doesn’t seem to be getting any better. “In our little community it is very high,” Knudson said. “We have a big problem.” Knudson said the problem seems to be growing with other substances, opium and methamphetamine, while with alcohol, the high level of use seems to be staying about the same. Hill County Public Health Director Danielle Golie said in a recent interview that perception is a major obstacle the group has to overcome in fighting alcohol abuse. It is considered normal in Montana, and in Havre and Hill County, to drink every time someone goes out, she said, with the results often people drinking a large amount in a short time — the definition of binge drinking. “It’s so normal for people to drink at every activity around here,” Golie said. “People don’t see it as a problem.” She said that in many states, people don’t consider it normal to drink socially all the time.

“It’s different in other parts of the country,” Golie said.

What is excessive use of alcohol? The accepted norms of health care diagnoses two kinds of alcohol abuse, binge drinking and heavy drinking. Heavy drinking is defined as, for men, drinking more than two drinks a day and more than one drink a day for women. Binge drinking — essentially, drinking to get drunk — occurs when a man drinks five or more alcoholic drinks or a woman drinks four or more alcoholic drinks on a single occasion. The modern accepted definition of binge drinking is drinking enough to raise the blood alcohol concentration of the drinker to .08 percent or higher. The Centers for Disease Control and Prevention reports that, although men are more likely to drink more at a time than women, differences in body structure and chemistry cause women to absorb more alcohol and take longer to break it down and remove it from their bodies, that is, to metabolize it.

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Consequences of underage drinking Youth who drink alcohol are more likely to experience: • School problems, such as higher absence and poor or failing grades. • Social problems, such as fighting and lack of participation in youth activities. • Legal problems, such as arrest for driving or physically hurting someone while drunk. • Physical problems, such as hangovers or illnesses. • Unwanted, unplanned, and unprotected sexual activity. • Disruption of normal growth and sexual development. • Physical and sexual assault. • Higher risk for suicide and homicide. • Alcohol-related car crashes and other unintentional injuries, such as burns, falls, and drowning. • Memory problems. • Abuse of other drugs. • Changes in brain development that may have lifelong effects. • Death from alcohol poisoning. In general, the risk of youth experiencing these problems is greater for those who binge drink than for those who do not binge drink. Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 2007;119:76–85. Source: Centers for Disease Control and Prevention “In other words, upon drinking equal amounts, women have higher alcohol levels in their blood than men, and the immediate effects occur more quickly and last longer,” the CDC website says. “These differences also make women more vulnerable to alcohol’s long-term effects on their health.” The impacts also are more severe to children — actually, anyone younger than 21, research indicates. Along with problems in

school, in society and with the law, and with increased likelihood of fights, pregnancy, and issues such as hangovers, youth who drink alcohol are more likely to experience memory problems, changes in brain development with potentially lifelong effects, disruption of normal growth and of sexual development, even death from alcohol poisoning, the CDC reports.

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Alcohol abuse on the Hi-Line: Costs to society, cultural pressure ■ Continued from page 5

The cost of alcohol use in Montana The 2008 report from the Bureau of Business and Economic Research breaks down the costs of alcohol use in Montana: • The money spent on alcohol-treatment centers around the state, supporting detoxification services, inpatient and outpatient treatment, and long- and short-term residential services: $10.7 million; • The money spent on medical care in hospitals and clinics, treating conditions either due to alcohol abuse or complicated by alcohol abuse: $100.3 million; • The cost to the economy caused by the loss of life — removing productive workers from the economy, often at a young age in the prime of their working lives: $296.8 million; • The price paid by businesses, governments and families for the impairing impacts of alcohol and alcoholism on worker productivity, from higher tardiness and absenteeism, lower productivity while on the job, more sick days, a shorter, more restricted working career: $53.3 million; • The cost paid due to alcohol’s impact on crime and criminal behavior — the extra police, judges and prison cells needed to protect citizens and enforce the laws that are broken because of the impairing impacts of alcohol: $49.1 million.

Total cost: $510.6 million

Definitions of patterns of drinking alcohol Excessive drinking includes heavy drinking, binge drinking, and any drinking by pregnant women or underage youth. • Binge drinking, the most common form of excessive alcohol consumption, is defined as consuming: • For women, 4 or more drinks during a single occasion. • For men, 5 or more drinks during a single occasion. • Heavy drinking is defined as consuming: • For women, more than 1 drink per day on average. • For men, more than 2 drinks per day on average. Source: Centers for Disease Control and Prevention

A high level of Montana drinkin’ Hill County is not alone — although perhaps in the top tier for counties in the state — for alcohol use. A study from the University of Montana’s Bureau of Business and Economic Research released in 2008 said the statistics show that many in Montana clearly enjoy drinking alcohol. In 2005, Montana residents collectively consumed 124.7 million shots of distilled spirits, 33 million glasses of wine and 279.6 million 12 oz. cans of beer statewide, the report shows. Use is a high concern here in the Havre area. The respondents in the survey for the health assessment listed alcohol abuse as their top concern about health in Hill County, with statistics backing that up. A behavioral risk factor surveillance syst e m re p o r t i s s u e d by t h e M o n ta n a Department of Health and Human Services using data from 2006-08 says 20.8 percent of Hill County adult residents reported binge drinking at least once in the prior 30 days. The same report listed 16.9 percent of Montana adult residents in general reported doing the same.

Broken down by ages, the difference is even more startling for some groups, with others closer to the norm for the state. Of Hill County residents 18-44, 26.2 percent reported binge drinking in the last 30 days, compared to 24.5 percent statewide. For people 45-64, 21.6 percent of Hill County respondents reported binge drinking, while 14.1 did statewide. For people 65 and older, 5.7 percent of Hill County respondents reported binge drinking, while the number statewide is 4 percent. The 20.8 percent for Hill County in general also is much higher than the national rate. The Centers for Disease Control and Prevention reports that the national rate for binge drinking was about 17 percent — about the same as the state level in Montana. Havre High School Principal Craig Mueller said in his year-and-a-half in Havre he has not seen students showing up drunk at the high school. He said he can only remember a couple of problems with students under the influence of controlled substances at Havre High, and none for alcohol. “We haven’t had a rash of arrests here at school for students who have been arrested for using before school or during lunches, which is a real positive,” he said. Mueller said having a uniformed law enforcement officer at the school, and having teachers very visible especially during lunches, could be one of the reasons for that. But the evidence is that children are drinking outside of school. In a self-reporting survey taken in 2012 in which the students can respond anonymously, 29 percent of eighth-graders reported binge drinking in the previous two weeks, while 17 percent of 10th-graders did and 28 percent of 12th-graders did.

High costs to society The costs to society, both of alcohol-related injuries and illnesses and other problems arising from alcohol use, are staggering. While the Havre Daily News was unable to obtain comments about specific impacts to the county from the Hill County Attorney’s Office or the Havre Police Department, a study from the 2008 bureau report lists some of the costs of alcohol use.

