Mercy Maricopa Integrated Care Prevention Services, System of Care

Mercy Maricpa Integrated Care Preventin Services, System f Care Assessment Findings Reprt fr Central Arizna (GSA 6) Revised February 2015 www.mercymaricpa.rg

Table f Cntents List f Tables... 2 List f Figures... 4 Eecutive Summary... 6 Methdlgy... 9 Limitatins... 23 Descriptin f Gegraphic Service Area 6 (GSA 6)... 24 Current Preventin Prviders... 25 1. Prevalence and Trends f Substance Use and Suicide... 26 a. Substance Use... 26 b. Suicide... 43 2. Reginal statistics infrming the needs f nn-dminant ppulatins... 50 3. Priritized tp 3 5 Substance Related Cnsequences... 51 Adult Suicide... 67 4. Priritized tp 3 5 Substance Related Behavirs r Trends Cntributing t Cnsequences... 69 5. Intervening Variables/Causal Factrs... 71 6. Prtective Factrs... 78 7. Cmmunity Readiness... 80 8. Eisting Resurces... 106 9. Preventin Service Gaps between Priritized Needs and Resurces... 114 10. Direct Stakehlder, Prgram Participant, Calitin Member, and Prvider Input... 114 Cnclusins and Recmmendatins... 116 Appendi A: Data Surces... 119 Appendi B: Adult and Yuth Suicide Survey Questins... 120 Appendi C: Fcus Grup and Key Infrmant Interview Tls... 126 Appendi D: Primary Data Surces... 134 Appendi E: Cmmunity Readiness Preventin Survey (CRPS)... 135 Appendi F: Cmmunity Views Survey (CVS)... 145 Appendi G: Priritizatin Wrksheets... 166 Appendi H: Cmmunity Resurce Guide... 175 1 Page

List f Tables Table 1. Dimensins f Readiness... 12 Table 2. Priritizatin Criteria and Rankings... 16 Table 3. Yuth Fcus Grup Demgraphics... 17 Table 4. Adult Fcus Grup and Key Infrmant Demgraphics... 18 Table 5. Yuth Suicide Survey Demgraphics... 19 Table 6. Adult Suicide Survey Demgraphics... 20 Table 7. CRPS Demgraphic Infrmatin... 21 Table 8. CVS Demgraphic Infrmatin... 22 Table 9. Pinal Cunty Census Data Demgraphics fr Zips within GSA 6... 23 Table 10. Current Mercy Maricpa Preventin Prviders... 25 Table 11. Alchl GSA 6 Data Past 30-day Use... 30 Table 12. Zip Cdes with Highest Rates f Past 30-day Alchl Use by Year... 30 Table 13. Tbacc GSA 6 Data Past 30-day Use... 31 Table 14. Zip Cdes with Highest Rates f Tbacc Use by Year... 32 Table 15. Marijuana GSA 6 Data Past 30-day Use... 32 Table 16. Zip Cdes with Highest Rates f Past 30-day Marijuana Use by Year... 33 Table 17. Prescriptin Drugs GSA 6 Data Past 30-day Use... 33 Table 18. Zip Cdes with Highest Past 30-day Prescriptin Drug Use by Year... 34 Table 19. Yuth Risk Behavir Survey Results f Relevant Items... 36 Table 20. Lcatins Where Yuth Obtained Alchl in the Past Year by Grade Level and Year... 39 Table 21. Where Yuth Obtained Prescriptin Drugs in the Past Year by Grade Level and Year... 39 Table 22. Tp 15 Zip Cdes fr Mercy Maricpa Enrllment (April t July 2014)... 42 Table 23. Ttal Mercy Maricpa Enrllment by Service Type (April t July 2014)... 43 Table 24. Suicide Deaths by Tp PCAs... 43 Table 25. Tp PCAs by Suicides (2010, 2011, 2012, 2013)... 44 Table 26. Yuth Risk Behavir Survey, Selected Suicide Data (2013)... 49 Table 27. Yuth Arrest Rates by Mst Occurring Zip Cdes... 52 Table 28. Numbers f Juvenile Referrals fr Alchl and Drugs by Gender, Age, and Race/Ethnicity in Arizna53 Table 29. Yuth Mrbidity Emergency Rm Primary Diagnses fr Alchl r Drug by Age... 54 Table 30. Yuth Risk Behavir Data fr Seual Intercurse... 55 Table 31. Ten (10) Mst ER Admittances (300+) by PCA fr Bth Yuth and Adults fr Alchl and Drugs... 57 Table 32. Adult Mrbidity, Emergency Rm Primary Diagnsis fr Alchl and Drug by Ethnicity... 60 Table 33. Adult Mrbidity Emergency Rm Primary Diagnses fr Alchl r Drug by Age... 61 Table 34. Ranking f PCAs Where Deaths Occurred due t Drugs and Alchl... 61 Table 35. Alchl and/r Drug Related Deaths by PCA per Year... 62 Table 36. Maricpa Cunty: Ttal Number f Alchl Related Crashes per Year... 65 Table 37. Adult Arrests/Citatins fr Drug Offenses by the Pheni Plice Department... 66 2 Page

Table 38. Yuth Issues Listed by Intervening Variables and Risk Factrs and Data Surce... 73 Table 39. Mesa Cmmunity Readiness Results and CRPS Demgraphic Infrmatin... 81 Table 40. Suth Scttsdale Cmmunity Readiness Results and CRPS Demgraphic Infrmatin... 83 Table 41. Suth Muntain Cmmunity Readiness Results and CRPS Demgraphic Infrmatin... 85 Table 42. Sunnyslpe Cmmunity Readiness Results and CRPS Demgraphic Infrmatin... 86 Table 43. Greater Buckeye Valley Cmmunity Readiness Results and CRPS Demgraphic Infrmatin... 88 Table 44. Tempe Cmmunity Readiness Results and CRPS Demgraphic Infrmatin... 90 Table 45. Chandler Cmmunity Readiness Results and CRPS Demgraphic Infrmatin... 91 Table 46. LGBTQ Cmmunity in Maricpa Cunty Cmmunity Readiness Results and CRPS Demgraphics... 93 Table 47. Urban Native American Cmmunity in Maricpa Cunty Cmmunity Readiness Results and CRPS.. 94 Table 48. Urban Native American Cmmunity in Maricpa Cunty Cmmunity Readiness Results and CRPS.. 96 Table 49. Older Adults in Maricpa Cunty Cmmunity Readiness Results and CRPS Demgraphics... 97 Table 50. Older Adults in Maricpa Cunty Cmmunity Readiness Results and CRPS Demgraphics... 99 Table 51. African American Cmmunity in Maricpa Cunty Cmmunity Readiness Results and CRPS...100 Table 52. African American Cmmunity in Maricpa Cunty Cmmunity Readiness Results and CRPS...102 Table 53. Maryvale Cmmunity Readiness Results and CRPS Demgraphic Infrmatin... 104 Table 54. Maryvale Cmmunity Readiness Results and CRPS Demgraphic Infrmatin... 105 Table 55. Current Mercy Maricpa Prviders and Calitins by Target Issue and Area...107 3 Page

List f Figures Figure 1. Stages f Cmmunity Readiness... 13 Figure 2. AYS Past 30-day Use by Substance, Grade Level and Year... 27 Figure 3.AYS GSA 6 vs. State by Substance and Year... 28 Figure 4. AYS Mean Age f First Use by Substance, Year and Grade Level... 29 Figure 5. AYS GSA 6 vs. Cunty Past 30-day Binge Drinking... 31 Figure 6. Synthetic Drugs AYS Past 30-day vs. Lifetime Use... 35 Figure 7. AYS: Lcatin Where Marijuana was btained by Grade Level (2012)... 40 Figure 8. Suicide Numbers by Age Grups (2010, 2011, 2012, 2013)... 45 Figure 9. Maricpa Cunty: Suicide Rates by Age Grups (2010, 2011, 2012, 2013)... 45 Figure 10. Suicide Numbers by Gender (2010, 2011, 2012, 2013)... 46 Figure 11. Maricpa Cunty: Suicide Rates by Gender (2010, 2011, 2012,2013)... 46 Figure 12: Suicide Numbers by Ethnicity... 47 Figure 13. Maricpa Cunty: Suicide Rates By Ethnicity (2010, 2011, 2012, 2013)... 47 Figure 14. Firearm Suicides in Arizna by Age Grup and Year (2010, 2011, 2012)... 48 Figure 15. Percent f Students Reprting Riding with a Drunk Driver r Drinking and Driving - AYS... 54 Figure 16. Maricpa Cunty vs. State f Arizna: Inpatient Discharges Related t Drugs (2010, 2011, 2012)... 56 Figure 17. Maricpa vs. State f Arizna: Inpatient Discharges Related t Drug Dependence and Drug Use (2010, 2011, 2012)... 57 Figure 18. Maricpa Cunty vs. State f Arizna: Emergency Rm Visits Related t Drugs (2010, 2011, 2012)... 58 Figure 19. Maricpa Cunty vs. State f Arizna Emergency Rm Visits and Inpatient Discharge Related t Pisning (2010, 2011, 2012)... 59 Figure 20. Maricpa Cunty vs. State f Arizna ER Visits and Inpatient Discharges Related t Alchl Abuse (2010, 2011, 2012)... 59 Figure 21. Adult Mrbidity fr Alchl and Drugs by Gender (2010, 2011, 2012, 2013)... 59 Figure 22. Mrtality fr Alchl and/r Drugs by Age (2010, 2011, 2012, 2013)... 62 Figure 23. Mrtality fr Alchl and/r Drugs by Gender (2010, 2011, 2012, 2013)... 63 Figure 24. Mrtality fr Alchl and/r Drugs by Ethnicity (2010, 2011, 2012, 2013)... 63 Figure 25. Maricpa Cunty: Drug Related Deaths (2010, 2011, 2012)... 64 Figure 26. Maricpa Cunty: Cnsequences frm Alchl Related Crashes (2007-2012)... 65 Figure 27. Maricpa Cunty vs. Arizna: Number f Injury Related Discharges (2008-2012)... 68 Figure 28. Maricpa Cunty vs. State f Arizna Number f Injury Related Emergency Rm Visits (2008-2012)... 69 Figure 29. Maricpa Cunty: AYS Risk Factrs 8th Grade (2008, 2010, 2012)... 74 Figure 30. Maricpa Cunty: AYS Risk Factrs 10th Grade (2008, 2010, 2012)... 74 Figure 31. Maricpa Cunty: AYS Risk Factrs 12th Grade (2008, 2010, 2012)... 74 Figure 32. Maricpa Cunty: AYS Prtective Factrs 8th Grade (2008, 2010, 2012)... 78 Figure 33. Maricpa Cunty: AYS Prtective Factrs 10th Grade (2008, 2010, 2012)... 79 Figure 34. Maricpa Cunty: AYS Prtective Factrs 12th Grade (2008, 2010, 2012)... 79 4 Page

Figure 35. Mesa CRPS Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Yuth Marijuana Use... 82 Figure 36. Suth Scttsdale CRPS Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Yuth Marijuana Use... 84 Figure 37. Suth Muntain CRPS Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Yuth Marijuana Use... 86 Figure 38. Sunnyslpe Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Yuth Marijuana Use... 87 Figure 39. Greater Buckeye Valley Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Underage Alchl Use... 89 Figure 40. Tempe Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Underage Alchl Use... 91 Figure 41. Chandler Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Underage Alchl Use... 92 Figure 42. LGBTQ Cmmunity in Maricpa Cunty Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status LGBTQ Adult Tbacc Use... 94 Figure 43. Urban Native American Cmmunity in Maricpa Cunty Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Native American Suicide... 95 Figure 44. Urban Native American Cmmunity in Maricpa Cunty Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Native American Prescriptin Drug Misuse... 97 Figure 45. Older Adults in Maricpa Cunty Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Older Adult Alchl Use... 98 Figure 46. Older Adults in Maricpa Cunty Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Older Adult Prescriptin Drug Misuse... 100 Figure 47. African American Cmmunity in Maricpa Cunty Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status African American Yuth Suicide... 102 Figure 48. African American Cmmunity in Maricpa Cunty Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status African American Yuth Marijuana Use... 103 Figure 49. Maryvale Cmmunity Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Spice... 105 Figure 50. Maryvale Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Yuth Marijuana Use... 106 5 Page

Eecutive Summary Mercy Maricpa Integrated Care, an Arizna nn-prfit crpratin spnsred by nn-prfit and gvernmental health-care prviders based in Maricpa Cunty is the largest public integrated managed care prgram in the United States. Thrugh cntract funding prvided by the Arizna Department f Health Services/Divisin f Behaviral Health Services (ADHS/DBHS) and the Arizna Health Care Cst Cntainment System (AHCCS) beginning April 1, 2014, it administers integrated, whle-health care fr apprimately 19,000 peple wh are diagnsed with a serius mental illness (SMI), as well as apprimately 800,000 ther adult, child and adlescent members with general mental health and substance abuse issues (GMH/SA), mst f whm are Medicaid r Medicare eligible. As the Reginal Behaviral Health Authrity (RBHA) fr Central Arizna (GSA 6), Mercy Maricpa cntracts with a wide cmmunity-based netwrk f behaviral and physical health-care prviders t deliver services t eligible members. Preventin services are an essential part f the System f Care, dedicated t decreasing the incidence, prevalence and severity f substance abuse and behaviral health issues amng ppulatins that d nt have a diagnsable behaviral health disrder and are nt enrlled in the behaviral health system. Preventin aims t change cnditins t develp and prmte healthy individuals, families and cmmunities. Funding fr preventin services cmes frm the Federal Substance Abuse Preventin and Treatment Blck Grant (SABG), annually allcated by the United States Substance Abuse Mental Health Services Administratin (SAMHSA). Mercy Maricpa cntracts with twelve prviders wh cllabrate with twelve cmmunity-based substance abuse preventin calitins t implement evidence-based, data-driven, cmprehensive strategic preventin plans in their targeted cmmunities. Each prvider and calitin engaged in a thrugh cmmunity assessment prcess t determine substance use issues mst significantly impacting their targeted ppulatin and/r gegraphic area, and thrugh a planning prcess, identified a mi f individual, family, cmmunity and envirnmental strategies t reduce the prevalence and cnsequences f the pririty substance use issue ver the past several years. Every three years r within si mnths f implementatin fllwing cntract award, the RBHA cnducts its wn reginal cmmunity assessment t determine prevalence f substance use and suicide. This prcess helps t identify underserved ppulatins and regins and determines system pririties. The last cmprehensive assessment f GSA 6 was cmpleted in 2009. Mercy Maricpa believed it crucial t perfrm a thrugh assessment t evaluate the current issues, trends, and cmmunity climate arund substance use and suicide, and cntracted with Pima Preventin Partnership (PPP) fr this purpse. This reprt will nt nly help t infrm Mercy Maricpa and ADHS/DBHS f pririties, but als will serve as a fundatin fr cmmunities t reflect and re-evaluate lcal needs and gaps. Primary and secndary data cllected as part f this needs assessment indicate there are several issues happening within Maricpa Cunty. The tp ranking issues f imprtance include (Fr priritizatin prcess and scring wrksheets, please reference page 16 and Appendi G.): 1. Yuth alchl = 15 2. Yuth marijuana = 14 6 Page

3. Adult suicide = 13 4. Yuth suicide = 11 5. LGBTQ adult alchl = 11 6. Yuth prescriptin drugs = 10 7. Older adult prescriptin drugs = 10 Substance Use Trends Primary and secndary data frm the needs assessment indicates the tp three substances f yuth use are (in rder f prevalence): 1. Alchl 2. Marijuana 3. Prescriptin Drugs The data demnstrates a 2% reductin in yuth 30 day alchl use in GSA 6 frm 2008 t 2012. Prescriptin drug use amng yuth has decreased by 3.3% and tbacc use has decreased by 2%. Yuth marijuana use, hwever, has shwn a 3% increase since 2008. Parties are the tp access pint fr alchl as well as a cmmn way f accessing prescriptin drugs and marijuana; hwever, yuth btain prescriptin drugs and marijuana mst ften frm their friends. The tp substances f use in adults reflect that f yuth: alchl and marijuana. Acrss all substances, the fllwing Primary Care Areas (PCA) shw the highest yuth use f substances: Pheni Suth Central Paradise Valley Scttsdale Tempe Suicide Trends Frm 2010 t 2013, suicides increased a cumulative 6.4% r apprimately 2% per year. Adults ages 65+, 45-65, and 25-44 have the highest rates and shw the greatest increases ver time, while rates are relatively stable fr yuth <18 and yung adults 18-24. Males are at the highest vulnerability fr suicide cmpletins, and females have mre attempts. Whites, fllwed by Native Americans, have the highest ppulatinadjusted rates. The tp fur PCA s where the majrity f suicides ccurred in 2013 were: 1. Deer Valley Village 2. Nrth Muntain Village 3. Mesa West 4. Paradise Valley Village It is imprtant t nte that all fur f these PCA s have been ranked in the tp 15 f all the PCA s fr suicide cmpletins since 2010. 7 Page

YRBS data cllected frm Arizna yuth in 2013 indicated that 19% f high schl students seriusly cnsidered attempting suicide during the past 12 mnths (trend increase frm 2003-2013), with 17% als indicating they had made a plan abut hw they wuld attempt suicide. 10.6% f students stated they had actually attempted suicide ne r mre times during the past 12 mnths. Qualitative data substantiates that suicide is an issue f significant cncern impacting adults and yuth within Maricpa Cunty cmmunities. Substance Related Cnsequences Despite a decrease in juvenile arrests fr drugs and alchl, as f 2012 there are 11,000 juveniles that have received referrals fr alchl r drugs. There were 480 yuth (17 and under) mrbidity cases in Maricpa Cunty fr alchl r drugs. Teen pregnancy has been n the decline since 2006; hwever, 21% f thse engaging in seual intercurse reprt drugs r alchl being used befre their last encunter. Yuth ages 11-17 led all age grups in mrtality fr alchl and/r drugs, ttaling 594 deaths in 2013. Adult perceptins f cnsequences related t alchl and marijuana are relatively cmmn between bth substances. The tp cnsequences perceived by adults fr substance use are: Driving under the influence (75.2% fr alchl use and 65.7% fr marijuana use) Alchl-related car crashes (72.6% fr alchl use) Alchl abuse r addictin (68.9% fr alchl use and 67.4% fr marijuana use) Vilence r getting int fights (68.8% fr alchl use) Getting arrested/juvenile delinquency (62% fr marijuana use) Prblems with learning/memry (58.8%) Adult male mrbidity has fluctuated between 2010 and 2013, thugh it reached its ape (within this time frame) in 2013 with 6,935 deaths. Female mrbidity has als fluctuated reaching 4,112 deaths in 2013. Whites and Hispanics by far have the highest mrbidity percentages at 66% and 19%, respectively, in 2013. In ttal there were 10,567 alchl r drug related adult deaths in 2013. In 2013 the tp three PCA s fr adult mrbidity (in rder) were: 1. Central City Village 2. Mesa West 3. Deer Valley Village Intervening Variables/Causal Factrs While there are several intervening variables cntributing t yuth substance use, there are als sme cmmnalities acrss substances. Self-medicatin, mental health issues, lack f cping skills, decreasing perceptin f harm (particularly with marijuana) and peer pressure were mst frequently mentined in the qualitative data. Other factrs include parent mdeling and substance use being seen as a rite f passage. Anther main theme that emerged is lack f educatin n substance use. Many f these factrs are als fund 8 Page

t be cntributrs t suicide, particularly mental health issues, lack f cping skills, lack f cnnectin t the cmmunity and parents nt knwing hw t navigate the behaviral health system. Cnclusin Substance use in Maricpa Cunty has shwn declines in yuth; hwever, there seem t be increases in mrbidity and mrtality amng adults linked t substance use. The mst prevalent substances used are alchl, marijuana and prescriptin drugs. Primary Care Areas with the highest rates f yuth use are: Pheni Suth Central, Paradise Valley, Scttsdale and Tempe. Suicide is als an issue f rising cncern, especially amng middle-aged and lder adults. Deer Valley Village, Nrth Muntain Village, Mesa West and Paradise Valley Village have cnsistently been in the tp 15 PCA s fr the highest prevalence f suicide. Substance use and suicide have several verlapping intervening variables. Mental health issues, lack f cping skills, lack f cnnectin t the cmmunity and stress are all intervening variables that are factrs in substance use and suicide. Delving deeper int the substance use and suicide issues amngst vulnerable ppulatins such as veterans, LGBTQ, cllege-age students and ther identified ppulatins is recmmended. Althugh the data indicates decreases in use, there is still much wrk t be dne as there are still high rates f substance use and suicide. Effrts and strategies t prevent and reduce substance use and suicide shuld be cntinued and imprved, especially as mre data is gathered. Methdlgy Upn receiving funding in April 2014, Mercy Maricpa Preventin Department began its needs assessment prcess. Over a si mnth timeframe, Mercy Maricpa wrked in cllabratin with Pima Preventin Partnership (PPP) t cnduct primary and secndary data cllectin t eamine substance use and suicide issues in GSA 6. Secndary data frm state and lcal agencies was cllected first, and helped t infrm the primary data cllectin prcess and pririties. While the majrity f data available is at the State r Cunty level, mre lcalized data such as zip cdes r Primary Care Areas (PCAs) were cllected where accessible. Fr a cmplete list f secndary data surces, please see Appendi A. Primary data included ten fcus grups, nine key infrmant interviews, and surveys administered t yuth and adults. A ttal f 5,879 individuals participated in primary data cllectin effrts. Please see Tables 1-6 fr demgraphics. Primary data surces included: Key infrmant interviews with identified cmmunity stakehlders in Maricpa Cunty (9) Adult (50) and Yuth (47) fcus grup participants Adult (259) and Yuth (172) Suicide Survey respndents Cmmunity Readiness Preventin Survey (739) respndents Cmmunity Views Survey (4,634) respndents 9 Page

A planning prcess was perfrmed by the needs assessment team t strategize qualitative data cllectin. Maricpa Cunty was rganized by the fllwing five regins: Central, Nrth, Suth, East, and West. Secndary data cllected helped t infrm areas f pririty within each regin, including the fllwing: substance use issues f highest prevalence; grups with highest rates f usage by age, gender, race, and ethnicity; zip cdes and PCA areas with highest rates f cnsequences; and identified gap areas needing mre lcal data. The team identified ppulatin grups and regins currently underserved r underrepresented due t a lack f data available, and fcused n recruiting these grups fr qualitative data gathering in rder t enhance data and address these gaps. Survey questins were designed by the needs assessment team, pilted, and adapted as needed after the initial administratin. Key Infrmant Interviews The needs assessment team identified a number f key stakehlders within Maricpa Cunty that included stakehlder agency representatives r a representative f an identified nn-dminant ppulatin such as Veterans. These individuals were identified thrugh the agency as having the mst knwledge and/r eperience regarding substance use and suicide and able t prvide infrmatin relevant t the needs assessment. Key infrmants were asked t sign a cnfidential cnsent frm. Fr a list f key infrmants see Appendi D. Fcus Grups Fcus grups cnducted utilized nn-prbability sampling techniques, where the participants gathered fr the fcus grups may nt give all the individuals in the ppulatin equal chances f being selected. Participant characteristics were determined by the needs assessment team within each f the five regins f Maricpa Cunty. A cmbinatin f nminatins and snwball sampling were emplyed t recruit adult and yuth fcus grup participants. Wherein, nminatins f participants were gathered frm neutral parties within the five regins f Maricpa Cunty. Once the nminatins technique was emplyed, fcus grup participants were asked fr their suggestins and additinal participants were recruited. Effrts were made t utreach t grups and individuals nt currently receiving services r participating with Mercy Maricpa-funded prjects r calitins. In additin t striving fr gegraphic and demgraphic diversity, the team aimed at btaining diversity f rles and sectrs represented in cmmunities (i.e. students, parents, educatrs, first respnders, etc.). Separate fcus grups were held with yuth and adults. Fcus grup participants were given cnsent frms prir t the fcus grup discussins. Fr a list f adult and yuth questins see Appendi B. Suicide Surveys In rder t gain a cmmunity-level perspective n the issue f suicide, surveys were designed and administered annymusly t yuth and adults residing and/r wrking in Maricpa Cunty. It is imprtant t nte that this was the first survey administratin f its scpe t fcus specifically n suicide in Maricpa Cunty, and ptentially within the state f Arizna. Separate surveys were designed fr yuth and adults by PPP and Mercy Maricpa, with input frm the Arizna Suicide Preventin Calitin s Eecutive Bard serving as subject matter eperts. Yuth Suicide Survey administratin was cnducted thrugh Teen Lifeline, an 10 Pa g e

rganizatin serving yuth in the cmmunity, during Teen Suicide Preventin Awareness Week in September 2014. Students in grades 9 12 were administered paper cpy surveys during class presentatins. A ttal f 172 f 175 yuth participated (98% respnse rate) frm nine high schls in the fllwing schl districts: Agua Fria, Glendale, Mesa, Pheni, and Scttsdale. Cmpleted surveys were sent t PPP fr analysis. The Adult Suicide Survey administratin used a snwball sampling methd. Snwball sampling is a methd where the survey is distributed t an initial netwrk f respndents wh in turn ask thers t cmplete the survey, resulting in a snwball effect f respnses. The intent is t grw the ptential netwrk f respndents t reach brader segments f the cmmunity and increase the number f surveys, resulting in mre reliable and accurate findings. This methdlgy can be highly effective, althugh it makes it challenging t determine respnse rates as it is difficult t track hw many times the survey was shared. In this case, a hard cpy as well as a link t the nline survey was shared via email in August 2014 thrugh the fllwing primary surces: 1) Arizna Suicide Preventin Calitin, Inc. s statewide listserv (164 members); 2) Mercy Maricpa Prvider Agencies listserv (160); 3) Mercy Maricpa s scial media sites (Facebk and Twitter); and 4) Mercy Maricpa Preventin Prviders and Calitins listserv (38). It was requested fr each individual t share the survey with ther adults wh lived in r wrked in Maricpa Cunty. The primary recipients then psted links t the nline survey n their scial media sites. The assessment team is aware f the survey being shared by ADHS staff n their nline blg (29 page views) and by several Mercy Maricpa funded preventin calitins n their Facebk pages. A ttal f 259 respndents cmpleted the survey within the specified tw week timeframe. Based slely n the available data (numbers f recipients in the primary email), this is a 71.5% respnse rate. Cmmunity Readiness Preventin Survey (CRPS) In Nvember f 2014, Mercy Maricpa Preventin Prviders cnducted a Cmmunity Readiness Preventin Survey (CRPS) within the cmmunities they are wrking in. Cmmunities, like peple, are unique. Cmmunities have their wn set f demgraphics, resurces, strengths, challenges, and plitical climate, the sum f which creates a unique envirnment. A cmmunity s readiness fr actin is als a unique characteristic that is nt t be frgtten if cmmunity-level change is desired. The degree t which a cmmunity is ready and willing t accept changes may likely impact any attempts t enact cmmunity-level, preventin strategies. If a cmmunity is nt ready, invested, r accepting f change, even the best preventin r awareness effrts may fall shrt. Crafting preventin strategies t a cmmunity s level f readiness is abslutely essential fr success, as what wrks in ne cmmunity may be ineffective in anther. Strategies must be challenging enugh t mve a cmmunity frward in its level f readiness, but nt s ambitius that they eceed the cmmunity members current capacity and willingness t respnd. Cnsistent leadership, crdinatin f activities, and cultural relevancy are vital t sustaining lng-term cmmunity-level effrts. This verall apprach t understanding cmmunity readiness is based n the Cmmunity Readiness Mdel, which was develped by Tri-Ethnic Center fr Preventin Research at Clrad State University. It is frm this mdel that the CRPS was develped. 1 1 Edwards, R.W., Jumper-Thurman, P., Plested, B.A., Oetting, E.R., and Swansn, L. (2000). Cmmunity Readiness: Research t Practice. Jurnal f Cmmunity Psychlgy, 28 (3), 291-307. 11 Pa g e

The CRPS was implemented with the intent f gathering infrmatin frm individuals abut a selected substance r issue (yuth alchl use, alchl use within the LGBTQ cmmunity, marijuana, prescriptin drugs, spice, suicide, and medicatin misuse amng lder adults) within their cmmunity, and t prvide infrmatin abut verall capacity fr implementing r supprting preventin strategies within the cmmunity. Sme calitins chse t implement mre than ne CPRS t assess readiness f the cmmunity arund multiple substances r issues, and utilized resurces t priritize emerging issues f cncern. The CRPS was designed t be administered nce every ther year, and this was the first administratin under Mercy Maricpa. The CRPS is used t cllect infrmatin that summarizes the respndent s perceptins f cmmunity readiness fr preventin in si different dimensins, and is eplained in Table 1. Table 1. Dimensins f Readiness Dimensin Dimensin A: Cmmunity Effrts Dimensin B: Cmmunity Knwledge f Effrts Dimensin C: Leadership Dimensin D:Cmmunity Climate Dimensin E:Cmmunity Knwledge Abut the Issue Dimensin F: Resurces Related t the Issue Descriptin Current effrts, prgrams, and plicies t address the issue. General cmmunity knwledge abut lcal effrts and their effectiveness, and the adaptability f effrts t all segments f the cmmunity. The supprt f appinted leaders and the influential members f the cmmunity. The prevailing attitude f the cmmunity twards the issueranging frm helplessness, t respnsibility and empwerment. General cmmunity knwledge abut the cause f the prblem, its cnsequences, and ht it impacts the cmmunity. The availability f lcal resurces t supprt preventin effrt including peple, time, mney and space. Respndents rate items within each dimensin n a scale frm 1 (n awareness) t 9 (high readiness). Respndents scres are averaged t determine a readiness scre fr each dimensin, which when cmpared t each ther, help the calitins t understand what dimensins f the cmmunity may be ready fr actin and thse dimensins which may be less ready fr actin. Additinally, scres frm all dimensins are averaged t determine an Overall Readiness Scre, frm which a determinatin as t the cmmunity s verall Stage f Cmmunity Readiness can be made. The nine Stages f Cmmunity Readiness range frm N Awareness t High Level f Cmmunity Ownership (see Figure 1). Nte that the CRPS was tailred slightly frm its riginal frm t fit the needs f the calitin and t gather infrmatin specific fr their cmmunity f interest. 12 Pa g e

Figure 1. Stages f Cmmunity Readiness All f the calitins were asked t cllect infrmatin frm at least three respndents frm each f twelve pre-defined sectrs, with a gal f thirty-si ttal respndents fr each CRPS administered. It was als recmmended that a rati f nn-calitin members cmpared t the number f calitin members be 2:1. It is therized that perceptins and knwledge f cmmunity readiness will vary between sectr representatives, therefre a diverse sample f sectr representatives may result in mre accurate interpretatins f verall cmmunity readiness. Anther imprtant part f ensuring that results are representative f the verall cmmunity is that n mre than ne-third f respndents shuld be calitin members, as their readiness is ften higher than the larger cmmunity. A ttal f 739 surveys were cllected and are brken dwn belw by substance: Older adult alchl use (43) Prescriptin drug misuse (84) Spice (31) Suicide (89) Tbacc use (40) Underage drinking (151) Yuth marijuana use (301) Please see sectin 7 (Tables 33-48) fr CRPS results by cmmunity/calitin. Cmmunity Views Survey (CVS) The Cmmunity Views Survey (CVS) was implemented during September and Octber 2014 by Mercy Maricpa s funded Preventin Prviders and calitins fr the purpses f gathering targeted infrmatin frm adults abut their views n alchl use amng yuth under the age f 21, yuth marijuana use, 13 Pa g e

medicatin misuse amng lder adults and alchl use within the LGBTQ cmmunity. The questins in the CVS were designed t cllect a range f infrmatin frm adults in the cmmunity regarding their perceptins n different aspects surrunding the varius substances: level f cncern, ptentially acceptable scenaris where substance use may be accepted, perceptins n ways yuth get alchl and marijuana, ptential prblems r cnsequences, and perceptins f alchl use preventin strategies. The CVS is an instrument that has the ability t prvide the calitin with unique insights and data that may nt therwise be cllected by any ther rganizatins r agencies due t the specificity f the questins and the sampling apprach. The recmmended sampling apprach included cllecting a minimum f 300 surveys per calitin and each calitin was t identify tw sampling strata. Eamples f sampling strata included: gender, race/ethnicity, and parents with children under the age f 18.The current versin f the CVS (frmerly called the Cmmunity Nrms Survey) was riginally adapted frm a substance abuse preventin tl develped by the Kentucky Divisin f Mental Health and Substance Abuse. 1 A ttal f 4,634 surveys were cllected fr the fllwing issues (with the number cllected in parentheses): LGBTQ adult alchl abuse (231) Medicatin misuse amng lder adults (55 years r lder) (626) Underage drinking (3,185) Yuth marijuana use (592) Please see sectin 3 fr CVS results. LGBTQ Primary Data LGBTQ data included in this reprt was shared by the LGBTQ Cnsrtium f Maricpa Cunty as part f recent data cllected fr their SAMHSA Service t Science initiative and substance abuse preventin effrts t fill gaps in readily available data specific t the LGBTQ ppulatin in Maricpa Cunty. The majrity f data cllectin activities included primary data gathering by administering an Adult Prevalence Survey with adults and cnducting key infrmant interviews and fcus grups within Central Pheni. Secndary Data The data surces used t deduce the fllwing were: Arizna Yuth Survey (AYS) past 30-day usage fr 2008, 2010, 2012; Maricpa Cunty Juvenile Prbatin Yearly Reprts f Juvenile Arrests 2007 2012; Pheni Plice Department arrests fr drug related ffenses 2004 2008; Arizna Department f Transprtatin Crash Facts 2007 2012; Emergency Rm primary diagnsis f drug r alchl 2010 2013; the 2013 Arizna Yuth Risk Behavir Survey (YRBS), St. Luke s Health Initiatives and Arizna State University (ASU) Suthwest Interdisciplinary Research Center Adult Arizna Health Survey 2010; and the ASU and the Natinal Cllege Health Assessment 2013. Data was brken ut by zip cde and identified by Primary Care Areas (PCA) as applicable and as available. PCAs are utilized by the Arizna Department f Health Services in rganizing cunties and areas fr the State. 14 Pa g e

