Public Health In Arkansas 2009

Transcription

1 Public Health In Arkansas 2009 Selected Health Statistics & Health-Related Contacts

2 2 Prepared by: Martha M. Phillips, PhD, MPH, MBA Melanie Goodell, MPH and Other Faculty and Staff Fay W. Boozman College of Public Health Data and supplemental materials provided by: Arkansas Department of Health Arkansas Center for Health Improvement Data included are the most recent available from cited sources.

3 3 Table of Contents Topic Page Directory of Public Health Contacts 6 Chapter 1: General Information: Essential Public Health Services 9 Public Health Challenges in the 21st Century 10 Core Competencies for Public Health Students 11 Diabetes Pathway 12 Heart Disease Pathway 13 Chapter 2: Disease Morbidity and Mortality Leading Causes of Death, Leading Causes of Death by Age Group 16 Leading Causes of Unintentional Injury 17 Motor Vehicle Fatalities by Restraint 19 Deaths due to Motor Vehicle Crashes 20 Infant Mortality 21 Contributors to Infant Health 22 Heart Disease Mortality Rates 23 Cancer Incidence Rates 24 Cancer Mortality Rates 25 Stroke Mortality Rates 26 Diabetes Prevalence 27 Oral Health (Ages 18-44) 28 Oral Health (Ages 45-64) 29 Oral Health (Ages 65+) 30 Chapter 3: Underlying Causes of Disease & Risk Factors Current Cigarette Smoking, Adults 32 Current Cigarette Smoking, Youth 33 Current Tobacco Use by Product, Youth 34 Women who Smoked During Pregnancy 35 Overweight & Obese, Adults 36 Overweight & Obese, Children, by Grade 37 Overweight & Obese, Children, By Gender and Ethnic Group 38 Overweight & Obese, Adults, By Age Group 39 Overweight & Obese, Adults,

4 4 Topic Page Physically Inactive Adults, yrs 41 Physically Inactive Adults, yrs 42 Physically Inactive Adults, 65+ yrs 43 Chapter 4: Disease Prevention Opportunities to Improve Public Health 45 How About Your Constituents? 47 Preventive Vaccinations, Adults Chapter 5: Access to Care Health Insurance Coverage, Adults, by Type 50 Physicians by County 51 Dentists by County 52 Chapter 6: Geographic Disparities Maps 54 Teen birth rate 55 Preterm births 56 Infant mortality 57 Early prenatal care 58 Low birth weight infants 59 Unintentional injury mortality rates 60 All-cause mortality rates 61 Cancer (all sites) mortality rates 62 Cardiovascular disease mortality rates 63 Diabetes mortality rates 64 Homicide rates 65 Influenza & Pneumonia mortality rates 66 Lung Cancer mortality rates 67 Nutritional deficiencies mortality rates 68 Prostate cancer mortality rates 69 Melanoma mortality rates 70 Suicide mortality rates 71 Binge drinking 72 No flu shot (adults 65+) 73 No HIV test 74 No health insurance (adults) 75 No mammogram 76 Physically Inactive (adults) 77 Obesity (adults) 78

5 Topic Page Maps, continued No Pap test 79 No pneumonia vaccination (adults 65+) 80 Tables (by county) The Social Environment 82 Access to Health Care and Risk Behaviors 84 Nutrition and Fitness 86 Preventive Care and Screenings 88 Health Outcomes and Mortality 92 5

6 6 Health-Related Phone Contacts UAMS Fay W. Boozman College of Public Health Dean Jim Raczynski, PhD Associate Dean Katharine Stewart, PhD, MPH Associate Dean Joe Bates, MD, MS Chair, Dept of Health Policy & Management -- Glen Mays, PhD, MPH Acting Chair, Dept. of Health Behavior & Health Education -- Carol Cornell, PHD Chair, Dept. of Biostatistics Paula Roberson, PhD Chair, Dept. of Epidemiology Fred Kadlubar, PhD Chair, Dept. of Environmental & Occupational Health Jay Gandy, PhD Director, Center on Tobacco Warren Bickel, PhD Director, Center on Obesity Delia West, PhD Assistant Dean, Government Relations & Special Projects Willa Black Sanders, MPA Arkansas Department of Health Director/State Health Officer Paul Halverson, DrPH, MHSA, FACHE Deputy State Health Officer Joe Bates, MD, MS Deputy Director/Chief Operating Officer Charles McGrew, MPH Deputy Director, Administration Mary Leath CDC Senior Management Official Steve Boedigheimer, MBA Dir. Office of Minority Health & Health Disparities Chris Patterson, MSW Dir., Ctr for Local Public Health Randy Lee, BSN, RN Dir., Ctr for Health Protection Donnie Smith, Med Dir., Ctr for Health Advancement Jennifer Dillaha, MD Dir., Center for Public Health Practice Glen Baker, MD Dir. Public Health Laboratory Glen Baker, MD Dir., Community Support Jodiane Trittt, JD Arkansas Center for Health Improvement Director, AR Surgeon General Joe Thompson, MD Exec. Assoc. Director Kevin Ryan, JD Assoc. Director Amy Rossi, LCSW Assoc. Director Paula Card-Higginson, ELS Founding Senior Associate Suzanne McCarthy, MPH

7 UAMS Area Health Education Centers (AHEC) Executive Director, AHEC Central Office Mark B. Mengel, MD, MPH Dir., AHEC Northwest Robert R. Gullett, Jr, MD Dir., AHEC Fort Smith Don Heard, EdD Dir., AHEC Southwest William McIntyre, PharmD Dir., AHEC North Central Dennis Moore, PharmD Interim Dir., AHEC Northeast Ron Cole, MBA Dir., AHEC Pine Bluff Eddie Maples, RN, RRT Dir., Delta AHEC Becky Hall, EdD Interim Dir., AHEC South AR Michael Fitts, PsyD UAMS Arkansas Aging Initiative Director Claudia Beverly, PhD Minority Health Commission Director Medical Director Creshelle Nash, MD, MPH Mental Health Council of Arkansas Exec. Vice President Pam Christie Arkansas Tobacco Commission Exec. Director Aaron Parish Black, JD, MPA Arkansas Foundation for Medical Care CEO Nick Pasilidis, MD ext 861 Arkansas Health Care Association Exec. Director Randy Wyatt Arkansas Prostate Cancer Foundation Director Helen Baldwin American Cancer Society Dir, State Government Relations Jason Brady Arkansas Hospital Association Exec. Vice President Robert Bo Ryall Arkansas Heart Association Dir., AR State Advocacy Barbara Kumpe Arkansas Medical Society Dir., Governmental Affairs Scott Smith Arkansas Nurses Association President Jean Zehler, MSE, RN-BC, NE-BC Community Health Centers of Arkansas, Inc. Executive Director Sip Mouden

