St. Lawrence County
Community Health Assessment
2014-2017
St. Lawrence County Community Health Assessment – November 2013
1
TABLE OF CONTENTS
Executive Summary
3
1. Demographics
1a. Health Status – Natality
1b. Morbidity
1c. Mortality
8
31
43
50
2. Health Challenges
2a. Behavioral Risk Factors
2b. Environmental Risk Factors
2c. Socioeconomic Risk Factors
2d. Policy Environment
2e. Other Unique Characteristics
74
74
75
76
77
77
3. Assets and Resources
77
4. Process and Methods
79
Attachments
80
Attachment A: CHA SURVEY SUMMARY
80
Attachment B: COMMUNITY HEALTH SERVICES ASSESSMENT
101
Attachment C: COMMUNITY HEALTH IMPROVEMENT PLAN
113
Attachment D: FOCUS GROUP NOTES
129
Attachment E: TRACKING INDICATORS
139
Attachment F: GLOSSARY OF ACRONYMS
145
St. Lawrence County Community Health Assessment – November 2013
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Executive Summary
The MAPP (Mobilizing for Action through Planning and Partnership) process was used to
conduct a Community Health Assessment for St. Lawrence County. The MAPP process
was developed by Rollins School of Public Health, at Emory University and the Association
of Schools of Public Health, and was adapted for use in “Building on Community Health
Assessments” workshops offered in June 2002 by Cornell University. This methodology has
proven to be an excellent method of combining community input with health behavior and
health status data in a systematized prioritization process that provides equitable input for all
decision makers.
MAPP includes four component assessments:
The first assessment looked at Community Health Status Indicators, which consisted of two
parts. The first part included the collection and analysis of the most available secondary healthrelated statistics including morbidity and mortality, health behaviors, utilization patterns and
other health status. Primary data was also obtained by conducting a comprehensive survey
among a sample of community residents to determine their opinions, health behaviors and health
needs. Just over 800 completed surveys were returned in St. Lawrence County. While the
survey was not random, a conscious attempt was made to reach out to all sectors of the
community. Surveys were distributed through placement throughout county establishments as
well as through employers, health, educational and human services agencies and through other
community groups. The survey was designed to obtain data on public perception of health
problems, in the community and in their own household, as well as obtain data on their health
status and health behaviors.
The second assessment evaluated the effectiveness of the Public Health System and the role of
the Public Health Department within that system. This was done using a modification of the
Local Public Health System Assessment tool developed by the CDC and NACCHO. A diverse
group of community members, community agencies and key community leaders who are
familiar in some way with the local public health system completed this ranking. The
assessment was completed through the use of a more user-friendly version of the CDC and
NACCHO tool, Local Public Health System Assessment (LPHSA). Each of the ten essential
public health services were ranked by the group by using the series of indicators within each
Essential Service to determine areas of strength and areas needing improvement within the Local
Public Health System.
The 10 Essential Public Health Services are as follows:
1.) Monitor health status to identify community health problems
2.) Diagnose and investigate health problems and health hazards in the community
3.) Inform, educate and empower people about health issues
4.) Mobilize community partnerships to identify and solve health problems
5.) Develop policies and plans that support individual and community health effects
6.) Enforce laws and regulations that protect health and safety
7.) Link people to needed personal health services an assure the provision healthcare when
otherwise unavailable
St. Lawrence County Community Health Assessment – November 2013
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8.) Assure a competent public health 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
The third assessment was the Community Themes and Strengths Assessment that was
conducted through Focus Group meetings throughout the County. This assessment looked
at the issues that affect the quality of life among community residents and the assets the
County has available to address health needs. In St. Lawrence County three focus groups
were held. The first was a group of key informants, the St. Lawrence County Community
Health Improvement Collaborative, who have overseen the entire process. Facilitators
reviewed data obtained through the Community Health Status Assessment and then
discussed the specific strengths and assets the community has to address these issues,
themes and trends. The second and third focus groups were specifically targeted to include
groups who weren't as well represented on the survey, to ensure that we had adequate input
from all sectors of the community. Thus the second group was comprised of a group
approximately 10 low-income residents from Canton, while the third group was a group of
twelve male firefighters from Morristown.
The fourth assessment was also conducted through the same Focus Group meetings listed
above, and looked at the “Forces of Change” that are at work locally, statewide and
nationally, and the types of threats and/or opportunities that are created by these changes.
When all four of these assessments were completed, the data was analyzed and combined to
create the Community Health Assessment.
When the assessment process was completed, the CHA facilitator combined and analyzed the
results of the assessments, and prepared a list of the issues that had either been identified through
more than one assessment as a top issue OR that were identified in one of the assessments as a
major issue. These issues included:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Cancer
Heart Disease
Cerebrovascular disease – stroke
Lead screening
Cirrhosis
Diabetes
Breastfeeding
Obesity – physical activity/nutrition
Oral health
Substance Abuse
Mental Health
Tobacco Use
CLRD – chronic lower respiratory disease
St. Lawrence County Community Health Assessment – November 2013
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Once these results were tallied, a Focus Group made up of service providers (please see section 4
for a list of agency representatives that completed the rankings) was again brought together to
the rank the issues identified. It was decided to use a ranking system that focused most heavily
on how effective any interventions might be, and chose the Hanlon Method for ranking priorities,
which uses the following formula to rank priorities:
[A + (2xB)] x C
where A= the size of the problem, B= the severity of the problem and C=the effectiveness of the
solution. As a multiplier, the effectiveness of the solution obviously is given a lot more weight
than the size or seriousness of the problem, with the hope of making wise use of limited
resources by targeting solutions that are known to be effective.
In the Hanlon Method, numbers are assigned through which to measure size, severity and
effectiveness, and the numbers are then plugged into the formula as the focus group ranked each
relative factor. It is important to note that while the Hanlon Method offers a numerical and
systematic method of ranking public health priorities, the method is still largely subjective, with
much room for error and interpretation. Measures of effectiveness in the public health area are
not absolute, and questions arise as to the application of the measurement, which make
measurement more than a little “fuzzy,” and include assumptions about human behavior. For
example, when addressing the issue of unintended pregnancy, the rating group might note that
birth control methods would mostly have a ranking of “highly effective” as an intervention based
on the relative effectiveness of each method of birth control at achieving the desired goal of
preventing pregnancy. However, birth control methods are not necessarily applied, or are
applied inconsistently, resulting in a much lower measure of effectiveness than the intervention
actually achieves. So the measures of effectiveness often included consideration of a variety of
factors that influence effectiveness and may reduce the effectiveness measure since, for whatever
reason, the intervention may not be uniformly applied.
HANLON METHOD: PEARL COMPONENT
P Propriety – Is a program for the health problem suitable?
E Economics – Does it make economic sense to address the problem? Are there economic
consequences if a problem is not carried out?
A Acceptability – Will a community accept the program? Is it wanted?
R Resources – Is funding available or potentially available for a program?
L Legality – Do current laws allow program activities to be implemented?
St. Lawrence County Community Health Assessment – November 2013
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Based upon the rankings via the Hanlon Method, St. Lawrence County determined the following
priorities, listed in priority order:
PRIORITIES Hanlon
162.53 151.31 136.88 135.94 135.56 125.66 122.00 114.38 1. Cancer 2. Heart Disease 11. Mental Health 6. Diabetes 8. Obesity 3. Cerebrovascular disease – stroke 9. Oral health 10. Substance Abuse 12. Tobacco use ‐ two areas were reviewed. 112.13 4. Lead screening 111.68 13. CLRD 110.16 5. Cirrhosis 87.75 7. Breastfeeding 86.75 PEARL 5.69 5.25 4.56 4.36 4.21 5.44 4.50 5.38 4.00 5.25 5.19 5.56 4.44 At a subsequent meeting, considerable discussion was devoted to how the top issues could be
addressed. Ultimately, two priorities and one disparity were chosen:
Priority One: Prevent Chronic Disease with a specific focus on Obesity
Priority Two: Promote Mental Health and Prevent Substance Abuse
Disparity: Cancer screening for the low-income population
St. Lawrence County Community Health Assessment – November 2013
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Some interesting conclusions can be made:
1. The definition and scope of issues that should be addressed by public health agencies
has broadened considerably in recent years. While communicable diseases, chronic
disease, injury prevention, dental health and maternal and child health are still important
areas to address, other issues so strongly affect health outcomes that they must
increasingly be included in the public health agenda. This requires intensifying efforts
that focus on creating behavioral change within both the general and targeted
populations. These include health issues such as physical activity, substance/alcohol
abuse and support services for the elderly.
2. These “newer” public health issues require more intense efforts since changing human
behavior is very difficult. Substance abuse, smoking cessation, obesity and similar
problems require long term, comprehensive interventions, with an emphasis on
policy and environmental changes. Additionally, many of the ultimate positive results
of these preventive efforts may not be seen for decades.
3. Additionally, these problems can only be successfully addressed in conjunction with other
community partners. Collaborative efforts are required to deal with more complex public
health issues and collectively used. This includes partnerships with other types of health care
providers as well as community partners with expertise in other disciplines.
4. These problems require several levels of intervention including education, prevention and
treatment. Alternative approaches that require changes in environment, policies and
regulations, and access to care must all be considered, and are often proving to be the most
successful methods of accomplishing needed behavioral changes.
5. The media is increasingly a much-needed partner in all efforts.
6. To accomplish the Triple Aim in our communities, Public Health needs to be more fully
recognized as a partner with the medical (treatment) community. Studies have shown that
the most effective way to reduce costs and improve population health is to focus on
prevention. Public Health is best equipped to play this role, but needs to be recognized as the
prevention leader, and provided with the resources needed to help enact the required policy
and environmental changes that will lead to reduced per capita costs and improved health
outcomes.
Next steps centered upon the development of a Community Health Improvement Plan that
outlines steps and actions to accomplish objectives related to identified priorities.
St. Lawrence County Community Health Assessment – November 2013
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1A. Demographic Information - Description of the Community Being Assessed
St. Lawrence County is large rural county located in the north-western portion of New York
State in the Central Region bordering Canada. To the East it borders Franklin County, to the
Southeast it borders Hamilton County, and to the South it borders Jefferson, Lewis, and
Herkimer Counties. The County is named after the St. Lawrence River which runs from the
Atlantic Ocean to Lake Ontario and runs between the Northern New York/Canadian border.
The County is the westernmost of New York’s northern tier counties, a region known since the
early 1800s as the North Country. Its northern boundary is mid-stream in the St. Lawrence River.
This rich, broad river valley section bordering the Province of Ontario is one of the most
beautiful stretches of the thousands of miles of the U.S. - Canada boundary. The southern and
eastern boundaries of the roughly triangular County reach deeply into the Adirondacks. The
landscape undergoes a dramatic transition from summer homes along the St. Lawrence River and
Black Lake to the dairy farms of the broad St. Lawrence lowland, to the Adirondack foothills
with their small farms, mines and forested areas, and finally to the vast forests of the interior, an
area designated by the State as the Adirondack Park.
At 2,821 square miles or 7,306 square kilometers, it is the largest county in New York by land
area. According to the 2010 census, St. Lawrence County has a population of 111,944 giving it a
population density of 41 people per square mile or 16 people per square kilometer. Unlike most
areas in USA for the 2010 census, St. Lawrence County actually had a slightly higher percentage
of males than females (49.2% were females and 50.8% were males.) This is a change from the
2000 census in which females made up a greater percentage of the population.
St. Lawrence County is the fifth largest county east of the Mississippi, and the largest and most
geographically diverse county in New York State. In addition to its rural population base, St.
Lawrence County has a number of significant communities. The county has five primary
population centers: the City of Ogdensburg, and the Villages of Massena, Potsdam, Canton and
Gouverneur which contain nearly one-half of the county’s population. There are thirty-two
towns, thirteen villages and one city. Seven towns have a population of less than 1,000 people
based on 2000 census. On the northeast border of the county is the Akwesasne Indian
Reservation.
Overall, the percent change in population in St. Lawrence County has been significant as
compared to percent population change in New York State as a whole. In 2010, the percent
population change in St. Lawrence County was more than double that of New York State.
YEAR
1910
1920
1930
1940
1950
1960
1970
St. Lawrence County
POPULATION
% CHANGE
89,000
88,100
-1.0
91,000
3.3
91,100
0.1
98,900
8.6
111,200
12.4
112,000
0.9
St. Lawrence County Community Health Assessment – November 2013
NY State
POPULATION
% CHANGE
9,113,600
10,385,200
13.9
12,588,100
21.2
13,479,100
7.1
14,830,200
10.0
16,782,300
13.2
18,237,000
8.7
8
1980
1990
2000
2005*
2010*
St. Lawrence County
114,300
112,000
111,900
118,600
121,100
NY State
17,558,100
17,990,500
18,490,000
18,865,300
18,984,200
1.8
-2.0
-0.09
6.0
2.1
Total Population Change for New York
Local Government Areas, 2000 to 2010
2010 Census: Public Law 94-171
Data as of March 24, 2011
St. Lawrence County
-3.7
2.5
2.8
2.0
0.6
Total Population
April 1,
April 1,
Towns
2000
2010
Brasher town
2,337
2,512
Canton town
10,334
10,995
Clare town
112
105
Clifton town
791
751
Colton town
1,453
1,451
De Kalb town
2,213
2,434
936
998
Edwards town
1,148
1,156
Fine town
1,622
1,512
Fowler town
2,179
2,202
Gouverneur town
7,419
7,085
Hammond town
1,209
1,191
Hermon town
1,069
1,108
Hopkinton town
1,020
1,077
Lawrence town
1,545
1,826
Lisbon town
4,047
4,102
Louisville town
3,195
3,145
Macomb town
846
906
Madrid town
1,828
1,735
Massena town
13,121
12,883
Morristown town
2,050
1,974
Norfolk town
4,565
4,668
Oswegatchie town
4,370
4,397
Parishville town
2,049
2,153
De Peyster town
St. Lawrence County Community Health Assessment – November 2013
9
Piercefield town
305
310
Pierrepont town
2,674
2,589
Pitcairn town
783
846
Potsdam town
15,945
16,041
Rossie town
785
877
Russell town
1,801
1,856
Stockholm town
Waddington town
3,592
2,212
3,665
2,266
Source: NY Population of Counties by Decennial Census, compiled by Richard L. Forstall, Population Division, US Bureau of the Census
* Populations have been rounded to the nearest hundred
*Asterisks in the chart above indicate census bureau estimates from the US Census Bureau State and County Quickfacts
As shown in the table below, the very large percent population change in 2010 shows a decrease
in population within St. Lawrence County from 1990 to 2000. The tables below break down
population changes by town, city or village from 2000 to 2010.
Total Population Change for New York
Local Government Areas, 2000 to 2010
2010 Census: Public Law 94-171
Data as of March 24, 2011
Canton village
Edwards village
Gouverneur village
Hammond village
Hermon village
Heuvelton village
Massena village
Morristown village
Norwood village
Ogdensburg city
Potsdam village
Rensselaer Falls village
Richville village
Waddington village
Total Population
2000
2010
5,954
6,314
465
439
4,267
3,949
302
280
402
422
804
714
11,209
10,936
456
395
1,685
1,657
12,364
11,128
9,378
9,428
337
332
274
323
923
972
Populations in most of the Villages and Cities decreased between 2000 and 2010, with only the
Villages of Canton, Hermon, Potsdam, Richville and Waddington increasing in population. Many
Towns, with their more rural areas however, have grown since the time of the last census. The
towns of Clare, Clifton, Colton, Fine, Gouverneur, Hammond, Lousville, Madrid, Massena,
Morristown and Pierreponthave decreased in size.
St. Lawrence County Community Health Assessment – November 2013
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Demographics of the Population Being Served - Gender
Like most of the Country, genders are fairly evenly distributed. had slightly more females than
males for the 2000 census however for the 2010 census the percentage of males was slightly
higher. Not surprisingly the younger male population was the main reason for the change.
2000 Census
2000
Census
Male
Female
St.
Lawrence
48.4
51.6
2010 Census
NY
State
48.2
51.8
2010
Census
Male
Female
St.
Lawrence
50.8
49.2
NY
State
48.5
51.5
US
49.1
50.9
US
49.2
50.8
Source: U.S. Census Bureau, 2000 and 2010 Census.
Demographics of the Population Being Served - Race and Special Populations
The percentage of racial minorities in St. Lawrence County remains low at 6.1%. The
percentage of blacks/African Americans is only 2.2%, which is well below the state and national
average. Native Americans and Asians each make up 1% of the population. (Please note: for all
of the Census Bureau tables that follow, the confidence internals for estimates of error have been
removed to simplify reading. Census Bureau data are still estimates however.)
Source: U.S. Census Bureau, 2010 Census
RACE
Total population
111,944
100.0 (%)
One Race
110,410
98.6
White
105,064
93.9
Black or African American
2,420
2.2
American Indian and Alaska Native
1,135
1.0
Asian
1,085
1.0
Some Other Race
1,827
1.5
Two or More Races
1,534
1.4
White; American Indian and Alaska Native [3]
638
0.6
White; Asian [3]
213
0.2
St. Lawrence County Community Health Assessment – November 2013
11
RACE
Total population
111,944
100.0 (%)
White; Black or African American [3]
344
0.3
White; Some Other Race [3]
114
0.1
106,470
95.1
Black or African American
2,895
2.6
American Indian and Alaska Native
1,901
1.7
Asian
1,366
1.2
Native Hawaiian and Other Pacific Islander
95
0.1
Some Other Race
845
0.8
111,944
100.0
2,146
1.9
Mexican
437
0.4
Puerto Rican
845
0.8
Cuban
67
0.1
Other Hispanic or Latino [5]
797
0.7
109,798
98.1
111,944
100.0
Hispanic or Latino
2,146
1.9
White alone
1,121
1.0
Black or African American alone
161
0.1
American Indian and Alaska Native alone
84
0.1
Asian alone
11
0.0
Race alone or in combination with one or more other races: [4]
White
HISPANIC OR LATINO
Total population
Hispanic or Latino (of any race)
Not Hispanic or Latino
HISPANIC OR LATINO AND RACE
Total population
St. Lawrence County Community Health Assessment – November 2013
12
As seen in the table below, special populations such as foreign born residents compromised a
very small percentage of the total population in St. Lawrence County. According to the
American Community Survey (2007-2011), 95.9% of St. Lawrence County residents were native
to the region, 94.8% of residents were born in the United States with only 4.1% of residents
being foreign born. Of the total population, 2.2% were not citizens of the United States.
NATIVITY AND PLACE OF BIRTH
Estimate
111,809
Total population
107,204
Native
106,037
Born in United States
90,325
State of residence
15,712
Different state
1,167
Born outside United States
4,605
Foreign born
Entered 2000 or later
270
Naturalized citizen
2,195
Not a citizen
2,410
REGION OF BIRTH OF FOREIGN BORN
4,605
Total (excluding born at sea)
1,332
Europe
959
Asia
83
Africa
27
Oceania
705
Latin America
1,499
Northern America
Percent
100.0 %
95.9%
94.8%
80.8%
14.1%
1.0%
4.1%
0.2%
2.0%
2.2%
100.0%
28.9%
20.8%
1.8%
0.6%
15.3%
32.6%
Source: U.S. Census Bureau, 2007-2011 American Community Survey
St. Lawrence County Community Health Assessment – November 2013
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As seen in the table below, the population of St. Lawrence County residents with their primary
language other than English is also low. Only 6.1% of residents reported speaking a language
other than English, and a total of 3.7% speak English less than very well.
LANGUAGE SPOKEN AT HOME
105,295
Population 5 years and over
98,905
English only
6,390
Language other than English
1,957
Speak English less than ″very well″
1,913
Spanish
567
Speak English less than ″very well″
3,438
Other Indo-European languages
1,022
Speak English less than ″very well″
797
Asian and Pacific Island languages
353
Speak English less than ″very well″
100.0%
93.9%
6.1%
1.9%
1.8%
0.5%
3.3%
1.0%
0.8%
0.3%
Source: U.S. Census Bureau, 2007-2011 American Community Survey
Demographics of the Population Being Served - Age
In 2010, the largest age population in the county was the 20-24 year old group, making up 9.7%
of the total population. The percentage of those under age 5, at 5.9% of the population, is
slightly below the State and Federal rate and about average for the region.
AGE
Total population
Under 5 years
2010 Census
St. Lawrence County
111,944
6,574
Percent
100.0
5.9
5 to 9 years
6,569
5.9
10 to 14 years
6,483
5.8
15 to 19 years
10,041
9.0
20 to 24 years
10,905
9.7
25 to 29 years
6,601
5.9
30 to 34 years
5,923
5.3
35 to 39 years
6,237
5.6
40 to 44 years
7,043
6.3
45 to 49 years
8,077
7.2
50 to 54 years
8,055
7.2
55 to 59 years
7,529
6.7
60 to 64 years
6,354
5.7
65 to 69 years
4,720
4.2
St. Lawrence County Community Health Assessment – November 2013
14
AGE
70 to 74 years
2010 Census
St. Lawrence County
3,664
75 to 79 years
2,933
2.6
80 to 84 years
2,271
2.0
1,965
1.8
85 years and over
Percent
3.3
Source: U.S. Census Bureau, 2010 Census.
The 45 to 49 and 50 to 54 age bracket also surfaced as one of the larger age ranges represented in
the county, both brackets compromising 7.2% of the population and 14.2% of the total
population together.
Percentage of Population age 65+
Census Year St. Lawrence
NY
USA
2010
13.7%
13.3%
13.89%
Source: U.S. Census Bureau, 2010 Census.
As seen in the table above, according to 2010 census data, St. Lawrence County has a higher
percentage of adults age 65 or older as compared to New York state as a whole and the country
as a whole. Since the elderly consume a high proportion of health care services, this of course
creates a higher need for health care services in St. Lawrence County than elsewhere.
Demographics of the Population Being Served - Income and Employment
EMPLOYMENT STATUS
Estimate
Percent
Population over 16 years of age
90,985
90,985
(100%)
In labor force
51,873
57.0%
Civilian labor force
51,701
56.8%
Employed
46,611
51.2%
Unemployed
5,090
5.6%
172
0.2%
39,112
43.0%
Armed Forces
Not in labor force
Source: U.S. Census Bureau, 2007-2011 American Community Survey
The table above portrays the overall employment status of the working population within St.
Lawrence County. Over fifty percent of the working population in 2010, 51,873 were in the
labor force (57%), with 56.8% being in the civilian workforce. The armed forces only
represented 0.2% of the working population in St. Lawrence County in 2010.
St. Lawrence County Community Health Assessment – November 2013
15
EMPLOYMENT STATUS
Estimate
Percent
Females 16 years and over
44,922
44,922 (100%)
In labor force
24,652
54.9%
Civilian labor force
24,652
54.9%
Employed
22,804
50.8%
Have children under 6 years
7,448
7,448 (100%)
All parents in family in labor force
5,034
67.6%
Have children 6 to 17 years
15,098
15,098 (100%)
All parents in family in labor force
11,325
75.0%
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
As shown above, more than fifty percent of working age females were in the labor force in 2010
(54.9%). In 2010, all females in the labor force were working in a civilian status. Many families
in St. Lawrence County also have all parents in the household working.
The percentage of the population aged 16 and older participating in the labor force is
significantly higher than the State average, although somewhat lower than the national average.
This percentage is especially important, given the high number of elderly and young children in
the county who rely on these adults for their support. The number of people participating in the
labor force is a good indicator of the need for outside assistance to the County from the State and
Federal governments, since it indicates a relatively higher dependency ratio (ratio of those
working to those not working). St. Lawrence County’s unemployment rates from 2008-2010 are
the highest in region and significantly higher than the state and national unemployment rate.
Labor Force Participation (NYS) - Data
in Thousands
Annual
Year
Average
9,504.2
2011
9,586.9
2010
9,640.6
2009
9,631.7
2008
9,532.1
2007
9,499.9
2006
9,421.4
2005
St. Lawrence County Community Health Assessment – November 2013
Labor Force Participation (Northern
Region) - Data in Thousands
Annual
Year
Average
191.1
2011
194.5
2010
195.5
2009
196.2
2008
194.4
2007
195.3
2006
193.7
2005
16
Labor Force Participation (St. Lawrence
County) - Data in Thousands
Annual
Year
Average
48.5
2011
49.3
2010
49.6
2009
50.1
2008
49.4
2007
49.5
2006
49.2
2005
Source: U.S. Bureau of Labor and Statistics, Labor force data by county, annual averages
Historically, St. Lawrence County’s unemployment rates are generally higher than the State, the
region and the rest of upstate NY, a fact that is still evident at the present time. The July 2013
rate is 9.3%, the best rate in July since 2008, But still significantly higher than the Northern
Region (8.4%) and State (7.6%) rates: (source: NYSDOL website)
Unemployment Rates (NY State)
Annual
Year
Average
8.5%
2012
8.2%
2011
8.6%
2010
8.3%
2009
5.4%
2008
4.6%
2007
4.6%
2006
5.0%
2005
St. Lawrence County Community Health Assessment – November 2013
Unemployment Rates (Northern Region)
Annual
Year
Average
10.1%
2012
9.8%
2011
9.8%
2010
9.2%
2009
6.8%
2008
5.7%
2007
5.6%
2006
5.9%
2005
17
Unemployment Rates (St. Lawrence County)
Annual
Year
Average
10.5%
2012
10.5%
2011
10.6%
2010
9.9%
2009
7.1%
2008
5.9%
2007
5.9%
2006
6.1%
2005
Source: U.S. Bureau of Labor and Statistics, Local Area Unemployment Statistics
St. Lawrence County has a population of 90,985 (or approximately 81.3%) who are 16 years or
older. According to the 2010 census, the county has a population of 15,553 (or 13.9%) who are
65 or over, giving St. Lawrence County a population of 75,432 (or approximately 67.4%) who
are between the ages of 16-65. Of those residents who are 16 years or older, 51,873 (or
approximately 57.0%) are in the workforce, with 51,701 in the civilian workforce and 172 in the
armed services. Of those 51,873 residents in the labor force, 5,090 individuals (or approximately
9.8%) were unemployed at the time of the census with an average of 9.2% between the years
2008-2010. St. Lawrence County has a female population aged 16 years or older of 44,922 or
about 40.1% of the total population. Of those, 24,652 are in the labor force with 22,804
employed at the time of the census.
COMMUTING TO WORK
Estimate
Percent
Workers 16 years and over
45,242
45,242
(100%)
Car, truck, or van -- drove alone
33,387
73.8%
Car, truck, or van -- carpooled
4,840
10.7%
106
0.2%
3,797
8.4%
759
1.7%
Worked at home
2,353
5.2%
Mean travel time to work (minutes)
20.6
(X)
Public transportation (excluding
taxicab)
Walked
Other means
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
St. Lawrence County Community Health Assessment – November 2013
18
According to the 2010 census, nearly all workers 16 years of age or older reported having to
commute to work (94.8%). A small percentage of workers reported carpooling (10.7%) and a
fraction of workers said they used public transportation to commute to work (0.2%). With St.
Lawrence County being such a large, rural county, commuting can be troublesome for workers.
Approximately 8.4% of workers actually reported walking to work which is surprising
considering the rural nature of the county and the harsh winters experienced in the north country.
OCCUPATION
Estimate
Percent
Civilian employed population 16
years and over
46,611
46,611
(100%)
Management, business, science, and
arts occupations
14,802
31.8%
Service occupations
10,569
22.7%
Sales and office occupations
10,779
23.1%
Natural resources, construction,
and maintenance occupations
5,324
11.4%
Production, transportation, and
material moving occupations
5,137
11.0%
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
Management, business, science and art occupations made up the largest percentage of workers
within St. Lawrence County in 2010. Service occupations and sales/office occupations weren't
far behind with 22.7% and 23.1% respectively. Surprisingly, natural resources, construction, and
maintenance and production, transportation and material moving occupations made up only
22.4% of the working population. Being such a rural county, many would think natural
resources/agriculture occupations would rise to the top.
St. Lawrence County Community Health Assessment – November 2013
19
INDUSTRY
Estimate
Percent
Civilian employed population 16
years and over
46,611
46,611
(100%)
Agriculture, forestry, fishing and
hunting, and mining
1,794
3.8%
Construction
2,866
6.1%
Manufacturing
3,263
7.0%
Wholesale trade
594
1.3%
Retail trade
5,901
12.7%
Transportation and warehousing,
and utilities
1,880
4.0%
847
1.8%
Finance and insurance, and real
estate and rental and leasing
1,817
3.9%
Professional, scientific, and
management, and administrative
and waste management services
2,179
4.7%
Educational services, and health
care and social assistance
15,620
33.5%
Arts, entertainment, and recreation,
and accommodation and food
services
3,988
8.6%
Other services, except public
administration
2,405
5.2%
Public administration
3,457
7.4%
Information
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
When observing the breakdown of civilian employees age16 and over in St. Lawrence County,
the largest industry represented in the county in 2010 was education services, healthcare, and
social services (33.5%). St. Lawrence County houses many educational institutions that account
for the larger number of workers in this industry, along with five (5) hospitals. Retail trades is
the second largest industry represented in St. Lawrence County with 12.7% of the workforce
over 16 years of age.
