1. Purpose of Sub-Regional Priority Setting Process The purpose of the process and the Sub-regional Prevention Priority Report is to describe 1) the burden of substance abuse, problem gambling, and suicide in the Capital Area Substance Abuse Council (CASAC) sub-region, 2) prioritized prevention needs, and 3) the capacity of the sub-regions' communities to address those needs. It is based on data-driven analyses of issue in the sub-region, with assistance from key community members.
The report and accompanying data will be used as a building block for state and community-level processes, including capacity and readiness building, strategic planning, implementation of evidence-based programs and strategies, and evaluation of efforts to reduce substance abuse and promote mental health. In addition, these data will form the core of each RAC's data repository. In this role, RACs will take every opportunity to publicize the availability of town-level data on various indicators, engage other organizations (especially schools) in gathering and sharing data, and will "push" data on various indicators to the community via brief reports in newsletters, on Web sites, etc. CASAC's Prevention Committee will utilize the data and subsequent priorities established within this report to engage the Local Prevention Councils and their communities and schools in coordinated efforts focused on the sub-region's priority problems.
2. Demographic Profile of the Sub-regions The CASAC sub-region makes up 12.6% of the state's population, and ranges from the very rural (Hartland, population 2,087), to the very urban (Hartford, population 121,067) [CERC 2009]. The sub-region is fairly typical in its gender breakdown, with towns ranging from 45.2% to 54.0% male, and from 46.0% to 54.8% female. The CASAC sub-region is a fairly racially and ethnically diverse sub-region of the state, with white minorities in two of the 16 towns (Bloomfield and Hartford). Many of CASAC's communities, however, are much less diverse, with 11 of 16 towns (69%) having white majorities between 80 and 90%. While there are large African-American populations in Windsor (24.5%), Hartford (31.7%), and Bloomfield (45.1%), only Hartford has a Hispanic population above 10% (46.9%). Half of CASAC's 16 communities have Hispanic populations below 3%.
Only one community in the CASAC sub-region has a lower median income household income (Hartford, $30,379) than the state average of $53,935. All other CASAC communities have higher median incomes, ranging from Windsor Locks ($61,356) to Avon ($115,186). Only one CASAC community has a higher poverty rate than the state average of 7.9% (Hartford, 30.6%). While Bloomfield is just below the state poverty rate at 7.6%, all other CASAC communities are closer to half the sate poverty rate, ranging from 4.5% in Farmington and West Hartford, to 1.5% in East Granby.
In summary, the CASAC sub-region tends to be about average in its gender make-up, with similar racial and ethnic diversity as the state, but is wealthier and with fewer people in poverty except for the city of Hartford.
3. Description of Methods and Processes for Identifying Sub-regional Priorities CASAC and its CNAW examined a multitude of data from national, state and local sources to determine local priorities. For example, while national data on drug abuse was mostly examined from the National Survey on Drug Use and Health, additional "digging" was required to locate data on 12-17 year old substance use, since this data more closely matched CASAC's sub-regional data. At times, we also found inclusion of comparisons to Monitoring the Future data on youth substance abuse to be helpful. CASAC also consulted the Uniform Crime Report to either confirm or attempt to confirm state-level data.
At the state level, data on alcohol and drug-related crime, impacts on eduction, as well as state-level data on mortality and morbidity for each substance was examined, as well as consequence data for suicide and problem gambling. There was certain local-level data that we could not access however, that would have assisted us in our process. There are very few CASAC communities who have conducted student surveys to determine youth substance abuse rates in the sub-region.
Community readiness data was very helpful in determining changeability for the six substances, but less helpful for determining the changeability for problem gambling and suicide. CNAW members noted however that fewer communities in the CASAC sub-region does speak to a lower level of community readiness.
CNAW member contributions were significant to the process. CNAW members related both capacity building efforts and effective prevention strategies in their communities. The CNAW priority ranking process was influenced by those CNAW members in attendance. This time of year proved difficult to get CNAW members to attend a meeting, with one about half of CASAC communities represented, leaving fewer members to have input into the resulting ranked priorities. In addition, three CNAW members in attendance felt they had too little local data to priority rank the six substances and two additional behaviors. Even with the sub-regional data report in front of them, they felt they needed more local data and so chose not to participate in the ranking process. CASAC believes a more inclusive process could take place at a different time of year.
4. Brief Summary of Sub-regional Priority Needs Alcohol was considered the most prevalent problem in the region by the CASAC CNAW, an this has not changed since the 2008 sub-regional data profile. On the other hand, CNAW members were drawn to the large impact of the small number of suicides in the sub-region as well as their perception of high changeability on this issue. They felt that while there were some programs to address this in the region, that more could be done. The CNAW ranked suicide as the second problem overall.
While marijuana still ranked as the #2 substance concern in the sub-region and 3rd overall, it received much lower changeability rating from this CNAW than in 2008. The feeling of the CNAW was that given the current atmosphere of increased medical marijuana and legalization efforts the ability to reduce marijuana use is being adversely impacted.
While there is little data to compare with the 2008 profile, the CNAW concerns around tobacco use have increased, and it is their perception that cigarette use may be actually increasing. The CNAW noted the decrease in national focus on reducing tobacco use. Tobacco was ranked as the #3 substance problem and the #4 problem overall - a significant rise in priority ranking from its place as the #5 substance in 2008.
In the CNAW's priority ranking process, heroin had consistent ranking across magnitude, impact and changeability. CNAW members' concerns over heroin have increased somewhat over the last two years, as they have seen heroin move more dramatically into the 18-25 year old population, and to a lesser extent, the high school population. CNAW members' ranking scores kept heroin as the 4th substance problem, and 5th overall, about the same ranking as two years ago.
The CNAW sees cocaine as more an adult problem than a youth problem, and as a lower ranking problem than heroin. In the priority ranking matrix, cocaine barely edged our prescription drug misuse for a higher ranking, and this may be possibly due to the fact that two of the three CNAW members who decided not to participate in the ranking process had spoken in stronger terms about the prescription drug problem. Prescription drug misuse was seen as a growing problem in the CASAC sub-region by the CNAW, however cocaine was ranked slightly higher as the 6th problem, while prescription drugs ranked 7th.
The CNAW felt additional data on problem gambling might have been helpful, especially the impact on CASAC's towns. The changeability ranking of problem gambling was tied with prescription drug misuse for the second lowest rating of all problems. One related issue discussed was that while gambling behavior is fairly prevalent in high schools, it is often not seen as "problem gambling." This is an issue that needs to be addressed in the CASAC sub-region.