8 8 CHAPTER 1 General Information

9 9 Essential Public Health Services 1. Monitor health status to identify and solve health problems. 2. Diagnose and investigate health problems and health hazards. 3. Inform, educate, and empower people about health issues. 4. Mobilize community partnerships and action to identify and solve health problems. 5. Develop policies and plans that support individual and community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8. Assure competent public and personal health care workforce. 9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. 10. Research for new insights and innovative solutions to health problems. Source: Public Health Functions Steering Committee (1994)

10 10 Public Health Challenges in the 21st Century 1. Chronic diseases Lifestyle and other risks Lifestyle change programs 2. Infectious diseases Viral and bacterial Safe food, water, limit sources of spread of infectious diseases 3. Other health risks injury, drugs, etc. 4. Groups at high risk 5. Preparedness Emerging threats Diseases e.g., AIDS, SARS, West Nile Virus, monkey pox Terrorism/disasters biological, chemical, nuclear, other Natural disasters hurricanes, earthquakes, tornados Source: UAMS, Fay W. Boozman College of Public Health

11 Core Competencies for Students Seeking Masters of Public Health Degrees 11

12 12 Diabetes Pathway Obesity/ Physical Activity Glucose elevations Insulin insufficiency Metabolic abnormalities Diabetes Arteriolar damage Retinal disease Amputations Renal dialysis Heart attack Renal failure Cardiac death Source: Arkansas Center for Health Improvement

13 13 Heart Disease Pathway Tobacco / Obesity/ Physical Activity High cholesterol / Limited blood flow Coronary artery blockage Heart attack Cardiac disability Cardiac death Source: Arkansas Center for Health Improvement

14 14 CHAPTER 2 Disease Morbidity and Mortality

15 15 Leading Causes of Death, Arkansas, 2005 Heart Disease Cancer Stroke Chronic Accidents Diabetes Flu/Pneumonia Alzheimer's Kidney Disease Septicemia 7% 6% 5% 3% 3% 2% 2% 2% 27% 23% 0% 10% 20% 30% Percent of deaths in year Data source: Arkansas Department of Health

16 Leading Causes of Death By Age Group, Arkansas, Age Group < 1 year Rank Congenital anomalies Sudden infant death 1 4 years Injury Homicide Short gestation 4 conditions tied for 3 rd position 5 14 years Injury Cancer Homicide years Injury Suicide Homicide years Injury Heart disease Cancer years Cancer Heart disease Injury 65+ years Heart disease Cancer Stroke Injury is the leading cause of death in every age group between 1 and 45 years. Data source: Arkansas Department of Health

17 Data source: Centers for Disease Control and Prevention 17

18 18 In 2006, just under 250,000 years of potential life were lost because of deaths among Arkansas citizens under the age of % lost because of injury deaths 27% lost to cancer deaths 28% lost of heart disease deaths Many of those deaths were preventable.

19 19 Motor Vehicle Fatalities: Restrained vs. Unrestrained 2004 (Ages 6 18) Restrained 29% 71% Unrestrained Data source: Arkansas Center for Health Improvement

20 Data source: Arkansas Center for Health Improvement 20

21 21

22 22 Contributors to Infant Health, 2005 AR US Preterm births (% of all live births) Low birth weight (% of all live births) Percentage of mothers beginning prenatal care in first trimester Data source: National Vital Statistics Reports

23 23 Heart Disease Mortality Rates (Age-adjusted), Arkansas vs. US, 2005 Deaths per 100,000 population AR US Arkansas heart disease mortality rates are the eighth highest in the US. Data source: Centers for Disease Control and Prevention

24 Data source: Centers for Disease Control and Prevention 24

25 Data source: Centers for Disease Control and Prevention 25

26 26 Stroke Mortality Rates (Age-adjusted), Arkansas vs. US, 2005 Deaths per 100,000 population AR 58.6 US 46.6 Arkansas has the highest stroke mortality rates in the US. Data source: Centers for Disease Control and Prevention

27 27 Percentage of Arkansas Adults with Diabetes (Age-adjusted), AR US Over the past 10 years, the percentage of persons with diabetes in the state of Arkansas has risen 164%. Over the same period, the percentage of persons with diabetes in the US overall rose by 132%. Data source: Centers for Disease Control and Prevention

28 28 Oral Health, Arkansas v. US Adults (18-45 years), 2006 Percentage AR US Visited dentist within past year No permanent teeth extracted Data source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey 62% of Arkansans are NOT covered by dental insurance. Source: Arkansas Department of Health, Office of Oral Health

29 Data source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey 29

30 Data source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey 30

31 31 CHAPTER 3 Underlying Causes of Disease & Risk Factors

32 32 Current Cigarette Smoking among Arkansas Adults, Percentage Source: Centers for Disease Control and Prevention, Youth Risk Behavior Survey

33 33

34 34 Current Users of Tobacco by Product, Arkansas vs. US Teens, AR US Percentagee Cigarettes Smokeless Tobacco Cigars Data source: Centers for Disease Control and Prevention, Youth Risk Behavior Survey

35 35 Percentage of pregnant women (all ages) who smoked during pregnancy, Arkansas Percentage Source: Arkansas Comprehensive Tobacco Control Program

36 36 Percentage of Arkansas & US Adults Who Are Overweight or Obese (BMI 25), Percent AR US Data source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey

37 37 Percent of Students Classified as Overweight or Obese by Grade, Obese Overweight K Data source: Arkansas Center for Health Improvement

38 Percent of Students Classified as Overweight or Obese by Gender and Ethnic Group, Obese Overweight F M F M F M F M F M White African Hispanic Asian Native American American Data source: Arkansas Center for Health Improvement

39 39 Overweight and Obese Adults, years, Arkansas v. US, AR 34.9 US 34.2 Percentage Overweight Obese Data source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey

40 40 Overweight and Obese Adults 65+ years, Arkansas v. US, AR US Percentage Overweight Obese Data source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey

41 41 Percentage of Adults (18-44 years) who are Physically Inactive, Arkansas v. US, AR 27.3 US Percentage Data source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey

42 42 Physically Inactive Adults (aged years), Arkansas v. US, 2007 Percentage AR US Data source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey

43 43 Physically Inactive Adults, Ages 65+ Arkansas v. US, Percentage AR US Data source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey

