Why Is This Important?

Overall, congenital malformations, deformations and chromosomal abnormalities are the leading cause of infant death (20.1% of deaths). Disorders related to short gestation and low birth weight are second, making up 16.6% of deaths. However, it is important to keep in mind that cause of death varies over the first year of life, and combining all causes during the first year of life obscures the importance of sudden infant death syndrome as the leading cause of death in the postneonatal period.

Why Is This Important?

Low birthweight increases the risk for infant mortality and morbidity. As birthweight decreases, the risk for death increases. Low birthweight infants who survive often require intensive care at birth, may develop chronic illnesses, and later may require special education services. Health care costs and length of hospital stay are higher for low birthweight infants.

What Is Being Done?

The Maternal Health Program collaborates with the UNM Maternal & Family Planning (M & FP) and Presbyterian Medical Group perinatologists to provide care to high risk, medically indigent women. These services are provided to patients free of charge through the High Risk Prenatal Care Fund (HRF) at the UNM Health Sciences Center in Albuquerque, UNM outreach clinics and Presbyterian hospitals and clinics throughout the State. UNM maintains the Physician Access Line for Service (PALS), providing statewide access to a perinatologist 24/7 for telephone consultations and to arrange transport for patients requiring intensive management at the university, including women in preterm labor. Additionally, UNM Telemedicine offers the High Risk Pregnancy direct patient evaluation, real-time fetal ultrasound analysis and counseling whereby remotely practicing physicians can access specialty services for patients.

This network of care and screening is designed to prevent low birthweight births through specialized care to the mother. These high risk providers are the most likely to anticipate and recognize preterm labor and other conditions where delivery at a tertiary care center is desirable and make appropriate transfers of care to them. Women in premature labor or with other pregnancy related complications may transfer out of the state if another tertiary care center is closer than Albuquerque. Albuquerque has the only two level one neonatal intensive care units in the state. Data on which facilities these women transfer to is not available.

Why Is This Important?

Birth defects pose a significant public health problem. One in 33 babies is born with a structural birth defect in the United States. Birth defects are a leading cause of infant mortality and responsible for considerable morbidity with enormous economic and social costs.

In 1992, the U.S. Public Health Service recommended that women of childbearing age increase consumption of the vitamin folic acid to reduce the number of spina bifida and anencephaly cases in the United States. By 1998, <30% of women were following this recommendation. In 2001, researchers from CDC determined that the overall birth prevalence of these two neural tube defects declined 19% after mandatory folic acid fortification.

Healthy People 2010 Objective 16.15:

Spina bifida and other neural tube defects (new cases per 10,000 live births)
U.S. Target for 2010: 3

Why Is This Important?

Breastfeeding provides a variety of important benefits for infants, mothers, families, society, and environment. It is the normal, preferred feeding for all infants, including premature and sick babies, with rare exceptions (American Academy of Pediatrics, 1997). Breast milk benefits the newborn infant by providing the ideal balance of nutrients, enzymes, immunoglobulin, anti-infective and anti-inflammatory substances, hormones, and growth factors. Breastfeeding helps the mother return to the physiologic pre-pregnant state. It benefits both mother and child by providing a time of intense, nurturing, maternal-infant interaction. In addition, breastfeeding provides social and economic benefits to the family, including reduced health care costs and reduced employee absenteeism for care related to children's illnesses.

Risk and Resiliency Factors

In the event that a mother is separated from her newborn (due to medical condition of mother or baby), a hospital-grade breast pump should be provided and utilized to establish successful lactation.

What Is Being Done?

The New Mexico Women, Infants and Children (WIC) Program WIC supports over 70% of NM women giving live birth, either prenatally or postpartum and promotes and supports breastfeeding.

WIC Breastfeeding Promotion activities include: training of professional and paraprofessional staff, providing grants to local agencies for "Peer Counseling Programs," providing hand pumps and electric pumps to WIC mothers, and developing written policies for WIC clinics that promote breastfeeding.

State and Federal laws protect pumping of breast milk in the workplace: USE OF A BREAST PUMP IN THE WORKPLACE: NMSA 1978, Section 28-20-2 (amended 2007) requires employers to provide flexible break time, and a clean, private space, not a bathroom, in order to foster the ability of a nursing mother who is an employee to use a breast pump in the workplace.

Healthy People 2010 Objective 16.19a:

Breastfeeding - In early postpartum period
U.S. Target for 2010: 75%

Why Is This Important?