St. Lawrence County Community Health Assessment – November 2013
20
CLASS OF WORKER
Estimate
Percent
Civilian employed population 16
years and over
46,611
46,611
(100%)
Private wage and salary workers
31,915
68.5%
Government workers
11,213
24.1%
Self-employed in own not
incorporated business workers
3,405
7.3%
78
0.2%
Unpaid family workers
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
INCOME AND BENEFITS
(IN 2011 INFLATION-ADJUSTED
DOLLARS)
Estimate
Percent
Total households
41,825
41,825
(100%)
Less than $10,000
3,559
8.5%
$10,000 to $14,999
3,141
7.5%
$15,000 to $24,999
5,481
13.1%
$25,000 to $34,999
4,828
11.5%
$35,000 to $49,999
6,498
15.5%
$50,000 to $74,999
8,338
19.9%
$75,000 to $99,999
4,859
11.6%
$100,000 to $149,999
3,684
8.8%
$150,000 to $199,999
979
2.3%
$200,000 or more
458
1.1%
Median household income (dollars)
43,390
(X)
Mean household income (dollars)
54,104
(X)
With earnings
30,606
73.2%
Mean earnings (dollars)
54,535
(X)
With Social Security
13,897
33.2%
Mean Social Security income
(dollars)
15,696
(X)
St. Lawrence County Community Health Assessment – November 2013
21
With retirement income
10,764
25.7%
Mean retirement income (dollars)
19,105
(X)
With Supplemental Security Income
2,550
6.1%
Mean Supplemental Security
Income (dollars)
9,088
(X)
With cash public assistance income
1,470
3.5%
Mean cash public assistance income
(dollars)
3,671
(X)
With Food Stamp/SNAP benefits in
the past 12 months
5,412
12.9%
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
In 2010, almost twenty percent of households in St. Lawrence County reported an income of
$50,000 to $74,999. 8.5% of households reported earning less than $10,000 and nearly thirty
percent of households (29.1%) reported earning less than $25,000.
Family Incomes
Estimate
Percent
Families
27,558
27,558
(100%)
Less than $10,000
1,478
5.4%
$10,000 to $14,999
1,159
4.2%
$15,000 to $24,999
2,996
10.9%
$25,000 to $34,999
2,908
10.6%
$35,000 to $49,999
4,497
16.3%
$50,000 to $74,999
6,215
22.6%
$75,000 to $99,999
4,010
14.6%
$100,000 to $149,999
3,156
11.5%
$150,000 to $199,999
810
2.9%
$200,000 or more
329
1.2%
Median family income (dollars)
52,251
(X)
Mean family income (dollars)
61,713
(X)
Per capita income (dollars)
21,013
(X)
Nonfamily households
14,267
14,267
St. Lawrence County Community Health Assessment – November 2013
22
Median nonfamily income (dollars)
24,665
(X)
Mean nonfamily income (dollars)
35,602
(X)
Median earnings for workers
(dollars)
21,242
(X)
Median earnings for male full-time,
year-round workers (dollars)
43,715
(X)
Median earnings for female fulltime, year-round workers (dollars)
33,006
(X)
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
Family earnings yielded similar results with 20.5% of families earning less than $25,000. The
largest bracket represented was $50,000 to $74,999 with 22.6% of families reporting that level of
income.
Overall, living in poverty is associated with lower health status, an increased risk of having
inadequate health insurance, and lower use of health services. According to the 2010 census
information the median income for a household in the county was $43,390, and the median
income for a family was $52,251. Males had a median income of $43,715 versus $33,006 for
females. The per capita income for the county was $21,013. As the map below indicates, St.
Lawrence County is in the highest tier for poverty rates in NY State.
Source: USDA, Economic Research Service 2010
St. Lawrence County Community Health Assessment – November 2013
23
Percent Living Below the Poverty Level - St. Lawrence County
Families
12.7
With related children under 18 years
20.9
With related children under 5 years
24.9
Families with female householder, no husband present
34.7
With related children under 18 years
43.9
With related children under 5 years
60.0
All People
17.6
18 years and over
15.2
65 years and over
10.3
Related children under 18 years
24.8
Related children 5 to 17 years
22.1
Unrelated individuals 15 years and over
30.2
Source: U.S. Census Bureau, 2007-2011 American Community Survey
Percent of Population in Poverty
All Individuals
Children Under 18
(2010)
(2010)
Percent
Number
Percent
Number
County
US
15.3
46,215,956
21.6
15,749,129
New York
14.2
2,708,119
20.2
878,114
Cayuga
13.5
10,138
19.9
3,271
Cortland
17.8
7,914
20.4
1,995
Herkimer
14.1
8,640
20.5
2,765
Jefferson
16.5
18,305
24.7
7,012
Lewis
16.2
4,199
22.6
1,335
Madison
11.3
7,307
15.5
2,294
Oneida
14.4
31,240
22.1
10,781
Onondaga
13.7
60,792
19
19,541
Oswego
14.7
17,034
20.3
5,490
St. Lawrence
17.8
17,504
22.9
5,097
Tompkins
18.8
16,715
15.9
2,560
U.S. Census Bureau, Small Area Income and Poverty Estimates
By the statistics poverty is clearly a problem in St. Lawrence County. The poverty rate for all
individuals as well as for children under the age of 18 is higher than the federal, state, and
regional rates. St. Lawrence County’s poverty rate is 17.8% making it 3.6% higher than the New
York State rate and 2.5% higher than the federal rate. Perhaps even more disturbing is the fact
that the poverty rate for children is 22.9% which is 2.7% above the New York state rate and
1.3% above the federal rate. Only one county in the region has a higher poverty rate than St.
Lawrence County (Tompkins County). The same is true for the poverty rate of children under 18
as only Jefferson County has a higher poverty for children. As stated in the Child and Adolescent
Health Profile: New York 1988, "poverty is the single most powerful predictor of poor health
among children (DHHS, 1981). Poverty is associated with poor nutrition, substandard
housing, disruptive social environment, and lack of health information (Randolph and Rivers,
St. Lawrence County Community Health Assessment – November 2013
24
1985)...poor children are more apt to become ill, suffer adverse consequences from illness and
die than children with greater economic resources (Starfield, 1982)."
As of March 2013 25,133 St. Lawrence County residents were eligible for Medicaid, or 22.4% of
the County's population, a slight increase from 2012 (21.9%)
Demographics of the Population Being Served - Education
Seemingly, a high value would be placed on education in St. Lawrence County, home to five
institutions of higher learning (SUNY Potsdam, SUNY Canton, SUNY College of
Environmental Sciences and Forestry at Wanakena, Clarkson University and St. Lawrence
University) with an annual enrollment of approximately 15,400 students, but that doesn't seem to
be the case for the permanent residents of the County.
EDUCATIONAL ATTAINMENT
Estimate
Percent
Population 25 years and over
70,576
70,576 (100%)
Less than 9th grade
3,419
4.8%
9th to 12th grade, no diploma
6,186
8.8%
High school graduate (includes equivalency)
26,671
37.8%
Some college, no degree
12,439
17.6%
Associate's degree
8,495
12.0%
Bachelor's degree
6,847
9.7%
Graduate or professional degree
6,519
9.2%
Percent high school graduate or higher
(X)
86.4%
Percent bachelor's degree or higher
(X)
18.9%
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
Lack of education is often associated with a lower health status and a greater likelihood of not
seeking health care, especially preventive services. According to the 2010 Census, 13.6% of St.
Lawrence County residents were not high school graduates. While this rate is better than both
the NY State and national average, the percent having a Bachelors degree or higher is only
18.9%, compared with a State rate of approximately 32.5% of the population (41.8% lower than
the State rate). This lower level of educational attainment contributes to lower earning ability,
which adversely affects health, but probably also associated with a lower level of knowledge
regarding how to practice healthy behaviors, how to access appropriate preventive health care
services and having a basic level of health literacy.
St. Lawrence County Community Health Assessment – November 2013
25
Demographics of the Population Being Served – Housing
Home Value
St. Lawrence County
2000
Median Value - Owner Occupied Units
$60,200
New York State (total)
Median Value - Owner Occupied Units
$148,700
2010
$79,600
$303,900
Source: U.S. Census Bureau, census data 2000 and 2010
The housing stock in St. Lawrence County is older than that in most surrounding areas, with
33.7% built prior to 1940 per the 2010 census. St. Lawrence County had 20.2% of its housing
units vacant, compared with 11.4% for the State as a whole. There are also nearly five times
more people in St. Lawrence County living in mobile homes (10.7%) than in the rest of the state.
In the 2010 census, of occupied housing units, 1.1% lacked complete plumbing facilities (447
households), 1.2% lacked complete kitchen facilities (550 households), and 2.9% lacked phone
service (1,219 households). Housing costs are well below the state and national average the
median home price was only $60,200 at the time of the 2000 census and $79,600 for the 2010
census. The statewide median home was much higher in 2000 and 2010, at $148,700 and
$303,900 respectively. Approximately 30.7% of the St. Lawrence County’s population has lived
in the same house since 1989 or earlier. About 8% of households (3,364) have no vehicle
available for use, creating significant transportation problems in this huge rural county.
Household Water Supply
St. Lawrence County
Number of Households on Public Water
Supply or Private Systems
Drilled/Dug Wells or other water supply
New York State
Number of Households on Public Water
Supply or Private Systems
Drilled/Dug Wells or other water supply
1990
21,426
21,953
6,329,446
1,721,777
For the 2000 and 2010 census, data on the source of the household water supply was not
available at the county level. In the 1990 census, 21,426 households were on the public water
supply or private systems (almost 50%) while the remaining 21,593 households had drilled or
dug wells, or some other source of water.
St. Lawrence County Community Health Assessment – November 2013
26
St. Lawrence
County
HOUSING OCCUPANCY
Estimate
Percent
Total housing units
52,006
52,006
(100%)
Occupied housing units
41,825
80.4%
Vacant housing units
10,181
19.6%
Homeowner vacancy rate
1.5
(X)
Rental vacancy rate
3.8
(X)
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
UNITS IN STRUCTURE
Estimate
Percent
Total housing units
52,006
52,006
(100%)
1-unit, detached
36,395
70.0%
1-unit, attached
482
0.9%
2 units
2,570
4.9%
3 or 4 units
2,264
4.4%
5 to 9 units
1,298
2.5%
847
1.6%
20 or more units
1,596
3.1%
Mobile home
6,546
12.6%
8
0.0%
10 to 19 units
Boat, RV, van, etc.
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
St. Lawrence County Community Health Assessment – November 2013
27
YEAR STRUCTURE BUILT
Estimate
Percent
Total housing units
52,006
52,006
(100%)
Built 2005 or later
860
1.7%
Built 2000 to 2004
2,199
4.2%
Built 1990 to 1999
5,933
11.4%
Built 1980 to 1989
5,400
10.4%
Built 1970 to 1979
6,759
13.0%
Built 1960 to 1969
4,417
8.5%
Built 1950 to 1959
5,354
10.3%
Built 1940 to 1949
3,237
6.2%
Built 1939 or earlier
17,847
34.3%
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
VEHICLES AVAILABLE
Estimate
Percent
Occupied housing units
41,825
41,825
(100%)
No vehicles available
3,364
8.0%
1 vehicle available
15,103
36.1%
2 vehicles available
17,087
40.9%
3 or more vehicles available
6,271
15.0%
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
St. Lawrence County Community Health Assessment – November 2013
28
HOUSE HEATING FUEL
Estimate
Percent
Occupied housing units
41,825
41,825
(100%)
Utility gas
13,553
32.4%
Bottled, tank, or LP gas
2,978
7.1%
Electricity
4,373
10.5%
Fuel oil, kerosene, etc.
14,464
34.6%
71
0.2%
5,876
14.0%
Solar energy
50
0.1%
Other fuel
331
0.8%
No fuel used
129
0.3%
Coal or coke (a derivation of coal)
Wood
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
SELECTED CHARACTERISTICS
Estimate
Percent
41,825
41,825
Lacking complete plumbing facilities
447
1.1%
Lacking complete kitchen facilities
501
1.2%
1,219
2.9%
Occupied housing units
No telephone service available
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
St. Lawrence County Community Health Assessment – November 2013
29
VALUE
Estimate
Percent
Owner-occupied units
29,917
29,917
Less than $50,000
6,420
21.5%
$50,000 to $99,999
12,092
40.4%
$100,000 to $149,999
5,006
16.7%
$150,000 to $199,999
2,697
9.0%
$200,000 to $299,999
1,834
6.1%
$300,000 to $499,999
991
3.3%
$500,000 to $999,999
708
2.4%
$1,000,000 or more
169
0.6%
80,900
(X)
Estimate
Percent
Owner-occupied units
29,917
29,917
Housing units with a mortgage
16,576
55.4%
Housing units without a mortgage
13,341
44.6%
Median (dollars)
MORTGAGE STATUS
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
GROSS RENT
Estimate
Percent
10,665
10,665
Less than $200
197
1.8%
$200 to $299
714
6.7%
$300 to $499
2,351
22.0%
$500 to $749
3,830
35.9%
$750 to $999
2,059
19.3%
$1,000 to $1,499
1,221
11.4%
$1,500 or more
293
2.7%
Median (dollars)
634
(X)
1,243
(X)
Occupied units paying rent
No rent paid
St. Lawrence County Community Health Assessment – November 2013
30
GROSS RENT AS A PERCENTAGE OF HOUSEHOLD INCOME
Estimate
(GRAPI)
Percent
Occupied units paying rent (excluding units where GRAPI cannot be
computed)
10,480
10,480
Less than 15.0 percent
1,653
15.8%
15.0 to 19.9 percent
1,086
10.4%
20.0 to 24.9 percent
1,277
12.2%
25.0 to 29.9 percent
981
9.4%
30.0 to 34.9 percent
952
9.1%
35.0 percent or more
4,531
43.2%
Not computed
1,428
(X)
Source: U.S. Census Bureau, 2007-2011 American Community Survey
According to the U.S. Census Bureau - '(X)' means that the estimate is not applicable or not available.
Health Status - Natality
Overall, both the birth rates and pregnancy rates are lower in St. Lawrence County than the State
as a whole and upstate NY. Between 2007-2009 St. Lawrence County’s birthrate for females
aged 15-44 years old was 54.3/1000 compared to 61.5/1000 statewide. Upstate NY’s birthrate
has been between 58 and 59/1000 every year since 2006. Every year since 2005 St. Lawrence
County has had about 1,200 births per year. St. Lawrence County’s pregnancy rate is
significantly lower than both the state (94.9) and upstate average (72.8).
Vital Statistics - Northern New York Region
Births
Region/County
Population
2007
2008
2009
Total 2007-2009
Rate
Cayuga
798
836
812
2,446
44,880
54.5
Cortland
528
574
556
1,658
33,968
48.8
Herkimer
711
646
671
2,028
35,702
56.8
Jefferson
1,784
2,127
1,995
5,906
74,787
79.0
294
335
351
980
15,226
64.4
Lewis
Madison
780
699
680
2,159
44,141
48.9
Oneida
2,606
2,617
2,633
7,856
130,626
60.1
Onondaga
5,526
5,553
5,479
16,558
282,184
58.7
Oswego
1,376
1,377
1,409
4,162
77,913
53.4
St Lawrence
1,240
1,253
1,191
3,684
67,900
54.3
944
886
918
2,748
83,595
32.9
890,922
56.3
Tompkins
Region Total
New York State Total
16,587 16,903 16,695 50,185
252,662 249,655 246,592 748,909 12,177,916
61.5
Source: NYS DOH - 2007-2009 Vital Statistics Data
St. Lawrence County Community Health Assessment – November 2013
31
Vital Statistics - Northern New York Region
Pregnancies - rate per 1,000 females (15-44) Population
Region/County
Cayuga
Cortland
2007
2008
2009
Total
2007-2009 Rate
1,011
1,023
1,015
3,049
44,880 67.9
682
719
688
2,089
33,968 61.5
Herkimer
860
843
867
2,570
35,702 72.0
Jefferson
2,169
2,468
2,321
6,958
74,787 93.0
348
393
395
1,136
15,226 74.6
Lewis
Madison
883
808
808
2,499
44,141 56.6
Oneida
3,734
3,610
3,580
10,924
130,626 83.6
Onondaga
7,377
7,602
7,468
22,447
282,184 79.5
Oswego
1,657
1,703
1,712
5,072
77,913 65.1
St Lawrence
1,510
1,481
1,423
4,414
67,900 65.0
Tompkins
1,309
1,166
1,212
3,687
83,595 44.1
Region Total
New York State Total
21,540
21,816
21,489
64,845
890,922 72.8
391,034
385,885
378,814
1,155,733
12,177,916 94.9
Source: NYS DOH - 2007-2009 Vital Statistics Data
Teen Pregnancies and Births: For the most part, teen pregnancies and births are below the State
and upstate averages. The exception is births to 15-17 year olds, which is consistently higher
than the upstate average, although currently lower than the State average.
Vital Statistics - Northern New York Region
Region/County
Cayuga
Teenage Pregnancies
(Age 10-14)
Population
2007 2008 2009 Total
20072009
Rate
1
4
0
5
7,116
0.7
Cortland
2
4
0
6
4,097
1.5
Herkimer
4
2
0
6
5,830
1.0
Jefferson
0
1
1
2
11,308
0.2
Lewis
0
0
0
0
2,553
0.0
Madison
2
2
1
5
6,271
0.8
Oneida
9
13
10
32
20,847
1.5
Onondaga
21
28
21
70
44,119
1.6
Oswego
4
1
4
9
11,791
0.8
St Lawrence
2
0
1
3
8,979
0.3
Tompkins
Region Total
New York State Total
1
0
1
2
6,285
0.3
46
55
39
140
129,196
1.1
867
862
828 2,557
1,796,004
1.4
Source: NYS DOH - 2007-2009 Vital Statistics Data
St. Lawrence County Community Health Assessment – November 2013
32
Vital Statistics - Northern New York Region
Pregnancies (Age 15-19) Population
Region/County
Cayuga
2007 2008 2009 Total 2007-2009 Rate
122
101
110
333
8,724
38.2
Cortland
75
75
77
227
7,655
29.7
Herkimer
97
101
117
315
6,311
49.9
Jefferson
205
227
234
666
11,197
59.5
Lewis
28
43
33
104
2,640
39.4
Madison
96
82
96
274
10,644
25.7
516
452
441
1,409
24,413
57.7
Onondaga
887
908
888
2,683
52,526
51.1
Oswego
235
211
207
653
15,860
41.2
St Lawrence
166
168
127
461
14,858
31.0
127
84
83
294
18,707
15.7
2,554 2,452 2,413
7,419
173,535
42.8
39,910 38,450 36,230 114,590
2,038,303
56.2
Oneida
Tompkins
Region Total
New York State Total
Source: NYS DOH - 2007-2009 Vital Statistics Data
Vital Statistics - Northern New York Region
Pregnancies (Age 15-17) Population
Region/County
2007 2008 2009 Total 2007-2009 Rate
Cayuga
28
32
29
89
5,208
17.1
Cortland
20
25
Herkimer
26
38
14
59
2,946
20.0
36
100
3,952
25.3
Jefferson
40
40
48
128
7,059
18.1
Lewis
Madison
10
15
11
36
1,750
20.6
32
13
25
70
4,299
16.3
Oneida
153
141
133
427
14,359
29.7
Onondaga
343
338
291
972
29,465
33.0
Oswego
66
63
59
188
8,307
22.6
St Lawrence
49
35
33
117
6,369
18.4
Tompkins
34
22
17
73
4,311
16.9
801
762
696
2,259
88,025
25.7
14,011 13,087 12,152 39,250
1,178,129
33.3
Region Total
New York State Total
Source: NYS DOH - 2007-2009 Vital Statistics Data
St. Lawrence County Community Health Assessment – November 2013
33
Vital Statistics - Northern New York Region
Pregnancies (Age 18-19)
Region/County
2007
2008
2009
Population
Total 2007-2009
Rate
Cayuga
94
69
81
244
3,516
69.4
Cortland
55
50
63
168
4,709
35.7
Herkimer
71
63
81
215
2,359
91.1
Jefferson
165
187
186
538
4,138
130.0
Lewis
18
28
22
68
890
76.4
Madison
64
69
71
204
6,345
32.2
363
311
308
982
10,054
97.7
Onondaga
544
570
597
1,711
23,061
74.2
Oswego
169
148
148
465
7,553
61.6
St Lawrence
117
133
94
344
8,489
40.5
Oneida
Tompkins
Region Total
New York State Total
93
62
66
221
14,396
15.4
1,753
1,690
1,717
5,160
85,510
60.3
25,899 25,363 24,078 75,340
860,174
87.6
Source: NYS DOH - 2007-2009 Vital Statistics Data
Vital Statistics - Northern New York Region
Region/County
Teenage Births (Age 10-14)
Population
2007
2007-2009
2008
2009
Total
Rate
Reg-3 Central New York
Cayuga
0
1
0
1
7,116
0.1
Cortland
0
0
0
0
4,097
0.0
Herkimer
2
0
0
2
5,830
0.3
Jefferson
0
0
0
0
11,308
0.0
Lewis
0
0
0
0
2,553
0.0
Madison
1
2
0
3
6,271
0.5
Oneida
1
9
3
13
20,847
0.6
Onondaga
5
9
11
25
44,119
0.6
Oswego
1
0
1
2
11,791
0.2
St Lawrence
2
0
0
2
8,979
0.2
Tompkins
0
0
1
1
6,285
0.2
Region Total
New York State Total
12
21
16
49
129,196
0.4
193
242
207
642
1,796,004
0.4
Source: NYS DOH - 2007-2009 Vital Statistics Data
St. Lawrence County Community Health Assessment – November 2013
34
St. Lawrence County Birth Rate per 1,000 Females Age 10-14
Year
Single Year
2000
0.5
2001
0.3
0.3
0.4
2002
0.0
0.2
0.4
2003
0.3
0.1
0.3
2004
0.0
0.3
0.3
2005
0.6
0.3
0.3
2006
0.3
0.5
0.3
2007
0.7
0.3
0.3
2008
0.0
0.2
0.4
2009
3-Year Average
Upstate New York
0.4
0.0
0.3
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
Vital Statistics - Northern New York Region
Births (Age 15-17)
Region/County
2007
Population
2008 2009 Total 2007-2009
Rate
Reg-3 Central New York
Cayuga
18
22
11
51
5,208
9.8
Cortland
13
13
6
32
2,946
10.9
Herkimer
16
20
23
59
3,952
14.9
Jefferson
26
31
31
88
7,059
12.5
5
11
11
27
1,750
15.4
Lewis
Madison
21
9
14
44
4,299
10.2
Oneida
71
71
70
212
14,359
14.8
187
176
149
512
29,465
17.4
Oswego
51
38
34
123
8,307
14.8
St Lawrence
29
24
22
75
6,369
11.8
9
9
8
26
4,311
6.0
424
379
1,249
88,025
14.2
5,074 4,687 15,038
1,178,129
12.8
Onondaga
Tompkins
Region Total
New York State Total
446
5,277
Source: NYS DOH - 2007-2009 Vital Statistics Data
St. Lawrence County Community Health Assessment – November 2013
35
St. Lawrence County Birth Rate per 1,000 Females Age 15-17
Year
Single Year
3-Year Average
Upstate New York
2000
15.6
2001
24.1
18.3
13.9
2002
15.3
18.2
12.6
2003
15.1
15.3
12.0
2004
15.4
14.6
11.3
2005
13.4
13.1
10.9
2006
10.6
12.3
10.6
2007
12.9
11.7
10.9
2008
11.5
11.8
2009
10.7
15.2
10.8
10.2
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
Vital Statistics - Northern New York Region
Births (Age 18-19)
Region/County
2007
Population
2008 2009 Total 2007-2009
Rate
Reg-3 Central New York
Cayuga
67
48
63
178
3,516
50.6
Cortland
37
36
45
118
4,709
25.1
Herkimer
44
34
50
128
2,359
54.3
Jefferson
131
151
155
437
4,138
105.6
Lewis
11
21
20
52
890
58.4
Madison
48
47
51
146
6,345
23.0
Oneida
207
189
183
579
10,054
57.6
Onondaga
347
368
381
1,096
23,061
47.5
Oswego
130
112
112
354
7,553
46.9
St Lawrence
88
102
77
267
8,489
31.5
Tompkins
36
32
33
101
14,396
7.0
1,140 1,170
3,456
85,510
40.4
12,322 12,171 11,561 36,054
860,174
41.9
Region Total
New York State Total
1,146
Source: NYS DOH - 2007-2009 Vital Statistics Data
St. Lawrence County Community Health Assessment – November 2013
36
St. Lawrence County Birth Rate per 1,000 Females Age 18-19
Year
Single Year
3-Year Average
Upstate New York
2000
35.4
2001
37.5
33.3
43.8
2002
27.2
35.3
41.3
2003
41.0
33.2
39.3
2004
31.1
34.8
36.8
2005
32.3
31.7
38.3
2006
31.6
32.1
37.2
2007
32.3
33.5
37.9
2008
36.5
31.5
2009
25.9
45.9
36.2
35.1
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
Out-of-Wedlock Births
Generally speaking, as shown in the charts below out-of-wedlock births are above both the state
and upstate rates. Out-of-wedlock births are tracked as they historically have had a negative effect
on maternal and child health outcomes. From 2008-2010, the crude rate of births to out-of-wedlock
mothers in St. Lawrence County was 45.2 as compared to NYS at 41.4, St. Lawrence County being
almost ten percent higher than the NYS average.
Percentage of births to out-of-wedlock mothers
Out-of-wedlock births
Region/County
2008
2009
2010
Average Births Crude
Total
2008-2010
Rate
Reg- 3 Central New York
Cayuga
401
397
414
1,212
823
49.1
Cortland
253
249
223
725
528
45.7
Herkimer
287
313
310
910
651
46.6
Jefferson
586
588
589
1,763
2,064
28.5
Lewis
116
114
106
336
332
33.7
Madison
287
301
266
854
674
42.3
Oneida
1,331
1,272
1,288
3,891
2,628
49.4
Onondaga
2,555
2,540
2,474
7,569
5,460
46.2
Oswego
650
707
695
2,052
1,370
49.9
St Lawrence
585
526
546
1,657
1,222
45.2
Tompkins
257
258
258
773
878
29.3
7,308
7,265
7,169
21,742
16,630
43.6
New York State Total 102,799 102,318 101,031 306,148
246,387
41.4
Region Total
Source: NYS DOH - 2008-2010 Vital Statistics Data
St. Lawrence County Community Health Assessment – November 2013
37
Percentage of births to out-of-wedlock mothers
Crude Rate
Year Single Year 3-Year Average Upstate New York
2001
35.0
26.7
2002
36.1
35.7
27.6
2003
36.0
37.8
29.7
2004
41.3
38.8
31.1
2005
39.0
40.5
32.4
2006
41.0
41.4
34.9
2007
44.1
43.9
35.8
2008
46.7
45.0
36.9
2009
44.2
45.2
37.7
2010
44.7
38.1
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
County
Total
New York State 101,608
Out of Wedlock Live Births by Mother's Age & Resident County NYS - 2010
< 15 15-17
18-19
20-24
25-29
30-34
35-39
40-44 45+ N.S.
184
4,198
9,494
32,152
26,727
17,297
8,736
2,617
202
1
New York City
54,240
99
2,111
4,362
15,477
14,609
10,372
5,400
1,657
153
0
Rest of State
47,368
85
2,087
5,132
16,675
12,118
6,925
3,336
960
49
1
547
2
25
74
232
128
58
21
7
0
0
St Lawrence
County
Total
Out of Wedlock Live Births by Mother's Age & Resident County NYS - 2009
< 15 15-17
18-19
20-24
25-29
30-34
35-39
40-44 45+ N.S.
New York State 102,318
203
4,494
10,149
32,551
27,203
16,476
8,502
2,529
211
0
New York City
55,245
110
2,235
4,663
15,987
14,947
10,028
5,443
1,692
140
0
Rest of State
47,073
93
2,259
5,486
16,564
12,256
6,448
3,059
837
71
0
526
0
21
62
223
122
67
28
3
0
0
St Lawrence
County
Total
Out of Wedlock Live Births by Mother's Age & Resident County NYS - 2008
< 15 15-17
18-19
20-24
25-29
30-34
35-39
40-44 45+ N.S.
New York State 102,799
240
4,840
10,657
33,310
26,865
15,833
8,387
2,470
197
0
New York City
55,577
114
2,416
5,028
16,364
14,960
9,664
5,309
1,583
139
0
Rest of State
47,222
126
2,424
5,629
16,946
11,905
6,169
3,078
887
58
0
585
0
21
85
270
129
52
24
4
Source: NYS DOH - Vital Statistics of NYS, Live Births by Mother's Age and Resident County
0
0
St Lawrence
Births by financial coverage statistics show that from 2008-2010 St. Lawrence County has a
slightly higher percentage of births paid by Medicaid/Family Health Plus than all of NY and a
much higher percentage than upstate NY. The percentage of births paid by Medicaid/ Family
Health Plus in St. Lawrence County has been approximately 46% from 2008-2010. These
statistics are indicative of the relative poverty of women of child-bearing age.
St. Lawrence County Community Health Assessment – November 2013
38
Percentage of Live Births Paid by Medicaid/Family Health Plus
2008
2009
2010
44.57%
45.75%
45.75%
NY State
31.66%
32.69%
31.98%
NY Excluding NYC
46.21%
46.26%
46.15%
St. Lawrence County
Source: NYS DOH - Vital Statistics of NYS, Live Births by Financial Coverage and Resident County
For the most part though, the maternal and child health indicators are better than the State
and upstate NY. All birthweight and mortality indicators are better than the State and upstate, as
are premature births. Indicators where St. Lawrence County fares worse include the percentage
of pregnant women in WIC with gestational weight gain greater than ideal, percentage of
pregnant women in WIC who were both underweight (numerator equals 20) and overweight
(though neither calculate as statistically different), the percentage of pregnant women in WIC
with hypertension during pregnancy, the percentage of WIC mothers breastfeeding at least 6
months, and the percentage of infants fed any breast milk in the delivery hospital. Interestingly,
the percentage of infants fed exclusively breast milk in the delivery hospital is much better than
the State and upstate averages, which would seemingly indicate good support for new mothers in
the hospital and baby-friendly policies.
