RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Teen Driving Safety in Scappoose and Columbia County Project Date: 4/27/2009 Motor vehicle accidents (MVA) are the leading cause of death for young people in the United States and Oregon. Teen driving safety has received increased attention in recent years from national healthcare bodies such as the American Academy of Pediatrics (AAP) which recommends that primary care physicians educate teenage drivers and their parents regarding risky teen driving behaviors. Statistical analysis as well as interviews with local residents of Scappoose and Columbia County indicated the need for such a primary care educational initiative. Following the recommendations of the AAP, an educational handout was formulated providing information on teen driving risk factors and ways to avoid them. Also included was a driving contract designed to be used by parents when talking with their teen about driving risks. This contract establishes a set of restrictions on driving consistent with a Graduated Drivers Licensing program with associated punishments for bad behaviors and rewards for good behaviors. These materials were made available to patients frequenting the clinic as part of a well or ill visit and are intended to be used in the same manner as other preventative educational materials such as handouts on tobacco avoidance, guidelines for good diet and exercise, and safe sexual practices. It is hypothesized that education on the dangers and risks of teenage driving directed at parents and teens as part of a medical visit in the Scappoose OHSU Family Medicine Clinic with a physician or other healthcare provider is an important step in reducing injury and death related to MVA in the community Alcohol Use vs Dependence in Harney County Project Date: 10/13/2008 Alcohol abuse and dependence is a commonly encountered problem in communities, particularly in Oregon vs. the U.S. This project was designed to investigate potential reasons for higher rates of alcohol consumption per capita in Harney County compared to other Oregon counties but equal rates of alcohol dependence between the two. Identifying potential contributing factors toward increased consumption yet equal rates of dependence between state and county was the primary goal. The design of this investigation included data review from the state epidemiological outcomes workgroup on alcohol statistics, 6 interviews with members in the community that encounter alcohol problems, a survey review of 52 high school students in Harney county, and observations of community advertisement/marketing adds. The data was collected and analyzed. Potential factors discussed in the interviews toward the disconnect between increased alcohol consumption and dependence were identified along with the number and locations of slogans/adds in the community. The final conclusion of the project was that contributions toward increases in alcohol consumption per capita in Harney County but equal rates of alcohol dependence are multi-factorial including community attitudes, attitudes toward rights of passage, marketing/advertising, potential loose law enforcement in the past, economic strains that potentiate alcohol use, and potential under diagnosis amongst clinicians. Recommendations that was used after considering the data was an information brochure to be administered to parents of older children, adolescents, and teenagers in routine doctor office visits promoting awareness about alcohol use amongst these groups in Harney County. Underage Drinking in Southern Oregon's Illinois Valley Project Date: 9/8/2008 The U.S. Surgeon General recently addressed the country's underage drinking problem in his 2007 Call to Action to Prevent & Reduce Underage Drinking. Underage drinking is especially prevalent in rural communities like the Illinois River Valley in Southern Oregon. This project analyzed the Illinois Valley's underage drinking problem, evaluated the best approach to help ameliorate it, and attempted to improve it. It was concluded that boosting alcohol prevention education and raising awareness in the community would have the most impact. "Every 15 Minutes” Program Immediate and Short Term Outcomes Project Date: 4/28/2008 Underage drinking and driving remains a problem throughout the US, including Harney County. About 8.6% of eleventh graders in Harney County had drove under the influence in 2005-2006. Harney County high schools participated in the “Every 15 Minutes” program which focuses on making responsible decisions around driving and alcohol. High school students, sophomores, juniors and seniors, were surveyed approximately thirty days after involvement in the program. After the program students were more likely to be designated drivers and less likely to ride with someone who had been drinking. In general, the “Every 15 Minutes” program has had positive immediate and short-term outcomes. This data was compared with similar data from the 8th grade Oregon Healthy Teen Survey from 2005-2006 which these students participated in. Ongoing surveys would determine long-term effects of the program. Establishing a Needle-exchange program in Klamath County Project Date: 3/17/2008 Hepatitis C infection is increasing in incidence throughout the state of Oregon, and particularly in Klamath County. Estimates of hepatitis C rates tend to under-estimate the true incidence: because most hepatitis C infections are asymptomatic, many people do not know they are infected. A majority of acute cases of hepatitis C are associated with injection drug use. Needle exchange programs, where clients can turn in needles and syringes used for drug injection in exchange for new ones, has been demonstrated to reduce the transmission of Hepatitis C and HIV, without increasing IV drug use. The aims of this project are to justify the need for needle exchange in Klamath County, present the data for the effectiveness of needle exchange as a tactic to reduce disease, and identify the steps needed to establish such a program. Educating patients in Cottage Grove Oregon about the many consequences of cigarette smoking Project Date: 9/10/2007 Tobacco causes more deaths each year than car accidents, suicides, murders, HIV, and illegal drug use combined, according to the CDC. People that are the most likely to smoke are those with lower level of education, lower socioeconomic status, and/or live in rural communities. Sadly, smoking rates are also higher during pregnancy and postpartum in these groups, leading to increased fetal and infant mortality rates. The goal of this project is to educate the community about the dangers of smoking during pregnancy, and exposing children to secondhand smoke, along with educating patients on the multiple consequences of smoking that effects their own bodies. The need for this project was recognized while interviewing patients and parents of patients at South Lane Medical Group in Cottage Grove. Additional information was gathered from government agency websites and from a literary review of studies on the consequences of tobacco use. Patient handouts were created to educate patients on the harmfulness of smoking, and to aid physicians in smoking cessation counseling. These handouts have been made available in patient rooms, so the patient can read them while waiting to see there health care provider, or so that the physician can hand them out to patients to take home to read. Helping Prineville Physicians Help Patients Quit Smoking: Efficacy and Cost Comparisons of Smoking Cessation Methods Project Date: 9/10/2007 Smoking continues to be a health burden in the United States and in Prineville, Oregon. As many hospital campuses are becoming tobacco-free, including Pioneer Memorial Hospital in Prineville as of October 1, 2007, now is a crucial time to assist patients with smoking cessation. This study is an analysis of the various smoking cessation methods available and their relative costs and efficacies. To study this, the four pharmacies in Prineville were contacted in person and/or by telephone to request pricing information for nicotine replacement products as well as first and second-line smoking cessation medications including Bupropion SR, Chantix, Nortriptyline, and Clonidine. In addition, two pharmacies commonly used by Prineville residents, Wal-Mart and Costco, were contacted by phone for pricing information. To study relative efficacies, evidence-based medicine and internet resources were used to analyze the relevant clinical trials and their