The AYS is administered by the Arizna Criminal Justice Cmmissin every tw years n even years thrughut Arizna public, private, and charter schls n a vluntary basis schls are nt required t participate. Cmmunity calitins engage in advcating that schls within their service area participate in the AYS t ensure that data is representative. This reprt includes sme published reprt AYS data frm years 2008, 2010, and 2012 fr Maricpa Cunty. At the time f this assessment, 2014 data was nt yet available, althugh Mercy Maricpa has requested data by zip cde level and will make it available t cmmunities within its service area. In additin t using sme published reprts f results frm the Maricpa Cunty AYS, a data subset was created frm specific AYS data btained zip cdes served by Mercy Maricpa as part f their Gegraphic Service Area 6 (GSA 6), which includes five zip cdes in Pinal Cunty. Data analysis was nly perfrmed with the zip cdes that cnstitute the GSA 6 service area. Data analysis was then cnducted using the IBM Statistical Package fr the Scial Science (SPSS), n the GSA 6 data and thus, represents 90% f the ttal sample size fr Maricpa Cunty. The GSA 6 data was reduced t a Yes r N respnse (i.e. 0 ccasins were cded as N r Nne and 1+ days usage categries were cded as Yes ). Fllwing this, the data was recnfigured t reduce t zip cdes as the unit f measure as ppsed t each respndent per year. That data set included the percent f Yes and N per drug usage and fr access t substances. That file cnfiguratin was used t rank rder the zip cdes with highest percent f Yes t lwest per drug per year. Thse zip cde ranks appear in the reprt. T btain percent usage by gender, race by year, and by grade we used the riginal SPSS dwnlads fr each year: 2008, 2010, and 2012. Fr each f these we again selected ut just the GSA 6 zip cdes. As a result, the sample size will be different between the GSA 6 data described abve and the published AYS reprt. The fllwing were the sample sizes in Maricpa Cunty yuth participatin in the AYS fr grades 8, 10, and 12: 2008 = 32,964 2010 = 42,435 2012 = 40,846 The fllwing were the sample sizes in the GSA 6 data fr grades 8, 10, and 12: 2008 = 30,792 2010 = 40, 896 2012 = 39,876 This reprt includes analysis and synthesis f all primary and secndary data cllected as part f this needs assessment. The primary fcus f this needs assessment was largely Maricpa Cunty; hwever, Arizna Yuth Survey data analysis included all zip cdes that fall within the Gegraphic Service Area 6 (GSA 6). Magnitude, changeability, impact, cncentratin and time lapse were cnsidered when priritizing the substance use and suicide issues affecting GSA 6, in particular target areas r ppulatins with the highest 15 Pa g e

levels f need. This priritizatin prcess included analyzing the risk factrs and/r intervening variables that can influence substance use r suicide and prtective factrs (variables that prevent the use f substances r suicide). The sectin belw describes the prcess in mre detail. Additinally, cmmunity readiness survey data cllected by Mercy Maricpa fr currently funded cmmunities was included t measure hw ready these cmmunities are t address identified substance use and suicide issues. Priritizatin prcess Once all f the primary and secndary data were cllected and analysis cnducted, several issues came t light. These varius indicatrs were identified and a priritizatin prcess was cnducted by the needs assessment team t priritize. The prcess included cmpleting wrksheets t assess each f the substances and in rder t priritize based n the fllwing criteria: Magnitude Changeability Impact Cncentratin Time lapse Each f the criteria was assessed using a number frm ne t fur. Table 20 includes the scring definitin fr each f the criteria. Table 2. Priritizatin Criteria and Rankings Criteria Descriptin Ranking = 1 Definitin Magnitude Amunt f peple this prblem affects A small grup Changeability Hw easily the prblem can be changed Very r addressed difficult Impact Depth f the prblem acrss dimensins Nt at all (health, ecnmic, criminal, impactful educatinal) Cncentratin Hw cncentrated the prblem is in the cmmunity Time lapse What is the gap in time between cnsumptin and cnsequence Ranking = 2 Ranking = 3 Ranking = 4 Definitin Definitin Definitin A lt Majrity Everybdy Difficult Easily Very easily Smewhat impactful Impactful Very Impactful Very limited Limited Widespread Very widespread Very slwly Slwly Quickly Very quickly Each f these criteria was numerically ranked frm ne t fur based n the relevant data cllected r lack f data in sme cases. Primary and secndary data were cnsidered as part f the ranking prcess and may have increased the weight in that a higher ranking was given if the data clearly supprted the finding and clearly addressed thse criteria. In sme cases, where secndary data was nt available, primary data weighted an item heavier if a majrity f the qualitative data indicated such a need. In the wrksheets, the time lapse criteria was nly incrprated fr individual substance cnsequences as there is a direct link between time lapse and cnsequences. 16 Pa g e

Pririties were identified fr substances/issues and fr intervening variables; higher ttal numbers were selected as pririties. Please see Appendi G fr the priritizatin wrksheets. Primary Data Demgraphics Primary Data Demgraphics fr Fcus Grups/Key Infrmant Interviews and Suicide Surveys, by yuth and adults, CRPS and CVS are shwn belw. Table 3. Yuth Fcus Grup Demgraphics Demgraphics Number Percent 1 Ttal Number f Respndents 47 100% Gender Male 21 44.7% Female 26 55.3% Race American Indian/Native Alaskan 6 15.8% Asian 2 5.3% Black r African American 2 5.3% Caucasian r White 6 15.8% Native Hawaiian/Pacific Islander 1 2.6% Multiracial 12 31.6% Other 9 23.7% Unknwn 9 - Ethnicity Hispanic/Latin 36 76.6% Nn-Hispanic/Latin 11 23.4% Grade 7th 1 2.2% 8th 7 15.2% 9th 2 4.3% 10th 7 15.2% 11th 8 17.4% 12th 21 45.7% Unknwn 1 - Zip Cdes 85032 9 20.0% 85392 7 15.6% 85009 5 11.1% 85016 3 6.7% 85022 2 4.4% 85202 2 4.4% 85234 2 4.4% 85323 2 4.4% 85339 2 4.4% 11 ther zips ccurring nce: 85004, 85008, 85013, 85023, 85031, 85033, 85051, 85213, 85283, 85338, 11 24.2% 85345 Unknwn 2-1. Percent based n valid percent. 17 Pa g e

Table 4. Adult Fcus Grup and Key Infrmant Demgraphics Demgraphics Number Percent 1 Ttal Number f Respndents 59 100% Gender Male 14 24.6% Female 43 75.4% Unknwn 2 - Race American Indian/Native Alaskan 7 18.4% Asian 0 0.0% Black r African American 2 5.3% Caucasian r White 18 47.4% Native Hawaiian/Pacific Islander 1 2.6% Multiracial 2 5.3% Other 8 21.1% Unknwn 21 - Ethnicity Hispanic/Latin 37 62.7% Nn-Hispanic/Latin 22 37.3% Age 21-30 6 10.2% 31-40 18 30.5% 41-50 21 35.6% 51-60 6 10.2% 61 r lder 8 13.5% Zip Cdes 85032 14 24.1% 85017 8 13.8% 85009 5 8.7% 85016 3 5.2% 85037 2 3.4% 85323 2 3.4% 85335 2 3.4% 85338 2 3.4% 85353 2 3.4% 18 ther zips ccurring nce: 85007, 85013, 85014, 85015, 85020, 85021, 85033, 85087, 85251, 85254, 85258, 85260, 85283, 85305, 85340, 85383, 85392, 85395 18 31.0% Unknwn 1-1. Percent based n valid percent. 18 Pa g e

Table 5. Yuth Suicide Survey Demgraphics Demgraphics Number Percent 1 Ttal Number f Respndents 172 100% Gender Male 74 46.5% Female 84 52.8% Unknwn 14 - Race American Indian/Native Alaskan 5 4.0% Asian 5 4.0% Black r African American 13 10.5% Caucasian r White 26 21.0% Native Hawaiian/Pacific Islander 2 1.6% Multiracial 24 19.4% Other: Hispanic/Meican American/Latin 37 29.8% Other 12 9.7% Unknwn 48 - Ethnicity Hispanic/Latin 129 75.0% Nn-Hispanic/Latin 43 25.0% Grade 9th 143 83.1% 10th 7 4.1% 11th 9 5.2% 12th 13 7.6% Zip Cdes 85006 25 16.8% 85014 18 12.1% 85008 13 8.7% 85015 12 8.1% 85009 7 4.7% 85016 7 4.7% 85338 7 4.7% 85034 6 4.0% 85007 5 3.4% 85017 4 2.7% 85031 3 2.0% 85035 3 2.0% 85040 3 2.0% 85041 3 2.0% 85018 2 1.3% 85022 2 1.3% 85051 2 1.3% 85303 2 1.3% 85392 2 1.3% 23 zip cdes each ccurring ne time: 85003, 85004, 85012, 85013, 85019, 85050, 85021, 85029, 85033, 85038, 85060, 85254, 85257, 85258, 23 15.4% 85331, 85339, 85340, 85356, 85394, 85395, 85260, 85860, 86392 Unknwn 23-1. Percent based n valid percent. 19 Pa g e

Table 6. Adult Suicide Survey Demgraphics Demgraphics Number Percent 1 Ttal Number f Respndents 259 100% Gender Male 49 19.0% Female 209 81.0% Unknwn 1 - Race American Indian/Native Alaskan 8 3.1% Asian 0 0.0% Black r African American 10 3.9% Caucasian r White 217 84.1% Native Hawaiian/Pacific Islander 1 0.4% Multiracial 14 5.4% Other 8 3.1% Unknwn 1 - Ethnicity Hispanic/Latin 31 12.0% Nn-Hispanic/Latin 228 88.0% Age 18-24 7 2.7% 25-44 124 48.1% 45-54 49 19.0% 55-64 61 23.6% 65+ 17 6.6% Zip Cdes 85282 11 4.3% 85018 9 3.5% 85251 9 3.5% 85225 8 3.1% 85257 7 2.7% 85014 6 2.3% 7 zip cdes each ccurring five times: 85007, 85008, 85013, 85020,85022, 85032, 85286 35 13.6% 10 zip cdes each ccurring fur times: 85016, 85028, 85037, 85210, 85281, 85283, 85295, 85296, 40 15.5% 85326, 85339 16 zip cdes each ccurring three times: 85004, 85006, 85021, 85024, 85034, 85044, 85050, 85051, 48 18.6% 85085, 85202, 85205, 85209, 85249, 85254, 85260, 85308 27 zip cdes each ccurring tw times: 85003, 85009, 85027, 85033, 85035, 85040, 85040, 85086, 85140, 85201, 85204, 85213, 85224, 85226, 85233, 85234, 52 20.2% 85248, 85258, 85259, 85302, 85310, 85331, 85345, 85379, 85383, 85388, 91775 33 zip cdes each ccurring ne time: 85048, 85012, 85015, 85023, 85029, 85042, 85048, 85118, 85120, 85143, 85203, 85206, 85207, 85208, 85212, 85252, 85253, 85255, 85268, 85284, 85297, 85301, 85307, 85323, 33 12.8% 85338, 85342, 85381, 85392, 95752, 85852, 86001, 90016, 95050 Unknwn 1-1. Percent based n valid percent. 20 Pa g e

Table 7. CRPS Demgraphic Infrmatin Number f Calitins 12 Demgraphics Number 1 Percent 2 Ttal Number f Respndents 739 100% Gender Male 364 65.8% Female 172 31.1% Transgender 11 2.0% Gender Variant 2 0.4% Interse 1 0.1% Decline t Answer 3 0.5% Race American Indian/Alaskan Native 54 8.1% Asian American/Asian 3 0.4% Black/African American 147 22.0% Caucasian/White 364 54.6% Multiracial 46 6.9% Other 53 7.9% Ethnicity Hispanic/Latin 158 24.6% Nn-Hispanic/Latin 485 75.4% Calitin Memberships Status Nn-Calitin Member 533 73.5% Calitin Member 192 26.5% Sectr (Number f Respndents) Behaviral health, preventin, recvery Law enfrcement agencies (38) (60) Business (58) Media (25) Civic and vlunteer grups (38) Schls and educatin (80) Cmmunity resident/family member (70) State, lcal, r tribal gvernmental agencies (56) Faith-based rganizatins (56) Yuth (74) Healthcare prfessinals (47) Yuth serving rganizatins (39) Other (21) N Respnse (69) 21 Pa g e

Table 8. CVS Demgraphic Infrmatin Number f Calitins 12 Demgraphics Number 1 Percent 2 Ttal Number f Respndents 4,634 100% Gender Male 1,344 29.2% Female 3,246 70.5% Transgender 9 0.2% Nn-binary/Genderqueer 5 0.1% Interse 1 Less than 0.1% Race American Indian/Alaskan Native 407 9.5% Asian American/Asian 55 1.3% Black/African American 466 10.9% Caucasian/White 2,338 54.7% Multiracial 293 6.8% Native Hawaiian/Other Pacific Islander 29 0.7% Other 690 16.1% Ethnicity Hispanic/Latin 1,744 39.3% Nn-Hispanic/Latin 2,691 60.7% Age f Respndent (Years) 18-20 190 4.1% 21-34 1,423 31.0% 35-44 1,038 22.6% 44-54 816 17.8% 55-64 611 13.3% 65 and lder 512 11.2% Number f Respndents with Children fr Each Age Categry 0-4 803 17.3% 5-9 1,172 25.3% 10-14 1,057 22.8% 15-17 607 13.1% 18-21 487 10.5% Over 21 877 18.9% N children 668 14.4% Mst Frequent Zip Cdes 85225 356 7.6% 85041 322 6.9% 85251 160 3.4% 85326 157 3.4% 85040 152 3.3% 85042 148 3.2% 85033 139 3.0% 22 Pa g e

Limitatins In reading this reprt and interpreting data presented, it shuld be acknwledged that there were ntable limitatins t cnducting a mre cmprehensive needs assessment prcess. The mst recent data available was used, but in sme cases due t reprting lags, data was utdated. Primarily, gaps in data prevent a mre thrugh eaminatin at cmmunity levels within the cunty. In sme cases, data is nt available utside state and cunty level rates. As the largest cunty in Arizna, Maricpa Cunty ften sets the mean fr the State. These factrs can make it difficult t make generalizatins fr individual cmmunities based n cunty data, as each cmmunity is unique and distinct with its wn set f characteristics. The availability f data cntinues t be a challenge in determining prevalence, specifically relating t adult substance use. In cnducting a needs assessment r tracking trends and utcmes ver time, secndary data may nt always be available fr bth yuth and adults, particularly arund detailed cnsequences and causal factrs. One f the cntinued challenges in Arizna is the ability t btain data fr adult prevalence, as there is n centralized reprting surce nr standardized data cllectin fr adult substance usage. Of nte are the effrts by St. Luke s Health Initiative where data was cllected via telephne interviews with a ttal f 8,215 adults acrss the state in the varius GSAs. Althugh it may nt be a representative sample acrss the state based n ttal ppulatin sizes within each f the GSAs, it is significant in itself t have pursued such effrts. These are particularly imprtant when cnsidering hw substance use is affecting individual cmmunities. Standardized tls and data cllectin methdlgies at natinal and state levels are nt always cnsistent with cunty level data cllectin rganizatin. Fr eample, sme data may be available by zip cde r by a primary care area, but may nt transfer well when rganizing by data by lcal cmmunity. In additin, data such as the Yuth Risk Behavir Survey (YRBS) is nt available at a cunty r cmmunity level. It is als imprtant t nte that the largest yuth data set frm the Arizna Yuth Survey (AYS) is based n schls that vluntarily participate in the survey and may nt be represented by all schls, cmmunities, and zip cdes within GSA 6. Secndary data n suicide attempts and hspitalizatins was nt accessible by cmmunity level. Suicide deaths were reprted by zip cde; hwever, it is imprtant t avid vergeneralizing numbers at this level. It was nt pssible t cllect data n the c-ccurrence f substance use and suicide due t limitatins in current data cllectin methds. Intervening variables cntributing t adult suicide was als fund t be a gap in data needing further research and/r eplratin in lcalized qualitative data gathering. Lastly, it is imprtant t take int cnsideratin the sample sizes f the data presented in cmparisn t ppulatin numbers, as they may nt always be represented by the majrity. 23 Pa g e

Descriptin f Gegraphic Service Area 6 (GSA 6) Maricpa Cunty is the largest cunty in the State f Arizna, with a ttal ppulatin f 3,817,117 (Census 2010), and is the primary fcus f this assessment. Arizna s capital, Pheni r the Valley f the Sun, is the sith largest (by ppulatin) city in the United States. The City f Pheni is cmprised f thirteen urban villages, each cntaining their wn planning and zning cmmissins. Within Maricpa Cunty, there are twenty-tw twns and cities that cmprise the greater Pheni area. As f the 2010 Census, 75.9% identify as White, 6.0% Black, 2.8% American Indian/Alaska Native, 4.4% Asian, 0.4% Native Hawaiian/Pacific Islander, and 29.6% Hispanic/Latin. Census data als shws that 26.4% f the ttal ppulatin is under the age f 18, with an average age f 34.6 and 31.5% f all husehlds having children under the age f 18. Gegraphic Service Area 6 (GSA 6) als includes five zip cdes in neighbring Pinal Cunty, lcated in the SanTan Valley and Apache Junctin (85120, 85140, 85142, 85143, and 85220). Table 9. Pinal Cunty Census Data Demgraphics fr Zips within GSA 6 85120 85140 85142 85143 Ttal % Ppulatin 28,168 36,711 48,870 35,015 148,764 100.00% Persns under 18 5,239 13,647 17,660 12,536 49,082 33.00% Persns 15-24 1,697 2,801 3,422 4,092 12,012 8.10% Persns 25-44 5,587 12,557 15,648 11,826 45,618 30.70% Persns 45-64 7,651 5,792 9,458 4,429 27,330 18.40% Persns ver 65 7,994 1,914 2,682 2,132 14,722 9.90% Female 14,397 18,382 24,418 17,817 75,014 50.40% Male 13,771 18,329 24,452 17,198 73,750 49.60% White 25,193 29,580 39,805 27,005 121,583 81.70% Black 312 1,264 1,773 2,168 5,517 3.70% American Indian/Alaska 324 370 448 454 1,596 1.10% Native Asian 212 677 1,200 727 2,816 1.90% Native Hawaiian/Pacific 19 59 93 137 308 0.20% Islander Hispanic/Latin 4,084 8,877 10,153 7,657 30,771 20.70% White Persns Nt Hispanic 24,084 24,906 34,471 23,130 106,591 71.70% 24 Pa g e

Current Preventin Prviders Table 10. Current Mercy Maricpa Preventin Prviders Prvider Calitin Prgram Gal Target Issue Target Area Area Agency n Prescriptin Maricpa Aging drugs Cunty Maricpa Elder Behaviral Health and Advcacy (MEBHAC) Calitin Decrease medicatin misuse in lder adults in targeted cmmunities thrughut Maricpa Cunty City f Tempe Tempe Calitin Delay the age f first use f alchl amng City f Tempe yuth Cmmunity Bridges Mesa Preventin T reduce yuth alchl use in Mesa Alliance DrugFreeAZ Way Out West (WW) Reduce underage drinking amng Calitin Buckeye Valley yuth grades 7 12 Imprving Chandler Chandler Calitin n Reduce availability/access f alchl Area Neighbrhds Yuth Substance Abuse t persns under the age f 21 in the (ICAN) (CCYSA) Calitin Chandler re-develpment area Pheni Indian Center Scttsdale Preventin Institute Suthwest Behaviral Health Services Tanner Cmmunity Develpment Crpratin TERROS and Tuchstne Behaviral Health Maricpa Cunty Urban Indian Calitin f AZ (UICAZ) Scttsdale Neighbrhds in Actin (SNIA) Calitin Suth Muntain Wrks (SMWORKS) Calitin Helping Enrich African- American Lives (HEAAL) Calitin Cmmunity Outreach Preventin Educatin (COPE) Calitin Reduce underage drinking amng urban Native American yuth in Maricpa Cunty T reduce underage drinking in the Suth Scttsdale cmmunity T address the high rate f alchl use amng yuth 12-20 years ld in the Suth Muntain cmmunity Decrease marijuana use amng African-American yuth in suthcentral and nrthwest Pheni, AZ T address underage alchl use amng 11-20 year lds in the Maryvale cmmunity TERROS LGBTQ Cnsrtium T reduce ecessive alchl cnsumptin amng 18-44 year lds within the LGBTQ cmmunity in in Central Pheni Valle del Sl Nrth Pheni Preventin Alliance (NOPAL) Calitin T reduce yuth marijuana use in the Nrth Pheni cmmunity f Sunnyslpe Underage drinking Underage drinking Underage drinking Underage drinking Underage drinking Underage drinking Underage drinking Yuth marijuana use Underage drinking Ecessive adult cnsumptin Yuth marijuana use City f Tempe Mesa Buckeye Chandler Redevelpme nt area (85225) Maricpa Cunty Suth Scttsdale Suth Pheni Suth Central and Nrthwest Pheni Maryvale Central Pheni Sunnyslpe Twelve preventin prviders in Maricpa Cunty are currently receiving funding thrugh Mercy Maricpa. Each wrks in partnership with a lcal cmmunity calitin. The fllwing table prvides details n the prgrams, including their target cmmunity and target substance. 25 Pa g e

1. Prevalence and Trends f Substance Use and Suicide a. Substance Use Primary and secndary data cllected as part f this needs assessment indicate there are several issues happening within Maricpa Cunty. The tp ranking issues f imprtance include (Fr priritizatin prcess and scring wrksheets, please reference Appendi G.): 2. Yuth alchl = 15 3. Yuth marijuana = 14 4. Adult suicide = 13 5. Yuth suicide = 11 6. LGBTQ adult alchl = 11 8. Yuth prescriptin drugs = 10 9. Older adult prescriptin drugs = 10 Rates Yuth Arizna Yuth Survey (AYS) results indicate that acrss all grade levels cunty-wide, alchl appears t be the number ne substance used by yuth in Maricpa Cunty. Hwever, decreases were shwn fr past 30-day use f alchl fr grades 8, 10, and 12 since 2008. Alchl use is highest amng 12 th graders when cmpared t the ther grade levels and remains in the frty percentile rank frm 2008 t 2012. Since 2008, fr all students, tbacc and prescriptin drug use has als decreased ver time. Of all substances reprted in the AYS, marijuana past 30-day use increased fr students in 10 th and 12 th grades; with the highest use amng 12 th graders in 2012 (23.1%). Substance abuse preventin effrts in the cunty appear t making impacts in reducing underage drinking and prescriptin drug use. 26 Pa g e

Figure 2. AYS Past 30-day Use by Substance, Grade Level and Year Surce: GSA 6 Data Cmparing past 30-day use percentages with State percentages, students in the targeted zip cdes within GSA 6 cnsistently had lwer rates frm 2008 t 2012 fr alchl and marijuana. In 2012, the percentage f students reprting alchl past 30-day use was almst equal fr Maricpa Cunty (28.0%) and the State (28.1%). The same was seen fr marijuana in 2012 where the Maricpa Cunty past 30-day use was 14% and the State percentage was almst the same at 14.3%. It is imprtant t mentin that while alchl and prescriptin drugs have seen decreases, past 30 day marijuana use increased frm 2008 t 2010 (14%) and has remained steady in 2012 (14%). Prescriptin drug percentages in 2010 and 2012 were als lwer than the State, althugh markedly higher than the State in 2008. It is als imprtant t nte that in Maricpa Cunty prescriptin drugs decreased frm 11% using in the past 30 days (2008) t 7% using in the past 30 days (2012). Tbacc use has als seen a steady decline in past 30 day use frm 14% in 2008 t 12% in 2012. It is ften the case, hwever, that Maricpa Cunty, being the largest cunty in the State f Arizna, sets the mean. 27 Pa g e

Figure 3.AYS GSA 6 vs. State by Substance and Year Surce: GSA 6 and AYS Maricpa Cunty AYS data fr GSA 6 als indicate that frm 2008 t 2012, the mean age f first use f alchl, tbacc, and marijuana has stayed relatively the same fr all grade levels with the mean age f first use f alchl and tbacc being yunger than that f marijuana. The average age f first use fr the majrity f substances is similar acrss grades and substance which is arund the age f 11.5. The eceptin reprted by AYS included 8 th graders indicating a higher average age (12) fr first time marijuana use when cmpared t alchl and tbacc use. YRBS data fr the State f Arizna indicated that 19.3% f respndents had their first drink f alchl ther than a few sips befre the age f 13 (see Table 19 fr relevant YRBS items). 28 Pa g e

Figure 4. AYS Mean Age f First Use by Substance, Year and Grade Level Surce: AYS Maricpa Cunty The fllwing sectin reprts AYS data fr the GSA 6 area fr each substance. Alchl GSA 6 data shw that acrss all grade levels in Maricpa Cunty, there was a 2% reductin in yuth past 30- day use f alchl frm 30% in 2008 t 28% in 2012. Data revealed that the majrity f usage was fr Females (53%) versus Males (47%). The trend is decreasing use fr Females, but increasing use fr Males. This may be an artifact f the sample wh respnded t the survey, which was 51% Female. Mst ethnic classificatins remained stable, with a slight increase fr Hispanics. 29 Pa g e

Table 11. Alchl GSA 6 Data Past 30-day Use 2008 2010 2012 ALCOHOL 30% 31% 28% Gender Ethnicity Male 45% 46% 47% Female 55% 54% 53% Asian 1.4% 1.8 % 1.9 % Hawaiian/Pacific Islander 0.8% 0.8% 0.8% Native American 1.4% 1.6% 1.6% African American 3.5% 3.8% 3.8% White 53% 50% 53% Hispanic 35% 42% 39% GSA 6 data brken ut by zip cdes revealed the fllwing tp 10 zip cdes (in rder f prevalence) fr highest rates f past 30-day Alchl use by year. The 85018 zip cde had high prevalence rates fr all three years. Table 12. Zip Cdes with Highest Rates f Past 30-Day Alchl Use by Year Order f 2008 2010 2012 Prevalence 1. 85220 85327 85253 2. 85254 85018* 85250 3. 85014 85201 85018* 4. 85018* 85251 85027 5. 85323 85035 85251 6. 85050 85033 85281 7 85028 85258 85283 8. 85253 85040 85327 9. 85024 85259 85258 10. 85242 85262 85028 * = All 3 years Zip cdes were matched t their PCA and the mst cnsistently ccurring zip cdes were: Zip Cde PCA 85018 Pheni Suth Central 85253 Paradise Valley 85028 Paradise Valley 30 Pa g e

Primary data cllectin amng bth yuth and adults supprts the high prevalence f alchl, as participants als demnstrated it was the mst abused substance used amng yuth. The AYS als includes a questin n binge drinking, which is defined as 5 r mre drinks in ne sitting. GSA 6 data shw in the fllwing graph that frm 2008 2012, past 30-day binge drinking has significantly decreased fr grades 8, 10, and 12. The majrity (26.7%) f students wh indicated they had binge drank in the past 30 days in 2012 were in the 12 th grade. Figure 5. AYS GSA 6 vs. Cunty Past 30-day Binge Drinking Surce: GSA 6 Data Tbacc GSA 6 data indicate that cigarette use has slightly declined cunty-wide frm 2008 2012 by abut 2% with 12% f survey respndents stating they used cigarettes in the past 30-days (2012). Of thse reprting usage, males used slightly mre (51%) than Females (49%), ther than the eceptin fr 2008 where the percentages were reversed. Whites reprted cntinual decrease in usage, but represented 53% f yuth wh used cigarettes in 2012. Hispanics were the net highest grup and shw an increase in usage ver time (38% in 2012) cmpared t 33% in 2008. Table 13. Tbacc GSA 6 Data Past 30-day Use 2008 2010 2012 TOBACCO 14% 13% 12% Gender Male 49% 51% 51% Female 51% 49% 49% Ethnicity Asian 1.2% 1.6% 1.6% Hawaiian/Pacific Islander 0.8 % 0.8% 0.8% Native American 2.5% 2.4% 2.5 % 31 Pa g e

African American 2.7% 3.2% 3.4 % White 60% 56% 53% Hispanic 33% 36 % 38% GSA 6 Data brken ut by zip cdes revealed the fllwing tp 10 zip cdes fr highest rates f past 30-day Tbacc use by year. The zip cde f 85032 shwed prevalence rates fr all three years. Table 14. Zip Cdes with Highest Rates f Tbacc Use by Year Order f 2008 2010 2012 Prevalence 1. 85220 85327 85250 2. 85050 85201 85327 3. 85208 85251 85018 4. 85254 85022 85022 5. 85028 85207 85224 6. 85018 85024 85283 7. 85249 85208 85032* 8. 85331 85250 85202 9. 85024 85032* 85225 10. 85032* 85050 85028 * = All 3 years Zip cdes were matched t their PCA and the mst cnsistently ccurring zip cdes were: Zip Cde PCA 85250 Scttsdale 85022 Paradise Valley 85032 Paradise Valley 85028 Paradise Valley 85018 Pheni Suth Central Marijuana GSA 6 Data indicate yuth marijuana use has increased 3% cunty-wide frm 2008 t 2010, but remained steady frm 2010 t 2012 (14%). Over time, males shw an increase in past 30-day marijuana use alng with African American, Asian, and Hawaiian/Pacific Islander yuth. Cnversely, 30-day female use has shwn a decline frm 2010 t 2012. Ethnicities with highest verall rates are White and Hispanic, respectively; past 30 day use f marijuana amng Whites has fluctuated between 2008-2012, hwever Hispanic use went up frm 2008-2010, but has seen a small reductin frm 2010 t 2012. Table 15. Marijuana GSA 6 Data Past 30-day Use 2008 2010 2012 MARIJUANA 11% 14% 14% Gender Ethnicity Male 53% 53% 56% Female 47% 47% 44% Asian 1.0% 1.3% 1.6% 32 Pa g e

Hawaiian/Pacific Islanders 0.6% 0.7% 0.9% Native American 2.7% 2.6% 2.3% African American 3.7% 4.2% 5.0% White 57% 52% 53% Hispanic 36% 39% 37% GSA 6 data brken ut by zip cdes revealed the fllwing tp 10 zip cdes fr highest rates f past 30-day Marijuana use by year. The zip cdes and 85253 f 85018 shwed prevalence rates fr all three years. Table 16. Zip Cdes with Highest Rates f Past 30-day Marijuana Use by Year Order f 2008 2010 2012 Prevalence 1. 85220 85327 85250 2. 85254 85257 85018* 3. 85018* 85251 85253* 4. 85050 85201 85281 5. 85201 85018* 85283 6. 85258 85207 85251 7. 85014 85253* 85016 8. 85253* 85258 85202 9. 85040 85254 85327 10. 85250 85262 85048 * = All 3 years Zip cdes were matched t their PCA and the mst cnsistently ccurring zip cdes included: Zip Cde PCA 85250 Scttsdale 85018 Pheni Suth Central 85253 Paradise Valley Prescriptin Drugs GSA 6 data shw decreases cunty wide ver time with a 7.0% decrease frm 2008. The data shws females are nt nly using at higher rates than males, but als that there is a 3% increase in past 30 day female use. There is a 3% decrease in reprted 30-day use amng males. There was a 1.0% increase fr White yuth. Table 17. Prescriptin Drugs GSA 6 Data Past 30-day Use PRESCRIPTION DRUGS Gender Ethnicity 2008 2010 2012 14% 10% 7.0% Male 45% 45% 42% Female 55% 55% 58% Asian 1.3% 1.3% 1.7% Hawaiian/Pacific Islanders 0.7% 0.7% 0.9% Native American 2.2% 2.2% 1.7% African American 3.7% 3.7% 4.0% 33 Pa g e