Maternal and Infant Health Indicators - St. Lawrence County 2008-2010
Indicator
Data
Links
3 Year County
Total
Rate
NYS
Rate Sig.Dif.
NYS
Rate
exc
NYC
Sig.Dif.
County
Ranking
Group
Percentage of births
% of births to women 25
years and older without a
high school education
(Table)
(Trend)
(Map)
217
10.1
14.8
Yes
10.3
No
3rd
% of births that were first (Table)
births
(Trend)
(Map)
1,521
41.5
43.5
No
41.3
No
3rd
(Table)
(Trend)
(Map)
142
3.9
3.9
No
4.2
No
3rd
% of births with early (1st (Table)
trimester) prenatal care
(Trend)
(Map)
2,701
78.0
72.8
Yes
75.2
No
2nd
(Table)
(Trend)
(Map)
157
4.5
5.9
Yes
4.3
No
3rd
% of births with adequate (Table)
prenatal care (Kotelchuck) (Trend)
(Map)
2,571
74.6
66.0
Yes
68.2
Yes
2nd
% of births that were
multiple births
% of births with late (3rd
trimester) or no prenatal
care
Source: NYS DOH - County Health Assessment Indicators 2008-2010
*County Ranking Groups are categorized based on the quartile distribution of all county rates (1=most favorable, 4=least favorable)
St. Lawrence County Community Health Assessment – November 2013
39
Maternal and Infant Health Indicators - St. Lawrence County 2008-2010
3 Year County NYS
Data Links Total
Rate
Rate Sig.Dif.
Indicator
% of pregnant women in WIC
with early (1st trimester)
prenatal care
(Table)
(Trend)
(Map)
1,045
% of pregnant women in WIC
who were pre-pregnancy
underweight (BMI less than
18.5)
(Table)
(Trend)
(Map)
20
% of pregnant women in WIC
who were pre-pregnancy
overweight but not obese (BMI
25-less than 30)~
(Table)
(Trend)
(Map)
% of pregnant women in WIC
who were pre-pregnancy obese
(BMI 30 or higher)~
88.6 85.6
NYS
Rate
exc
NYC
Sig.Dif.
County
Ranking
Group
No
86.3
No
2nd
4.6
No
4.1
No
4th
96
24.8 26.6
No
26.3
No
3rd
(Table)
(Trend)
(Map)
105
27.1 23.4
No
26.7
No
2nd
% of pregnant women in WIC
with anemia in 3rd trimester
(Table)
(Map)
51
33.8 37.3
No
35.4
No
2nd
% of pregnant women in WIC
with gestational weight gain
greater than ideal
(Table)
(Trend)
(Map)
604
52.9 41.8
Yes
47.1
Yes
4th
% of pregnant women in WIC
with gestational diabetes
(Table)
(Trend)
(Map)
74
6.7
5.5
No
5.7
No
4th
% of pregnant women in WIC
with hypertension during
pregnancy
(Table)
(Trend)
(Map)
107
9.7
7.2
Yes
9.0
No
2nd
% of WIC mothers breastfeeding (Table)
at least 6 months
(Trend)
(Map)
152
18.9 39.7
Yes
28.7
Yes
3rd
5.2
% of infants fed any breast milk
in delivery hospital
(Table)
(Trend)
(Map)
2,222
64.7 78.3
Yes
73.5
Yes
4th
% of infants fed exclusively
breast milk in delivery hospital
(Table)
(Trend)
(Map)
2,083
60.6 42.5
Yes
52.1
Yes
2nd
% of births delivered by
cesarean section
(Table)
(Trend)
(Map)
1,453
39.6 34.4
Yes
36.1
Yes
4th
Mortality rate per 1,000 live births
Infant (less than 1 year)
(Table)
(Trend)
(Map)
16
4.4
5.3
No
5.7
No
2nd
Neonatal (less than 28 days)
(Table)
(Trend)
(Map)
11
3.0
3.6
No
4.0
No
2nd
Post-neonatal (1 month to 1
year)
(Table)
(Trend)
5
1.4*
1.7
No
1.7
No
2nd
St. Lawrence County Community Health Assessment – November 2013
40
Maternal and Infant Health Indicators - St. Lawrence County 2008-2010
Indicator
3 Year County NYS
Data Links Total
Rate
Rate Sig.Dif.
NYS
Rate
exc
NYC
Sig.Dif.
County
Ranking
Group
(Map)
Fetal death (>20 weeks
gestation)
(Table)
(Trend)
(Map)
20
5.4
6.9
No
4.8
No
3rd
Perinatal (20 weeks gestation 28 days of life)
(Table)
(Trend)
(Map)
31
8.4 10.4
No
8.8
No
2nd
Perinatal (28 weeks gestation - 7 (Table)
days of life)
(Trend)
(Map)
19
5.2
5.7
No
5.7
No
2nd
0.0* 23.3
Yes
17.6
Yes
2nd
Maternal mortality rate per
100,000 live births +
(Table)
(Trend)
(Map)
0
% very low birthweight (less
than 1.5 kg) births
(Table)
(Trend)
(Map)
37
1.0
1.5
Yes
1.4
No
1st
% very low birthweight (less
than 1.5kg) singleton births
(Table)
(Trend)
(Map)
22
0.6
1.1
Yes
1.0
Yes
1st
% low birthweight (less than 2.5 (Table)
kg) births
(Trend)
(Map)
274
7.7
8.2
No
7.7
No
3rd
% low birthweight (less than
2.5kg) singleton births
199
5.7
6.2
No
5.7
No
3rd
Low birthweight indicators
(Table)
(Trend)
(Map)
% of premature births by gestational age
less than 32 weeks gestation
(Table)
(Trend)
(Map)
54
1.6
2.0
No
1.9
No
1st
32 - less than 37 weeks
gestation
(Table)
(Trend)
(Map)
325
9.5
9.9
No
9.3
No
3rd
less than 37 weeks gestation
(Table)
(Trend)
(Map)
379
11.1 12.0
No
11.2
No
3rd
% of births with a 5 minute
APGAR less than 6
(Table)
(Trend)
(Map)
25
0.7
No
0.7
No
3rd
Newborn drug-related discharge
rate per 10,000 newborn
discharges
(Table)
(Trend)
(Map)
15
45.2 64.0
No
78.4
Yes
2nd
0.7
Source: NYS DOH - County Health Assessment Indicators 2008-2010
*County Ranking Groups are categorized based on the quartile distribution of all county rates (1=most favorable, 4=least favorable)
*=Fewer than 10 events in the numerator, therefore the rate is unstable
St. Lawrence County Community Health Assessment – November 2013
41
The abortion rates overall are also much lower than the State rate as a whole or upstate NY.
Roughly 2/3rds of all abortions have Medicaid as the payer source.
Vital Statistics - Northern New York Region
Induced Abortions - ratio per 100 live births
Region/County
2007
2008
2009
Total
Births
2007-2009 Ratio
Reg-3 Central New York
Cayuga
189
176
186
551
2,446
22.5
Cortland
149
141
120
410
1,658
24.7
Herkimer
118
163
167
448
2,028
22.1
Jefferson
197
197
184
578
5,906
9.8
Lewis
21
31
20
72
980
7.3
Madison
95
99
116
310
2,159
14.4
982
862
826
2,670
7,856
34.0
Oneida
Onondaga
1,642
1,845
1,741
5,228
16,558
31.6
Oswego
237
253
225
715
4,162
17.2
St Lawrence
186
160
169
515
3,684
14.0
Tompkins
353
268
288
909
2,748
33.1
4,169
4,195
4,042
12,406
50,185
24.7
120,554
118,381
115,008
353,943
748,909
47.3
Region Total
New York State Total
Source: NYS DOH - Vital Statistics Data 2007-2009
Abortions per 100 Live Births
Year Single Year 3-Year Average
Upstate New York
2000
11.8
26.3
2001
12.6
12.6
26.9
2002
13.5
12.7
27.5
2003
12.1
12.5
26.0
2004
12.0
12.5
26.7
2005
13.5
13.4
27.4
2006
14.6
14.3
29.4
2007
15.0
14.1
28.8
2008
12.8
14.0
2009
14.2
28.1
27.6
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
County
Induced Abortions by Financial Coverage & Resident County NYS - 2010
Total
Medicaid
HMO
Other Insurance Self-Pay Multiple Payer Not Stated
New York State 111,212
47,548
3,576
29,272
23,944
291
6,581
New York City
77,327
33,440
25
23,776
16,752
3
3,331
Rest of State
33,885
14,108
3,551
5,496
7,192
288
3,250
4
6
St Lawrence
154
101
1
13
29
Source: NYS DOH - Vital Statistics Data, Induced Abortions by Financial Coverage and Resident County
St. Lawrence County Community Health Assessment – November 2013
42
1b. Morbidity
For the most part, morbidity data for rural counties such as St. Lawrence County is
unreliable since it is statistically insignificant even over a three or five year period due to the
very small numbers involved. The numbers of cases of Chlamydia, which has recently been
added to the reportable disease list, are high enough to yield statistically reliable trend rate data
in future years. The data is more useful as a method to track the presence of the disease in the
County. One thing worth noting, however, is that the percentage of adults overweight or obese is
6% to 7% higher than both the state and upstate rates.
Sugar-sweetened beverages (SSBs), including regular (non-diet) soda, sports drinks, fruit
drinks, lemonade, energy drinks, and caloric sweetened water, are the single largest source of
added sugars in the diet of children in the United States (US).1 SSBs are a source of excess
calories with no or minimal nutritional value.2 In children and adolescents, consumption of SSBs
is associated with dental caries, diabetes, weight gain, and decreased bone density.3,4,5 Reducing
consumption of SSBs is a key strategy in the prevention of childhood obesity and Type 2
diabetes.
This BRFSS (Behavioral Risk Factor Surveillance System) brief presents 2009-2010
data on the daily consumption rates of soda and other SSBs among children and adolescents in
New York State. It shows that nearly one in three children between the ages of 2 and 17 years of
age consume SSBs daily. Three times as many children between 2 and 17 years of age in New
York consume fruit drinks, punches, iced teas and sports drinks daily than soda (27% and 9%,
respectively). Children are more likely to consume SSBs daily if they have a TV in their
bedroom, their parent or guardian has low educational attainment, their parent is non-White or
Hispanic, their parent consumes SSBs at least weekly, their parent is obese or their family has a
low household income.
2009
2008
2007
2006
2005
#
#
#
#
#
Rate
Rate
Rate
Rate
Rate
SOCIO-DEMOGRAPHICS
Population
109,715
Unemployment
4,975 10.0
109,701
3,519 7.0
109,809
2,910 5.9
111,284
2,881 5.8
111,380
3,003 6.1
Percent in Poverty
17,504 17.8 16,865 17.2 15,693 15.9 17,408 17.4 17,151 17.2
Median Household Income (in
dollars)
41,627
40,970
39,035
38,024
36,553
PERINATAL HEALTH
Infant Deaths
4 3.4
0 0.0
13 10.5
11 8.6
12 9.7
Neonatal Deaths
4 3.4
0 0.0
11 8.9
8 6.2
9 7.3
Postneonatal Deaths
0 0.0
0 0.0
2 1.6
3 2.3
3 2.4
Spontaneous Fetal Deaths (20+
wks)
5 4.2
6 4.8
10 8.0
8 6.2
3 2.4
Source: NYS DOH - County Health Assessment Indicators
St. Lawrence County Community Health Assessment – November 2013
43
2009
#
2008
Rate
#
2007
Rate
#
2006
Rate
#
2005
Rate
#
Rate
MORTALITY (Rates per 100,000 Population)
Lung Cancer (Total)
73 66.5
92 83.9
75
68.3
89
80.0
73 65.5
Lung Cancer (Male)
43 77.1
43 77.4
43
77.3
42
74.6
44 77.9
Lung Cancer (Female)
30 55.6
49 90.5
32
59.1
47
85.5
29 52.9
Cerebrovasular Disease
43 39.2
49 44.7
43
39.2
42
37.7
61 54.8
240 218.7
305 278.0
281 252.5
267 239.7
Diseases of the Heart
Homicides
2
1.8
2
264 240.4
1.8
2
1.8
3
2.7
5
4.5
Suicides
12 10.9
15 13.7
7
6.4
16
14.4
16 14.4
Unintentional Injury
30 27.3
36 32.8
44
40.1
29
26.1
44 39.5
Motor Vehicle
14 12.8
12 10.9
18
16.4
11
9.9
17 15.3
Non-Motor Vehicle
16 14.6
24 21.9
26
23.7
18
16.2
27 24.2
AIDS
Cirrhosis (Liver)
0.0
0
0.0
2
1.8
1
0.9
17 15.5
0
9
8.2
16
14.6
14
12.6
12 10.8
3
2.7
HOSPITALIZATIONS (Rates Per 10,000 Population)
Pediatric (0-4)
- Asthma
18 28.9
15 24.8
29
49.2
20
33.8
27 46.0
- Gastroenteritis
20 32.1
8 13.2
31
52.6
24
40.5
28 47.7
- Otitis Media
Drug Related
Head Injury (5)
2
3.2
371 33.8
3.3
3
5.1
1
1.7
309 28.2
2
252
22.9
266
23.9
1
1.7
287 25.8
46
4.2
42
3.8
53
4.8
67
6.0
57
5.1
AIDS Cases (4)
3
2.7
1
0.9
5
4.6
5
4.5
5
4.5
Early Syphilis
0
0.0
0
0.0
3
2.7
0
0.0
1
0.9
DISEASE MORBIDITY
Chlamydia Incidence
215 196.0
216 196.9
179 163.0
174 156.4
147 132.0
TB Incidence
0
0.0
2
1.8
0
0.0
1
0.9
7
6.3
Ecoli O157 Incidence
1
0.9
4
3.6
1
0.9
3
2.7
1
0.9
Meningococcal Incidence
2
1.8
0
0.0
0
0.0
1
0.9
1
0.9
Pertussis Incidence
1
0.9
11 10.0
16
14.6
7
6.3
1
0.9
47 42.8
25 22.8
10
9.1
1
0.9
2
1.8
Lyme Disease Incidence
Source: NYS DOH - County Health Assessment Indicators
St. Lawrence County Community Health Assessment – November 2013
44
Health Risks and Behaviors - St. Lawrence County, 2007-2009
Indicator
3 Year County NYS Sig
Total
Rate Rate Dif
% Pregnant Women in WIC with Anemia in 3rd
Trimester, Low SES (2009)
County
Sig
Ranking
Dif
Group
28.4
N/A
4.2
No
3rd
N/A
N/A
% Pregnant Women in WIC Who Were Prepregnancy
Underweight (BMI Under 18.5), Low SES
21
5.2
% Pregnant Women in WIC Who Were Prepregnancy
Overweight but not Obese (BMI 25-<30), Low SES
95
23.3
26.5 No
26.3
No
2nd
% Pregnant Women in WIC Who Were Prepregnancy
Obese (BMI 30+), Low SES
117
28.7
22.8 Yes
26.2
No
2nd
% of Infants in WIC Who Were Breastfeeding at 6
Months, Low SES
155
18.8
40.6 Yes
N/A
No
3rd
% Underweight Children in WIC, 0-4 years, Low SES
106
2.3
4.5 Yes
3.7
Yes
2nd
% Obese Children in WIC (>= 95th Pctl), 2-4 years,
Low SES
297
14.0
14.5 No
15.2
No
2nd
% Anemic Children in WIC, 6mo-4 years, Low SES
33.9 N/A
NYS
Rate
exc
NYC
4.7
No
490
11.8
12.0 No
12.2
No
2nd
1,656
73.1
78.5 Yes
80.5
Yes
4th
County
Rate
CI #
NYS CI Upstate CI County
Rate #
# Ranking
Group
% adults overweight or obese (BMI 25+)
66.5
± 5.3
59.3
±
2.6
60.6
±
1.4
4th
% adults that participated in leisure time physical
activity in last 30 days
78.9
± 3.8
76.3
±
2.2
78.9
±
1.1
2nd
% adults smoking cigarettes
24.7
± 4.7
17.0
±
1.8
18.9
±
1.1
4th
% adults living in homes where smoking is prohibited
75.2
± 4.4
80.9
±
1.8
79.3
±
1.1
3rd
% adults that binge drink
21.8
± 5.1
18.1
±
2.0
19.8
±
1.2
4th
% adults eating 5 or more servings of fruit or
vegetables daily
30.9
± 5.2
27.1
±
2.2
27.7
±
1.3
1st
% of Children in WIC Viewing TV <=2 Hours per Day
0-4 years, Low SES
Behavior/Risk Indicator (2008-09)
Source: NYS DOH - County Health Assessment Indicators 2007-2009
*County Ranking Groups are categorized based on the quartile distribution of all county rates (1=most favorable, 4=least favorable)
St. Lawrence County Community Health Assessment – November 2013
45
Heart Disease and Stroke St. Lawrence County, 2007-2009
Indicator
County
County NYS
NYS Rate
Sig.Dif.
Sig.Dif. Ranking
Rate
Rate
exc NYC
Group
3 Year
Total
CARDIOVASCULAR DISEASE
Mortality rates per 100,000 (ICD-10 I00-I99)
Crude
1,013
307.8
296.2
No
306.6
No
3rd
Age-adjusted
1,013
276.6
256.7
Yes
251.9
Yes
3rd
Premature death (ages 35-64)
151
123.9
103.0
Yes
96.7
Yes
3rd
Pretransport mortality
488
148.3
143.7
No
155.4
No
3rd
Crude
6,296
191.3
186.0
Yes
188.6
No
3rd
Age-adjusted
6,296
174.7
168.7
Yes
163.2
Yes
3rd
No
248.1
No
2nd
3rd
Hospitalization rates per 10,000
(ICD-9 390-459)
DISEASE OF THE HEART
Mortality rates per 100,000 (ICD-10 I00-I09, I11, I13, I20-I51)
Crude
809
245.8
247.6
Age-adjusted
809
221.1
214.2
No
203.6
Yes
Premature death (ages 35-64)
128
105.0
84.7
Yes
79.5
Yes
3rd
Pretransport mortality
396
120.3
125.5
No
129.8
No
2nd
Yes
2nd
CORONARY HEART DISEASE
Mortality rates per 100,000 (ICD-10 I11, I20-I25)
Crude
518
157.4
203.2
Yes
183.8
Age-adjusted
518
141.7
175.8
Yes
150.8
No
2nd
97
79.6
70.4
No
61.2
Yes
3rd
262
79.6
105.5
Yes
99.2
Yes
1st
3rd
Premature death (ages 35-64)
Pretransport mortality
CONGESTIVE HEART FAILURE
Mortality rates per 100,000 (ICD-10 I50)
Crude
72
21.9
13.5
Yes
19.7
No
Age-adjusted
72
19.4
11.4
Yes
15.7
No
4th
s
1.6*
1.7
No
2.1
No
2nd
38
11.5
7.1
Yes
10.7
No
3rd
Premature death (ages 35-64)
Pretransport mortality
CEREBROVASCULAR DISEASE (STROKE)
Mortality rates per 100,000 (ICD-10 I60-I69)
Crude
135
41.0
30.1
Yes
38.7
No
3rd
Age-adjusted
135
36.8
26.3
Yes
31.9
No
3rd
Premature death (ages 35-64)
17
13.9*
10.5
No
10.7
No
3rd
Pretransport mortality
61
18.5
10.7
Yes
16.1
No
3rd
County
Rate
CI #
NYS
Rate
CI #
Upstate
8.3
± 2.2
7.6
± 1.1
7.2
± 0.6
3rd
74.1
± 5.0
77.3
± 2.6
79.3
± 1.3
3rd
Behavior/Risk Indicator
(2008-09)
% of adults with diagnosis of heart
attack, stroke, or angina
% of adults with cholesterol
checked in the last 5 years
CI # County
Ranking
Group
% of adults ever told they have
28.8
± 4.4
25.7
± 1.9
27.1
± 1.1
3rd
high blood pressure
Source: NYS DOH - County Health Assessment Indicators 2007-2009
*County Ranking Groups are categorized based on the quartile distribution of all county rates (1=most favorable, 4=least favorable)
St. Lawrence County Community Health Assessment – November 2013
46
HIV/AIDS and STDs St. Lawrence County, 2007-2009
Indicator
3 Year County
Total
Rate
NYS
Rate
Sig.Dif.
NYS
Rate
exc
NYC
Sig.Dif.
County
Ranking
Group
HIV/AIDS
AIDS case rate per 100,000
7
2.1 *
19.8
Yes
6.3
Yes
1st
HIV case rate per 100,000
4
1.2 *
22.8
Yes
7.7
Yes
1st
AIDS mortality rate per 100,000
s
0.6 *
6.3
Yes
1.9
No
2nd
AIDS mortality rate age-adjusted
s
0.7*
5.9
No
1.8
No
2nd
3
0.9 *
12.4
Yes
2.6
No
2nd
All Ages
34
10.3
88.5
Yes
60.3
Yes
2nd
15-19 years
12
39.6 *
310.8
Yes
224.9
Yes
2nd
SEXUALLY TRANSMITTED DISEASES
Early Syphillis rate per 100,000
Gonorrhea rate per 100,000
Chlamydia rate per 100,000
Males
All Ages
176
105.6
279.4
Yes
163.4
Yes
2nd
15-19 years
51
324.9
901.7
Yes
531.0
Yes
3rd
20-24 years
80
409.1
1280.3
Yes
799.1
Yes
2nd
All Ages
434
267.2
604.4
Yes
405.9
Yes
2nd
15-19 years
217 1484.1
3280.7
Yes 2207.4
Yes
2nd
20-24 years
159 1041.9
2930.8
Yes 2123.4
Yes
1st
No
3rd
Females
Pelvic inflammatory disease (PID)
hospitalization rate per 10,000
women ages 15-44 years
25
3.6
4.8
No
3.4
Source: NYS DOH - County Health Assessment Indicators 2007-2009
*County Ranking Groups are categorized based on the quartile distribution of all county rates (1=most favorable, 4=least favorable)
*=Fewer than 10 events in the numerator, therefore the rate is unstable
Immunization and Infectious Diseases St. Lawrence County, 2007-2009
Indicator
Pneumonia/flu hospitalizations
in adults 65+ years per 10,000
(ICD9 480-487)
Pertussis incidence per 100,000
3 Year County NYS
NYS Rate
Total
Rate Rate Sig.Dif. exc NYC Sig.Dif.
1,182
262.5 136.0
County
Ranking
Group
Yes
150.5
Yes
4th
28
8.5
2.8
Yes
3.8
Yes
4th
H. Influenza incidence per
100,000
3
0.9*
1.3
No
1.5
No
1st
Hepatitis A incidence per
100,000
0
0.0*
0.9
Yes
0.6
Yes
1st
Hepatitis B incidence per
100,000
s
0.3*
0.9
No
0.7
No
2nd
Tuberculosis incidence per
100,000
s
0.6*
5.8
Yes
2.4
Yes
2nd
E. Coli incidence per 100,000
6
1.8*
0.7
No
0.9
No
4th
St. Lawrence County Community Health Assessment – November 2013
47
3 Year County NYS
NYS Rate
Total
Rate Rate Sig.Dif. exc NYC Sig.Dif.
Indicator
Salmonella incidence per
100,000
County
Ranking
Group
53
16.1
13.9
No
13.0
No
4th
s
0.3*
4.3
Yes
3.1
Yes
2nd
Lyme disease incidence per
100,000
82
24.9
39.4
Yes
62.2
Yes
3rd
Behavior/Risk Indicator
(2008-09)
County
Rate
CI #
NYS
Rate
CI #
Upstate
CI #
County
Ranking
Group
% of adults 65+ years with flu
shot in last year
74.1
± 6.3
75.0
± 3.5
76.0
± 1.5
2nd
% of adults 65+ years that ever
received pneumonia shot
70.2
± 7.3
64.7
± 4.3
71.2
± 1.8
3rd
Shigella incidence per 100,000
Source: NYS DOH - County Health Assessment Indicators 2007-2009
*County Ranking Groups are categorized based on the quartile distribution of all county rates (1=most favorable, 4=least favorable)
*=Fewer than 10 events in the numerator, therefore the rate is unstable
Injury Mortality and Morbidity St. Lawrence County, 2007-2009
Indicator
3
Year County NYS
Total Rate Rate Sig.Dif.
NYS
Rate
exc
NYC
Sig.Dif.
County
Ranking
Group
Suicide Mortality Rate per 100,000
Crude
34
10.3
6.9
Yes
8.0
No
3rd
Age-adjusted
34
10.8
6.6
Yes
7.7
Yes
3rd
0
0.0*
3.8
Yes
4.3
Yes
1st
15-19 years
Self-Inflicted Injury Hospitalization Rate per 10,000
Crude
341
10.4
5.0
Yes
5.8
Yes
4th
Age-adjusted
341
10.4
4.9
Yes
5.9
Yes
4th
47
15.5
9.2
Yes
10.4
Yes
3rd
15-19 years
Homicide Mortality Rate per 100,000
Crude
6
1.8*
4.3
Yes
2.9
No
2nd
Age-adjusted
6
1.7*
4.3
Yes
3.0
No
2nd
Assault Hospitalization Rate per 10,000
Crude
44
1.3
4.7
Yes
2.7
Yes
2nd
Age-adjusted
44
1.3
4.7
Yes
2.8
Yes
1st
Unintentional Injury Mortality Rate per 100,000
Crude
110
33.4
24.2
Yes
28.6
No
3rd
Age-adjusted
110
31.1
22.8
Yes
26.4
No
3rd
Unintentional Injury Hospitalization Rate per 10,000
Crude
2,456
74.6
69.2
Yes
73.3
No
3rd
Age-adjusted
2,456
70.9
64.6
Yes
66.2
Yes
3rd
<10 years
73
20.8
26.9
Yes
22.9
No
3rd
10-14 years
26
14.5
22.8
Yes
21.1
No
1st
15-24 years
182
27.9
32.9
Yes
33.8
Yes
2nd
St. Lawrence County Community Health Assessment – November 2013
48
Indicator
25-64 years
65+ years
3
Year County NYS
Total Rate Rate Sig.Dif.
NYS
Rate
exc
NYC
Sig.Dif.
County
Ranking
Group
891
53.7
46.5
Yes
46.4
Yes
4th
1,284
285.1
259.5
Yes
281.1
No
3rd
Falls Hospitalization Rate per 10,000
Crude
1,330
40.4
39.7
No
43.3
Yes
2nd
Age-adjusted
1,330
37.3
36.1
No
37.6
No
3rd
<10 years
22
6.3
10.0
Yes
8.9
No
2nd
10-14 years
6
3.4*
7.8
Yes
6.7
No
1st
15-24 years
24
3.7
7.0
Yes
6.4
Yes
1st
25-64 years
299
18.0
18.6
No
18.6
No
2nd
65-74 years
209
88.9
77.8
No
80.4
No
4th
75-84 years
413
265.3
234.3
Yes
251.6
No
4th
85+ years
357
599.5
544.9
No
617.7
No
3rd
Poisoning Hospitalization Rate per 10,000
Crude
488
14.8
10.1
Yes
9.8
Yes
4th
Age-adjusted
488
14.6
9.9
Yes
9.7
Yes
4th
Motor Vehicle Mortality Rate per 100,000
Crude
44
13.4
6.5
Yes
8.6
Yes
4th
Age-adjusted
44
12.5
6.3
Yes
8.3
Yes
3rd
Non-Motor Vehicle Mortality Rate per 100,000
Crude
66
20.1
17.7
No
20.0
No
2nd
Age-adjusted
66
18.6
16.5
No
18.1
No
3rd
Traumatic Brain Injury Hospitalization Rate per 10,000
Crude
186
5.7
9.7
Yes
10.0
Yes
1st
Age-adjusted
186
5.4
9.3
Yes
9.4
Yes
1st
Alcohol
Related Motor
Vehicle
Injuries and
Deaths per
100,000
204
62.0
37.6
Yes
52.7
Yes
3rd
Source: NYS DOH - County Health Assessment Indicators 2007-2009
*County Ranking Groups are categorized based on the quartile distribution of all county rates (1=most favorable, 4=least favorable)
*=Fewer than 10 events in the numerator, therefore the rate is unstable
St. Lawrence County Community Health Assessment – November 2013
49
1c. Mortality
Similar to NY State and upstate, the leading cause of death in St. Lawrence County is heart
disease, which has a higher age-adjusted rate per 100,000 than either upstate NY or the State as a
whole. In 2013, heart disease is followed by cancer, at about the same rate as NYS. The next
three leading causes of death rank 3rd (Chronic Lower Respiratory Disease (CLRD)), 4th
(stroke) and 5th (Unintentional Injury, similar to NY and upstate). However, all are at
rates/100,000 that are significantly higher than NY and upstate, especially CLRD.