The bottom line is, actually it’s the most dangerous drug out there Debbie Knudson Licensed Addiction Counselor The study says it takes an economy-wide perspective: “We ask the question, what resources would be available to the economy — that could be used on other priorities — if there were no abuse of alcohol?” The study, again, notes that Montana is one of the states with the top — in this context worse — rates of drinking. In 2003, the number of beers drank in Montana averaged to 435 per adult, with only four other states having a higher rate. The study estimates the cost to Montana in medical expenses that otherwise could be used for other expenditures. That includes costs of inpatient hospital care both for alcohol-induced illness and for alcohol-related complications of other diagnoses, outpatient care, care at U.S. Veterans Administration facilities, physician care, prescription drugs and nursing home care, for a total cost of $100.7 billion a year. The study also looks at the cost to the state due to alcohol-related fatalities. The earnings lost to the state due to alcohol related deaths is $206 million, with another $96.2 million due to deaths in alcohol-related crashes, for a total of $312.2 million to the state in lost earnings. The loss of earnings due to people being impaired and unable to work, or work effectively, is looked at separately. The study estimates that that costs the state another $53.3 million. The study also estimates the cost in additional work by law enforcement in dealing with alcohol-related crimes — something the working group on Aug. 29 noted often are related. Alcohol often is linked to unintended pregnancies and unsafe sex, and to crimes ranging from non-violent victimless crimes to more serious offenses ranging from partner or family member assault to theft, burglary or even murder.

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Teen pregnancies in Hill County down slightly, but more needs to be done Pam Burke community@havredailynews.com The good news about teen pregnancies in Hill County is that the numbers are down slightly, the bad news is that the county’s rate of teen pregnancies is still more than three times higher than the national benchmark. Teen pregnancy has been identified by residents of Hill County as one of three key issues of concern, including alcohol abuse and mental health, which will be addressed in the upcoming Community Health Improvement Plan being developed for the county by a group of medical, mental health, government and social service organizations. Though U.S. Department of Health and Human Services statistics and data from numerous studies show that the number of teen pregnancies in the U.S. has been s t e a d i l y fa l l i n g fo r m o r e t h a n t wo decades, many of these same sources

reveal that the U.S. has one of the highest rates of teen pregnancies in developed nations. Data for Montana and Hill County show the same downward trend in that time frame. While this is encouraging news, another fact of the data remains that Hill County still has a high number of teen pregnancies, especially in comparison to the state and national figures. Statistics compiled by the Robert Wood Johnson Foundation for CountyHealthRankings.org show that, at 68 pregnancies per 1,000 female teens, Hill County’s pregnancy rate among 15- to 19-year-olds is twice that of the state, 36 per 1,000, and more than three times the national benchmark at 21 per 1,000.

The difficulty behind the issue

Talking about sex in public is difficult for

many, and this discomfort is compounded when talking about teens having sexual intercourse and possibility of them getting pregnant, babies having babies, as the saying goes. And it’s not necessarily any easier talking with the teens on these subjects, either. “It’s a very emotional issue for pare n t s, ” s a i d H a v r e P u b l i c S c h o o l s Superintendent Andy Carlson, “and it can be very difficult to communicate with the kids who can get embarrassed by the topic.” Havre public school system teaches an abstinence-based sex education curriculum

that starts in fourth-grade, with students in the earliest grades separated according to gender being taught the basic facts about their reproductive system and biological changes they can expect coming up, Carlson said. Each year sex ed information builds on that information through the students’ senior year. In high school, the classes are taught co-ed and, Carlson said, students are provided clear and factual information on topics which include contraception and teen pregnancy.

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The Green Team offers productive outlets

Havre Daily News/File Wayne Small of the Center for Mental Health's The Green Team trims hedges at a 2nd Street residence August 2011.

www.havredailynews.com John Paul Schmidt jpschmidt@havredailynews.com The Green Team has been serving customers and businesses since its formation in 2011. “Right now, we serve about half a dozen businesses and 25 to 30 residences,” Rollie Murdock of the Green Team said. The Green Team was started by the Center for Mental Health in Havre in 2011. Murdock said they usually pick up recycling for residences once a month and some businesses every day. A work day for the Green Team is usually four hours long, Murdock said. The crew picks up an average of 850 pounds of recycling a day to take to Pacific Steel and Recycling. “It’s amazing the amount we take to Pacific every day,” Murdock said. The ultimate purpose of the Green Team is to ebb the flow of garbage to the landfill, according to Murdock. The Green Team used to offer services like lawn care and snow removal, but decided in January to eliminate these due to high costs of equipment and expense. Murdock said his crew of four is still accepting new customers until they feel like they have enough they can handle. They are still hiring new employees. The cost of a recycling pickup is $5. Those interested in signing up for the Green Team’s services can reach Murdock at 3991409 or Josh Dixon at 390-4965.

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The health assessment reported that Hill County had significantly higher rates of offense in several areas than the rest of the state, including family offenses, threeyear rate of domesic offense, three-year rate of sex offenses and three-year rate of rape. The cost to the state in providing law enforcement to deal with those alcoholrelated offenses is $19.8 million, the report says. Another $10 million is spent in the courts system, with another $2.8 million for incarceration in local jails and $16.5 million in state corrections facilities, with a total cost in the legal system of $49.1 million a year. The report concludes that Montana spends or loses $510.6 million —  about 1.7 percent of the state’s Gross Domestic Product — each year dealing with the impacts of alcohol.

Finding a solution The group, still in its initial stages in setting measurable goals and strategies toward reducing alcohol abuse, including community involvement in the program. Bullhook Executive Director Cindy Smith said at the Aug. 29 meeting that that involvement is crucial for all of the health improvement plan priorities. “We can’t all do it by ourselves,” Smith said. “We need the rest of the community, too.” The group agreed that what they need to work on is alcohol abuse, not use of alcohol in general. “It’s a social norm in our state,” Golie said during the meeting. “We don’t feel we can take on all use. The group agreed to try to put out a media blitz, explaining to people the difference between binge drinking and excessive drinking and drinking in moderation. They also agreed to research programs already in place, both in the Havre and Hill County communities and in other parts of the state and country, to find programs that are working and tie them in to their plans, including linking up with programs already in Havre and Hill County. The local DUI task force and the recently created DUI court were listed as examples. Another focus listed by the group planning strategies was to teach youths ways to