White 53% 53% 54% Hispanic 39% 39% 39% GSA 6 Data brken ut by zip cdes revealed the fllwing tp 10 zip cdes fr highest rates f past 30-day Prescriptin Drug use by year. The 85018 zip cde shwed prevalence rates acrss all three years. Table 18. Zip Cdes with Highest Past 30-day Prescriptin Drug Use by Year Order Prevalence f 2008 2010 2012 1. 85220 85327 85283 2. 85242 85201 85281 3. 85050 85339 85035 4. 85254 85018* 85326 5. 85207 85208 85017 6. 85249 85323 85202 7. 85018* 85331 85018* 8. 85024 85040 85208 9. 85326 85202 85042 10. 85209 85225 85044 * = All 3 years Zip cdes were matched t their PCA and the mst cnsistently ccurring zip cdes included: Zip Cde PCA 85018 Pheni Suth Central 85283 Tempe 85281 Tempe Synthetic drugs Beginning with the 2012 AYS administratin, past 30-day use and lifetime synthetic drug use (such as Bath Salts, Ivry Wave r White Lighting r herbal incense prducts like K2, Spice, r Gld) was asked f 8, 10, and 12 th graders. Fr past 30-day use f synthetic drugs, AYS results indicate that 10 th grade students used synthetic drugs the mst (4.8%). The fllwing graph lists the percentages by grade. Cmpared t the State verall, Maricpa Cunty reprted percentages are lwer fr lifetime synthetic drugs use fr grades 8, 10, and 12. State past 30-day and lifetime use percentages are as fllws: 8 th grade: past 30- day use = 3.8%; Lifetime = 9.9% 10 th grade: past 30-day use = 5.0%; Lifetime use = 11.1% 12 th grade: past 30-day use = 5.2%; Lifetime use = 13.9% 34 Pa g e

Figure 6. Synthetic Drugs AYS Past 30-day vs. Lifetime Use Surce: AYS Maricpa Cunty Yuth Risk Behavir Survey YRBS The YRBS is administered every tw years (dd years) by the Centers Disease fr Disease Cntrl and Preventin thrugh Arizna Department f Educatin. The YRBS cllects data n si types f health-risk behavirs that cntribute t the leading causes f death and disability. In 2013 a ttal f 1,623 high schl students in grades 9-12 participated fr Arizna. YRBS data was nt available at a cunty r cmmunity level. Cmparisns f the YRBS and AYS data indicate that similar percentages were seen statewide fr past 30-day tbacc use, while alchl and marijuana past 30-day use were higher n the YRBS: Tbacc: AYS 15%; YRBS 14% Alchl: AYS 32%; YRBS 36% Marijuana: AYS 14%; YRBS 23% It is imprtant t nte, hwever, that the sample size f the AYS is much higher than the YRBS and is disaggregated fr the Cunty. Other YRBS highlights include: 20% f students indicated they had five r mre drinks f alchl in a rw, within a cuple f hurs, n ne r mre f the past 30 days (i.e. binge drinking), which is abut the same as GSA6 data fr all grades cmbined 35 Pa g e

Table 19. Yuth Risk Behavir Survey Results f Relevant Items TOTAL YRBS SAMPLE IN ARIZONA 2013 1,623 Survey Questin and Number QN31: Percentage f students wh ever tried cigarette smking, even n r tw puffs QN32: Percentage f students wh smked a whle cigarette fr the first time befre age 13 years QN33: Percentage f students wh smked cigarettes n ne r mre f the past 30 days QNFRCIG: Percentage f students wh smked cigarettes n 20 r mre f the past 30 days QN34: Amng students wh reprted current cigarette use, the percentage wh smked mre than 10 cigarettes per day n the days they smked during the past 30 days QN36: Percentage f students wh smked cigarettes n schl prperty n ne r mre f the past 30 days QN38: Amng students wh reprted current cigarette use, the percentage wh ever tried t quit smking cigarettes during the past 12 mnths QN39: Percentage f students wh used chewing tbacc, snuff, r dip n ne r mre f the past 30 days QN40: Percentage f students wh smked cigars, cigarills, r little cigars n ne r mre f the past 30 days QN41: Percentage f students wh smked cigarettes r cigars r used chewing tbacc, snuff, r dip n ne r mre f the past 30 days QN42: Percentage f students wh had their first drink f alchl ther than a few sips befre age 13 years The value in ( ) is the percent f the sample wh respnded Yes t that behavir Ttal N (%) Male N (%) Female N (%) 1422(43.9) 670(47.9) 747(39.9) - 1554(8.4) 747(9.6) 802(7.2) - 1515(14.1) 728(16.4) 783(11.6) - 1515(4.6) 728(5.0) 783(4.2) - 207(8.3) 122(8.9) 84(-) 0 1574(3.1) 761(3.2) 809(3.1) - 200(49.3) 115(50.5) 84(-) 0 1603(6.6) 779(9.0) 818(3.8) 0 1600(11.8) 778(15.5) 816(7.7) - 1498 (19.5) 716(23.7) 778(14.9) - 1587(19.3) 771(21.9) 811(16.5) - Increase (+) decrease (-) r stayed the same (0) BLANK indicates n trend reprted frm 2003 2013 36 Pa g e

QN43: Percentage f students wh had at least ne drink f alchl n ne r mre f the past 30 days. QN44: Percentage f students wh had five r mre drinks f alchl in a rw, that is, within a cuple f hurs, n ne r mre f the past 30 days QN46: Amng students wh reprted current alchl use, the percentage wh usually gt the alchl they drank frm smene wh gave it t them in the past 30 days QN47: Percentage f students wh used marijuana ne r mre times during their life QN48: Percentage f students wh tried marijuana fr the first time befre age 13 years QN49: Percentage f students wh used marijuana ne r mre times during the past 30 days QN50: Percentage f students wh used any frm f ccaine, including pwder, crack, r freebase ne r mre times during their life QN51: Percentage f students wh sniffed glue, breathed the cntents f aersl spray cans, r inhaled any paints r sprays t get high ne r mre times during their life QN52: Percentage f students wh used herin ne r mre times during their life QN53: Percentage f students wh used methamphetamines ne r mre times during their life QN55: Percentage f students wh tk sterid pills r shts withut a dctr's prescriptin ne r mre times during their life QN58: Percentage f students wh were ffered, sld, r given an illegal drug by smene n schl prperty during the past 12 mnths Surce: YRBS 1502(36.0) 721(33.9) 778(37.8) - 1548(20.1) 741(19.5) 803(20.4) - 488(35.8) 219 (33.0) 267(38.6) 1513(43.3) 720(47.0) 789(39.6) 0 1535(9.8) 734(12.0) 796(7.69) 0 1547(23.5) 744(27.6) 801(19.3) 0 1595(10.1) 773(11.6) 815(8.3) - 1445(10.7) 687(11.0) 751(10.0) - 1592 (4.7) 773(5.6) 812(3.7) 0 1561(4.7) 756(5.3) 798(3.9) - 1585 (5.9) 767(6.6) 811(4.7) - 1562 (31.3) 758(34.2) 799(28.3) 0 Fcus grups, key infrmant interviews, and surveys cnducted as part f the reginal needs assessment supprt much f the secndary data cllected and presented; with the majrity f bth yuth and adult participants indicating that alchl and marijuana were tp substances being used by yuth in their cmmunity. Secndary substances discussed, but nt part f the verall majrity f participants indicted that 37 Pa g e

prescriptin drugs and synthetics were in their pinin being used by yuth in their cmmunity. Qualitative analysis revealed the fllwing substances were being used by yuth in Maricpa Cunty: Alchl Marijuana Edibles such as baked gds and candy Prescriptin drugs Synthetic drugs Spice Bath salts Due t the wide range f substances that were mentined thrugh the qualitative data cllectin, a priritizatin prcess was cmpleted by the needs assessment team and further details can be fund in that sectin. Where Yuth Obtain Substances An imprtant piece in identifying strategies t address yuth substance use is learning where and hw yuth are using substances. Fr yuth access t substances there are differences in AYS published data and the GSA 6 data included, as fficial AYS data analysis methdlgy selects nly thse yuth wh have stated that they did drink within the past 30 days, which is a much smaller sample size. The GSA 6 data analysis cnducted included the entire sample (i.e. the percent that did nt drink). Data frm the AYS indicates that yuth in GSA 6 are primarily getting alchl: At parties (#1 surce fr 8 th, 10 th, and 12 th graders acrss all years) Gave smene else mney t buy it fr them (#2 surce fr 10 th and 12 th graders acrss all years) They take it frm hme (#2 surce fr 8 th graders acrss all years, #3 surce fr 10 th graders acrss all years) Frm smene ver 21 (#3 surce fr 12 th graders acrss all years) Sme ther way (#3 surce fr 8 th graders acrss all years) Qualitative data cllected thrugh primary data surces suggest that adults perceive yuth getting alchl frm parties r their friends. Thrugh bth the AYS (see Figure 7) and qualitative data (including yuth, adults and surveys) parties are the mst cmmn access pint fr yuth t btain alchl. Beynd parties, there is a significant gap in the perceptin f where adults believe yuth are accessing alchl t where yuth are actually btaining it. Adult perceptins are that friends are the secnd mst available surce f alchl, hwever data (qualitative and quantitative) indicate therwise. Giving mney fr smene else t purchase alchl is the secnd mst ppular way t access alchl fr 10 th and 12 th graders, while 8 th graders take it frm hme. 38 Pa g e

It is wrth nting that there is a cnsistent decrease in all access pints fr all grade levels ver time, which may be a result f the wrk f current prviders and calitins targeting scial accessibility thrugh educatin and enfrcement activities. Fr eample, there was a 2.7% decrease in 8 th graders accessing alchl thrugh parties frm 2008 t 2012, and a 3.3% decrease fr 10 th and 12 th graders fr the same timeframe. Twelfth graders reprting getting alchl frm smene ver 21 drpped 4.5% frm 2008 t 2012. Table 20. Lcatins Where Yuth Obtained Alchl in the Past Year by Grade Level and Year Where did yu get the alchl frm?. 2008 2010 2012 8th 10th 12th 8th 10th 12th 8th Grade Grade Grade Grade Grade Grade Grade I did nt drink 77.5% 65.2% 54.6% 80.9% 69.2% 58.2% 81.1% 69.7% 58.1% Stre 0.9% 2.2% 4.9% 0.8% 1.8% 3.7% 0.7% 1.7% 4.2% Restaurant/Bar 0.6% 0.8% 2.4% 0.4% 0.7% 1.4% 0.5% 0.8% 1.8% Public Event 0.6% 0.8% 1.8% 0.5% 0.6% 0.9% 0.5% 0.8% 1.1% Gave smene else Mney 3.6% 10.2% 18.1% 3.0% 9.1% 16.7% 2.0% 8.4% 15.6% Parent/Guardian 3.6% 4.8% 6.1% 3.2% 4.6% 5.9% 2.8% 4.6% 6.6% Family Member Over 21 3.6% 5.2% 7.6% 2.9% 4.8% 5.8% 2.5% 4.7% 6.3% Smene ver 21 3.4% 8.8% 16.9% 2.6% 7.1% 12.5% 2.2% 6.7% 12.4% Smene Under 21 4.3% 8.3% 10.0% 3.7% 6.9% 7.9% 3.1% 7.6% 9.4% Party 7.7% 17.2% 25.0% 6.6% 14.9% 23.1% 5.0% 13.9% 21.7% Tk it frm Hme 6.0% 8.3% 6.3% 5.3% 7.1% 5.8% 3.9% 6.9% 6.1% Tk it frm Stre r Smene Else s Huse 10th Grade 12th Grade 2.2% 4.0% 3.8% 1.6% 3.1% 2.4% 1.1% 2.8% 2.3% Sme ther way 5.1% 7.2% 6.9% 4.2% 5.2% 5.1% 3.3% 4.9% 4.8% Surce: GSA 6 AYS Data When Maricpa Cunty students were asked in the AYS where they btained prescriptin drugs in 2012, the majrity indicated frm: 1. Friends (10.8% f 12 th graders) 2. Hme (4.4% f 12 th graders) 3. Party (3.1% f 12 th graders) Adults participating in primary data cllectin effrts reveal that mst adults believe yuth are btaining prescriptin drugs frm their hme, schl, and at parties, which is relatively similar t yuth data cllected, althugh schl was nt in the tp three surces f access as reprted by yuth. Similar surces were als cited by yuth participating in fcus grups, indicating cmparable surces f prescriptin drugs. Adults may underestimate friends as a surce, which was cnsistently the mst prevalent. Table 21. Where Yuth Obtained Prescriptin Drugs in the Past Year by Grade Level and Year 2010 2012 Where did yu get the prescriptin 8th Grade 10th Grade 12th Grade 8th Grade 10th Grade 12th Grade drugs frm.? Never Used 89.0% 82.3% 78.6% 88.5% 84.2% 80.6% Friends 5.1% 10.8% 14.2% 2.6% 7.8% 10.8% Family/Relatives 1.9% 3.2% 3.9% 1.0% 2.2% 2.6% Party 2.4% 4.8% 5.4% 1.3% 2.5% 3.1% Hme 2.8% 4.9% 5.3% 1.7% 4.3% 4.4% 39 Pa g e

Dctr/Pharmacy 1.2% 2.6% 4.5% 0.8% 1.9% 3.2% Schl 1.4% 3.8% 3.2% 0.7% 2.1% 2.1% Over the Internet 0.3% 0.4% 0.3% 0.1% 0.2% 0.1% Outside the US 0.7% 0.9% 1.4% 0.3% 0.5% 0.5% Other 1.6% 2.6% 2.9% 0.9% 1.5% 2.0% Surce: GSA 6 AYS Data In 2012, the AYS began t include the questin t students n where they btained marijuana frm. The majrity f students indicated they gt marijuana frm: 1. Friends (22.0% f 12 th graders) 2. Party (8.2% f 12 th graders) 3. Other (5.0% f 12 th graders) 4. Smene with a medical marijuana card (4.3% f 12 th graders) Adult qualitative data gathered indicated that adults perceive yuth are getting marijuana frm their friends, parties, and at schl, which is similar t what yuth reprted. Figure 7. AYS: Lcatin Where Marijuana was btained by Grade Level (2012) Surce: GSA 6 AYS Data Lking at alchl, prescriptin drugs and marijuana verall, parties and hme are the mst prevalent ways yuth are accessing substances. Friends are als reprted as a cmmn surce f access fr prescriptin drugs and marijuana. In additin, AYS data indicated that 31% f students were ffered, sld, r given an illegal drug by smene n schl prperty during the past 12 mnths. This is supprted by what was reprted in primary data cllectin where funding cuts have reduced mnitring n schl campuses, including student behavir and activities. Mrever, bth AYS and qualitative data supprt there is a lack f yuth cnnectin t their schls. A challenge that was identified was in parents feeling that schls have becme ne stp shps 40 Pa g e

wherein they feel schl persnnel shuld be respnsible fr mnitring substance use and prvide behaviral health services. YRBS highlights related t access f substances included: In 2013, 35.8% f yuth stated they usually gt the alchl they drank frm smene wh gave it t them in the past 30 days 8.6% f students in 2013 wh reprted current cigarette use, indicated they usually gt their cigarettes by buying them in a stre r gas statin Qualitative data cllected frm fcus grups supprt the AYS data cllected in that yuth get substances frm their friends; hwever, sme mentined they buy them, which is nt cnsistently reprted as a high access pint in the AYS data. Mst yuth participants indicated that nwadays n substance is hard t get as lng as yu want it. Hw Yuth Use Substances/Cnsumptin Data Knwing hw yuth are using the substances is anther imprtant piece t identifying strategies t address yuth substance use. While there is n secndary data t prvide details as t hw yuth are using varius substances, primary data cllected indicated the fllwing trends: Alchl Marijuana Beer and hard liqur are being used at parties in their nrmal cntainers, At schl the students are putting clear alchl int water bttles Abandned hmes Smking Swallwing raw marijuana by muth Edibles such as candy and desserts Adults Data gathered by Arizna State University (ASU) and the Natinal Cllege Health Assessment II in 2013 with a randm sample f ASU students indicated that 60% f respndents used alchl in the past 30 days; 27% engaged in high-risk drinking the last time they partied r scialized; and ASU has seen that the students that take the mst risks tend t be the yunger men f cllege age. The Arizna Behaviral Health Epidemilgy Prfile (2013) als reprted that abut ne in five cllege males reprted using marijuana in the past 30-days; and marijuana use by Asian/Pacific Islander students increased frm 5.8% in 2010 t 10.7% in 2012. Increases in adult, Asian/Pacific Islander use are cnsistent with incremental yuth increases in marijuana use (particularly because f the primity in age). The use f pain killers als increased significantly frm 1.9% in 2010 t 9.9% in 2012 amng Asian/Pacific Islanders. Additinally, the Prfile nted that male cllege students under the age f 21 reprted the highest percentage f stimulant use. 41 Pa g e

While adult substance use prevalence data is nt cllected widely in the State, there have been attempts t assess the level f substance use amng adults in Arizna. In 2010, an Arizna Health Survey was administered thrugh cllabratin with St. Luke s Health Initiatives and the Arizna State University s Suthwest Interdisciplinary Research Center. Data was gathered thrugh randmized telephne survey interviews with the adult heads f husehlds living in Arizna. A ttal f 8,215 surveys were cmpleted. Highlights f relevance frm this survey include the fllwing: 19% were current cigarette smkers; with adult ages 18-28 the mst likely t be current smkers 50% f adults surveyed had used alchl in the past 30-days; with adults with higher incmes mre likely t begin drinking befre age 21 than thse in lwer incme categries Marijuana was the mst frequently used illicit drug; with the highest use amng thse with incmes in the $30,000 - $49,999 incme range 10% f adults indicated they had misused prescriptin drugs in the past 30-days; with the highest rate f use amng 60-69 year lds; adults indicated they did nt have a dctr s cnsent 17% f all adults surveyed indicated a mental health cnditin and equally stated a psychlgical distress in the past 30-days Adults wh indicated a psychlgical distress were mre likely t have used an illicit drug in the past 30-days when cmpared t adults wh did nt indicate a psychlgical distress Anecdtal data cllected thrugh fcus grups, key infrmant interviews, and surveys revealed that the fllwing substances are being used by adults in their cmmunity: Alchl Marijuana Medical marijuana Illicit drugs Meth Adult and Yuth Enrllment Data Data cllected frm Mercy Maricpa enrllment as f July 2014 shw that a ttal f 743,400 adults, children, and adlescents with general mental health and substance abuse issues and 18,390 adults with serius mental illness were receiving integrated services fr physical and behaviral health. Table 22. Tp 15 Zip Cdes fr Mercy Maricpa Enrllment (April t July 2014) GMHSA Integrated** Zip Cde N Zip Cde N 85301* 28,267 85301* 749 85033 22,988 85015* 612 85041* 21,294 85021 541 85035 19,660 85007 528 85009* 19,043 85051* 505 85008* 18,730 85008* 496 85017* 16,893 85201* 464 42 Pa g e

85204 16,232 85029 462 85016* 14,896 85018 434 85225 14,505 85014 369 85037 14,406 85016* 356 85015* 13,867 85017* 342 85040 13,859 85032 342 85051* 13,801 85009* 341 85201* 13,384 85202 335 *In tp 15 fr enrllment fr bth GMHSA and Integrated ** Refers t receiving bth Primary Care and Behavir Health Treatment Mercy Maricpa enrllment numbers can als be seen belw by zip cde. The tp three zip cdes fr GMHSA enrllment include: 85301, 85033, and 85041. Fr integrated care fr the SMI ppulatin, the tp three are: 85301, 85015, and 85021. Table 23. Ttal Mercy Maricpa Enrllment by Service Type (April t July 2014) General Mental Health Substance Abuse (GMHSA) 743,400 Integrated* 18,390 *Refers t receiving bth Primary Care and Behaviral Health Treatment b. Suicide Deaths The fllwing tables and graphs demnstrate that numbers f suicide deaths increase at abut 2% per year with a ttal percent f increase f 6.4% frm 2010 thrugh 2013. The mst salient cnclusins based n this data are that: Males die by suicide at a greater rate (76%) than females (24%) The majrity (56%) f deaths by suicide is fr peple 45 years ld with the majrity being white (80%) Eight PCAs in Maricpa Cunty have seen the majrity f suicides in 2013 Gegraphically, by Primary Care Area (PCA), the majrity f suicides in 2013 ccurred in: Table 24. Suicide Deaths by Tp PCAs Rank 2013 1 Deer Valley Village* 2 Nrth Muntain Village* 3 Mesa West* 4 Paradise Valley Village* ++ 5 Mesa Nrth* 6 Tempe Nrth* 7 Alhambra Village 8 Glendale Nrth* 9 Camelback East Village* 43 Pa g e

10 Maryvale Village** 11 Mesa Gateway** 12 Mesa East 13 Ahwatukee Fthills Village** 14 Avndale 15 Gilbert Suth* * = Tp 15 all ** = Tp 15 bth 2012 and 2013 n ++ = Als rated high in yuth substance use fr alchl, marijuana and tbacc Between 2010 and 2013 the majrity f suicides ccurred in the fllwing PCAs and sme PCAs are cnsistent ver the last fur years: Table 3. Tp PCAs by Suicides (2010, 2011, 2012, 2013) Rank 2010 2011 2012 2013 1 Nrth Muntain Village* Nrth Muntain Village* Deer Valley Village* Deer Valley Village* 2 Deer Valley Village* Deer Valley Village* Paradise Valley Village* Nrth Muntain Village* 3 Scttsdale Central Camelback East Village* Mesa Nrth* Mesa West* 4 Tempe Nrth* Mesa West* Nrth Muntain Village* Paradise Valley Village* 5 Camelback East Village* Paradise Valley Village* Glendale Nrth* Mesa Nrth* 6 Mesa West* Glendale Nrth* Maryvale Village** Tempe Nrth* 7 Paradise Valley Village* Mesa East Mesa West* Alhambra Village 8 Alhambra Village Scttsdale Central Camelback East Village* Glendale Nrth* 9 Glendale Nrth* Tempe Nrth* Tempe Nrth* Camelback East Village* 10 Mesa Nrth* Mesa Gateway Surprise Suth Maryvale Village** 11 Mesa East Encant Village Scttsdale Nrth Mesa Gateway** 12 Gilbert Suth* Mesa Nrth* Gilbert Suth* Mesa East 13 Suth Mtn Village/Guadalupe Scttsdale Suth Peria Suth Ahwatukee Fthills Village** 14 Surprise Suth Alhambra Village Ahwatukee Fthills Village** Avndale 15 Chandler Central Gilbert Suth* Mesa Gateway* Gilbert Suth* * = Tp 15 all 4 years ** = Tp 15 bth 2012 and 2013, but nt all 4 years Suicides were als brken dwn by age, gender, and ethnicity and are displayed in the fllwing charts. It is imprtant t nte that numbers are nt adjusted fr ppulatin size; rates are the preferred methd when making cmparisns. The majrity f suicides cmpleted between 2010 and 2013 ccurred with individuals between 45 t 65 years f age and individuals 65+ years ld. Over the past fur years, suicides have remained relatively steady amng 45 t 65 year lds, with 65+ year lds shwing a decline between 2011 and 2012 and then a sharp increase frm 2012 t 2013. Increases were als shwn fr persns between the ages f 25 t 44 between 2012 and 2013. Ages 18-20 spiked epnentially in 2012 yet decreased at a similar rate in 2013. Fr Maricpa Cunty in 2013, a ttal f 213 suicides were reprted by ADHS fr persns 45 t 65 years f age, 185 suicides reprted fr individuals 65+ years f age, and the third highest f 109 ccurring amng 25 t 44 year lds. 44 Pa g e

Figure 8. Suicide Numbers by Age Grups (2010, 2011, 2012, 2013) Surce: ADHS Figure 9. Maricpa Cunty: Suicide Rates by Age Grups (2010, 2011, 2012, 2013) Data reprted by gender and ethnicity reveal that males have higher numbers f suicides, as well as suicide rates, than females and that in 2013, 440 males died by suicide, while 137 females died by suicide. The highest suicide numbers based n ethnicity were fr White (Nn-Hispanics) fllwed by Hispanics. Hwever, as mentined abve, lking at ppulatin-adjusted rates shws that Native Americans have the secnd highest rate f suicide in Maricpa Cunty. Statewide, Whites cnsistently have the highest rate f suicide (20.2 per 100,000 in 2012), fllwed by Native Americans (17.9 per 100,000 in 2012). This cincides with fcus grups cnducted with members f the Native American ppulatin wh identified suicide as an issue f high cncern. 45 Pa g e

Figure 10. Suicide Numbers by Gender (2010, 2011, 2012, 2013) Figure 11. Maricpa Cunty: Suicide Rates by Gender (2010, 2011, 2012,2013) Nte. Rates per 100,000 46 Pa g e

Figure 12: Suicide Numbers by Ethnicity Surce: ADHS Figure 13. Maricpa Cunty: Suicide Rates By Ethnicity (2010, 2011, 2012, 2013) Nte. Rates per 100,000. Suicide Means Firearms are the mst cmmn means f suicide statewide, which is als cnsistent with natinal data. Frm 2010 t 2012, suicides by firearms have remained relatively steady, with the majrity f 45 t 64 year lds 47 Pa g e

chsing firearms as their methd f suicide, fllwed by 20 t 44 year lds. When lking at ppulatinadjusted rates statewide, firearm deaths are mst prevalent amng lder adults ages 65+. Figure 14. Firearm Suicides in Arizna by Age Grup and Year (2010, 2011, 2012) Surce: ADHS Qualitative data was als cllected n the means in which yuth may be attempting and/r dying by suicide with the fllwing infrmatin revealed. Yuth are using the fllwing means t attempt suicide: Hanging Cutting Firearms Overdse n drugs pills Fr adults, qualitative data revealed that adults are using the fllwing means t attempt suicide: Overdse Pills Other drugs Firearms Hanging/asphyiatin Cutting Suicide Behavirs In rder t better understand the issue f suicide, it is imprtant t lk nt nly at deaths, but als at unreprted suicides and suicide behavirs. Unreprted suicides, deaths where the intent was unable t be determined r was misclassified as accidental, are estimated t be between 5%-25% higher than numbers f deaths by suicide wrldwide. Suicide behavirs, meaning actins that are ften linked t suicide, are generally 48 Pa g e

estimated t be 40 t 100 times greater. Suicide attempt data is ften highly underreprted; thus, lking at inpatient discharges, ER visits, and hspitalizatins related t suicide behavirs is imprtant. YRBS data cllected frm Arizna yuth in 2013 indicated that 19% f high schl students seriusly cnsidered attempting suicide during the past 12 mnths (trend increase frm 2003-2013), with 17% als indicating they had made a plan abut hw they wuld attempt suicide. 10.6% f students stated they had actually attempted suicide ne r mre times during the past 12 mnths. Table 26. Yuth Risk Behavir Survey, Selected Suicide Data (2013) TOTAL YRBS SAMPLE IN ARIZONA 2013 1,623 Survey Questin and Number QN27: Percentage f students wh seriusly cnsidered attempting suicide during the past 12 mnths. QN28: Percentage f students wh made a plan abut hw they wuld attempt suicide during the past 12 mnths QN29:Percentage f students wh actually attempted suicide ne r mre times during the past 12 mnths QN30: Percentage f students wh made a suicide attempt during the past 12 mnths that resulted in an injury, pisning, r verdse that had t be treated by a dctr r nurse The value in ( ) is the percent f the sample wh respnded Yes t that behavir Ttal N (%) 1606 (19.2) 1606 (17.4) 1433 (10.6) Male N (%) Female N (%) 783(14.4) 818 (23.9) + 781 (15.3) 518 (19.2) 0 668 (8.1) 759 (12.9) 0 1422 (4.3) 660 (3.2) 757 (5.2) 0 Increase (+) decrease (-) r stayed the same (0) BLANK indicates n trend reprted frm 2003 2013 Trends Anecdtal data cllected frm fcus grups, key infrmant interviews, and surveys indicate that: Suicide is an issue in the cmmunity f serius cncern Suicide is mst affecting adlescents and the elder ppulatin Yuth surveyed knew smene their age wh died by suicide Males are cmpleting suicide mre, while Females are attempting suicide mre Highest rates in the state are with Whites fllwed by the Native American ppulatin The means mre cmmnly used fr suicide cmpletins by teens is firearms The means mre cmmnly used fr suicide attempts by teens is pills 49 Pa g e

Acrss all ppulatins there is pushback and lack f willingness t allw peple t cme in and prvide supprtive services and educatin There is a high crrelatin between substance use and suicide fr bth attempters and survivrs Suicide is n the rise fr middle-aged wrking males Suicide is an issue that wuld benefit frm further study in lcalized qualitative data gathering effrts, t fill in gaps in quantitative data arund suicide behavirs. It is imprtant t cnsider hw the issue impacts cmmunities nt nly in relatin t verall deaths, but als attempts and ideatin. There are sme discrepancies between the primary data and the secndary data which will be imprtant t cnsider in terms f gauging cmmunity awareness arund the issue. Middle-aged adults verwhelmingly have the highest number (althugh lder adults have the highest rates) f suicide cmpletin in Maricpa Cunty. Primary data suggests that suicides are highest in part amng adlescents, which is nt supprted by secndary data n deaths; hwever, high frequency f suicide ideatin amng yuth is supprted by bth primary and secndary data. This cincides with data presented later in this assessment implying yuth are using substances t selfmedicate and t cpe. 2. Reginal statistics infrming the needs f nn-dminant ppulatins One f the gaps in cmprehensively addressing the needs f nn-dminant ppulatins includes the lack f data available at sub-ppulatin level and access t these ppulatins. Veterans Data was cllected frm a veteran s serving rganizatin and prvided the fllwing insight t veterans. This data nly applies t thse veterans participating in the veteran serving rganizatin. Frm May 2010 t September 2013 there were 67 suicides cmpleted Frm January 2010 t September 2013 there were 642 suicide attempts Fr Fiscal year 2013 there were 1,232 calls t the htline Suicide rates amng veterans are nt necessarily linked t their invlvement in cmbat activities, but mre assciated with psych-scial issues in general and financial issues Veteran serving rganizatins see the primary substances being used by veterans as alchl and piates Native Americans Primary data cllected via fcus grups and key infrmant interviews indicate a need fr mre culturally relevant substance abuse and suicide services frm staff that are f Native American descent. Qualitative data als indicated that in rder t get t the rt f substance abuse and suicide issues amng the Native American ppulatin, services and prgrams need t address the different types f trauma that is affecting Native Americans that has becme generatinal. Additinally, yuth indicated that inhalant use is n the rise n the reservatins, but nt necessarily in the urban areas f Maricpa Cunty. 50 Pa g e

LGBTQ Ppulatin A current Mercy Maricpa preventin prvider is fcusing their effrts n the LGBTQ cmmunity within Maricpa Cunty, and was able t supplement effrts this past year as part f a Service t Science Initiative awarded t TERROS and the LGBTQ Cnsrtium by the Substance Abuse and Mental Health Services Administratin (SAMHSA). As part f this initiative, the LGBTQ Cnsrtium develped and administered an Adult Substance Use Prevalence Survey with 872 adults in the Pheni area LGBTQ cmmunity. The majrity f survey respndents indicated they were hmseual (48.3%) and either White (49.5%) r Hispanic/Latin (23.7%); and 16.1% stated they were 18-20 years f age, 23% stated they were 21-25 years f age, 16.1% stated they were 26-30 years f age, and 15.4% indicated they were 31-40 years f age. Results shared by the LGBTQ Cnsrtium revealed the fllwing highlights: 64% indicated they had used alchl in the past 30-days 31% stated they used cigarettes in the past 30-days 30% stated they had used marijuana in the past 30-days 19% indicated they had unprtected se within in the past si mnths 27% stated they had driven after drinking any alchl 23% indicated they had eperienced dmestic vilence 7.7% specified they seriusly cnsidered suicide 22.4% indicated they had eperienced seual assault r rape These survey results may indicate a need and pprtunity with the LGBTQ ppulatin t address alchl and marijuana prevalence within Maricpa Cunty. These data cllectin effrts are a huge achievement fr the LGBTQ cmmunity and Maricpa Cunty and further effrts shuld be eplred t sustain such activities t help infrm preventin prgramming fr the cunty. 3. Priritized tp 3 5 Substance Related Cnsequences Please refer t priritizatin prcess n page 16 and Appendi G fr a detailed eplanatin f scring prcess and cnclusins. The narrative belw describes cnsequence data cllected. Yuth Juvenile Arrests fr Alchl and Drugs Juvenile arrests per zip cde were gathered frm the Maricpa Cunty Juvenile Prbatin Department Year bks fr 2007 2012. That data fr Maricpa Cunty revealed: As with mst jurisdictins there has been a steady decline in juvenile arrests with an verall decline f ver 10 20% during this time frame; Regardless f the decrease it was interesting t nte that the mst ccurrences fr juvenile arrests fr 2012 were in the fllwing zip cdes and PCAs: 51 Pa g e