Leading Causes of Death by County, New York State, 2011
Source: Vital Statistics Data as of March, 2013
New York State Department of Health - Bureau of Biometrics and Health Statistics
#1 Cause of #2 Cause of
#4 Cause of
#3 Cause of
#5 Cause of
Death and # Death and #
Death and #
County and
Death and # of
Death and # of
of Deaths
of Deaths
of Deaths
# of
Deaths
Deaths
AgeAgeAgeDeaths
Age-adjusted
Age-adjusted
adjusted
adjusted
adjusted
Death Rate
Death Rate
Death Rate Death Rate
Death Rate
St
Lawrence
Total: 979
Rest of
State
Total:
95,734
New York
State
Total:
147,078
Heart
Disease
254
201 per
100,000
Cancer
212
163 per
100,000
Heart
Disease
27,165
189 per
100,000
Cancer
22,556
165 per
100,000
Heart
Disease
43,959
191 per
100,000
Cancer
35,032
159 per
100,000
Chronic Lower
Respiratory
Diseases
(CLRD)
83
66 per 100,000
Chronic Lower
Respiratory
Diseases
(CLRD)
5,117
37 per 100,000
Chronic Lower
Respiratory
Diseases
(CLRD)
6,902
31 per 100,000
*Rates based on fewer than 20 events in the numerator are unstable.
**Ranks based on numbers of deaths
Questions or comments: [email protected], Revised: June, 2013, Disclaimer,
St. Lawrence County Community Health Assessment – November 2013
Stroke
45
35 per
100,000
Unintentional
Injury
39
32 per 100,000
Stroke
4,374
31 per
100,000
Unintentional
Injury
3,680
30 per 100,000
Stroke
6,152
27 per
100,000
Unintentional
Injury
5,246
25 per 100,000
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Leading Causes of Death Among Females by County, New York State, 2011
Source: Vital Statistics Data as of March, 2013
New York State Department of Health - Bureau of Biometrics and Health Statistics
#1 Cause of #2 Cause of
#4 Cause of
#3 Cause of
#5 Cause of
Death and # Death and #
Death and #
County and
Death and # of
Death and # of
of Deaths
of Deaths
of Deaths
# of
Deaths
Deaths
AgeAgeAgeDeaths
Age-adjusted
Age-adjusted
adjusted
adjusted
adjusted
Death Rate
Death Rate
Death Rate Death Rate
Death Rate
St
Lawrence
Total: 474
Rest of
State
Total:
49,802
New York
State
Total:
76,474
Heart
Disease
120
156 per
100,000
Cancer
93
131 per
100,000
Heart
Disease
14,164
156 per
100,000
Cancer
11,284
146 per
100,000
Heart
Disease
23,272
160 per
100,000
Cancer
17,714
140 per
100,000
Chronic Lower
Respiratory
Diseases
(CLRD)
42
57 per 100,000
Chronic Lower
Respiratory
Diseases
(CLRD)
2,782
34 per 100,000
Chronic Lower
Respiratory
Diseases
(CLRD)
3,741
28 per 100,000
*Rates based on fewer than 20 events in the numerator are unstable.
**Ranks based on numbers of deaths
Questions or comments: [email protected], Revised: June, 2013, Disclaimer,
Stroke
23
30 per
100,000
Unintentional
Injury
16
23 per 100,000*
Stroke
2,680
30 per
100,000
Unintentional
Injury
1,371
19 per 100,000
Stroke
3,731
26 per
100,000
Pneumonia and
Influenza
2,506
17 per 100,000
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St. Lawrence County Community Health Assessment – November 2013
51
Leading Causes of Death Among Males by County, New York State, 2011
Source: Vital Statistics Data as of March, 2013
New York State Department of Health - Bureau of Biometrics and Health Statistics
#1 Cause of
Death and
County and
# of Deaths
# of
AgeDeaths
adjusted
Death Rate
St
Lawrence
Total: 505
Rest of
State
Total:
45,927
New York
State
Total:
70,599
#2 Cause of
#3 Cause of
Death and
Death and # of
# of Deaths
Deaths
AgeAge-adjusted
adjusted
Death Rate
Death Rate
Heart
Disease
134
259 per
100,000
Cancer
119
196 per
100,000
Heart
Disease
13,000
230 per
100,000
Cancer
11,271
192 per
100,000
Heart
Disease
20,686
233 per
100,000
Cancer
17,317
187 per
100,000
Chronic Lower
Respiratory
Diseases
(CLRD)
41
77 per 100,000
Chronic Lower
Respiratory
Diseases
(CLRD)
2,335
42 per 100,000
Unintentional
Injury
3,342
35 per 100,000
*Rates based on fewer than 20 events in the numerator are unstable.
**Ranks based on numbers of deaths
Questions or comments: [email protected], Revised: June, 2013, Disclaimer,
#5 Cause of
#4 Cause of
Death and
Death and # of
# of Deaths
Deaths
AgeAge-adjusted
adjusted
Death Rate
Death Rate
Unintentional
Injury
23
42 per 100,000
Stroke
22
43 per
100,000
Unintentional
Injury
2,309
42 per 100,000
Stroke
1,693
31 per
100,000
Chronic Lower
Respiratory
Diseases
(CLRD)
3,161
36 per 100,000
Stroke
2,420
27 per
100,000
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St. Lawrence County Community Health Assessment – November 2013
52
Leading Causes of Premature Death (Death before age 75), New York State, 2009-2011
Source: Vital Statistics Data as of March 2013
New York State Department of Health - Bureau of Biometrics and Health Statistics
#1 Cause of #2 Cause of
Premature
Premature
#3 Cause of
Death and # Death and #
Premature
County and
of
of
Death and #
# of 3
Premature
Premature of Premature
Years
Deaths
Deaths
Deaths
Premature
AgeAgeAge-adjusted
Deaths
adjusted
adjusted
Premature
Premature
Premature
Death Rate
Death Rate Death Rate
St
Lawrence
Total: 1,254
Rest of
State
Total:
105,565
New York
State
Total:
174,360
#5 Cause of
#4 Cause of
Premature
Premature
Death and #
Death and #
of
of Premature Premature
Deaths
Deaths
Age-adjusted
AgePremature
adjusted
Death Rate
Premature
Death Rate
Cancer
402
362 per
100,000
Heart
Disease
250
287 per
100,000
Chronic Lower
Respiratory
Unintentional
Diseases
Injury
(CLRD)
68
100
70 per 100,000
129 per
100,000
Cancer
35,364
294 per
100,000
Heart
Disease
21,139
176 per
100,000
Unintentional
Injury
6,505
65 per 100,000
Cancer
56,321
273 per
100,000
Heart
Disease
37,699
182 per
100,000
Chronic Lower
Respiratory
Diseases
(CLRD)
4,918
38 per 100,000
Chronic Lower
Unintentional
Respiratory
Injury
Diseases
9,876
(CLRD)
55 per 100,000
6,762
31 per 100,000
*Rates based on fewer than 20 events in the numerator are unstable.
**Ranks based on numbers of deaths
Questions or comments: [email protected], Revised: June, 2013, Disclaimer,
St. Lawrence County Community Health Assessment – November 2013
Diabetes
38
39 per
100,000
Suicide
38
38 per
100,000
Stroke
3,085
25 per
100,000
Diabetes
5,299
26 per
100,000
Privacy Policy, Accessibility
53
Leading Causes of Premature Death (Death before age 75) Among Male by County, New
York State, 2009-2011
Source: Vital Statistics Data as of March 2013
New York State Department of Health - Bureau of Biometrics and Health Statistics
#1 Cause of #2 Cause of
Premature
Premature
#3 Cause of
Death and # Death and #
Premature
County and
of
of
Death and #
# of 3 Years Premature
Premature of Premature
Premature
Deaths
Deaths
Deaths
Deaths
AgeAgeAge-adjusted
adjusted
adjusted
Premature
Premature
Premature
Death Rate
Death Rate Death Rate
St
Lawrence
Total: 750
Rest of
State
Total:
62,231
New York
State
Total:
102,635
Cancer
234
483 per
100,000
Heart
Disease
167
297 per
100,000
Cancer
18,299
307 per
100,000
Heart
Disease
14,208
243 per
100,000
Cancer
28,915
288 per
100,000
Heart
Disease
24,732
248 per
100,000
#5 Cause of
#4 Cause of
Premature
Premature
Death and #
Death and #
of
of Premature Premature
Deaths
Deaths
Age-adjusted
AgePremature
adjusted
Death Rate
Premature
Death Rate
Chronic Lower
Respiratory
Unintentional
Diseases
Injury
(CLRD)
42
53
86 per 100,000
134 per
100,000
Chronic Lower
Unintentional
Respiratory
Injury
Diseases
4,686
(CLRD)
93 per 100,000
2,480
39 per 100,000
Chronic Lower
Unintentional
Respiratory
Injury
Diseases
7,108
(CLRD)
80 per 100,000
3,473
34 per 100,000
*Rates based on fewer than 20 events in the numerator are unstable.
**Ranks based on numbers of deaths
Questions or comments: [email protected], Revised: June, 2013, Disclaimer,
Suicide
30
58 per
100,000
Suicide
2,253
47 per
100,000
Suicide
3,221
37 per
100,000
Privacy Policy, Accessibility
St. Lawrence County Community Health Assessment – November 2013
54
Leading Causes of Premature Death (Death before age 75) Among Female by County, New
York State, 2009-2011
Source: Vital Statistics Data as of March 2013
New York State Department of Health - Bureau of Biometrics and Health Statistics
#1 Cause of
Premature
Death and #
County and
of Premature
# of 3 Years
Deaths
Premature
AgeDeaths
adjusted
Premature
Death Rate
St Lawrence
Total: 504
Rest of
State
Total:
43,330
New York
State
Total:
71,720
#2 Cause of
Premature
Death and #
of Premature
Deaths
Ageadjusted
Premature
Death Rate
Cancer
168
402 per
100,000
Heart
Disease
83
204 per
100,000
Cancer
17,064
281 per
100,000
Heart
Disease
6,931
110 per
100,000
Cancer
27,405
259 per
100,000
Heart
Disease
12,967
118 per
100,000
#5 Cause of
#3 Cause of
#4 Cause of
Premature
Premature
Premature
Death and #
Death and # Death and # of
of Premature
of Premature
Premature
Deaths
Deaths
Deaths
AgeAge-adjusted Age-adjusted
adjusted
Premature
Premature
Premature
Death Rate
Death Rate
Death Rate
Chronic
Lower
Respiratory
Diseases
(CLRD)
47
124 per
100,000
Chronic
Lower
Respiratory
Diseases
(CLRD)
2,438
37 per
100,000
Chronic
Lower
Respiratory
Diseases
(CLRD)
3,289
29 per
100,000
*Rates based on fewer than 20 events in the numerator are unstable.
**Ranks based on numbers of deaths
Questions or comments: [email protected], Revised: June, 2013, Disclaimer,
St. Lawrence County Community Health Assessment – November 2013
Unintentional
Injury
26
57 per 100,000
Stroke
14
26 per
100,000*
Unintentional
Injury
1,819
36 per 100,000
Stroke
1,442
23 per
100,000
Unintentional
Injury
2,768
30 per 100,000
Stroke
2,294
21 per
100,000
Privacy Policy, Accessibility
55
Premature deaths or deaths between the ages of 35-64 have a somewhat higher rate in St.
Lawrence County than in all of NY and NY excluding NYC. The rate of childhood, infant,
neonatal, post neonatal, and spontaneous fetal deaths have varied between 2005 and 2009 but are
statistically unreliable due to small numbers. St. Lawrence County had the highest rate of
colorectal cancer deaths in the region and was also significantly higher than state rate. The good
news is that although from the years 2000 to 2007 the rate was higher than upstate rate for every
year in 2008 and 2009 the rate was lower than the upstate rate. The rates for lung cancer deaths
have shown variability in females. While male lung cancer deaths have remained between a total
of 77-78 except for 2006 when it dropped to 74.6, female deaths have shown a bouncing pattern
from year to year ranging from 52.9 in 2005 to 90.5 in 2008. The death rates for female breast
and cervical cancer have shown a general drop from 2005-2009. Diseases of the heart have also
followed somewhat of a bouncing pattern as well ranging from 218.7 in 2009 to a high point of
278.0 in 2008. Between 2005 and 2009 the rates of cirrhosis deaths are highest in the region, and
more than double the state rate. It is also higher than upstate rate every year from 2000 to 2009.
The County had the second highest diabetes death rate in the region for the time period and was
significantly higher than the NY rate. In addition, the rate for the county was higher than the
upstate rate every year from 2000-2009. The death rates for chronic respiratory illnesses for the
years following was highest in the region and significantly higher than the NY rate. In addition
the rate for the county was higher than the upstate rate every year from 2000-2009. Homicide
death rates are so low as to be statistically unreliable. Unintentional injury, motor vehicle, and
non motor vehicle have also shown an up-down pattern from year to year. The motor vehicle
mortality rate per 100,000 people in St. Lawrence County is more than twice as high as NYS,
and significantly higher than NYS excluding NYC.
Infant Mortality - Rate per 1,000 Live Births
Deaths <1 Year
Births
Region/County 2007 2008 2009 Total 2007-2009 Rate
Reg-3 Central New York
Cayuga
3
7
4
14
2,446
5.7
Cortland
4
1
5
10
1,658
6.0
Herkimer
4
5
8
17
2,028
8.4
Jefferson
15
13
14
42
5,906
7.1
Lewis
4
1
0
5
980
5.1
Madison
4
2
2
8
2,159
3.7
Oneida
16
19
11
46
7,856
5.9
Onondaga
36
43
45
124
16,558
7.5
7
7
12
26
4,162
6.2
13
0
4
17
3,684
4.6
3
0
4
7
2,748
2.5
109
98
109
316
50,185
6.3
New York State Total 1,382 1,359 1,296 4,037
748,909
5.4
Oswego
St Lawrence
Tompkins
Region Total
Source: NYS DOH - 2007-2009 Vital Statistics Data
St. Lawrence County Community Health Assessment – November 2013
56
Infant Mortality Rate per 1,000 live Births
Year Single Year 3-Year Average Upstate New York
2000
6.5
2001
4.0
5.7
5.9
2002
6.6
6.0
6.0
2003
7.4
6.6
5.8
2004
5.7
7.6
6.0
2005
9.7
8.0
5.9
2006
8.6
9.6
5.5
2007
10.5
6.4
5.9
2008
0.0
4.6
5.8
2009
6.2
3.4
5.6
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
Neonatal Mortality - Rate per 1,000 Live Births
Deaths <28 Days
Births
Region/County 2007 2008 2009 Total 2007-2009 Rate
Reg-3 Central New York
Cayuga
3
5
4
12
2,446
4.9
Cortland
2
1
5
8
1,658
4.8
Herkimer
4
3
6
13
2,028
6.4
Jefferson
8
10
8
26
5,906
4.4
Lewis
4
0
0
4
980
4.1
Madison
2
1
2
5
2,159
2.3
Oneida
12
11
9
32
7,856
4.1
Onondaga
29
28
31
88
16,558
5.3
5
6
8
19
4,162
4.6
11
0
4
15
3,684
4.1
1
0
4
5
2,748
1.8
81
65
81
227
50,185
4.5
909
919
886 2,714
748,909
3.6
Oswego
St Lawrence
Tompkins
Region Total
New York State Total
Source: NYS DOH - 2007-2009 Vital Statistics Data
St. Lawrence County Community Health Assessment – November 2013
57
Neonatal Mortality Rate per 1,000 Live Births
Year Single Year 3-Year Average Upstate New York
2000
3.3
2001
3.2
4.1
4.0
2002
5.8
4.4
4.5
2003
4.1
4.4
4.2
2004
3.3
4.9
4.4
2005
7.3
5.6
4.3
2006
6.2
7.5
3.8
2007
8.9
5.0
4.0
2008
0.0
4.1
4.0
2009
4.5
3.4
4.0
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
Post neonatal Mortality - Rate per 1,000 Live Births
Deaths >28 Days - <1 Year
Region/County
2007
2008
2009
Births
Total 2007-2009 Rate
Reg-3 Central New York
Cayuga
0
2
0
2
2,446
0.8
Cortland
2
0
0
2
1,658
1.2
Herkimer
0
2
2
4
2,028
2.0
Jefferson
7
3
6
16
5,906
2.7
Lewis
0
1
0
1
980
1.0
Madison
2
1
0
3
2,159
1.4
Oneida
4
8
2
14
7,856
1.8
Onondaga
7
15
14
36
16,558
2.2
Oswego
2
1
4
7
4,162
1.7
St Lawrence
2
0
0
2
3,684
0.5
Tompkins
Region Total
New York State Total
2
0
0
2
2,748
0.7
28
33
28
89
50,185
1.8
473
440
410
1,323
748,909
1.8
Source: NYS DOH - 2007-2009 Vital Statistics Data
St. Lawrence County Community Health Assessment – November 2013
58
Post neonatal Mortality Rate per 1,000 Live Births
Year Single Year 3-Year Average Upstate New York
2000
3.3
2001
0.8
1.6
1.7
1.9
2002
0.8
1.6
1.6
2003
3.3
2.2
1.7
2004
2.4
2.7
1.6
2005
2.4
2.4
1.6
2006
2.3
2.1
1.7
2007
1.6
1.3
1.9
2008
0.0
0.5
1.8
2009
0.0
1.7
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
Spontaneous Fetal Deaths (20+ weeks) rate per 1,000
Fetal Deaths 20+ Weeks Births+SFDS
Region/County 2007 2008 2009 Total 2007-2009 Rate
Reg-3 Central New York
Cayuga
7
3
3
13
2,459
5.3
Cortland
0
2
5
7
1,665
4.2
Herkimer
4
2
4
10
2,038
4.9
Jefferson
5,954
8.1
20
12
16
48
Lewis
7
3
2
12
Madison
0
0
2
2
Oneida
17
21
22
Onondaga
28
41
42
5
9
13
10
6
6
6
104
105
992 12.1
2,161
0.9
60
7,916
7.6
111
16,669
6.7
27
4,189
6.4
5
21
3,705
5.7
2
14
2,762
5.1
116
325
50,510
6.4
New York State Total 1,673 1,760 1,711 5,144
754,055
6.8
Oswego
St Lawrence
Tompkins
Region Total
Source: NYS DOH - 2007-2009 Vital Statistics Data
St. Lawrence County Community Health Assessment – November 2013
59
Spontaneous Fetal Deaths (20+ Weeks) rate per 1,000
Year Single Year 3-Year Average
Upstate New York
2000
4.9
2001
6.4
5.4
5.7
2002
4.9
6.5
5.8
2003
8.2
5.7
5.3
2004
4.1
4.9
5.0
2005
2.4
4.3
4.6
2006
6.2
5.6
4.7
2007
8.0
6.3
4.7
2008
4.8
5.7
5.1
2009
5.7
4.2
5.0
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
Maternal Mortality - per 100,000 Live Births
Maternal Deaths
Births
Region/County 2007 2008 2009 Total 2007-2009 Rate
Reg-3 Central New York
Cayuga
1
0
0
1
2,446 40.9
Cortland
0
0
0
0
1,658
Herkimer
0
0
1
1
2,028 49.3
Jefferson
0
0
0
0
5,906
0.0
Lewis
0
0
0
0
980
0.0
Madison
0
0
0
0
2,159
0.0
Oneida
0
3
0
3
7,856 38.2
Onondaga
1
0
1
2
16,558 12.1
Oswego
0
0
0
0
4,162
0.0
St Lawrence
0
0
0
0
3,684
0.0
Tompkins
0
0
0
0
2,748
0.0
Region Total
2
3
2
7
50,185 13.9
36
65
51
152
748,909 20.3
New York State Total
0.0
Source: NYS DOH - 2007-2009 Vital Statistics Data
St. Lawrence County Community Health Assessment – November 2013
60
Maternal Mortality - per 100,000 Live Births
Year Single Year 3-Year Average Upstate New York
2000
0.0
2001
0.0
0.0
8.2
2002
0.0
27.3
3.8
2003
82.7
27.4
15.7
2004
0.0
27.3
16.1
2005
0.0
0.0
8.6
2006
0.0
0.0
10.0
2007
0.0
0.0
10.0
2008
0.0
0.0
18.8
2009
9.5
0.0
12.8
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
Early Childhood (age 1-4) Deaths - rate per 100,000
Year Single Year 3-Year Average Upstate New York
2000
50.4
21.6
2001
34.7
40.2
22.1
2002
35.2
29.0
21.3
2003
17.3
28.7
19.5
2004
33.8
45.5
17.8
2005
85.2
56.5
19.2
2006
50.6
50.9
17.5
2007
17.0
44.7
18.9
2008
66.0
44.0
2009
48.2
20.2
18.0
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
St. Lawrence County Community Health Assessment – November 2013
61
Childhood/Adolescent (Age 5-14) - Deaths and Death Rates Per 100,000 Residents
Age 5-14
Deaths
Region/County
2007
2008
2009
Population
Crude
2008
Rate
Total
Reg-3 Central New York
Cayuga
2
0
1
3
9,057
11.0
Cortland
2
2
0
4
5,367
24.8
Herkimer
2
1
1
4
7,045
18.9
Jefferson
1
2
1
4
15,416
8.6
Lewis
0
2
1
3
3,158
31.7
Madison
0
3
0
3
7,948
12.6
Oneida
7
3
4
14
26,504
17.6
Onondaga
10
10
6
26
56,753
15.3
Oswego
1
4
4
9
14,532
20.6
St Lawrence
1
4
2
7
11,605
20.1
Tompkins
Region Total
New York State Total
1
1
1
3
8,012
12.5
27
32
21
80
165,397
16.1
299
304
276
879
2,395,645
12.2
Source: NYS DOH - 2007-2009 Vital Statistics Data
Childhood/Adolescent (Age 5-14) Death Rate Per 100,000 Residents
Year
Single Year
3-Year Average
Upstate New York
2000
47.1
2001
41.2
29.9
12.9
2002
0.0
19.1
12.7
2003
15.0
9.8
12.8
2004
15.0
17.8
12.5
2005
23.7
13.0
12.2
2006
0.0
10.8
10.7
2007
8.4
13.9
13.0
2008
34.5
19.6
12.8
2009
11.9
16.2
12.1
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
St. Lawrence County Community Health Assessment – November 2013
62
Adolescent/Young Adult (Age 15-19) Deaths and Death Rates Per 100,000
Residents
Deaths
Region/County
2007
2008
2009
Population
Crude
2008
Rate
Total
Reg-3 Central New York
Cayuga
3
2
4
9
5,733
52.3
Cortland
1
1
0
2
4,714
14.1
Herkimer
0
1
1
2
4,292
15.5
Jefferson
4
5
6
15
8,182
61.1
Lewis
0
1
1
2
1,721
38.7
Madison
3
4
1
8
6,810
39.2
Oneida
2
4
8
14
16,665
28.0
15
20
10
45
35,180
42.6
Oswego
4
3
4
11
10,482
35.0
St Lawrence
5
1
4
10
10,106
33.0
Tompkins
3
0
4
7
12,633
18.5
40
42
43
125
116,518
35.8
538
495
543
1,576
1,403,050
37.4
Onondaga
Region Total
New York State Total
Source: NYS DOH - 2007-2009 Vital Statistics Data
Adolescent/Young Adult (Age 15-19) Adult Death Rate Per 100,000 Residents
Year
Single Year
3-Year Average
Upstate New York
2000
19.3
46.3
2001
86.5
54.5
52.5
2002
57.6
51.4
52.0
2003
9.7
44.9
47.0
2004
67.1
42.2
46.0
2005
49.6
58.5
44.4
2006
58.4
52.3
46.0
2007
48.7
39.2
40.0
2008
9.9
32.5
36.9
2009
38.4
40.0
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
Chronic Disease
When considering chronic disease statistics in St. Lawrence County, it is apparent that much
work needs to be done. Most all rates for hospitalization and mortality for all diseases of the
heart, coronary heart disease and congestive heart failure fall within the third quartile when
considering county ranking groups. The same is true for cerebrovascular disease (stroke). The
rates for many factors that contribute to chronic disease are also quite high in St. Lawrence
County. For example, obesity is one problem that contributes to many chronic diseases.
According to NYSDOH county indicators 2008-2009, the percentage of adults that are
overweight or obese in St. Lawrence County was 66.5% as compared to the NYS rate of 59.3%,
more than ten percent higher (12.1%). The same is true for the percentage of adults smoking
cigarettes (24.7%) and the percentage of adults that binge drink (21.8%), each being more than
St. Lawrence County Community Health Assessment – November 2013
63
twenty percent higher than the state rate (45.3% and 20.4% respectively). Detailed data
portraying the burden of chronic disease in St. Lawrence County is found below.