44 44 CHAPTER 4 Disease Prevention

45 45 A Sample of Opportunities To Improve Public Health Infant mortality - Prenatal care - Teen pregnancy prevention - Tobacco cessation and prevention - Obesity prevention - Second-hand smoking exposure - Newborn screening - Car seat safety - Immunizations School-aged youth (ages 6 to 18) - School Health - STD/HIV prevention - Tobacco prevention and cessation - Motor vehicle safety - Graduated drivers licenses - Seat belt use - Impaired driving prevention - Distracted driving prevention - Drivers education - Teen pregnancy prevention - Helmet use (bicycles, motorcycles) - Suicide prevention - Obesity prevention - Immunizations - Dental sealants Young adults (19-44 years) - Tobacco cessation and prevention - Prenatal care - Physical activity - Obesity prevention - Motor vehicle safety - Helmet use - Routine screening for chronic conditions - STD/HIV prevention - Immunizations - Worksite wellness programs

46 Middle year adults (45-64 years) - Worksite wellness programs - Obesity prevention - Routine screening for chronic conditions - STD/HIV prevention - Immunizations Older adults (65+ years) - Adult nutrition - Physical activity - Chronic disease management - In-home services and hospice - Immunizations - Motor vehicle safety - Prevention of falls For all ages - Environmental health - Drinking water safety - Food safety - Milk safety - Septic tank safety - Potential environmental hazards (landfills, gasoline storage, chemical stockpiles, nuclear reactors, etc.) - Medical waste disposal - Emergency preparedness - Pandemic flu - Bio-terroristic threats - Natural disasters (earthquakes, tornadoes, floods, hurricanes) - Infectious disease prevention and control - Tuberculosis - Whooping cough (pertussis) - Measles - Chicken pox - Mumps - Meningitis - Others - Violence prevention - Access to healthcare services - Medical - Dental - Preventive - Health insurance - Provider availability - Oral health - Water fluoridation - Fire injury prevention - Smoke detectors - Sprinkler systems 46

47 How About Your Constituents? 47 How About YOU? 30% of Arkansas adults have not had their cholesterol checked in the past 5 years. 25% have never had their cholesterol checked. 28% of Arkansas adults get no physical activity. 78% of Arkansas adults eat fewer than 5 servings of fruits and vegetables each day. 30% of Arkansas adults 65 years of age or older did not get a flu shot last year. 36% of our older adults have never had a pneumonia vaccination, 47% of Arkansans 50 years of age or older have never had a sigmoidoscopy or a colonoscopy to screen for colorectal cancer. 40% of Arkansas adults did not visit the dentist in the past year. 47% of Arkansas men 40 years of age or older have not had a prostate-specific antigen (PSA) test. 30% of Arkansas women 40 years of age of older have not had a mammogram in the past 2 years. 20% of Arkansas women 18 years of age or older had not had a Pap test in the past 3 years. Data source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey, 2006, 2007

48 48 Data source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance Survey

49 49 CHAPTER 5 Access to Care

50 50 Health Insurance Coverage for Arkansas v. US Adults, ( ) AR # AR % US % Employer 987, Individual 93, Medicaid 93, Other Public 97, Uninsured 420, Data source: Kaiser Foundation, statehealthfacts.org

51 51 Physicians per 10,000 population (Physicians recorded by county of residence, which may not reflect county of practice) Data source: Arkansas Center for Health Statistics

52 52 Dentists per 10,000 population (Physicians recorded by county of residence, which may not reflect county of practice) Data source: Arkansas Center for Health Statistics

53 53 CHAPTER 6 Geographic Disparities

54 54 Geographic Disparities Maps Maps included address: Infant mortality and low birthweight purple Mortality burgundy Risk factors and preventive care green Lighter colors indicate areas with better values. Darker colors indicate areas with worse values.

55 55 Teen birth rate 2006 Data source: Arkansas Department of Health

56 56 Preterm births, (as percentage of live births) Data source: March of Dimes Peristats

57 57 Infant mortality, 2004 (deaths per 1000 live births) Data source: National Center for Health Statistics

58 58 Percentage of mothers receiving early (1 st trimester) prenatal care (as percentage of all live births) Data source: March of Dimes Peristats

59 59 Births resulting in low birthweight infants, (as percentage of live births) Data source: March of Dimes Peristats

60 60 Unintentional injury mortality, (deaths per 100,000 population, age-adjusted) Data source: Arkansas Center for Health Statistics

61 61 Mortality from all causes, (deaths per 100,000 population, age-adjusted) Data source: Arkansas Center for Health Statistics

62 62 Cancer mortality, all sites, (deaths per 100,000 population, age-adjusted) Data source: Arkansas Center for Health Statistics

63 63 Cardiovascular disease mortality, (Deaths per 100,000 population, age-adjusted) Data source: Arkansas Center for Health Statistics

64 64 Diabetes Mortality, (deaths per 100,000 population, age-adjusted) Data source: Arkansas Center for Health Statistics

65 65 Homicide, (deaths per 100,000 population, age-adjusted) Data source: Arkansas Center for Health Statistics

66 66 Influenza and Pneumonia Mortality, (deaths per 100,000 population, age-adjusted) Data source: Arkansas Center for Health Statistics

67 67 Lung Cancer Mortality, (Deaths per 100,000 population, age-adjusted) Data source: Arkansas Center for Health Statistics

68 68 Nutritional deficiencies mortality, (deaths per 100,000 population, age-adjusted) Data source: Arkansas Center for Health Statistics

69 69 Prostate Cancer Mortality, (deaths per 100,000 males, age-adjusted) Data source: Arkansas Center for Health Statistics

70 70 Melanoma (skin cancer) mortality, (deaths per 100,000 population, age-adjusted) Data source: Arkansas Center for Health Statistics

71 71 Suicide Mortality, (deaths per 100,000 population, age-adjusted) Data source: Arkansas Center for Health Statistics

72 72 Binge drinking, 2007 (percent of adults, 18+ years of age) Data source: Arkansas Center for Health Statistics

73 73 No flu shot, 2007 (Percentage of adults 65+) Data source: Arkansas Center for Health Statistics

74 74 No HIV Test, 2007 (Percentage of adults 18+ years of age) Data source: Arkansas Center for Health Statistics

75 75 No health insurance, adults, 2007 (percentage of adults, 18+ years of age) Data source: Arkansas Center for Health Statistics

76 76 No mammogram in past 2 years, 2007 (Percentage of women aged 40+ years) Data source: Arkansas Center for Health Statistics

