HAMILTON COUNTY DATA PROFILE ADULT CIGARETTE SMOKING North Country Population Health Improvement Program
HAMILTON COUNTY DATA PROFILE: ADULT CIGARETTE SMOKING INTRODUCTION The Hamilton County Data Profile supplements the data presented in the regional report on adult cigarette smoking Review of Data Associated with Adult Cigarette Smoking in the North Country. The Data Profile provides additional information about the social and economic conditions in Hamilton County that are linked to elevated rates of cigarette smoking. Where available, data by time trends, demographic characteristics (e.g. gender, age) and zip code are presented to help inform the development of strategies and efforts to reduce cigarette smoking in the county. Note: Due to Hamilton County s small population size (2015 population estimate of 4,712), data for some of measures related to cigarette smoking are not available. Absent data measures are noted within the report. A D U LT C I G A R E T T E S M O K I N G P R E V A L E N C E Due to the small population size of Hamilton County, there is a significant difference between the ageadjusted percentage (31%) and the crude percentage (19%) of adult cigarette smokers in Hamilton County as reported by NYSDOH (BRFSS 2013-2014). In the June 2016 StatShot published by NYSDOH, the prevalence of current smoking among adults in Hamilton County is reported as being 19%. Data for the following smoking-related measures are not available for Hamilton County due to the county s small population size: estimate of the adult population who report ever smoking 100 or more cigarettes; and estimate of adult smokers who attempted to quit smoking for at least 1 day in the past year. This lack of data makes it more difficult to fully quantify the prevalence and impact of cigarette smoking in Hamilton County. Data measures related to adult cigarette smoking in Hamilton County that are available are discussed below. Percentage of Adult Smokers Age-adjusted Rate (and Crude Rate for Hamilton County) 35 31.0% 30 25 20 22.6% 19.0% 16.8% 15.9% 15 10 5 0 US NYS North Country Source: NYSDOH BRFSS 2013-2014 C-163 Hamilton County (Age-adjusted) Prepared by AHI ~ North Country Population Health Improvement Program, January 2017 Hamilton County (Crude Rate) 3
Percentage of Adults Who Smoke in Hamilton County Change over Time 35 30 change in methodology 31% 25 22.9% 20 2009 2014 Source: New York Expanded Behavioral Risk Factor Surveillance System 2014. The BRFSS 2014 prevalence data should be considered a baseline year for data analysis and is not directly comparable to previous years of BRFSS data because of the changes in weighting methodology and the addition of the cell phone sampling frame. C-164 PERCENTAGE OF SMOKERS BY GENDER A higher percentage of adult females compared to males smoke cigarettes in the North Country. In Hamilton County, a significantly higher percentage of adult women smoke cigarettes in comparison to men. Lower percentages of males in Hamilton County smoke in comparison to males in the US, NYS and North Country region. Percentage of Smokers by Gender 35 30 25 20 15 18.8% 18.8% 14.8% 12.7% 20.1% 22.7% 22.6% 15.5% 10 5 0 US NYS North Country Hamilton County Source: NYSDOH BRFSS 2013-2014. C-165 4 Prepared by AHI ~ North Country Population Health Improvement Program, January 2017
Hamilton County ranks 24 out of 62 counties in New York State for cigarette expenditures as a percent of total household expenditures. This means that 23 other NYS counties have lower cigarette expenditures as a percent of total household expenditures than Hamilton County. Among the six counties in the North Country region, Hamilton and Warren Counties are both ranked lowest (24th) on this measure. The distribution of cigarette expenditures as a percent of total household expenditures in Hamilton County is depicted in the map below. Percent of Cigarette Expenditures ~ Hamilton County Percent of Total Expenditures 1st Quintile (Highest) 2nd Quintile 3rd Quintile 4th Quintile 5th Quintile (Lowest Expenditures) No Data or Data Suppressed Source: Stated Rank by tract, Nielson 2014. C-166 Prepared by AHI ~ North Country Population Health Improvement Program, January 2017 5