Zip Cde PCA 85225 Chandler 85301 Glendale 85009 Pheni Suth Central 85008 Pheni Suth Central 85201 Mesa 85041 Pheni Suth Muntain 85006 Pheni Suth Central 85323 Avndale It is als interesting t nte that, with the eceptin f the 85225 zip cde ranking 9 th fr prevalence f tbacc use, nne f these tp eight zip cdes fr juvenile arrests was fund in the tp ten zip cdes reprting yuth use f alchl, tbacc, marijuana r prescriptin drugs. The Pheni Suth Central PCA des rutinely shw up indicating high rates f yuth use; hwever, it is a different zip cde than thse fund fr juvenile arrests. Table 27. Yuth Arrest Rates by Mst Occurring Zip Cdes Zip Cde Ttal FY 2007 Ttal FY 2008 Ttal FY 2009 Ttal FY 2010 Ttal FY 2011 Ttal FY 2012 Average Annual Change frm 2007-2012 85301 1109 1028 871 777 759 636 10.4% 85323 957 795 718 649 508 398 15.9% 85009 853 739 688 592 487 549 12.9% 85225 852 837 1077 1053 901 859-1.1% 85033 845 816 829 594 468 460 11.4% 85035 712 655 706 598 499 443 8.7% 85041 683 779 746 628 430 462 6.0% 85204 683 744 687 616 637 586 2.7% 85017 658 533 495 418 331 297 14.6% 85008 614 599 587 503 466 515 3.1% 85040 614 496 450 357 292 286 13.9% 85345 555 563 522 530 467 425 5.0% 85201 543 507 628 550 528 493 1.1% 85032 531 479 395 390 327 256 13.3% 85006 480 464 391 358 363 409 2.7% 85015 480 441 417 413 434 369 4.9% 85037 440 447 522 521 373 315 6.3% 85051 428 346 417 295 249 260 7.8% 85031 85326 425 365 456 432 459 421 307 5.4% 482 541 567 435 381-2.7% 52 Pa g e

State data fr juvenile ffenders indicate verall, that alchl and drug arrests are decreasing. The fllwing table details juvenile referrals fr alchl and drugs frm 2010 2012 by gender, race/ethnicity, and age. While mst juvenile referrals fr mst ethnicities have decreased ver time; African American juvenile referrals have remained steady ver the three-year reprting perid. Table 28. Numbers f Juvenile Referrals fr Alchl and Drugs by Gender, Age, and Race/Ethnicity in Arizna Categry 2010 2011 2012 Juveniles 12,735 11,857 10,921 Female 3,548 3,269 3,106 Male 9,187 8,588 7,815 African American 679 660 674 American Indian 942 944 835 Asian 93 93 80 Pacific Islander 3 5 5 Other/Unknwn 151 166 158 White 6,096 5,716 5,161 Hispanic 4,771 4,273 4,008 8-12 years 308 287 282 13 years 614 622 595 14 years 1,384 1,399 1,181 15 years 2,360 2,308 2,144 16 years 3,550 3,284 2,945 17 years 4,519 3,957 3,774 The AYS als asks respndents t identify whether they have driven a car after drinking alchl r rde in the car with a persn that has been drinking. Fr students wh had rde in a car with smene after they had been drinking alchl, there have been steady declines fr 8 th graders since 2008; 10 th graders spiked in 2010; and 12 th graders shwing an verall decrease frm 2008 t 2012. Fr the survey item that asked students t 53 Pa g e

indicate whether they had driven a car after drinking alchl, there were steady decreases fr all grades between 2008 and 2012 with 12th graders shwing the highest percentages acrss the bard. Figure 15. Percent f Students Reprting Riding with a Drunk Driver r Drinking and Driving - AYS Surce: AYS Maricpa Cunty YRBS data cllected in 2013 fr Arizna als indicated abut 9.0% f YRBS respndents had driven a car after drinking. Yuth Mrbidity fr Alchl and Drugs Since 2010, the yuth mrbidity rates have decreased fr yuth ages 0 4 and 12-17 fr alchl r drugs. Yuth ages 5 11 saw steady numbers frm 2010 t 2011, with a substantial increase between 2011 and 2012 and then a decline frm 2012 t 2013. The majrity f ER primary diagnses ccurred amngst 12 17 year lds. Table 29. Yuth Mrbidity Emergency Rm Primary Diagnses fr Alchl r Drug by Age Age Grup 2010 2011 2012 2013 0-4 57 75 61 47 5-11 12 12 22 15 12-17 487 530 498 418 YRBS data indicate that almst 21% f the yuth surveyed in 2013 had drunk alchl r used drugs befre their last seual intercurse. ADHS data indicate that there have been steady declines in teen pregnancy since 2007 thrugh 2012 fr the Cunty. Hwever, 18-19 year lds appear at mst risk with 78.4% in 2011 and 54 Pa g e

69.3% in 2012 f all Cunty pregnancies ccurring amng this age grup. This may suggest a need fr further lcal study. Table 30. Yuth Risk Behavir Data fr Seual Intercurse TOTAL YRBS SAMPLE IN ARIZONA 2013 1,623 Survey Questin and Number Ttal N (%) QN63: Amng students wh had seual intercurse during the past three mnths, the percentage wh drank alchl r used drugs befre last seual intercurse Cmmunity Views Survey (CVS) Results The value in ( ) is the percent f the sample wh respnded Yes t that behavir Male N (%) Female N (%) 447(20.6) 212(26.6) 233(15.4) Mercy Maricpa preventin prviders administered the CVS t adults (18+) within their cmmunities in which adults were given the pprtunity t select frm a list the prblems/cnsequences that were ccurring as a result f yuth alchl use. A ttal f 3,185 adults participated in the CVS and the tp fur prblems/cnsequences f yuth alchl use included: 1. Driving under the influence (75.2%); 2. Alchl-related car crashes (72.6%); 3. Alchl abuse r addictin (68.9%); and 4. Vilence r getting int fights (68.8%). Fr prviders addressing yuth marijuana use in their cmmunities, they were asked t select frm a list f prblems and cnsequences that were being bserved fr yuth marijuana use. A ttal f 592 adults (18+) participated in the CVS and the tp fur prblems/cnsequences f yuth marijuana use included: 1. Alchl abuse r addictin (67.4%); 2. Driving under the influence (65.7%); 3. Getting arrested/juvenile delinquency (62.0%); and 4. Prblems with learning/memry (58.8%). Anecdtal data cllected frm fcus grups and key infrmant interviews als indicated that the fllwing cnsequences are ccurring with yuth as a result f alchl and drug use: Increase in yuth mental health/behaviral health issues 55 Pa g e

Suicide attempts and cmpletins Teen Pregnancy Yuth hmelessness Dysfunctinal families Further eplratin and mre data are needed t fully assess the areas f yuth mental/behaviral health issues, suicide attempts and teen pregnancy in relatin t substance use. In sme cases, the qualitative data is nt supprted. Adults Data cllected frm the ADHS frm 2010 2012 n inpatient discharges fr amphetamines, ccaine, and piates indicate that the majrity f inpatient discharges fr Maricpa Cunty is mre than half that which is reprted fr the State verall. Ccaine use appears t be trending dwnwards between 2011 and 2012. Amphetamine use is shwing an upward trend as far as increased use since 2010. The highest number f inpatient discharges is fr piate use, which cntinues t trend upward at an alarming rate. Figure 16. Maricpa Cunty vs. State f Arizna: Inpatient Discharges Related t Drugs (2010, 2011, 2012) ADHS data cllected frm 2010 2012 als reveal that Maricpa Cunty has the majrity f inpatient discharges related t drug dependence and drug use when cmpared t State ttals. This cntinues t trend upward and numbers mre than dubled frm 2011-2012. 56 Pa g e

Figure 17. Maricpa vs. State f Arizna: Inpatient Discharges Related t Drug Dependence and Drug Use (2010, 2011, 2012) The fllwing infrmatin n the tp 10 ER admittances fr alchl and drugs was gathered frm ADHS upn request. Data indicate that fr three years, the Paradise Valley Village PCA was ranked number ne fr ER admittances fr alchl and drugs. Table 31. Ten (10) Mst ER Admittances (300+) by PCA fr Bth Yuth and Adults fr Alchl and Drugs Rank 2010 2011 2012 2013 1 Nrth Muntain Paradise Valley Paradise Valley Paradise Valley Village* Village* Village* Village* 2 Alhambra Village* Nrth Muntain Village* Nrth Muntain Village* Nrth Muntain Village* 3 Central City Village* Camelback East Village* Camelback East Village* 4 Mesa West* Alhambra Village* Central City Village* Camelback East Village* Alhambra Village* 5 Tempe Nrth* Central City Village* Mesa West* Central City Village* 6 Deer Valley Village* 7 Paradise Valley Village* 8 Camelback East Village* 9 Maryvale Village* Mesa West* Tempe Nrth* Mesa West* Tempe Nrth* Deer Valley Village* Tempe Nrth* Deer Valley Village* Alhambra Village* Deer Valley Village* Maryvale Village* Maryvale Village* Maryvale Village* 10 Glendale Nrth Glendale Nrth Glendale Nrth Scttsdale Suth * = Present all fur years 57 Pa g e

Emergency Rm Admittance fr Drug And Or Alchl Diagnsis Yuth (0 17) admittance appeared t decrease frm 2010 t 2012 with an verall 14 % decrease. Adult admittances, hwever, increased abut 13 % ver the last 4 years, with the 25 44 age grup increasing and the mst increase fr the 55 64 age grup, Males accunt fr ver 60 % f the ER admittance fr drugs and alchl Whites have the highest prevalence f mrbidity frm alchl and drugs verall, triple the amunts f the secnd and third highest prevalence (Hispanic/Latin and Native American respectively). Data cllected fr amphetamines, ccaine, and piates fr emergency rm visits indicates that Maricpa Cunty makes up the majrity f ER visits when cmpared t State numbers fr 2010 2012. Despite ccaine use appearing t decrease between 2011 and 2012 fr inpatient discharges, ER visits related t ccaine seem t be increasing frm 2010 t 2012. Opiate ER visits seem t have decreased frm 2010 t 2011, hwever have shwn an increase cmparing 2011 t 2012. Fr the state, piate use seems t lead the way fr ER visits, hwever eamining Maricpa Cunty specifically; it appears the highest number f ER visits is a result f amphetamines. Figure 18. Maricpa Cunty vs. State f Arizna: Emergency Rm Visits Related t Drugs (2010, 2011, 2012) Data btained by ADHS als indicates that Maricpa Cunty makes up the majrity f emergency rm and inpatient discharge visits fr pisning by drugs, medicinal and bilgical substances when cmpared t State rates. 2012 shws a spike in inpatient discharges fr Cunty and State. 58 Pa g e

Figure 19. Maricpa Cunty vs. State f Arizna Emergency Rm Visits and Inpatient Discharge Related t Pisning (2010, 2011, 2012) Data btained fr alchl abuse emergency rm visits indicates that since 2010, Maricpa Cunty has had decreases shwn fr inpatient discharges and emergency rm visits, thugh an increase can be seen frm 2011 t 2012 (albeit nt at the same level as 2010). It als appears that Maricpa Cunty represents the bulk f alchl abuse related emergency rm visits when cmpared t the State verall. Inpatient discharges saw a drastic decrease frm 2010 t 2011 and a slight decrease frm 2011 t 2012. Figure 20. Maricpa Cunty vs. State f Arizna ER Visits and Inpatient Discharges Related t Alchl Abuse (2010, 2011, 2012) Adult mrbidity numbers frm 2010 t 2013 indicate that males utnumber females fr alchl and drugs f ER primary diagnsis. Frm 2012 t 2013 there was an increase fr bth males and females in Maricpa 59 Pa g e

Cunty n the ttal number f deaths due t alchl and drugs, thugh there appear t be fluctuatins thrughut the years. Figure 21. Adult Mrbidity fr Alchl and Drugs by Gender (2010, 2011, 2012, 2013) Adult mrbidity percentages cllected frm ADHS by ethnicity indicate that Whites and Hispanics typically have the highest percentages in ER primary diagnsis fr alchl and drugs. It als appears that Asian, White, Other and refused t identify have fluctuated thrughut the years; Blacks/African-Americans, Hispanics and Native Americans (slight decrease frm 2012 t 2013) have seen increases in adult mrbidity ER Primary Diagnsis fr Alchl and Drugs. Table 32. Adult Mrbidity, Emergency Rm Primary Diagnsis fr Alchl and Drug by Ethnicity 2010 2011 2012 2013 N (%) N (%) N (%) N (%) Asian 63 1% 52 0% 55 1% 49 0% Black r African 417 4% 497 5% 510 5% 516 5% American Hispanic r Latin 1787 18% 1911 18% 1945 18% 2059 19% Native American 858 9% 977 9% 1021 10% 1017 9% White 6702 67% 7226 67% 6967 66% 7257 66% Other 28 0% 35 0% 22 0% 47 0% Refused 138 1% 93 1% 82 1% 102 1% Mrbidity rates based n age indicate that 25-44 year lds have the highest number f ER primary diagnses fr alchl and drugs, with the secnd highest rates by thse 45-54 years f age. In additin, bth f these age categries have seen increases ver the fur year perid reprted belw. There is a steady increase fr ages 55-64 and 65+ ver time. The 18-20 year ld age grup has shwn decreases in mrbidity. Likewise the 21-24 year ld age grup has shwn decreases since 2011, thugh it still remains a higher number than in 2010. 60 Pa g e

Table 33. Adult Mrbidity Emergency Rm Primary Diagnses fr Alchl r Drug by Age Age Grups 2010 2011 2012 2013 18-20 548 599 569 533 21-24 890 1029 988 934 25-44 4213 4514 4359 4545 45-54 2346 2405 2382 2581 55-64 1039 1157 1212 1428 65+ 399 470 506 546 In additin t Emergency Rm data, ADHS prvided the numbers f alchl r drug related deaths frm 2010 thrugh 2013. There has been a 14% increase in such deaths frm 1,034 in 2010 t 1,174 in 2013. The majrity f these deaths were fr individuals between the ages f 45 and 64 (apprimately 51% r mre per year). This was fllwed by 27 % f the deaths between the ages f 25 and 44. Thus, abut 78% f alchl and drug related deaths were fr these tw age categries. Men die frm alchl r drug related causes at a greater rate than wmen. Overall men accunt fr 66% f these deaths (44% fr wmen). White nn Hispanics accunt fr 73 74% f these deaths with Hispanics accunting fr 17 18%. The fllwing is a list f the 2013 PCA s where ver 200 deaths ccurred due t drugs and alchl. Mst f these PCAs were als where deaths ccurred fr 2010, 2011, 2012. When eamining adult vs. yuth data, it appears as thugh yuth and yung adult mrbidity rates are slightly decreasing, while middle-aged and lder adults are increasing. Table 34. Ranking f PCAs where Deaths Occurred due t Drugs and Alchl Rank 2013 1 Central City Village 2 Mesa West 3 Deer Valley Village 4 Maryvale Village 5 Scttsdale Suth 6 Glendale Central 7 Paradise Valley Village 8 Nrth Muntain Village 9 Camelback East Village 10 Alhambra Village 11 Tempe Nrth 61 Pa g e

Data was disaggregated by PCA t identify alchl and drug related deaths fr the perid f 2010 thrugh 2013. Areas where alchl and/r drug related deaths ccurred fr the fur year perid include(indicated by an *): Alhambra Village, Camelback East Village, Deer Valley Village, Maryvale Village, Mesa West, Nrth Muntain Village, Paradise Valley Village, and Tempe Nrth. Of these PCA s nly Paradise Valley cnsistently appeared n the AYS has having high rates f yuth use. Table 35. Alchl and/r Drug Related Deaths by PCA per Year (N 200 deaths per year) PCA 2010 2011 2012 2013 *Alhambra Village X X X X *Camelback East Village X X X X Central City Village X X X *Deer Valley Village X X X X Encant Village X Glendale Central X X X Glendale Nrth X X *Maryvale Village X X X X *Mesa West X X X X *Nrth Muntain Village X X X X *Paradise Valley Village X X X X Scttsdale Suth Suth Muntain Village & Guadalupe. X X *Tempe Nrth X X X X Frm 2010 t 2013, there has been an increase in mrtality rates fr alchl and/r drugs fr mst age grups, with the majrity f deaths ccurring amng 11 t 17 year lds, fllwed by 25 t 44 year lds. Figure 22. Mrtality fr Alchl and/r Drugs by Age (2010, 2011, 2012, 2013) 62 Pa g e

In cmparing gender mrtality rates fr alchl and/r drugs, males cntinue t have higher rates than females, with bth males and females having substantial increases between 2012 and 2013. Figure 23. Mrtality fr Alchl and/r Drugs by Gender (2010, 2011, 2012, 2013) Eamining mrtality rates by ethnicity indicates that fr mst ethnic grups, rates are increasing while the majrity f deaths fr alchl and/r drugs are ccurring with White, Nn-Hispanics, fllwed by Hispanics/Latins. Figure 24. Mrtality fr Alchl and/r Drugs by Ethnicity (2010, 2011, 2012, 2013) Data fr drug related deaths in Maricpa Cunty fr 2010 2012 reveal that the majrity f deaths are fr accidental pisning fllwed by intentinal self-pisning by drugs, althugh much lwer in numbers when 63 Pa g e

cmpared t accidental pisning numbers. Hwever, there des appear t be a decrease in accidental pisning by drugs. Figure 25. Maricpa Cunty: Drug Related Deaths (2010, 2011, 2012) Alchl Related Crashes fr Maricpa Cunty Review f the Arizna Department f Transprtatin Crash data revealed: There has been a dramatic reductin in alchl related crashes frm 2007 t 2012 frm 5,055 t 3,366 r 33%. Fatalities have als decreased frm 168 112 r abut 66%. Table 36. Maricpa Cunty: Ttal Number f Alchl Related Crashes by Year 2007 2008 2009 2010 2011 2012 CRASHES 5055 4240 3601 3369 3503 3366 Fatality 157 122 104 89 106 104 PERSONS Injury 2128 1843 1594 1406 1442 1487 Prperty 2770 2275 1903 1901 1954 1775 Damage Killed 168 132 112 95 120 112 Injured 3416 2888 2418 2174 2219 2245 64 Pa g e

Maricpa Cunty data btained fr alchl related crashes shw that the majrity f incidents have included prperty damage r injury and data has shwn a decrease ver the last si years. Thugh there have been significant decreases in alchl related crashes, the perceptin f adults, accrding t the CVS, is that drunk driving and alchl-related crashes are the mst likely cnsequences related t underage drinking. Cautin must be used when analyzing adult perceptins, actual crash-related data and ther cnsequences (perceived r real) as the data cllectin methds may vary. Please refer t the Priritizatin tables fr a quantified apprach t priritize cnsequences by substance. Figure 26. Maricpa Cunty: Cnsequences frm Alchl Related Crashes (2007-2012) Althugh n cmprehensive usage survey data is cllected fr adults, Pheni Plice Department data cllected indicates the fllwing: An verall decrease in the ttal number f drug arrests frm 2004 2008 The mst ccurring t least ccurring ffenses were: Pssessin f Narctic Drugs Pssessin f drug paraphernalia Pssessin f dangerus drugs Pssessin f Marijuana Adult arrests and citatins fr drug ffenses reveal that the majrity f adults were arrested r given citatins fr pssessin f drug paraphernalia r pssessin f narctic drugs, hwever, this has seen decreases ver the years reprted. Table 37. Adult Arrests/Citatins fr Drug Offenses by the Pheni Plice Department Offense 2004 2005 2006 2007 2008 Ttal Pssessin f Dangerus Drugs 168 210 149 135 131 793 Pssessin f Drug Paraphernalia 312 274 257 268 221 1,332 Pssessin f Imitatin Cntrlled 1 1 0 0 0 2 Substance Pssessin f Marijuana 131 114 130 121 120 616 Pssessin f Narctic Drugs 209 183 185 239 201 1,017 65 Pa g e

Pssessin f Peyte 2 1 0 0 0 3 Pssessin f Prescriptin Drugs 3 5 2 3 2 15 Pssessin f Vapr-Releasing 0 0 0 1 0 1 Substance Sale f Precursr Chemicals 1 0 0 0 1 2 Use f Building fr Sale r 1 0 0 1 1 3 Manufacture f Drugs Use f Electrnic Cmmunicatin in 1 1 4 1 1 11 Drug Transactin Ttals* 459 437 420 462 410 2,188 *Ttals may nt reflect all citatins, as sme ffenders had multiple citatins during cntact r arrest. Cmmunity Views Survey (CVS) Results Mercy Maricpa preventin prviders administered the CVS t adults (18+) within their cmmunities in which adults were given the pprtunity t select frm a list the prblems/cnsequences that were ccurring as a result f alchl use amng the LGBTQ cmmunity and medicatin misuse amng lder adults. A ttal f 231 respndents participated in the LGBTQ CVS and the tp fur prblems/cnsequences were indicated fr alchl use amng LGBTQ adults: Driving under the influence (72.6%); Alchl abuse r addictin (61.7%); Vilence r getting int fights (49.1%) and Alchl-related car crashes (47.0%). CVS surveys were cllected frm a ttal f 626 adult respndents abut their perceptins f medicatin misuse amng lder adults (55+). The fllwing prblems/cnsequences were selected frm a list as being the tp fur prblems/cnsequences related t lder adults (55+) and medicatin misuse: Cnfusin/disrientatin (74.6%); Falls (73.0%); Overdse (66.0%); and Unepected prescriptin interactins (56.2%). Anecdtal data was als cllected via fcus grups and amng cmmunity grups wrking with lder adults and the fllwing cnsequences were indicated fr alchl use amng adults 55 and lder: Islatin Decrease in cgnitive acuity Falls Increase in chrnic health issues Anecdtal data was als cllected fr prescriptin drug use amng adults 55 and lder and the fllwing cnsequences were indicated: 66 Pa g e

Medicatin misuse Cntra indicated prescriptin interactins Nt keeping up t date list f medicatins Nt understanding what chrnic health issues medicatins are treating Ecnmic Csts Ecessive alchl cnsumptin csts states billins f dllars. In Arizna ecessive alchl cnsumptin, fr bth yuth and adults, csts the state 5.325 billin dllars ranking it 13 th in the cuntry. Of the 5.325 billin spent in Arizna as a result f ecessive alchl cnsumptin, apprimately $617 millin (11%) was spent n healthcare csts, $3.7 billin (69%) in lst prductivity and just under $1 billin (19%) in ther csts. Binge drinking amng all ages csts Arizna $4.1 billin, while underage binge drinking csts the state $533 millin. It is imprtant t nte that Maricpa Cunty level data is nt available; hwever it can be reasnably assumed that because Maricpa Cunty cmprises a majrity f Arizna s ppulatin that a majrity f these csts are frm Maricpa Cunty. 2 Adult Suicide Data regarding the number f injury related inpatient discharges fr selected internal causes (accidental pisning, drugs causing adverse effects, and suicide) fr 2008 2012 indicate that the majrity f inpatient discharges have been fr drugs causing adverse effects fr bth the state and Maricpa Cunty. Data shws there were increases between 2008 and 2011, with dramatic increases starting in 2009. Thugh a decline is evident frm 2011 t 2012, it still remained a significantly higher number than in 2008. Further data cllectin, with an emphasis n primary data, may be helpful t identify the increases in drugs causing adverse effects. Data als reveal that in each f the three selected internal causes, Maricpa Cunty represents at least half f all the ttal numbers when cmpared t Arizna verall. Accidental pisnings, hwever, saw slight but steady increases in inpatient discharges with a small decrease in 2011. Suicide related inpatient discharges have remained relatively stable between 2008-2012. 2 http://www.ajpmnline.rg/article/s0749-3797(13)00373-5/pdf 67 Pa g e

Figure 27. Maricpa Cunty vs. Arizna: Number f Injury Related Discharges (2008-2012) Surce: ADHS Data btained fr injury related emergency rm visits fr selected causes frm 2008-2012 indicate that the majrity f ER visits were frm cutting r piercing instruments, fllwed by suicide. It is imprtant t nte that that Maricpa Cunty makes up fr mre than half f all ER visits related t suicide when cmpared t the state verall and numbers have remained relatively unchanged since 2009, althugh there was an increase f 26% frm 2008 t 2012. Pisnings have increased 32% verall frm 2008 t 2012. 68 Pa g e

Figure 28. Maricpa Cunty vs. State f Arizna Number f Injury Related Emergency Rm Visits (2008-2012) Surce: ADHS 4. Priritized tp 3 5 Substance Related Behavirs r Trends Cntributing t Cnsequences Please refer t priritizatin prcess n page 16 and Appendi G fr a detailed eplanatin f scring prcess and cnclusins. The narrative belw describes data cllected n substance related behavirs and trends. Yuth Alchl and Marijuana Cnsumptin and Cnsequences Apprimately 28% f yuth reprt drinking alchl within the past 30 days, and althugh AYS reprts a reductin f past 30-day alchl use, there are still abut 40% f yuth wh indicated they had drank alchl. Additinally, AYS reprted a 3% increase f yuth marijuana use since 2008. The average age f alchl cnsumptin is 12.9 years ld. Binge drinking is anther behavir cntributing t underage drinking cnsequences with 15.7% f yuth reprting having participated in binge drinking within the past tw weeks. Behaviral trends cntributing t the cnsequences fr yuth alchl and marijuana cnsist f risk factrs assciated with nt feeling cnnected t their cmmunity r schl; lw perceptin f risk, particularly surrunding marijuana use with the mied messaging f medical marijuana, including that yuth indicate there is mre risk in harm with alchl use than there is with marijuana use; and easy access fr bth alchl and marijuana. 69 Pa g e

LGBTQ Cnsumptin and Cnsequences Trends assciated with LGBTQ adult alchl cnsumptin included: mre than half (64%) f all adults surveyed indicated they used alchl in the past 30 days, LGBTQ adults believe that ther LGBTQ adults drink an average f 2-4 days per week and LGBTQ adults d nt think that 2 fr 1 drink specials encurage ecessive alchl cnsumptin. Data cllected by the LGBTQ Cnsrtium indicated the fllwing cnsequences as a result f adult alchl use: Engaged in unprtected se Did smething they later regretted Frgt where they were/what they did Victim r perpetratr f seual assault r rape Seriusly cnsidered The abve stated cnsequences were als indicated fr marijuana by LGBTQ adults wh participated in the LGBTQ Cnsrtium s Service t Science data cllectin effrts. Yuth Prescriptin Drug Use Cnsumptin and Cnsequences Fr misuse f prescriptin drugs by yuth trends cnsisted f: yuth are eperimenting with prescriptin drugs at a yunger age and mre than half f yuth stated they btained prescriptin drugs frm friends (54.4%) and at hme (24.4%). Althugh cnsequences are nt cllected fr yuth fr prescriptin drugs, primary data cllected indicated that yuth self-medicating is ccurring as a result f prescriptin drug use. Older Adults Cnsumptin and Cnsequences Data was als shared with Mercy Maricpa by a cmmunity rganizatin specifically wrking with lder adults (age 55+) and the fllwing infrmatin was gathered. Alchl cnsumptin - Thrugh qualitative data gathering, the MEBHAC Calitin was able t identify cnsumptin data amng lder adults. The Natinal Institute f Alchl Abuse and Alchlism (2008) fund that 40% f adults 65 and ver drink alchl. The Centers fr Disease Cntrl (CDC, 2010) reprts that binge drinking amng lder adults is a new, increasing cncern. Fcus grup data reveals that lder adults drink scially with peers, at events r with dinner. Primary data als indicates miing alchl with prescriptin drugs; 4% f participating in the CVS see n harm in miing alchl and prescriptin drugs. Older adults invlved in data cllectin d nt view lder adult alchl cnsumptin as dangerus as yuth cnsumptin. Primary data cllectin als disclses that because lder adults drink a glass r tw f wine (r ccktails) with dinner and with friends, it becmes part f their daily scial rutine. Further data cllectin is needed, but primary data als insinuated that during retirement drinking begins earlier and earlier the mre int retirement they get. Prescriptin drugs - Older adult prescriptin drug cnsumptin des nt seem t indicate the use f prescriptin drugs with any particular cnsumptin patterns. Prescriptin drugs are used (r misused) based 70 Pa g e

n directins frm their physicians r when they felt it was needed. Older adults reprt nt using prescribed medicatins as directed because they felt they did nt wrk; they als reprt using the prescriptin medicatins f thers if they felt it was needed. Yuth and Adult Suicide Suicide is bth an issue/trend as well as a cnsequence. Hwever, mre data is needed t supprt the latter. The majrity f suicides cmpleted between 2010 and 2013 ccurred with individuals between 45 t 65 years f age and individuals 65+ years ld, althugh the age-adjusted rate shws 65+ having the highest rate. Similarly, while yuth are nt cmpleting suicide with the same numbers as adults (and lder adults), there is high prevalence f suicidal ideatin (19.2%), plans t cmplete (17.4%) and attempts (10.6%). 5. Intervening Variables/Causal Factrs Data cllected fr intervening variables/causal factrs were priritized in the same manner as previusly referenced n page 16. See Appendi G fr Priritizatin wrksheets. Evidence based quantitative data cllectin tls such as the AYS d nt cllect intervening variables (i.e. risk factrs) by substance. Qualitative data prcesses, similarly, did nt cnsistently identify specific intervening variables fr each substance if multiple substances r issues were mentined. Primary and secndary data did shw cmmn intervening variables/risk factrs acrss all substances. This can ptentially be attributed t intervening variables/risk factrs being the rt cause f issues, as ppsed t the substances themselves. AYS risk factrs are reprted fr all substances and rganized by risk and prtective factr dmains (cmmunity/envirnmental, family, schl, individual). The fllwing substance related trends cntributing t cnsequences are listed belw based n primary data cllected fr yuth. Over-arching themes included: Yuth self-medicating as a means f dealing with life Yuth self-medicating in lieu f taking prescribed psychiatric medicatins Lack f yuth having the ability t knw hw t cpe with things Primary data cllected as part f this needs assessment infrmed the trends listed abve that are cntributing t the cnsequences as this is a gap in the data that is available fr yuth. Yuth self-medicatin was a finding cnsistent with the fcus grup, key infrmant, and yuth suicide data cllected. Self-medicatin included the use f alchl and substances such as marijuana, prescriptin drugs, and illegal drugs and was mentined as having a crrelatin with attempts r cmpletins f yuth suicide. Fr adults, ne f the prevalent behavirs apparent in the primary data included self-medicatin with alchl and substances (marijuana, prescriptin drugs and illegal drugs). There were high crrelatins that were mentined fr adults regarding self-medicatin and suicide attempts and cmpletins. As secndary data is currently nt being cllected n these factrs, it warrants further eplratin fr data cllectin. 71 Pa g e

Substance Use As mentined, bth primary and secndary data was gathered fr intervening variables and causal/risk factrs. The fllwing table summarizes bth primary and secndary data and what surce the infrmatin came frm. Figures 29 31 reprt detailed infrmatin frm the AYS fr 8, 10, and 12 grades in which the AYS reprted fr all substances cmbined. These risk factrs are als included in Table 32. Cmmn themes acrss multiple substances that were identified in bth quantitative and qualitative data included: Easy access Lack f schl cnnectin Peer pressure Lack f educatin 72 Pa g e

Table 38. Yuth Issues listed by Intervening Variables and Risk Factrs and Data Surce Substance/Issue Intervening Variables/Risk Factrs Identified in Quantitative Data Alchl Easy access X Identified in Qualitative Data X Identified in Bth X Lack f cnnectin with the cmmunity X Marijuana Favrable parent attitudes Family nrms/rite f passage Limited schl resurces Lack f schl cnnectin Peer pressure Lack f educatin Lack f cping skills Easy access X X X X X X X X X X X X X X X X Lack f cnnectin with the cmmunity Scial acceptance f medical marijuana X X X X Favrable parent attitudes X Limited schl resurces X Lack f schl cnnectin X X X Prescriptin drugs Suicide Yuth perceive marijuana as less harmful than alchl and ther drugs Peer pressure Lack f educatin Self-medicating Lack f cping skills Easy access Lack f cping skills Adults/parents dn t have skills t seek help Lack f yuth cnnectin t the cmmunity X X X X X X X X X X X X X X X X X X X Lack f schl cnnectin X X X Peer pressure Depressin X X Lack f cping skills X Self-medicating X Bullying X Undiagnsed mental health issues X 73 Pa g e