HEALTH GUIDE

We’re trying to change the cultural norm. Danielle Golie Hill County Public Health Director either feel comfortable not drinking, or at least not drinking as much, and to tell others they need to slow down. Knudson said, on the counseling and treatment side, working as a team to address issues and find programs or techniques to help people deal with addiction — to all substances, not just alcohol — can help people overcome their addiction. But, the person has to want to change, she said. Part of the issue in Montana is that it is accepted in society in this state, she said. “Montanans find it to be acceptable and to the point where they act like it’s a ritual or something,” she said. The reasons people begin drinking may vary, but the underlying reason is the same, she added. “It’s because they want to change the way they feel. That’s basically why anybody uses, period, to change the way they feel,” she said. “And the consequences of that trying to change the way they feel is devastating to a lot of people,” Knudson added. But the key is to change how people think about alcohol. “Everybody’s got a reason why they drink, and if we’re talking about straight alcohol, it’s legal, it’s easy-accessible,” said Knudson. “The Montana thought processing is that it’s a normal thing that you do, its acceptable. People don’t look at it like it’s wrong. “But the bottom line is, actually it’s the most dangerous drug out there because of those issues, and alcohol affects all parts of the body and you can actually die from alcohol withdrawal, while, with others, its really rare,” she added. Golie said the same. The way to succeed in the Health Improvement Plan goal to reduce reports of alcohol abuse, and to reduce repeat DUIs, is to change how people think about alcohol. “We’re trying to change the cultural norm,” Golie said.

www.havredailynews.com

Some people should never drink According to the Dietary Guidelines for Americans, if people drink alcoholic beverages, they should do so in moderation, which is defined as no more than one drink per day for women and no more than two drinks per day for men. However, there are some people who should not drink any alcohol, including those who are: • Pregnant or trying to become pregnant. • Taking prescription or over-the-counter medications that may cause harmful reactions when mixed with alcohol. • Younger than age 21. • Recovering from alcoholism or are unable to control the amount they drink. • Suffering from a medical condition that may be worsened by alcohol. • Driving, planning to drive, or participating in other activities requiring skill, coordination, and alertness. Source: Centers for Disease Control and Prevention

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www.havredailynews.com

Beautiful minds:

Center for Mental Health serves hundreds on the Hi-Line Depression, anxiety among most common mental illnesses John Paul Schmidt jpschmidt@havredailynews.com The Center for Mental Health serves 360 “beautiful minds” in Hill Country and 79 in Blaine County. “In general, the more common illnesses we treat depression, anxiety, schizophrenia, bipolar disorder, personality disorder and (post-traumatic stress disorder),” said Amber Spring, an outpatient therapist at the Center for Mental Health branch in Havre. Personality disorder is one of the more severe illnesses they treat at the Center for Mental Health, Spring said. “Personality disorder will affect every aspect of a person’s life; their whole day-today living,” Spring said. “There’s no pill you can take for it.” The Center for Mental Health tends to

see people who are more severely mentally ill than those with less threatening illnesses. They see more people who are more likely to be on disability due to their illnesses, but they see anyone who wants their services. T h e c l i n i c o f f e rs s eve ra l s e r v i c e s including in-home nurses that stay with patients to take care of them; making sure they take their medications and go to their appointments. The clinic also offers group therapy aimed at people who need dialectical behavioral therapy and people with borderline personality disorder. A person with BPD struggles with a sense of self, is impulsive and has issues in relationships. The National Institute of Mental Health website says that borderline personality disorder is “a serious mental illness marked by unstable moods, behavior and relationships … Because some people with severe BPD have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders. While mental health experts now generally agree that the name

“borderline personality disorder” is misleading, a more accurate term does not exist yet.” Symptoms include: • Problems with regulating emotions and thoughts; • Impulsive and reckless behavior; • Unstable relationships with other people. “People with this disorder also have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with selfharm, suicidal behaviors, and completed suicides.” The NIMH website goes on to say that work conducted in recent yearshas shown some effectiveness using dialectical behavioral therapy to help treat sexual abuse survivors and chemical dependency. The therapy sessions are designed to help people who have substance abuse problems, suicidal thoughts, or inflict self-harm due to their own mental illnesses. "We currently have a men's group and a women's group," Spring said. "We're trying to get an adolescent group going." The program offers aides to those who

suffer from severe disabling mental illness, anger management therapy, psychiatric rehabilitation and support for “teaching skills and assisting with everyday needs such as grocery shopping, budgeting, symptom management, coping strategies, assistance in attending appointments, health and exercise, socialization skills, and recreational skills in either group or individual settings.” Another program started in 2011 by the Havre Center for Mental Health employs clients in a program called Green Team. Originally started to do lawn care, the group has since teamed up with a local recycling group and now collects recyclable materials on regular routes for customers and delivers the materials to Pacific Steel and Recycling. The National Institute of Mental Health estimated that one out of every four Americans have one or more diagnosable mental disorder and CBS recently reported that Montana has been in the top five states for high suicide rates for the past 30 years, according to the American Association of Suicidology. In 2009, Montana had the highest rate of suicide in the nation.

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Community health centers offer help to all community residents Community health centers are required to serve all residents of their service area with charges on a sliding fee scale based upon ability to pay. CHCs provide comprehensive health care — this includes primary health c are an d preve n t i ve c are fo r i n fan t s, c h i l d ren a nd a d u lts; some u rgent care; mental health and substance abuse; dental; and pharmaceutical services. CHCs must be either a public or nonprofit facility that is governed by a board of directors. At least 51 percent of the CHC’s board of directors must be composed of members who are patients at the center. This means that the community has a voice in the services offered, helps to assure quality of care, and determines the future of the community health center. Bullhook Community Health Center in Havre is funded in part by federal grant dollars, patient income and donations. Because the clinic is federally funded, it is able to offer medical and dental care to the community on a sliding fee scale, making access to excellent health care possible for every family on the Hi-Line. Bullhook Clinic also has a voucher system that may be used to offset some health care costs. Bullhook Clinic also accepts most major insurances as well as Medicaid.

www.havredailynews.com

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www.havredailynews.com

Beautiful minds:

Center for Mental Health serves hundreds on the Hi-Line Depression, anxiety among most common mental illnesses John Paul Schmidt jpschmidt@havredailynews.com The Center for Mental Health serves 360 “beautiful minds” in Hill Country and 79 in Blaine County. “In general, the more common illnesses we treat depression, anxiety, schizophrenia, bipolar disorder, personality disorder and (post-traumatic stress disorder),” said Amber Spring, an outpatient therapist at the Center for Mental Health branch in Havre. Personality disorder is one of the more severe illnesses they treat at the Center for Mental Health, Spring said. “Personality disorder will affect every aspect of a person’s life; their whole day-today living,” Spring said. “There’s no pill you can take for it.” The Center for Mental Health tends to

see people who are more severely mentally ill than those with less threatening illnesses. They see more people who are more likely to be on disability due to their illnesses, but they see anyone who wants their services. T h e c l i n i c o f f e rs s eve ra l s e r v i c e s including in-home nurses that stay with patients to take care of them; making sure they take their medications and go to their appointments. The clinic also offers group therapy aimed at people who need dialectical behavioral therapy and people with borderline personality disorder. A person with BPD struggles with a sense of self, is impulsive and has issues in relationships. The National Institute of Mental Health website says that borderline personality disorder is “a serious mental illness marked by unstable moods, behavior and relationships … Because some people with severe BPD have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders. While mental health experts now generally agree that the name