Asthma is a chronic inflammatory disease characterized by wheezing, coughing, breathlessness and chest tightness resulting from the constriction of the airways. Although the cause(s) of asthma is(are) unknown, asthma symptoms can be triggered by allergens or irritants such as tobacco smoke, dust, animal dander, air pollution, pollen, dust mites, mold, exercise, cold air, or stress.

More than 22 million Americans have asthma, and it is one of the most common chronic diseases of childhood, affecting an estimated 6 million children. The burden of asthma affects the patients, their families, and society in terms of lost work and school, lessened quality of life, and avoidable emergency department (ED) visits, hospitalizations, and deaths.

Effective management is the key to preventing recurrent exacerbations of asthma and minimizing the need for ED visits or hospitalizations.

Risk and Resiliency Factors

Asthma event triggers or risk factors include viral infections, allergens (like pollen in the air, molds, the house dust mite, cockroach droppings, or foods), or irritants (like smoke and other air pollution) and pets.

What Is Being Done?

New Mexico Department of Health Asthma Program collects, analyzes, and disseminates asthma data in order to identify populations that have high rates. The Program then works with partners throughout the state (such as hospitals, physician groups, insurance plans, and schools) to design and implement health interventions to lessen the disease burden. In many cases these interventions have been designed with evaluation components in order to measure effectiveness. Current interventions include providing asthma self-management education to pediatric patients, supporting indoor air quality assessments of schools so as to limit exposures to potential asthma triggers, and offering provider training on the NAEPP asthma medical guidelines.

Evidence-based Practices

There is no cure for asthma, but there are ways to keep it under control. The majority of problems associated with asthma, including hospitalization, are preventable if asthma is managed according to established guidelines. Effective management includes control of exposure to factors that trigger exacerbations, adequate pharmacological management, continual monitoring of the disease, and patient education in asthma care.

The most effective ways of preventing asthma at home are minimizing dust, cleaning up mold, eliminating irritants, controlling pet dander, and eliminating smoking.

Remember:
--Have regular check-ups with your doctor.
--Follow your asthma care plan and take medications as prescribed.
--Eliminate your exposure to triggers.
--Do not allow smoking in your home or car.
--Regularly clean your home and car to reduce triggers.
--Avoid being outdoors during high pollution hours.

Healthy People 2010 Objective 1.9a:

Hospitalization for ambulatory-care-sensitive conditions - Pediatric asthma (admissions per 10,000 population, ages under 18 years)
U.S. Target for 2010: 17.3/10,000 population

Why Is This Important?

Environmental lead is a common toxic metal, present in all areas of the United States. Lead exposure and lead poisoning is preventable. Lead exposure can affect nearly every organ and system in the body, adversely affecting the nervous, blood, hormonal, kidney, and reproductive systems. Children are more vulnerable to lead poisoning than adults. Children from all social and economic levels can be affected. The bodies of young children absorb lead more readily than adults. During the first three years of life, children's brains are growing the fastest, developing the critical connections in the nervous system that control thought, learning, hearing, movement, behavior, and emotions. The normal behaviors of children at this age, such as crawling, exploring, teething, and putting objects in their mouth, put them at an increased risk for lead exposure. Even blood lead levels lower than 10 micrograms per deciliter (ug/dL) may be associated with negative outcomes for children, such as cognitive impairment, delayed development, changes in behavior, kidney problems and anemia. There is no known safe level of exposure to lead. The state requires all children enrolled in Medicaid be tested for lead exposure at ages 12 months and 24 months.

Why Is This Important?

Early pregnancy and childbearing is closely linked to a host of other critical social issues, including poverty and income disparity, overall child well-being, out-of-wedlock births, and education, to name just a few. Simply put, if more children in this country were born to parents who are ready and able to care for them, we would see a significant reduction in a host of social problems afflicting children in the United States, from school failure and crime to child abuse and neglect.

Teen childbearing is costly to the public sector - federal, state, and local governments and the taxpayers who support them. Reducing teen pregnancy will enhance overall child well-being. The children of teen mothers bear the greatest burden of teen pregnancy and childbearing, and are at significantly increased risk for a number of economic, social, and health problems.

Preventing teen pregnancy is critical to improving not only the lives of today's young women and men but also to enhancing the future prospects of their children. Indeed, one of the surest ways to improve overall child well-being is to reduce the proportion of children born to teen mothers.

