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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

Community health representative: The first tribally contracted program, since 1968 - American indian paraprofessional healthcare providers

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What Can One CHR Program Do?

Energy drinks regulated in Montana thanks to efforts of Blackfeet CHRs

"The Blackfeet Community Health Representatives (CHRs) did an amazing job of identifying an issue that's real in our community," said Montana Rep. Shannon Augare last week. The local legislator was referring to SB-438, a senate bill regulating the sale and distribution of energy drinks, one created and made possible through the efforts of the Blackfeet CHR program.

"We went to a convenience store and saw kids drinking energy drinks, and we didn't know anything about it so we did our own research," said Honey Davis of the CHR program. "After we finished with the referendum [prohibiting the sale of alcohol during North American Indian Days and the Heart Butte Society Celebration], we looked at malt liquor and energy drinks with alcohol," added Patty Welch, also of the CHR program. "We checked into High Gravity and things like that because we were concerned about our people dying of cirrhosis, and with our research we found there were energy drinks that contained alcohol, too. They look alike, and you can't tell the difference between them, so we started by buying energy drinks in different places."

Welch noted that although some energy drinks contain more alcohol than beer - as much as eight percent - when someone buys it at a store, it doesn't ring up as anything special at all, just another grocery item.

So the pair of CHRs paid a visit to Shauna Helfert of the Montana Department of Revenue and gave her a presentation on the cost and availability of energy drinks, and to find out what the state had in place to regulate the sale of alcohol-containing items. In the end, Davis and Welch aimed at limiting the sale of all energy drinks to people 18 and older and making the sale of alcohol-containing energy drinks available only in liquor stores.

In addition, the CHRs asked for information about the alcohol content of malt beverages [something that's not listed on the label], the presence of formaldehyde, the difference between alcohol as a percentage of volume as opposed to weight, the health effects of energy drinks with alcohol on pregnant women, specific health hazards of High Gravity-like drinks on alcoholics, safe levels of caffeine and guarana for people, and how these chemicals interact with alcohol.

The pair discovered that more than 500 energy drinks were introduced into the market in 2005, with confusing and attractively designed labels aimed at young people. "Ten and 11-year-olds can buy energy drinks with alcohol, and nobody checks," said Davis. "They look so much alike that the clerk doesn't know and it doesn't come up as alcohol. Maybe the kid didn't even know, so kids are buying these at a young age."

"Five-year-olds, even three-year-olds could buy them, and their parents wouldn't be aware," said Welch. In addition to there being far more energy drinks on the market, sizes have also increased, said Welch, from about eight ounces a few years ago to as much as 64 ounces today.

"They got with [Sen.] Carol Juneau and me, and they created a piece of legislation that would regulate the way energy drinks are sold," said Augare. "They helped write it, lobby for it and got it passed, so the community will see how successful some attempts can be. As a legislator I was really proud that people in Browning can see how state government can work to their benefit. The CHRs were a driving force. It was their idea; they authorized the language and created a movement."

CHR Director Mary Ellen LaFromboise noted the CHR movement toward improved community conditions began with its push for a referendum on alcohol sales in the last general election for BTBC members. "Carol Juneau was at a meeting where this was discussed and we suggested doing something at the state level, with two issues - limiting sales and segregating the types," LaFromboise said.

Staying in touch with the state senator was the key. "People don't understand how to access state legislators, and Indian people feel outside that process. They feel it does not pertain to them, so the interaction between Carol Juneau and Honey and Patty was about learning how it's done. The state people didn't realize there are programs like the CHRs and the things they do in their responsibility to upgrade health, so it was a learning experience to help all of us. There are things we can do, and things get changed."

Locally, Davis and Welch are grateful to P&M of Browning for contributing energy drink samples they could study. The pair has taken their message on the road to the local schools, talking about the maze of energy drinks to students. "We hope we can do more education at the middle school and high school," said Welch, "and we're especially concerned about the athletes because lots of them are using energy drinks to get them through. I don't know if the school has a policy, but they should."

"This was an opportunity to see change happen from point to point," said LaFromboise, adding she would like to see a similar ordinance passed by the Blackfeet Tribal Business Council. "We can go further to limit the sale of energy drinks on the reservation," she said. "The tribe has the ability to enact an ordinance to regulate these things, but even in Montana, this is one of the first states with limits on these things."

The Guide to Community Preventive Services is a free resource to help you choose programs and policies to improve health and prevent disease in your community.

State legislators, Governor Brian Schweitzer and Blackfeet CHRs
This is the group of state legislators, Governor Brian Schweitzer and the Blackfeet CHRs who, together, created one of the first set of laws in the United States, regulating the sale of energy drinks. Photo by John McGill

Story/Photo by John McGill, Glacier Reporter, Browning, MT

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