“borderline personality disorder” is misleading, a more accurate term does not exist yet.” Symptoms include: • Problems with regulating emotions and thoughts; • Impulsive and reckless behavior; • Unstable relationships with other people. “People with this disorder also have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with selfharm, suicidal behaviors, and completed suicides.” The NIMH website goes on to say that work conducted in recent yearshas shown some effectiveness using dialectical behavioral therapy to help treat sexual abuse survivors and chemical dependency. The therapy sessions are designed to help people who have substance abuse problems, suicidal thoughts, or inflict self-harm due to their own mental illnesses. "We currently have a men's group and a women's group," Spring said. "We're trying to get an adolescent group going." The program offers aides to those who

suffer from severe disabling mental illness, anger management therapy, psychiatric rehabilitation and support for “teaching skills and assisting with everyday needs such as grocery shopping, budgeting, symptom management, coping strategies, assistance in attending appointments, health and exercise, socialization skills, and recreational skills in either group or individual settings.” Another program started in 2011 by the Havre Center for Mental Health employs clients in a program called Green Team. Originally started to do lawn care, the group has since teamed up with a local recycling group and now collects recyclable materials on regular routes for customers and delivers the materials to Pacific Steel and Recycling. The National Institute of Mental Health estimated that one out of every four Americans have one or more diagnosable mental disorder and CBS recently reported that Montana has been in the top five states for high suicide rates for the past 30 years, according to the American Association of Suicidology. In 2009, Montana had the highest rate of suicide in the nation.

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HEALTH GUIDE

Community health centers offer help to all community residents Community health centers are required to serve all residents of their service area with charges on a sliding fee scale based upon ability to pay. CHCs provide comprehensive health care — this includes primary health c are an d preve n t i ve c are fo r i n fan t s, c h i l d ren a nd a d u lts; some u rgent care; mental health and substance abuse; dental; and pharmaceutical services. CHCs must be either a public or nonprofit facility that is governed by a board of directors. At least 51 percent of the CHC’s board of directors must be composed of members who are patients at the center. This means that the community has a voice in the services offered, helps to assure quality of care, and determines the future of the community health center. Bullhook Community Health Center in Havre is funded in part by federal grant dollars, patient income and donations. Because the clinic is federally funded, it is able to offer medical and dental care to the community on a sliding fee scale, making access to excellent health care possible for every family on the Hi-Line. Bullhook Clinic also has a voucher system that may be used to offset some health care costs. Bullhook Clinic also accepts most major insurances as well as Medicaid.

www.havredailynews.com

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The Green Team offers productive outlets

Havre Daily News/File Wayne Small of the Center for Mental Health's The Green Team trims hedges at a 2nd Street residence August 2011.

www.havredailynews.com John Paul Schmidt jpschmidt@havredailynews.com The Green Team has been serving customers and businesses since its formation in 2011. “Right now, we serve about half a dozen businesses and 25 to 30 residences,” Rollie Murdock of the Green Team said. The Green Team was started by the Center for Mental Health in Havre in 2011. Murdock said they usually pick up recycling for residences once a month and some businesses every day. A work day for the Green Team is usually four hours long, Murdock said. The crew picks up an average of 850 pounds of recycling a day to take to Pacific Steel and Recycling. “It’s amazing the amount we take to Pacific every day,” Murdock said. The ultimate purpose of the Green Team is to ebb the flow of garbage to the landfill, according to Murdock. The Green Team used to offer services like lawn care and snow removal, but decided in January to eliminate these due to high costs of equipment and expense. Murdock said his crew of four is still accepting new customers until they feel like they have enough they can handle. They are still hiring new employees. The cost of a recycling pickup is $5. Those interested in signing up for the Green Team’s services can reach Murdock at 3991409 or Josh Dixon at 390-4965.

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The health assessment reported that Hill County had significantly higher rates of offense in several areas than the rest of the state, including family offenses, threeyear rate of domesic offense, three-year rate of sex offenses and three-year rate of rape. The cost to the state in providing law enforcement to deal with those alcoholrelated offenses is $19.8 million, the report says. Another $10 million is spent in the courts system, with another $2.8 million for incarceration in local jails and $16.5 million in state corrections facilities, with a total cost in the legal system of $49.1 million a year. The report concludes that Montana spends or loses $510.6 million —  about 1.7 percent of the state’s Gross Domestic Product — each year dealing with the impacts of alcohol.

Finding a solution The group, still in its initial stages in setting measurable goals and strategies toward reducing alcohol abuse, including community involvement in the program. Bullhook Executive Director Cindy Smith said at the Aug. 29 meeting that that involvement is crucial for all of the health improvement plan priorities. “We can’t all do it by ourselves,” Smith said. “We need the rest of the community, too.” The group agreed that what they need to work on is alcohol abuse, not use of alcohol in general. “It’s a social norm in our state,” Golie said during the meeting. “We don’t feel we can take on all use. The group agreed to try to put out a media blitz, explaining to people the difference between binge drinking and excessive drinking and drinking in moderation. They also agreed to research programs already in place, both in the Havre and Hill County communities and in other parts of the state and country, to find programs that are working and tie them in to their plans, including linking up with programs already in Havre and Hill County. The local DUI task force and the recently created DUI court were listed as examples. Another focus listed by the group planning strategies was to teach youths ways to

HEALTH GUIDE

We’re trying to change the cultural norm. Danielle Golie Hill County Public Health Director either feel comfortable not drinking, or at least not drinking as much, and to tell others they need to slow down. Knudson said, on the counseling and treatment side, working as a team to address issues and find programs or techniques to help people deal with addiction — to all substances, not just alcohol — can help people overcome their addiction. But, the person has to want to change, she said. Part of the issue in Montana is that it is accepted in society in this state, she said. “Montanans find it to be acceptable and to the point where they act like it’s a ritual or something,” she said. The reasons people begin drinking may vary, but the underlying reason is the same, she added. “It’s because they want to change the way they feel. That’s basically why anybody uses, period, to change the way they feel,” she said. “And the consequences of that trying to change the way they feel is devastating to a lot of people,” Knudson added. But the key is to change how people think about alcohol. “Everybody’s got a reason why they drink, and if we’re talking about straight alcohol, it’s legal, it’s easy-accessible,” said Knudson. “The Montana thought processing is that it’s a normal thing that you do, its acceptable. People don’t look at it like it’s wrong. “But the bottom line is, actually it’s the most dangerous drug out there because of those issues, and alcohol affects all parts of the body and you can actually die from alcohol withdrawal, while, with others, its really rare,” she added. Golie said the same. The way to succeed in the Health Improvement Plan goal to reduce reports of alcohol abuse, and to reduce repeat DUIs, is to change how people think about alcohol. “We’re trying to change the cultural norm,” Golie said.