Cardiovascular Disease Deaths and Death Rates
Cardiovascular Disease Death Rate Per 100,000 Population
Deaths
Population Crude Adjusted
Region/County 2007 2008 2009 Total
2008
Rate
Rate
Reg-3 Central New York
Cayuga
248
249
235
732
79,823
305.7
232.0
Cortland
130
151
111
392
48,302
270.5
245.9
Herkimer
263
253
271
787
62,200
421.8
290.3
Jefferson
260
285
343
888
118,046
250.7
250.8
74
78
87
239
26,176
304.4
248.9
Madison
181
183
169
533
69,766
254.7
235.7
Oneida
897
859
881
2,637
231,590
379.6
260.6
1,279 1,176 1,135
3,590
452,633
264.4
215.9
Lewis
Onondaga
Oswego
360
343
332
1,035
121,395
284.2
287.4
St Lawrence
326
376
311
1,013
109,701
307.8
276.6
Tompkins
227
186
196
609
101,136
200.7
223.4
4,245 4,139 4,071 12,455
1,420,768
292.2
244.0
New York State Total 58,770 58,624 55,796 173,190
19,490,297
296.2
256.7
Region Total
Source: NYS DOH - 2007-2009 Vital Statistics Data
Cardiovascular Disease Death Rates per 100,000 Residents
Year
Single Year
3-Year Average
Upstate New York
2000
371.0
2001
358.2
369.6
377.6
367.1
2002
379.6
353.1
364.2
2003
321.5
338.2
354.5
2004
313.6
317.9
333.7
2005
318.7
313.8
332.7
2006
309.1
308.3
319.4
2007
296.9
316.2
313.9
2008
342.7
307.7
311.3
2009
283.5
296.9
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
St. Lawrence County Community Health Assessment – November 2013
64
Cerebrovascular Disease (Stroke) Deaths and Death Rates
Cerebrovascular Disease (Stroke) Deaths per 100,000 Population
Deaths
Population Crude Adjusted
Region/County 2007 2008 2009 Total
2008
Rate
Rate
Reg-3 Central New York
Cayuga
31
29
34
94
79,823
39.3
30.0
Cortland
16
27
26
69
48,302
47.6
42.3
Herkimer
24
22
28
74
62,200
39.7
28.3
Jefferson
46
55
68
169
118,046
47.7
47.0
Lewis
8
12
10
30
26,176
38.2
30.7
40
25
29
94
69,766
44.9
42.4
Oneida
117
137
117
371
231,590
53.4
36.6
Onondaga
Madison
217
219
183
619
452,633
45.6
37.1
Oswego
54
45
42
141
121,395
38.7
39.4
St Lawrence
43
49
43
135
109,701
41.0
36.8
34
Tompkins
101
101,136
33.3
36.4
614 1,897
1,420,768
44.5
37.1
New York State Total 5,882 5,882 5,823 17,587
19,490,297
30.1
26.3
Region Total
34
33
630
653
Source: NYS DOH - 2007-2009 Vital Statistics Data
Cerebrovascular (Stroke) Deaths per 100,000 Residents
Year Single Year
3-Year Average
Upstate New York
2000
65.3
2001
45.8
57.7
51.6
2002
62.1
56.6
51.0
2003
61.8
57.8
48.2
2004
49.4
55.3
45.2
2005
54.8
47.3
44.2
2006
37.7
43.9
41.5
2007
39.2
40.5
38.8
2008
44.7
41.0
38.8
2009
53.8
39.2
38.7
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
St. Lawrence County Community Health Assessment – November 2013
65
Coronary Heart Disease Deaths and Death Rates
Coronary Heart Disease Deaths per 100,000 Populatison
Deaths
Population Crude Adjusted
Region/County 2007 2008 2009 Total
2008
Rate
Rate
Reg-3 Central New York
Cayuga
158
Cortland
152
138
448
79,823
187.1
143.3
71
79
59
209
48,302
144.2
132.1
Herkimer
156
160
163
479
62,200
256.7
173.0
Jefferson
147
159
186
492
118,046
138.9
140.6
Lewis
52
44
50
146
26,176
185.9
151.6
Madison
78
98
81
257
69,766
122.8
113.4
477
458
489
1,424
231,590
205.0
140.5
Onondaga
690
621
596
1,907
452,633
140.4
115.1
Oswego
218
190
199
607
121,395
166.7
168.4
St Lawrence
162
203
153
518
109,701
157.4
141.7
110
78
87
275
101,136
90.6
102.4
2,319 2,242 2,201
6,762
1,420,768
158.6
132.9
New York State Total 40,450 40,364 37,987 118,801
19,490,297
203.2
175.8
Oneida
Tompkins
Region Total
Source: NYS DOH - 2007-2009 Vital Statistics Data
Coronary Heart Disease Rate per 100,000 Residents
Year Single Year 3-Year Average Upstate New York
2000
207.4
2001
204.7
206.3
231.4
2002
206.9
194.5
231.3
2003
172.0
181.7
223.6
2004
166.2
166.6
207.2
2005
161.6
168.0
205.7
2006
176.1
161.8
195.7
2007
147.5
169.6
189.2
2008
185.0
157.3
186.6
2009
238.7
139.5
177.0
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
St. Lawrence County Community Health Assessment – November 2013
66
Lung & Bronchus Cancer - Deaths And Death Rates Per 100,000 Residents
Lung and Bronchus Cancer Death Rates per 100,000 Residents
Deaths
Population Crude Adjusted
Region/County 2005 2006 2007 2008 2009 Total 2005-2009 Rate
Rate
Reg-3 Central New York
Cayuga
64
71
50
42
44
271
402,112
67.4
57.0
Cortland
27
24
36
24
30
141
241,772
58.3
55.1
Herkimer
42
43
46
43
40
214
314,106
68.1
53.2
Jefferson
57
69
74
50
60
310
584,614
53.0
56.9
Lewis
8
16
22
4
15
65
132,061
49.2
42.0
42
40
46
45
46
219
350,083
62.6
56.8
Oneida
162
164
173
154
150
803
1,162,997
69.0
55.2
Onondaga
319 1,505
Madison
340
290
286
270
2,276,226
66.1
58.7
Oswego
74
92
108
78
80
432
610,676
70.7
70.0
St Lawrence
73
89
75
92
73
402
551,889
72.8
66.6
35
Tompkins
194
504,395
38.5
46.0
892 4,556
7,130,931
63.9
57.7
New York State Total 9,286 9,189 9,317 9,180 8,918 45,890
96,890,292
47.4
43.5
Region Total
40
41
40
38
929
939
956
840
Source: NYS DOH - 2007-2009 Vital Statistics Data
Lung and Bronchus Cancer Death Rates per 100,000 Residents
Year
Single Year
3-Year Average
Upstate New York
2000
76.9
2001
59.3
68.2
58.7
2002
68.4
63.7
59.6
2003
63.6
66.7
58.0
2004
68.3
65.8
58.3
2005
65.5
71.3
57.9
2006
80.0
71.3
57.9
2007
68.3
77.4
58.7
2008
83.9
72.9
57.4
2009
66.5
60.1
55.9
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
St. Lawrence County Community Health Assessment – November 2013
67
Female Breast Cancer - Deaths And Death Rates Per 100,000 Female Residents
Female Breast Cancer Death Rates per 100,000 Female Residents
Deaths
Population Crude Adjusted
Region/County 2005 2006 2007 2008 2009 Total 2005-2009 Rate
Rate
Reg-3 Central New York
Cayuga
7
12
Cortland
3
Herkimer
7
Jefferson
Lewis
8
8
12
47
198,505
23.7
17.3
11
5
5
3
27
125,232
21.6
19.3
10
10
9
6
42
161,096
26.1
18.4
8
16
10
10
9
53
285,604
18.6
18.1
7
3
1
2
4
17
66,114
25.7
19.7
Madison
14
7
6
8
6
41
177,895
23.0
19.1
Oneida
33
31
35
31
33
163
582,332
28.0
19.6
Onondaga
62
74
77
77
62
352
1,180,618
29.8
23.6
Oswego
14
10
9
13
21
67
308,318
21.7
19.5
St Lawrence
20
12
14
10
10
66
272,101
24.3
20.0
Tompkins
8
13
15
12
12
60
252,344
23.8
24.6
183
199
190
185
178
935
3,610,159
25.9
20.9
New York State Total 2,840 2,717 2,715 2,639 2,654 13,565
49,886,258
27.2
22.4
Region Total
Source: NYS DOH - 2007-2009 Vital Statistics Data
Female Breast Cancer Death Rates per 100,000 Female Residents
Year
Single Year
3-Year Average
Upstate New York
2000
20.0
2001
36.5
30.4
32.6
2002
34.7
29.2
32.2
2003
16.4
24.9
32.2
2004
23.7
25.5
29.8
2005
36.5
27.3
29.3
2006
21.8
28.0
28.2
2007
25.8
22.0
29.7
2008
18.5
21.0
28.3
2009
33.7
18.5
28.4
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
St. Lawrence County Community Health Assessment – November 2013
68
Uterine Cervical Cancer - Deaths And Death Rates Per 100,000 Female Residents
Uterine Cervical Cancer Deaths per 100,000 Female Residents
Deaths
Population Crude Adjusted
Region/County 2005 2006 2007 2008 2009 Total 2005-2009 Rate
Rate
Reg-3 Central New York
Cayuga
1
0
1
3
1
6
198,505
3.0
2.3
Cortland
0
1
3
0
0
4
125,232
3.2
3.1
Herkimer
1
1
0
1
1
4
161,096
2.5
1.8
Jefferson
3
2
0
1
2
8
285,604
2.8
2.9
Lewis
0
2
0
0
0
2
66,114
3.0
2.5
Madison
1
3
0
0
0
4
177,895
2.2
2.0
Oneida
1
7
3
4
3
18
582,332
3.1
2.5
Onondaga
2
5
8
1
3
19
1,180,618
1.6
1.5
Oswego
3
5
2
3
3
16
308,318
5.2
4.6
St Lawrence
3
2
1
1
1
8
272,101
2.9
2.7
Tompkins
Region Total
New York State Total
1
3
1
1
0
6
252,344
2.4
2.4
16
31
19
15
14
95
3,610,159
2.6
2.3
275
295
250
252 1,360
49,886,258
2.7
2.4
288
Source: NYS DOH - 2007-2009 Vital Statistics Data
Uterine Cancer Death Rates per 100,000 Female Residents
Year Single Year
3-Year Average
Upstate New York
2000
5.4
2001
1.8
5.5
2.5
2002
9.1
4.3
2.7
2003
1.8
6.1
2.5
2004
7.3
4.9
2.4
2005
5.5
5.5
2.5
2006
3.6
3.7
2.3
2007
1.8
2.4
2.5
2008
1.8
1.8
2.1
2009
2.6
1.9
2.1
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
St. Lawrence County Community Health Assessment – November 2013
69
Colorectal Cancer - Deaths And Death Rates Per 100,000 Residents
Colorectal Cancer Death Rates per 100,000 Residents
Deaths
Population Crude Adjusted
Region/County 2005 2006 2007 2008 2009 Total 2005-2009 Rate
Rate
Reg-3 Central New York
Cayuga
22
16
16
Cortland
13
7
12
Herkimer
12
9
20
Jefferson
12
20
22
22
Lewis
21
8
83
402,112
20.6
16.6
7
8
47
241,772
19.4
18.8
15
10
66
314,106
21.0
15.7
22
98
584,614
16.8
17.8
9
5
4
7
6
31
132,061
23.5
19.4
Madison
15
14
15
9
17
70
350,083
20.0
18.7
Oneida
49
48
53
62
48
260
1,162,997
22.4
17.0
Onondaga
75
88
86
85
70
404
2,276,226
17.7
15.3
Oswego
29
19
19
20
20
107
610,676
17.5
17.6
St Lawrence
22
28
32
19
17
118
551,889
21.4
19.7
18
Tompkins
73
504,395
14.5
16.6
244 1,357
7,130,931
19.0
16.8
New York State Total 3,506 3,510 3,437 3,399 3,318 17,170
96,890,292
17.7
16.1
Region Total
17
8
14
16
275
262
293
283
Source: NYS DOH - 2007-2009 Vital Statistics Data
Colorectal Cancer Death Rates per 100,000 Residents
Year Single Year 3-Year Average Upstate New York
2000
32.2
2001
23.3
28.7
23.2
2002
30.6
28.7
23.3
2003
32.2
31.1
21.3
2004
30.5
27.5
21.1
2005
19.8
25.2
19.4
2006
25.2
24.7
19.0
2007
29.1
23.9
19.3
2008
17.3
20.7
18.4
2009
24.3
15.5
18.0
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
St. Lawrence County Community Health Assessment – November 2013
70
Cirrhosis Deaths and Death Rates
Cirrhosis Death Rates per 100,000 Residents
Deaths
Population Crude Adjusted
Region/County 2007 2008 2009 Total
2008
Rate
Rate
Reg-3 Central New York
Cayuga
5
6
5
16
79,823
6.7
6.0
Cortland
4
3
4
11
48,302
7.6
7.2
Herkimer
6
7
4
17
62,200
9.1
7.5
Jefferson
9
9
3
21
118,046
5.9
6.6
Lewis
3
2
2
7
26,176
8.9
7.2
Madison
5
8
3
16
69,766
7.6
6.7
Oneida
22
28
22
72
231,590
10.4
8.5
Onondaga
37
39
32
108
452,633
8.0
7.0
4
15
16
35
121,395
9.6
8.9
16
9
17
42
109,701
12.8
12.2
Oswego
St Lawrence
Tompkins
4
5
6
15
101,136
4.9
6.0
115
131
114
360
1,420,768
8.4
7.8
New York State Total 1,285 1,358 1,272 3,915
19,490,297
6.7
6.0
Region Total
Source: NYS DOH - 2007-2009 Vital Statistics Data
Cirrhosis Death Rates per 100,000 Population
Year Single Year 3-Year Average Upstate New York
2000
9.8
2001
11.7
11.4
8.1
2002
12.6
11.7
7.6
2003
10.7
11.7
7.9
2004
11.7
11.1
7.1
2005
10.8
11.7
7.0
2006
12.6
12.6
6.9
2007
14.6
11.8
7.9
2008
8.2
12.8
7.7
2009
8.0
15.5
7.2
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
St. Lawrence County Community Health Assessment – November 2013
71
Diabetes Deaths and Death Rates
Diabetes Death Rates per 100,000 Residents
Deaths
Population Crude Adjusted
Region/County 2007 2008 2009 Total
2008
Rate
Rate
Reg-3 Central New York
Cayuga
14
17
Cortland
10
Herkimer
22
Jefferson
24
Lewis
14
45
79,823
18.8
14.9
11
9
30
48,302
20.7
19.4
19
11
52
62,200
27.9
20.7
12
17
53
118,046
15.0
15.7
6
7
12
25
26,176
31.8
26.5
Madison
15
15
11
41
69,766
19.6
18.0
Oneida
63
64
55
182
231,590
26.2
19.0
Onondaga
89
101
95
285
452,633
21.0
18.3
Oswego
12
26
17
55
121,395
15.1
15.0
St Lawrence
31
27
26
84
109,701
25.5
23.2
Tompkins
11
6
14
31
101,136
10.2
12.7
297
305
281
883
1,420,768
20.7
18.2
New York State Total 3,694 3,582 3,684 10,960
19,490,297
18.7
16.8
Region Total
Source: NYS DOH - 2007-2009 Vital Statistics Data
Diabetes Death Rates per 100,000 Population
Year Single Year 3-Year Average Upstate New York
2000
28.6
2001
31.4
27.5
19.2
2002
22.5
29.6
20.2
2003
34.9
26.9
21.3
2004
23.4
31.7
19.8
2005
36.8
26.9
20.6
2006
20.7
28.6
19.5
2007
28.2
24.5
19.3
2008
24.6
25.5
17.8
2009
19.9
23.7
18.2
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
St. Lawrence County Community Health Assessment – November 2013
72
Chronic Lower Respiratory Disease Deaths and Death Rates
Chronic Lower Respiratory Disease Death and Death Rates per 100,000 Residents
Deaths
Region/County
2007 2008 2009
Total
Population
Crude
Adjusted
2008
Rate
Rate
Reg-3 Central New York
Cayuga
45
53
61
159
79,823
66.4
51.4
Cortland
35
32
34
101
48,302
69.7
65.7
Herkimer
39
38
37
114
62,200
61.1
44.4
Jefferson
69
59
53
181
118,046
51.1
53.7
Lewis
12
13
14
39
26,176
49.7
41.2
Madison
47
51
37
135
69,766
64.5
59.8
Oneida
156
156
139
451
231,590
64.9
48.1
Onondaga
225
247
222
694
452,633
51.1
43.7
72
69
58
199
121,395
54.6
56.1
St Lawrence
96
92
89
277
109,701
84.2
76.4
Tompkins
46
30
34
110
101,136
36.3
43.6
842
840
778
2,460
1,420,768
57.7
50.4
6,466
6,841
6,661
19,968
19,490,297
34.2
30.7
Oswego
Region Total
New York State Total
Source: NYS DOH - 2007-2009 Vital Statistics Data
Chronic Lower Respiratory Disease Death Rates per 100,000 Population
Year
Single Year
3-Year Average
Upstate New York
2000
69.7
47.2
2001
67.3
75.7
47.0
2002
89.9
79.6
47.4
2003
81.5
84.1
45.0
2004
80.9
81.4
45.3
2005
81.7
75.8
46.7
2006
64.7
77.9
43.8
2007
87.4
78.6
45.9
2008
83.9
84.1
2009
81.1
46.9
46.0
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
St. Lawrence County Community Health Assessment – November 2013
73
Asthma Deaths and Death Rates
Asthma Death Rates per 100,000 Residents
Deaths
Population Crude Adjusted
Region/County 2007 2008 2009 Total
2008
Rate
Rate
Reg-3 Central New York
Cayuga
0
1
0
1
79,823
4.2
2.5
Cortland
3
0
2
5
48,302
34.5
36.1
Herkimer
1
0
3
4
62,200
21.4
16.6
Jefferson
1
1
2
4
118,046
11.3
10.4
Lewis
1
0
0
1
26,176
12.7
10.8
Madison
0
0
0
0
69,766
0.0
0.0
Oneida
0
4
1
5
231,590
7.2
5.7
Onondaga
4
2
5
11
452,633
8.1
7.0
Oswego
0
1
0
1
121,395
2.7
2.6
St Lawrence
2
0
0
2
109,701
6.1
6.7
Tompkins
2
1
0
3
101,136
9.9
10.7
14
10
13
37
1,420,768
8.7
7.8
232
241
235
708
19,490,297
12.1
11.2
Region Total
New York State Total
Source: NYS DOH - 2007-2009 Vital Statistics Data
Asthma Death Rates per 100,000 Population
Year Single Year 3-Year Average Upstate New York
2000
8.9
11.1
2001
18.0
15.0
11.6
2002
18.0
23.9
11.4
2003
35.8
18.0
11.9
2004
0.0
15.0
10.0
2005
9.0
9.0
10.3
2006
18.0
15.0
8.3
2007
18.2
12.1
8.7
2008
0.0
6.1
2009
0.0
8.1
8.3
Source: NYS DOH - Vital Statistics Data, Trend Data, crude rates
2. Health Challenges
2a. Behavioral Risk Factors
As noted in the Executive Summary, through the survey and during focus group discussions,
several behavioral risk factors were discussed, with many of them much worse than the State as a
whole (see attached survey results for comparison of some risk factors with State averages) and
primarily included: Alcohol and substance abuse, tobacco use, poor nutrition and lack of
physical activity. A lot of discussion also centered on the high rates of depression in the area.
St. Lawrence County Community Health Assessment – November 2013
74
Both through the survey and in the focus groups, people expressed the fact that the long winters,
coupled with limited employment opportunities and rural isolation contributed to a lot of
depression and substance abuse issues.
The following comments from focus group meetings provide some more depth to this discussion:
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Underage drinking lower than they thought – perception vs what is true
Behavior problems with young children – pediatric psychologists shortage, child on a
waiting list, been on it a long time
Unemployment – no work – root of problems
Mental health causes many of the issues
Drugs in middle and high schools – going to greater lengths, handfuls of anything in the
medicine cabinets, drugs from their own homes, prescription drug abuse
Parties throwing pills in a bowl - Generational – following pattern, crime up due to drug
use
Prescription drug abuse – doctors automatically pulling out script pads
Mental Health – root, drug abuse to address MH issues, need for counseling earlier
Stigma of seeking counseling – afraid to go, no respect when they do go, no gun permit if
you do, effects job opportunities
Parents need to be more responsible – lock up prescriptions
Homeless #’s up? More friends staying with friend, or 2 or 3 families in one place,
chronic campers
Obesity- limited opportunities for physical activity especially in winter months
People don’t exercise – winter/ice a huge factor, house bound
Bus kids who are within a mile of school – parents driving kids, no crossing guards, high
# of sex offenders near schools makes it difficult for kids to walk to school– a lot of fear,
concern for safety
Doctors seem to be dispensing a lot of different prescriptions, over prescribing? And no
one coordinating all the medications a person is on? Too dependent on them? Lots of
calls with people on a multitude of prescriptions from many doctors. Seems to be with
the elderly or those on public assistance.
2b. Environmental Risk Factors
While the very rural, isolated nature of much of the county has been discussed, and the water and
air quality, for the most part, seemed to be good, other types of environmental considerations in
the physical and social service/support environment seemed to be issues from the focus group
comments. These included:
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Cuts in public health re prenatal care, breast feeding, funding cuts
Psych center closing?
Unemployment #’s not accurate – don't count those whose UI has expired, and partially
or under employed people
St. Lawrence County Community Health Assessment – November 2013
75
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Colleges – lots of students from cities/urban areas–
Prison system – families moving to the area to be near inmates
Meth labs
Community gardens needed
Community book needed – blue book of resources and services
Need info on how to preserve food
Uncertainty of funding
Scholarships for kids camps needed
Need to get word out re programs and resources available
Some residents can’t afford computers and internet services nor have the skills to use
one
Some food at pantries is not very healthy
School lunches – 51% qualify for free lunches, ala carte at breakfast is not healthy
Church dinners – all you can eat, unhealthy. May be an opportunity to introduce
healthier choices.
Access to mental health care – 6 month wait for county MH services
Veterans clinic at Massena MH has grown in last five years
Claxton – one week wait for MH services
School lunches – kids hungry, small portions, kids don’t like healthy options, kids buy 2
lunches, give kids healthy choices
Sidewalks – lack of in general and near school
Not enough EMS – all volunteer departments, don’t bill, 450 calls a year, have to
fundraise, plus required training
Free clinic – over -booked, 2700 registered
FQHC (UCP) in Canton and Malone
Church free clinic - Governeur
Lack of services/care/protection for the elderly – alone, refuse help, lonely, need
companionship
Autism? More kids diagnosed with it, affected by diet
2c. Socioeconomic Risk Factors
As noted extensively in the demographic section, although there are few minorities in St.
Lawrence County, poverty, low/marginal income and lack of education among the population are
major risk factors. As noted in Freidan's pyramid, socio-economic factors and as evidenced
more and more in new research, socio-economic factors have the biggest influence on health
outcomes. In fact, recent work of the Finger Lakes Health Systems Agency demonstrates a
strong direct statistical correlation between Years of Potential Life Lost (YPLL) and socioeconomic status (SES) with the lowest SES showing the highest YPLL.
Therefore, it is easy to see how low income and lack of higher education negatively impact St.
Lawrence County residents. Additional comments from the focus groups:
 Access – fewer doctors accepting Medicaid; moms having to travel for prenatal care;
uninsured patients: dentists - not many taking Medicaid; transportation to the doctors is a
problem if you aren’t in one of the larger communities
St. Lawrence County Community Health Assessment – November 2013
76
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Poverty – trying to get money any way they can- including selling drugs
2d. Policy Environment
Some examples of policies were health-friendly, while some provide opportunity for action and
improvement. These include:
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Backpack program has been instituted to feed children on weekends– started 2 years ago
Farm to business could be expanded, use in schools – SUNY Potsdam Chef worked with
school, Claxton Hepburn cafeteria doing this
Need to make communities more pedestrian friendly
Need for bike lanes
Prescription drug problem – Sheriff started a task force to address; Kinney’s conducts a
take-back program – police have to be there so cost involved; Massena PD has drug drop
box, but the policy is that the DEA has to pick up, so there is room for improving this
policy/program
2e. Other Unique Characteristics
The sheer size and rural nature of the County, along with the topography and climate, create rural
isolation for a good part of the year. The high rate of unemployment and lack of employment
opportunities create an environment of despair for many of the County's residents. On the other
hand, the five colleges and five hospitals in the region, coupled with the natural resources,
diverse scenic beauty and inexpensive land, St. Lawrence County offers many opportunities and
assets to improve the health of residents.
3. Assets and Resources
As part of the focus group process, both residents and professionals were asked to identify
community resources and assets. The following bullet list shows their list of assets from these
meetings. In general, the County has many assets, including community leaders, hospitals,
health and human service providers, a reasonable cost of living and natural resources. Mostly,
participants felt they just needed more assets, and more marketing of the availability of
resources:
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Lots of unknown services – Price Chopper gives away antibiotics and diabetes meds –
free; free screenings at hospitals, what are the barriers? Transportation and knowledge,
lack of follow up care, wait for crisis
Colleges – huge asset, students required to do community service projects, some health
related, foremost experts in the country at college
Access to care program (but losing this)
Cancer Services Program
ReachOut – mental health service, hotline, suicide prevention trainings
St. Lawrence County Community Health Assessment – November 2013
77
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County suicide coalition
Governeur has military housing – some impact
Several employees from the military
Boys and Girls Club in Ogdensburg
Strong sports environment for kids – public goes whether their own kids are there or not
Fun runs, 5k’s
Lots of natural resources – trails, waterways, kayaks available
300,000 acres of fallow farm land – farmland very cheap, Amish moving in because land
is so cheap
Cost of living very reasonable – affordable housing, $150k very nice house (if you can
get a job)
Food Hub – raw processing plant coming in Canton where Jubilee was, create jobs,
United Helpers doing it, food processing; sold in bulk, maybe commercial kitchen to
develop products, maybe cold storage to store products so can be sold throughout the
year, got economic development funding, maybe 2014, flash freezing and stored for year
long use
Steve Knight – UH, visionary
Cooperation – willingness to work together
People who want to do things
Churches
Garden share
Farmers
Community Supported Agriculture (CSA) – food stamps (can be used if they have a
EBT- swiper)
Bonus bucks – CSA is $150, can get $100 towards it
Wonderful interagency partnerships and sharing
Neighborhood centers are great assets– help make ends meet, fills in gaps
Food pantries at churches (one 30 to 66 families)
Holiday fund – Christmas presents to kids
Farmers markets – all over, but people think it’s too expensive, many accept EBT
CCE – teach how to preserve food
Elks $40 scholarship to play softball – very nice – groups do a lot for the community/give
back
Volunteer Fire Dept
Office for the Aging (OFA) kitchen – 150 meals a day from here (could be used more)
Medical transportation available
Community supports fire dept. well/100%
St. Lawrence County Community Health Assessment – November 2013
78
4. Process and Methods
As noted in the Executive Summary, the MAPP process was used to conduct the assessment.
Community input was widely sought in the survey process, and lengthy surveys were completed
by over 800 county residents from all sectors of the community. (Please see attached summary
of survey results.) Full details of the process are discussed in the St. Lawrence Community
Health Improvement Plan as well.
Additionally, approximately 22 low-income and mostly younger males participated in two focus
groups held on 4/10/13, as well as a broad variety of community agencies that participated in a
focus group to review all the data from the survey, secondary data and Public Health System
Assessment, and then set priorities. (These included: Office for the Aging/NY Connects, Head
Start, Seaway Valley Prevention Council, North Country Prenatal Perinatal Network, Saint
Lawrence County Community Development Program, Potsdam Neighborhood Center, Cerebral
Palsy of the North Country, Hospice and Palliative Care of St. Lawrence Valley, ClaxtonHepburn Medical Center, St. Lawrence Health Initiative, St. Lawrence County Community
Services, Canton-Potsdam Hospital, St. Lawrence County Public Health Department, Massena
Memorial Hospital). At each of these focus groups, the results of the survey and secondary data
analysis were provided, and residents and key informants offered their input.
All five hospitals (Claxton-Hepburn Medical Center, Canton-Potsdam Hospital, E J Nobel
Hospital, Clifton Fine Hospital and Massena Memorial Hospital, along with the St. Lawrence
Health Initiative and the St. Lawrence County Public Health Department participated in meetings
(and email chains) at the beginning of the process, and several meetings at the end of the process
to develop the CHIP (7/9/12, 4/10/13, 5/29/13, 7/9/13, 8/13/13).
After the CHA and CHIP are finalized, both will be posted on the St. Lawrence County Public
Health Department's website as well as on the hospitals’ websites. The hospitals will post their
Community Service Plans on their websites as well.
St. Lawrence County Community Health Assessment – November 2013
79
ATTACHMENT A
St. Lawrence County Community Health Assessment Survey Summary
County
# surveys
Under 35 yo
35 to 65 yo
White
AAS or more
Bach or more
$25k or more
$50k or more
Married
Insured
Female
Average BMI
Female BMI
Male BMI
Full time
Town
20+ yrs in
Comp survey
St.
Lawrence
809
15.7%
68.7%
98.3%
62.1%
44.1%
81.8%
56.3%
66.0%
89.7%
67.2%
Census
111,778
48.0%
38.5%
93.8%
30.5%
18.7%
70.2%
28.3%
48.1%
88.1% (EBRFSS)
49.1%
30.75
30.64
30.96
56.8%
Canton - 13.5% Massena - 12.3%
75.0%
670 (82.8%)
#1 Priority
Top five issues that survey
respondents named as what they Ability to Access
think should be the number 1
Health Care
priority for SLC
# of respondents that chose the
priority as #1
225 (29.1%)
Cancer
Drug Abuse
Depression/
Mental Illness
Poor Nutrition
103 (13.3%)
100 (12.9%)
51 (6.6%)
39 (5.0%)
#2 Priority
Top five issues that survey
respondents named as what they
think should be the number 2
priority for SLC
Drug Abuse
Cancer
Poor Nutrition
# of respondents that chose the
priority as #2
106 (13.7%)
78 (10.1%)
68 (8.8%)
Ability to
Alcohol Abuse Access Health
Care
61 (7.9%)
46 (6.0%)
#3 Priority
Top five issues that survey
respondents named as what they
think should be the number 3
priority for SLC
Drug Abuse
Poor Nutrition
Lack of Physical
Activity
Cancer
Depression/Men
tal Illness
# of respondents that chose the
priority as #3
78 (10.1%)
56 (7.2%)
52 (6.7%)
49 (6.3%)
46 (6.0%)
Total
Respondents
St. Lawrence County Community Health Assessment – November 2013
773
80
Which of the following health-related behaviors would you like to
improve?
Answer Options
Response Percent
Response Count
55.9%
379
Better eating habits
46.9%
318
Managing stress
65.3%
443
Managing weight
60.6%
411
Increase physical activity
11.5%
78
Decrease alcohol consumption
18.6%
126
Decrease tobacco use
678
Total Respondents
Do you think this is a health problem for you or your community?
Ability to Access Health Care
16.9%
Problem
for Your
Communit
y
55.3%
28.5%
797
Alcohol abuse
1.1%
72.9%
14.4%
12.6%
792
Arthritis, Alzheimer’s, Dementia, Memory Loss
8.6%
55.2%
28.6%
11.4%
788
Arthritis
28.4%
42.7%
25.8%
10.4%
790
Behavioral Problems in Children
3.3%
71.5%
17.7%
9.8%
792
Cancer
8.9%
78.1%
9.9%
8.3%
800
Depression / other mental illnesses
17.1%
69.8%
16.1%
7.3%
794
Diabetes
13.1%
66.0%
18.2%
8.2%
793
Drug abuse/abuse of prescription drugs or illegal drugs
0.9%
84.1%
9.5%
6.6%
792
Eating disorders
4.7%
38.8%
47.0%
12.5%
793
Heart disease (Congestive heart failure, Angina, “A-fib”)
7.7%
60.3%
26.6%
8.4%
794
7..8%
6.3%
High blood pressure, stroke
23.8%
61.2%
16.0%
6.7%
801
28.8%
25.7%
Lack of physical activity
24.2%
73.0%
8.4%
9.3%
797
21.1%
23.7%
Poor nutrition (unhealthy eating)
13.9%
73.2%
11.7%
9.3%
794
69.1%
72.9%
Problems with teeth or gums
13.9%
51.6%
30.5%
10.2%
791
Lung diseases (COPD, emphysema, asthma)
9.7%
60.1%
25.1%
9.5%
796
Quality of well water
Sexually transmitted diseases (Chlamydia, Herpes, Gonorrhea,
HIV/AIDS)
8.1%
26.5%
46.0%
24.1%
791
1.0%
32.9%
54.3%
12.7%
787
Second hand smoke
8.8%
57.5%
23.3%
17.2%
795
Smoking / tobacco use
8.4%
71.5%
12.7%
10.3%
793
24.7%
17.0%
Suicide
2.0%
44.5%
42.2%
13.1%
784
Teen pregnancy
0.6%
58.2%
34.1%
8.1%
791
21%
2.1%
Transportation to medical appointments and health care
5.3%
56.0%
25.6%
15.8%
797
Tuberculosis
0.5%
6.4%
66.5%
27.4%
785
Underweight or premature babies
1.8%
16.2%
68.0%
14.8%
784
7.4%
8.2%
Unintended pregnancy
0.9%
47.0%
42.1%
10.7%
791
Underage drinking
0.6%
78.7%
13.8%
7.3%
790
Answer Options
Problem
for
YOU
Total Respondents
St. Lawrence County Community Health Assessment – November 2013
Don't
Know
or
Unsure
9.8%
Not a
Problem
Response
Count
EBRFSS/DOH
St. Lawrence
County
EBRFS
S/DOH
NYS
21.8%
18.1%
10.8%
9.0%
806
81
If you are currently employed, what is your current occupation?
Answer Options
Response
Percent
Response
Count
Census
St.