Linking Teen Pregnancy Prevention to Other Critical Social Issues, March 2010, National Campaign to Prevent Teen Pregnancy. Washington DC.

How Are We Doing?

The rate of births to 15-17 year old girls in New Mexico has decreased steadily from 46.4/1,000 girls in 1990 to 29.2 in 2010. Northern New Mexico health regions consistently had the lowest teen birth rates, while the southeastern region had the highest rates. Hispanic teens have the highest birth rates both in New Mexico and nationally. Almost half of the population of females ages 15-17 years in New Mexico is Hispanic, yet they account for 70% of the births to this age group. (The State of Health in New Mexico 2011).

Birth rates to NM teens 15-17 years by race/ethnicity 2000-2010:

Birth rates for American Indian teens decreased by 31%
Birth rates for Hispanic teens decreased by 31%
Birth rates for African American teens decreased by 44%
Birth rates for White teens decreased by 48%

What Is Being Done?

Clinical reproductive health services are provided at all local health offices, and some community health centers and school-based health centers and a detention center. Services are also provided with a network of medical care providers through provider agreements where the Program provides medical supplies and contraceptives and the clinician provides medical care and oversight.

NM DOH Family Planning Program funds the Teen Outreach Program (TOP) at 27 sites in 10 counties. TOP is a service learning program designed to prevent teen pregnancy and academic failure while promoting positive youth development. TOP sites are in Taos county, San Miguel county, Bernalillo county, Dona Ana county, Luna county, Sierra county, Chaves county, Valencia county, Cibola county, and Torrance county. These sites also implement Raices y Alas parent-teen communication workshops. The workshops are designed to increase parents' confidence in talking with their children about sex and sexual health topics.

In addition to this programming, these State agencies provide teen pregnancy prevention programming:

Office of School and Adolescent Health provides primary care and behavioral health care at School Based Health Centers. Family planning services are provided where approved by the school district.

Children Youth and Families Department (CYFD) in collaboration with New Mexico Teen Pregnancy Coalition, supports the Young Father's Program, which is a network of mentorship and support services for high-risk young males 26 years of age or younger. CYFD also supports other fatherhood programs statewide.

Public Education Department supports the Graduation, Reality and Dual-Role Skills (GRADS) Program a vocational, in-school drop out recovery and intervention program for pregnant and parenting adolescent families, pregnancy prevention programs for traditional students, Career Readiness, Youth Development and on-site childcare.

Effective June 1, 2011 the Human Services Department changed the family planning waiver to a state plan service, which expands Medicaid coverage to: 1) cover men whose income is below 185 percent of the federal income poverty level; and 2) cover men and women without age restriction.

Evidence-based Practices

The New Mexico Department of Health and the New Mexico Teen Pregnancy Coalition recommend these strategies to reduce teen pregnancy:

Family Planning Services offer access to confidential reproductive health services at low or no cost. In NM, services are provided at all local public health offices, and some community health centers and school-based health centers.

Service learning programs engage youth in constructive activities to build on their strengths and interests, and increase their motivation to delay childbearing by providing positive alternatives and leadership opportunities. The Teen Outreach Program (TOP) decreases teen pregnancy and increases school success, with curriculum-guided activities and community based volunteer service throughout the school year.

Adult-teen communication programs give adults information and skills to communicate effectively with young people about reducing risky sexual behavior. Parents influence teen decisions about sex more than their friends, the media, or their siblings. Raices y Alas, a two-hour workshop for parents of adolescents, is designed to increase parents' confidence in talking with their children about sex and sexual health topics.

Comprehensive sex education like Cuidate! teach that abstinence is the best method for avoiding sexually transmitted infections and unintended pregnancy, and also teach about the use of condoms and contraception. These programs help youth to make responsible decisions and to develop healthy life skills and healthy relationships.

Male clinical and educational services provide access to reproductive health care for men and promote the importance of men's role in teen pregnancy prevention.

Healthy People 2010 Objective 9.7:

Adolescent pregnancy (per 1,000 population, ages 15 to 17 years)
U.S. Target for 2010: 43

Why Is This Important?

Alcohol-related death, injury, and disease are a serious public health problem in the United States and in New Mexico. In the United States, alcohol is the third leading actual cause of death (after tobacco and poor diet/physical inactivity), responsible for more than 75,000 deaths per year.