www.havredailynews.com

Some people should never drink According to the Dietary Guidelines for Americans, if people drink alcoholic beverages, they should do so in moderation, which is defined as no more than one drink per day for women and no more than two drinks per day for men. However, there are some people who should not drink any alcohol, including those who are: • Pregnant or trying to become pregnant. • Taking prescription or over-the-counter medications that may cause harmful reactions when mixed with alcohol. • Younger than age 21. • Recovering from alcoholism or are unable to control the amount they drink. • Suffering from a medical condition that may be worsened by alcohol. • Driving, planning to drive, or participating in other activities requiring skill, coordination, and alertness. Source: Centers for Disease Control and Prevention

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Alcohol abuse on the Hi-Line: Costs to society, cultural pressure ■ Continued from page 5

The cost of alcohol use in Montana The 2008 report from the Bureau of Business and Economic Research breaks down the costs of alcohol use in Montana: • The money spent on alcohol-treatment centers around the state, supporting detoxification services, inpatient and outpatient treatment, and long- and short-term residential services: $10.7 million; • The money spent on medical care in hospitals and clinics, treating conditions either due to alcohol abuse or complicated by alcohol abuse: $100.3 million; • The cost to the economy caused by the loss of life — removing productive workers from the economy, often at a young age in the prime of their working lives: $296.8 million; • The price paid by businesses, governments and families for the impairing impacts of alcohol and alcoholism on worker productivity, from higher tardiness and absenteeism, lower productivity while on the job, more sick days, a shorter, more restricted working career: $53.3 million; • The cost paid due to alcohol’s impact on crime and criminal behavior — the extra police, judges and prison cells needed to protect citizens and enforce the laws that are broken because of the impairing impacts of alcohol: $49.1 million.

Total cost: $510.6 million

Definitions of patterns of drinking alcohol Excessive drinking includes heavy drinking, binge drinking, and any drinking by pregnant women or underage youth. • Binge drinking, the most common form of excessive alcohol consumption, is defined as consuming: • For women, 4 or more drinks during a single occasion. • For men, 5 or more drinks during a single occasion. • Heavy drinking is defined as consuming: • For women, more than 1 drink per day on average. • For men, more than 2 drinks per day on average. Source: Centers for Disease Control and Prevention

A high level of Montana drinkin’ Hill County is not alone — although perhaps in the top tier for counties in the state — for alcohol use. A study from the University of Montana’s Bureau of Business and Economic Research released in 2008 said the statistics show that many in Montana clearly enjoy drinking alcohol. In 2005, Montana residents collectively consumed 124.7 million shots of distilled spirits, 33 million glasses of wine and 279.6 million 12 oz. cans of beer statewide, the report shows. Use is a high concern here in the Havre area. The respondents in the survey for the health assessment listed alcohol abuse as their top concern about health in Hill County, with statistics backing that up. A behavioral risk factor surveillance syst e m re p o r t i s s u e d by t h e M o n ta n a Department of Health and Human Services using data from 2006-08 says 20.8 percent of Hill County adult residents reported binge drinking at least once in the prior 30 days. The same report listed 16.9 percent of Montana adult residents in general reported doing the same.

Broken down by ages, the difference is even more startling for some groups, with others closer to the norm for the state. Of Hill County residents 18-44, 26.2 percent reported binge drinking in the last 30 days, compared to 24.5 percent statewide. For people 45-64, 21.6 percent of Hill County respondents reported binge drinking, while 14.1 did statewide. For people 65 and older, 5.7 percent of Hill County respondents reported binge drinking, while the number statewide is 4 percent. The 20.8 percent for Hill County in general also is much higher than the national rate. The Centers for Disease Control and Prevention reports that the national rate for binge drinking was about 17 percent — about the same as the state level in Montana. Havre High School Principal Craig Mueller said in his year-and-a-half in Havre he has not seen students showing up drunk at the high school. He said he can only remember a couple of problems with students under the influence of controlled substances at Havre High, and none for alcohol. “We haven’t had a rash of arrests here at school for students who have been arrested for using before school or during lunches, which is a real positive,” he said. Mueller said having a uniformed law enforcement officer at the school, and having teachers very visible especially during lunches, could be one of the reasons for that. But the evidence is that children are drinking outside of school. In a self-reporting survey taken in 2012 in which the students can respond anonymously, 29 percent of eighth-graders reported binge drinking in the previous two weeks, while 17 percent of 10th-graders did and 28 percent of 12th-graders did.

High costs to society The costs to society, both of alcohol-related injuries and illnesses and other problems arising from alcohol use, are staggering. While the Havre Daily News was unable to obtain comments about specific impacts to the county from the Hill County Attorney’s Office or the Havre Police Department, a study from the 2008 bureau report lists some of the costs of alcohol use.

The bottom line is, actually it’s the most dangerous drug out there Debbie Knudson Licensed Addiction Counselor The study says it takes an economy-wide perspective: “We ask the question, what resources would be available to the economy — that could be used on other priorities — if there were no abuse of alcohol?” The study, again, notes that Montana is one of the states with the top — in this context worse — rates of drinking. In 2003, the number of beers drank in Montana averaged to 435 per adult, with only four other states having a higher rate. The study estimates the cost to Montana in medical expenses that otherwise could be used for other expenditures. That includes costs of inpatient hospital care both for alcohol-induced illness and for alcohol-related complications of other diagnoses, outpatient care, care at U.S. Veterans Administration facilities, physician care, prescription drugs and nursing home care, for a total cost of $100.7 billion a year. The study also looks at the cost to the state due to alcohol-related fatalities. The earnings lost to the state due to alcohol related deaths is $206 million, with another $96.2 million due to deaths in alcohol-related crashes, for a total of $312.2 million to the state in lost earnings. The loss of earnings due to people being impaired and unable to work, or work effectively, is looked at separately. The study estimates that that costs the state another $53.3 million. The study also estimates the cost in additional work by law enforcement in dealing with alcohol-related crimes — something the working group on Aug. 29 noted often are related. Alcohol often is linked to unintended pregnancies and unsafe sex, and to crimes ranging from non-violent victimless crimes to more serious offenses ranging from partner or family member assault to theft, burglary or even murder.

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Teen pregnancies in Hill County down slightly, but more needs to be done Pam Burke community@havredailynews.com The good news about teen pregnancies in Hill County is that the numbers are down slightly, the bad news is that the county’s rate of teen pregnancies is still more than three times higher than the national benchmark. Teen pregnancy has been identified by residents of Hill County as one of three key issues of concern, including alcohol abuse and mental health, which will be addressed in the upcoming Community Health Improvement Plan being developed for the county by a group of medical, mental health, government and social service organizations. Though U.S. Department of Health and Human Services statistics and data from numerous studies show that the number of teen pregnancies in the U.S. has been s t e a d i l y fa l l i n g fo r m o r e t h a n t wo decades, many of these same sources

reveal that the U.S. has one of the highest rates of teen pregnancies in developed nations. Data for Montana and Hill County show the same downward trend in that time frame. While this is encouraging news, another fact of the data remains that Hill County still has a high number of teen pregnancies, especially in comparison to the state and national figures. Statistics compiled by the Robert Wood Johnson Foundation for CountyHealthRankings.org show that, at 68 pregnancies per 1,000 female teens, Hill County’s pregnancy rate among 15- to 19-year-olds is twice that of the state, 36 per 1,000, and more than three times the national benchmark at 21 per 1,000.