Figure 29. Maricpa Cunty: AYS Risk Factrs 8th Grade (2008, 2010, 2012) Figure 30. Maricpa Cunty: AYS Risk Factrs 10th Grade (2008, 2010, 2012) 74 Pa g e

Figure 31. Maricpa Cunty: AYS Risk Factrs 12th Grade (2008, 2010, 2012) Qualitative data gathered frm surveys, fcus grups, and key infrmant interviews indicated several key factrs fr yuth using substances fr the fllwing risk factr dmains: Cmmunity/Envirnmental Easy access t marijuana edibles and yuth unintentinally getting high Lack f yuth cnnectin t the cmmunity and feeling part f the cmmunity Lack f things t d in the cmmunity Lack f plice presence in the cmmunity Access t substances in general and can be fund in mst schls and cmmunities if there is that want by the yuth; many respndents indicated that it is ften easier t btain marijuana than alchl Medical marijuana has cntributed t an increase f scial acceptance f marijuana use Family Favrable parent attitudes and invlvement in the prblem behavir Family nrms as yuth see their parents drinking alchl regularly Yuth see their parents and adults with medical marijuana cards and perceive little t n risk t marijuana use since they dn t see any negative effects f their parents using Alchl and marijuana use is seen as a rite f passage fr yuth Increase in single parent hmes Undcumented families fear accessing services Adults/parents d nt have skills t seek help, make phne calls, appintments, etc. 75 Pa g e

Schl Limited schl resurces Schl campuses have becme ne stp shps in that parents feel schl persnnel shuld be respnsible fr mnitring substance use and als prviding behaviral health services Funding cuts have reduced the number f schl mnitrs n campus t mnitr student behavirs and activities Lack f yuth cnnectin t their schl Yuth are ending up in charter schls that are ill equipped t handle substance abuse High schls lack schl mnitrs and security Peer /Individual Yuth perceive marijuana as less harmful than alchl Peer pressure Lack f educatin n substance use Using substances t self-medicate and deal with prblems r mental health issues Yuth self-medicating because parents dn t believe in psychiatric medicatin Depressin Anger issues Trauma Lack f the yuths ability t knw hw t cpe with things Yuth Suicide Qualitative data cllected revealed similar causal factrs fr yuth suicide that were indicated fr substance use that can lead t suicide attempts and cmpletins: Cmmunity Family Nt feeling cnnected t the cmmunity Lack f things t d in the cmmunity Suicide is a culturally tab tpic Suicide nt taken seriusly Stigma assciated with suicide Increase in single parent hmes Adults/parents d nt have skills t seek help, make phne calls, appintments, etc. Schl Lack f yuth cnnectin t schl 76 Pa g e

Peer /Individual Lack f the yuths ability t knw hw t cpe with things Peer pressure Stress Using substances t self-medicate and deal with prblems r mental health issues Yuth self-medicating because parents dn t believe in psychiatric medicatin Depressin Bullying Undiagnsed mental health issues Discriminatin Adult Suicide Data cllected frm fcus grups, key infrmant interviews, and surveys indicated the intervening variables fr adult suicide were in the general themes f: Grief Lss f spuse Islatin hpelessness Mental health issues (trauma, depressin, stress) Physical illness Adults lack access t care Adult stress Lack f supprt and resurces Self-medicatin Adult Causal Factrs Data cllected fr intervening variables implies there is significant crss-ver in terms f what the intervening variables are that are causing the substance abuse and suicide issues. As is always a challenge t determine, it is nt knwn if the substance use issues are causing the mental health issues r vice versa. In either way, qualitative and quantitative data are ehibiting that ptential issues are mre related t causal factrs causing issues with multiple substances. This pssibility is further strengthened by the cmmnalities with causal factrs cntributing t suicide attempts and cmpletins. The 2010 Arizna Health Survey (ASU and St. Luke s Health Initiative) reveals that adults that either have a mental illness r have eperienced psychlgical distress within the last 30 days, they are mre prne t binge drink. 77 Pa g e

Further data cllectin (mainly primary data) is needed t distinguish between sme intervening variables and cnsequences. Fr eample, lder adults are reprting alchl use due t depressin, cnsequently leading t a decreased interest in participating in activities. Similarly, increased health issues are a cncern related t lder adult alchl cnsumptin; hwever, mre data is need t determine whether these health issues are eacerbated by alchl use (cnsequence) r if alchl cnsumptin is a frm f self-medicatin t cpe with these health issues. This can either be a cnsequence f alchl cnsumptin, a cntributing factr t alchl cnsumptin r a cmbinatin f bth. Scial nrms, such as cnsuming alchl at dinner, with friends r at events, are cntributing factrs t lder adult alchl cnsumptin. Arizna is an ideal destinatin fr retirees; because f this, many lder adults live in cmmunities eclusive t lder adults. These cmmunities can ften prmte the scial nrming assciated with lder adult alchl cnsumptin. Primary data cllectin als shws that lder adults may nt be aware f their behavir, but many self-medicate with alchl after the lss f a lved ne, the lss f independence (further data cllectin needed) and/r a change in lifestyle. 6. Prtective Factrs Prtective factrs are imprtant cnsideratins when develping strategies t address substance use and suicide issues, particularly t encurage strength based slutins. A cmbinatin f data was cllected frm the AYS and key infrmant interviews and fcus grups cnducted. As is similar with risk factr data cllected, typically the data is nt available by substance r issue and all substances are lumped tgether in the AYS. The fllwing figures reprt AYS prtective factr data by dmain fr 8, 10, and 12 grades. Figure 32. Maricpa Cunty: AYS Prtective Factrs 8th Grade (2008, 2010, 2012) 78 Pa g e

Figure 33. Maricpa Cunty: AYS Prtective Factrs 10th Grade (2008, 2010, 2012) Figure 34. Maricpa Cunty: AYS Prtective Factrs 12th Grade (2008, 2010, 2012) Mre than half f all students acrss grades 8, 10, and 12 reprted high prtective factrs verall and similar percentages fr each grade. In 2012, 8 th and 10 th graders reprted the highest prtectin factr in the peer/individual dmain f belief in mral rder, while 12 th graders reprted their highest prtective factr in 79 Pa g e

the schl dmain in the pprtunities fr pr-scial invlvement item. Aggregate qualitative data cllected indicated prtective factrs in the fllwing tpical areas (rganized by dmain): Cmmunity Resiliency Families that have lived in the cmmunity fr a lng time Churches as resurces Family Traditinal cultural values Family pride Family invlvement Schl Safety Teachers that care Opprtunities fr pr-scial invlvement Peer/Individual Resiliency Cultural pride Scial cmpetence 7. Cmmunity Readiness Cmmunity Readiness Preventin Surveys (CRPS) were cnducted by 12 Mercy Maricpa preventin prviders in Nvember 2014 in cllabratin with cmmunity calitins. The prvider and calitin culd select a substance that they wanted t assess in their targeted cmmunity ranging frm alchl, marijuana, ther drugs, and issues specific t a targeted ppulatin such as lder adults and LGBTQ. As such, an verall readiness scre is prvided by cmmunity by substance. Cmmunity readiness t address the tpic f yuth marijuana use within the Mesa cmmunity results suggest that the Mesa cmmunity is in the Preparatin stage f readiness (5.1). The CRPS was administered t 46 peple that have knwledge f the Mesa cmmunity and have sme cnnectin t the tpic f yuth marijuana use. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Preparatin stage indicates that leaders in the cmmunity are planning ut preventin strategies within the cmmunity, and that the cmmunity is supprtive f effrts t address the issue, but there is still a need t infrm cmmunity members abut thse preventin effrts. 80 Pa g e

Table 39. Mesa Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 5.1 Readiness Stage Preparatin Substance/Issue Yuth Marijuana Use Demgraphics Number 1 Percent 2 Ttal Number f Respndents 46 100% Gender Male 22 84.6% Female 4 15.4% Race Black/African American 2 5.0% Caucasian/White 32 80.0% Multiracial 3 7.5% Other 3 7.5% Ethnicity Hispanic/Latin 13 32.5% Nn-Hispanic/Latin 27 67.5% Calitin Memberships Status Nn-Calitin Member 37 80.4% Calitin Member 9 19.6% Sectr (Number f Respndents) Behaviral health, preventin, recvery (4) Law enfrcement agencies (3) Business (2) Media (0) Civic and vlunteer grups (2) Schls and educatin (6) Cmmunity resident/family member (5) State, lcal, r tribal gvernmental agencies (1) Faith-based rganizatins (5) Yuth (6) Healthcare prfessinals (2) Yuth serving rganizatins (3) Other (2) N Respnse (5) 1. Sme respndents did nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. 81 Pa g e

Figure 35. Mesa CRPS Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Yuth Marijuana Use Suth Scttsdale Cmmunity Cmmunity readiness t address the tpic f yuth marijuana use within the Suth Scttsdale cmmunity results suggest that the Suth Scttsdale cmmunity is in the Preparatin stage f readiness (5.4). The CRPS was administered t 66 peple that have knwledge f the Suth Scttsdale cmmunity and have sme cnnectin t the tpic f yuth marijuana use. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Preparatin stage indicates that leaders in the cmmunity are planning ut preventin strategies within the cmmunity, and that the cmmunity is supprtive f effrts t address the issue, but there is still a need t infrm cmmunity members abut thse preventin effrts. 82 Pa g e

Table 4. Suth Scttsdale Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 5.4 Readiness Stage Preparatin Substance/Issue Yuth Marijuana Use Demgraphics Number 1 Percent 2 Ttal Number f Respndents 66 100% Gender Male 27 52.9% Female 23 45.1% Transgender 1 2.0% Race American Indian/Alaskan Native 1 1.7% Black/African American 3 5.0% Caucasian/White 46 76.6% Multiracial 6 10.0% Other 4 6.7% Ethnicity Hispanic/Latin 25 43.1% Nn-Hispanic/Latin 33 56.9% Calitin Memberships Status Nn-Calitin Member 39 60.9% Calitin Member 25 39.1% Sectr (Number f Respndents) Behaviral health, preventin, recvery Law enfrcement agencies (5) (4) Business (9) Media (1) Civic and vlunteer grups (4) Schls and educatin (6) Cmmunity resident/family member (10) State, lcal, r tribal gvernmental agencies (9) Faith-based rganizatins (3) Yuth (7) Healthcare prfessinals (0) Yuth serving rganizatins (2) Other (2) N Respnse (4) 1. Sme respndents did nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. 83 Pa g e

Figure 36. Suth Scttsdale CRPS Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Yuth Marijuana Use Suth Muntain Cmmunity Cmmunity readiness t address the tpic f yuth marijuana use within the Suth Muntain cmmunity in Pheni results suggest that the Suth Muntain cmmunity is in the Preparatin stage f readiness (5.0). The CRPS was administered t 35 peple that have knwledge f the Suth Muntain cmmunity and have sme cnnectin t the tpic f yuth marijuana use. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Preparatin stage indicates that leaders in the cmmunity are planning ut preventin strategies within the cmmunity, and that the cmmunity is supprtive f effrts t address the issue, but there is still a need t infrm cmmunity members abut thse preventin effrts. 84 Pa g e

Table 41. Suth Muntain Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 5.0 Readiness Stage Preparatin Substance/Issue Yuth Marijuana Use Demgraphics Number 1 Percent 2 Ttal Number f Respndents 35 100% Gender Male 17 85.0% Female 1 5.0% Transgender 2 10.0% Race American Indian/Alaskan Native 1 3.0% Black/African American 11 33.3% Caucasian/White 12 36.4% Multiracial 5 15.2% Other 4 12.1% Ethnicity Hispanic/Latin 10 31.3% Nn-Hispanic/Latin 22 68.8% Calitin Memberships Status Nn-Calitin Member 20 57.1% Calitin Member 15 42.9% Sectr (Number f Respndents) Behaviral health, preventin, recvery (4) Law enfrcement agencies (4) Business (3) Media (0) Civic and vlunteer grups (2) Schls and educatin (6) Cmmunity resident/family member (2) State, lcal, r tribal gvernmental agencies (4) Faith-based rganizatins (3) Yuth (3) Healthcare prfessinals (0) Yuth serving rganizatins (2) N Respnse (2) 1. Sme respndents did nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. 85 Pa g e

Figure 37. Suth Muntain CRPS Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Yuth Marijuana Use Sunnyslpe Cmmunity Cmmunity readiness t address the tpic f yuth marijuana use within the Sunnyslpe cmmunity in Pheni results suggest that the Sunnyslpe cmmunity is in the Preplanning stage f readiness (4.5). The CRPS was administered t 34 peple that have knwledge f the Sunnyslpe cmmunity and have sme cnnectin t the tpic f yuth marijuana use. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Preplanning stage indicates that there is clear recgnitin that actin must be taken t address yuth marijuana use in the cmmunity, but there is still a need t fcus effrts n frmulating actins t address the issue. Table 42. Sunnyslpe Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 4.5 Readiness Stage Preplanning Substance/Issue Yuth Marijuana Use Demgraphics Number 1 Percent 2 Ttal Number f Respndents 34 100% Gender Male 17 65.4% Female 9 34.6% Race Black/African American 7 21.2% Caucasian/White 18 54.6% Multiracial 1 3.0% Other 7 21.2% Ethnicity Hispanic/Latin 15 46.9% Nn-Hispanic/Latin 17 53.1% Calitin Memberships Status 86 Pa g e

Nn-Calitin Member 21 65.6% Calitin Member 11 34.4% Sectr (Number f Respndents) Behaviral health, preventin, recvery (2) Law enfrcement agencies (2) Business (5) Media (1) Civic and vlunteer grups (1) Schls and educatin (4) Cmmunity resident/family member (2) State, lcal, r tribal gvernmental agencies (3) Faith-based rganizatins (3) Yuth (2) Healthcare prfessinals (3) Yuth serving rganizatins (2) Other (2) N Respnse (2) did nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. 1. Sme respndents The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. Figure 38. Sunnyslpe Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Yuth Marijuana Use The Greater Buckeye Valley Cmmunity readiness t address the tpic f underage alchl use within the Greater Buckeye Valley cmmunity results shw that the Greater Buckeye Valley cmmunity is in the Initiatin stage f readiness (6.1). The CRPS was administered t 42 peple that have knwledge f the Greater Buckeye Valley cmmunity and have sme cnnectin t the tpic f underage drinking. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Initiatin stage indicates that effrts t address underage drinking have been justified and that activities within the cmmunity t address the issue have begun. 87 Pa g e

Table 5. Greater Buckeye Valley Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 6.1 Readiness Stage Initiatin Substance/Issue Underage Alchl Use Demgraphics Number 1 Percent 2 Ttal Number f Respndents 42 100% Gender Male 19 70.4% Female 5 18.5% Transgender 3 11.1% Race Black/African American 4 11.4% Caucasian/White 27 77.1% Multiracial 1 2.9% Other 3 8.6% Ethnicity Hispanic/Latin 8 26.7% Nn-Hispanic/Latin 22 73.3% Calitin Memberships Status Nn-Calitin Member 25 61.0% Calitin Member 16 39.0% Sectr (Number f Respndents) Behaviral health, preventin, recvery Law enfrcement agencies (2) (1) Business (3) Media (3) Civic and vlunteer grups (3) Schls and educatin (4) Cmmunity resident/family member (3) State, lcal, r tribal gvernmental agencies (3) Faith-based rganizatins (4) Yuth (3) Healthcare prfessinals (2) Yuth serving rganizatins (0) N Respnse (9) 1. Sme respndents did nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. 88 Pa g e

Figure 39. Greater Buckeye Valley Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Underage Alchl Use Tempe Cmmunity Cmmunity readiness t address the tpic f underage alchl use within the Tempe cmmunity results shw that the Tempe cmmunity is in the Preparatin stage f readiness (5.4). The CRPS was administered t 76 peple that have knwledge f the Tempe cmmunity and have sme cnnectin t the tpic f underage drinking. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Preparatin stage indicates that leaders in the cmmunity are planning ut strategies t address the issue, and that many peple in the cmmunity are supprtive f thse effrts, understand the issue, and sme are ready t participate in the underage drinking preventin effrts. 89 Pa g e

Table 44. Tempe Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 5.4 Readiness Stage Preparatin Substance/Issue Underage Alchl Use Demgraphics Number 1 Percent 2 Ttal Number f Respndents 76 100% Gender Male 38 92.7% Female 1 2.4% Transgender 2 4.9% Race Asian American r Asian 1 1.6% Black/African American 4 6.3% Caucasian/White 50 78.0% Multiracial 3 4.7% Other 6 9.4% Ethnicity Hispanic/Latin 12 18.7% Nn-Hispanic/Latin 52 81.3% Calitin Memberships Status Nn-Calitin Member 48 64.0% Calitin Member 27 36.0% Sectr (Number f Respndents) Behaviral health, preventin, recvery Law enfrcement agencies (3) (3) Business (4) Media (3) Civic and vlunteer grups (7) Schls and educatin (18) Cmmunity resident/family member (3) State, lcal, r tribal gvernmental agencies (4) Faith-based rganizatins (4) Yuth (7) Healthcare prfessinals (3) Yuth serving rganizatins (4) N Respnse (13) 1. Sme respndents did nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. 90 Pa g e

Figure 40. Tempe Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Underage Alchl Use Chandler Cmmunity Cmmunity readiness t address the tpic f underage alchl use within the Chandler cmmunity results shw that the Chandler cmmunity is in the Preplanning stage f readiness (4.9). The CRPS was administered t 33 peple that have knwledge f the Chandler cmmunity and have sme cnnectin t the tpic f underage drinking. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Preplanning Stage indicates that there is clear recgnitin that actin must be taken t address underage drinking, but there is still a need t fcus effrts n frmulating actins t address the issue. Table 45. Chandler Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 4.9 Readiness Stage Substance/Issue Preplanning Underage Alchl Use Demgraphics Number 1 Percent 2 Ttal Number f Respndents 33 100% Gender Male 11 36.7% Female 18 60.0% Decline t Answer 1 3.3% Race Black/African American 2 6.3% Caucasian/White 24 75.0% Multiracial 4 12.4% Other 2 6.3% Ethnicity Hispanic/Latin 11 36.7% Nn-Hispanic/Latin 19 63.3% 91 Pa g e

Calitin Memberships Status Nn-Calitin Member 29 90.6% Calitin Member 3 9.4% Sectr (Number f Respndents) Behaviral health, preventin, recvery (3) Law enfrcement agencies (3) Business (3) Media (2) Civic and vlunteer grups (2) Schls and educatin (3) Cmmunity resident/family member (3) State, lcal, r tribal gvernmental agencies (2) Faith-based rganizatins (3) Yuth (3) Healthcare prfessinals (3) Yuth serving rganizatins (3) 1. Sme respndents did nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. Figure 41. Chandler Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Underage Alchl Use LGBTQ Cmmunity in Maricpa Cunty Cmmunity readiness t address the tpic f tbacc use within the LGBTQ cmmunity in Maricpa Cunty results suggest that the LGBTQ cmmunity is in the Preplanning stage f readiness (4.5). The CRPS was administered t 40 peple that have knwledge f the LGBTQ cmmunity and have sme cnnectin t the tpic f tbacc use. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Preplanning Stage indicates that there is clear recgnitin that actin must be taken t address tbacc use, but there is still a need t fcus effrts n frmulating actins t address the issue. 92 Pa g e

Table 46. LGBTQ Cmmunity in Maricpa Cunty Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 4.5 Readiness Stage Preplanning Substance/Issue LGBTQ Adult Tbacc Use Demgraphics Number 1 Percent 2 Ttal Number f Respndents 40 100% Gender Male 19 50.0% Female 15 39.5% Gender Variant 2 5.3% Transgender 1 2.6% Decline t Answer 1 2.6% Race American Indian/Alaskan Native 1 2.7% Black/African American 2 5.4% Caucasian/White 27 73.0% Multiracial 4 10.8% Other 3 8.1% Ethnicity Hispanic/Latin 6 16.7% Nn-Hispanic/Latin 30 83.3% Calitin Memberships Status Nn-Calitin Member 29 74.4% Calitin Member 10 25.6% Sectr (Number f Respndents) Behaviral health, preventin, recvery (10) Law enfrcement agencies (0) Business (0) Media (2) Civic and vlunteer grups (1) Schls and educatin (3) Cmmunity resident/family member (5) State, lcal, r tribal gvernmental agencies (2) Faith-based rganizatins (0) Yuth (1) Healthcare prfessinals (1) Yuth serving rganizatins (5) Other (1) N Respnse (9) 1. Sme respndents did nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. 93 Pa g e

Figure 42. LGBTQ Cmmunity in Maricpa Cunty Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status LGBTQ Adult Tbacc Use Urban Native American Cmmunity in Maricpa Cunty (Suicide) Cmmunity readiness t address the tpic f suicide amng urban Native Americans in Maricpa Cunty results suggest that the urban Native American cmmunity in Maricpa Cunty is in the Preparatin stage f readiness (5.0). The CRPS was administered t 33 peple that have knwledge f the urban Native American cmmunity and have sme cnnectin t the tpic f suicide. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Preparatin stage indicates that leaders in the cmmunity are planning ut preventin strategies within the cmmunity, and that the cmmunity is supprtive f effrts t address the issue, but there is still a need t infrm cmmunity members abut thse preventin effrts. Table 6. Urban Native American Cmmunity in Maricpa Cunty Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 5.0 Readiness Stage Preparatin Substance/Issue Native American Suicide Demgraphics Number 1 Percent 2 Ttal Number f Respndents 33 100% Gender Male 20 83.3% Female 3 12.5% Interse 1 4.2% Race American Indian r Alaskan Native 23 76.7% Black/African American 1 3.3% Caucasian/White 5 16.7% Other 1 3.3% Ethnicity 94 Pa g e

Hispanic/Latin 2 7.1% Nn-Hispanic/Latin 26 92.9% Calitin Memberships Status Nn-Calitin Member 18 54.5% Calitin Member 15 45.5% Sectr (Number f Respndents) Behaviral health, preventin, recvery (4) Law enfrcement agencies (3) Business (2) Media (2) Civic and vlunteer grups (3) Schls and educatin (4) Cmmunity resident/family member (3) State, lcal, r tribal gvernmental agencies (1) Faith-based rganizatins (1) Yuth (2) Healthcare prfessinals (1) Yuth serving rganizatins (3) Other (1) N Respnse (3) did nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. 1. Sme respndents The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. Figure 43. Urban Native American Cmmunity in Maricpa Cunty Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Native American Suicide Urban Native American Cmmunity in Maricpa Cunty (Prescriptin Drug Misuse) Cmmunity readiness t address the tpic f prescriptin drug misuse amng urban Native Americans in Maricpa Cunty results suggest that the urban Native American cmmunity in Maricpa Cunty is in the Preplanning Stage f readiness (4.9). The CRPS was administered t 39 peple that have knwledge f the urban Native American cmmunity and have sme cnnectin t the tpic f prescriptin drug misuse. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Preplanning stage indicates that there is clear recgnitin that actin must be taken t address 95 Pa g e

prescriptin drug misuse amng urban Native Americans in the cmmunity, but there is still a need t fcus effrts n frmulating actins t address the issue. Table 7. Urban Native American Cmmunity in Maricpa Cunty Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 4.9 Readiness Stage Preplanning Substance/Issue Native American Prescriptin Drug Misuse Demgraphics Number 1 Percent 2 Ttal Number f Respndents 39 100% Gender Male 16 57.1% Female 10 35.7% Transgender 1 3.6% Decline t Answer 1 3.6% Race American Indian r Alaskan Native 25 75.8% Black/African American 1 3.0% Caucasian/White 4 12.1% Multiracial 3 9.1% Ethnicity Hispanic/Latin 4 12.5% Nn-Hispanic/Latin 28 87.5% Calitin Memberships Status Nn-Calitin Member 24 61.5% Calitin Member 15 38.5% Sectr (Number f Respndents) Behaviral health, preventin, recvery Law enfrcement agencies (2) (2) Business (1) Media (2) Civic and vlunteer grups (2) Schls and educatin (4) Cmmunity resident/family member (5) State, lcal, r tribal gvernmental agencies (3) Faith-based rganizatins (3) Yuth (2) Healthcare prfessinals (5) Yuth serving rganizatins (1) Other (2) N Respnse (5) 1. Sme respndents did nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. 96 Pa g e

Figure 44. Urban Native American Cmmunity in Maricpa Cunty Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Native American Prescriptin Drug Misuse Older Adults in Maricpa Cunty (Alchl) Cmmunity readiness t address the tpic f alchl use amng lder adults ver the age 55 in Maricpa Cunty results suggest that the lder adult cmmunity in Maricpa Cunty is in the Preplanning stage f readiness (4.4). The CRPS was administered t 43 peple that have knwledge f the lder adult cmmunity and have sme cnnectin t the tpic f alchl use. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Preplanning Stage indicates that there is clear recgnitin that actin must be taken t address alchl use, but there is still a need t fcus effrts n frmulating actins t address the issue. Table 49. Older Adults in Maricpa Cunty Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 4.4 Readiness Stage Preplanning Substance/Issue Older Adult Alchl Use Demgraphics Number 1 Percent 2 Ttal Number f Respndents 43 100% Gender Male 25 86.2% Female 3 10.3% Transgender 1 3.4% Race Black/African American 1 2.6% Caucasian/White 35 92.1% Other 2 5.3% Ethnicity 97 Pa g e

Hispanic/Latin 5 12.8% Nn-Hispanic/Latin 34 87.2% Calitin Memberships Status Nn-Calitin Member 38 88.4% Calitin Member 5 11.6% Sectr (Number f Respndents) Behaviral health, preventin, recvery (4) Law enfrcement agencies (4) Business (1) Media (1) Civic and vlunteer grups (1) Schls and educatin (2) Cmmunity resident/family member (5) State, lcal, r tribal gvernmental agencies (6) Faith-based rganizatins (1) Yuth (0) Healthcare prfessinals (9) Yuth serving rganizatins (0) Other (5) N Respnse (4) nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. 1. Sme respndents did The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. Figure 45. Older Adults in Maricpa Cunty Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Older Adult Alchl Use Older Adults in Maricpa Cunty (Prescriptin Drug Misuse) Cmmunity readiness t address the tpic f prescriptin drug misuse amng lder adults ver the age 55 in Maricpa Cunty was measured in 2014 by using the Cmmunity Readiness Preventin Survey (CRPS). The results f the survey suggest that the lder adult cmmunity is in the Preplanning stage f readiness (4.4). The CRPS was administered t 45 peple that have knwledge f the lder adult cmmunity and have sme cnnectin t the tpic f prescriptin drug misuse. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Preplanning Stage indicates that there 98 Pa g e

is clear recgnitin that actin must be taken t address prescriptin drug misuse, but there is still a need t fcus effrts n frmulating actins t address the issue. Table 50. Older Adults in Maricpa Cunty Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 4.4 Readiness Stage Preplanning Substance/Issue Older Adult Prescriptin Drug Misuse Demgraphics Number 1 Percent 2 Ttal Number f Respndents 45 100% Gender Male 29 85.3% Female 5 14.7% Race Asian American/Asian 1 2.6% Black/African American 2 5.1% Caucasian/White 35 89.7% Other 1 2.6% Ethnicity Hispanic/Latin 4 10.5% Nn-Hispanic/Latin 34 89.5% Calitin Memberships Status Nn-Calitin Member 40 88.9% Calitin Member 5 11.1% Sectr (Number f Respndents) Behaviral health, preventin, recvery (3) Law enfrcement agencies (0) Business (2) Media (3) Civic and vlunteer grups (2) Schls and educatin (2) Cmmunity resident/family member (3) State, lcal, r tribal gvernmental agencies (5) Faith-based rganizatins (4) Yuth (0) Healthcare prfessinals (8) Yuth serving rganizatins (1) Other (6) N Respnse (6) 1. Sme respndents did nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. 99 Pa g e

Figure 46. Older Adults in Maricpa Cunty Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Older Adult Prescriptin Drug Misuse African American Cmmunity in Maricpa Cunty (Yuth Suicide) Cmmunity readiness t address the tpic f suicide amng African American yuth in Maricpa Cunty results suggest that the African-American cmmunity in Maricpa Cunty is in the Preplanning stage f readiness (4.9). The CRPS was administered t 56 peple that have knwledge f the African American cmmunity and have sme cnnectin t the tpic f suicide. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Preplanning stage indicates that there is clear recgnitin that actin must be taken t address suicide, but there is still a need t fcus effrts n frmulating actins t address the issue. 100 P a g e

Table 8. African American Cmmunity in Maricpa Cunty Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 4.9 Readiness Stage Preplanning Substance/Issue African American Suicide Amng Yuth Demgraphics Number 1 Percent 2 Ttal Number f Respndents 56 100% Gender Male 27 56.3% Female 21 43.8% Race American Indian/Alaskan Native 1 1.9% Asian American/Asian 0 0.0% Black/African American 38 70.4% Caucasian/White 8 14.8% Multiracial 4 7.4% Other 3 5.6% Ethnicity Hispanic/Latin 6 11.8% Nn-Hispanic/Latin 45 88.2% Calitin Memberships Status Nn-Calitin Member 40 71.4% Calitin Member 14 25.9% Sectr (Number f Respndents) Behaviral health, preventin, recvery (6) Law enfrcement agencies (1) Business (6) Media (0) Civic and vlunteer grups (5) Schls and educatin (3) Cmmunity resident/family member (9) State, lcal, r tribal gvernmental agencies (3) Faith-based rganizatins (6) Yuth (8) Healthcare prfessinals (3) Yuth serving rganizatins (5) Other (0) N Respnse (1) 1. Sme respndents did nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. 101 P a g e

Figure 47. African American Cmmunity in Maricpa Cunty Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status African American Yuth Suicide African American Cmmunity in Maricpa Cunty (Marijuana) Cmmunity readiness t address the tpic f yuth marijuana use amng African Americans in Maricpa Cunty results suggest that the African American cmmunity in Maricpa Cunty is in the Preparatin stage f readiness (5.1). The CRPS was administered t 92 peple that have knwledge f the African American cmmunity and have sme cnnectin t the tpic f African American yuth marijuana use. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Preparatin stage indicates that leaders in the cmmunity are planning ut preventin strategies within the cmmunity, and that the cmmunity is supprtive f effrts t address the issue, but there is still a need t infrm cmmunity members abut thse preventin effrts. Table 52. African American Cmmunity in Maricpa Cunty Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 5.1 Readiness Stage Preparatin Substance/Issue African American Yuth Marijuana Use Demgraphics Number 1 Percent 2 Ttal Number f Respndents 92 100% Gender Male 48 59.3% Female 33 40.7% Race American Indian/Alaskan Native 2 2.4% Asian American/Asian 1 1.2% 102 P a g e

Black/African American 63 76.8% Caucasian/White 8 9.8% Multiracial 5 6.1% Other 3 3.7% Ethnicity Hispanic/Latin 5 6.4% Nn-Hispanic/Latin 73 93.6% Calitin Memberships Status Nn-Calitin Member 68 77.3% Calitin Member 20 22.7% Sectr (Number f Respndents) Behaviral health, preventin, recvery (7) Law enfrcement agencies (1) Business (12) Media (3) Civic and vlunteer grups (2) Schls and educatin (7) Cmmunity resident/family member (5) State, lcal, r tribal gvernmental agencies (4) Faith-based rganizatins (11) Yuth (24) Healthcare prfessinals (4) Yuth serving rganizatins (5) Other (0) N Respnse (1) 1. Sme respndents did nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. Figure 48. African American Cmmunity in Maricpa Cunty Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status African American Yuth Marijuana Use Maryvale Cmmunity (Spice) Cmmunity readiness t address the tpic f the use f Spice amng yuth in the Maryvale cmmunity results suggest that the Maryvale cmmunity is in the Preparatin stage f readiness (5.2). The CRPS was 103 P a g e

administered t 31 peple that have knwledge f the Maryvale cmmunity and have sme cnnectin t the tpic f Spice use. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Preparatin stage indicates that leaders in the cmmunity are planning ut preventin strategies within the cmmunity, and that the cmmunity is supprtive f effrts t address the issue, but there is still a need t infrm cmmunity members abut thse preventin effrts. Table 53. Maryvale Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 5.2 Readiness Stage Preparatin Substance/Issue Spice Demgraphics Number 1 Percent 2 Ttal Number f Respndents 31 100% Gender Male 16 59.3% Female 11 40.7% Race Black/African American 5 16.1% Caucasian/White 16 51.6% Multiracial 7 22.6% Other 3 9.7% Ethnicity Hispanic/Latin 17 56.7% Nn-Hispanic/Latin 13 43.3% Calitin Memberships Status Nn-Calitin Member 29 93.5% Calitin Member 2 6.5% Sectr (Number f Respndents) Behaviral health, preventin, recvery Law enfrcement agencies (3) (0) Business (4) Media (0) Civic and vlunteer grups (1) Schls and educatin (3) Cmmunity resident/family member (3) State, lcal, r tribal gvernmental agencies (5) Faith-based rganizatins (4) Yuth (3) Healthcare prfessinals (3) Yuth serving rganizatins (1) Other (0) N Respnse (1) 1. Sme respndents did nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. Nte: this CRPS did nt have enugh calitin members t be included in the analysis. 104 P a g e