BURDEN OF DISEASES ASSOCIATED WITH CIGARETTE SMOKING The two leading causes of premature death (before the age of 65 years) in Hamilton County from 2012-2014 were cancer and heart disease; both are closely associated with smoking. The map below depicts the distribution of premature deaths in Hamilton County by Minor Civil Division. Percentage of Premature Deaths Before Age 65, 4-Year Average, 2011-2014 MCD Number MCD Name Deaths before age 65 years Percentage Percentage of Deaths Hamilton County - 26.3 New York State - 23.8 NYS excluding NYC - 21.0 Quartile (Q) Distribution excluding NYC 0 < 24.1 : Q1 & Q2 24.1-29.2 : Q3 29.2+ : Q4 43412 37495 48340 02572 37374 40794 79059 02572 Arietta 3 30.0* 05958 Benson 2 28.6* 35496 Hope 2 15.4* 37374 Indian Lake 17 22.4 37495 Inlet 8 36.4* 40794 Lake Pleasant 12 32.4 43412 Long Lake 12 30.0 48340 Morehouse 2 25.0* 79059 Wells 5 16.7* Source: Centers for Disease Control and Prevention 2014. C-167 05958 35496 * Fewer than 10 events in the numerator, therefore the rate is unstable. s: Data suppressed; do not meet reporting criteria. CT-167 Other indicators of the disease burden associated with cigarette smoking in Hamilton County include: the incidence rate for all cancers exceeds the rates for NYS and the North Country region; the cardiovascular disease premature death rate exceeds the rates for NYS and the North Country; and Chronic Lower Respiratory Disease Mortality Cardiovascular Disease Premature Death Rate Rate Per 100,000 Population 30 49 37 61 107 166 NYS North Country Hamilton County the mortality rate for chronic lower respiratory disease exceeds the NYS rate. All Cancers Incidence 489 514 529 6 Prepared by AHI ~ North Country Population Health Improvement Program, January 2017 0 100 200 300 400 500 600 Source: Incidence rates for all cancers from NYSDOH Cancer Registry 2010-2012. Mortality rate for chronic lower respiratory disease and cardiovascular disease premature death rate are from NYSDOH Vital Statistics 2011-2013. C-168
POVERTY AND INCOME MEASURES Poverty is strongly associated with a higher prevalence of cigarette smoking. Nationally, 42% more people who live below the poverty level smoke cigarettes compared to people living at or above the poverty level. According to BRFSS 2014 data, 35.2% of Hamilton County adults with annual household incomes less than $25,000 are current smokers, which is significantly higher than the 19% of the total adult population in Clinton County who smoke. The percentage of Hamilton County residents living below the poverty level has remained relatively stable from 2006 to 2014 and is below the NYS value of 15.6%. Unlike the experience in the other counties in the North Country region, where a higher percentage of females live below the poverty level compared to males, the percentages of women and men living below the poverty level in Hamilton County are comparable. 10 9.5 9 8.5 Percentage of People Living Below the Poverty Level in Hamilton County Change over Time Source: BRFSS Data 2014 Hamilton County. C-169 Percentage of People Living Below Poverty Level by Gender Female Male Overall 9.5% 9.5% 8.8% 2006-2010 2007-2011 2008-2012 2009-2013 2010-2014 Source: BRFSS Data 2014 Hamilton County. C-170 9.4% Percentage of People Living Below Poverty Level by Age 9.5% 9.5% 9.4% 0 1 2 3 4 5 6 7 8 9 10 9.5% By a very large margin, people between the ages of 18 to 24 constitute the largest age cohort of people living below the poverty level in Hamilton County. This is in contrast to the experience in the other counties in the North Country, where higher percentages of children (under the age of 12) live below the poverty level. Since most adult smokers first start smoking prior to the age of 18 years, children living in poverty is an important population to target for tobacco prevention efforts. <6 6-11 12-17 18-24 25-44 45-64 65-74 75+ Overall 7.3% 8.1% 8.1% 26.2% 10.4% 9.0% 6.2% 6.7% 9.5% 0 5 10 15 20 25 30 Source: American Community Survey 2010-2014 Hamilton County. C-171 Prepared by AHI ~ North Country Population Health Improvement Program, January 2017 7
Percent of Population Living Below the Poverty Level in Hamilton County Percent of Population Below the Poverty Level Over 20% 15.1-20.0% 10.1-15.0% Under 10.1% Percentage of People Living Below 200% of the Poverty Level in Hamilton County Source: Population Below the Poverty Level, Percent by ZCTA, ACS 2010-14. C-172 Percentage of Children, Age 0-17, Living Below the Poverty Level in Hamilton County Percent of Population Below 200% Poverty Level 26.1-38.0% Under 26.1% Percent of Children Below the Poverty Level Source: Population Below 200% the Poverty Level, Percent by ZCTA, ACS 2010-14. C-174 15.1-22.0% Under 15.1% No Population Age 0-17 Reported Source: Population Below the Poverty Level, Children Age 0-17, Percent by ZCTA, ACS 2010-14. C-173 8 Prepared by AHI ~ North Country Population Health Improvement Program, January 2017