The difficulty behind the issue

Talking about sex in public is difficult for

many, and this discomfort is compounded when talking about teens having sexual intercourse and possibility of them getting pregnant, babies having babies, as the saying goes. And it’s not necessarily any easier talking with the teens on these subjects, either. “It’s a very emotional issue for pare n t s, ” s a i d H a v r e P u b l i c S c h o o l s Superintendent Andy Carlson, “and it can be very difficult to communicate with the kids who can get embarrassed by the topic.” Havre public school system teaches an abstinence-based sex education curriculum

that starts in fourth-grade, with students in the earliest grades separated according to gender being taught the basic facts about their reproductive system and biological changes they can expect coming up, Carlson said. Each year sex ed information builds on that information through the students’ senior year. In high school, the classes are taught co-ed and, Carlson said, students are provided clear and factual information on topics which include contraception and teen pregnancy.

■ Continued on page 14

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It’s so normal for people to drink at every activity around here. People don’t see it as a problem. Danielle Golie Hill County Public Health Director

Lowering the risks This month is National Breast Cancer Awareness Month. Various organizations partner at this time of year to remind women of the importance of breast cancer prevention and mammograms. The American Cancer Society, one of the NBCAM partners, reports that after skin cancer, breast cancer is the most pervasive cancer among American women. Improvements in screening and early diagnosis, as well as better public education about prevention, have contributed to a slight decline in breast cancer rates over the last 20 years. The best chances of surviving breast cancer come with early detection through regular screen-

ing. Getting annual mammograms after the age of 40 is one of the recommendations made by the ACS. Clinical breast exams and selfbreast exams every two to three years are recommended for women in their 20s and 30s. There are some lifestyle related risk factors for breast cancer. These are unlike the unchangeable risk factors that women can do nothing to alter, such as genetic predisposition, dense breast tissue, and having had previous chest radiation treatments. Women can take some steps to improve their chances of staying free from this disease by keeping a moderate body weight, getting plenty of physical exercise, eating a healthy diet, and giving up tobacco use. Post-menopausal women considering hormone replacement therapy should discuss with their doctors the risks involved with that kind of treatment, as should women using oral contraceptives. Research has also shown a link between alcohol consumption and breast cancer. The ACA reports that women who consume one drink per day have a “very small” increase in risk, while those who consume two to five drinks a day are one-and-ahalf times more likely to contract a form of breast cancer.

What others can do to help A woman who is in the process of fighting breast cancer needs a great deal of support. Some days can be hard to get through, and a well-organized support network can make all the difference. Who will do the shopping and the housework? Who will come with me to my treatments? How can I find the time to rest? Many women have difficulty asking for help. Shyness, pride, or the fear of disturbing others prevails. And yet, being given a helping hand can facilitate adaptation to the changes caused by the cancer. When a woman accepts help from others, she is giving herself extra resources in order to fight this disease. These other people will include members of the family, of course, but also friends, co-workers, volunteers, neighbors, or someone who has lived through a similar experience. As well as providing support for the woman living with cancer, this network can give valuable help to her partner and children. Even under the best of circumstances, cancer can put a great deal of stress on family life. Everyone’s roles and responsibilities can change, and children and spouse alike are exposed to feelings of insecurity. On those more difficult days, it is reassuring to be able to count on someone, even if it’s only to walk the dog, prepare a hot meal, or take the children to the movies. A woman living with breast cancer also needs someone to talk to. She needs to be able to talk when she feels the need, or to be quiet without being questioned. Supporters and friends can be a big help with this as well.

Debby Knudson, licensed addiction counselor at Bullhook Community Health Center, said in a recent interview that the problem is widespread and doesn’t seem to be getting any better. “In our little community it is very high,” Knudson said. “We have a big problem.” Knudson said the problem seems to be growing with other substances, opium and methamphetamine, while with alcohol, the high level of use seems to be staying about the same. Hill County Public Health Director Danielle Golie said in a recent interview that perception is a major obstacle the group has to overcome in fighting alcohol abuse. It is considered normal in Montana, and in Havre and Hill County, to drink every time someone goes out, she said, with the results often people drinking a large amount in a short time — the definition of binge drinking. “It’s so normal for people to drink at every activity around here,” Golie said. “People don’t see it as a problem.” She said that in many states, people don’t consider it normal to drink socially all the time.

“It’s different in other parts of the country,” Golie said.

What is excessive use of alcohol? The accepted norms of health care diagnoses two kinds of alcohol abuse, binge drinking and heavy drinking. Heavy drinking is defined as, for men, drinking more than two drinks a day and more than one drink a day for women. Binge drinking — essentially, drinking to get drunk — occurs when a man drinks five or more alcoholic drinks or a woman drinks four or more alcoholic drinks on a single occasion. The modern accepted definition of binge drinking is drinking enough to raise the blood alcohol concentration of the drinker to .08 percent or higher. The Centers for Disease Control and Prevention reports that, although men are more likely to drink more at a time than women, differences in body structure and chemistry cause women to absorb more alcohol and take longer to break it down and remove it from their bodies, that is, to metabolize it.

www.havredailynews.com

Consequences of underage drinking Youth who drink alcohol are more likely to experience: • School problems, such as higher absence and poor or failing grades. • Social problems, such as fighting and lack of participation in youth activities. • Legal problems, such as arrest for driving or physically hurting someone while drunk. • Physical problems, such as hangovers or illnesses. • Unwanted, unplanned, and unprotected sexual activity. • Disruption of normal growth and sexual development. • Physical and sexual assault. • Higher risk for suicide and homicide. • Alcohol-related car crashes and other unintentional injuries, such as burns, falls, and drowning. • Memory problems. • Abuse of other drugs. • Changes in brain development that may have lifelong effects. • Death from alcohol poisoning. In general, the risk of youth experiencing these problems is greater for those who binge drink than for those who do not binge drink. Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 2007;119:76–85. Source: Centers for Disease Control and Prevention “In other words, upon drinking equal amounts, women have higher alcohol levels in their blood than men, and the immediate effects occur more quickly and last longer,” the CDC website says. “These differences also make women more vulnerable to alcohol’s long-term effects on their health.” The impacts also are more severe to children — actually, anyone younger than 21, research indicates. Along with problems in

school, in society and with the law, and with increased likelihood of fights, pregnancy, and issues such as hangovers, youth who drink alcohol are more likely to experience memory problems, changes in brain development with potentially lifelong effects, disruption of normal growth and of sexual development, even death from alcohol poisoning, the CDC reports.