Figure 49. Maryvale Cmmunity Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Spice Maryvale Cmmunity (Marijuana) Cmmunity readiness t address the tpic f yuth marijuana use amng yuth in the Maryvale cmmunity results suggest that the Maryvale cmmunity is in the Preparatin stage f readiness (5.0). The CRPS was administered t 28 peple that have knwledge f the Maryvale cmmunity and have sme cnnectin t the tpic f marijuana use. Survey respndents represented a wide range f prfessins r interests within the cmmunity ( sectrs ). Being in the Preparatin stage indicates that leaders in the cmmunity are planning ut preventin strategies within the cmmunity, and that the cmmunity is supprtive f effrts t address the issue, but there is still a need t infrm cmmunity members abut thse preventin effrts. Table 54. Maryvale Cmmunity Readiness Results and CRPS Demgraphic Infrmatin Cmmunity Readiness Scre 5.0 Readiness Stage Preparatin Substance/Issue Yuth Marijuana Use Demgraphics Number 1 Percent 2 Ttal Number f Respndents 28 100% Gender Male 13 56.5% Female 10 43.5% Race Black/African American 1 3.8% Caucasian/White 17 60.7% Other 8 28.6% Ethnicity Hispanic/Latin 15 60.0% Nn-Hispanic/Latin 10 40.0% Calitin Memberships Status 105 P a g e

Nn-Calitin Member 28 100.0% Calitin Member 0 0.0 % Sectr (Number f Respndents) Behaviral health, preventin, recvery (3) Law enfrcement agencies (2) Business (1) Media (2) Civic and vlunteer grups (0) Schls and educatin (5) Cmmunity resident/family member (4) State, lcal, r tribal gvernmental agencies (1) Faith-based rganizatins (1) Yuth (3) Healthcare prfessinals (0) Yuth serving rganizatins (2) Other (0) N Respnse (4) 1. Sme respndents did nt respnd t each questin, therefre ttals between questins may vary. 2. Percent is based n Valid Percent. The fllwing figure displays scres by readiness dimensin fr respndents wh indicated they were r were nt calitin members and cmbined scres fr bth calitin and nn-calitin members. Nte: n calitin members participated in this CRPS. Figure 50. Maryvale Levels f Cmmunity Readiness, by Dimensins and Respndent s Calitin Status Yuth Marijuana Use 8. Eisting Resurces GSA-6 has pprtunities fr cntinued cllabratin and leveraging t address its substance abuse issues and scial determinants (risk factrs/intervening variables) cntributing t the substance abuse issues. Belw is an inventry f twelve current Mercy Maricpa funded calitins: 106 P a g e

Table 9. Current Mercy Maricpa Prviders and Calitins by Target Issue and Area Prvider Calitin Prgram Gal Target Issue Target Area Primary Care Area Area Agency n Aging City f Tempe Cmmunity Bridges DrugFreeAZ Imprving Chandler Area Neighbrhds (ICAN) Pheni Indian Center Scttsdale Preventin Institute Suthwest Behaviral Health Services Tanner Cmmunity Develpment Crpratin Maricpa Elder Behaviral Health and Advcacy (MEBHAC) Calitin Tempe Calitin Mesa Preventin Alliance Way Out West (WW) Calitin Chandler Calitin n Yuth Substance Abuse (CCYSA) Calitin Maricpa Cunty Urban Indian Calitin f AZ (UICAZ) Scttsdale Neighbrhd s in Actin (SNIA) Calitin Suth Muntain Wrks (SMWORKS) Calitin Helping Enrich African- American Lives (HEAAL) Calitin Decrease medicatin misuse in lder adults in targeted cmmunities thrughut Maricpa Cunty Delay the age f first use f alchl amng City f Tempe yuth T reduce yuth alchl use in Mesa Reduce underage drinking amng Buckeye Valley yuth grades 7 12 Reduce availability/access f alchl t persns under the age f 21 in the Chandler redevelpment area Reduce underage drinking amng urban Native American yuth in Maricpa Cunty T reduce underage drinking in the Suth Scttsdale cmmunity T address the high rate f alchl use amng yuth 12-20 years ld in the Suth Muntain cmmunity Decrease marijuana use amng African-American yuth in suth-central and nrthwest Pheni, AZ Prescriptin drugs Underage drinking Underage drinking Underage drinking Underage drinking Underage drinking Underage drinking Underage drinking Yuth marijuana use Maricpa Cunty City f Tempe Mesa Buckeye Chandler Redevelpment area (85225) Maricpa Cunty Suth Scttsdale Suth Pheni Suth Central and Nrthwest Pheni All PCA s Tempe Nrth/Tempe Suth Mesa Nrth Mesa West Mesa Central Mesa East Mesa Gateway Buckeye Chandler Central All PCA s Scttsdale Suth Suth Muntain Village and Guadalupe Suth Muntain and 107 P a g e

TERROS and Tuchstne Behaviral Health TERROS Cmmunity Outreach Preventin Educatin (COPE) Calitin LGBTQ Cnsrtium T address underage alchl use amng 11-20 year lds in the Maryvale cmmunity T reduce ecessive alchl cnsumptin amng 18-44 year lds within the LGBTQ cmmunity in in Central Pheni Underage drinking Ecessive adult cnsumptin Maryvale Central Pheni Maryvale Valle del Sl Nrth Pheni Preventin Alliance (NOPAL) Calitin T reduce yuth marijuana use in the Nrth Pheni cmmunity f Sunnyslpe Yuth marijuana use Sunnyslpe Nrth Muntain It can be reasnably presumed that the evidence f verall substance use decline can be partially attributed t an increasing number f resurces available in GSA-6. These resurces include bth Mercy Maricpa funded areas and nn-funded areas thrugh a cmbinatin federal, state and lcal funding; in many cases these funds are leveraged in rder t increase efficiency and effectiveness. There are als resurces available t address cmmunity issues that may ptentially have sme relatin t substance abuse, but are nt necessarily targeting substance abuse such as: teen pregnancy, juvenile delinquency, parenting skills and ther identified cmmunity cncerns. Funding surces directly addressing substance use preventin are typically leveraged by the funded prviders. Additinal substances are typically addressed beynd substances currently funded by Mercy Maricpa. Fr eample, with Mercy Maricpa funding, the City f Tempe addresses alchl; hwever, with Drug Free Cmmunities (DFC) funding they als address marijuana. Marketing effrts are ften enhanced thrugh these additinal dllars. Life skills prgrams are als ften leveraged thrugh these additinal funds, as life skills is als ften tied t yuth leadership activities. Drug Free Cmmunities (DFC): The White Huse Office f Natinal Drug Cntrl Plicy (ONDCP) ffers Drug Free Cmmunities grants thrughut the cuntry t reduce substance abuse. In Maricpa Cunty, there are three agencies wh are currently receiving these funds: The City f Tempe receives funds frm DFC t supprt the Tempe Calitin in further addressing underage alchl cnsumptin, in additin t marijuana. The calitin uses these additinal funds t prvide awareness, infrmatin and educatin n the risks assciated with yuth substance use. Epanding the calitin effectiveness, calitin capacity, increasing cmmunicatin, increasing awareness (yuth and adult) and mnitring effectiveness are als included with DFC funds. TERROS, a fiscal agent f the COPE Calitin (in additin t Tuchstne Behaviral Health), als receives funding t establish and strengthen calitin cllabratin t reduce substance use amng yuth in Maryvale. 108 Pa g e

ICAN and the Chandler Calitin n Yuth Substance Abuse receive DFC funds t increase its ability t decrease yuth marijuana and prescriptin drug use in the 85225 zip cde f Chandler. Parents Cmmissin: The Arizna s Gvernr s Office f Children, Yuth and Families (GOCYF) has preventin funding t address substance abuse. Mercy Maricpa and Maricpa Cunty funded agencies receiving these funds include: ICAN Pheni Indian Center, Inc. Suthwest Behaviral Health GOCYF Title II Frmula Grant: GOCYF is recipient f the Department f Justice (DOJ), Office f Juvenile Justice Delinquency and Preventin (OJJDP) Title II Frmula preventin grant; GOCYF sub-cntracts these funds t varius agencies thrughut Arizna. In Maricpa Cunty, the fllwing agencies are funded: ICAN TERROS A New Leaf Additinally, the Safe Out Prgram thrugh the Maricpa LGBTQ Cnsrtium (TERROS as the fiscal agent) received SAMHSA Service t Science Prject funding. This funding serves t enhance the evaluatin needs f the prgram, which targets the LGBTQ cmmunity in Pheni. With careful guidance, this prgram is paving the way t becme a federally recgnized Evidence Based Practice. Beynd substance use preventin directly funded by Mercy Maricpa and leveraged thrugh ther funding surces, there are sme key additinal funding pprtunities thrughut Maricpa Cunty. The Maricpa Cunty Educatin Service Agency receives the Building Futures grant frm the US DOJ, OJJDP Secnd Chance Act Juvenile Reentry Implementatin Grant. This prgram attempts t reduce juvenile recidivism by: imprving crdinatin amng educatin, behaviral health and juvenile justice, increasing capacity t address crimingenic needs f juveniles in target areas, increase family invlvement, increase cntinuity f services in after-care, imprve access t cmmunity-based treatment and services, and imprving juvenile mental health. The Maricpa Cunty Attrney s Office, in crdinatin with 104.7 Kiss FM and the US Army, visits varius high schl ftball games n Friday Nights. Yuth sign pledges t stay ff drugs, alchl and prescriptin drugs and are eligible t win prizes. Maricpa Cunty als has tw teen pregnancy preventin prgrams implemented by the Maricpa Cunty Public Health Department and Tuchstne Behaviral Health. These prgrams aim t decrease risky seual behavir while prmting healthy decisin making, bth identified factrs related t substance use. 109 P a g e

The Suth Pheni Preventative Health Cllabrative fcuses n the needs f children ages 0-5. This cllabrative increases crdinatin amng agencies, decreases duplicatin and prmtes preventative health. In dwntwn Pheni the Capitl Mall Assciatin (CMA) is a calitin wrking t rebuild lcal neighbrhds in the dwntwn Pheni cmmunity. The CMA supprts prgrams and activities such as: Affrdable Husing, Lcal Streets and Alley Safety, After Schl Prgrams, as well as Cmmunity Safety prgrams, and Crime and Blight Reductin. The CMA s Drug and Gang interventin prgram DEFY, has graduated ver 400 yuths aged 9 t 11. Amng these 400 yuth, 90% cntinued their educatin and graduated high schl. Anther prgram implemented by the CMA has prduced a reductin in vilent crimes by 46% in the dwntwn Pheni cmmunity. The CMA has created frmal partnerships with the U.S Department f Justice, City f Pheni Plice Department, Lcal Initiative Supprt Crpratin, and the City f Pheni Neighbrhd Services Department. These partnerships are part f the CMA s plan t t sustain and rebuild safe neighbrhds by develping varius levels f quality prgrams within the City f Pheni. In Central Pheni the mst visible and widely knwn resurces are the lcal recreatin centers that ffer prgrams fr yuth and families: Marc Atkinsn Recreatin Center, Gelet A.C. Beuf Cmmunity Center, Central Park Recreatin Center, Cffelt-Lamreau Recreatin Center, Vernell Cleman Recreatin Center, Deer Valley Cmmunity Center, Desert West Cmmunity Center, Devnshire Senir Center, Eastlake Cmmunity Center, Grant Recreatin Center, Faye Gray Recreatin Center, Harmn Recreatin Center, Hayden Neighbrhd Recreatin Center, Lngview Neighbrhd Recreatin Center, Muntain View Cmmunity Center, Paradise Valley Cmmunity Center, Pecs Cmmunity Center, Smith Park Recreatin Center, Sunnyslpe Cmmunity Center, Sunnyslpe Yuth Center, Bret Tarver Learning Center, Thunderbirds Teen Center, University Park Recreatin Center, Verde Park Recreatin Center, and Washingtn Activity Center. The Suth Muntain area als has the Rsevelt Schl District, Suth Muntain Cmmunity Center, Juvenile Prbatin, Suth Pheni Plice Department, Suth Pheni Yuth Center, and the Neighbrhd Renewal Task Frce. Ebny Huse prvides substance abuse treatment fr adults in the cmmunity. Individual schls prvide activities surrunding substance abuse thrughut the year. Suth Muntain High Schl prvides interventin and diversin prgrams fr first time ffenders f substance abuse n campus. AA and NA meetings are available in the cmmunity fr adults and yuth. There is als a YMCA and Bys and Girls Club in the Suth Muntain area. Other prgrams fr yuth in the area are: VisinQuest, Octill Library, The Salvatin Army, Playa Margarita Recreatin Center, Laveen Cub and By Scuts, and Laveen Girl Scuts. The City f Pheni Parks and Recreatinal Center has the Suth Pheni Yuth Center which has activities and grups fr yuth. In the Glendale/Maryvale area the mst visible and widely knwn resurces are the lcal recreatin centers that ffer prgrams fr yuth and families: the Maryvale Cmmunity Center, Hliday Park Recreatin Center, Glden Gate Cmmunity Center, the Maryvale Family YMCA, and the Spencer D. & Mary Jane Stewart Branch f the Bys & Girls Club. All fur Centers engage in substance preventin by ffering healthy alternatives such as, but nt limited t: fitness classes, yuth sprts leagues, and ther recreatinal activities. The schls ffer: 110 P a g e

Family Resurce Centers; many have schl cunselrs, after schl prgrams, and ffer prgrams during schl time. Hwever, very few f these prgrams were drug preventin prgrams, There are many agencies in Maryvale that are assets t the cmmunity, including TERROS, Tuchstne, the Salvatin Army, Chicans Pr La Causa, Nuestra Familia, Alchlics Annymus, and Jewish Family Childrens Services. Maryvale, additinally, has a wide array f cmmunity prgrams that are geared t better the area. There are vlunteers wh clean up the area, cmmunity activists, the Maryvale Revitalizatin Cmmittee, Maryvale Weed and Seed, Maryvale Adlescent Prvider Partnerships (MAPPs), Maryvale Partnership in Actin, Graffiti-Busters, active blck watches, and varius calitins. The City f Tempe funds three cmmunity centers in high risk neighbrhds. The centers prvide recreatinal and leadership activities t yuth. Yuth identified activities that they feel cnnected t, such as music and sprts, as reasns why they stay ff drugs. The city als funds a yuth sprts and a befre-and-after schl prgram fr elementary schl children. The Tempe Plice Department has a plice party patrl that targets underage drinking and lud parties, and receives State and Federal mnies fr schl resurce fficers in ur middle and high schls. ASU Plice wrk clsely with Tempe Plice t address underage drinking amng cllege students. Alchl-free graduatin parties are funded by ur plice department and lcal charities. In the public schls, drug and alchl use is a serius issue. Health classes in the middle and high schls levels require drinking and substance abuse preventin cmpnents. Mst elementary schls prvide character educatin curriculum which is wven thrughut the academic subjects. Each high schl has a preventin cunselr n site fr ten hurs per week. In additin, specific substance abuse preventin prgrams are ffered as an after schl activity. There are multiple faith based rganizatins and facilities prviding a diverse religius cmmunity with pprtunities fr yuth and family invlvement. Additinally, the Department f Ecnmic Security has branch ffices in Mesa with services such as Child Prtective Services, unemplyment, jb services, and childcare. Mesa als has active Rtary rganizatins that prvide multiple pprtunities fr cmmunity educatin, invlvement, and vlunteer recruitment. The City f Mesa is als hme t a diverse cmmunity f scial service rganizatins. There are Bys and Girls Clubs, YMCA, the Washingtn Recreatin Center, the CARE Partnership, and five majr cmmunity centers fr yuth and families. Family crisis is addressed thrugh the East Valley Crisis Center and the Family Resurce Center (FRC). There are family and individual shelter services, including A New Leaf s La Mesita, which prvides shelter fr victims f dmestic vilence. Save the Family, Huse f Refuge East, and the East Valley Men s Shelter prvide transitinal husing fr thse wh are hmeless. A New Leaf prvides yuth prgrams, cunseling and fster care services thrughut the city. The Salvatin Army and Mesa Cmmunity Actin Netwrk assist lw incme individuals and families. Mesa City Gvernment is very cmmunity riented and has an active Neighbrhd Services Department. The Building Strng Neighbrhds Initiative survey neighbrhds t identify and address tp cncerns thrugh resident cmmittees and educates cmmunities based n cncerns identified. Additinally, the department encurages neighbrhd assciatins t register with them t encurage neighbrs t get t knw each ther and take wnership fr their cmmunity. The Initiative helps t build strng and cnnected neighbrhds. There are currently ver 400 registered neighbrhds in Mesa. 111 P a g e

Mesa Public Schls is a strng asset and is cmmitted t being invlved in initiatives that will imprve the well-being f yuth. The M.E.S.A. (Making Every Student Accuntable) Prgram is delivered by Mesa Plice and identifies students wh are beginning t engage in risky behavir such as drugs and gangs and engages them in after schl activities t build character and help get them n the right track. The schl district has trained all schl cunselrs in multiple preventin curricula fr implementatin in the classrm setting including Keepin it Real, Student Success thrugh Preventin and T Gd fr Drugs best practice curriculum. Additinally all Mesa public schls have an active parent rganizatin that will help t build a netwrk fr cmmunicatin, educatin, and develpment and implementatin f initiatives.jewish Family and Children s Services prvides preventin prgramming in Scttsdale schls thrugh a cntract with the Scttsdale Unified Schl District. Funtain Hills has a yuth substance abuse preventin calitin aimed at reducing substance use amng yuth ages 12-18, and ver time, amng adults. Initiatives include: The Safe Hmes Netwrk f Funtain Hills, Arizna is a grup f cncerned parents and citizens wh have taken a pledge nt t allw the cnsumptin f alchl r illegal drugs t yuth, under the age f 21, in ur hme; Tet-a-Tip; Parent Sympsiums; and ther advcacy and educatin activities arund underage drinking and drug abuse preventin. There is als a grup in Anthem that is wrking n yuth substance abuse educatin, thrugh Anthem Cmmunity Cuncil. This grup is new but has invlvement frm key stakehlders including law enfrcement and city fficials. There are many resurces fr suicide preventin in Maricpa Cunty, but wrk still needs t be dne in crdinating these effrts. Suicide preventin cmmunity resurces include the Arizna Suicide Preventin Calitin, Crisis Respnse Netwrk, EMPACT-SPC/La Frntera, Teen Lifeline, Natinal Suicide Preventin Lifeline, OASIS Behaviral Health, TERROS, American Fundatin fr Suicide Preventin,, Area Agency n Aging, St. Luke s Behaviral Health Center, Banner, Pheni Area Indian Health Services, Maricpa Juvenile Crrectins, and the Veterans Administratin. The Arizna Suicide Preventin Calitin crdinates with these partners t ffer annual cnferences, awareness walks fr survivrs f suicide, gatekeeper training in suicide interventin, pstventins and debriefing, and links t resurces. Crisis mbile teams are prvided thrugh TERROS fr anyne in the cmmunity, and Crisis Respnse Netwrk, EMPACT, and Teen Lifeline prvide critical crisis services. There is als a veteran-specific crisis line and nline chat thrugh the Natinal Suicide Preventin Lifeline. Teen Lifeline prvides schl-based educatin fr yuth, crdinates an annual Teen Suicide Preventin Awareness Week, and has a print marketing campaign targeting LGBT yuth at risk. The Teen Screen has been effective at identifying teens that shw subtle signs f depressin and/r hpelessness in ther cunties, but has nt been the fcus f widespread implementatin in Maricpa Cunty. Thrugh ADHS, there have been free nline trainings prvided t schls and hspitals fr learning gatekeeper skills. Cmmunity resurces specifically fr lder adults in Maricpa Cunty include Jewish Family and Children s Services Geriatric Cunseling and Case Management prgram, St. Luke s Geriatric psychiatric unit, Haven Senir Hrizns geriatric psychiatric prgrams, and Banner Del Web s geriatric psychiatric prgrams. There are als attempt survivr grups available at several peer-run rganizatins funded by Mercy Maricpa Integrated Care, including STAR (Stand Tgether and Recver) and Hpe Lives/Vive la Esperanza. 112 P a g e

The Central Pheni regin has a variety f resurces and assets available which fcus n building capacity and enhancing the quality f early childhd prgrams. Fllwing are the key agencies identified as cmmunity resurces and pssible links t current preventin effrts. Assciatin fr Supprtive Childcare: The Assciatin fr Supprtive Child Care (ASCC) is a private, nn-prfit rganizatin, dedicated t enhancing the quality f child care in Arizna. ASCC missin is t enhance the quality f child care fr children in Arizna and is directly linked t preventin effrts. Valley f the Sun United Way: The Valley f the Sun United Way s gal is t create lng-lasting and measurable changes that imprve the quality f life fr struggling individuals, families and children thrughut Maricpa Cunty. Wmen s Health Calitin f Arizna: The Wmen s Health Calitin is a grassrts cmmunity grup whse missin is t identify underserved ppulatins in targeted cmmunities with barriers t accessing apprpriate health care, t advcate fr adequate and apprpriate services and t educate and empwer cmmunities t be active in their wn health. There is a great need within the Central Pheni regin fr accessing health care and educatin n preventive health care. Lcal Hspitals: The Central Pheni regin is hme t many medical facilities including St. Jseph s Hspital and Medical Center, Pheni Children s Hspital, and Maricpa Integrated Health. Each medical facility ffers cmmunity educatin t the regin. Fr eample, Maricpa s Integrated Health Rsevelt lcatin has a Family Learning Center. The center cntains a wealth f materials and resurces fr the public including cmputer access. They als ffer a variety f free classes. Pheni Children s Hspital has been actively invlved in child abuse preventin ffering a Trainer f Trainers n the Preventing Child Abuse and Neglect Curriculum fr childcare centers. They have als intrduced the Triple P Parenting prgram thrugh a Trainer f Trainers frmat. Greater Pheni Child Abuse Preventin Cuncil: The Cuncil is made up f interested cmmunity members wh are cmmitted t the reductin f child abuse in Maricpa Cunty and an increased awareness f child abuse preventin issues. The Cuncil has a grant thrugh the Department f Ecnmic Security t fcus n cllabrating with cmmunity rganizatins and agencies t enhance public educatin n child abuse preventin issues. Crisis Nursery: The Crisis Nursery's, lcated within the Central Pheni regin, missin is t break the cycle f child abuse and neglect by prviding prtectin, supprt and pprtunities t trubled families and their children. Nt nly can the center by a valuable resurces t families within the regin it ffers an pprtunity fr childcare centers t cllabrate n meeting the needs f sme f the mst high risk families within the regin. Please see Appendi H fr a full publicatin f Mercy Maricpa s cmmunity resurce guide, which is als available in Spanish. 113 P a g e

9. Preventin Service Gaps between Priritized Needs and Resurces Based n data cllected r lack f data available, in many cases, a number f preventin services gaps were brught t light. Generally speaking, there is a limited amunt f awareness r understanding by sme in the cmmunity f what resurces are available fr substance use and suicide. Mst wh are knwledgeable f services and places t g fr help wrk in the field r in the schl system. Althugh many attempts are made by cmmunity grups t crdinate services and prgrams, there appears t be a discnnect in sme cmmunities abut what resurces are available. General preventin service gaps include a need fr mre educatin and awareness f alchl and drug issues and hw they can affect yung peple and families. Parents want mre infrmatin abut hw t address substance use and suicide issues and hw they can be mre invlved, especially when it cmes t cmmunicating with their yuth abut substance use and suicide. Qualitative data cllected frm cmmunity fcus grups indicated a lack f culturally cmpetent services and resurces in hw there are differences culturally in the way that substance use and suicide tpics are apprached. There als appears t be an verwhelming need as indicated by fcus grups, key infrmant interviews, and surveys f mental health services and hw t get thse services ut mre t the cmmunity at large withut a stigma attached t it, and this may include cllabrating mre with schl districts. Fr sme fcus grup participants, the schls have becme a ne-stp shp fr parents, including a mental health clinic. Primary data and secndary data als imply the need t imprve stress reductin and cping skills within lcal cmmunities, hwever mre data is needed t gain a better understanding f the issue and hw t address the issue in a targeted fashin. 10. Direct Stakehlder, Prgram Participant, Calitin Member, and Prvider Input A ttal f 5,879 yuth and adults participated in either a fcus grup, key infrmant interview r survey as part f the primary data cllectin effrts. Thrughut this reprt, primary data is included as relevant t address prevalence, cnsequences, and intervening variables as apprpriate t supprt secndary data cllected. Calitin members and Prviders helped in sme cases t recruit cmmunity members, stakehlders, and prgram participants fr the primary data cllected fr this needs assessment. The primary fcus, hwever, was n utreach t individuals utside f the current Mercy Maricpa funded preventin system. The assessment team wanted t cllect unbiased infrmatin and t reach underserved areas and grups. Prviders had input in the prcess including input in survey develpment. The assessment team made every effrt t ensure diversity in representatin by age, gender, race, ethnicity, gender rientatin, seual rientatin, gegraphic lcatin, and sectr. The fllwing infrmatin was cllected as part f the primary data cllectin and helps t infrm the needs f many cmmunities within Maricpa Cunty and may help infrm strategies t address substance use and suicide issues. 114 P a g e

Anecdtal data cllected indicate that parents and adults may have a level f awareness f substance use and suicide issues, but are nt willing t seek help utside f the family. Fr many parents and adults, they dn t believe they need help nr are they willing t admit they need help. Fr many families and cultures, there is a stigma assciated with asking fr help r needing t seek services fr help. This is mst relevant with suicide. With Arizna s passing f medical marijuana use, it is causing cnfusin fr bth adults and yuth and there is a lack f understanding fr bth adults and yuth n where t draw the line. Fr many, they dn t knw hw habitual use is different than prescribed use and a lt f peple knw peple with medical marijuana cards and have heard stries r seen first-hand f hw marijuana has helped them with their physical ailments. Fr many yuth and adults, the perceived harm and risk f marijuana use is less than alchl. Yuth als indicated that alchl is harder t get than marijuana. Law enfrcement data cllected indicate a rise in party crews r ne-gangs whse primary purpse is t thrw the best parties fr teens that always includes alchl and drugs n site. With the rise f these party crews, there is als the tendency fr these activities t escalate t mre vilent crimes, with law enfrcement seeing an increase in female teen prstitutin. Scial media is a big cntributr t the increase f bth the party crews and female teen prstitutin, including the selling f drugs n these scial media sites and chat frums, specifically with marijuana purchases. Law enfrcement als pinted ut hw there has been an increase in yuth marijuana pssessin frm five years ag: I think that s anther imprtant strategy, t really give yung peple wnership fr develping a cmmunity that they want t be a part f, and that they want t live in, and t really help us all be able t take that respnsibility. Mercy Maricpa plans t share this cmpleted Reginal Needs Assessment with Prviders, Calitins, Stakehlders, and the general public nce final, t help infrm prgram planning at a systems-level. Currently funded Prviders may use this data as a starting pint t seek additinal cmmunity input fr their lcalized assessments and pprtunity t further refine and enhance cmmunity and data-driven strategic plans. 115 P a g e

Cnclusins and Recmmendatins Maricpa Cunty has made strides in the past fur years in the preventin f substance abuse as evidenced by the reductin in the number f yuth reprting past 30-day use fr Alchl, Marijuana and Prescriptin Drugs. The Cunty levels fr past 30-day use have decreased and have cnstantly remained lwer than the State percentages. Althugh there has been a reductin f use fr sme f these substances, it is imprtant t nte that the use rates cntinue t be high. Alchl remains t be the number ne substance used by the yuth in the targeted zip cdes in GSA 6. Past 30 day use, reprted in 2012, fr 8 th graders was 16.2%, 10 th graders 31.7% and 12 th graders 43.8%. The 2008, 2010 and 2012 AYS identified parties as the number ne place where yuth btained alchl acrss 8 th, 10 th and 12 th graders. Yuth als reprted giving mney t smene else t buy alchl fr them r simply taking it frm their hme. it is recmmended that lcal calitins further eplre and btain qualitative data t identify where yuth are drinking if they are giving thers mney t purchase r taking it frm hme (i.e. is drinking ging n at parties, after schl hurs r at sme ther time?). The PCAs in Maricpa Cunty which have the highest prevalence fr substance use are: Pheni Suth Central, Paradise Valley, Scttsdale, and Tempe. Further eplratin shuld cntinue with the PCAs having the highest substance use in cmparisn t juvenile arrests as the highest PCAs fr juvenile arrests were: Avndale, Chandler, Glendale, Suth Muntain, and Pheni Suth Central (the nly PCA that mirrrs AYS findings, thugh different zip cdes). Tracking juvenile arrests is an imprtant data indicatr t assess any changes in cnsequences related t alchl and substance use. There have als been decreases in the reprt f past 30-day tbacc use at a GSA 6 level between 2008 and 2012. Unlike tbacc, the percentage f yuth reprting past 30-day use fr Marijuana increased amng 10 th and 12 th graders between 2008 and 2012. The majrity f yuth, at all grade levels, reprted btaining marijuana frm their friends. Reprted Prescriptin Drug use in the last 30-days decreased at the Cunty level between 2008 and 2012. A significant decrease (mre than 7 percentage pints) in past 30-day usage f Prescriptin Drugs between 2008 and 2012 was reprted by 8 th, 10 th and 12 th graders in the targeted zip cdes f GSA 6. As with marijuana, the majrity f yuth, at all grade levels, reprted they btained Prescriptin Drugs frm their friends. Ultimate cnsequences f substance use may include death, bth unintentinal, and, in sme cases, intentinal. Maricpa Cunty reprted 572 suicides in 2013 and 576 drug related deaths in 2012. The eight PCAs with the majrity f suicides in Maricpa Cunty in 2013 are: Deer Valley Village; Nrth Muntain Village; Mesa West; Paradise Valley Village; Mesa Nrth; Tempe Nrth, Alhambra Village; and Glendale Nrth. The majrity (56%) f deaths by suicide are by peple 45 years ld and the majrity f them are white (80%). Males die by suicide at a greater rate (76%) than females (24%). Infrmatin frm fcus grups and key infrmant interviews highlighted that cmmunity members recgnized that suicide is a serius cncern. Interestingly, many felt that suicide mst affects adlescents and the elder ppulatin when in fact data shws middle age (45 t 64 years ld) as being the mst affected grup in Maricpa Cunty. YRBS data and 116 P a g e

primary data cllectin indicate that while yuth are nt cmpleting suicide at the same rates as middle-aged adults, there are a significant number f yuth indicating suicidal ideatin and thughts. This is als cnsistent with yuth indicating substance use has a link t lack f cping skills, stress and mental illness. Recmmendatins This needs assessment generated a cnsiderable amunt f data related t yuth and adult substance use and suicide. Target areas (PCA s and zip cdes) were identified as having high use, in many instances acrss multiple substances. A substantial amunt f data was cllected; hwever there are still questins t answer. Specifically, mre data cllectin is warranted fr adults in terms f rates f cnsumptin and intervening variables cntributing t adult use f substances. Similarly, mre data is needed in the same regard t identify cntributing factrs fr adult and yuth suicide. A key finding that will be critical t the future f preventin implementatin is the crss-pllinatin f substance use. Substances are nt cnsumed in islatin; furthermre, intervening variables and risk factrs are nt tied t particular substances. Strategies will need t be implemented mre efficiently in a capacity where they will address multiple substances. Likewise, these strategies shuld be designed and eecuted in a manner addressing the intervening variables and risk factrs. By addressing the intervening variables and risk factrs, multiple substances can ptentially be addressed cncurrently. Fr eample, lack f cping skills was identified as a risk factr fr alchl and marijuana. If cping skills are imprved amng yuth, alchl and marijuana will mre likely decrease. Likewise, if the access pint f parties (identified as an access pint fr all three majr substances) is decreased using envirnmental strategies, yuth access t alchl, marijuana and prescriptin drugs will likely decline. SAMHSA guidelines fr Evidence Based Practice will be used as the fundatin t pinpint addressing intervening variables and risk factrs. Maricpa Cunty has a variety f resurces that are nt RBHA funded that may r may nt be addressing substance use directly; hwever they may be aiming t address risk factrs r intervening variables f substance use. Funding and cllabrative are pprtunities shuld be sught t address thse risk factrs, which will ultimately result in the reductin f substance use. An eample f this type f cllabratin is Mercy Maricpa s current partnership with the Arizna Criminal Justice Cmmissin (ACJC) and the Maricpa Cunty Department f Public Health t reduce prescriptin drug use. This cllabrative will implement the data-driven and supprted R Initiative in Maricpa Cunty. Nne f the areas identified as having high use f substances currently have calitins r any ther identified resurces. Further eplratin f services, resurces is needed in rder t make an impact in thse cmmunities. If necessary, it may be needed t build capacity and increase readiness within these cmmunities in rder t reduce substance use and suicide within these areas. Currently funded calitins that have identified suicide as an issue in their cmmunity als need additinal resurces in rder t address suicide in their cmmunities. Lastly, given the clse, cmple relatinship between mental illness, suicide, substance use and physical care, integratin f services can prve t be an where preventin services are vital. Calitins have access t 117 P a g e

cmmunity members and have eperience in eecuting successful marketing campaigns. They can serve as liaisns between the cmmunity and lcal healthcare (behaviral and physical health) rganizatins. As mental health, stress, islatin, lack f cping skills, psychlgical distress seem t be cmmn risk factrs amidst all ages, yuth and adult and in mst cmmunities, initial screenings in health care settings can be simple, yet effective tls t refer t treatment. Given calitin accessibility t the cmmunity, this culd be anther pipeline fr treatment services. 118 P a g e