Median Household Income The median household income in Hamilton County increased by more than $3,000 since the 2006 2010 census period. However, it remains below the median household income for NYS and the US ($58,687 and $53,483, respectively). Median Household Income in Hamilton County Median Household Income Change over Time 54k 52k 50k 48k $52,939 $51,142 $51,595 $51,522 $49,557 2006-2010 2007-2011 2008-2012 2009-2013 2010-2014 Source: American Community Survey 2010-2014 Hamilton County. C-175 Median Household Income by Tract Over $55,000 $45,001 - $55,000 Source: Median Household Income by Tract, Hamilton County. ACS 2010-14. C-178 Single Parent Households Change over Time 27.5 24.8% 25 22.5 21.2% 21.8% 19.9% 20.0% 20 17.5 2006-2010 2007-2011 2008-2012 2009-2013 2010-2014 Source: American Community Survey 2010-2014 Hamilton County. C-176 It is estimated that 36% of children in NYS live in singleparent households. The percentage of children living in single-parent households in Hamilton County has steadily increased from 2006 to 2014. Single-parent households with children in Hamilton County have significantly lower median incomes in comparison to incomes for all other household categories. Households comprised of single females with children have, by a substantial amount, the lowest median household income ($19,333) in the county. Percentage of Single Parent Households with Children Living Below the Poverty Level Single Parent Households with Children Living Below the Poverty Level Report Area Married Couple Families without Children Married Couple Families with Children Single Males without Children Single Males with Children Single Females without Children Single Females with Children Over 47% 38.1-47.0% 29.1-38.0% Under 29.1% No Single Parent Families with Children Reported Hamilton County $62,986 $71,250 $31,979 $59,250 $51,500 $19,333 New York $85,466 $95,193 $58,661 $39,611 $49,196 $26,478 United States $75,434 $84,541 $51,768 $37,640 $43,046 $24,403 Source: American Community Survey 2010-2014 Hamilton County. CT-177 Source: Single Parent Family Households with Children Living Below the Poverty Level, Hamilton County. Percent by ZCTA, ACS 2010-14. C-177 Prepared by AHI ~ North Country Population Health Improvement Program, January 2017 9
Nationally, the prevalence of cigarette smoking is higher among people who are insured by Medicaid. NYSDOH estimates that 28% of Medicaid beneficiaries were smokers in 2015. The percentage of Hamilton County residents with health insurance who are insured by Medicaid (14%) is substantially lower in comparison to the rest of New York State. Percent of Insured Population Receiving Medicaid Report Area Total Population (For Whom Insurance Status is Determined) Population with Any Health Insurance Population Receiving Medicaid Percent of Insured Population Receiving Medicaid Hamilton County 4,759 4,313 601 13.93% New York 19,342,656 17,290,104 4,345,119 25.13% United States 309,082,272 265,204,128 55,035,660 20.75% 0 30% Hamilton County 13.93% New York 25.13% United States 20.75% Source: US Census Bureau, American Community Survey. Hamilton County. 2010-2014. C-179 Percentage of Population Insured by Medicaid in Hamilton County Insured by Medicaid 15.1-20.0% Under 15.1% Source: Insured, Medicaid/ Means-Tested Coverage, Percent by ZCTA, ACS 2010-14. C-180 10 Prepared by AHI ~ North Country Population Health Improvement Program, January 2017
Percentage of People 25+ with a Bachelor s Degree or Higher Change over Time EDUCATIONAL ATTAINMENT Cigarette smoking rates vary greatly by level of educational attainment. For instance, national data show that 23% of people with less than a high school education and 22% of people with a high school diploma smoke cigarettes compared to only 8% of people with a college degree. The percentage of Hamilton County residents age 25 and older with a Bachelor s degree or higher (23.8%) is substantially below the NYS average (33.7%). As indicated in the chart to the right above, there has been a steady decline in the percentage of Hamilton County adults 25 years and older with a college degree from 2006 to 2014. A larger percentage of females than males age 25 years and older have a Bachelor s degree or higher in Hamilton County. 27 26 25 24 23 25.9% 25.6% 25.1% 24.2% 23.8% 2006-2010 2007-2011 2008-2012 2009-2013 2010-2014 Source: American Community Survey 2010-2014 Hamilton County. C-181 Percentage of Population with a Bachelor s Degree or Higher in Clinton County Population with a Bachelor s Degree or Higher Over 23.0% 18.1-23.0% 13.1-18.0% Under 13.1% Source: Population with a Bachelor s Degree or Higher, Percent by ZCTA, ACS 2010-14. C-182 Percentage of People 25+ with a Bachelor s or Higher Degree by Gender Female 26.0% Male 21.5% Overall 23.8% 0 2.5 5 7.5 10 12.5 15 17.5 20 22.5 25 27.5 Source: American Community Survey 2010-2014 Hamilton County. C-183 Prepared by AHI ~ North Country Population Health Improvement Program, January 2017 11