outcomes. Research was also done to identify local resources available in Prineville for smoking cessation as well as available patient handouts and other telephone and internet support resources. After collecting this data, the results were presented to the physicians of Prineville at their weekly staff meeting in an effort to provide them with knowledge of smoking cessation methods to better assist their patients with their cessation efforts. Data was presented in the form of a handout to the physicians, which included the efficacy and cost comparisons as well as a short summary of other useful resources. Hepatitis C and Associated Methamphetamine Abuse in Grant County, Oregon. Is it a Problem? Project Date: 8/6/2007 Hepatitis C (HCV) is a chronic blood born disease that can lead to long-term disability and death. It is most often transmitted through injection drug use. In Oregon methamphetamine is often the drug of choice for injection drug users, and there is significantly higher rate of HCV infection among this population. Methamphetamine is considered a major problem throughout Oregon in rural, suburban, and metropolitan communities. Rural Grant County is no exception to this, and it has a population of people addicted to the drug. However, when compared to neighboring rural Umatilla County it appears to have a smaller population of methamphetamine users with a lower incidence of HCV infection. This is most likely due to the fact that few people in Grant County inject the drug, but instead tend to smoke it or snort it. Also, the smaller population size of Grant County may make it easier for law enforcement officials to target drug users. However, county residents interviewed feel that methamphetamine use does pose a threat to their community. Also, if users switch from current methods of use to injecting the drug, the HCV infection rate would be likely to increase. Methamphetamine Use and Treatment Resources in Lebanon, OR and Linn County Project Date: 7/2/2007 I contacted DHS, Linn County Alcohol & Drug, and Dr. Carol Chervenak (OMA Methamphetamine (MA) Task Force/ABC House Medical Director) to inquire about MA use/abuse in Lebanon, OR and the surrounding communities. Through working with Dr. Chervenak, and educating myself in regards to MA use/abuse, I became aware of the magnitude of the MA problem in the area, and furthermore, the MA treatment problem was brought to my attention. In turn, I decided to investigate community resources available for those seeking help for themselves/family members addicted to MA. In the past, I had only heard vague references as to how difficult it was to get adequate inpatient treatment for MA use. I wanted to create a list of local resources that patients could access when confronting their addiction or the addiction of a loved one. Upon investigating this issue, I found more community resources than I anticipated. I found a variety of treatment options that were committed to treating drug users from all walks of life. I contacted DHS, Linn County Alcohol & Drug, and Dr. Carol Chervenak (OMA Methamphetamine (MA) Task Force/ABC House Medical Director) to inquire about MA use/abuse in Lebanon, OR and the surrounding communities. Through working with Dr. Chervenak, and educating myself in regards to MA use/abuse, I became aware of the magnitude of the MA problem in the area, and furthermore, the MA treatment problem was brought to my attention. In turn, I decided to investigate community resources available for those seeking help for themselves/family members addicted to MA. In the past, I had only heard vague references as to how difficult it was to get adequate inpatient treatment for MA use. I wanted to create a list of local resources that patients could access when confronting their addiction or the addiction of a loved one. Upon investigating this issue, I found more community resources than I anticipated. I found a variety of treatment options that were committed to treating drug users from all walks of life. Elimination of tobacco use at a small community hospital as a means to better promote public health: development and implementation of a tobacco-free hospital plan Project Date: 4/30/2007 The adverse effects of smoking are well-known to health care workers and to virtually all of the general population. Yet in the face of strong data, smoking remains a prevalent activity that places a large burden on the health care system. A November 2006 report from the Public Health division of the Oregon Department of Human Services stated that “Tobacco continues to be the leading preventable cause of death and disability in Oregon.” The Tobacco Prevention and Education Program (TPEP) of Oregon has sought to better public health through a three pronged approach: 1) preventing kids from starting to use tobacco, 2) reducing exposure to secondhand smoke, and 3) helping current tobacco users to quit. As sites specifically intended for bettering and promoting health, hospitals are visible platforms for addressing public health issues. This study addressed smoking on the grounds of the Santiam Memorial Hospital and how the approach of the TPEP could be instituted to further promote a healthy community. As a plan for a tobacco-free hospital was developed, all three aspects of the three pronged approach were included. The local Tar Wars program was used a method for attempting to prevent children in the community from starting to use tobacco. Eight local 4th and 5th grade classes received anti-tobacco presentations during the month of May. A ban on tobacco use on the hospital grounds will be put into effect as a method for reducing exposure to secondhand smoke at the hospital. Thirdly, the plan for the tobacco-free hospital included several community outreach activities designed to promote tobacco cessation in the community as a whole. A brief analysis of current smoking cessation aids was also created to help hospital staff evaluate tools for helping patients, staff, and community members overcome nicotine addiction. A timeline for the tobacco-free hospital plan has been created and is currently in motion at the hospital and in the Stayton community. The Impact of Methamphetamine on Community Health in Baker City Project Date: 4/30/2007 Methamphetamine (MA) is a stimulant drug with a high abuse potential and multiple adverse health consequences ranging from psychosis, intoxication-related trauma and self-mutilation to burns, abscesses and endocarditis. MA is unique among stimulant drugs of abuse in that it can be manufactured locally using simple and widely available starting materials. This drug may particularly impact rural areas as lower density population provides more privacy for clandestine MA labs. Small communities are less able to absorb the cost of MA-related visits to the emergency room, lost productivity and broken families. The methamphetamine epidemic has received much media attention, but how deep does the problem really go and what resources are needed? The Storm of Users: How can physicians actively participate in identifying and treating addiction without falling into the common pitfalls of either ignoring or contributing to this growing problem? Project Date: 3/19/2007 Substance dependency in this country is continuing to grow at epidemic rates. Some estimates indicate that twenty percent of primary care patients are affected by substance use or dependency, with upwards of fifty percent of emergency room visits being related to drugs or alcohol. The overwhelmingness of this problem has left our healthcare system fractured without clear roles for providers. This project attempted to explain how physicians could actively participate in identifying/treating addiction without falling into the common pitfalls of either ignoring the problem or contributing to it. Data was collected through informal interviews of key individuals with some role in substance use/dependency, recover, treatment, prevention, or enforcement. Collaborating data was collected from the Oregon Department of Human Services, National Institute on Alcohol And Alcoholism (NIAAA), and the National Institute on Drug Abuse (NIDA). Results found that the enormity of the problem is paralyzing. The consensus of individuals interviewed was the substance dependency is a growing problem with no signs of slowing in the future. At present due to the lack of a uniform approach, appropriate training, lack of time and resources, physicians are often tempted to ignore the problem or even add to it by careless prescription