Excessive alcohol consumption contributes to many different poor health outcomes. Chronic heavy drinking (defined as drinking more than two drinks a day for men and more than one drink a day for women) contributes to a variety of alcohol-related chronic diseases, including liver cirrhosis and alcohol dependence. Episodic heavy (or binge) drinking (defined as drinking five or more drinks on a single occasion for men and four or more drinks on a single occasion for women) contributes to a variety of alcohol-related injuries, including motor vehicle crashes, poisonings, falls, homicides, and suicides.

According to the most recent available comprehensive estimate, the annual cost of alcohol-related harm in the United States, in 1998, was roughly 185 billion dollars per year (NIAAA, http://pubs.niaaa.nih.gov/publications/economic-2000/index.htm). This estimate included health care costs, economic costs such as the cost of lost productivity, and the cost of other effects of alcohol on society such as crime and motor vehicle crashes. Given trends in the component costs since the time of this report, this estimate likely represents a substantial underestimate of current alcohol-related costs in the United States.

In 2006, the cost of alcohol abuse in New Mexico was estimated, based on this national estimate, to be $2.5 billion. The economic burden of alcohol abuse amounted to over $1,250 for every person in the state (NMDOH, http://nmhealth.org/ERD/HealthData/SubstanceAbuse/ER%20Alcohol%20related%20costs%20112309.pdf).

How Are We Doing?

Alcohol-related death rates declined in the United States during the 1980s and 1990s, driven by reductions in some of the major causes of alcohol-related death such as alcohol-related liver disease and alcohol-related motor vehicle crashes. Alcohol-related death rates have been increasing in the U.S. in the 2000s as a result of increasing rates of alcohol-related injury death.

Evidence-based Practices

There is a large body of evidence on effective strategies to prevent excessive alcohol use and alcohol-related harm. In the past decade, this evidence base has been the subject of numerous systematic expert reviews to assess the quality and consistency of the evidence for particular strategies; and to make recommendations based on this evidence. These expert reviews have recently been summarized by the NMDOH. The following list summarizes the evidence-based prevention strategies that are well-recommended by experts; and that could be more widely or completely implemented in New Mexico to reduce our alcohol-related problems:

http://ibis.health.state.nm.us/docs/Evidence/EvidenceBasedExcessiveAlcoholUsePrevention.pdf

To access this list, please copy and paste this URL into your browser.

The following is a bit more information on prevention in general, and alcohol-related prevention in particular.

Primary prevention attempts to stop a problem before it starts. In New Mexico, primary prevention of alcohol-related health problems has focused on regulating access to alcohol and altering the alcohol consumption behavior of high-risk populations. Regulatory efforts have included increasing the price of alcohol (shown to be effective in deterring alcohol use among adolescents), establishing a minimum legal drinking age, regulating the density of liquor outlets, and increasing penalties for buyers and servers of alcohol to minors. DWI-related law enforcement (e.g., sobriety checkpoints), when accompanied by media activity, can also be an important form of primary prevention, increasing the perceived risk of driving after drinking among the general population.

Secondary prevention efforts try to detect and treat emergent cases before they cause harm. Screening and brief interventions (SBI) for adults in primary care settings is an evidence-based intervention to address problem drinking before it causes serious harm. Implementing this intervention more broadly in New Mexico primary care settings could help reduce our serious burden of alcohol-related chronic disease and injury.

Tertiary prevention involves the treatment of individuals diagnosed with alcohol use disorders so they can recover to the highest possible level of health while minimizing the effects of the disease and preventing complications. According to the most recent estimates from the National Survey on Drug Use and Health (NSDUH, http://oas.samhsa.gov/2k7State/NewMexico.htm#Tabs), roughly 130,000 New Mexicans report past-year alcohol dependence or abuse, indicating an acute need for treatment.

However, fewer than one in ten people in need of treatment receives it.

Nationally, the most common reasons that people who need and seek treatment do not receive it are because: they have no health insurance and cannot afford the cost; they are concerned about the possible negative effect on their job; or they are not ready to stop using.

Meanwhile, evidence from the NSDUH suggests that the vast majority (more than 90%) of people in need of treatment in the U.S. do not feel they need treatment; and do not seek it (see recent national estimates at http://oas.samhsa.gov/NSDUH/2k9NSDUH/2k9Results.htm#Fig7-10).

These findings emphasize the importance of pursuing effective primary and secondary prevention strategies in addition to treatment.