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Group planning to fight alcohol abuse in Hill County Tim Leeds tleeds@havredailynews.com

Illinois Liquor Control Commission

A group of health care providers and local officials is moving forward with plans to fight a perennial problem in Havre and Hill County — alcohol abuse. Some 30 representatives of local government and health care organizations met Aug. 29 to sift through results of a Hill County Health Assessment, released in 2013 in a collaborative effort spearheaded by Benefis Healthcare of Great Falls and Havre’s Northern Montana Health Care, the Hill County Health Department and Bullhook Community Health Center. After reviewing the data from the 2013 health assessment and a 2012 early childhood health assessment, and spending nearly five hours discussing the contents, the group narrowed down its focus to three top priorities on which to focus in the health improvement plan being drafted: mental illness, reducing teen pregnancy and reducing alcohol abuse. Alcohol abuse was a top concern in the survey of the Hill County residents released in the assessment, as well as data cited in the survey. It also was a top concern for each of the five groups that brainstormed Aug. 29 about what to prioritize in the assessment.

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More or Less likely to have or father a child as a teen Less likely

More likely

Enrolled in school

Mother was a teen-mom

Participating in activities

Mother has high school or less education

Has good grades

Has a positive attitude toward school

Single parent household Live in low-income neighborhood with limited employment

Source: Office of Adolescent Health, www.hhs.gov

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Pregnancy on the Hi-Line: Sexually transmitted disease also high ■ Continued from page 11 “We really try in everything that we do, we do it in a very clinical, factual method, and we coach our folks, and our folks do a wonderful job on this of not bringing in opinion,” he said about the teachers and school nurse who present information in the classrooms. “We try to be very honest with the kids but do it from a very clinical and factual way.” One of the important components of the schools sex ed curriculum is to have teachers and staff meet with parents before the first sex ed class to tell them about what the kids will be taught that year, and how, and to suggest ways that these conversations can be furthered at home. “We get a very small amount of time that we can provide students with factual information,” he said, especially compared to the amount of time they can get information elsewhere. “We have really tried to focus on bridging that gap between here’s the factual information they’re getting in school and saying, OK, mom, dad, we’re going to give you a conversation starter. We’re hoping that this talk continues at home,” he said. “There are homes … where these conversations are not occurring,” he added, “and we would hope that we can provide maybe a little bit of a window to make that happen.” Wanda Meredith, Hill County Family Planning coordinator, said that today the subject of teen pregnancy and sexual activity is much more transparent than in was in generations past when pregnant girls were “just sent to Aunt Tilly’s house.” Still, she said, when the conversation turns to teens, sex and sexually transmitted infections, it can quickly turn into a moral issue because people are uncomfortable with the topic as if “we can’t talk about it because then people will do it.” When families feel that these conversations are best kept in the home, she doesn’t disagree, but she has seen in the community a wide variety of family situations that don’t fit that ideal of the parents taking on that responsibility. “I don’t argue that a bit,” she said. “But, you know, some kids don’t necessarily have a place to sleep or parents who will do this. ... Then you can have the other side of it — the so-oppressive type of a parent that it’s not a safe place for them to have that discussion either.” That’s where education from outside, neutral sources, like the school classroom, the confidential office of Family Planning, or some other safe place, is so important,

There are homes where these conversations are not occurring. Andy Carlson Havre Public Schools Superintendent

she said.

Why curbing teen pregnancy is important Teen pregnancy was identified as a key area of concern for the Community Health Improvement Plan through the 2013 Hill County Needs Assessment and the 2012 community assessment by the Early Childhood Investment Team, an independent group which began as a committee of the community health consortium. “It is such a larger creature in the fact th at w h e n p e o p l e h ave c h i l d re n younger, they don’t finish school, they don’t go to college, they end up being on more of the welfare system, at the lower s o c i o - e c o n o m i c e n d, a n d we h ave s o many kids that are being raised in poverty — and we keep repeating that cycle,” said Meredith, a member of the planning group. The U.S. Department of Health and Human Resources website cites reports that the economic and social costs of teenagers giving birth is that the mothers tend not to finish school or go on to college, the children are most likely to be raised in poverty in single-parent households, to have poorer health than the average child and to have a high likelihood of ending up in the justice system. Multiplying the problem, all these factors are listed as contributing to a child’s likelihood of growing up to be a teenager who gets pregnant or fathers a child. “Teen pregnancies are your highest risk because they’re young, they don’t have income and … statistically it shows that once they’ve had one pregnancy they’re likely to have a second one within a year to two years after that first teen pregnancy, so then that’s a huge impact on our society as well,” said Danielle Golie, Hill County Public Health Director. The nonprofit group National Campaign to Prevent Teen and Unplanned Pregnancy compiled statistics from 2008 and found that the cost of teen pregnancies to Montana taxpayers was $29 million — of that $12 was

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Bullhook Community Health Center Executive Director Cindy Smith, then county health director, spearheaded an effort to create the Hill County Consortium. The consortium, which included health and social service providers, faith-based representatives, educational consultants and representatives of the Hutterite community, did its own health assessment of the county to determine the top priorities it should address then. The top need identified by the consortium was to increase health care access in the county, which led to the creation in 2005 of the Bullhook Community Health Center, which now is erecting a new facility across from City Hall on 4th Street and 5th Ave. in which to house its services, including in medical, dental and mental health. The consortium continued its work, including in 2011 released a health assessment and health improvement plan that focused on reducing obesity and increasing physical activity for Hill County residents; increasing awareness of health care resources available in the county, and increasing awareness of the dangers of unsafe sex. Another assessment looking at issues in maternity and in families with young children was adopted by the Hill County Early Childhood Investment Team in 2012.

Another health assessment conducted The latest health assessment of the county, released this year, had its origins in the national health care reform, the Affordable Care Act. That act requires certain organizations, including community health centers and nonprofit hospitals, as well as accredited health departments, to conduct periodic health assessments in their region. Benefis Healthcare began preparing a health assessment for its region, including Hill County, and the Havre hospital, community health center and county health department partnered with the Great Falls hospital in developing the health assessment for Hill County. The health assessment used data both from a survey sent out to residents as well as statistics from a variety of sources to provide a snapshot of health issues in the county. More of the respondents felt that the overall health of the county was not good, with 30 percent responding that they believed the county was healthy and 42 responding that they did not. Another 22 percent did not respond to that question. The most serious concern for the Hill County residents who participated was alcohol abuse, followed by cancer, illegal drug abuse, weight and obesity, and dental care. Binge drinking and tobacco use both were listed in the report at a higher rate

HEALTH GUIDE

A look at three three major health problems in Hill County

The Community Needs Assessment conducted for Hill County selected three major areas that should be the focus of activities for area health care professionals. The three problems involved alcohol abuse, mental disorders and teen pregnancy. The Havre Daily News in this special section will look at each of these areas in depth. Staff writers Pam Burke, Tim Leeds and John Paul Schmidt have talked to professionals in the area and, defining what services are available in these areas and what can be done to help people with these problems.

than for the state overall. The Early Childhood assessment noted that Hill County has a much higher rate of teen pregnancy than the state, and also that 26 percent of families with children younger than 18 live on incomes below the federal poverty level.