77 Physically inactive, (Percentage of adults, 18+ years of age) Data source: Arkansas Center for Health Statistics

78 Obesity, (Percentage of adults, 18+ years of age, overweight or obese (BMI 25) Data source: Arkansas Center for Health Statistics

79 No Pap Test in Past 3 Years, (Percentage of women 18+ years of age) Data source: Arkansas Center for Health Statistics

80 No Pneumonia Vaccination, (percentage of adults, 65+ years of age) Data source: Arkansas Center for Health Statistics

81 81 Geographic Disparities Tables Tables present county-specific data for a variety of health indicators and associated variables. Colors indicate county s relative standing to other counties in the state. Green best 25% among Arkansas counties Yellow middle 50% among Arkansas counties Red lowest ( worst ) 25% among Arkansas counties

82 The Social Environment 82 High School Completion Average Wages Housing Hardship Unemployment Elderly poverty Child poverty Child Abuse Violent Crime Arkansas 72.4% $29, % 8.9% 15.5% 26.0% Ashley 72.5% $25, % 8.4% 17.2% 30.7% Baxter 77.5% $27, % 5.5% 8.9% 23.9% Benton 80.4% $31, % 3.8% 7.3% 13.4% Boone 76.8% $25, % 5.2% 12.9% 23.2% Bradley 66.6% $23, % 6.2% 20.8% 33.7% Calhoun 68.7% $23, % 6.9% 18.2% 24.1% Carroll 71.8% $22, % 4.4% 13.6% 25.1% Chicot 64.2% $21, % 8.6% 20.7% 46.8% Clark 75.3% $24, % 5.7% 18.4% 25.7% Clay 60.6% $21, % 9.5% 22.7% 26.1% Cleburne 74.8% $27, % 6.2% 11.9% 24.0% Cleveland 73.1% $27, % 5.9% 15.7% 23.2% Columbia 74.1% $28, % 6.7% 20.0% 29.8% Conway 73.2% $26, % 5.0% 13.1% 26.1% Craighead 77.3% $26, % 5.0% 13.4% 24.3% Crawford 71.5% $23, % 5.0% 13.7% 23.8% Crittenden 69.2% $25, % 6.6% 23.7% 36.1% Cross 68.3% $20, % 7.6% 17.5% 28.6% Dallas 66.8% $25, % 7.2% 20.0% 31.8% Desha 65.0% $22, % 10.2% 24.0% 44.0% Drew 73.1% $23, % 7.5% 21.8% 27.6% Faulkner 83.3% $27, % 4.5% 12.0% 15.7% Franklin 71.1% $25, % 4.5% 15.7% 25.2% Fulton 72.2% $21, % 5.1% 12.7% 30.4% Garland 78.3% $30, % 5.6% 8.6% 27.1% Grant 77.2% $27, % 5.0% 13.0% 17.0% Greene 72.1% $23, % 6.5% 12.8% 26.3% Hempstead 69.2% $22, % 6.0% 16.7% 31.2% Hot Spring 73.3% $23, % 5.4% 14.2% 25.9% Howard 70.7% $24, % 5.6% 17.0% 24.4% Independence 75.5% $27, % 6.3% 14.4% 23.6% Izard 73.3% $22, % 6.1% 13.7% 28.6% Jackson 66.0% $23, % 7.7% 16.7% 37.5% Jefferson 74.8% $25, % 7.6% 17.8% 30.5% Johnson 67.6% $21, % 4.9% 15.3% 27.2% Lafayette 65.3% $22, % 7.7% 19.3% 36.9% Lawrence 63.3% $21, % 7.0% 20.1% 34.1% Lee 56.2% $19, % 9.6% 27.6% 50.9% Lincoln 65.0% $19, % 8.0% 17.9% 32.1% Little River 73.4% $25, % 4.2% 17.8% 23.5% Logan 69.8% $22, % 5.1% 19.6% 28.0% Lonoke 77.6% $26, % 4.4% 13.6% 16.4% Madison 67.8% $22, % 4.0% 18.0% 26.5% Marion 76.0% $22, % 5.6% 14.4% 37.8% Miller 74.3% $28, % 4.6% 16.5% 30.9% Mississippi 64.7% $26, % 7.5% 19.8% 35.8% Monroe 63.8% $22, % 6.9% 22.4% 39.9% Montgomery 69.8% $22, % 5.5% 16.0% 31.9% Nevada 69.1% $24, % 5.8% 27.1% 31.9% Best 25% of counties Middle 50% of counties Worst 25% of counties

83 83 High School Completion Average Wages Housing Hardship Unemployment Elderly poverty Child poverty Child Abuse Violent Crime Ouachita 73.5% $25, % 7.4% 18.6% 28.1% Perry 73.8% $25, % 4.9% 15.0% 23.5% Phillips 62.2% $22, % 7.6% 26.2% 47.7% Pike 68.8% $25, % 5.8% 20.2% 24.7% Poinsett 62.0% $22, % 7.1% 20.5% 34.8% Polk 72.6% $21, % 5.0% 16.2% 32.0% Pope 77.4% $25, % 4.8% 14.0% 23.0% Prairie 68.2% $22, % 5.9% 16.8% 27.0% Pulaski 84.4% $39, % 4.8% 9.8% 22.0% Randolph 69.2% $20, % 9.5% 15.2% 27.9% St. Francis 65.1% $21, % 9.8% 23.1% 41.1% Saline 82.3% $31, % 4.2% 7.3% 14.0% Scott 65.4% $21, % 4.8% 14.1% 33.5% Searcy 68.0% $19, % 5.0% 26.6% 38.2% Sebastian 76.6% $33, % 5.3% 10.0% 24.0% Sevier 64.6% $22, % 4.2% 14.2% 29.1% Sharp 72.9% $20, % 6.8% 13.2% 34.2% Stone 68.0% $22, % 5.8% 12.1% 36.4% Union 74.5% $35, % 7.0% 14.3% 26.2% Van Buren 71.6% $22, % 6.1% 10.6% 32.4% Washington 79.5% $29, % 3.9% 10.2% 19.4% White 72.9% $23, % 6.6% 14.3% 22.3% Woodruff 60.6% $20, % 8.9% 27.0% 41.7% Yell 64.1% $22, % 4.3% 12.8% 25.3% Best 25% of counties Middle 50% of counties Worst 25% of counties