Why Is This Important?

Alcohol-related death, injury, and disease are a serious public health problem in the United States and in New Mexico. In the United States, alcohol is the third leading actual cause of death (after tobacco and poor diet/physical inactivity), responsible for more than 75,000 deaths per year.

Excessive alcohol consumption contributes to many different poor health outcomes. Chronic heavy drinking (defined as drinking more than two drinks a day for men and more than one drink a day for women) contributes to a variety of alcohol-related chronic diseases, including liver cirrhosis and alcohol dependence. In the most recent three-year period for which death data is available (2007-2009) the five leading causes of alcohol-related chronic disease death in New Mexico (and the corresponding death rate per 100,000 population) were: alcohol-related chronic liver disease (14.4 deaths per 100,000); alcohol dependence (5.1 deaths per 100,000); hypertension (0.7 deaths per 100,000); alcohol abuse (0.6 deaths per 100,000); and hemorrhagic stroke (0.4 deaths per 100,000). Alcohol-related chronic liver disease was the leading cause of alcohol-related death in New Mexico, with a rate almost twice the second leading cause (falls injuries).

How Are We Doing?

Alcohol-related chronic disease death rates have declined steadily in the United States in recent decades, driven by reductions in alcohol-related liver disease, the major cause of alcohol-related chronic disease death.

Evidence-based Practices

There is a large body of evidence on effective strategies to prevent excessive alcohol use and alcohol-related harm. The following list summarizes the evidence-based prevention strategies that are well-recommended by experts; and that could be more widely or completely implemented in New Mexico to reduce our alcohol-related problems:

http://ibis.health.state.nm.us/docs/Evidence/EvidenceBasedExcessiveAlcoholUsePrevention.pdf

To access this list, please copy and paste the URL into your browser.

For more information on this topic, see the "Evidence-based Practices" section of the Alcohol-Related Deaths indicator report (http://ibis.health.state.nm.us/indicator/important_facts/AlcoholRelatedDth.html).

Why Is This Important?

Alcohol-related death, injury, and disease are a serious public health problem in the United States and in New Mexico. In the United States, alcohol is the third leading actual cause of death (after tobacco and poor diet/physical inactivity), responsible for more than 75,000 deaths per year.

Excessive alcohol consumption contributes to many different poor health outcomes. Episodic heavy (or binge) drinking (defined as drinking five or more drinks on a single occasion for men and four or more drinks on a single occasion for women) contributes to a variety of alcohol-related injuries, including motor vehicle crashes, poisonings, falls, homicides, and suicides. In the most recent three-year period for which death data is available (2007-2009) the five leading causes of alcohol-related injury death in New Mexico (and the corresponding death rate per 100,000 population) were: falls injuries (7.3 deaths per 100,000); motor vehicle traffic crashes (5.3 deaths per 100,000); non-alcohol poisoning (5.1 deaths per 100,000); suicide (4.2 deaths per 100,000); and homicide (3.4 deaths per 100,000). While alcohol-related motor vehicle traffic crash death rates have declined dramatically in the past 30 years, other alcohol-related injury death rates have remained stable or increased.

How Are We Doing?

Alcohol-related injury death rates declined in the United States during the 1980s and 1990s, but they have been increasing in the 2000s as a result of increasing rates of alcohol-related falls injury and non-alcohol poisoning deaths.

Evidence-based Practices

There is a large body of evidence on effective strategies to prevent excessive alcohol use and alcohol-related harm. The following list summarizes the evidence-based prevention strategies that are well-recommended by experts; and that could be more widely or completely implemented in New Mexico to reduce our alcohol-related problems:

http://ibis.health.state.nm.us/docs/Evidence/EvidenceBasedExcessiveAlcoholUsePrevention.pdf

To access this list, please copy and paste the URL into your browser.

For more information on this topic, see the "Evidence-based Practices" section of the Alcohol-Related Deaths indicator report (http://ibis.health.state.nm.us/indicator/important_facts/AlcoholRelatedDth.html).

Why Is This Important?

For many years, New Mexico has been among the top U.S. states for drug-induced death, largely due to the high rates of unintentional drug poisoning or overdose. Although the burden from illicit drugs remains high, there has been a considerable rise in prescription drug overdose death in New Mexico and other U.S. states. In 2007, drug overdose was the leading cause of unintentional injury death in New Mexico and accounted for 9.6% of lost life due to premature death, among all causes of death.