Percentage of People 25+ with a High School Diploma or Higher Change over Time 90 89.9% 89.9% 89.5 89 88.6% 88.8% 89.1% 88.5 2006-2010 2007-2011 2008-2012 2009-2013 2010-2014 Source: American Community Survey 2010-2014 Hamilton County. C-184 Percentage of People 25+ with a High School Diploma or Higher by Gender Female 93.5% Male 86.3% Overall 89.9% The percentage of people age 25 and older in Hamilton County who have completed a high school degree or the equivalent is 89.9%, above the NYS average of 85.4%. A higher percentage of females than males have completed high school or the equivalent in Hamilton County. 0 10 20 30 40 50 60 70 80 90 100 Source: American Community Survey 2010-2014 Hamilton County. C-185 Percentage of Population with, at most, a High School Diploma in Hamilton County Population with, at most, a High School Diploma Over 41.0% 35.1-41.0% 29.1-35.0% Under 29.1% Source: Population with Only a High School Diploma, Percent by ZCTA, ACS 2010-14. C-186 12 Prepared by AHI ~ North Country Population Health Improvement Program, January 2017
Percentage of Population Age 25+ with No High School Diploma Report Area Total Population Age 25+ Population Age 25+ with No High School Diploma Percent Population Age 25+ with No High School Diploma Hamilton County 3,674 370 10.07% New York 13,329,734 1,949,187 14.62% United States 209,056,128 28,587,748 13.67% 0 50% Hamilton County 10.07% New York 14.62% United States 13.67% Source: American Community Survey 2010-14 Hamilton County. C-187 National data indicate that 23% of adults who do not have a high school diploma smoke. There are 370 persons age 25 and older without a high school diploma (or equivalent) in Hamilton County. This represents 10.1% of the total population age 25 and older. A higher percentage of males than females age 25 years and older do not have a high school diploma (or equivalent) in the county. Report Area Total Male Percent Male Total Female Percent Female Hamilton County 249 121 13.68% 6.53% New York 943,308 1,005,879 14.96% 14.32% United States 14,483,210 14,104,538 14.37% 13.03% Source: American Community Survey 2010-14 Hamilton County. C-188 Percentage of Population with No High School Diploma in Hamilton County Population with No High School Diploma 16.1-21.0% 11.1-16.0% Under 11.1% Source: Population with no High School Diploma, Percent by ZCTA, ACS 2010-14. C-189 Prepared by AHI ~ North Country Population Health Improvement Program, January 2017 13
MENTAL HEALTH Nationally, it is estimated that 36% of adults with some form of a mental health condition smoke cigarettes and that 31% of all cigarettes smoked in the US are smoked by adults with a mental health condition. Clearly, a person s mental health status has a large impact on if he or she is a smoker. The data at right indicate that Hamilton County residents report experiencing less mental distress and better mental health compared to all NYS residents. The percent of Hamilton County adults who report frequent mental distress is slightly below the NYS value; 9.7% in Hamilton County and 10.0% in NYS. This measure is an indication of the percentage of adults who reported that their mental health, which includes stress, depression, and problems with emotions, was not good for 14 or more of the past 30 days. Source: County Health Rankings, 2014. The percentage of Hamilton County adults who stated that their mental health was not good 14 or more days in the past month is well below the NYS percentage, 4.9% compared to 11.1%, respectively. Source: NYSDOH BRFSS, 2014. 10 7.5 5 Poor Mental Health: 14+ Days Change over Time 2.5 2009 2014 Source: New York Expanded Behavioral Risk Factor Surveillance System 2014. The BRFSS 2014 prevalence data should be considered a baseline year for data analysis and is not directly comparable to previous years of BRFSS data because of the changes in weighting methodology and the addition of the cell phone sampling frame. Hamilton County. C-190 12 10 8 6 8.9% 4.9% Depression: Medicare Population Change over Time 7.1% 8.3% 9.5% change in methodology 8.5% 9.5% 2009 2010 2011 2012 2013 2014 Source: American Community Survey 2010-2014 Hamilton County. C-191 10.6% Similarly, the percentage of Hamilton County Medicare beneficiaries who were treated for depression is also below the NYS percentage, 10.6% compared to 14.9%, respectively. Source: Centers for Medicare and Medicaid Services, 2014. There has been a steady increase in the percentage of Hamilton County Medicare beneficiaries treated for depression since 2009. Data for another measure of mental health, the age-adjusted death rate due to suicide, is not available for Hamilton County. 14 Prepared by AHI ~ North Country Population Health Improvement Program, January 2017
