Acronyms & Terminology vi

Executive Summary 1

Description of the Tri-County Area 6

Prioritizing Tri-County Community Health Issues 11

Leading Causes of Death And Disease 19

Access To and Delivery of Health Care 23

Education 26

Healthy Births 29

Mental Health 34

Nutrition 37

Physical Activity 39

Safe and Healthy Work Environment 41

Sexual Activity 43

Substance Abuse: Alcohol & Other Drugs 45

Tobacco Use 48

Unintentional Injury 50

Violent and Abusive Behavior 53

Populations of Special Concern 56

Native Americans 56

Residents with Disabilities 57

Older Residents 59

Lower Income Families 61

Youth Issues 63

Environmental Health 65

Next Steps 67

Bibliography 71

Appendix A-1: Priority Issues Identified During Community Workshops 73

Appendix A-2: Survey Findings from Community Workshops 74

Appendix A-3: Survey Findings on Health Concerns and Priorities 75

Appendix A-4: Focus Group Health Concerns and Priorities 76

Map 2 1: Median Household Income, 1997, by Minor Civil Division 8

Map 2 2: Percent of Population Below 100% of Poverty Level 9

Map 2 3: Percent of Population Below 150% of Poverty Level 10

Map 5 1: Provider Location for Franklin, Essex & Clinton Counties 24

Map 7 1: Low Weight Births 32

Map 7 2: Births to Teenage Mothers 33

Figure 2 1: Percentage of Employment by Major Sector (1993) 7

Figure 2 2: Poverty Indicators for the Tri-County Area 7

Figure 4 1: Leading Causes of Death in the Tri-County Area 20

Figure 4 2: Leading Causes of Death in the Tri-County Area and Upstate New York, as Compared to Healthy People 2000 Objectives 21

Figure 4-3: Incidence of Disease: Comparative Rates for the Tri-County Area and Upstate New York 22

Figure 6 1: Academic Failure Percentage in the Tri-County Area 26

Table 2 1: Population by Age Group 6

Table 3 1: Tri-County Health Status Compared to Healthy People 2000 Objectives 15

Table 3 2: Tri-County Rates Exceeding the Healthy People 2000 Objective, by Percentage Above the Objective 14

Table 3 3: Summary of Tri-County Community Health Priorities, According to Type of Community Input, Listed in Order of Priority 18

Table 6 1: Education Indicators for the Tri-County Area 27

Table 7 1: Healthy Birth Indicators: Comparative Rates of Occurrence 30

Table 8 1: Mental Health Objectives 35

Table 8 2: Mental Health Indicators, 1994 36

Table 12 1: Rates of Teen Pregnancies and Births; STDs 44

Table 13 1: Substance Abuse Indicators, 1994 46

Table 13 2: Relative County Rankings of Youth AODA Risk 46

Table 13 3: Youth Alcohol and Other Drug Consequences, 1994 47

Table 15 1: Unintentional Injury Indicators 51

Table 16 1: Rates of Violent Abuse Behavior 55