Lawrence
County
Census
NYS
42.6%
205
30.7%
37.9%
46.2%
222
22.1
19.1%
2.7%
13
12.4%
7.8%
3.1%
8.1%
15
39
11.0%
23.8%
9.9%
25.2%
Management, business, science and arts (includes education,
computers, engineering, social services)
Services (includes health, law enforcement, firefighting)
Natural resources/Construction and Maintenance (includes
farming/forestry)
Production/transportation (includes manufacturing)
Sales
Total Respondents
481
Do you have health insurance?
Prefer to
pay my
own
Choose
not to
have it
Response
Count
Yes
No
N/A
Can't
afford
Medical insurance for yourself
89.7%
8.4%
0.3%
4.6%
0.1%
0.4%
760
Medical insurance for your children
Dental insurance for yourself
Dental insurance for your children
Total Respondents
43.8%
56.8%
34.5%
9.8%
35.1%
17.2%
45.9%
1.0%
46.2%
1.9%
9.3%
2.7%
0.2%
1.6%
0.6%
761
0.3%
1.9%
1.1%
630
733
623
Answer Options
EBRFSS
St.
Lawrence
County
88.1%
(yes)
Do you have health
insurance?
Medical
insurance for
yourself (Yes)
Medical
insurance for
your children
(Yes)
Dental insurance
for yourself (Yes)
Dental insurance
for your children
(Yes)
Less than $15,000
5.6% 8.8% 25.3% 27.5% 19.9% 13.0% 3.4% 6.1% 20.8% 26.5% 25.0% 18.2% 4.5% 5.5% 21.6% 30.2% 21.9% 16.3% 3.4% 6.3% 20.3% 28.0% 25.6% 16.4% Medical
insurance for
yourself (Yes)
Medical
insurance for
your children
(Yes)
Dental insurance
for yourself (Yes)
Dental insurance
for your children
(Yes)
0.4% 0.9% 14.5% 19.4% 18.2% 20.5% 26.1% 0.4% 0.0% 10.2% 18.6% 22.3% 19.3% 29.2% 0.5% 0.7% 10.4% 17.6% 21.5% 20.5% 28.7% 0.5% 0.0% 11.3% 17.8% 25.4% 18.3% 26.8% $15,001 to $25,000
$25,001 to $50,000
$50,001 to $75,000
$75,001 to $100,000
Over $100,000
Do you have health
insurance?
< 9th grade
9th to 12 grade
High School Grad
Some college no degree
Associates
Bachelors
Graduate+
St. Lawrence County Community Health Assessment – November 2013
82
EBRF
SS
NYS
86.7%
(yes)
If you have insurance who pays for it?
Response Response
Answer Options
Percent
Count
I do
21.9%
141
My employer does
19.0%
122
I share the cost with my
48.1%
309
employer
Public Funded (Medicaid, etc.)
11.0%
71
Total Respondents
643
Do you think that access to behavioral health care is a
problem in your community?
Problem for
YOU
Problem for
your community
Don't Know
or Unsure
Response
Count
Treatment for alcoholism
Mental Health treatment for children 18 years and younger
Treatment for drug abuse
Treatment for gambling addictions
Treatment for depression / or other Mental Health issues
Suicide prevention
Total Respondents
1.0%
2.6%
0.1%
0.1%
8.1%
1.7%
62.1%
58.2%
70.4%
40.5%
64.0%
49.7%
37.6%
40.9%
29.9%
59.8%
31.9%
49.9%
699
705
702
701
708
696
716
Do you think the following issues are a problem in your community?
Problem for
Problem for your
Answer Options
YOU
community
0.6%
70.8%
Child abuse / neglect
0.4%
46.1%
Elder abuse / neglect
0.4%
55.9%
Sexual assault / sexual abuse
0.7%
71.0%
Domestic Abuse
Violence among youth - bullying
2.1%
77.4%
Total Respondents
719
Don't Know or
Unsure
28.8%
53.6%
44.0%
28.8%
22.6%
Response
Count
713
703
705
711
712
Do you think that any of these environmental issues are a problem in your community?
Problem for
Problem for your
Answer Options
YOU
community
6.0%
39.8%
Agricultural chemicals
5.5%
34.2%
Air pollution
0.7%
15.8%
Carbon Monoxide Poisoning
3.8%
29.7%
Contaminated well water
4.5%
37.0%
Diseases transmitted by insects
1.6%
27.0%
Lead
3.8%
28.3%
Septic systems
Water pollution
4.4%
38.8%
Total Respondents
707
Don't Know or
Unsure
59.0%
64.8%
83.6%
68.5%
62.2%
72.5%
69.9%
60.9%
Response
Count
688
676
676
680
687
681
681
680
St. Lawrence County Community Health Assessment – November 2013
83
Do you think there is a problem being seen by or receiving services from any of the following in your community?
Problem for
Problem for your
Don't Know or
Answer Options
YOU
community
Unsure
5.6%
46.0%
50.5%
Care for persons with disabilities
11.5%
61.6%
34.2%
Specialty health care
1.3%
35.4%
64.0%
Home care / hospice and supports
5.7%
58.0%
39.3%
Mental / behavioral health
0.3%
34.0%
65.9%
Prenatal care
0.6%
38.1%
61.6%
Family Planning Services
0.9%
51.9%
48.5%
Nursing homes
3.9%
42.9%
56.6%
Nutritionists / Dieticians
2.0%
18.4%
80.8%
Pharmacies
Therapists (physical, speech,
2.3%
34.3%
64.9%
occupational)
704
Total Respondents
Response
Count
661
679
627
679
645
648
647
643
588
616
Do you engage in regular physical activity?
Answer Options
Yes
No
Total Respondents
Response
Percent
Response
Count
No Leisure Time
Activity
EBRFSS
St. Lawrence County
No Leisure Time
Activity EBRFSS
NYS
65.4%
34.6%
464
246
21.1%
23.7%
710
If you engage in regular physical activity, how many
times per week are you physically active?
St. Lawrence County Community Health Assessment – November 2013
84
Answer Options
One
Two
Three
Four
More than Four
Does not Apply
Total Respondents
Response
Percent
4.6%
10.2%
18.4%
13.0%
34.1%
19.7%
Response
Count
28
63
113
80
210
121
615
If you engage in regular physical activity, how long are
you physically active each time?
Response
Response
Answer Options
Percent
Count
4.5%
28
15 minutes or less
19.7%
122
16-30 minutes
24.1%
149
31-45 minutes
12.6%
78
46-60 minutes
18.4%
114
1 hour or more
20.6%
127
Does not apply
618
Total Respondents
If no, what stops you from being physically active?
Response
Answer Options
Percent
23.6%
Physically unable
26.4%
Weather
54.6%
Lack of time
15.2%
Safety (no street lights or sidewalks)
20.1%
Choose not to
368
Total Respondents
In your community do you have adequate:
Check all that are adequate.
Response Response
Answer Options
Percent
Count
Sidewalks
62.4%
327
Street lights
69.3%
363
Bike paths
26.9%
141
Walking trails
46.9%
246
Access to public gym
30.5%
160
Access to public pool
23.3%
122
Total Respondents
524
Response
Count
87
97
201
56
74
Is your community breast-feeding friendly?
Response Response
Answer Options
Percent
Count
Yes
17.6%
125
No
8.0%
57
Don't know / Unsure
74.4%
529
Total Respondents
711
Is your workplace breast-feeding friendly?
Yes
28.0%
184
No
11.7%
77
Don't know / Unsure
60.3%
396
Total Respondents
657
St. Lawrence County Community Health Assessment – November 2013
85
How many fruits and vegetables do you eat in a day?
Answer Options
5 or more
3-4
1-2
Yourself
Your children
Total Respondents
18.5%
16.6%
34.3%
37.8%
41.0%
38.9%
If fewer than five, why? Check all that apply.
Answer Options
Cost
Don't like them
Time needed to prepare
Spoil too fast
Total Respondents
Response Response
Percent
Count
50.6%
238
13.4%
63
27.7%
130
51.1%
240
470
0
(Rarely)
6.3%
6.7%
720
Response
Count
715
283
5+ EBRFSS
St. Lawrence
County
30.9%
5+
EBRFSS
NYS
27.1%
Are you currently taking care of?
Response Response
Answer Options
Percent
Count
An elderly or disabled parent
49.6%
57
An elderly OR disabled spouse
28.7%
33
A disabled child
19.1%
22
A grandchild
17.4%
20
Total Respondents
115
Please answer these questions regarding your alcohol use: (One drink is a beer, a glass of wine or a mixed drink)
Answer Options
None
1 or 2
a
month
1 or 2
a week
1 or 2 a
day
More
than 2 a
day
Response
Count
How much alcohol do you drink?
How much do others in your
household drink?
Total Respondents
38.1%
24.8%
23.0%
10.7%
3.4%
701
38.3%
21.8%
20.1%
13.5%
6.4%
593
St. Lawrence County Community Health Assessment – November 2013
Heavy
Drinking
EBRFSS
St.
Lawrence
County
7.9%
Heavy
Drinking
EBRFSS
NYS
5.0%
706
86
How many times in the last 30 days did you have more than 5 drinks (if a
man) or 4 drinks (if a women) on one occasion?
Binge Drinking
Binge
Response Response
EBRFSS
Drinking
Answer Options
Percent
Count
St. Lawrence
EBRFSS
County
NYS
73.8%
505
None
13.2%
90
Once
5.6%
38
21.8%
18.1%
Twice
4.4%
30
3 or 4
3.1%
21
4 or more
Total
684
Respondents
Do you think it is ok for people to drink
alcohol under the age of 21?
Response
Response
Answer Options
Percent
Count
6.1%
43
Yes
Yes, as long as they
11.5%
81
are not driving
63.5%
448
No
Yes, under parental
18.9%
133
supervision
705
Total Respondents
Do you smoke cigarettes?
Answer Options
No
Yes
Response
Percent
Response
Count
84.7%
15.3%
597
108
St. Lawrence County Community Health Assessment – November 2013
EBRFSS
St. Lawrence
County
75.3%
24.7%
EBRF
SS
NYS
83.0%
17.0%
87
Yes, less than a pack per day
Yes, one pack (20) per day
Yes, more than a pack per day
Yes, more than two packs per day
Total Respondents
8.9%
4.3%
2.0%
0.1%
63
30
14
1
705
Are you trying to quit smoking?
Response Response
Answer Options
Percent
Count
Yes
12.7%
54
No
87.3%
372
Total Respondents
426
Do you use e-cigarettes?
St. Lawrence County Community Health Assessment – November 2013
88
Do you use chewing tobacco or snuff?
Response Response
Answer Options
Percent
Count
Yes, chewing tobacco
1.5%
10
Yes, both
0.6%
4
Yes, snuff
1.8%
12
No, neither
96.1%
634
Total Respondents
660
Do you have a prescription for pain medication?
Response
Response
Answer Options
Percent
Count
Yes
21.5%
150
No
78.5%
548
Total Respondents
698
St. Lawrence County Community Health Assessment – November 2013
Do you have unused (leftover) prescription
pain medication?
Response Response
Answer Options
Percent
Count
Yes
20.5%
142
No
79.5%
551
Total Respondents
693
89
Have you received any of the following immunizations (shots) as an adult (over 19)?
EBRFSS
EBRFSS
Response
Response
Answer Options
Last 12 Months
Last 12 Months
Percent
Count
St. Lawrence County
NYS
80.7%
489
39.8%
41.7%
Flu shot
8.9%
54
Shingles (Zostavax)
75.1%
455
Tetanus shot
36.3%
220
Hep A/Hep B
32.2%
195
30.6%
25.4%
Pneumonia
12.2%
74
Whooping Cough
7.1%
43
Meningitis
606
Total Respondents
About how long has it been
since you last visited a
dental office / dentist for any
reason?
Within the past year
Within the past 2 years
Within the past 5 years
5 or more years
I have never been to a dentist
Total Respondents
Response
Percent
67.0%
9.4%
8.1%
15.1%
0.3%
EBRFSS
St.
Lawrence
County
66.4%
Response
Count
469
66
57
106
2
EBRFSS
NYS
Was there a time during the past 12 months
when you needed to get dental care, but could
not find a dentist or could not afford the cost?
Response
Percent
Response
Count
Yes
Couldn't find a dentist
Couldn't afford the cost
10.9%
2.1%
18.6%
76
15
130
No
Total Respondents
68.3%
477
Answer Options
71.1%
700
698
If you live where there is un-fluoridated public water supply,
would you support adding fluoride to the water supply to improve
dental health in the community?
Response Response
Answer Options
Percent
Count
Yes
61.8%
371
No
38.2%
229
Total Respondents
600
St. Lawrence County Community Health Assessment – November 2013
90
Please answer the following questions for yourself or any member of your
household who has used any of the listed services in the last 12 months.
In the last 12 months, when you wanted to be seen as soon as possible, did you
have to wait more than 3 days for an appointment to see a doctor for primary
(not specialty) health care?
In the last 12 months, did you have to wait more than 30 minutes in the doctor's
waiting room for primary (not specialty) health care?
If disabled did you receive necessary accommodations (i.e. wheelchair
accessibility, interpreters, etc.) to fully benefit from services?
Total Respondents
Do you have the following
emergency supplies? Check
all that you have on hand.
Batteries
Candles/Matches
Canned food
Battery operated radio
First aid kit
Manual can opener
Bottled water
Blankets
Flashlight
Total Respondents
Response
Percent
Response
Count
82.4%
93.5%
85.7%
58.4%
77.6%
90.2%
64.6%
95.5%
93.7%
571
648
594
405
538
625
448
662
649
Yes
No
N/A
Response
Count
35.9%
55.6%
8.5%
696
56.8%
39.4%
3.9%
701
9.1%
4.2%
86.8%
574
Do you have a plan
for? Check all that
you have a plan for.
Weather related
(flood, ice storm)
Disease
Man Made
Natural disasters
(earthquake)
Fire
Total Respondents
702
Response Response
Percent
Count
82.0%
377
18.9%
20.7%
87
95
27.4%
126
75.7%
348
460
693
St. Lawrence County Community Health Assessment – November 2013
91
Please answer the following questions for yourself or any
member of your household who has used any of the listed
services in the last 12 months:
Adult Day Care / Respite Care
Alcohol / Drug Treatment
Ambulance service
Audiology (hearing care)
Counseling / Mental Health for adults
Counseling / Mental Health for children
Dentists
Dialysis
Doctor's Office
Domestic Violence
Emergency Response System
Eye Care / Ophthalmology
Early Intervention Services
Family Planning Services
Gerontology
Prenatal Care
Home Health Services
Hospice
Help with Breastfeeding
Long Term Care Facility
Home Delivered Meals
Senior Nutrition Sites
Occupational Therapy
Orthodontists
Orthopedics
Physical therapy services
Public transportation
Speech Therapy
Testing, counseling & treatment for STD's, including
HIV/AIDS
Total Respondents
Used in my
communit
y
Used in
County
Used
out of
County
Qualit
y OK?
27.1%
33.3%
69.2%
33.7%
43.7%
37.7%
58.8%
45.6%
70.1%
29.2%
65.7%
57.1%
34.9%
47.8%
27.1%
45.3%
45.1%
43.4%
35.2%
37.0%
46.3%
37.7%
50.0%
34.7%
49.5%
68.8%
22.5%
32.7%
7.1%
26.7%
21.1%
28.8%
35.6%
26.0%
28.4%
22.8%
30.6%
27.1%
15.7%
32.2%
20.9%
20.9%
16.7%
32.8%
25.4%
28.3%
25.9%
20.4%
20.4%
20.8%
25.0%
22.7%
23.8%
24.8%
20.2%
22.4%
3.5%
10.0%
11.3%
19.2%
8.9%
6.5%
12.4%
8.8%
13.1%
6.3%
7.8%
13.3%
2.3%
4.5%
8.3%
7.8%
7.0%
5.7%
5.6%
5.6%
3.7%
3.8%
3.6%
18.7%
18.1%
3.8%
4.5%
14.3%
11.8%
13.3%
29.3%
16.3%
18.5%
20.8%
31.2%
15.8%
28.8%
14.6%
18.6%
28.0%
9.3%
17.9%
8.3%
14.1%
11.3%
17.0%
13.0%
14.8%
18.5%
11.3%
17.9%
25.3%
23.8%
22.9%
6.7%
8.2%
Service
needed, but
missing in
County
57.6%
28.3%
3.8%
17.3%
15.6%
31.2%
3.9%
22.8%
1.2%
33.3%
9.8%
2.6%
32.6%
23.9%
43.8%
15.6%
21.1%
15.1%
31.5%
29.6%
20.4%
26.4%
17.9%
17.3%
9.5%
4.5%
50.6%
34.7%
50.0%
22.4%
1.7%
17.2%
19.0%
St. Lawrence County Community Health Assessment – November 2013
Response
Count
85
60
133
104
135
77
493
57
579
48
102
422
43
67
48
64
71
53
54
54
54
53
56
75
105
157
89
49
58
642
92
If you or a family member needed to be
hospitalized for treatment that is not available in
St. Lawrence County, which hospital would you
prefer?
Answer Options
If you or a family member needed to be
hospitalized, which hospital would you prefer?
Answer Options
Response
Percent
Burlington Area Hospital
Plattsburgh Hospital
Adirondack Medical Center
(Saranac Lake)
Albany Area Hospital
Syracuse Area Hospital
Total Respondents
Response
Percent
Response
Count
58.5%
7.1%
373
45
8.6%
55
3.1%
44.0%
20
281
638
Response
Count
51.0%
Canton-Potsdam
24.4%
Claxton-Hepburn
6.8%
Clifton-Fine
7.1%
EJ Noble
11.2%
Massena Memorial
Adirondack Medical
9.9%
Center (Saranac Lake)
618
Total Respondents
Please answer Yes or No
315
151
42
44
69
61
Answer Options
Would you or anyone in your household benefit from a suicide prevention
program?
Do you know who to report animal bites to?
Have you removed a tick from your body in the last year?
Have you removed a tick from your pet in the last year?
If you heat with wood, coal or natural gas do you have working carbon
monoxide detectors in your home?
Total Respondents
St. Lawrence County Community Health Assessment – November 2013
Yes
No
Response
Count
9.2%
90.8%
660
58.3%
22.9%
39.5%
41.7%
77.1%
60.5%
667
668
651
74.4%
25.6%
590
671
93
Please Answer Yes or No Have you had the
following screening tests?
Pap test - If you are a woman and are 21 or over
Mammogram - If you are a woman and are 40 or over
Colorectal exam - If you are 50 or older
Prostate exam - If you are a man and are 40 or over
Total Respondents
Please Answer Yes or No
Have you had the following
screening tests?
Less than $15,000
$15,001 to $25,000
$25,001 to $50,000
$50,001 to $75,000
$75,001 to $100,000
Over $100,000
Pap test - If you are
a woman and are 21
or over (yes)
6.0%
10.2%
24.8%
26.1%
21.8%
11.2%
Yes
No
Doesn't
Apply
Response
Count
69.0%
58.9%
49.2%
29.3%
11.3%
13.5%
23.9%
16.7%
19.7%
27.6%
26.8%
54.0%
610
601
593
491
661
Mammogram - If
you are a woman
and are 40 or over
(Yes)
6.3%
9.9%
25.7%
27.2%
20.1%
10.8%
St. Lawrence County Community Health Assessment – November 2013
Ever
Screened
EBRFSS
St. Lawrence
County
97.1%
88.3%
65.8%
Not Available
Ever
Screened
EBRFSS
NYS
91.8%
91.1%
66.6%
73.7%
Colorectal exam - If
you are 50 or older
(Yes)
Prostate exam - If
you are a man and
are 40 or over (Yes)
4.7%
9.7%
24.1%
28.4%
22.7%
10.4%
3.6%
9.3%
25.7%
28.6%
19.3%
13.6%
94
Please Answer Yes or No
Have you had the following
screening tests?
< 9th grade
9th to 12 grade
High School Grad
Some college no degree
Associates
Bachelors
Graduate+
Pap test - If you are
a woman and are 21
or over
Mammogram - If you
are a woman and are
40 or over
Colorectal exam - If
you are 50 or older
Prostate exam - If
you are a man and
are 40 or over
0.0%
0.5%
13.9%
16.5%
21.8%
21.3%
25.9%
0.0%
1.1%
16.9%
19.4%
22.0%
16.3%
24.3%
0.0%
1.0%
16.1%
18.5%
20.6%
17.5%
26.2%
0.0%
1.4%
17.3%
24.5%
19.4%
16.5%
20.9%
About how long has it been since you last visited a doctor for a routine
checkup? Do not include times you visited the doctor because you were
sick.
EBRFSS
Response Response
St.
EBRFSS
Answer Options
Percent
Count
Lawrence
NYS
County
Within the past year
78.0%
520
66.0%
72.7%
Within the last 2 years
7.5%
50
78.7%
85.7%
Within the last 5 years
3.9%
26
Five or more years ago
5.8%
39
Don't know / unsure
2.2%
15
Never
2.5%
17
Total Respondents
667
At night and weekends, where do you
receive medical care?
Response Response
Answer Options
Percent
Count
My local ER/ED
55.4%
346
Urgent Care
23.2%
145
My doctor
4.5%
28
Out of town ER/ED
6.2%
39
Does not apply
18.9%
118
Total Respondents
625
St. Lawrence County Community Health Assessment – November 2013
95
If you do have health insurance what kind is it? Check all
that apply:
If you don't have health insurance, why not? (choose one)
Answer Options
Blue Cross/Blue Shield
Blue Choice
Medicaid
Medicaid (Blue Choice Option)
Dental insurance
Vision coverage
Medicare (Social Security)
Preferred Care
Tri-Care
Child Health Plus
V.A.
Family Health Plus
Total Respondents
Response
Percent
Response
Count
54.3%
0.4%
8.5%
1.2%
39.0%
31.1%
26.6%
0.8%
3.5%
2.2%
4.3%
1.8%
276
2
43
6
198
158
135
4
18
11
22
9
Answer Options
Not offered where I work
Can't afford
Prefer to pay my own medical expenses
Does not apply, I have insurance
Choose not to have it
Total Respondents
Response
Percent
Response
Count
4.2%
30.9%
1.0%
63.4%
0.5%
8
59
2
121
1
191
508
Have you been unable to get health care service due to the
cost?
EBRFSS
Answer
Response Response
St.
EBRFSS
Options
Percent
Count
Lawrence
NYS
County
Yes
29.2%
146
14.5%
13.8%
No
70.8%
354
Total
500
Respondents
St. Lawrence County Community Health Assessment – November 2013
96
Which services
have you been
unable to get?
Check all that
apply:
Doctor
Dentist
Mental Health
Prescriptions
Does not Apply
Total Respondents
Response
Percent
Response
Count
16.3%
32.7%
7.3%
19.2%
57.5%
73
147
33
86
258
If you can't afford a prescription, what do you do?
Check all that apply:
Respons
Respons
Answer Options
e
e Count
Percent
Tell my doctor / request
21.8%
119
samples
Tell my pharmacist
3.5%
19
Take medicine less often
9.5%
52
Do not fill my prescription
28.1%
153
Use discount prescription card
7.7%
42
Prescription assistance program
2.2%
12
Does not apply
51.7%
282
Total Respondents
545
449
On about how many days during the past 6 months was your mental health not
good? (includes depression, excessive stress, emotional problems)
Answer Options
0 Days
1 to 7 Days
8 to 14 Days
Greater than 14 Days
Greater than 30 Days
Greater than 90 Days
180 Days (every day)
Total Respondents
Response
Percent
Response
Count
EBRFSS
14+ days/month
St. Lawrence
County
EBRFSS
14+
days/month
NYS
38.1%
18.0%
10.2%
33.7%
28.5%
12.4%
9.0%
123
58
33
109
92
40
29
11.3%
10.2%
St. Lawrence County Community Health Assessment – November 2013
323
97
During the past 6 months, when your mental health was not good...
Answer Options
Did you seek professional
help?
Was the help you got in your
community (yes or no)?
Was the help you got in St.
Lawrence County (yes or
no)?
Did you consider suicide as
an option at any time?
Did poor mental health keep
you from doing your usual
activities?
Total Respondents
Response
Count
If poor mental health kept you from doing your
usual activities, how many days?
Yes
No
Does not
Apply
13.0%
38.2%
48.8%
537
Answer Options
9.3%
14.0%
76.7%
485
13.9%
9.5%
76.6%
482
6.2%
41.9%
51.8%
515
24.7%
23.9%
51.3%
522
N/A (0 Days)
1 to 7 Days
8 to 14 Days
Greater than 14 Days
Greater than 30 Days
Greater than 90 Days
180 Days (every day)
Total Respondents
539
Response
Percent
Response
Count
27.7%
26.9%
5.9%
39.5%
29.4%
13.4%
11.8%
33
32
7
47
35
16
14
119
Do you have children in the home who are
under 18?
Response Response
Answer Options
Percent
Count
Yes
27.4%
183
No
72.6%
484
Total Respondents
667
St. Lawrence County Community Health Assessment – November 2013
98
Did the children in your household receive a flu shot this
year?
Response Response
Answer Options
Percent
Count
Yes
50.3%
87
No, I didn't have time
2.3%
4
No, I didn't feel it was needed
36.4%
63
No, I couldn't afford it
1.7%
3
No, my insurance doesn't cover it
1.7%
3
No, I didn't know they should get it
3.5%
6
Not sure
4.0%
7
Total Respondents
173
Have the children in your household been tested for lead?
Incidence
Response Response
DOH
Answer Options
Percent
Count
St. Lawrence
County
Yes, at age one
14.4%
26
Yes, at age two
8.8%
16
Yes, at age one & two
13.3%
24
9.1 per 1,000
Yes, but I don't remember their
among
27.6%
50
age
children <72
months of age
No
21.0%
38
Does not apply
3.3%
6
Not sure
11.6%
21
Total Respondents
181
St. Lawrence County Community Health Assessment – November 2013
Incidence
DOH
NYS
11.1 per
1,000 among
children < 72
months of
age
99
Do your children wear helmets when
bicycling, skateboarding or rollerblading
etc.?
Response Response
Answer Options
Percent
Count
Never
9.0%
15
Sometimes
33.7%
56
Always
57.2%
95
Total Respondents
166
Have the children in your house received
immunizations (shots) against childhood
diseases?
Response Response
Answer Options
Percent
Count
No
1.1%
2
Yes
93.4%
169
Some, not all
4.4%
8
Not sure
1.1%
2
Total Respondents
181
Are there affordable, organized
opportunities for your children to be
involved in physical activity?
Response Response
Answer Options
Percent
Count
Yes
68.4%
119
No
31.6%
55
Total Respondents
174
How much do you estimate your household paid
for all medical expenses in the last calendar year
("out of pocket expenses", prescriptions, dental
care, vision, health insurance premiums, medical
care, hospitalization, co-payments, deductibles)?
Response Response
Answer Options
Percent
Count
$0 - $500
17.4%
113
$501 - $1,000
16.7%
109
$1,001 - $2,000
17.8%
116
$2,001 - $3,000
15.7%
102
$3,001 - $4,000
10.1%
66
$4,001 - $5,000
7.7%
50
$5,001 - $7,500
6.6%
43
$7,501 +
8.0%
52
Total Respondents
651
St. Lawrence County Community Health Assessment – November 2013
100
St. Lawrence County Health Initiative PO Box 5069, 6439 SH 56, Potsdam, NY 13676 Phone: (315)261‐4760 ext. 221 Attachment B Community Health Services Assessment Indicator 2: Health Promotion Activities to Facilitate Health Living in Healthy Communities Answer Options Conducts health promotion activities for the community‐at‐
large or for populations at increased risk for negative health outcomes Develops collaborative networks for health promotion activities that facilitate healthy living in healthy communities Assesses the appropriateness, quality and effectiveness of health promotion activities at least every 2 years. Total Respondents Yes, met 100% ‐ 76% Mostly, 75% ‐ 51% Low, 50% ‐ 26% No, 25% ‐ 0% Response Count 36% 36% 17% 11% 36 31% 44% 19% 6% 36 33% 22% 22% 22% 36 No 25% ‐ 0% Response Count 36 Mobilize Community Partnerships to Identify and Solve Health Problems Answer Options Has a process to identify key constituents for population based health in general (e.g. improved health and quality of life at the community level) or for specific health concerns (e.g., a particular health theme, disease, risk factor, life stage need). Encourages the participation of its constituents in community health activities, such as in identifying community issues and themes and in engaging in volunteer public health activities. Establishes and maintains a comprehensive directory of community organizations. Uses broad‐based communication strategies to strengthen linkages among LPHS organizations and to provide current information about public health services and issues. Total Respondents Yes, met Mostly Low 100% ‐ 76% 75% ‐ 51% 50% ‐ 26% 37% 23% 29% 11% 35 29% 31% 31% 9% 35 33% 33% 25% 8% 36 22% 25% 39% 14% 36 36 Mission: To measurably improve the health of St. Lawrence county residents through a collaborative community effort.