People with Disabilities Nationally, people with disabilities smoke at a higher percentage (22%) than people without disabilities (16%). It is estimated that 17.4% of the adult population of Hamilton County are limited in any activities because of physical, mental, or emotional problems (below the NYS percentage of 19.9%). The distribution of Hamilton County residents with a disability by zip code is depicted below. Veterans Nationally, veterans smoke at a higher percentage than non-veterans. US Census data indicate that 15.2% of the population of Hamilton County are veterans (well above the NYS percentage of 5.7% and the highest percentage among the six counties in the region). The distribution of veterans in Hamilton County by census tract is depicted above right. Native American Population Data indicate that, among all racial/ethnic groups in the US, cigarette smoking is highest among Native Americans/Alaska Natives; 29% of Native Americans/ Alaska Native adults smoke cigarettes nationally. According to the US Census 2015 estimate, 0.3% of the residents of Hamilton County are Native Americans (1% of the NYS population is Native American). The distribution of the Native American population in Hamilton County is depicted below right. Veterans in Hamilton County Veteran Population Over 13.0% 11.1-13.0% Source: Veterans in Hamilton County, Percent by ZCTA, ACS 2010-14. C-193 Native American Population in Hamilton County People Living with a Disability in Hamilton County Native American Population Over 2.0% Under 0.6% Disabled Population Over 18.0% 15.1-18.0% 12.1-15.0% Under 12.1% Source: Native American Population, Percent by ZCTA, ACS 2010-14. C-194 Source: Disabled Population, Percent by ZCTA, ACS 2010-14. C-192 Prepared by AHI ~ North Country Population Health Improvement Program, January 2017 15
Primary Care Provider Rate Per 100,000 Population Change over Time 21.5 21 21 21 21 2011 2012 2013 21 20.5 20 20 19.5 change in methodology 2008 2010 Source: Hamilton County providers per 100,000 population. County Health Rankings 2013 due to a change in the source s calculation methodology, comparison of 2010 data with earlier data is not recommended. C-195 Access to Primary Care Rate per 100,000 Population by Year 125 100 75 New York United States Hamilton County 50 25 ACCESS TO SERVICES Primary Care Providers Access to primary care providers increases the likelihood that community members will have routine checkups and screenings. Primary care providers can play a critical role in assisting their patients initiate smoking cessation activities. As the charts to the right depict, the primary care provider rate (providers per 100,000 population) in Hamilton County has remained stagnant for several years and is well below the rate for the US and NYS. Additionally, there are no more than 1 to 3 primary care physicians within a 10-mile radius in all of Hamilton County. 0 2004 2005 2006 2007 2009 2010 2011 2012 2013 2014 Source: Access to Primary Care, Rate per 100,000 Population by Year, CMS 2004-2014. C-196 Access to Primary Care Physician within 10 Miles in Hamilton County Access to Primary Care Physicians Over 500 201-500 61-200 21-60 4-20 1-3 0 Source: Access to Primary Care Physicians. Total Physicians within 10 miles by Tract. CMS 2012 Hamilton County. C-197 16 2008 Prepared by AHI ~ North Country Population Health Improvement Program, January 2017
Non-Physician Primary Care Provider Rate Per 100,000 Population Change over Time Non-Physician Primary Care Providers The non-physician primary care provider rate per 100,000 population has remained stagnant in Hamilton County as well. Primary care providers who are not physicians include nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists. These providers can assist community members access and initiate smoking cessation services. 