practices. Proper identification of the problem, education, and treatment with whatever means available (inpatient, outpatient, 12-step, individual, group) is key to future efforts. Parental safety education for infant children and implementation of the Baby Safe program in Coos County, OR Project Date: 2/12/2007 There are high rates of child abuse and neglect in Coos County, Oregon. Struggling industry and associated poverty, along with difficulties associated with resource accessibility in rural Coos County have contributed to the problem. Although poverty, drug and alcohol abuse, and low education levels will continue in the community, education of mothers regarding infant safety may help to reduce the burden of child abuse and neglect. Working with the Bay Area Hospital MOMS program and the Bay Clinic pediatricians, I updated and developed an electronic program for the new Baby Safe program, a class for mothers designed to educate them how to safely care for their infant children from birth to one year of age. Along with the Baby Safe presentation, I provided local pediatricians and their staff with an overview of National, County, and hospital-based resources for educating and supporting mothers Methamphetamine Abuse in Lane County Project Date: 10/16/2006 This project seeks to illuminate the story of methamphetamine abuse in Lane County: the drug's history, the experience of its users, its production and the effects of "meth labs" in the county, the effects on the community and on families, and resources available to help users quit. Through interviews with physicians, law enforcement officials, nonprofit organization workers, and users themselves; journal articles; and interaction with local service organizations, I discuss the history and scope of the problem in Lane County. Finally, I suggest three broad categories of solutions to the problem, and steps I would take if I were to continue this project further. Patient awareness of smoke cessation resources in a Stayton family medicine clinic and Physician intervention. Project Date: 10/16/2006 Cigarette smoking has been identified as the most important source of preventable morbidity and premature mortality worldwide. Smoking is responsible for approximately one in five deaths in the United States. According to the a survey done by the Centers for Disease Control in 2002, there were 50 million smokers in he United States, of which 70% wanted to quit smoking. 41% of those smokers make at least one attempt each year, but only 7% are successful. The majority of these people (90%) attempt to quit “cold turkey.” Countless studies have shown that although this is the most common way to quit it is by far the least effective. Those who use other resources have up to a 30-45 % success rate compare with a less than 10% overall success rate for quitting cold turkey. This study was done to evaluate patients’ awareness of these resources in a Stayton family medicine clinic as well as to determine if they are being encouraged to quit by us as care givers. Through an electronic chart review it was shown that 80% of the smokers in this clinic have documentation in their chart that quitting was discussed. A survey was done and showed the following percentage of patients that knew about each of the resources available: 100% nicotine gum or nicotine patch; 57% Zyban pill; 0% SMART shot; 100% hypnosis, 71% acupuncture; 14% Chantix pill; 42% free telephone counseling. If we can better educate our patients concerning the use of quitting resources it is more likely that they will attempt to quit using them the next time. This will significantly increase the number of patients who are successful quitters and obviously markedly improve their health and the health of the community Understanding Chemical Dependency as a Family Illness: Ways to Help in a Rural Primary Care Facility Project Date: 9/11/2006 Misconceptions about drug and alcohol addiction abound in American society. Addiction is a brain disease as shown by neurobiological studies. However, most Americans, even physicians, view it as primarily a moral or personal weakness. Families need to be educated about the causes of addiction, but they also need to understand their roles in helping their loved ones. Resources for addicts are available, but often the effects of chemical dependency on the family system are overlooked. My project’s concrete goals were to educate the staff about addiction, as well as to develop some handouts they can give to families suffering from a loved one’s addiction. Abstract goals were to help families: 1. Understand chemical dependency 2. Accept chemical dependency as a family illness 3. Embrace self-acceptance 4. Commit to a continuing recovery program 5. Identify local resources The identification and care of substance exposed newborns, a case study. Project Date: 8/7/2006 There are numerous children born in Eugene already compromised because they have been exposed to substances in utero. I identified this problem when I met Teresa Donavan who has eleven children; she has three biological children and eight foster children. All of her foster children were born to substance abusing mothers and have similar health challenges. There is a meth epidemic in Eugene and all of Oregon; the number of substance exposed newborns is on the rise. These children face similar problems such as a diminished suck reflex, increased incidence of pneumonia, minimal circadian rhythm, need for routines, and ADHD. Parents receive financial and training support from the state because children are deemed to have “special needs.” Little of the Eugene care system is organized to specifically help substance exposed newborns. However with the development of FEAT: Family Early Advocacy and Treatment, there plans to be increased identification, referral, treatment, and support of newborns exposed in utero. Patients and Providers’ Perceptions of Motivations for Cessation of Methamphetamine Use on the Warm Springs Reservation Project Date: 8/7/2006 Methamphetamine abuse continues to be a scourge on the health and welfare of rural communities throughout Oregon. While treatment programs exist, screening for use and facilitating users’ willingness to enter such programs are significant problems. This project examined the motivations of methamphetamine users to quit while concurrently probing the ways in which providers at the clinic on the Warm Springs Reservation screen for and encourage cessation of methamphetamines. The assessment of both groups was done via standardized interview. The results of this study show that the perceived motivations for cessation of use between users and providers were similar in some respects and dissimilar in others. Specifically, a fear of losing custody of children was a common perceived motivation by both groups although there was little implementation of this motivation in patient care. Also, abusive relationships were found to be a perceived barrier for former users while this went largely unrecognized among providers. Streamlining and Clarification of Alcohol Withdrawal Standing Orders at Harney District Hospital Project Date: 7/3/2006 Harney District Hospital (HDH) administration and medical staff were interested in providing better care for their patients experiencing alcohol withdrawal by revising their current alcohol withdrawal orders and educating their staff. In the recent past they had some increased morbidity from unrecognized alcohol withdrawal that the staff and administration found unacceptable. A comparison of alcohol withdrawal orders from HDH and a larger Portland-area trauma one emergency department revealed some improvements that could be made to help minimize confusion and aid in earlier recognition of alcohol withdrawal syndrome (AWS). Some improvements were addressed in a revision of the current orders that is under submission for the next medical staff meeting at HDH. As a second area of improvement, an in-service was given for HDH nursing staff on alcohol withdrawal syndrome and the proposed revision of the alcohol withdrawal orders. The in-service consisted of a a 30-45 minute PowerPoint presentation about AWS and the proposed revisions of the alcohol withdrawal orders. The nursing staff was informally polled at the in-service about their concerns with the revised orders with an eye toward further clarification of the protocol. This approach was well received by both physicians and support staff at the hospital. Hyperlipidemia in John Day, OR: An Assessment of