101
St. Lawrence County Health Initiative PO Box 5069, 6439 SH 56, Potsdam, NY 13676 Phone: (315)261‐4760 ext. 221 Community Partnerships Answer Options Yes, met 100% ‐ 76%
Mostly 75% ‐ 51% Low 50% ‐ 26% No 25% ‐ 0% Response Count 33% 42% 22% 3% 36 33% 28% 28% 11% 36 28% 25% 36% 11% 36 Establishes community partnerships to assure a comprehensive approach to improving health in the community. Assure the establishment of a broad‐
based community health improvement committee. Assesses the effectiveness of community partnerships in improving community health. Total Respondents 36 Assure a Competent Public and Personal Health Care Workforce Answer Options Assessment of workforce (including volunteers and other lay community health workers) to meet the community needs for public and personal health care services. Maintaining public health workforce standards, including efficient processes for licensure/credentialing of professionals and incorporation of core public health competencies needed to provide the Essential Public Health Services into personnel systems. Adoption of continuous quality improvement and life‐long learning programs for all members of the public health workforce, including opportunities for formal and informal public health leadership development. Total Respondents Yes, met 100% ‐ 76% Mostly 75% ‐ 51% Low 50% ‐ 26% No Response 25% ‐ 0% Count 39% 19% 31% 11% 36 39% 19% 22% 19% 36 31% 28% 22% 19% 36 36 Mission: To measurably improve the health of St. Lawrence county residents through a collaborative community effort.
102
St. Lawrence County Health Initiative PO Box 5069, 6439 SH 56, Potsdam, NY 13676 Phone: (315)261‐4760 ext. 221 Life‐long Learning Through Continuing Education, Training & Mentoring Yes, met 100% ‐ 76% Answer Options Identify education and training needs and encourage opportunities for public health workforce development. Provide opportunities for all personnel to develop core public health competencies. Provide incentives (e.g. improvements in pay scale, release time, tuition reimbursement) for the public health workforce to pursue education and training. Provide opportunities for public health workforce members, faculty and student interaction to mutually enrich practice‐
academic settings. Total Respondents Mostly Low No 75% ‐ 51% 50% ‐ 26% 25% ‐ 0% Response Count 31% 14% 29% 26% 35 31% 11% 29% 29% 35 26% 0% 34% 40% 35 25% 19% 22% 34% 32 35 Public Health Leadership Development Answer Options Provide formal (educational programs, leadership institutes) and informal (coaching, mentoring) opportunities for leadership development for employees at all organizational levels. Promote collaborative leadership through the creation of a local public health system with a shared vision and participatory decision‐making. Assure that organizations and/or individuals have opportunities to provide leadership in areas where their expertise or experience can provide insight, direction or resources. Provide opportunities for development of diverse community leadership to assure sustainability of public health initiatives. Total Respondents Yes, met 100% ‐ 76% Mostly 75% ‐ 51% Low 50% ‐ 26% No 25% ‐ 0% Response Count 27% 12% 36% 24% 33 29% 18% 29% 24% 34 29% 12% 32% 26% 34 27% 12% 24% 36% 33 34 Mission: To measurably improve the health of St. Lawrence county residents through a collaborative community effort.
103
St. Lawrence County Health Initiative PO Box 5069, 6439 SH 56, Potsdam, NY 13676 Phone: (315)261‐4760 ext. 221 Access to and Utilization of Current Technology to Manage, Display and Communicate Population Health Data Answer Options Uses state of the art technology to collect, manage, integrate and display health profile databases. Promotes the use of geocoded data. Uses geographic information systems. Uses computer‐generated graphics to identify trends and/or compare data by relevant categories (e.g. race, gender, age group). Total Respondents Yes, met 100% ‐ 76% Mostly 75% ‐ 51% Low 50% ‐ 26% No 25% ‐ 0% Response Count 31% 20% 14% 34% 35 31% 23% 6% 23% 23% 20% 40% 34% 35 35 34% 11% 20% 34% 35 35 Diagnose and Investigate Health Problems and Health Hazards in the Community Answer Options Epidemiological investigations of disease outbreaks and patterns of infectious and chronic disease and injuries, environmental hazards, and other health threats. Active infectious disease epidemiology programs. Access to public health laboratory capable of conducting rapid screening and high volume testing. Total Respondents Yes, met 100% ‐ 76% Mostly 75% ‐ 51% Low 50% ‐ 26% No 25% ‐ 0% Response Count 51% 14% 17% 17% 35 46% 23% 17% 14% 35 37% 20% 17% 26% 35 35 Mission: To measurably improve the health of St. Lawrence county residents through a collaborative community effort.
104
St. Lawrence County Health Initiative PO Box 5069, 6439 SH 56, Potsdam, NY 13676 Phone: (315)261‐4760 ext. 221 Plan for Public Health Emergencies Answer Options Defines and describes public health disasters and emergencies that might trigger implementation of the LPHS emergency response plan. Develops a plan that defines organizational responsibilities, establishes communication and information networks, and clearly outlines alert and evacuation protocols. Tests the plan each year through the staging of one or more “mock events.” Revises its emergency response plan at least every two years. Total Respondents Yes, met 100% ‐ 76% Mostly 75% ‐ 51% Low 50% ‐ 26% No 25% ‐ 0% Response Count 47% 24% 12% 18% 34 44% 32% 9% 15% 34 56% 24% 3% 18% 34 53% 18% 3% 26% 34 34 Investigate & Respond to Public Health Emergencies Answer Options Designates an Emergency Response Coordinator Develops written epidemiological case investigation protocols for immediate investigation of: Communicable disease outbreaks Environmental health hazards Potential chemical and biological agent threats Radiological threats and Large scale disasters Maintains written protocols to implement a program of source & contact tracing. Maintain a roster of personnel with technical expertise to respond to biological, chemical or radiological emergencies Evaluates past incidents for effectiveness & continuous improvement Total Respondents Yes, met 100% ‐ 76% Mostly 75% ‐ 51% Low No 50% ‐ 26% 25% ‐ 0% Response Count 74% 20% 0% 6% 35 41% 28% 7% 24% 29 57% 51% 23% 26% 0% 3% 20% 20% 35 35 49% 29% 3% 20% 35 49% 54% 26% 23% 3% 3% 23% 20% 35 35 57% 17% 3% 23% 35 57% 14% 3% 26% 35 57% 23% 0% 20% 35 35 Mission: To measurably improve the health of St. Lawrence county residents through a collaborative community effort.
105
St. Lawrence County Health Initiative PO Box 5069, 6439 SH 56, Potsdam, NY 13676 Phone: (315)261‐4760 ext. 221 Laboratory Support for Investigation of Health Threats Answer Options Yes, met 100% ‐ 76% Mostly 75% ‐ 51% Low 50% ‐ 26% No 25% ‐ 0% Response Count 37% 20% 11% 31% 35 49% 17% 9% 26% 35 44% 18% 9% 29% 34 44% 21% 6% 29% 34 Maintains ready access to laboratories capable of supporting investigations. Maintains ready access to labs capable of meeting routine diagnostic & surveillance needs. Confirms that labs are in compliance with regs & standards through credentialing and licensing agencies. Maintains protocols to address handling of lab samples– storing, collecting, labeling, transporting and delivering samples and for determining the chain of custody. Total Respondents 35 Develop Policies & Plans that support Individual and Community Health Efforts. Answer Options An effective governmental presence at the local level. Development of policy to protect the health of the public and to guide the practice of public health. Systematic community‐level and state‐level planning for health improvement in all jurisdictions. Alignment of LPHS resources & strategies with the community health improvement plan. Total Respondents Yes, met 100% ‐ 76% Mostly 75% ‐ 51% Low 50% ‐ 26% No 25% ‐ 0% Response Count 29% 26% 20% 26% 35 34% 20% 20% 26% 35 29% 23% 17% 31% 35 26% 26% 11% 37% 35 35 Mission: To measurably improve the health of St. Lawrence county residents through a collaborative community effort.
106
St. Lawrence County Health Initiative PO Box 5069, 6439 SH 56, Potsdam, NY 13676 Phone: (315)261‐4760 ext. 221 Public Health Policy Development Yes, met Mostly Low No Response 100% ‐ 76% 75% ‐ 51% 50% ‐ 26% 25% ‐ 0% Count Answer Options Contributes to the development and/or modification of public health policy by facilitating community involvement in the process and by engaging in activities that inform this process. Reviews existing policies at least every 2 years and alerts policy makers and the public of potential unintended outcomes and consequences. Advocates for prevention and protection policies, particularly policies that affect populations who bear a disproportionate burden of mortality and morbidity. Total Respondents 23% 23% 31% 23% 35 34% 17% 14% 34% 35 31% 20% 23% 26% 35 35 Community Health Improvement Process Answer Options Establishes a community health improvement process, which includes broad based participation and uses information from the community health assessment as well as perceptions of community residents. Develops strategies to achieve community health improvement objectives and identifies accountable entities to achieve each strategy. Total Respondents Yes, met 100% ‐ 76% Mostly 75% ‐ 51% Low 50% ‐ 26% No 25% ‐ 0% Response Count 29% 26% 23% 23% 35 31% 20% 26% 23% 35 35 Mission: To measurably improve the health of St. Lawrence county residents through a collaborative community effort.
107
St. Lawrence County Health Initiative PO Box 5069, 6439 SH 56, Potsdam, NY 13676 Phone: (315)261‐4760 ext. 221 Strategic Planning & Alignment with the Community Health Improvement Process Answer Options Conduct organizational strategic planning activities. Review its own organizational strategic plan to determine how it can best be aligned with the community health improvement process. Conducts organizational strategic planning activities and uses strategic planning to align its goals, objectives, strategies and resources with the community health improvement process. Total Respondents Yes, met 100% ‐ 76% Mostly 75% ‐ 51% Low 50% ‐ 26% No 25% ‐ 0% Response Count 30% 21% 24% 24% 33 27% 24% 18% 30% 33 31% 22% 19% 28% 32 33 Mission: To measurably improve the health of St. Lawrence county residents through a collaborative community effort.
108
St. Lawrence County Health Initiative PO Box 5069, 6439 SH 56, Potsdam, NY 13676 Phone: (315)261‐4760 ext. 221 Enforce Laws & Regulations that Protect Health and Ensure Safety Answer Options Review, evaluate and revise laws and regulations designed to protect health and safety to assure they reflect current scientific knowledge and best practices for achieving compliance. Education of persons and entities obligated to obey or to enforce laws and regulations designed to protect health and safety in order to encourage compliance. Enforcement activities in areas of public health concern, including but not limited to the protection of drinking water, enforcement of clean air standards, regulation of care provided in health care facilities and programs, re‐inspection of workplaces following safety violations; review of new drug, biologic and medical device applications, enforcement of laws governing sale of alcohol and tobacco to minors; seat belts and child safety seat usage and childhood immunizations. Total Respondents Yes, met 100% ‐ 76% Mostly Low No Response 75% ‐ 51% 50% ‐ 26% 25% ‐ 0% Count 31% 23% 23% 23% 35 31% 29% 20% 20% 35 34% 34% 14% 17% 35 35 Link People to Needed Personal Health Services and Assure the Provision of Health Care when Otherwise Unavailable Yes, met Mostly Low No Response Answer Options 100% ‐ 76% 75% ‐ 51% 50% ‐ 26% 25% ‐ 0% Count Identifying populations with barriers to 38% 41% 15% 6% 34 personal health services. Identifying personal health service needs of populations with limited access to a 35% 38% 21% 6% 34 coordinated system of clinical care. Assuring the linkage of people to 32% 26% 29% 12% 34 appropriate personal health services. Total Respondents 34 Mission: To measurably improve the health of St. Lawrence county residents through a collaborative community effort.
109
St. Lawrence County Health Initiative PO Box 5069, 6439 SH 56, Potsdam, NY 13676 Phone: (315)261‐4760 ext. 221 Identifying Personal Health Services Needs of Population Answer Options Defines personal health service needs for the general population. This includes defining specific preventive, curative and rehabilitative health service needs for the catchment areas within its jurisdiction. Assesses the extent to which personal health services are provided. Identifies the personal health service needs of populations who may encounter barriers to the receipt of personal health services. Total Respondents Yes, met 100% ‐ 76% Mostly Low No Response 75% ‐ 51% 50% ‐ 26% 25% ‐ 0% Count 26% 37% 26% 11% 35 31% 37% 20% 11% 35 29% 43% 17% 11% 35 35 Assuring the Linkage of People to Personal Health Services Answer Options Assures the linkage to personal health services, including populations who may encounter barriers to care. Provides community outreach and linkage services in a manner that recognizes the diverse needs of unserved and underserved populations. Enrolls eligible beneficiaries in state Medicaid or Medical Assistance Programs. Coordinates the delivery of personal health and social services with service providers to optimize access. Conducts an analysis of age‐specific participation in preventive services. Total Respondents Yes, met 100% ‐ 76% Mostly Low No Response 75% ‐ 51% 50% ‐ 26% 25% ‐ 0% Count 26% 29% 29% 17% 35 37% 14% 31% 17% 35 49% 34% 6% 11% 35 40% 23% 23% 14% 35 26% 18% 18% 38% 34 35 Mission: To measurably improve the health of St. Lawrence county residents through a collaborative community effort.
110
St. Lawrence County Health Initiative PO Box 5069, 6439 SH 56, Potsdam, NY 13676 Phone: (315)261‐4760 ext. 221 Evaluation of Population‐based Health Services Answer Options Yes, met 100% ‐ 76% Evaluate population‐based health services against established criteria for performance, including the extent to which program goals are achieved for these services. Assesses community satisfaction with population‐based services and programs through a broad‐based process, which includes residents who are representative of the community and groups at increased risk of negative health outcomes. Identifies gaps in the provision of population‐based health services. Uses evaluation findings to modify the strategic and operational plans of LPHS organizations to improve services and programs. Total Respondents Mostly Low No Response 75% ‐ 51% 50% ‐ 26% 25% ‐ 0% Count 21% 24% 15% 41% 34 29% 11% 17% 43% 35 29% 17% 20% 34% 35 32% 15% 6% 47% 34 35 Evaluate Effectiveness, Availability and Quality of Personal and population based health services? Answer Options Identifies community organizations or entities that contribute to the delivery of the Essential Public Health Services. Evaluates the comprehensiveness of the LPHS activities against established criteria at least every five years and ensures that all organizations within the LPHS contribute to the process. Assesses the effectiveness of communication, coordination and linkage among LPHS entities. Uses information from the evaluation process to refine existing community health programs, to Yes, met 100% ‐ 76% Mostly Low No Response 75% ‐ 51% 50% ‐ 26% 25% ‐ 0% Count 34% 34% 6% 26% 35 29% 15% 12% 44% 34 29% 11% 20% 40% 35 29% 17% 11% 43% 35 Mission: To measurably improve the health of St. Lawrence county residents through a collaborative community effort.
111
St. Lawrence County Health Initiative PO Box 5069, 6439 SH 56, Potsdam, NY 13676 Phone: (315)261‐4760 ext. 221 establish new ones, and to redirect resources as needed to accomplish LPHS goals. Total Respondents 35 Research for New Insights and Innovative Solutions to Health Problems Answer Options A continuum of innovative solutions to health problems ranging from practical field‐based efforts to foster change in public health practice, to more academic efforts to encourage new directions in scientific research. Linkages with institutions of higher learning and research. Capacity to mount timely epidemiological and health policy analyses and conduct health systems research. Total Respondents Yes, met Mostly Low No Response 100% ‐ 76% 75% ‐ 51% 50% ‐ 26% 25% ‐ 0% Count 26% 6% 29% 40% 35 34% 14% 17% 34% 35 29% 9% 14% 49% 35 35 Mission: To measurably improve the health of St. Lawrence county residents through a collaborative community effort.
112
333333333333333333393332222+9 Attachment C
St. Lawrence County
Community Health
Improvement Plan
November 2013
113 1..
Executive Summary
What are the health priorities facing St. Lawrence County?
This was the question facing well over 1,000 people in a comprehensive process that involved
health care organizations, hospitals, business and community leaders, academia, government
agencies, non-profit organizations and county residents. Key partner agencies, five (5) hospitals
and the St. Lawrence County Public Health Department, led by a Rural Health Network, engaged
a consultant in a 16 month process to collect data, solicit opinions, facilitate a process and guide
a discussion to determine not only what are the most pressing problems facing our residents, but
also what can we effectively and efficiently address as a community.
In the end, the partner agencies decided to tackle two tough priorities:
Prevent Chronic Disease
Chronic diseases are among the leading causes of death, disability and rising health care costs in
New York State (NYS). Specifically, they account for approximately 70% of all deaths in NYS,
and affect the quality of life for millions of other residents, causing major limitations in daily
living for about 10% of the population. Costs associated with chronic disease and their major
risk factors account for more than 75% of our nation’s health care spending. (NYS Prevention
Agenda)
Promote Mental Health and Prevent Substance Abuse
At any given time, almost one in five young people nationally are affected by mental, emotional
and behavioral (MEB) disorders, including conduct disorders, depression and substance abuse.
About 75% of all MEB disorders are diagnosed between the ages of 14 and 24 years. (NYS
Prevention Agenda)
114 2..
Background and Process
Community Health Improvement Plan
The St. Lawrence County Health Initiative, along with the St. Lawrence County Public Health
Department and local hospitals (Claxton Hepburn Medical Center, Canton-Potsdam Hospital,
Massena Memorial Hospital, Clifton Fine Hospital and EJ Nobel Hospital) utilized the
Mobilizing for Action through Planning and Partnership (MAPP) process to determine two
priorities from the 2013 Prevention Agenda. The MAPP process is a strategic approach to
community health improvement. This tool helps communities improve health and quality of life
through community-wide strategic planning. Using MAPP, communities seek to achieve
optimal health by identifying and using their resources wisely, taking into account their unique
circumstances and needs, and forming effective partnerships for strategic action. The MAPP
tool was developed by the National Association of County and City Health Officials (NACCHO)
in cooperation with the Public Health Practice Program Office, Centers for Disease Control and
Prevention (CDC). A work group comprised of local health officials, CDC representatives,
community representatives, and academicians developed MAPP between 1997 and 2000. The
vision for implementing MAPP is: "Communities achieving improved health and quality of life
by mobilizing partnerships and taking strategic action”. The MAPP process encompasses
several steps.
Organize for Success- Partner Development
The goal of this step is to bring together key partners and familiarize them with the MAPP
process, as well as to determine key local questions. To accomplish this, the partners invited
participants from a wide range of the organizations throughout the county. While the main
organizations involved in developing and organizing the process included The St. Lawrence
County Health Initiative, St. Lawrence County Public Health, Claxton-Hepburn Medical Center,
Canton-Potsdam Hospital, Massena Memorial Hospital, Clifton Fine Hospital and EJ Nobel
Hospital, other organizations that participated in the community health assessment process were:


Office for the Aging/NY Connects
Head Start
115 






Seaway Valley Prevention Council
North Country Prenatal Perinatal Network
St. Lawrence County Community Development Program
Potsdam Neighborhood Center
Cerebral Palsy of the North Country
Hospice and Palliative Care of St. Lawrence Valley
St. Lawrence County Community Services
Assessments
Four Assessments inform the entire MAPP process. The assessment phase provides a
comprehensive picture of a community in its current state using both qualitative and quantitative
methods. The use of four different assessments is a unique feature of the MAPP process. Most
planning processes look only at quantitative statistics and anecdotal data. MAPP provides tools
to help communities analyze health issues through multiple lenses.
The first assessment examined the Community Health Status Indicators. Two methods were
used to examine indicators: The first was to collect relevant statistical data using the NYSDOH
Community Health Indicator Reports and a variety of other secondary sources. This was
completed by our consultant, Human Service Development. The second method was to collect
primary data by conducting a comprehensive survey among a random sample of community
residents to determine their opinions, health-related behaviors and health needs. A total of 809
people participated by completing surveys in St. Lawrence County. Surveys were conducted
electronically through a Survey Monkey link, along with paper copies which were distributed to
the public through employers, health, educational and human services agencies and through other
community groups. The survey was designed to encompass questions in the five Prevention
Agenda areas that the New York State Department of Health (NYSDOH) has identified as high
priority issues on a statewide basis. The leadership team met several times to develop and refine
the survey tool.
The second assessment evaluated the effectiveness of the Public Health System and the role of
the St. Lawrence County Public Health Department within that system. The assessment was
completed through the use of a more user-friendly version of the CDC and NACCHO tool called
the Local Public Health System Assessment (LPHSA) which was conducted via an electronic
survey on Survey Monkey. A diverse group of key informants were chosen to complete the
survey, including community leaders who are familiar in some way with the local public health
system. Each of the ten essential public health services was rated by the group by ranking the
series of indicators within each Essential Service to determine areas of strength and areas
needing improvement within the Local Public Health System.
The third assessment was the Community Themes and Strengths Assessment that was conducted
through focus groups that were held throughout the County. This assessment looked at the issues
that affect the quality of life among community residents and the assets the County has available
to address health needs. These were held in conjunction with the fourth assessment that looked
at the “Forces of Change” that are at work locally, statewide and nationally, and what types of
116 threats and/or opportunities are created by these changes. The three focus groups in St.
Lawrence County included male firefighters, the key informants listed above and a low-income
group. These groups helped to ensure that an adequate representation of the public was included
in the assessments and provided additional input from lower income residents as well as younger
male residents.
Identification of Strategic Issues
Once these results were tallied, a finalized list of the top issues from all components of the
assessment process was compiled, and the data was presented at a meeting of community
representatives including the local hospital, Public Health staff and partners from a variety of the
agencies listed above. They were charged with ranking the priorities based on their knowledge
of health needs and available services, along with the data presented, to select two priorities and
one disparity. The consultants presented a series of PowerPoint slides to the prioritization group
that reviewed a summary of secondary data from the NYSDOH and other sources, survey results
and focus group results and input so that they were as fully informed as possible prior to ranking.
In order to accomplish the ranking, the Hanlon Method was used. This method of ranking
focuses most heavily on how effective any interventions might be. The Hanlon Method utilizes
the following formula to rank priorities:
[A + (2xB)] x C
A= the size of the problem,
B= the severity of the problem
C=the effectiveness of the solution
The effectiveness of the solution is given a lot more weight than the size or seriousness of the
problem, with the hope of making wise use of limited resources by targeting solutions that are
known to be effective. Participants also consider the weight of the propriety, economic
feasibility, acceptability, resources and legality (PEARL) of issues in this ranking system.
Numerical values were determined by each participant for size, severity and effectiveness, and
then plugged into the formula along with average PEARL scores. It is important to note that
while the Hanlon Method offers a numerical and systematic method of ranking public health
priorities, it is still a method that is largely subjective, but which represents a quantitative way to
rank qualitative and non-comparable quantitative information. Since respondents ranked each
component (size, seriousness and effectiveness of the solution) individually using a paper
ranking form, the rankings were not heavily influenced by group dynamics. Based upon the
ranking through the Hanlon Method, St. Lawrence County’s scores on the top health related
issues in the county were:
117 1. Cancer
2. Heart Disease
11. Mental Health
6. Diabetes
8. Obesity
3. Cerebrovascular disease – stroke
9. Oral health
10. Substance Abuse
12. Tobacco use
4. Lead screening
13. CLRD
5. Cirrhosis
7. Breastfeeding
Hanlon
Score
162.53
151.31
136.88
135.94
135.56
125.66
122.00
114.38
112.13
111.68
110.16
87.75
86.75
PEARL
Score
5.69
5.25
4.56
4.36
4.21
5.44
4.50
5.38
4.00
5.25
5.19
5.56
4.44
A great deal of time was then spent by community partners discussing all these issues, but they
concentrated mainly on the top ranked issues. After reviewing, discussing and considering
county assessments, data and previous initiatives, the group decided to focus on the top two
priorities of:
1. Chronic Disease- with a specific focus on obesity and tobacco use
2. Mental Health and Substance Abuse
And the following disparity:
Cancer screening for the low-income population
It was felt that by focusing on obesity, we would also be addressing heart disease,
cerebrovascular disease and diabetes. Cancer would be addressed through the disparity, with
colorectal cancer being one of the cancers in the county that has rates significantly higher than
the rest of the state. Breastfeeding would be incorporated as a part of our anti-obesity strategy,
and mental health, substance abuse and cirrhosis would be addressed by our focus area under the
Mental Health/Substance Abuse goal.
118 119 3..
Community Health Improvement Plan
Several meetings were then held to develop specific goals and strategies. During this stage,
research and evidence-based best practices were considered from many different sources
including the Health Impact Pyramid developed by Thomas R. Frieden, MD, MPH. This is a
pyramid approach to describe the impact of different types of public health interventions and
provides a framework to improve health. The base of the pyramid indicates interventions with
the greatest potential impact and in ascending order are interventions that change the context to
make individuals' default decisions healthy, clinical interventions that require limited contact but
confer long-term protection, on-going direct clinical care, and health education and counseling.
Interventions focusing on lower levels of the pyramid tend to be more effective because they
reach broader segments of society and require less individual effort. Policy and environmental
changes were seen as the most practical way to effect desired change, but other levels of the
pyramid were also incorporated.
We decided to produce a ”CHIP Chart,” essentially a work plan that designates responsibility for
implementing the strategies outlined in the plan, incorporates specific focus areas from the NYS
Prevention Agenda. The main outcome measure we incorporated was changing the rate of
breastfeeding. This included a % increase of WIC mothers breastfeeding at 6 months, and a %
increase of mothers who exclusively breastfeed in hospital. Both of these indicators were
believed to be realistic and achievable, and research has demonstrated that they would lead to
decreased obesity over the long term. Many other process measures were incorporated into the
CHIP chart. While the goal is to reduce obesity over the five year period, without being aware of
any additional resources available to accomplish this, it was unrealistic to state that we would
reduce obesity by 5% over this period, though it is our intent to try to do so. With no additional
resources however, the two breastfeeding outcomes should be realistic to achieve. Based on past
experience and lessons learned, our CHIP should be achievable.
Evidence-based best practices were incorporated in the CHIP Chart from the NYS Prevention
Agenda, and are included on the following pages.
The main partners (The St. Lawrence County Health Initiative, St. Lawrence County Public
Health, Claxton-Hepburn Medical Center, Canton-Potsdam Hospital, Massena Memorial
Hospital, Clifton Fine Hospital and EJ Nobel Hospital), comprising the St. Lawrence County
Community Health Improvement Collaborative, have agreed to continue meeting at least
quarterly over the next five years to report on progress, troubleshoot obstacles, make mid-course
corrections and achieve objectives.
120 People who live in rural areas are consistently battling higher rates of obesity and chronic
diseases compared to people who live in urban areas. This was noted by M. Renee Umstattd,
PhD, MCHES in her editorial on “Combating the Obesity Epidemic in Rural America: A Few
Considerations” found in the Journal of Public Health Management and Practice in the
November/December 2013 issue. Transportation challenges continue to plague the rural
communities by making distances that people must travel to medical appointments or health
venues longer. Higher gas prices, lack of public transportation, barriers and lack of structures
needed for a walkable community also affect the ability of people to be mobile in the
community.
Over the last few years, Research has shown that behavior change approaches incorporated at
multiple levels to include changes in policies would be effective in combating obesity. The
issue becomes focusing on how to implement and evaluate policies along with looking at how
the environment can be changed to improve diet, physical activity and sedentary behaviors.
The CDC has invested in strategies called Common Community Measures for Obesity
Prevention known as COCOMO for the urban areas. We know that the rural areas are different
so the CDC funded Nutrition and Obesity and Policy Research and Evaluation Network
(NOPREN) and the Physical Activity Policy Research Network (PAPRN) are looking at
literature reviews in order to adapt COCOMO to the rural areas.
It would be relevant to consider a Health in All Policies strategy (HiAP). The 7 strategies that
could help address changes in the health of the community (county) are, 1. Developing a crossagency task force; 2. Synchronizing communication and messages; 3. Coordinating funding and
investments; 4. Incorporating health into decision-making processes at every level; 5.
Enhancing the work force by cross training; 6. Integrating research, evaluation and data; 7.
Implementing accountability structures. St Lawrence County is looking at using some of these
strategies not just in obesity prevention, but also in the Mental Health arenas.
Recently the American Medical Association (AMA) classified obesity as a disease. The AMA
compared obesity with tobacco stating that obesity is a disease with a significant public health
impact. By working together with the same messages, coordinated funding and incorporating
health in all policies, a difference could be made for people in St Lawrence county. The most
difficult problem is showing progress/change in a short period of time. It is usually 5 or 10 years
after a project has started before the benefits can be realized. Michele Obama’s “Lets Move”
with tools for organizing at many different levels has been effective. She’s an example of
inspiration for everyone. Something as easy as Plan, Purchase and Prepare can help people
manage food when on a budget or with limit funding for food. There is funding and movement
towards the Health and Wellness in the community. The 10 Essential Public Health services
describe the activities that all our communities should undertake and serve as the framework for
making healthier communities. It will be interesting to look at St Lawrence County’s statistics
in 2017.
121 Goal 1: Prevent Chronic Disease Strategy Area
Objective
Activities
Partners
Timeframe
1.
Reduce Obesity in
Children and
Adults
Create community
environments that
promote and support
healthy food and
beverage choices and
physical activity
Conduct an assessment of what is currently
being done in the community to promote
and support healthy food and beverage
choices and physical activity
SLHI – county-wide
By April 2014
Based on above assessment, promote
healthy choices in community using
existing agencies, organizations and
government entities
(GET HEALTHY ST. LAWRENCE)
Examples:
 Map out walking/cross country ski
routes
 Promote community gardens and local
Farmers Markets
Educate partners and residents on
Complete Streets vision
-Work together to increase breastfeeding in
St. Lawrence County
-Investigate Baby-Friendly Hospital status
and promote where indicated
-Utilize data from Electronic Health
Records as they are implemented
-Collaborate with providers
-Research what is being done
Measurement/
Evaluation
Assessment
completed
SLCPHD – link to all
participating websites
Hospitals – defined
service area
SLHI – county-wide
SLCPHD – link to all
participating websites
Begin June
2014 and
assess at least
quarterly
Increase the
number of hits on
the GET
HEALTHY ST.