84 Access to Health Care and Risk Behaviors 84 No Personal Doctor Primary Care Physicians No Health Insurance Adequacy of Prenatal Care Smoking Binge Drinking Teen drug use Arkansas 7.7% % 67.0% 25.0% 11.5% 44.3% Ashley 12.9% % 80.2% 24.8% 10.7% 39.2% Baxter 12.6% % 79.6% 23.7% 9.5% 42.7% Benton 19.6% % 64.7% 17.5% 9.6% 43.1% Boone 12.3% % 75.5% 25.7% 10.5% 42.1% Bradley 13.6% % 78.5% 24.7% 12.2% 44.6% Calhoun 9.2% % 71.7% 21.9% 8.9% 34.1% Carroll 15.2% % 67.6% 18.8% 8.9% 39.9% Chicot 13.7% % 76.1% 23.4% 7.6% 38.1% Clark 13.2% % 73.6% 16.6% 10.5% 34.5% Clay 10.4% % 78.0% 17.8% 9.9% 51.0% Cleburne 13.5% % 69.9% 19.4% 8.3% 45.4% Cleveland 11.8% % 74.8% 25.2% 11.7% 36.9% Columbia 16.4% % 68.2% 19.8% 7.9% 14.8% Conway 18.1% % 74.6% 23.0% 10.2% 47.3% Craighead 12.3% % 75.1% 21.5% 7.0% 42.8% Crawford 25.0% % 77.6% 23.4% 10.1% 43.2% Crittenden 18.3% % 65.2% 28.6% 12.1% 41.0% Cross 19.1% % 71.2% 28.4% 12.8% 44.9% Dallas 9.1% % 64.4% 16.9% 8.7% 38.7% Desha 13.3% % 66.9% 22.4% 9.1% 35.7% Drew 16.4% % 80.2% 28.1% 11.3% 32.3% Faulkner 10.1% % 75.0% 18.8% 10.3% 36.7% Franklin 22.3% % 72.3% 20.2% 6.7% 48.3% Fulton 13.7% % 70.1% 26.1% 7.5% 39.7% Garland 14.6% % 79.3% 26.1% 12.8% 49.4% Grant 9.1% % 77.0% 20.1% 11.3% 42.7% Greene 11.5% % 85.1% 21.3% 9.6% 38.0% Hempstead 14.8% % 62.7% 23.6% 9.4% 37.3% Hot Spring 14.3% % 76.4% 23.4% 12.5% 44.5% Howard 14.5% % 70.9% 25.0% 12.6% 39.7% Independence 17.9% % 52.9% 23.6% 7.2% 33.9% Izard 15.2% % 57.1% 23.2% 8.2% 35.5% Jackson 15.2% % 73.3% 23.2% 7.7% 35.5% Jefferson 10.5% % 62.2% 21.0% 9.5% 37.4% Johnson 20.0% % 69.1% 19.2% 7.0% 44.2% Lafayette 17.8% % 66.5% 20.7% 6.3% 43.2% Lawrence 14.9% % 76.5% 22.7% 7.9% 44.4% Lee 14.0% % 66.3% 25.7% 15.0% 20.8% Lincoln 15.2% % 66.3% 30.8% 12.4% 38.3% Little River 19.1% % 77.8% 22.3% 7.6% 29.9% Logan 21.5% % 71.9% 21.1% 8.1% 39.3% Lonoke 8.1% % 74.7% 19.6% 11.0% 46.2% Best 25% of counties Middle 50% of counties Worst 25% of counties

85 85 No Personal Doctor Primary Care Physicians No Health Insurance Adequacy of Prenatal Care Smoking Binge Drinking Teen drug use Marion 11.9% % 73.6% 23.8% 9.6% 46.2% Miller 19.1% % 74.0% 25.9% 7.3% 45.9% Mississippi 12.5% % 56.9% 24.6% 6.9% 38.8% Monroe 9.2% % 68.4% 25.4% 12.1% 27.3% Montgomery 16.2% % 76.2% 25.7% 11.6% 40.7% Nevada 14.6% % 69.0% 18.6% 9.1% 30.3% Newton 15.3% % 71.3% 22.2% 9.5% 41.0% Ouachita 11.9% % 57.3% 19.5% 9.5% 39.0% Perry 10.8% % 72.3% 20.8% 11.6% 38.5% Phillips 9.0% % 56.6% 22.5% 11.4% 34.0% Pike 13.0% % 75.4% 18.7% 9.6% 44.8% Poinsett 14.2% % 68.0% 24.1% 8.3% 42.5% Polk 17.6% % 74.0% 27.5% 12.0% 28.8% Pope 21.4% % 73.5% 21.8% 8.7% 42.7% Prairie 9.0% % 68.4% 24.3% 9.7% 48.3% Pulaski 11.1% % 68.6% 19.4% 10.3% 46.5% Randolph 10.0% % 79.0% 25.1% 10.8% 43.8% St. Francis 18.2% % 69.5% 29.3% 12.7% 45.3% Saline 10.4% % 73.5% 21.0% 11.8% 46.0% Scott 23.9% % 66.9% 26.4% 11.4% 40.5% Searcy 13.0% % 67.6% 23.4% 9.3% 35.5% Sebastian 23.0% % 71.4% 21.4% 8.9% 46.9% Sevier 17.7% % 70.1% 24.2% 11.0% 30.5% Sharp 13.1% % 54.1% 25.2% 6.6% 41.7% Stone 14.6% % 55.1% 23.7% 9.2% 32.7% Union 12.7% % 82.1% 22.4% 9.2% 37.4% Van Buren 12.9% % 69.6% 19.8% 8.0% 43.5% Washington 24.8% % 51.6% 21.5% 11.0% 43.5% White 14.3% % 74.4% 21.0% 10.7% 42.4% Woodruff 15.6% % 72.0% 26.2% 9.6% 43.3% Yell 21.3% % 66.1% 27.2% 13.4% 45.9% Best 25% of counties Middle 50% of counties Worst 25% of counties