Follow-Up and Management Project Date: 7/3/2006 BACKGROUND: Although mortality from heart disease has steadily declined since 1980, it still remains the leading cause of death in the United States and the second leading cause of death in Oregon. Of the 685,089 deaths caused by heart disease in the US, 70% were due to ischemic heart disease. Correlation between certain risk factors and premature coronary heart disease (CHD) has been markedly established, and about 80-85% of individuals with CHD possess one or more of the four conventional risk factors: cigarette smoking, diabetes, hyperlipidemia, and hypertension. Current data suggests that optimal control of hyperlipidemia with appropriate follow-up can significantly reduce an individual’s risk for cardiovascular events, and proper management in patients with CHD can significantly decrease cardiovascular events, cardiovascular mortality, and overall mortality. OBJECTIVE: To assess whether or not the stated goal of six-month cholesterol screenings for previously identified hyperlipidemic patients is being met; and to determine if treatment plans accomplish the desired goal of lowering cholesterol. METHODS: A random chart review of patients with hyperlipidemia in Dr. Holland’s practice was performed. CONCLUSIONS: Because there was a significant decrease in total cholesterol, LDL, and triglyceride levels in patients with hyperlipidemia, therapeutic management of this disease in Dr. Holland’s clinic is adequate. However, there was an overall decrease in HDL, which is less than desirable. Also, the stated desired goal of six-month follow-ups for hyperlipidemic patients is not being met but implementing a patient reminder system could increase follow-up. Tobacco Cessation Counseling: Are We Wasting Our Breath? Project Date: 5/1/2006 Tobacco use is a major public health concern and affects 21% of all Oregonians and 29% of residents of Douglas County, a rural area in Southwestern Oregon that includes the town of Reedsport (population 4500). It is the leading cause of premature death and disability in the state, and the medical and economic consequences of its use are well-documented and well-publicized. The purposes of this project were to research current evidence-based literature and clinical practice guidelines, and compare the current recommendations to individual practices at Dunes Family Health Care (DFHC) clinic, the major health-care provider for the town of Reedsport. This was done in order to identify areas for improvement with the intent of potentially improving patient quit rates. A questionnaire detailing their current practices regarding tobacco cessation counseling was distributed to all providers at the clinic. Results demonstrated that physicians at DFHC are consistently asking their patients about tobacco use and advising them to quit. However, similar to providers around the country, they are often not assisting patients in the quitting process by recommending over-the-counter nicotine replacement therapy, prescribing approved cessation pharmacotherapy, or referring patients to tobacco quit lines, all methods that have been shown to potentially double patient quit rates. In a presentation to providers at the clinic, each of their cited barriers to effective and comprehensive tobacco cessation counseling were addressed and strategies for improvement were given. Ideally, this project will have empowered physicians to provide their patients with the tools necessary to optimize their chances for a successful quit attempt. Chronic Pain Group Classes in Scappoose: Value of the Program, Barriers to Participation, and Advice from Oregon’s Pain Management Leaders Project Date: 1/2/2006 Chronic pain management continues to be a challenging issue for patients and physicians. Multidisciplinary chronic pain management groups have become an important part of pain management for many patients in Oregon. A group of this nature was recently attempted in a Scappoose, Oregon family medicine clinic. The main obstacle to success was poor attendance. This study attempted to identify barriers to attendance and investigate solutions used by experts who have faced and overcome this obstacle within their own programs. The design was interviews with patients of the Scappoose family practice clinic as well as interviews with pain management leaders. Outcomes data was collected, where possible, to assess the potential value of continuing a multidisciplinary chronic pain management group at the clinic. Cholesterol Education in Grant County Project Date: 1/2/2006 The Strawberry Mountain Wilderness Family Medicine Clinic sees a large number of senior citizens and middle aged patients, many whom have hyperlipidemia. The goal of this project was to create several handouts that address common questions patients have about cholesterol. These handouts discuss what cholesterol is and where it comes from along with the different types of cholesterol. They present guidelines from the NCEP so patients can compare their lab results with recommended levels. They provide methods of lowering cholesterol including diet, exercise and medication. Finally, they will include a summary table of different kinds of fat and how each type affects cholesterol. As part of this project, individuals who participated took a small quiz before and after going over the handouts with the medical student. This quiz was designed as a teaching aid and to help evaluate the effectiveness of the handouts. Nine individuals completed the quiz. Participants preformed moderately better on the post-quiz. Participants reported that they had a better understanding of cholesterol after going-over the information and felt they could share information with their friends and family members. The cholesterol education handouts will stay in the clinic for future use by practitioners. Alcohol and Methamphetamine Related Hospitalizations: A Chart Review of 100 Warm Springs Patients Admitted to Mountain View Hospital Project Date: 10/17/2005 After noticing that a large number of Warm Springs patients were being admitted to the hospital as a result of alcohol or methamphetamine abuse, I decided to choose this as my project topic. I completed a chart review of 100 consecutive admissions to Mountain View Hospital in Madras, OR. All patients were older than 10 years of age. Emergency Department visits were not included. I found that 22 patients were admitted with either a positive urine drug screen (UDS) or a blood alcohol level above 0.08. Six patients had a positive UDS: 4 for methamphetamine and 2 for cannabinoids. A total of 30 patients were admitted for alcohol-related reasons, including intoxication, withdrawal or other conditions. This amounts to a 30% alcohol-related hospitalization rate, which jumps to 36% when admissions for obstetrical conditions are excluded. This is a high number of costly hospital stays, some of which could have been avoided if the patient had another place to stay while he or she became sober. The tribe may want to consider establishing such a place and investing the recuperated money into substance-abuse prevention programs. Methamphetamine use in Grant County: Development of a patient handout to increase methamphetamine treatment. Project Date: 8/8/2005 Methamphetamine use continues to be a growing and seriously problem in the United States, with rural areas being affected particularly heavily. This project was designed to increase the use of treatment options by methamphetamines users in Grant County, with the creation of a brochure that is available to patients in the Emergency Room at Blue Mountain Hospital and Grant County Center for Human Development. Before this project, there was a lack of ready information for people who use methamphetamines about their treatment options locally and regionally. The attention grabbing and succinct brochure highlights the reasons why methamphetamine use is harmful, increases insight into the person’s habit, and explains what options are available to help them quit. The handout can be easily altered to accommodate different regions of Oregon and the US, and it is hoped that it will increase the number of people who successfully quit their addiction to methamphetamines. Meth Use During Pregnancy Project Date: 7/4/2005 Methamphetamine use during pregnancy is quickly becoming a major problem in rural Oregon. This study attempted to identify the health effects of meth use during pregnancy on the mother and the baby and the resources available in Klamath Falls for meth cessation. The