LAWRENCE
links
January 2014
thru December
2015
Annually upon
release of State
data
2 municipalities per
year
Hospitals – defined
service area
SLHI
North Country
Prenatal/Perinatal
Council
% increase of WIC
mothers
breastfeeding at 6
months
Hospitals
Increase % of
mothers who
exclusively
breastfeed in
hospital
122 Goal 1: Prevent Chronic Disease Strategy Area
Objective
Activities
Partners
Timeframe
1.1 a
Reduce Obesity in
Children and Adults
Expand the role of
public and private
employers in obesity
prevention
Improve hospital meals served to:
patients, visitors, employees and (where
appropriate) LTC residents by: making
them trans-fat free; labeling healthy
choices in cafeteria meals; using local
produce; making healthier choices less
expensive than less-healthy items;
ensuring that there are healthier vending
machine choices for food products and
that there are fewer sugar sweetened
beverage (SSB) choices and that SSBs
are placed at the bottom of vending
machines and healthier options at eye
level
Ensuring that there are healthier
vending machine choices for food
products and that there are fewer sugar
sweetened beverage (SSB) choices and
that SSBs are placed at the bottom of
vending machines and healthier options
at eye level
Hospitals with
assistance from SLHI
Massena in
2014
Measurement/
Evaluation
X# of healthy
meals served
CantonPotsdam
2015
ClaxtonHepburn
2016
SLCPHD for St.
Lawrence County
Government
December
2015
# of healthy
vending machine
options and
changes in vending
machine sales
123 Strategy Area
Objective
Activities
Partners
Timeframe
1.1.b
Reduce Obesity in
Children and Adults
Expand the role of
public and private
employers in obesity
prevention
Promote and continue to expand
enhanced physical fitness opportunities
for hospital and county employees
including: aerobics, yoga, zumba,
bicycle racks, free gym use, wellness
policy, quarterly biometrics &
counseling, kayaking, 5k’s, health
coaching and use the stairs program
Adopt healthy meeting guidelines
Hospitals
SLCPHD
2014-2017
Assess
annually
SLHI
SLCPHD
Hospitals
2 partner
organizations
each year for 3
years
beginning
January 2014
SLHI
SLCPHD
Hospitals
Begin January
2014 and
quarterly
thereafter
1.1.c
Reduce Obesity in
Children and Adults
Prevent childhood
obesity through earlycare and schools
Promote available resources developed
in 1.1.b above
(GET HEALTHY ST. LAWRENCE)
with local schools and early childhood
providers to promote healthy living,
including physical activity and healthy
eating
Measurement/
Evaluation
X# of employees
using options / X#
of employees
6 partner
organizations
adopting Healthy
Meeting
Guidelines,
affecting over
5,000 people
124 Goal 1: Prevent Chronic Disease Strategy Area
Objective
Activities
Partners
Timeframe
1.2
Reduce tobacco use
among youth and
young adults
Prevent initiation of
tobacco use by youth
and young adults
Adopt an anti-tobacco marketing policy
SLCPHD
December
2014
Decrease the prevalence of any tobacco
use (cigarettes, cigars, smokeless
tobacco) by high school age students
SLCPHD
Begin 1/1/14
Assess baseline
December
2017
Decrease tobacco
use by 5%
1.3
Increase access to high
quality chronic disease
preventive care and
management in
clinical and
community settings
Expand the role of
health care and health
service providers and
insurers in obesity
prevention
Measurement/
Evaluation
Ensure that PCPs can easily link their
patients with available community
resources
Hospitals
Begin 1/1/16
EMR/EHR
documentation of
education
Assess number of providers who
provide the new reimbursable
preventive services
SLHI
Hospitals
Survey all
health care
providers by
end of 2014
and annually
thereafter
Document # of all
referrals made to
community
resources for diet
and exercise and to
breast feeding
specialist
Through educational programming,
increase the number of providers who
provide reimbursable preventive
services
SLHI
Hospitals
At least 1
educational
program per
hospital/
year
5% increase in
providers who
provide
reimbursable
preventive services
125 Strategy Area
Objective
Activities
Partners
Timeframe
Disparity: Improve
rates of colorectal
screening among lowincome adults
Utilize colorectal
screening program to
increase number and
percentage of lowincome adults who
receive colorectal
cancer screenings
Promote the Cancer Services Program
SLHI
SLCPHD
Hospitals
1/1/14 and
on-going
Provide employee reminders of all
wellness screenings which are now free
under the Affordable Care Act
Develop and promote common
messaging and PSA’s regarding free
preventive care and screenings and
work on marketing strategies
Measurement/
Evaluation
Increase the
number and
percentage of
colorectal cancer
screenings
completed
Decrease the rate of
colorectal cancers
that result in
premature death
through early
screening
126 Goal 2: Promote Mental Health and Prevent Substance Abuse Strategy Area
Objective
Activities
Support
collaboration among
leaders, professionals
and community
members working in
MEB health
promotion, substance
abuse and other
MEB disorders and
chronic disease
prevention,
treatment and
recovery
Educate referral
agents regarding
MEB-related
programs and
resources
Use web portal of SLHI (Inter-Agency Help
Net) that lists, updates and catalogues
resources
Train this committee
Partners
SLHI
Hospitals
SLCPHD
Time
frame
Measurement/
Evaluation
December
2014
# of trainings held
Partners take information back to their own
agencies and train their staff
Hospitals
SLCPHD
June 2015
# of staff trained and
# of accounts created
Input information and keep information
current.
Hospitals
SLCPHD
June 2015
Increase the # of
agencies with
information listed by
100%.
Increase # of posts.
Increased hits – usage
127 Strategy Area
Objective
Activities
Partners
Time
frame
June 2015
Measurement/
Evaluation
# of agencies
providing link
Educate referral
agents regarding
MEB-related
programs and
resources
Determine possibility of adding resource link
to Electronic Medical Records
Hospitals
Providers
Verify and update annually (possibly use
college intern)
Reminder sent annually by SLHI
SLHI
Hospitals
SLCPHD
June 2015,
then
annually
Intra-Agency
Health Network
updated
Promote the use of Reach Out Information
and Referral for MEB resources
SLHI
Hospitals
SLCPHD
Reach Out
December
2014
Posting of Reach
Out number on all
partner websites
Increase the number of partners that support
Suicide Coalition efforts
Suicide Coalition
December
2016
Add 3 hospital
memberships on
coalition (1 each
year)
128 Attachment D
Focus Group Notes
Group 1: 12 Male firefighters, Morristown
Missing
Seeing lots of cancer
Lack of services/care/protection for the elderly – alone, refuse help, lonely, need companionship
Autism? More kids diagnosed with it, affected by diet
Obesity
Doctors seem to be dispensing a lot of different prescriptions, over prescribing? And no one
coordinating all the medications a person is on? Too dependent on them? Lots of calls with
people on a multitude of prescriptions from many doctors. Seems to be with the elderly or those
on public assistance.
Not enough EMS – all volunteer, don’t bill, 450 calls a year, have to fundraise, plus required
training
Trends
Elderly too proud to access services
Increased welfare use
Fires caused by smoking and chimney fires – given away over 5000 smoke alarms, have fire
prevention education program, partner with schools
Drug over usage – more pain killer use, using friends prescriptions, prescription pain medication
is currency
Over use of emergency room – not going to the doctor and transported by them
90% of calls are not true emergencies
Poverty level – just over income levels
Sometimes service refused because of cost concerns, other times over used because it doesn’t
cost
129 Assets
Volunteer Fire Dept
OFA kitchen – 150 meals a day from here (could be used more)
Medical transportation available
Community supports fire dept. well/100%
-30,000 volunteer fire fighters per NYS from 107k
130 Group 2: Low-income group, approximately 10 females, 1 male
MISSING
Underage drinking lower than they thought – perception vs what is true
A lot of heart patients here
Access – fewer doctors accepting Medicaid, moms having to travel for prenatal care; uninsured
patients: dentists - not many taking Medicaid, transportation to the doctors is a problem if you
aren’t in one of the larger communities
Behavior problems with young children – pediatric psychologists shortage, child on a waiting
list, been on it a long time
Unemployment – no work – root of problems
Mental health causes many of the issues
Cuts in public health re prenatal care, breast feeding, funding cuts
Drugs in middle and high schools – going to greater lengths, handfuls of anything in the
medicine cabinets, drugs from their own homes, prescription drug abuse
Parties throwing pills in a bowl - Generational – following pattern, crime up due to drug use
Psych center closing?
Unemployment #’s not accurate – don't count those whose UI has expired, and partially or under
employed people
Colleges – lots of students from cities/urban areas–
Prison system – families moving to the area to be near inmates
Meth labs
Poverty – trying to get money any way they can
Prescription drug abuse – doctors automatically pulling out script pads
Mental Health – root, drug abuse to address MH issues, need for counseling earlier
Stigma of seeking counseling – afraid to go, no respect when they do go, no gun permit if you
do, effects job opportunities
Parents need to be more responsible – lock up prescriptions
131 Homeless #’s up? More friends staying with friend, or 2 or 3 families in one place, chronic
campers
Community gardens needed
Community book needed – blue book of resources and services
Need info on how to preserve food
Uncertainty of funding
Scholarships for kids camps needed
Need to get word out re programs and resources available
Some residents can’t afford computers and internet services nor have the skills to use one
Some food at pantries is not very healthy
School lunches – 51% qualify for free lunches, ala carte at breakfast is not healthy
Trends/Factors
Nickle and diming of programs, cutting of funds, Planned Parenthood cut
Free programs needed – college charges for gym, free zumba or other classes
SOAR – thru Potsdam for age 55+ $65 a year for facilities and classes
Family programs needed – no Y
Environmental – toxic dumping, 2nd in the country in cancer rates
Mistrust of authority
Homeland security trespassing
Lots of hunting and fishing – awareness of where and how often to consume fish from where
ASSETS
People who want to do things
Churches
Garden share
Farmers
132 CSA – food stamps (can be used if they have a EBT- swiper)
Bonus bucks – CSA is $150, can get $100 towards it
Wonderful interagency partnerships and sharing
Neighborhood centers are great assets– help make ends meet, fills in gaps
Food pantries at churches (one 30 to 66 families)
Holiday fund – Christmas presents to kids
Farmers markets – all over, but people think it’s too expensive, many accept EBT
CCE – teach how to preserve food
Elks $40 scholarship to play softball – very nice – groups do a lot for the community/give back
133 Group 3: The St. Lawrence County Community Health Improvement Collaborative
Missing
Break survey data down by zip code
Obesity
Heart disease is high, as is stroke
High cholesterol and blood pressure - at college (staff) health fairs
People don’t exercise – winter/ice a huge factor, house bound
Church dinners – all you can eat, unhealthy. May be an opportunity to introduce healthier
choices.
Access to mental health care – 6 month wait for county MH services
Veterans clinic at Massena MH has grown in last five years
Claxton – one week wait for MH services
School lunches – kids hungry, small portions, kids don’t like healthy options, kids buy 2 lunches,
give kids healthy choices
Backpack program to feed children on weekends– started 2 years ago
Farm to business could be expanded, use in schools – SUNY Potsdam Chef worked with school,
Claxton Hepburn cafeteria doing this
Sidewalks – lack of in general and near school
Bus kids who are within a mile of school – parents driving kids, no crossing guards, high # of
sex offenders near schools makes it difficult for kids to walk to school– a lot of fear, concern for
safety
Need to make communities more pedestrian friendly
Need for bike lanes
Prescription drug problem – Sheriff started a task force, Kinney’s conducts a take-back program
– police have to be there so cost involved, Massena PD has drug drop box, DEA has to pick up
Free clinic – over -booked, 2700 registered
FQHC (UCP) in Canton and Malone
134 Church free clinic - Governeur
Trends
Increasing unemployment – consistently at 10 – 12%, GM plant closed 5 years ago, several
layoffs
Alcoa – $800 million upgrade, modernize, company and jobs staying, 600 construction jobsvery good news
Newton Falls Paper Mill closed - 100 jobs, water and sewer system in jeopardy, collapsing
Food prices up
One grocery store per 95 miles vs one convenience store per 30 miles
Aging population – nursing homes lost, shortage, wait times
Gained an assisted living facility
College population – increased students, staff the same
SUNY Canton and Potsdam being asked to consolidate
ACA – affordable? Not enough doctors to serve all
Clarkson started PA program
Albany Med, Upstate sending students up here is positive
More on Medicaid?
FQHC applied for supplemental funding, problem getting providers
Physical therapy/rehab limited visits by insurance
Rescue squads losing volunteers, having a hard time recruiting
Airvac service new to area
Outmigration? Patients sent to Burlington and Syracuse depending on location, need and weather
Assets
Lots of unknown services – Price Chopper gives away anti-biotics and diabetes meds – free; free
screenings at hospitals, what are the barriers? Transportation and knowledge, lack of follow up
care, wait for crisis
135 Colleges – huge asset, students required to do community service projects, some health related,
foremost experts in the country at college
Access to care program (but losing this)
Cancer Services Program
ReachOut – mental health service, hotline, suicide prevention trainings
County suicide coalition
Governeur has military housing – some impact
Several employees from the military
Boys and Girls Club in Ogdensburg
Strong sports environment for kids – public goes whether their own kids are there or not
Fun runs, 5k’s
Lots of natural resources – trails, waterways, kayaks available
300,000 acres of fallow farm land – farmland very cheap, Amish moving in because land is so
cheap
Cost of living very reasonable – affordable housing, $150k very nice house (if you can get a job)
Food Hub – raw processing plant coming in Canton where Jubilee was, create jobs, United
Helpers doing it, food processing; sold in bulk, maybe commercial kitchen to develop products,
maybe cold storage to store products so can be sold throughout the year, got economic
development funding, maybe 2014, flash freezing and stored for year long use
Steve Knight – UH, visionary
Cooperation – willingness to work together
136 May 29, 2013
St. Lawrence County
Priority Setting Meeting
The process for the Community Health Assessment, Community Health Improvement Plan and
Community Service Plans were reviewed with the group, along with some key statistics and
findings from the various assessments to date. The consultants also reviewed the instructions for
the Hanlon method, following which participants rated the 13 highest identified needs in the
County. The Hanlon Scores, along with the scores from the PEARL factors follow:
1. Cancer 2. Heart Disease 11. Mental Health 6. Diabetes 8. Obesity 3. Cerebrovascular disease – stroke 9. Oral health 10. Substance Abuse 12. Tobacco use (two areas were reviewed) 4. Lead screening 13. CLRD 5. Cirrhosis 7. Breastfeeding hanlon 162.53 151.31 136.88 135.94 135.56 125.66 122.00 114.38 112.13 111.68 110.16 87.75 86.75 pearl 5.69 5.25 4.56 4.36 4.21 5.44 4.50 5.38 4.00 5.25 5.19 5.56 4.44 Based upon the above rankings, the group decided to focus their efforts on identifying strategies
and indicators in the areas of Chronic Disease and Mental Health/Substance Abuse.
Freidan’s Pyramid, St. Lawrence County indicators and the NYSDOH Prevention Agenda
Indicators for these two areas were reviewed with the group.
Discussion focused on what was doable that could make a difference. In the area of substance
abuse/mental health, several key points were made:






There are provider shortages. Over time an achievable objective could be set to increase
the supply
There are many programs and resources, but not all people, or referral agents, are aware
of them.
There are “grow your own” programs in place to develop some local providers in
conjunction with the local educational facilities, but these could be expanded and
relationships with out-of-area educational institutions could be expanded as well.
Behavioral health specialization should be considered as well.
Watertown Community College actually has an MSW program
The community in general and the health and human services community in particular are
not aware of all the services that are available.
Some programs have waiting lists and some are under-utilized
137 



There is a web-portal that the SLHI created that can list, update and categorize resources.
This was something that was seen as needed. Like NY Connects.
Need to communicate to public through media, and have a sustained campaign with
logo/theme/catchy phrase to let the public know about resources. Need to also reach the
justice community, law enforcement community and faith community.
Telehealth as a method of making providers accessible was discussed. Massena Hospital
has a veteran’s clinic that is implementing tele-mental health.
Root causes of the problems were discussed, with poverty (and weather) being huge
contributors to mental health and substance abuse problems. While nothing much could
be done about the weather, the group could have a role in educating the economic
development community and advocating for the importance (and cost-effectiveness) of a
more vibrant economy.
Chronic disease indicators and strategies were discussed. Indicators and objectives to focus on
within this area seemed to include:
 Working with primary care providers to train them about how to talk with their patients
about their weight, especially dividing goals into reasonable milestones, and helping the
PCPs to link their patients with community resources (including physical activity and
nutrition)
 Reducing colorectal cancer through expansion of colorectal cancer screening
 Physical activity and nutrition should be interwoven into existing programs such as Stepby-Step
 In some situations, with the mammoth system changes occurring, staying the same can
actually be an achievement
There is some good and trendable data on youth risk factors that can be shared with the group
(PNA).
Next steps: Consultants will write draft CHIP from the above discussion for review and revision
at the next meeting. Date for next meeting will be determined through a meeting Doodle.
138 Attachment E St Lawrence County Indicators For Tracking
Public Health Priority Areas, 2013-2017
Technical Notes About the Indicators For Tracking Public Health Priority Areas - New York
State - 2013-2017 Improve Health Status and Reduce Health Disparities
Indicator
1. Percentage of premature death
(before age 65 years)
St
Data Lawrence
Years
County
20082010
New
York
State
Data Links
NYS 2017
Objective
24.0
24.3 (Table)(Map)
21.8
2.
Ratio of Black nonHispanics to White nonHispanics
2.43+
2.12 (Table)(Map)
1.87
3.
Ratio of Hispanics to White
non-Hispanics
2.61+
2.14 (Table)(Map)
1.86
220.8
155.0 (Table)(Map)
133.3
4. Age-adjusted preventable
hospitalizations rate per 10,000
- Ages 18+ years
20082010
5.
Ratio of Black nonHispanics to White nonHispanics
0.80
2.09 (Table)(Map)
1.85
6.
Ratio of Hispanics to White
non-Hispanics
0.92
1.47 (Table)(Map)
1.38
7. Percentage of adults with health
insurance - Ages 18-64 years
2010 84.5 (82.886.2)
83.1 (Table)(Map)
(82.983.3)
100
8. Age-adjusted percentage of
adults who have a regular
health care provider - Ages 18+
years
2008- 80.0 (74.985.0)
2009
83.0 (Table)(Map)
(80.485.5)
90.8
Promote a Healthy and Safe Environment
Indicator
St
Data Lawrence
Years
County
New
York
State
Data Links
NYS 2017
Objective
9. Rate of hospitalizations due to
falls per 10,000 - Ages 65+
years
20082010
208.9
204.6 (Table)(Map)
Maintain
10. Rate of emergency department
visits due to falls per 10,000 Ages 1-4 years
20082010
783.2
476.8 (Table)(Map)
429.1
139 11. Assault-related hospitalization
rate per 10,000
20082010
1.3
4.8 (Table)(Map)
4.3
12.
Ratio of Black nonHispanics to White nonHispanics
0.00+
7.43 (Table)(Map)
6.69
13.
Ratio of Hispanics to White
non-Hispanics
0.00+
3.06 (Table)(Map)
2.75
14.
Ratio of low income ZIP
codes to non-low income ZIP
codes
1.57
3.25 (Table)(Map)
2.92
20082010
340.5
36.7 (Table)(Map)
33.0
16. Percentage of population that
lives in a jurisdiction that
adopted the Climate Smart
Communities pledge
2012
11.4
26.7 (Table)(Map)
32.0
17. Percentage of commuters who
use alternate modes of
transportation1
20072011
25.0
44.6 (Table)(Map)
49.2
18. Percentage of population with
low-income and low access to a
supermarket or large grocery
store2
2010
6.1
2.5 (Table)(Map)
2.24
19. Percentage of homes in Healthy
Neighborhood Program that
have fewer asthma triggers
during the home revisits
20082011
NA
12.9 (Table)(Map)
20
20. Percentage of residents served
by community water systems
with optimally fluoridated water
2012
73.2
71.4 (Table)(Map)
78.5
15. Rate of occupational injuries
treated in ED per 10,000
adolescents - Ages 15-19 years
Prevent Chronic Diseases
Indicator
St
Data Lawrence
Years
County
21. Percentage of adults who are
obese
2008- 29.1 (24.32009
34.0)
22. Percentage of children and
adolescents who are obese
20102012
New
York
State
Data Links
NYS 2017
Objective
23.2 (Table)(Map)
(21.225.3)
23.2
24.4
17.6 (Table)(Map)
NYC: 19.7
ROS: 16.7
23. Percentage of cigarette smoking
among adults
2008- 24.9 (20.02009
29.8)
16.8 (Table)(Map)
(15.118.6)
15.0
24. Percentage of adults who
receive a colorectal cancer
screening based on the most
recent guidelines - Ages 50-75
2008- 64.1 (57.670.1)
2009
66.3 (Table)(Map)
(63.569.1)
71.4
140 years
25. Asthma emergency department
visit rate per 10,000
20082010
63.8
83.7 (Table)(Map)
75.1
26. Asthma emergency department
visit rate per 10,000 - Ages 0-4
years
20082010
119.3
221.4 (Table)(Map)
196.5
27. Age-adjusted heart attack
hospitalization rate per 10,000
2010
18.7
15.5 (Table)(Map)
14.0
28. Rate of hospitalizations for
short-term complications of
diabetes per 10,000 - Ages 6-17
years
20082010
2.6
3.2 (Table)(Map)
3.06
29. Rate of hospitalizations for
short-term complications of
diabetes per 10,000 - Ages 18+
years
20082010
6.9
5.6 (Table)(Map)
4.86
Prevent HIV/STDs, Vaccine Preventable Diseases and Healthcare-Associated
Infections
Indicator
St
Data Lawrence
Years
County
New
York
State
Data Links
NYS 2017
Objective
30. Percentage of children with
4:3:1:3:3:1:4 immunization
series - Ages 19-35 months3
2011
61.7
47.6 (Table)(Map)
80
31. Percentage of adolescent
females with 3-dose HPV
immunization - Ages 13-17
years
2011
16.2
26.0 (Table)(Map)
50
32. Age-adjusted percentage of
adults with flu immunization Ages 65+ years
2008- 74.1 (67.880.4)
2009
75.0 (Table)(Map)
(71.578.5)
66.2
33. Newly diagnosed HIV case rate
per 100,000
20082010
1.8*
21.6 (Table)(Map)
14.7
34.
Difference in rates (Black
and White) of new HIV
diagnoses
s
59.4 (Table)(Map)
45.7
35.
Difference in rates
(Hispanic and White) of new HIV
diagnoses
s
31.1 (Table)(Map)
22.3
36. Gonorrhea case rate per
100,000 women - Ages 15-44
years
2010
22.9*
203.4 (Table)(Map)
183.1
37. Gonorrhea case rate per
100,000 men - Ages 15-44
years
2010
20.1*
221.7 (Table)(Map)
199.5
38. Chlamydia case rate per
100,000 women - Ages 15-44
2010
727.0
1619.8 (Table)(Map)
1,458
141 years
39. Primary and secondary syphilis
case rate per 100,000 males
2010
3.5*
40. Primary and secondary syphilis
case rate per 100,000 females
2010
0.0*
11.2 (Table)(Map)
0.5 (Table)
10.1
0.4
Promote Healthy Women, Infants, and Children
Indicator
41. Percentage of preterm births
St
Data Lawrence
Years
County
20082010
New
York
State
Data Links
NYS 2017
Objective
11.1
12.0 (Table)(Map)
10.2
42.
Ratio of Black nonHispanics to White nonHispanics
0.00+
1.61 (Table)(Map)
1.42
43.
Ratio of Hispanics to White
non-Hispanics
1.75+
1.25 (Table)(Map)
1.12
44.
Ratio of Medicaid births to
non-Medicaid births
0.94
1.10 (Table)(Map)
1.00
60.6
42.5 (Table)(Map)
48.1
0.54+
0.50 (Table)(Map)
0.57
45. Percentage of infants exclusively 2008breastfed in the hospital
2010
46.
Ratio of Black nonHispanics to White nonHispanics
47.
Ratio of Hispanics to White
non-Hispanics
0.56
0.55 (Table)(Map)
0.64
48.
Ratio of Medicaid births to
non-Medicaid births
0.78
0.57 (Table)(Map)
0.66
20082010
0.0*
23.3 (Table)(Map)
21.0
2011
48.4
69.9 (Table)(Map)
76.9
49. Maternal mortality rate per
100,000 births
50. Percentage of children who have
had the recommended number
of well child visits in
government sponsored
insurance programs4
51.
Percentage of children ages
0-15 months who have had the
recommended number of well
child visits in government
sponsored insurance programs
s
82.8 (Table)(Map)
91.3
52.
Percentage of children ages
3-6 years who have had the
recommended number of well
child visits in government
sponsored insurance programs
71.2
82.8 (Table)(Map)
91.3
53.
Percentage of children ages
12-21 years who have had the
recommended number of well
41.6
61.0 (Table)(Map)
67.1
142 child visits in government
sponsored insurance programs
54. Percentage of children with any
kind of health insurance - Ages
0-19 years
55. Percentage of third-grade
children with evidence of
untreated tooth decay
56.
2010 92.6 (90.994.3)
94.9 (Table)(Map)
(94.595.3)
100
2009- 18.1 (13.223.1)
2011
24.0 (Table)(Map)
(22.625.4)
21.6
2.33
2.46 (Table)(Map)
2.21
16.3
31.1 (Table)(Map)
25.6
0.00+
5.74 (Table)(Map)
4.90
s
5.16 (Table)(Map)
4.10
35.3
26.7 (Table)(Map)
24.2
s
2.09 (Table)(Map)
1.88
1.42+
1.58 (Table)(Map)
1.36
1.97
1.69 (Table)(Map)
1.56
2010 84.5 (82.386.7)
86.1 (Table)(Map)
(85.886.4)
100
28.4
18.0 (Table)(Map)
17.0
Ratio of low-income
children to non-low income
children
57. Adolescent pregnancy rate per
1,000 females - Ages 15-17
years
58.
Ratio of Black nonHispanics to White nonHispanics
59.
Ratio of Hispanics to White
non-Hispanics
60. Percentage of unintended
pregnancy among live births
61.
Ratio of Black nonHispanics to White nonHispanics
62.
Ratio of Hispanics to White
non-Hispanics
63.
Ratio of Medicaid births to
non-Medicaid births
64. Percentage of women with
health coverage - Ages 18-64
years
65. Percentage of live births that
occur within 24 months of a
previous pregnancy
20082010
2011
20082010
Promote Mental Health and Prevention Substance Abuse
Indicator
St
Data Lawrence
Years
County
New
York
State
Data Links
NYS 2017
Objective
66. Age-adjusted percentage of
adults with poor mental health
for 14 or more days in the last
month
20082009
11.3 (7.015.5)
10.2 (Table)(Map)
(8.711.7)
10.1
67. Age-adjusted percentage of
adult binge drinking during the
past month
2008- 21.8 (16.726.8)
2009
18.1 (Table)(Map)
(16.120.2)
18.4
68. Age-adjusted suicide death rate
per 100,000
20082010
6.8 (Table)(Map)
5.9
12.0
143 * Fewer than 10 events in the numerator, therefore the rate is unstable
+ Fewer than 10 events in one or both rate numerators, therefore the ratio is unstable
s Data do not meet reporting criteria
1- Alternate modes of transportation include public transportation, carpool, bike, walk, and
telecommute
2- Low access is defined as greater than one mile from a supermarket or grocery store in
urban areas or greater than ten miles from a supermarket or grocery store in rural areas
3- The 4:3:1:3:3:1:4 immunization series includes: 4 DTaP, 3 polio, 1 MMR, 3 hep B, 3 Hib,
1 varicella, 4 PCV13
4- Government sponsored insurance programs include Medicaid and Child Health Plus
Questions or comments: [email protected]
Revised: June 2013
*Disclaimer Privacy Policy Accessibility 144 Attachment F GLOSSARY OF ACRONYMS
ACA – Affordable Care Act
BRFSS – Behavioral Risk Factor Surveillance System
CDC – Centers for Disease Control and Prevention
CCE – Cornell Cooperative Extension
CHA – Community Health Assessment
CHIP – Community Health Improvement Plan
CLRD – Chronic Lower Respiratory Disease
CSA – Community Supported Agriculture
EBT – Electronic Benefit Transfer
EHR – Electronic Health Record
EMR – Electronic Medical Record
FQHC – Federally Qualified Health Center
GRAPI – Gross Rent as a Percentage of Household Income
IAHN – Inter-Agency Health Net
LPHSA – Local Public Health System Assessment
LTC – Long-Term Care
MAPP – Mobilization for Action through Planning and Partnerships
MEB – Mental, Emotional and Behavioral (Disorders)
MD – Medical Doctor
MPH – Masters Degree in Public Health
NACCHO – National Association of City and County Health Officials
NYS – New York State
NYSDOH – New York State Department of Health
NYSDOL – New York State Department of Labor
OFA – Office for the Aging
PEARL – Propriety, Economic Feasibility, Acceptability, Resources and Legality
PSA – Public Service Announcement
SLCPHD – St. Lawrence County Public Health Department
SLHI – St. Lawrence Health Initiative
SSB – Sugar Sweetened Beverages
SUNY – State University of New York
UH – United Helpers
145