86 Nutrition and Fitness 86 Low Fruit /Veg. Consumption Physical inactivity Overweight or Obese Obesity Arkansas 74.7% 30.0% 69.7% 36.5% Ashley 79.1% 28.2% 65.6% 34.1% Baxter 80.7% 25.5% 65.7% 22.6% Benton 74.6% 24.9% 64.6% 25.8% Boone 79.8% 26.6% 64.1% 28.9% Bradley 76.9% 30.8% 65.9% 33.4% Calhoun 75.3% 35.8% 65.1% 31.4% Carroll 75.8% 25.4% 65.4% 27.0% Chicot 84.5% 27.4% 70.5% 35.9% Clark 86.5% 31.9% 69.5% 35.4% Clay 81.2% 32.3% 73.9% 28.3% Cleburne 79.7% 27.6% 66.9% 28.1% Cleveland 75.2% 30.9% 71.3% 33.3% Columbia 84.2% 28.9% 64.1% 31.2% Conway 78.4% 27.0% 66.8% 26.7% Craighead 80.6% 32.5% 65.1% 30.8% Crawford 74.6% 28.0% 64.3% 25.4% Crittenden 80.5% 34.3% 72.0% 36.7% Cross 83.1% 41.6% 73.1% 40.2% Dallas 82.5% 35.1% 70.0% 33.5% Desha 79.4% 32.5% 70.6% 41.5% Drew 83.2% 29.4% 72.1% 39.1% Faulkner 77.8% 26.2% 66.2% 26.5% Franklin 75.8% 30.8% 63.9% 30.2% Fulton 81.5% 28.3% 66.7% 23.4% Garland 79.0% 29.7% 67.5% 28.9% Grant 77.7% 27.0% 66.4% 26.8% Greene 80.0% 34.0% 68.6% 30.3% Hempstead 82.2% 34.6% 71.2% 33.7% Hot Spring 79.4% 29.8% 68.2% 31.9% Howard 82.9% 27.8% 66.9% 32.1% Independence 80.0% 31.3% 68.5% 27.8% Izard 78.2% 27.4% 68.1% 21.9% Jackson 81.3% 33.2% 67.8% 33.1% Jefferson 71.6% 29.1% 67.0% 29.9% Johnson 75.3% 31.1% 64.4% 34.9% Lafayette 83.4% 35.6% 74.1% 37.0% Lawrence 78.9% 33.5% 67.2% 27.1% Best 25% of counties Middle 50% of counties Worst 25% of counties

87 87 Low Fruit /Veg. Consumption Physical inactivity Overweight or Obese Obesity Lincoln 76.3% 26.8% 68.0% 31.9% Little River 81.9% 31.4% 77.3% 36.1% Logan 78.1% 30.4% 66.1% 32.5% Lonoke 77.4% 26.5% 66.8% 27.8% Madison 74.5% 27.9% 64.7% 26.9% Marion 81.5% 25.8% 65.8% 27.0% Miller 79.4% 36.7% 79.0% 38.0% Mississippi 78.8% 29.5% 67.9% 33.4% Monroe 72.6% 38.0% 73.4% 41.4% Montgomery 81.5% 30.3% 66.3% 29.5% Nevada 86.6% 31.3% 65.7% 31.4% Newton 76.2% 27.2% 65.6% 29.3% Ouachita 81.0% 31.7% 64.4% 30.1% Perry 77.7% 26.4% 66.8% 25.0% Phillips 76.0% 40.2% 72.2% 42.9% Pike 83.5% 31.8% 63.9% 30.5% Poinsett 80.6% 32.2% 68.8% 33.8% Polk 82.2% 31.0% 64.8% 28.6% Pope 76.9% 29.6% 65.2% 30.7% Prairie 79.7% 31.1% 70.2% 35.3% Pulaski 73.5% 27.6% 65.9% 27.6% Randolph 80.6% 32.5% 70.9% 26.9% St. Francis 81.0% 40.1% 72.6% 40.3% Saline 77.5% 27.4% 66.5% 26.3% Scott 80.1% 29.3% 62.8% 28.6% Searcy 79.3% 25.8% 67.2% 28.3% Sebastian 77.2% 26.7% 64.1% 28.5% Sevier 82.9% 25.2% 71.5% 33.5% Sharp 77.9% 31.2% 69.2% 23.8% Stone 77.8% 26.5% 67.2% 24.5% Union 77.8% 30.7% 61.8% 30.1% Van Buren 78.5% 26.6% 65.8% 27.0% Washington 73.5% 25.3% 63.1% 24.8% White 82.3% 28.0% 65.5% 30.4% Woodruff 83.1% 39.4% 70.0% 35.7% Yell 78.9% 29.6% 67.0% 30.5% Best 25% of counties Middle 50% of counties Worst 25% of counties

88 Preventive Care and Screenings 88 Childhood Immunizations No Flu shot No Pneumo shot No Breast Cancer Screen No Cervical Cancer Screen Arkansas 72.2% 35.6% 53.3% 33.1% 23.6% Ashley 94.6% 22.7% 30.5% 28.1% 10.4% Baxter 76.6% 33.4% 39.4% 38.3% 27.6% Benton 74.0% 29.2% 30.4% 29.0% 19.1% Boone 82.2% 40.0% 34.8% 35.1% 29.6% Bradley 85.7% 21.0% 31.4% 29.0% 10.6% Calhoun 89.0% 23.1% 29.1% 20.0% 8.1% Carroll 75.3% 32.9% 32.3% 31.3% 28.3% Chicot 93.5% 31.6% 39.7% 23.8% 11.9% Clark 85.2% 24.9% 37.7% 24.1% 12.1% Clay 90.7% 22.2% 44.3% 24.7% 20.9% Cleburne 86.4% 37.0% 36.1% 28.8% 20.6% Cleveland 93.3% 29.3% 50.7% 23.1% 17.6% Columbia 81.7% 26.7% 41.8% 26.3% 16.0% Conway 76.4% 28.4% 38.1% 30.2% 19.5% Craighead 82.2% 22.8% 40.3% 32.7% 24.0% Crawford 74.8% 33.6% 32.8% 31.4% 18.0% Crittenden 64.0% 34.3% 50.5% 32.8% 15.7% Cross 87.8% 33.8% 47.6% 31.6% 17.0% Dallas 100.0% 26.0% 38.2% 20.5% 11.6% Desha 90.5% 40.7% 53.6% 31.7% 20.9% Drew 94.0% 26.8% 44.6% 26.0% 12.6% Faulkner 77.3% 31.0% 35.8% 23.6% 15.5% Franklin 93.6% 32.6% 35.3% 31.6% 23.4% Fulton 92.1% 30.1% 35.2% 32.4% 30.0% Garland 63.5% 23.0% 30.0% 27.1% 15.7% Grant 76.8% 28.4% 39.0% 23.8% 15.4% Greene 77.9% 22.2% 40.1% 26.4% 22.4% Hempstead 84.0% 31.9% 39.0% 23.9% 15.0% Hot Spring 62.3% 23.1% 31.5% 28.2% 14.9% Howard 93.0% 27.0% 37.1% 33.9% 19.4% Independence 90.7% 36.0% 36.1% 33.2% 25.7% Izard 94.6% 33.3% 34.5% 31.3% 25.1% Jackson 77.8% 29.2% 39.0% 34.1% 25.2% Jefferson 68.6% 36.7% 46.7% 24.2% 13.8% Johnson 83.1% 29.3% 41.1% 36.7% 22.8% Lafayette 91.1% 33.9% 50.3% 21.2% 19.2% Lawrence 90.0% 27.7% 37.0% 29.4% 25.3% Best 25% of counties Middle 50% of counties Worst 25% of counties