design was a meeting with Molley Boham RN, instructor of prenatal classes at Cascades East Family Practice, and Merlaine Zwartverwer RN Maternity Care Coordinator for Cascades Comprehensive Care to determine the extent of meth use during pregnancy with their patients. A medline search for methamphetamine and pregnancy articles was then done, as well as an extensive Internet search, focusing on meth use in Oregon. I also consulted with Dr. Sohl, perinatologist for Southern Oregon. There are multiple opportunities to reach pregnant women including office visits at Cascades East, office visits with Dr. Sohl, prenatal classes by Molley and home visits by Merlaine. However, there is currently no handouts or material about meth use being used. Therefore, the final product of this project was development of a patient handout for pregnant women coming to Cascades East or in Merlaine's program. Also, a presentation was given to all physicians at Cascades East to educate them about meth. Substance Dependence In Josephine County Project Date: 7/4/2005 Background: The abuse of substances including tobacco, alcohol, and elicit drugs impact the wellbeing of the individual and drains the financial and social strength of the community. I-5 is a major corridor for drug traffic and smugglings. In Oregon, the nest of this problem appears to be small rural communities along this mega-highway such as those found within Josephine County, including but not restricted to Grants Pass, the site of my rural rotation. In Josephine County, 33% of adults were smokers in 2001; Alcohol was the eighth top cause of death in 2002; In 2004, the Josephine County Sheriffs office seized 25 methamphetamine labs, 7,891 marijuana plants, and 198,718 grams of drugs with a street value of $19,479,868. This study examines the availability, accessibility, and effectiveness of medical treatment and rehabilitation services for individuals with substance dependence within Josephine County. Method: Research was conducted through the internet and yellow pages, followed by questionnaires and interviews with local Josephine county healthcare providers, a hospital social worker, an addiction counselor, and representatives of local rehabilitation programs involved in the care of individuals with substance dependence disorders. Results: Findings indicate a lack of funding, dwindling services and resources, and defective communication and referral protocols are among the sources of problems with access and quality of care for substance dependent individuals. Conclusion: I propose that protocol for referral and communication between the primary care community and the mental health/substance abuse treatment community be reevaluated by a committee of representatives from all involved parties and that new protocol be established and made clear to all members of these parties for the improvement of access and quality of care to patients. Meanwhile, a chart that lists local resources and summarizes some referral protocol was developed and distributed locally to several local primary care providers. Mental Health and Addiction services are vital component of our communities. Project Date: 4/25/2005 Mental health and addiction services are vital components of our communities. In my short time at the OHSU Scappoose Family Practice (SFP) Clinic, the tremendous amount of mental health and addiction issues within the patient population became readily apparent. This project focused on identifying the major mental health and addiction resources within Columbia County, the county which is home to the OHSU SFP Clinic. Additionally, this project attempted to strengthen the ties and communication between those mental health resources and the practitioners at the OHSU SFP Clinic. The data was obtained through interviews with Columbia Community Mental Health (CCMH) and OHSU SFP Clinic staff members. As a result of the interview with the Executive Director of CCMH, a listing of services provided by CCMH was created and distributed to OHSU SFP Clinic staff. In addition, the framework for efficient and effective long-term communication (about patients, resources, etc.) between the two entities was constructed. Alcohol Misuse in Benton County Project Date: 4/25/2005 Alcohol misuse is strongly associated with health problems, disability, death, accident, injury, social disruption, and violence. In the United States, alcohol abuse generates nearly $185 billion in economic costs. In general, alcohol misuse is under diagnosed by the primary care physician. The purpose of this community project is to assess the magnitude of the problem of alcohol misuse in Benton County, methods of detecting alcohol problems in our patients, examine the most successful treatment programs for achieving and maintaining sobriety, and the availability of alcohol treatment programs in Philomath, OR and Benton County. Mental Health Resources in Clatsop County: A Summary of the Need For and Existing Mental Health Services Project Date: 3/21/2005 Mental health disorders and the need for mental health services are pervasive in all areas of Oregon, including rural communities like Clatsop County. Residents of Clatsop County have a greater proportion of alcohol and drug-related problems and have at least equal to or greater need for other mental health services. Despite the need for mental health services, resources are seemingly lacking, and furthermore, resources are not readily evident to local health care providers who must often align their patients with appropriate mental health services. The goal of this project was to examine the scope of the need for mental health services in Clatsop County, identify mental health resources in Clatsop County, formulate a pamphlet for use by local health care providers and community members which summarizes existing mental health resources, and approximate whether current resources adequately meet the needs of the population with mental illness. Neonatal Mortality in Josephine County: Current and Historical Perspectives Project Date: 2/7/2005 The problem of neonatal mortality and its associated risk factors in Josephine County, Oregon was examined in 1997 by OHSU Masters student and Public Health Nurse Virginia Adams. Her work demonstrated a community whose newborn babies suffered a 33% increased relative risk of neonatal mortality (death within the first 28 days of postnatal life) compared to babies born elsewhere in the state. The objective of this investigation is to compare the most current statistics regarding neonatal mortality to this historical data to identify areas of improvement and continued struggle within the community of Josephine County. Methods employed in this investigation include critical examination of health statistics and a series of interviews conducted by myself with care providers in Josephine County. To the credit of the community, this investigation found many admirable gains made by dedicated providers. Since the publication of Adams' study, neonatal mortality rates have in Josephine County have decreased significantly (from 8.6 to 5.0/1,000 live births), rates of inadequate prenatal care have dropped from 10.1% to 3.6% (well below OR state averages), and numerous other risk factors for poor neonatal outcomes have been decreased. However, despite these gains, several substantial problems exist in Josephine County which pose potential threats to newborns. Perhaps most notably is the problem of illicit drug use during pregnancy, for which Josephine County maintains the highest rate of all counties in Oregon. Other persistent risk factors for neonatal mortality identified by care providers include recent reductions in public funds which have forced clinic closures and ended subsidized housing programs for pregnant women. Barriers to Enrollment in the Oregon Medical Marijuana Program in Madras, Oregon Project Date: 2/7/2005 Since its approval by voters in 1998, the Oregon Medical Marijuana Program has provided legal protection for enrolled patients to grow and use marijuana for symptomatic treatment of cancer, glaucoma, HIV/AIDS, agitation due to Alzheimer’s Disease, and any medical condition that produced cachexia, severe pain, severe nausea, seizures, or persistent muscle spasms. Initial estimates predicted growth of 500 members per year, but by July 1, 2004, OMMP membership cards had been issued to 10,196 people. Despite the popularity and rapid growth of the OMMP, many barriers exist in enrolling patients with qualifying medical problems. Through