Appendi A: Data Surces Arizna Behaviral Health Epidemilgy Prfile (2013). Assessing Substance Abuse Trends Amng At-Risk Ppulatins. Arizna Criminal Justice Cmmissin. (2008, 2010, 2012). Arizna Yuth Survey. Disaggregate data set prvided by ACJC specifically fr this analysis. Arizna Department f Educatin. (2013). 2013 Yuth Risk Behavir Survey. http://www.azed.gv/preventinprgrams/resurces/data/yrbs/ Arizna Department f Health Services; Ppulatin Health and Vital Statistics; Hspital Inpatient Discharges & Emergency Rm Visits Statistics, http://www.azdhs.rg/plan/inde.htm. Specialized aggregate data set prvided by ADHS specifically fr this analysis. Arizna Department f Transprtatin (2007-2012). http://www.azdt.gv/mvd/statistics/arizna-mtrvehicle-crash-facts Maricpa Cunty Juvenile Prbatin Department Year Bks (2007-2012). http://www.superircurt.maricpa.gv/juvenileprbatin/dcs/2012databk.pdf Pheni Plice Department. http://www.azcentral.cm/stry/news/lcal/pheni/2014/07/02/pheniplice-crime-mapping-abrk/12017437/ St. Luke s Health Initiatives (2010). Arizna Health Survey Reprt. Adult Substance Use in Arizna 2010. TERROS, Inc. and the LGBTQ Cnsrtium. Service t Science Initiative. This prject made pssible with supprt frm Educatin Develpment Center, Inc., n behalf f the U.S. Substance Abuse and Mental Health Services Administratin (Center fr Substance Abuse Preventin, Cntract #HHSS277200800004C, Reference #277-08- 0218). The cntent f this publicatin des nt necessarily reflect the views r plicies f the Department f Health and Human Services, and the views epressed herein are thse f the authrs. U.S. Census Bureau. 2010. Census 2010 fr the State f Arizna, http://factfinder2.census.gv/faces/tableservices/jsf/pages/prductview.html?src=bkmk Pheni Veteran s Administratin (2013). Suicide Preventin Reprt, Pheni Arizna. 119 P a g e

Appendi B: Adult and Yuth Suicide Survey Questins Adult Survey Thank yu fr yur participatin in this survey. This is a vluntary survey abut what yu knw and see happening with suicide in yur cmmunity. We are asking fr yur hnest feedback t help us knw mre abut suicide s yur input is greatly needed and appreciated! This survey is cnfidential in that we are nt asking yu fr yur name r anything that can be linked t yu individually. All f the survey infrmatin gathered will be cmbined and reprted as part f a needs assessment that is being cmpleted fr Maricpa Cunty by Mercy Maricpa Integrated Care and Pima Preventin Partnership. This survey is intended nly fr thse wh live in r wrk in Maricpa Cunty. These first few questins are abut yu: What is yur zip cde? What is yur age range? 18-20 21-24 25-44 45-54 55-64 65+ What is yur gender? Male Female Other (please describe): Hw wuld yu describe yur ethnic backgrund? Nn-Hispanic Hispanic Hw wuld yu describe yur racial backgrund? American Indian r Alaskan Native Asian Black r African American Caucasian r White Native Hawaiian r Other Pacific Islander 120 P a g e

Multiracial Other (Please specify) Are yu a member f any f the fllwing calitins? (This is asked nly t filter respnses based n hw yu heard abut the survey.) Arizna Suicide Preventin Calitin, Inc. (AZSPC) Chandler Calitin n Yuth Substance Abuse (CCYSA) Cmmunity Outreach Preventin and Educatin (COPE) Help Enrich African American Lives (HEAAL) Maricpa Cunty Urban Indian Calitin f AZ (UICAZ) Maricpa LGBTQ Cnsrtium Mesa Preventin Alliance Nrth Pheni Preventin Alliance (NOPAL) Scttsdale Neighbrhds in Actin (SNIA) Suth Muntain Wrking t build Opprtunities, Resurces, Knwledge, and Skills (SM WORKS) Tempe Calitin Way Out West (WOW) Calitin Other (please specify): The fllwing questins require yu t write r type in a respnse. Please answer all questins t the best f yur knwledge and if there is a questin yu are nt sure hw t answer, please write r type in dn t knw. Fr purpses f this survey, cmmunity is defined as the area where yu live r yur neighbrhd. 1. Please tell us what yu knw abut suicide in yur cmmunity? 2. Wh is mst affected by suicide at this time? Please be as specific as yu can (e.g., age grups, genders, ppulatins). 3. Hw much f a cncern is suicide in yur cmmunity? 4. Why d yu think suicide is happening? 5. Have yu knwn anyne in yur cmmunity that has attempted suicide? O Yes O N 6. Have yu knwn anyne in yur cmmunity that died frm suicide? O Yes O N 7. What means/methds are mst cmmnly used? 121 P a g e

8. When are suicides mre cmmn? 9. What d yu knw abut peple in yur cmmunity having thughts f suicide? 10. Where have yu cme acrss peple with thughts f suicide? 11. Where wuld yu g fr help fr yurself r a friend? 12. Wh wuld yu tell if yu were having thughts f suicide? 13. Hw shuld suicide preventin be addressed? 14a. What is the best way t get infrmatin ut abut suicide t yuth? 14b. What is the best way t get infrmatin ut abut suicide t adults? 15. What are sme pprtunities that are available in ur cmmunity? 16. What is ne thing yu think yur cmmunity needs t d better in? 17. What else wuld yu like t share with us that we have nt asked? Thank yu fr yur time in filling ut this survey. If yu need help r are in crisis, please call: 602-222-9444 r fr 24 hur assistance visit suicidepreventinlifeline.rg. Fr questins abut this survey, please cntact Lisa Teyechea at 602-251-3171. 122 P a g e

Yuth Survey Thank yu fr yur participatin in this survey. This is a vluntary survey abut what yu knw and see happening with yuth and suicide in yur cmmunity. We are asking fr yur hnest feedback t help us knw mre abut suicide s yur input is greatly needed and appreciated! This survey is cnfidential in that we are nt asking yu fr yur name r anything that can be linked t yu individually. All f the survey infrmatin gathered will be cmbined and reprted as part f a needs assessment that is being cmpleted fr Maricpa Cunty by Mercy Maricpa Integrated Care and Pima Preventin Partnership. These first few questins are abut yu: What is yur zip cde? What grade are yu in? Hw wuld yu describe yur racial backgrund? American Indian r Alaskan Native Asian Black r African American Caucasian r White Native Hawaiian r Other Pacific Islander Multiracial Other (Please specify) 6 th 7 th 8 th 9 th 10 th 11 th 12 th What is yur gender? Male Female Hw wuld yu describe yur ethnic backgrund? Nn-Hispanic Hispanic 123 P a g e

What is the zip cde f where yu live? The fllwing questins require yu t write r type in a respnse. Please answer all questins t the best f yur knwledge and if there is a questin yu are nt sure hw t answer, please write r type in dn t knw. In this survey we ask questins abut yur cmmunity. Hw d yu define cmmunity? Please mark belw: O O O O Where I live r my neighbrhd My schl Scial media sites Other (please describe): Please answer the questins abut cmmunity based n what yu marked abve (i.e. hw yu define cmmunity). 1. Please tell us abut what yu knw abut suicide in yur cmmunity? 2. Wh is mst affected by suicide at this time? Please be as specific as yu can. 3. Hw much f a cncern is suicide in yur cmmunity? a) Why d yu think suicide is happening? 4. What means are mst cmmnly used by yuth t die frm suicide (ie. hw are yuth suiciding)? 5. Have yu knwn anyne yur age that has attempted suicide? O Yes O N 6. Have yu knwn anyne yur age that died frm suicide? O Yes O N 7. When are suicides mre cmmn? 8. What d yu knw abut yuth in yur cmmunity having thughts f suicide? a) Where have yu cme acrss yuth with thughts f suicide? 9. Where wuld yu g fr help fr yurself r a friend? a) Wh wuld yu tell if yu were having thughts f suicide? 10. Hw shuld suicide be addressed with yuth? 12. What is the best way t get infrmatin ut t yuth abut suicide? 13. What are sme pprtunities that are available in ur cmmunity? 14. What is ne thing yu think yur cmmunity needs t d better in? 124 P a g e

15. What else wuld yu like t share with us that we have nt asked? If yu need help r are in crisis, please call: 602-222-9444 r visit suicidepreventinlifeline.rg fr 24 hur assistance. Teen Lifeline is als available between 3-9pm at 602-248-8337(TEEN) Fr questins abut this survey, please cntact Lisa Teyechea at 602-251-3171. 125 P a g e

Appendi C: Fcus Grup and Key Infrmant Interview Tls Infrmatin & Cnsent Frm Title: Spnsr: Adult Fcus Grups Maricpa Cunty Needs Assessment Mercy Maricpa Integrated Care Investigatr: Pima Preventin Partnership Site: [address f fcus grup discussin] Please ask the investigatr r the prgram staff t eplain any wrds r infrmatin that yu d nt clearly understand. Purpse Mercy Maricpa Integrated Care is cnducting a cunty-wide needs assessment in rder t better understand substance use and suicide issues in ur cmmunity. The purpse f the prject is t find ut the issues, cnsequences, and reasns behind substance use and suicide. Prcedures If yu vlunteer t participate in this fcus grup discussin, yu will be asked t answer sme questins related t substance use and pssibly suicide [if applicable]. These questins will help us t better understand the cmmunity perspectives n these issues. Yu d nt have t answer any questins that yu d nt wish t answer. Benefits & Risks Yur participatin may benefit yu and ther members f the cmmunity by reducing the harm and csts assciated with substance use. It is pssible that the questins and the discussin in tday s fcus grup may make yu uncmfrtable at times. Everyne will be asked t respect the privacy f the ther grup members, but ther peple in the grup with yu may nt keep all infrmatin private and cnfidential. Additinal cunseling and referrals t scial services prviders are available utside this prject. Yu may discuss this with the investigatr at any time. Cnfidentiality Annymus data frm this study will be analyzed by Pima Preventin Partnership and reprted t Mercy Maricpa Integrated Care. N individual participant will be identified r linked t the results. Study recrds (including this cnsent frm signed by yu) may be inspected by Mercy Maricpa Integrated Care. The results 126 P a g e

f this study may be presented at meetings r in publicatins; hwever, yur identity will nt be disclsed. All study data will be kept in lcked file cabinets and access t study files will be restricted t paid prgram staff. Vluntary Participatin/Withdrawal Participatin in the research is vluntary. Yu have the right t decline r t withdraw at any pint. If yu d nt wish participate r if yu decide t stp participating, it will nt affect any ther services yu r yur family members are eligible t receive. Questins If yu have questins abut the fcus grup prject, yu may call Lisa Teyechea, the Prject Investigatr, at 602-251-3171. Yu may call this persn if yu have any cmments abut this prject r questins abut yur rights as research subjects. Please d nt sign this cnsent frm unless yu have had a chance t ask questins and have received satisfactry answers t all f yur questins. Cnsent I have read and I understand the infrmatin in this cnsent frm. All my questins have been answered. I agree t participate in the fcus grup. I understand that I will receive a signed and dated cpy f this cnsent frm fr my recrds. By signing this cnsent frm, I have nt waived any f the legal rights which I therwise wuld have as a subject in a research study. Signature Date Printed Name Signature f Persn Cnducting Infrmed Cnsent Discussin Infrmatin & Parent Cnsent Frm fr Yuth Fcus Grups 127 P a g e

Title: Spnsr: Investigatr: Site: Yuth Fcus Grup Maricpa Cunty Needs Assessment Mercy Maricpa Integrated Care Pima Preventin Partnership (insert address where fcus grup will be held) Please ask the investigatr r the prgram staff t eplain any wrds r infrmatin that yu d nt clearly understand. Purpse Mercy Maricpa is cnducting fcus grup discussins with yuth in rder t gather infrmatin n substance abuse issues in ur cmmunity. The purpse f the prject is t find ut the needs f the cmmunity. Prcedures If yu give permissin fr yur child t participate in this fcus grup, yur child will be asked t answer sme questins related t substance use. These questins will be recrded t ensure accuracy f respnses and will help us t better understand the cmmunity perspectives n this issue. Yur child des nt have t answer any questins that he/she des nt wish t answer. Benefits & Risks Yur child s participatin may benefit yu and ther members f the cmmunity by reducing the harm and cst assciated with substance use. There is a slight pssibility that the questins and the discussin in tday s fcus grup may make yur child uncmfrtable at times. Everyne will be asked t respect the privacy f the ther grup members, but ther peple in the grup with yur child may nt keep all infrmatin private and cnfidential. Additinal cunseling and referrals t scial services prviders are available utside this prject. Yu may discuss this with the facilitatr/investigatr at any time. Cnfidentiality Annymus data frm this study will be analyzed by Pima Preventin Partnership and reprted t Mercy Maricpa. N individual participant will be identified r linked t the results. Study recrds (including this cnsent frm signed by yu) may be inspected by Mercy Maricpa. The results f this assessment may be presented at meetings r in publicatins; hwever, yur child s identity will nt be disclsed. All study data will be kept in lcked file cabinets and access t study files will be restricted t paid prgram staff. Vluntary Participatin/Withdrawal 128 P a g e

Participatin in the research is vluntary. Yur child has the right t decline r t withdraw at any pint. If yur child des nt wish t participate r if yu decide fr yur child t stp participating, it will nt affect any ther services yu r yur family members are eligible t receive frm any prviders. Questins If yu have questins abut the fcus grup prject, yu may call Lisa Teyechea, the Prject Investigatr, at 602-251-3171. Yu may call this persn if yu have any cmments abut this prject r questins abut yur child s rights as research subjects. Please d nt sign this cnsent frm unless yu have had a chance t ask questins and have received satisfactry answers t all f yur questins. Cnsent I have read and I understand the infrmatin in this cnsent frm. All my questins have been answered. I agree t give permissin fr my child t participate in the fcus grup. A signed and dated cpy f this cnsent frm can be btained fr my recrds upn request. By signing this cnsent frm, I have nt waived any f the legal rights which I therwise wuld have as a parent/guardian f a subject in a research study. Signature Date Printed Name 129 P a g e

Mercy Maricpa Integrated Care Adult Key Infrmant Interview Questins Thank yu fr yur willingness t participate in this needs assessment fr Maricpa Cunty. I will be asking yu questins abut substance use and suicide in the cmmunity. The cmmunity can be defined as the general cmmunity yu wrk with as well as yur neighbrhd r the area yu live in. As we g thrugh the discussin, please clarify hw yu are defining cmmunity as part f yur respnse. 1. Please tell me abut sme f the wrk yu d. a. Hw lng have yu wrked in yur field? 2. What d yu like mst abut yur cmmunity? What are sme strengths in yur cmmunity? What are sme pprtunities that are available in ur cmmunity? 3. What are sme f the issues yu see happening in yur cmmunity? Prbe: a) with yuth? b) with adults? 4. What d yu knw abut drugs and alchl in yur cmmunity? a) What types f substances [drugs] are mst prevalent? b) Wh is using? (If yuth, then) Where are they getting these substances? Wh is prviding these substances? c) Where are they using these substances? 5. Why is substance use happening in yur cmmunity? 6. Hw shuld substance use issues be addressed? Prbe: a) with yuth? b) with adults? 7. What cnnectins r crrelatins d yu see between alchl and drug use and physical health? Nw we will be shifting fcus t discuss suicide issues. 130 P a g e

8. Please tell me abut what yu knw abut suicide in the cmmunity? a) What ppulatin is it mst affecting at this time? b) Why is suicide affecting this ppulatin at this time? What ther factrs might be invlved? c) When is this ppulatin mst vulnerable? d) What means are mst cmmnly used? 9. Hw shuld suicide issues be addressed? a) with yuth? b) with adults 10. What is the best way t get infrmatin ut t the cmmunity regarding suicide? Just a cuple f mre questins: 11. What are sme weaknesses r threats in yur cmmunity? 12. What is ne thing yu think yur cmmunity needs t d better in? 13. What else wuld yu like t share with us that we have nt asked? 131 P a g e

Mercy Maricpa Integrated Care Fcus Grup Questins 2014 Adult Questins [paper survey f demgraphics given t participants] Gender; Race/ethnicity; age range; zip cde they live in 1. Hw lng have yu lived in this cmmunity? 2. What d yu like mst abut yur cmmunity? Prbe: What are sme strengths in yur cmmunity? What are sme pprtunities that are available in ur cmmunity? 3. What are sme f the issues yu see happening in yur cmmunity? Prbe: a) with yuth? b) with adults? 4. What d yu knw abut drugs and alchl in yur cmmunity/schls? a) What types f substances [drugs] are yuth using? b) Where are they getting these substances frm? Prbe: Wh is prviding these substances? c) Where are they using these substances? 5. Why is yuth substance use happening in yur cmmunity? 6. Hw shuld these issues be addressed? Prbe: a) with yuth? b) with adults? 7. What cnnectins r crrelatins d yu see between alchl and drug use and physical health? 8. What are sme weaknesses r threats in yur cmmunity? 9. What is the best way t get infrmatin ut t yur cmmunity? 10. What else wuld yu like t share with us that we have nt asked? Yuth Questins [paper survey f demgraphics given t participants] Gender; Race/ethnicity; grade; zip cde they live in 1.What d yu like mst abut yur cmmunity? Prbe: What are sme f the gd things abut living in yur cmmunity? 2.What d yuth in yur cmmunity d fr fun? Prbe: What d yu wish yur cmmunity r neighbrhd had fr fun after schl and n the weekends? 3.What are sme f the issues yu see happening in yur cmmunity? 4.What d yu knw abut drugs and alchl in yur cmmunity? a) What types f substances [drugs] are yuth using? b) Where are they getting these substances [drugs] frm? 132 Pa g e

Prbe: Wh is prviding these substances [drugs]? Prbe: Hw easy are drugs t get? What are the easiest substances [drugs] t get? c) Where are they using these substances [drugs]? 5. Out f all the substances [drugs] we have talked abut, which nes d yu think are the mst dangerus? 6. What are sme negative effects f yuth drug use? 7. What can we d t reduce the use f these substances [drugs]? 8. What cnnectins r linkages d yu see between alchl and drug use and physical health? 9. What is the best way t get infrmatin ut t yuth? 10. What else wuld yu like t share with us that we have nt asked? 133 P a g e

Appendi D: Primary Data Surces DATE LOCATION/AGENCY # ATTENDING ACTIVITY TARGET AUDIENCE TYPE 6/26/14 Maryvale 12 Fcus Grup Hispanic Adults 7/14/14 Yuth serving Key Infrmant Yuth Suicide 1 agency Interview 7/24/14 Yuth/adult agency 1 Key Infrmant Yuth/Adult Suicide Interview 8/11/14 Avndale 10 Fcus Grup Yuth 8/13/14 Avndale 12 Fcus Grup Schl Administatin Adults 8/21/14 Pheni 10 Fcus Grup Native American Yuth 8/26/14 Pheni 9 Fcus Grup Native American Adults 8/26/14 Law enfrcement - Key Infrmant Yuth Subtance Use and 2 Pheni Interview Suicide 8/28/14 Health Services 1 Key Infrmant Substance Use and Suicide Interview 9/2/14 Scttsdale 4 Fcus Grup Parents f yuth in high schl 9/3/14 Veterans serving Key Infrmant Veterans Substance Use and 1 agency Interview Suicide 9/4/14 Mesa 3 Fcus Grup Yuth in High Schl 9/4/14 Law Enfrcement Key Infrmant Yuth Substance Use and 2 Mesa Interview Suicide 9/4/14 Arizna State Key Infrmant Cllege Substance Use and 1 University Interview Suicide 9/6/14 Central Pheni 14 9/10/14 Paradise Valley 10 9/11/14 Paradise Valley 13 Fcus Grup Fcus Grup Fcus Grup Yuth Yuth Adults 134 P a g e

Appendi E: Cmmunity Readiness Preventin Survey (CRPS) COMMUNITY READINESS PREVENTION SURVEY 2014-2015 Thank yu fr yur willingness t participate in this survey! The fllwing questins ask fr yur pinin n hw ready yur cmmunity is t engage in a variety f preventin activities. Please answer the questins as best as yu can, based n what yu knw abut yur cmmunity. Each item will ask yu t refer t a specific issue and cmmunity. Please use the calitin, target issue, and the cmmunity indicated in yur cver letter t cmplete this survey. When cmpleting the survey, please fill in the circle net t yur selectin with blue r black ink r pencil: Please indicate the Calitin that is cnducting this survey as fund in yur cver letter: Buckeye Way Out West (WW) Calitin Chandler Calitin n Yuth Substance Abuse (CCYSA) Cmmunity, Outreach, Preventin, and Educatin (COPE) Help Enrich African American Lives (HEAAL) Maricpa Cunty Urban Indian Calitin f Arizna (UICAZ) Maricpa Elder Behaviral Health Advcacy Calitin (MEBHAC) Maricpa LGBTQ Cnsrtium Mesa Preventin Alliance Nrth Pheni Preventin Alliance (NOPAL) Scttsdale Neighbrhds in Actin (SNIA) Suth Muntain Wrking t build Opprtunities, Resurces, Knwledge, Skills (WORKS) Calitin The Tempe Calitin Are yu a member f the Calitin yu checked? Please use the space belw t write in the target issue prvided n yur cver letter. This will be the issue that yu will refer t in each f the remaining questins. Please use the space belw t write in the cmmunity prvided n yur cver letter. This is the cmmunity yu will refer t in each f the remaining questin. PLEASE NOTE: Unless therwise nted, all questins use a scale frm 1 t 9, where 9 is high (r the mst psitive respnse). 135 Pa g e

1. Using a scale frm 1-9, hw wuld yu rate the eisting preventin effrts fr the issue in yur cmmunity with 1 being n awareness that effrts are needed and 9 being several effrts, activities, and plicies are in place? N awareness that effrts are needed Effrts are being planned Several effrts are in place 2. Hw wuld yu rate the strength f preventin effrts fr the issue in yur cmmunity? N effrts eist Smewhat strng effrts Very strng effrts 3. Hw wuld yu rate the evaluatin f eisting preventin effrts fr the issue in yur cmmunity? N awareness f the need t test effrts fr effectiveness Tests fr effectiveness are being planned Effrts are being tested fr effectiveness 4. Hw wuld yu rate the quality f the evaluatin (e.g., tests f effectiveness) fr preventin effrts in the cmmunity? N evaluatin is in place Smewhat advanced Very advanced 5. Is there a need t increase preventin effrts fr the issue in yur cmmunity? N Yes Dn t Knw 6. Is there planning fr additinal preventin effrts t address the issue in yur cmmunity? 136 P a g e

N Yes Dn t Knw 7. Hw aware are peple in yur cmmunity f preventin effrts t address the issue? Nt aware Smewhat aware Very aware 8. Hw wuld yu rate the cmmunity knwledge f preventin effrts t address the issue in yur cmmunity? N knwledge f the need fr effrts Basic knwledge abut effrts Specific knwledge f effrts and hw well they wrk 9. D yu knw wh the preventin leaders fr this issue are in yur cmmunity? N Yes 10. Hw imprtant is it t all levels f leadership t prevent the issue? Nt imprtant Smewhat imprtant Very imprtant 11. Hw wuld yu rate the invlvement f cmmunity leadership in preventin effrts fr the issue? Leaders are nt invlved in effrts Leaders are in the planning prcess fr effrts Leaders mdify supprt fr effrts based n hw they wrk 12. Wuld the leadership in yur cmmunity supprt additinal preventin effrts fr the issue? N Yes Dn t Knw 137 P a g e

13. Hw wuld yu rate the cmmunity cncern abut the issue? It is nt a cncern There mdest cncern 14. Hw imprtant is it t yur cmmunity t prevent the issue? is The cmmunity is highly cncerned Nt imprtant Smewhat imprtant Very imprtant 15. Hw ften d members f yur cmmunity think that the issue shuld be accepted? Never accepted under any Smetimes accepted circumstances Always accepted 16. Hw supprtive are the peple in yur cmmunity f preventin effrts t address the issue? Nt supprtive Smewhat supprtive Very supprtive 17. Hw des the cmmunity feel abut its ability t address the issue? N ability Mderate level f ability High level f ability 18. Hw knwledgeable are members f yur cmmunity abut hw many peple are affected by the issue? N knwledge Knwledge f general Knwledge f specific 138 P a g e

infrmatin lcal level infrmatin 19. Hw knwledgeable are members f yur cmmunity abut the cnsequences f the issue? N knwledge f cnsequences General knwledge f cnsequences Knwledge f specific lcal level cnsequences 20. Hw knwledgeable are members f yur cmmunity abut causes leading t the issue? N knwledge f causes General knwledge f causes Knwledge f specific lcal level causes 21. Is lcal data n the issue available in yur cmmunity? N Yes Dn t Knw 22. Is enugh lcal data n the issue available in yur cmmunity? N Yes Dn t Knw 23. Which f the areas f interest belw d yu believe need mre lcal data cllected t lk at the issues in yur cmmunity? (Select all that apply). 139 P a g e

Lcatins Maryvale Lcal parks 68 th Street Suth Pheni Laveen Peria Tpics African American yuth Marijuana use Educatin and preventin prgrams High schl and cllege campuses Drugs and addictin Alchl and addictin Peer leadership prgrams fr yuth Parent and caregiver prgrams Other (Please prvide which lcatin(s) and/r what tpic(s)?) 24. Hw much d the lcal media cntribute t infrm and educate yur cmmunity n the issue? N cntributin Mderate cntributin Etensive cntributin This survey was develped by Pima Preventin Partnership and Mercy Maricpa Integrated Care alng with input frm preventin prviders. The survey was adapted frm a tl develped fr substance abuse preventin wrk at the Kentucky Divisin f Mental Health and Substance Abuse. Last Revisin10/7/14. Page 140 f 175

25. Rate the fllwing public health issues n the number f prblems they cause in yur cmmunity: Causes prblems n Causes many prblems Suicidal behavir Depressin Alchl and substance abuse HIV/AIDS/STDs Seual assault / Relatinship Vilent crime Juvenile Delinquency Aniety / Stress Grief / Lss Teen Pregnancy Child Abuse Dn t Knw This survey was develped by Pima Preventin Partnership and Mercy Maricpa Integrated Care alng with input frm preventin prviders. The survey was adapted frm a tl develped fr substance abuse preventin wrk at the Kentucky Divisin f Mental Health and Substance Abuse. Last Revisin10/7/14. Page 141 f 175

26. Rate the fllwing substances n the number f prblems they cause in yur cmmunity. Causes prblems n Causes many prblems Dn t Knw Alchl Ccaine/Crack Hallucingens Herin Inhalants Marijuana Methamphetamine Over-the-Cunter Medicatins (e.g., Cugh syrup, Sudaphedrine) Prescriptin Drugs Rave Drugs (e.g., Ecstasy, GHB, Mlly) Tbacc Synthetic Drugs (e.g., Spice, Bath Salts) 27. What is the level f epertise, training, and/r skill amng the preventin prgram staff related t the issue in yur cmmunity? N epertise Mderate epertise Etensive epertise This survey was develped by Pima Preventin Partnership and Mercy Maricpa Integrated Care alng with input frm preventin prviders. The survey was adapted frm a tl develped fr substance abuse preventin wrk at the Kentucky Divisin f Mental Health and Substance Abuse. Last Revisin10/7/14. Page 142 f 175

28. Hw supprtive are the lcal businesses in yur cmmunity f preventin effrts t address the issue (such as vlunteering time, making financial dnatins, prviding space, etc.)? Nt supprtive Smewhat supprtive Very supprtive 29. Hw much cllabratin ccurs amng public and private agencies invlved in preventin t address the issue? N cllabratin Mderate cllabratin Etensive cllabratin 30. Hw wuld yu rate the available resurces related t the issue in yur cmmunity? N awareness f the need fr resurces Sme are lking int available resurces 31. Rate yur knwledge f preventin effrts fr the issue in yur cmmunity. N knwledge Sme knwledge Substantial supprt and resurces fr current and new effrts Etensive knwledge 32. Please indicate yur gender: Male Female Gender Variant Interse Transgender Decline t answer Other: 33. Please indicate yur race: This survey was develped by Pima Preventin Partnership and Mercy Maricpa Integrated Care alng with input frm preventin prviders. The survey was adapted frm a tl develped fr substance abuse preventin wrk at the Kentucky Divisin f Mental Health and Substance Abuse. Last Revisin10/7/14. Page 143 f 175

American Indian r Alaskan Native Asian-American r Asian Black r African American Caucasian r White Multiracial Native Hawaiian r Other Pacific Islander Other: 34. Please indicate yur ethnicity: Hispanic / Latin Nt Hispanic / Latin 35. Hw lng have yu lived in this cmmunity (in years)? I have lived in this cmmunity fr years I d nt live in this cmmunity 36. Hw lng have yu wrked in this cmmunity (in years)? I have wrked in this cmmunity fr years I d nt wrk in this cmmunity 37. Which f the fllwing categries best describes the sectr f the cmmunity yu represent? (Please chse nly ne categry.) Yuth Cmmunity resident, family member Business Media Schls and educatin Yuth-serving rganizatins Law enfrcement agencies Faith-based rganizatins Civic and vlunteer grups Healthcare prfessinals State, lcal, r tribal gvernmental agencies This survey was develped by Pima Preventin Partnership and Mercy Maricpa Integrated Care alng with input frm preventin prviders. The survey was adapted frm a tl develped fr substance abuse preventin wrk at the Kentucky Divisin f Mental Health and Substance Abuse. Last Revisin10/7/14. Page 144 f 175

Behaviral health, preventin, r recvery Other: Thank yu fr taking the time t cmplete this survey! Appendi F: Cmmunity Views Survey (CVS) Alchl Thank yu fr participating in this shrt survey! It shuld take nly abut 10-15 minutes f yur time t cmplete. All f yur respnses will remain annymus. The fllwing questins ask fr yur pinins abut yuth, under the age f 21, drinking alchl in ur cmmunity (called yuth in the rest f this survey). Please answer the questins as best as yu can, based n what yu knw abut yur cmmunity. When answering each questin n the survey, please cmpletely fill in the circle net t yur selectin using a black pen r a pencil: 1. Hw cncerned are yu abut yuth drinking alchl in yur cmmunity? Very cncerned Cncerned Nt very cncerned Nt cncerned at all Nt sure D yu agree r disagree with the fllwing statements? 2. It is OK fr yuth t drink at parties if they dn t get drunk. 3. It is OK fr yuth t drink if they dn t drive afterward. Strngly Agree Agree Disagree Strngly Disagree This survey was develped by Pima Preventin Partnership and Mercy Maricpa Integrated Care alng with input frm preventin prviders. The survey was adapted frm a tl develped fr substance abuse preventin wrk at the Kentucky Divisin f Mental Health and Substance Abuse. Last Revisin10/7/14. Page 145 f 175