89 89 Childhood Immunizations No Flu shot No Pneumo shot No Breast Cancer Screen No Cervical Cancer Screen Lincoln 80.9% 34.3% 55.8% 29.9% 20.5% Little River 86.5% 32.4% 35.8% 24.7% 12.6% Logan 92.0% 26.8% 31.9% 32.2% 20.7% Lonoke 80.9% 29.1% 37.1% 24.2% 16.7% Madison 78.0% 31.8% 33.0% 31.2% 22.2% Marion 87.2% 34.4% 40.4% 34.1% 24.5% Miller 70.2% 41.8% 44.9% 20.3% 15.7% Mississippi 90.7% 26.7% 44.8% 34.8% 23.1% Monroe 75.5% 34.1% 51.1% 36.8% 23.9% Montgomery 87.5% 23.6% 31.0% 27.7% 15.5% Nevada 83.3% 23.7% 42.4% 22.6% 15.2% Newton 95.8% 32.7% 39.7% 37.7% 27.9% Ouachita 73.9% 24.4% 34.6% 20.8% 11.7% Perry 92.9% 25.4% 32.8% 23.1% 15.3% Phillips 85.7% 40.9% 56.1% 41.0% 27.6% Pike 90.7% 24.5% 45.6% 31.5% 20.6% Poinsett 81.7% 28.8% 45.7% 34.5% 22.2% Polk 85.7% 35.7% 36.7% 32.6% 23.1% Pope 57.6% 26.3% 37.8% 34.5% 19.2% Prairie 91.2% 31.0% 43.5% 32.1% 22.4% Pulaski 78.7% 33.2% 39.1% 24.1% 13.3% Randolph 97.4% 26.0% 41.5% 24.3% 22.0% St. Francis 68.1% 34.7% 48.2% 28.0% 14.2% Saline 85.7% 26.4% 35.3% 24.6% 15.2% Scott 74.4% 27.5% 27.7% 27.8% 18.2% Searcy 88.1% 30.4% 37.0% 36.3% 23.2% Sebastian 67.2% 26.7% 27.4% 28.2% 19.8% Sevier 82.6% 28.9% 28.9% 35.4% 17.3% Sharp 91.1% 33.0% 31.0% 26.4% 28.9% Stone 83.5% 35.6% 36.4% 32.3% 20.4% Union 84.1% 24.7% 31.4% 27.7% 12.0% Van Buren 81.4% 31.9% 36.3% 29.9% 20.5% Washington 53.3% 32.8% 29.3% 30.9% 17.1% White 82.2% 34.3% 35.8% 29.8% 19.4% Woodruff 90.9% 33.6% 40.6% 31.9% 19.2% Yell 78.7% 26.5% 31.5% 31.2% 17.3% Best 25% of counties Middle 50% of counties Worst 25% of counties

90 Preventive Care and Screenings, continued 90 No Prostate Cancer Screen No Colonoscopy No Fecal Occult Blood Test No HIV Test Arkansas 50.0% 50.8% 82.0% 65.8% Ashley 47.5% 56.9% 76.4% 59.1% Baxter 45.8% 40.6% 80.9% 56.4% Benton 47.4% 45.2% 71.0% 68.2% Boone 51.0% 53.7% 79.4% 69.7% Bradley 54.6% 56.4% 79.7% 56.6% Calhoun 49.3% 56.3% 78.2% 57.0% Carroll 44.7% 45.2% 73.9% 71.5% Chicot 33.3% 46.5% 67.8% 59.2% Clark 35.0% 51.0% 68.8% 68.3% Clay 44.3% 47.5% 83.3% 74.0% Cleburne 51.7% 45.3% 78.1% 72.4% Cleveland 45.7% 51.1% 80.4% 60.1% Columbia 51.1% 58.7% 82.1% 59.3% Conway 52.1% 46.6% 78.8% 62.0% Craighead 50.5% 55.0% 82.5% 69.9% Crawford 48.9% 50.0% 73.0% 68.5% Crittenden 43.1% 59.1% 79.2% 57.1% Cross 51.4% 57.6% 84.6% 62.3% Dallas 38.8% 54.2% 72.8% 70.2% Desha 57.3% 53.0% 81.0% 61.2% Drew 47.8% 52.1% 77.5% 59.8% Faulkner 43.3% 38.1% 77.2% 65.4% Franklin 49.9% 49.9% 70.9% 69.4% Fulton 50.9% 40.7% 77.0% 58.0% Garland 42.3% 43.0% 76.1% 68.6% Grant 34.2% 37.4% 78.7% 68.5% Greene 50.7% 54.4% 82.7% 72.4% Hempstead 56.1% 53.8% 79.7% 66.7% Hot Spring 41.8% 44.8% 75.4% 70.1% Howard 66.0% 55.5% 80.6% 72.6% Independence 54.4% 50.1% 80.3% 69.8% Izard 52.1% 45.4% 82.4% 61.6% Jackson 49.0% 51.4% 81.6% 71.7% Jefferson 46.5% 42.6% 77.5% 56.3% Johnson 50.8% 57.3% 75.7% 63.0% Lafayette 48.7% 59.3% 84.0% 64.8% Lawrence 50.0% 50.0% 80.1% 69.9% Best 25% of counties Middle 50% of counties Worst 25% of counties