interviews with physicians, a physician’s assistant, home health & hospice nurses, patients, as well as chart reviews, barriers to enrollment in the OMMP were identified, some of which are unique to the rural community in Madras and others that apply to patients statewide. Information regarding the OMMP, Madras Medical Group’s enrollment in the program, and barriers to enrollment were presented in a lecture to the clinic’s providers with the goal of increasing provider understanding of medical marijuana in Oregon. The Impact of Alcoholism in Tillamook County and the Resources Available for Alcoholics. Project Date: 2/7/2005 Unhealthy alcohol use can be associated with multiple economic, social, and medical problems. This project will assess the impact of alcoholism in Tillamook County and assess the resources available for alcoholics. To assess the impact of alcoholism, community members who were dealing with alcoholism either directly or indirectly were interviewed. Statistical information was gathered by the Oregon DHS, National Institute of Alcoholism and Alcohol Abuse, and Oregon Crime Data websites. According to the Oregon Department of Human Services, the rate of adult alcohol abuse or dependence in Tillamook County is roughly similar to the state average (7.5% vs. 7.8%). The rate of alcohol related arrests in Tillamook County is significantly higher than the state average (182.5 vs. 48.6 per 10,000 in 2002) however, and this might be attributed to the influx of tourism during the summer and the lack of public transportation in the evening and taxicabs. However, in a 2004 survey, the rate of binge drinking among North Coast County (Tillamook, Clatsop, Columbia) eighth graders, the rate of binge drinking was 39% versus 29% statewide. A barrier to treatment in Tillamook County is a lack of a formal detox center. Individuals hoping to detox must drive over one hour away either to Lincoln County or Portland. However, there are also some great resources available as well, including AA, which has 21 meeting times a week and Tillamook Family Counseling Center, the primary mental health and alcohol/drug service. Physicians can take a proactive approach by screening patients with the AUDIT questionnaire, engaging in brief interventions, and providing medications when necessary. A Survey of Alcohol Use Amongst Seniors at Grant Union High School In John Day, Oregon Project Date: 10/18/2004 Underage drinking continues to be a problem among adolescents and has serious social, health, and economic consequences. The purpose of this study was to identify the prevalence of alcohol use among 12th grade students at Grant Union High School (John Day, OR) compared to that of high school students throughout the United States. It is hoped that the information gathered will be used by school district authorities to assess the success of currently instituted alcohol prevention programs, stimulate thought into further methods of prevention, and help promote student understanding and insight into the pitfalls of alcohol abuse. The study was conducted in a survey format, which was completed by individual students on a confidential and anonymous basis. The final results of this project show that alcohol use is common among students at Grant Union High School, with many of them being initially exposed to alcohol at an alarmingly young age. Prevalence of Methamphetamine Use In Jefferson County, Oregon Project Date: 8/9/2004 Methamphetamines use has major health and societal impacts in rural communities across the United States. A previous community project in Madras, Oregon, sought to educate high school students regarding the ill effects of methamphetamine use. That investigator acknowledged the prevalence of methamphetamine use in the area, but did not attempt to quantify the prevalence. The aim of this project was to try and provide some numbers and demographics of methamphetamine use in Jefferson County, Oregon. Because there is no single source where such information is stored and tracked, a number of different sources were queried. Smoking Cessation Intervention at the West Salem Clinic Project Date: 7/5/2004 According to the most recent survey done by the Centers for Disease Control, there are almost 50 million smokers in the United States, of which 70% want to quit smoking. At least one third of those who want to quit, will make at least one attempt each year, but only 7% will be successful. However, as little as three minutes of smoking cessation intervention provided by a physician, can increase the chances of quitting successfully by 50%. The U.S. Public Health Service research on smoking cessation has shown that efficacious cessation treatments for tobacco users are available and should become part of standard care giving. Furthermore, delivering treatment of tobacco users is cost-effective. Despite these national guidelines, physicians are struggling to implement smoking intervention into their daily clinical practice. Tobacco is the largest single cause of lung cancer and 82% of lung cancer deaths in Oregon can be linked directly to tobacco use. In recognition of the local tobacco problem and the national recommendations from the Department of Public Health, I have designed this research project to evaluate several aspects of smoking intervention needs, practices and procedures at the West Salem Clinic. I have additionally designed a tailored smoking assessment and intervention implementation program for the West Salem Clinic based on the results of this evaluation. Off Highway Vehicle Injuries at Lower Umpqua Hospital in 2002 and 2003. Project Date: 5/10/2004 Introduction: In May 2003, the US Forest Service implemented a policy banning the possession of alcohol outside of designated areas in the Oregon Dunes National Recreation Area. The goal of that policy was to reduce the risks of using Off Highway Vehicles (OHV) to both the people using them and the natural environment. Organizers of a OHV centered event called Dunefest also attempted to increase regulation of riders in an attempt to increase safety. Methods: A retrospective chart review was conducted of all patient charts presenting to the Lower Umpqua Hospital emergency room between July 1 and August 31 of 2002 and 2003. 165 charts were abstracted for the following variables: date, time, patient age, Dunefest weekend, insurance status, EMS usage, alcohol use prior to the incident, protective equipment used at time of incident, type of injury, and disposition. Chi-square and Fisher’s exact test were used to analyze the data. Results: The average age of injured riders was 27.9 with 34 patients being 16 years old or younger. No significant change in the number of OHV related injuries was found other than a decrease in the number of patients without helmets. Alcohol use was associated with higher rates of admission or transfer to higher levels of care, lack of documented insurance, presentation to the ER between 2100 and 0700, and lack of helmet usage. Thirty-one (19%) patients had no documented insurance representing a significant potential financial burden for the hospital. Conclusions: While the new US Forest Service policy did not appear to reduce the number or severity of injuries presenting to LUH ER, the number of unhelmeted patients declined. Riding OHV’s while under the influence of alcohol was associated with greater risk of injury and higher morbidity. Efforts to decrease the operation of OHV’s under the influence of alcohol should continue. Physicians may utilize the ER encounter to screen for alcohol use among injured patients and apply brief interventions to educate patients and their friends and families about risks of combining alcohol with OHV recreation. Future studies will be needed to better determine the effects of the policy. Assessing Needs, Access, and Barriers to Alcoholism Treatment in the Rural Community of Grant County, Oregon Project Date: 5/10/2004 Alcoholism and its negative social, economic, and medical consequences increasingly pose major problems in the American society and important challenges in doctor offices, especially in rural settings where there are few available resources. It is the objective of this study to attempt to assess the needs for, the access to, and the barriers against alcoholism treatment in Grant County, Oregon. The design of the study includes multiple facets of researching work on available literature and published reports, reviewing medical records in medical facilities, meeting with personnel involved in alcoholism