85.5 85 85 84.5 84 83.5 84 84 2013 2014 2015 Source: County Health Rankings 2015 Hamilton County. C-198 Mental Health Care Providers Given the high prevalence of cigarette smoking among people with mental health conditions, access to a mental health provider can be a critical asset in helping people quit smoking. The mental health provider rate (e.g. psychiatrists, psychologists, licensed clinical social workers, counselors, and advanced practice nurses specializing in mental health care) per 100,000 population has also been stagnant in Hamilton County from 2013 to 2015. The rate of mental health providers in the county is far below the rate for NYS and the US. 1000 500 Mental Health Provider Rate Per 100,000 Population Change over Time 0 948 62 change in methodology 21 21 2008 2010 2013 2014 2015 Source: County Health Rankings 2013 due to a change in the source s calculation methodology, comparison of 2013 data with earlier data is not recommended Hamilton County. C-199 21 Mental Health Provider Rate Per 100,000 Population in Hamilton County Report Area Estimated Population Number of Mental Health Providers Ratio of Mental Health Providers to Population (1 Provider per x Persons) Mental Health Care Provider Rate (Per 100,000 Population) Hamilton County 4,715 1 4,714.8 21.2 New York 19,746,147 47,032 419.8 238.1 United States 317,105,555 643,219 493 202.8 0 250 Hamilton County 21.2 New York 238.1 United States 202.8 Source: University of Wisconsin Population Health Institute, County Health Rankings 2016. C-200 Prepared by AHI ~ North Country Population Health Improvement Program, January 2017 17
Percentage of Households without a Vehicle in Clinton County Change over Time 5 4.6% 4.7% 4.8% 4 3.7% 3.1% ACCESS TO SERVICES Transportation Public transportation options are very limited in Hamilton County making access to a vehicle critical for people to get to needed health and mental health services. Compared to the other five counties in the North Country region, Hamilton has the lowest percentage of households without a vehicle. However, given the low density of health and mental health providers in the county, people without a vehicle face substantial barriers to accessing services. 3 2006-2010 2007-2011 2008-2012 2009-2013 2010-2014 Source: American Community Survey 2010-2014 Hamilton County. C-201 Households without a Vehicle in Hamilton County Percent by Tract 6.1-8.0% 4.1-6.0% Under 4.1% Source: Households without a vehicle in Hamilton County. Percent by Tract. CMS 2012. C-202 Percentage of Households without a Vehicle Report Area Total Occupied Households Households with No Motor Vehicle Percentage of Households with No Motor Vehicle Hamilton County 1,639 78 4.76% New York 7,255,528 2,128,870 29.34% United States 116,211,088 10,594,153 9.12% Source: US Census Bureau, American Community Survey 2010-14. C-203 18 Prepared by AHI ~ North Country Population Health Improvement Program, January 2017
ACKNOWLEDGMENT Adirondack Health Institute and the North Country Population Health Improvement Program thank the members of the Population Health Improvement Program Advisory Council, staff from the Glens Falls Hospital Health Promotion Center and Living Tobacco-Free Initiative, and staff from the North Country Healthy Heart Network for their review of drafts of this report. The reviewers insights and comments greatly improved the report s content. AHI Adirondack Health Institute North Country Population Health Improvement Program (NC PHIP) AHI is an independent, non-profit organization supporting hospitals, physician practices, behavioral health providers, community-based organizations, patients and others in the region transform health care and improve population health. The North Country Population Health Improvement Program (NC PHIP) is a program of AHI and is supported through a grant from the New York State Department of Health. The NC PHIP promotes initiatives to improve the health of communities in Clinton, Essex, Franklin, Hamilton, Warren and Washington counties. The goal of the NC PHIP is to help build a culture of health in the North Country. Specific activities include: assess a diverse range of data to identify factors that impact health in the region promote effective strategies, programs and policies to improve the region s health reduce differences in health outcomes (health disparities) in the region; and engage a wide spectrum of community sectors in health improvement efforts Many of the data measures contained in this report are found on HealthyADK, a website of the NC PHIP. HealthyADK is a resource to locate a diverse set of community health and quality-of-life data, explore promising practices, and access key documents that describe the challenges and opportunities for improving the health of North Country communities. HealthyADK can be found at: http://www.healthyadk.org/. Prepared by AHI ~ North Country Population Health Improvement Program, January 2017 19
North Country Population Health Improvement Program www.healthyadk.org