4. It is OK fr yuth t drink alchl at hme, as lng as parents r ther family members are present. 5. When wuld yu say it is OK r acceptable fr yuth t drink alchl? (Please mark all that apply) Religius event Hliday related event After schl-related event (prm, graduatin, ftball game, etc.) Family gathering It is never OK fr yuth t drink alchl Other (describe) 6. In yur pinin, what are the ways yuth get alchl? (Please mark all that apply) A parent r guardian gives it t them Buying it at a restaurant, bar, r club Anther family member lder than 21 gives it t them An unrelated adult lder than 21 gives it t them Smene else under the age f 21 gives it t them Frm parties Asking an adult t buy it fr them Frm their parents hme Buying it at a public event, such as a cncert r sprting event Buying it frm stres (liqur stre, cnvenience stre, supermarket, r gas statin) Stealing it frm stres, r a beer run Other (describe) 7. Based n what yu have seen r heard abut, which f the fllwing prblems r cnsequences is yuth alchl use causing in yur cmmunity? (Please mark all that apply) Alchl abuse/alchl addictin Seually transmitted diseases r infectins Driving under the influence Physical harm, such as ther accidents r injuries Alchl-related car crashes Unintended r teen pregnancy This survey was develped by Pima Preventin Partnership and Mercy Maricpa Integrated Care alng with input frm preventin prviders. The survey was adapted frm a tl develped fr substance abuse preventin wrk at the Kentucky Divisin f Mental Health and Substance Abuse. Last Revisin10/7/14. Page 146 f 175

Getting arrested r juvenile delinquency Vilence r getting int fights with ther peple Mental health and/r emtinal prblems Limits brain develpment Suicide attempts, self-injuries, and/r suicide Other (describe) D yu agree r disagree with the fllwing statements? 8. The plice in yur cmmunity d a gd jb at stpping adults frm prviding alchl t yuth. 9. Adults prviding alchl fr yuth, including parents and family members, shuld receive heavy fines. Strngly Agree Agree Disagree Strngly Disagree This survey was develped by Pima Preventin Partnership and Mercy Maricpa Integrated Care alng with input frm preventin prviders. The survey was adapted frm a tl develped fr substance abuse preventin wrk at the Kentucky Divisin f Mental Health and Substance Abuse. Last Revisin10/7/14. Page 147 f 175

D yu supprt the fllwing strategies t prevent yuth frm drinking alchl and/r reduce negative cnsequences f yuth drinking alchl? Yes N 10. Requiring liqur law training fr everyne that serves r sells alchl at bars, restaurants and stres? 11. Having plice check t see if bars, restaurants and stres are selling alchl t yuth during the year? 12. Having a law that hlds adults respnsible fr hsting parties where yuth are drinking alchl? 13. Increasing alchl taes by 10 cents a drink t fund substance abuse preventin and treatment? 14. Educating yuth n the effects f drinking alchl? 15. Educating yuth abut cping skills and stress reductin? 16. Educating parents and adults n the effects f underage drinking, cnsequences, and available resurces t help parents? 17. Asking yuth abut their alchl use during medical visits r check-ups? 18. Asking yuth abut mental health prblems during medical visits r check-ups? This survey was develped by Pima Preventin Partnership and Mercy Maricpa Integrated Care alng with input frm preventin prviders. The survey was adapted frm a tl develped fr substance abuse preventin wrk at the Kentucky Divisin f Mental Health and Substance Abuse. Last Revisin10/7/14. Page 148 f 175

19. Are yu: Female Male 20. Hw ld are yu? 21. What zip cde d yu live in? 22. Hw wuld yu describe yur racial backgrund? American Indian r Alaskan Native Asian Black r African American Caucasian r White Multiracial Native Hawaiian r Other Pacific Islander Other (describe) 23. Hw wuld yu describe yur ethnic backgrund? Hispanic Nn-Hispanic 24. Hw many ttal children d yu have under the age f 21? 25. Describe the ages f any children yu have. (Please mark all that apply) 0-4 years 5-9 years 10-14 years 15-17 years 18-21 years Over 21 years I d nt have any children 26. Have yu ever heard r read abut the XXX Calitin? Yes N Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 149 P a g e

27. Where have yu seen r heard any f the fllwing C.O.P.E. Calitin ads r media materials in yur cmmunity? (Mark all that apply) Flyers frm cmmunity events Newspaper ads in La Vz Blck watch newsletter articles Radi ads r radi public service annuncements I have nt seen any C.O.P.E. Calitin ads r media materials 28. Have yu seen any f the fllwing Respnsible1.cm materials? (Mark all that apply) Dr hanger ads Refrigeratr dr clings Stickers n alchl items Magnets Pstcards Psters Buttns I have nt seen any Respnsible1.cm materials 29. Check if yu have any f the fllwing: Regular r frequent access t the Internet (either by cmputer r mbile device) A Facebk accunt A Twitter accunt 30. In yur pinin, what are the best ways t reach adults with children in this cmmunity? (Mark all that apply) Facebk Twitter Tumblr Ggle+ Snapchat Instagram YuTube Lcal Papers Billbards TV Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 150 P a g e

Radi Other (describe): 31. D yu have any ther cmments r cncerns that yu wuld like t share? Marijuana Thank yu!!! Thank yu fr yur willingness t participate in this shrt survey! It shuld take nly abut 10-15 minutes f yur time t cmplete. All f yur respnses will remain annymus. The fllwing questins ask fr yur pinins abut yuth marijuana use in ur cmmunity. Please answer the questins as best as yu can, based n what yu knw abut yur cmmunity. When answering each questin n the survey, please cmpletely fill in the circle net t yur selectin using a black pen r a pencil, like this: 1. Hw cncerned are yu abut yuth using marijuana? Very cncerned Cncerned Nt very cncerned Nt cncerned at all Nt sure Strngly Strngly D yu agree r disagree with the fllwing statements? Agree Agree Disagree Disagree 2. It is OK fr yuth t use marijuana. 3. It is OK fr yuth t use marijuana if they dn t drive afterward. 4. It is OK fr yuth t use marijuana at hme, as lng as parents r ther family members are present. 5. Marijuana is nt that harmful cmpared t ther drugs. 6. In yur pinin, hw d yuth get marijuana? (Please mark all that apply) Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 151 P a g e

Buy it frm a friend Buy it frm a relative r family member Buy it frm a stranger r smene they dn t knw well Get it fr free frm a friend Get it fr free frm a relative r family member Get it fr free frm a stranger r smene they dn t knw well Frm smene with medical marijuana card Frm parties Take it frm their parents hme Grw it themselves Trade smething fr it with a friend Trade smething fr it with a relative r family member Trade smething fr it with a stranger r smene they dn t knw well Other: 7. Based n what yu have seen r heard abut, which f the fllwing prblems r cnsequences is yuth marijuana use causing in yur cmmunity? (Please mark all that apply) Driving under the influence Mental and/r emtinal prblems Marijuana-related car crashes Prblems with learning r memry Physical harm, such as ther accidents r injuries Vilence r getting int fights with ther peple Limits brain develpment Seually transmitted diseases r infectins Drug abuse and/r drug addictin Unintended r teen pregnancy Getting arrested r juvenile delinquency Suicide attempts, self-injuries, and/r suicide Other: Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 152 P a g e

D yu agree r disagree with the fllwing statements? 8. The plice in yur cmmunity d a gd jb at stpping adults frm prviding marijuana t yuth. 9. Retailers (including smke shps and cnvenience stres) in my cmmunity are careful when it cmes t preventing the sale f drug paraphernalia (bngs, pipes, etc.) t yuth. 10. Adults wh prvide marijuana t yuth, including parents and family members, shuld receive heavy fines. Strngly Agree Agree Disagree Strngly Disagree D yu supprt the fllwing strategies t prevent yuth frm using marijuana and/r reduce the negative cnsequences f yuth marijuana use? Yes N 11. Increased enfrcement f laws fr pssessin and/r use f marijuana? 12. Increased enfrcement f laws fr selling marijuana? 13. Stricter zning arund the placement f smke shps? 14. Lcal rdinances t ban the sale f drug paraphernalia, such as bngs and pipes? 15. Having a law that hlds adults respnsible fr hsting parties where yuth are using marijuana? 16. Educating yuth n the effects f smking marijuana? 17. Educating yuth abut cping skills and stress reductin? 18. Educating parents and adults n the effects f yuth marijuana use, cnsequences, and available resurces t help parents? 19. Asking yuth abut their marijuana use during medical visits r check-ups? 20. Asking yuth abut mental health prblems during medical visits r check-ups? Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 153 P a g e

21. In yur pinin, which f the fllwing wuld be mst effective in reducing the ability f yuth frm btaining marijuana? (Mark all that apply) Increased enfrcement f drug laws Reduced access t drug paraphernalia (bngs, pipes, etc. fr marijuana use) Stricter penalties/fines fr selling marijuana Stricter penalties/fines fr marijuana pssessin Other (describe): 22. Have yu ever heard r read abut the XXX Calitin? Yes N 23. Have yu ever seen the XXX Calitin n these scial marketing sites? (Mark all that apply) XXX s Facebk page XXX s Website I have nt seen XXX n either f these sites 24. Check if yu have any f the fllwing: Regular r frequent access t the Internet (either by cmputer r mbile device) A Facebk accunt A Twitter accunt 25. In yur pinin, what are the best ways t reach adults with children in this cmmunity? (Mark all that apply) Facebk Twitter Tumblr Ggle+ Snapchat Instagram YuTube Lcal Papers Billbards TV Radi Other (describe): Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 154 P a g e

26. Are yu: Female Male 27. Hw ld are yu? 28. What zip cde d yu live in? 29. Hw wuld yu describe yur racial backgrund? American Indian r Alaskan Native Asian Black r African American Caucasian r White Multiracial Native Hawaiian r Other Pacific Islander Other (describe) 30. Hw wuld yu describe yur ethnic backgrund? Hispanic Nn-Hispanic 31. Hw many ttal children d yu have under the age f 18? 32. Describe the ages f any children yu have. (Please mark all that apply) 0-4 years 5-9 years 10-14 years 15-17 years 18-21 years Over 21 years I d nt have any children 33. D yu have any ther cmments r cncerns that yu wuld like t share? Thank yu!!! Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 155 P a g e

LGBTQ Adult Alchl Thank yu fr yur willingness t participate in this shrt survey! The fllwing questins ask fr yur pinins abut alchl use by Lesbian, Gay, Biseual, Transgender, and Questining (LGBTQ) adults ages 18 and lder in Maricpa Cunty. Please answer the questins as best as yu can, based n what yu knw abut LGBTQ adults and Maricpa Cunty. It shuld nt take mre than 10-15 minutes f yur time t cmplete. All f yur respnses will remain annymus. When answering each questin n the survey, please cmpletely fill in the circle net t yur selectin using a black pen r a pencil, like this: Think abut the typical LGBTQ adult. During a typical week: 1. On average, hw many days a week d yu think the typical LGBTQ adult drinks alchl? 2. On a typical drinking day, hw many drinks d yu think the typical LGBTQ adult has? Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 156 P a g e

3. In yur pinin, which f the fllwing are the mst cmmn cnsequences caused by LGBTQ adult alchl abuse in yur cmmunity? Please mark all that apply. Alchl abuse/alchl addictin Suicide attempts, self-injuries, and/r suicide Driving under the influence Vilence r getting int fights with ther peple Alchl-related car crashes Seually transmitted diseases, such as HIV/AIDS Physical harm, such as ther accidents r injuries Rape Mental health and/r emtinal prblems Other (describe) Other (describe) D yu agree r disagree with the fllwing statements? Please select the respnse that best captures yu pinin. Strngly Agree Agree Disagree Strngly Disagree I Dn t Knw 4. It is OK fr adults t drink alchl as lng as they dn t get drunk. 5. It is OK fr adults t drink alchl if they dn t drive afterward. 6. Penalties fr adults that drink and drive are adequately enfrced. 7. Traffic accidents caused by drunk drivers put residents at risk. 8. It is dangerus fr adults t cnsume five r mre drinks in ne sitting. 9. LGBTQ Bars and restaurants serve alchl respnsibly (e.g. d nt serve bviusly inticated custmers). Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 157 P a g e

10. Drink specials ( 2 fr 1, etc.) encurage ecessive cnsumptin f alchl (as cmpared t regularly priced drinks) and increase the risk f harmful cnsequences (depressin, addictin/lss f cntrl). 11. Servers at restaurants and bartenders shuld be trained t detect when a persn has had t much t drink and hw t refuse service t inticated custmers. 12. A bar r restaurant caught serving alchl t bviusly inticated custmers twice within the same year shuld lse its liqur license. D yu supprt the fllwing strategies t prevent alchl abuse? 13. Require servers in bars and restaurants t be trained n respnsible alchl service? 14. Eliminate discunt-price drink specials in bars and restaurants? 15. Increase enfrcement f drinking and driving (DUI) laws? 16. Educate adults abut cnsequences f ecessive drinking? Yes N 17. Are yu: Female Interse Male Transgender (Male t Female) Transgender (Female t Male) Nn-binary/Genderqueer 18. Please select the best descriptin f yur seual rientatin: Aseual Biseual Gay Heterseual Lesbian Questining Queer Decline t answer Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 158 P a g e

19. Hw ld are yu? 20. What zip cde d yu live in? 21. Hw wuld yu describe yur racial backgrund? American Indian r Alaskan Native Asian Black r African American Caucasian r White Multiracial Native Hawaiian r Other Pacific Islander Other (describe) 22. Hw wuld yu describe yur ethnic backgrund? Hispanic Nn-Hispanic 23. Have yu ever heard f the XXX Cnsrtium? Yes N 24. Where have yu seen r heard XXX messaging? (Please mark all that apply) Facebk Print advertisements Twitter Meetings Email Festivals/Events Billbards I have nt seen/heard XXX messaging 25. Has the XXX message caused a change in yur thinking abut the issue f ecessive alchl cnsumptin? Yes N Nt applicable/des nt apply t me Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 159 P a g e

26. Are XXX advertisements visually eye- catching? Yes N; If n, please tell us what culd be dne t imprve them: Nt applicable/des nt apply t me 27. D yu have any f the fllwing? (Please mark all that apply) Regular (frequent) access t the Internet (either by cmputer r mbile device) A Facebk accunt A Twitter accunt 28. In yur pinin, what are the best ways t reach LGBTQ adults in this cmmunity? (Mark all that apply) Facebk Twitter Tumblr Ggle+ Snapchat Instagram YuTube Ech magazine In magazine Billbards TV Radi Other (describe): 29. D yu have any ther cmments r cncerns that yu wuld like t share? Thank yu!!! Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 160 P a g e

Medicatin Misuse f Older Adults Thank yu fr participating in this shrt survey! It shuld nt take mre than 10-15 minutes f yur time t cmplete. All f yur respnses will remain annymus. The fllwing questins ask fr yur pinins abut Older Adults, ver the age f 55, misusing prescriptin medicatin in ur cmmunity (called Older Adults in the rest f this survey). Please answer the questins as best as yu can, based n what yu knw abut yur cmmunity. When answering each questin n the survey, please cmpletely fill in the circle net t yur selectin using a black pen r a pencil: 1. Hw cncerned are yu abut Older Adults misusing medicatins? Very cncerned Cncerned Nt very cncerned Nt cncerned at all Nt sure D yu agree r disagree with the fllwing statements? 2. It is generally OK fr Older Adults t take mre than the recmmended dsage f a prescriptin medicatin if they are feeling mre pain. Strngly Agree Agree Disagree Strngly Disagree 3. It is generally OK fr Older Adults t take any medicatin and drink alchl. 4. It is generally OK fr Older Adults t save the prescriptin medicatins fr times when they will need it in the future. 5. Medicatins are ptentially just as dangerus as illegal drugs. Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 161 P a g e

6. In yur pinin, which f the fllwing are the mst cmmn prblems r cnsequences caused by lder adults medicatin misuse in yur cmmunity? (Please mark all that apply) Falls Cnfusin/Disrientatin Hspitalizatin Overdse Mental health/emtinal prblems Unepected prescriptin interactins Suicide attempts, self-injuries, and/r suicide Alchl Other Health Issue (describe): Other Health Issue (describe): D yu agree r disagree with the fllwing statements? 7. Pharmacies have a respnsibility t help cntrl the abuse f prescriptin medicatin. 8. Medical prfessinals wh dn t check fr interactins between medicatins shuld be fined. Strngly Agree Agree Disagree Strngly Disagree D yu supprt the fllwing strategies t prevent prescriptin medicatin misuse by lder adults? Yes N 9. Having pharmacy prgrams that check fr interactins between medicatins. 10. Penalties fr dctrs wh d nt check fr negative interactins between medicatins befre writing prescriptins fr lder adults. 11. Requiring pharmacies t check fr interactins between prescriptin medicatins befre filling a prescriptin fr lder adults. 12. Asking lder adults abut medicatin misuse during medical visits r check-ups. 13. Offering lder adults pprtunities fr prper dispsal f prescriptin medicatins. 14. Offering educatin t lder adults abut negative effects f medicatin misuse. Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 162 P a g e

15. Offering educatin n medicatin misuse t caregivers and/r prfessinals respnsible fr servicing lder adults. Hw ften have these items applied t yu persnally? Never Rarely Very Often Always Nt Applicable 16. Taken prescriptin medicine prescribed fr smene else? 17. Run ut f medicatin because it wasn t refilled in time? 18. Stpped taking yur medicatin because yu didn t think it was wrking? 19. Carry a current list f yur medicatins at all times? 20. Ask yur dctr abut side effects when she/he prescribes a new medicatin fr yu? 21. Taken any f yur medicatins withut knwing the cnditins they treat? 22. Maintained an up-t-date medical lg with all medicatins and supplements? 23. Have yu read r heard abut the XXX Calitin? Yes N 24. Please mark the places where yu have heard r read abut the XXX Calitin. (Mark all that apply) Cmmunity presentatin Radi Brchure Friend/prfessinal Other XXX member Magnet A XXX spnsred event Pstcard I have nt ever seen r heard abut XXX Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 163 P a g e

25. Please indicate whether yu prvide care fr an lder adult. Include thse lder adults wh may nt be currently living with yu. (Mark all that apply) Yes, I care fr an lder adult wh lives with me. Yes, I care fr an lder adult wh des nt live with me. I d nt prvide care fr any lder adults. 26. Are yu: Female Male 27. Hw ld are yu? 28. What zip cde d yu live in? 29. Hw wuld yu describe yur racial backgrund? American Indian r Alaskan Native Asian Black r African American Caucasian r White Multiracial Native Hawaiian r Other Pacific Islander Other (describe) 30. Hw wuld yu describe yur ethnic backgrund? Hispanic Nn-Hispanic 31. D yu have any f the fllwing? (Mark all that apply) Regular r frequent access t the Internet (either by cmputer r mbile device) A Facebk accunt A Twitter accunt 32. In yur pinin, what are the best ways t reach lder adults in this cmmunity? (Mark all that apply) Facebk Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 164 P a g e

Twitter Tumblr Ggle+ Snapchat Instagram YuTube Lcal Papers Billbards TV Radi Other (describe): 33. D yu have any ther cmments r cncerns that yu wuld like t share? Thank yu!!! Mercy Maricpa Integrated Care Preventin Assessment Findings Reprt 165 P a g e

Appendi G: Priritizatin Wrksheets Priritizatin f Substances Alchl (Yuth) Please scre each clumn within each pssible area f imprvement. After each rw has been scred with a 1,2,3 r 4, please add A+B+C+D and write each scre n clumn E. Please cmplete ALL rws t the best f yur knwledge. Prpsed area f imprvemen t: List f cnsequences f alchl use A. Magnitude: Hw many pe ple des this prblem affect? 1= A Small Grup 2= A Lt 3= Majrity 4= Everybdy B. Changeability: Hw easi ly the prblem can be changed r addressed? 1= Very Difficult 2= Difficult 3= Easily 4= Very Easily C. Impact: The depth f the prblem acrss dimensins (health, ecnmic, criminal, and educatinal)? 1= Very Limited 2= Limited 3= Widespread 4= Very Widespread D. Cncentratin: Hw cncen trated is the prblem t yur targeted cmmunity? 1= Very Limited 2= Limited 3= Widespread 4= Very Widespread E. Time Lapse Hw much tim e ccurs between cnsumptin and cnsequences? 1= Very Slwly 2=Slwly 3=Quickly 4=Very Quickly F. SCORE: Please add each rw (A+B+C+D) and scre each area f imprvement. 1. Driving under the 1 3 2 2 4 = 12 influence 2. Alchl-related car 1 3 2 2 4 = 12 crashes 3. Alchl abuse r 2 2 4 2 1 = 11 addictin 4. Vilence r getting int fights 3 2 2 2 3 = 12 5. Other: self-medicating 2 2 4 2 2 = 12 6. Other: lack f ability t cpe with things 3 2 4 2 1 = 12 166

Priritizatin f Substances Alchl (Y uth) Please scre each clumn within each pssible area f imprvement. After each rw has been scred with a 1,2,3 r 4, please add A+B+C+D and write each scre n clumn E. Please cmplete ALL rws t the best f yur knwledge. Prpsed area f imprvement: List f intervening variables f alchl use G. Magnitude: Hw many pe ple des this prblem affect? 1= A Small Grup 2= A Lt 3= Majrity 4= Everybdy H. Changeability : Hw easi ly the prblem can be changed r addressed? 1= Very Difficult 2= Difficult 3= Easily 4= Very Easily I. Impa ct: The depth f the prblem acrss dimensins (health, ecnmic, criminal, and educatinal)? 1= Very Limited 2= Limited 3= Widespread 4= Very Widespread J. Cncentratin : Hw cncen trated is the prblem t yur targeted cmmunity? 1= Very Limited 2= Limited 3= Widespread 4= Very Widespread K. SCORE: Please add each rw (A+B+C+D) and scre each area f imprvement. 1. Easy access 3 2 4 4 = 15 2. Lack f yuth 2 2 3 3 = 11 cnnectin t the cmmunity 3. Favrable parent 2 2 2 2 = 10 attitudes 4. Family nrms/rit e f passage fr yuth 2 2 2 2 = 11 5. Limited schl resurces 2 2 2 2 6. Lack f schl 2 2 3 2 cnnecti n 7. Peer pressure 2 2 3 3 8. Lack f educatin 3 2 3 3 9. Lack f cping skills 3 2 3 3 = 9 = 11 = 14 = 13 = 12 167

Priritizatin f Substances Marijuana (Yuth) Please scre each clumn within each pssible area f imprvement. After each rw has been scred with a 1,2,3 r 4, please add A+B+C+D and write each scre n clumn E. Please cmplete ALL rw s t the best f yur knwledge. Prpsed area f imprvement: List f cnsequences f mariju ana use L. Magnitude: Hw many peple des this prblem affect? 1= A Small Grup 2= A Lt 3= Majrity 4= Everybdy M. Changeability: Hw easi ly the prblem can be changed r addressed? 1= Very Difficult 2= Difficult 3= Easily 4= Very Easily N. Impact: The depth f the prblem acrss dimensins (health, ecnmic, criminal, educatinal)? 1= Very Limited 2= Limited 3= Widespread 4= Very Widespread O. Cncentratin: Hw cncentrated is the prblem t yur targeted cmmunity? 1= Very Limited 2= Limited 3= Widespread 4= Very Widespread P. Time Lapse Hw much time ccurs between cnsumptin and cnsequences? 1= Very Slwly 2=Slwly 3=Quickly 4=Very Quickly 1. Substance abuse r addictin 2 2 3 4 2 2. Driving under the influence 2 2 3 2 3 3. Getting arrested/juvenile 1 2 3 2 2 delinquency 4. Prblems with 2 2 2 2 2 learning/memry 5. Other: self-medicating 2 2 3 2 2 6. Other: lack f abilit y t 2 2 3 2 1 cpe with thin gs Q. SCORE: Please add each rw (A+B+C+D) and scre each area f imprvement. = 13 = 12 = 10 = 10 = 11 = 10 168

Priritizatin f Substances Marijuana (Yuth) Please scre each clumn within each pssible area f imprvement. After each rw has been scred with a 1,2,3 r 4, please add A+B+C+D and write each scre n clumn E. Please cmplete ALL rw s t the best f yur knwledge. Prpsed area f imprvement: List f intervening variables f marijuana use R. Magnitude: Hw many pe ple des this prblem affect? 1= A Small Grup 2= A Lt 3= Majrity 4= Everybdy S. Changeability: Hw easily the prblem can be changed r addressed? 1= Very Difficult 2= Difficult 3= Easily 4= Very Easily T. Impact: The depth f the prblem acrss dimensins (health, ecnmic, criminal, and educatinal)? 1= Very Limited 2= Limited 3= Widespread 4= Very Widespread U. Cncentratin: Hw cncentrated is the prblem t yur targeted cmmunity? 1= Very Limited 2= Limited 3= Widespread 4= Very Widespread V. SCORE: Please add each rw (A+B+C+D) and scre each area f imprvement. 1. Easy access 4 1 4 3 = 12 2. Lack f yuth cnnectin t th e 3 2 3 3 = 11 cmmunity 3. Scial acceptance f medical 2 2 2 2 = 8 marijuan a 4. Favrable parent attitudes 2 3 2 2 = 9 5. Limited schl resurces 2 2 2 3 6. Lack f schl cnnectin 2 2 3 3 7. Yuth perceive marijuana as less 2 2 4 3 harmful than alchl and ther drugs = 9 = 10 = 11 8. Peer pressure 2 2 2 2 = 8 9. Lack f educati n 2 3 3 3 = 11 10. Self-medicating 1 3 3 2 = 9 11. Lack f cping skill s 3 2 3 2 = 10 169

Priritizatin f Issues Suicide (Yuth) Please scre each clumn within each pssible area f imprvement. After each rw has been scred with a 1,2,3 r 4, please add A+B+C+D and write each scre n clumn E. Please cmplete ALL rw s t the best f yur knwledge. Prpsed area f imprvement: List f intervening variables f yuth suicide W. Magnitude: Hw many pe ple des this prblem affect? 1= A Small Grup 2= A L t 3= Maj rity 4= Everybd y X. Changeability : Hw easi ly the prblem can be changed r addressed? 1= Very Difficu lt 2= Difficult 3= Easily 4= Very Easily Y. Impa ct: The depth f the prblem acrss dimensins (health, ecnmic, criminal, educatinal)? 1= Very Li mited 2= Limi ted 3= Widespread 4= Very Widespread Z. Cncentratin : Hw cncentrated is the prblem t yur targeted cmmunity? 1= Very Li mited 2= Limi ted 3= Widespread 4= Very Widespread AA. SCORE: Please add each rw (A+B+C+D) and scre each area f imprvement. 1. Adults/parents d nt 2 3 3 3 have skills t seek help 2. Lack f yuth cnnectin 3 2 3 3 t the cmmunity 3. Suicide is a culturally 2 2 2 2 tab t pic 4. Lack f schl cnnectin 2 2 2 2 5. Peer pressure 2 2 2 2 6. Depressin 2 2 3 3 7. Self-medicating 2 2 3 2 8. Bullying 2 2 2 2 9. Undiagnsed mental health 2 2 3 2 issues = 11 = 11 = 8 = 8 = 8 = 10 = 9 = 8 = 9 170

Priritizatin f Issues Suicide (Adult) Please scre each clumn within each pssible area f imprvement. After each rw has been scred with a 1,2,3 r 4, please add A+B+C+D+E and write each scre n clumn E. Please cmplete ALL rws t the best f yur knwledge. Prpsed area f imprvemen t: List f intervening va riables f adult suicide BB. Magnitude: Hw many peple des this prblem affect? 1= A Sm all Grup 2= A L t 3= Maj rity 4= Everybd y CC. Changeabilit y: Hw easily the prblem can be changed r addressed? 1= Very Difficult 2= Difficult 3= Easily 4= Very Easily DD. Impa ct: The depth f the prblem acrss dimensins (health, ecnmic, criminal, educatinal)? 1= Nt at all Impactful 2= Smewhat Impactful 3= Impactful 4= Very Impactful EE. Cncentratin : Hw cncen trated is the prblem t yur targeted cmmunity? 1= Very Li mited 2= Limi ted 3= Widespread 4= Very Widespread FF. SCORE: Please ad d each rw (A+B+C+D) and scre each area f imprvement. 4. Depressin/stres s 1 2 2 2 = 7 5. Self-medicating 1 2 2 2 6. Lack f 1 2 2 2 = 7 Supprt/Resurces/Access t care 7. Mental Health 2 2 3 2 = 9 Issues/Substance Abuse Issues 8. Hpelessness/ Pain 1 2 2 2 9. Islatin 1 2 2 2 = 7 = 7 171

Priritizatin f Substances Prescriptin Drugs (Yuth) Please scre each clumn within each pssible area f imprvement. After each rw has been scred with a 1,2,3 r 4, please add A+B+C+D+E and write each scre n clumn E. Please cmplete ALL rws t the best f yur knwledge. Prpsed area f imprvemen t: List f cnsequences f prescriptin drug s GG. Magnitude: Hw many peple des this prblem affect? 1= A Small Grup 2= A Lt 3= Majrity 4= Everybdy HH. Changeability: Hw easi ly the prblem can be changed r addressed? 1= Very Difficult 2= Difficult 3= Easily 4= Very Easily II. Impact: The depth f the prblem acrss dimensins (health, ecnmic, criminal, educatinal)? 1= Nt at all Impactful 2= Smewhat Impactful 3= Impactful 4= Very Impactful JJ. Cncentratin: Hw cncentrated is the prblem t yur targeted cmmunity? 1= Very Limited 2= Limited 3= Widespread 4= Very Widespread KK. Time Lapse Hw much time ccurs between cnsumptin and cnsequences? 1= Very Slwly 2=Slwly 3=Quickly 4=Very Quickly 4. Substance abuse r addictin 1 2 3 2 2 2. Other: self-medicating 2 2 3 2 2 3. Other: lack f ability t 1 2 3 2 2 cpe with things LL. SCORE: Please add each rw (A+B+C+D) and scre each area f imprvement. = 10 = 11 = 10 172

Priritizatin f Substances Prescriptin Drugs (Yuth) Please scre each clumn within each pssible area f imprvement. After each rw has been scred with a 1,2,3 r 4, please add A+B+C+D+E and write each scre n clumn E. Please cmplete ALL rws t the best f yur knwledge. Prpsed area f imprvemen t: List f intervening va riables f prescriptin drugs 5. Lack f schl cnnecti n 2. Access t prescriptin drugs 3. Other: lack f ability t cpe with things MM. Magnitu de: Hw many pe ple des this prblem affect? 1= A Small Grup 2= A Lt 3= Majrity 4= Everybdy NN. Changeability: Hw easi ly the prblem can be changed r addressed? 1= Very Difficult 2= Difficult 3= Easily 4= Very Easily OO. Impact: The depth f the prblem acrss dimensins (health, ecnmic, criminal, educatinal)? 1= Nt at all Impactful 2= Smewhat Impactful 3= Impactful 4= Very Impactful PP. Cncentratin: Hw cncen trated is the prblem t yur targeted cmmunity? 1= Very Limited 2= Limited 3= Widespread 4= Very Widespread QQ. Time Lapse Hw much time ccur s between cnsumptin and cnsequences? 1= Very Slwly 2=Slwly 3=Quickly 4=Very Quickly 2 2 2 2 2 1 1 3 2 2 2 2 2 2 2 RR. SCORE: Please add each rw (A+B+C+D) and scre each area f imprvement. = 10 = 9 = 10 173

OVERALL Priritizatin f Issues Please scre each clumn within each pssible area f imprvement. After each rw has been scred with a 1,2,3 r 4, please add A+B+C+D and write each scre n clumn E. Please cmplete ALL rws t the best f yur knwledge. Prpsed area f imprvemen t: List f issu es SS. Magnitude: Hw many pe ple des this prblem affect? 1= A Small Grup 2= A Lt 3= Majrity 4= Everybdy TT. Changeability: Hw easi ly the prblem can be changed r addressed? 1= Very Difficult 2= Difficult 3= Easily 4= Very Easily UU. Impact: The depth f the prblem acrss dimensins (health, ecnmic, criminal, educatinal)? 1= Very Limited 2= Limited 3= Widespread 4= Very Widespread VV. Cncentratin: Hw cncen trated is the prblem t yur targeted cmmunity? 1= Very Limited 2= Limited 3= Widespread 4= Very Widespread WW. Time Lapse Hw much time ccur s between cnsumptin and cnsequences? 1= Very Slwly 2=Slwly 3=Quickly 4=Very Quickly XX. SCORE: Please add each rw (A+B+C+D) and scre each area f imprvement. 6. Alchl 3 2 4 4 2 = 15 7. Marijuana 3 2 4 4 1 = 14 8. Prescriptin Drugs - yuth 1 2 3 1 3 = 10 4. Prescriptin Drugs lder 1 3 2 1 3 = 10 adults 5. LGBTQ adult alchl use 2 2 3 2 2 = 11 6. Adult suicide 2 2 3 4 2 = 13 7. Yuth suicide 1 2 3 3 2 = 11 174

Appendi H: Cmmunity Resurce Guide 175

Living well in yur cmmunity Mercy Maricpa Integrated Care Cmmunity Resurce Guide 2015 www.mercymaricpa.rg