treatment programs, and attending Alcoholics Anonymous meeting, all of which focus on the population of Grant County, Oregon. Published data regarding the rate of alcohol misuse and abuse in Grant County which would be reveal a lower rate of alcoholism in Grant County as compared to that of the entire state of Oregon (6.7% vs. 7.8%). However, the needs for alcoholism treatment in Grant County are still considered greater that those of the rest of Oregon with finding of greater magnitude of negative consequences of alcoholism in Grant County, i.e., alcohol-induced death, alcohol-related traffic fatalities, adult alcohol-related arrests, and drunken driving arrests. It was so found that 207 people in Grant County sought treatments in four of major resources for alcoholism help in Grant County (Blue Mountain Hospital, Strawberry Wilderness Family Clinic, Grant County Center for Human Development, and Alcoholics Anonymous program) in the period of about one year through medical records. The rate of utilization of medical help of 207 makes up only 43.5% of the 476 in needs for alcoholism treatment, suggesting multiple barriers that are difficult to identify. Among these barriers are finance with Grant County being one of the poorest county in Oregon with high unemployment rate (16.9%) and low educational level (15.5% without high school diplomas), low affordability of alcoholism treatments (high rate of uninsured population of 16.47%), social stigma, and other factors unique to each alcoholism treatment options in Grant County. Treatment of Opiate Addiction in Rural Communities Project Date: 3/29/2004 Background: Opiate abuse is a chronic, relapsing brain disease with significant public health implications. Traditionally, methadone maintenance is the standard of care for this disorder. Methadone maintenance is structured so that, at least initially, patients must present to the clinic every day to receive their dose. The nearest methadone clinic to Lebanon, Oregon is over 30 miles away, which poses a significant barrier to care to those seeking treatment. In addition, physicians in Lebanon recently decided not to implement a methadone maintenance program due to concerns about financial constraints and community perception. The purpose of this study was to determine whether office-based treatment of opiate addiction with a sublingual formulation of buprenorphine and naloxone is a viable alternative to the treatment of opiate addiction for rural communities with limited access to a methadone maintenance program. Methods: A literature review was conducted to determine efficacy of buprenorphine/naloxone in the treatment of opiate addiction. A Medline search of English language articles pertaining to human subjects provided four studies. Results: The studies showed that buprenorphine alone is as efficacious as equivalently dosed methadone. One study showed that, in comparison to placebo, a sublingual formulation of buprenorphine and naloxone is safe and reduces opiate-addicted patients’ cravings when used in a primary care setting. Conclusion: Buprenorphine is a safe and efficacious alternative to methadone for rural communities with limited access to a methadone maintenance program. However, the cost of the medication and restrictions placed on providers limit the potential for this medication. A study of Drug, Alcohol and Tobacco Use Among 7th Graders in Grant County Project Date: 11/10/2003 Drug, alcohol and tobacco use by adolescents are not only prevalent in urban cities but in rural areas as well. Several studies have shown the importance of parental communication on adolescent behavior, especially those who are in their early teens. A reduced rate of alcohol, tobacco and illegal drug use by teens is correlated with positive relationships with and clearly communicated expectations by parents. This study attempted to identify the rate of alcohol, tobacco and illegal drug use by 7th grade students in three rural middle schools in Grant County and compare that to the average in communication as well as to identify if parents were communicating clear expectations regarding alcohol, drug and tobacco use. Information obtained will be used by both school administrators and local physicans to determinine the need for screening, education and intervention in this age group. Furthermore, as the school district implements a similar survey for 8th grade students, they will use the information obtained to follow students throughout their middle school years and for grang writing purposes. Lastly, results obtained will be used to educate parents in Grant County about the importance of discussing alcohol, tobacco and drug use in this age group and the effect that communicationg clear expecations can have on their child's behavior. Methamphetamine Use and Manufacturing in Lebanon, Oregon Project Date: 7/7/2003 For my community project I analyzed the problem of methamphetamine (meth) use in Lebanon. I was really interested in this topic because I know nothing about this drug and it is one of the most popular drugs in Lebanon. At the clinic I saw a number of patients who were meth addicts and was told by the doctors that its use and manufacturing is a significant problem in the community. The demographics of Lebanon include a very low socio-economic class of people who are either blue-collar workers or unemployed. Meth is cheap and easy to make and therefore tends to be very prevalent in rural towns like Lebanon. My goal in doing this community project was to find out what meth is, how it affects the body, how it is made, the prevalence of the problem and the options for treatment once a person becomes addicted. In order to answer these questions, I did extensive research on the Internet regarding general information about meth and its manufacturing; I interviewed a detective who works with the local drug enforcement program in Lebanon, and I interviewed a counselor who works at ACES, the only drug treatment center in Lebanon. Through these experiences, I was able to learn a wide range of information regarding meth. The following information is a summary of what I learned from my research. Methamphetamine abuse: a growing problem in Central Oregon. Project Date: 3/24/2003 Methamphetamine abuse is a serious and growing problem throughout the United States, especially in rural communities. The prevalence of methamphetamine abuse is increasing in Madras, Oregon and the ill consequences of the problem are becoming obvious to the community at large. This project acknowledges the problem and identifies a high school population as needing education for primary prevention of methamphetamine use. The design of the project was giving a thirty-minute presentation with a question and answer period to the health classes at Madras High School. Given that the average age of first methamphetamine use is in the mid-late teens, it was felt that the high school population needed to be informed of the problem, risks, and consequences of methamphetamine use. Also, handouts were given to the students written by the National Institute of Drug Abuse. The findings of this project were that the high school students had never been given information on methamphetamine use. They gained knowledge of this serious and growing problem in their community and the consequences of methamphetamine use. Methadone Maintenance Therapy: An evaluation of health benefits, cost-effectiveness, social impact. Project Date: 12/30/2002 BACKGROUND: Injection drug use in the United States is a significant cause of morbidity and mortality, increased health care costs, and criminal behavior. While methadone maintenance therapy (MMT) reduces criminality, health care expenditures, and morbidity and mortality among injection drug users and the general population, economic, social and political barriers prevent its universal funding. The purpose of this review was to examine the cost effectiveness, effect on morbidity and mortality, and effect on criminality of MMT in order to help determine whether MMT should be covered by health care plans. METHODS: A literature review was conducted to determine the cost effectiveness of MMT with respect to morbidity and mortality, criminal behavior, and survival as measured by overall survival and quality-adjusted life-years. RESULTS: Among a population of drug users and non-users, methadone maintenance treatment leads to significantly decreased health care costs, decreased morbidity and mortality, and has a cost per quality-adjusted life-years that