91 91 No Prostate Cancer Screen No Colonoscopy No Fecal Occult Blood Test No HIV Test Lincoln 49.0% 53.9% 81.1% 57.4% Little River 49.0% 52.0% 80.6% 66.2% Logan 48.2% 50.8% 77.3% 70.0% Lonoke 39.5% 38.5% 77.4% 67.7% Madison 45.3% 48.1% 71.8% 69.3% Marion 42.7% 47.0% 79.3% 64.9% Miller 49.9% 55.8% 83.0% 64.7% Mississippi 42.8% 58.7% 79.1% 65.6% Monroe 53.8% 58.9% 85.8% 72.7% Montgomery 42.1% 48.0% 72.8% 74.9% Nevada 40.1% 52.3% 77.9% 66.9% Newton 45.2% 53.2% 78.5% 67.9% Ouachita 42.9% 55.9% 77.2% 60.9% Perry 35.6% 38.1% 77.7% 67.3% Phillips 63.5% 58.6% 88.5% 70.1% Pike 47.6% 48.5% 72.0% 75.4% Poinsett 44.8% 55.4% 82.3% 65.0% Polk 49.0% 52.4% 81.1% 75.2% Pope 50.6% 53.3% 79.5% 60.2% Prairie 49.8% 45.8% 76.7% 70.8% Pulaski 43.1% 36.1% 77.8% 61.0% Randolph 58.1% 51.2% 78.4% 69.8% St. Francis 45.6% 64.6% 83.8% 61.5% Saline 34.5% 36.8% 78.1% 68.1% Scott 44.7% 47.0% 75.9% 74.6% Searcy 43.1% 51.0% 81.4% 64.5% Sebastian 45.1% 47.0% 72.2% 72.9% Sevier 50.4% 55.6% 82.6% 70.0% Sharp 54.6% 45.5% 79.0% 67.9% Stone 51.3% 48.1% 82.5% 65.7% Union 52.3% 59.0% 79.2% 58.4% Van Buren 51.1% 45.3% 79.0% 65.7% Washington 51.5% 49.6% 72.9% 64.7% White 51.3% 44.3% 77.3% 70.0% Woodruff 55.3% 53.6% 80.1% 70.3% Yell 50.7% 51.0% 78.9% 64.7% Best 25% of counties Middle 50% of counties Worst 25% of counties

92 92 Health Outcomes and Mortality Poor Mental Health Poor Physical Health Infectious Disease Preventable hospitalizations Infant mortality Arkansas 9.3% 42.3% Ashley 11.1% 46.5% Baxter 14.1% 39.5% Benton 8.2% 34.0% Boone 12.9% 43.6% Bradley 11.5% 45.1% Calhoun 9.7% 43.7% Carroll 9.0% 37.3% Chicot 10.8% 45.0% Clark 8.6% 37.0% Clay 14.0% 47.5% Cleburne 11.7% 40.4% Cleveland 12.0% 39.2% Columbia 10.9% 35.9% Conway 9.3% 40.0% Craighead 8.7% 34.3% Crawford 6.5% 34.8% Crittenden 17.8% 39.0% Cross 17.5% 39.3% Dallas 9.6% 42.6% Desha 8.4% 48.2% Drew 12.4% 44.2% Faulkner 10.6% 39.8% Franklin 7.1% 34.4% Fulton 14.8% 44.3% Garland 11.5% 39.6% Grant 9.6% 39.4% Greene 10.6% 41.4% Hempstead 9.9% 38.9% Hot Spring 12.8% 40.1% Howard 10.0% 35.4% Independence 15.7% 41.2% Izard 14.7% 40.8% Jackson 12.5% 37.0% Jefferson 12.2% 39.8% Johnson 8.1% 32.4% Best 25% of counties Middle 50% of counties Worst 25% of counties

93 93 Poor Mental Health Poor Physical Health Infectious Disease Preventable hospitalizations Infant mortality Lafayette 9.6% 40.6% Lawrence 12.4% 41.7% Logan 9.0% 34.8% Lonoke 10.1% 38.8% Madison 7.8% 35.5% Marion 12.9% 40.5% Miller 9.4% 48.7% Mississippi 10.8% 35.5% Monroe 11.1% 48.3% Montgomery 11.3% 37.6% Nevada 10.2% 33.7% Newton 9.8% 37.9% Ouachita 9.0% 41.0% Perry 10.0% 39.3% Phillips 8.3% 51.1% Pike 9.9% 31.9% Poinsett 12.2% 34.6% Polk 11.9% 38.1% Pope 9.0% 36.1% Prairie 9.9% 36.3% Pulaski 11.7% 40.4% Randolph 15.9% 48.3% St. Francis 16.8% 41.8% Saline 10.1% 39.0% Scott 10.8% 35.0% Searcy 12.3% 38.3% Sebastian 8.0% 33.9% Sevier 10.7% 40.0% Sharp 15.7% 45.5% Stone 14.7% 40.0% Union 10.5% 43.5% Van Buren 9.7% 40.8% Washington 7.6% 35.9% White 11.6% 37.3% Woodruff 12.7% 37.2% Yell 10.8% 38.5% Best 25% of counties Middle 50% of counties Worst 25% of counties

94 Health Outcomes and Mortality, continued 94 Teen suicide Elderly suicide Homicide Alcohol-related traffic deaths Arkansas % Ashley % Baxter % Benton % Boone % Bradley % Calhoun % Carroll % Chicot % Clark % Clay % Cleburne % Cleveland % Columbia % Conway % Craighead % Crawford % Crittenden % Cross % Dallas % Desha % Drew % Faulkner % Franklin % Fulton % Garland % Grant % Greene % Hempstead % Hot Spring % Howard % Independence % Izard % Jackson % Jefferson % Johnson % Lafayette % Lawrence % Best 25% of counties Middle 50% of counties Worst 25% of counties

95 95 Teen suicide Elderly suicide Homicide Alcohol-related traffic deaths Lincoln % Little River % Logan % Lonoke % Madison % Marion % Miller % Mississippi % Monroe % Montgomery % Nevada % Newton % Ouachita % Perry % Phillips % Pike % Poinsett % Polk % Pope % Prairie % Pulaski % Randolph % St. Francis % Saline % Scott % Searcy % Sebastian % Sevier % Sharp % Stone % Union % Van Buren % Washington % White % Woodruff % Yell % Best 25% of counties Middle 50% of counties Worst 25% of counties

96 Health Outcomes and Mortality, continued 96 Occupational fatalities Cardiovascular disease deaths Cancer deaths Premature death (years) Arkansas Ashley Baxter Benton Boone Bradley Calhoun Carroll Chicot Clark Clay Cleburne Cleveland Columbia Conway Craighead Crawford Crittenden Cross Dallas Desha Drew Faulkner Franklin Fulton Garland Grant Greene Hempstead Hot Spring Howard Independence Izard Jackson Jefferson Johnson Lafayette Lawrence Best 25% of counties Middle 50% of counties Worst 25% of counties

97 97 Occupational fatalities Cardiovascular disease deaths Cancer deaths Premature death (years) Lincoln Little River Logan Lonoke Madison Marion Miller Mississippi Monroe Montgomery Nevada Newton Ouachita Perry Phillips Pike Poinsett Polk Pope Prairie Pulaski Randolph St. Francis Saline Scott Searcy Sebastian Sevier Sharp Stone Union Van Buren Washington White Woodruff Yell Best 25% of counties Middle 50% of counties Worst 25% of counties