Developing a plan At a meeting Aug. 29, about 30 people representing a variety of health care and governmental organizations spent five or so hours reviewing the 2012 and 2013 assessments, then narrowing down local concerns and issues to items on which the group could set goals with measurable results. The final vote brought dealing with alcohol abuse, teen pregnancy and mental health issues to the top of the list, followed by nutrition. The group agreed to forward the nutrition issue to the OPEN GYM group that developed as a result of the 2011 health improvement plan to address obesity, exercise and nutrition, allowing the new Health Improvement Plan to focus specifically on the top three. The people at the meeting then split into three groups to start developing specific objectives regarding those three priorities, and set strategies —  and measurements — for meeting those goals. A common thread in the three groups was to try to hook up with other groups already working on those issues in the community, and to find — locally and nationally — proven strategies already in use. Part of the next step is to develop focus groups to continue developing, and implementing, the strategies to address the issues selected.

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Group moves forward with Hill County Health Improvement Plan Sets reducing alcohol abuse, teen pregnancy and helping with mental health problems as first priorities Tim Leeds tleeds@havredailynews.com With a comprehensive health assessment and a planning meeting under its belt, a group comprising local health care organizations is moving forward with plans to address three main health problems in the county. At a planning meeting in August sponsored by Northern Montana Health Care, Hill County Health Department and Bullhook Community Health Center, a group narrowed down a lengthy list of health concerns to three top priorities to address first: alcohol abuse, teen pregnancies and mental illness. Hill County Public Health Director Danielle Golie said she expects those topics to be a main part of the agenda at the Hill County Health Consortium’s meeting Nov. 19. Golie said she expects the consortium to set task forces to work on those issues along with the committees that were formed at the August planning meeting.

A new focus on a local strategy Havre Daily News/Lindsay Brown, file Desiree Norden, case manager for the Montana Medicaid Health Improvement Plan, from left, Hill County Extension Agent Lea Ann Larson and Bullhook Community Health Center Executive Director Cindy Smith discuss Hill County health issues at a meeting Aug. 29. The group at the meeting set reducing alcohol abuse and teen pregnancies and addressing mental health issues as the top three priorities on which to focus in a Health Improvement Plan being drafted for Hill County.

The 2103 health assessment used in the planning meeting, available online at the Northern Montana Health Care website at http://www.nmhcare.org/?id=950, is the latest in efforts to assess the health of Hill County, started by the county Health Department a decade ago.

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federal taxes and $17 million was state and local taxes. Another factor linked to the issue of teen pregnancy, and a big part of why it is one of the three health issues for the improvement plan, is the remarkably high incidence of sexually transmitted disease in Hill County. Montana has a higher than national average percentage of teens of both genders having sex by ninth grade, said Meredith, and a rate of sexual experience by 12th grade that is equivalent to the national percentage — in the mid-60 percent range for both genders. If they’re having sex, they are at risk for sexually transmitted infection, Meredith added, and Hill County’s rate of STIs is more than 12 times higher than the rest of the nation’s.

What is being done in Hill County Part of what the committees for the three focus areas will be doing for the Community Health Improvement Plan is to look at what systems and programs are in place in the county already. Everyone is working with a minimal budget and personnel, Meredith said, and this is an opportunity for them to get together to fulfill their needs with pooled resources. For the issue of teen pregnancy, the preventative systems in place include sex ed at the schools and Hill County Family Planning, which work to prevent pregnancy through education and access to contraception. Once a teen becomes pregnant, other systems and programs in the community help to ensure the health and success of both the teen mother and the baby. These include the Health Department programs like the home visiting nurse program and WIC, support and education programs through Early Head Start, n o n p r o f i t g r o u p s, s u c h a s H i - L i n e Pregnancy Resource Center, and Family Planning. Meredith said that the programs in place now and the entities working on the improvement plan are “just trying to help people be more successful in life,” and that they work to “help keep the life picture in mind of having a future and finishing school and doing all of that. "If that person at 15 has a baby," she added, “how can we help keep her in school and not have another unplanned pregnancy?”

What will be done in Hill County Another component of the work to be done by the action committees is to create and implement a plan of action, determined with input from as many different

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We need a lot more community staeholders to come and be a part of our task groups. Danielle Golie Hill County Public Health Director

stakeholders in the community as possible, said Golie. Participants at the Aug. 29 meeting brainstormed possible measurable objective and strategies to meet the objectives. The group meeting on teen pregnancy came up with nine possible objectives, including lowering the teen pregnancy rate over the next three years; school completion for pregnant teens and adolescent parents; parent education opportunities; and risk management assessments for teens at Havre Middle School. The objectives will be pared down to about six measurable, attainable goals, s a i d C h r i s t e n O b r e s l ey, d i r e c t o r o f Northern Montana Health Care Foundation. Once the Community Health Improvement Plan is written the consortium will meet with its members and anyone in the community to come in to review it and see where and how they can contribute to the objectives. “We need a lot more community stakeholders to come and be a part of our task groups,” Golie said, people with a passion to address these issues. With Montana Department of Health and Human Services statistics showing that more than twice as many births are to Native American teens than white teens, it is important to have good representation of Native Americans in the action committee to provide a cultural perspective that will help the group be more effective, Meredith said. “The more voices we have, the better outcomes we’ll have, also,” said Obresley, who also pointed out that one of the proposed objectives was to get teen parents, both fathers and mothers, to participate in the teen-pregnancy action group to provide their unique perspective. “Once the Community Health Improvement Plan is done,” Obresley said, “it’s up to the entities involved to say where they can make a difference and work with the members of the committee. In the end, the teen pregnancy action committee will work on the objectives for the next three years then reassess what is working or not. At that point, the stakeholders will decide whether or not to continue or abandon each objective, she said. “As organizations,” she added, “we need to look at the Community Health Improvement Plan and say this is how we can have an impact.”

Statistics on Risky Behaviors Teens who engaged in risky behavior also engaged in other behaviors that increase risk for teen pregnancy. • Rarely or never wore seatbelt. • Rode with a driver who had been drinking • Drove when drinking • In a physical fight one or more times in last year • Smoked cigarettes in last 30 days • Smokeless tobacco use • Drank alcohol in last 30 days • Used marijuana during last 30 days Source: Montana Youth Risk Behavior Survey, 2011

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Health Guide 2013