is well below many other accepted medical interventions. CONCLUSIONS: Methadone maintenance treatment is cost-effective on the basis of commonly accepted criteria for medical interventions. Funding MMT is a cost-effective investment by health care plans that should lead to long term monetary savings and increased quality-adjusted life years among the entire population. Implementation of the Client Self Assessment (CSA) into Lutheran Community Services NW Treatment Center in Klamath Falls Project Date: 11/4/2002 Substance abuse treatment success is highly correlated with client motivation. While there is no guaranteed method of increasing client motivation, one could assume that engaging clients in their own treatment would be one method for doing so. The Client Self Assessment (CSA) is a client-centered instrument that may help engage clients in monitoring their own progress in treatment. It is a weekly self-assessment tool that measures the emotional state, substance use, difficulty in reducing use, and treatment satisfaction of clients. Clients and therapists can then monitor over time how treatment is going and provide “real-time” feedback to the therapists. Benefits include: improvement of record-keeping, ability to show trends over time, allows time for clients to reflect on previous week’s activities, and allows therapists to intervene more quickly with “real-time” feedback. The CSA was implemented into Lutheran Community Services NW in Klamath Falls for a trial bases. Therapists were interviewed after 3 weeks of using the instrument. Overall, there was a favorable response to using the CSA. It engaged clients in discussion and in monitoring their own treatment as well as provided weekly record-keeping for the therapists. The center plans on continuing to use the self-assessment form. Prevalence of Methamphetamine Abuse in Ontario High School, Ontario, Oregon: A demonstration of the spread of methamphetamine abuse to rural communities Project Date: 11/4/2002 Methamphetamine is a drug of abuse which has been traditionally used in urban areas by mostly white, male, blue collar workers on the west coast. Attributes of this drug, such as its low cost, ease of production, and longer half-life, have led to its spread into more rural areas. This study surveyed 104 high school students in Ontario, Oregon, a town of about 10,500 people, in order to identify attitudes regarding and use of methamphetamine in this rural community. Students were administered a 22 question survey designed to measure exposure, use of, and attitudes towards methamphetamine and other common drugs of abuse. While students generally acknowledged the danger of methamphetamine, comparing it to drugs like cocaine and heroin, 7.7% (8/104) acknowledged use of the drug, a rate nearly twice the national average. Further, 1 in 3 acknowledged having been in the presence of others intoxicated by methamphetamine, 1 in 4 stated they had friends who had used the drug, and a majority (52.9%) knew people who had used the drug. Methamphetamine was also readily available. Half stated that they knew someone who could give or sell them methamphetamine, and more than 1 in 5 (21.2%) had been offered the drug at some point. While exposure is rampant, the attitude that methamphetamine is a dangerous drug is prevalent. This presents a unique window of opportunity for the community of Ontario to address this problem amongst a still receptive audience. Alcohol Abuse/Dependency Treatment in Harney County: An informal Survey of Available Services Project Date: 9/23/2002 Alcohol/ substance abuse is a significant problem in rural communities, particularly in times of economic downturn. This project is an informal survey of services available in Harney County for alcohol abuse and how the different branches of the health care community communicate and respond to this issue. Personal interviews with the clinical directors at Harney Behavioral Health and Harney District Hospital as well as an administrator at the Sheriff’s Department and a counselor at the Indian Health Service were conducted at various times throughout the clerkship. From these interviews, a barrier to accessing mental health services was identified. Patients seen in the ER after hours for Substance abuse related health problems were not being referred to mental health services for substance abuse disorders. As a result of this observation and subsequent interview with the clinical director at Harney Behavioral Health, renewed efforts at improving communication between the hospital and HBH are being made. This will take the form of HBH sending a representative to monthly staffing meetings in order to network and increase access to mental health services. Prevention of Smoking, Tobacco, and Illicit Drug Use by Native American School Children and Adolescents. Project Date: 7/1/2002 Smoking, alcohol, and illicit drug use cause significant health problems in society. These health problems not only affect the patient, but it affects the community as a whole. Often drugs of any kind are first tried when people are young. It has been found Native Americans on reservations have an increased rate of use of alcohol, tobacco, and illicit drugs. Additionally, many studies have found substance abuse by Native Americans whether they live on or off the reservation is increased compared to the general population. Adolescents who live on the reservation are most likely to use drugs followed by non-reservation Indian youth and finally non-Indian youth are least likely to use drugs in school. Reducing alcohol, tobacco, and illicit drug use could substantially increase the health status of Native American patients who live on or near the reservation. It has been found educating children about the effects of drugs on one's health and social relationships is an effective way to reduce substance abuse. However, it has also been noted starting the education program in high school is much too late. It is important to begin educating children while they are in elementary and middle school. This paper will outline the importance of an education program in the form of a lecture series that has medical, legal, and law enforcement contributions. A lecture was developed in conjunction with this research project to be used by my preceptor starting this fall for school aged children on the nearby Native American reservation. A basic survey was also constructed to help track the changes in substance use in the years following the initiation of this project. Methamphetamine: Educating the Health Professionals of Rural Oregon Project Date: 3/25/2002 Methamphetamine is a powerfully addictive stimulant that dramatically affects the central nervous system. The drug is made easily in clandestine laboratories with relatively inexpenseive over-the-counter ingredients. These factors combine to make methamphetamine a drug with high potential for widespread abuse. Methamphetamine abuse, long reported as the dominant drug problem in California, has now become a substantial drug problem in other sections of the Southwest and West, particularly Oregon. Portland consistently ranks 3rd-4th in major US metropolitan cities for positive urine drug screens at the time of arrest. However, recent data suggests that methamphetamine is rapidly becoming a larger problem in rural regions than urban centers. Methamphetamine use was traditionally associated with white, male, blue-collar workers, but is now being used by younger and more diverse population groups usually differing by geographic area. According to the 2000 National Household Survey on Drug Abuse, an estimated 8.8 million people (4.0% of the population) have tried methamphetamine at some time in their lives, and based on similar surveys it is thought that many of these people use on a regular basis. Another shocking result from the NHSDA survey found that an estimated 6.9% of US high school students have used methamphetamine at least once suggesting methamphetamine use is occurring more commonly in younger age groups. The purpose of this project was to put together recent national and statewide data in order to lead a discussion targeted to the health care professionals of Burns, Oregon about methamphetamine. Hopefully this information will increase their overall understanding of the drug, the increasing problem in rural America, the signs and symptoms of methamphetamine use, and some of the medical problems they are likely to see associated with it. Back to subject search page or search by preceptor site