In the U.S., drug overdose is the second leading cause of unintentional injury death behind motor vehicle crashes, but is the leading cause of injury death among persons 35 to 54 years of age. In 2007, unintentional drug overdose accounted for 6.0% of lost life due to premature death among all causes of death in the U.S.

In addition to the high death rates, drug abuse is one of the most costly health problems in the U.S. , estimated at $180.8 billion in 2002 according to costs of illness studies by the National Institutes of Health. (http://www.whitehousedrugpolicy.gov/publications/economic_costs/). Drug abuse disorders are associated with a number of well-recognized sequelae: health consequences and their impacts on the health care system; criminal behavior, violence and participation in the drug trade, as a means for income; and job loss, with subsequent dependence on societal safety nets.

Healthy People 2010 Objective 15.8:

Deaths from poisoning (age adjusted per 100,000 standard population)
U.S. Target for 2010: 1.5/100,000 population

Why Is This Important?

Chlamydia is the most common bacterial sexually transmitted disease. Even though symptoms of chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur "silently" before a woman ever recognizes a problem(1). It is the leading preventable cause of infertility, and screening and treatment are the best means of preventing it.

Risk and Resiliency Factors

Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.

Any sexually active person can be infected with chlamydia. The greater the number of sex partners, the greater the risk of infection.

Evidence-based Practices

Despite an A recommendation from the U.S Preventive Services Task Force to annually screen all sexually active females under age 25, data from health plans shows that fewer than 50% of that group actually gets screened each year. Chlamydia is the leading preventable cause of infertility, and screening and treatment are the best means of preventing it.

Why Is This Important?

Diseases of the heart is the leading cause of death in New Mexico and is a major source of disability. In 2009, diseases of the heart accounted for over 20% of all deaths in New Mexico.

Risk and Resiliency Factors

Risk factors for heart disease include: high blood pressure, abnormal cholesterol, prediabetes, diabetes, tobacco use, secondhand smoke exposure, physical inactivity, poor nutrition and excess weight. Controlling and preventing these risk factors is crucial in reducing risk of developing heart disease as well as death from heart disease.

How Are We Doing?

The trend in deaths from diseases of the heart has been decreasing, primarily due to decreased tobacco use and secondhand smoke exposure, as well as improved control of blood pressure and cholesterol through pharmacologic and lifestyle means. Advances in medicine has also contributed to the decrease, leading to more people surviving following an event. Despite this, the trend for some risk factors have been increasing (e.g., diabetes and obesity). Therefore, it is important to acknowledge that the declining trend in death could be reversed in the future.

Evidence-based Practices

Promote heart-healthy and stroke-free worksite policies and programs, such as smoke-free workplaces, wellness programs, and insurance coverage of preventive health services for employees. Work with health care providers to make system changes, such as automated reminders from providers to patients, that help increase the number of people who bring their blood pressure under control. Coordinate stroke prevention efforts to ensure that systems of care provide the highest quality of stroke care for all. Promote training and standard protocols for emergency medical service staff.
Source: Heart Disease and Stroke Prevention Addressing the Nation's Leading Killers AT A GLANCE 2010
URL: http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2010/dhdsp.pdf

Why Is This Important?

Stroke is the fifth leading cause of death in New Mexico.

Risk and Resiliency Factors

Risk factors for stroke include: high blood pressure, abnormal cholesterol, prediabetes, diabetes, tobacco use, physical inactivity, poor nutrition and excess weight. Controlling and preventing these risk factors is crucial in reducing risk of developing cerebrovascular disease as well as death from stroke.

How Are We Doing?

The trend in deaths from cerebrovascular disease has been decreasing, primarily due to improved control of blood pressure and cholesterol through pharmacologic and lifestyle means, as well as advances in medicine so more people can survive following an event. Despite this, the trend for other risk factors have been increasing (e.g., diabetes and obesity). Therefore, it is important to acknowledge that the declining trend in death could be reversed in the future.

Healthy People 2010 Objective 12.7:

Stroke deaths (age adjusted per 100,000 standard population)
U.S. Target for 2010: 48/100,000 population

Why Is This Important?

Diabetes is the 6th leading cause of death for New Mexicans and the 7th leading cause in the U.S. Diabetes complications, costly to individuals, families and to society, include premature death, cardiovascular disease, blindness, end stage kidney disease, and lower extremity amputations. People with diabetes are two to four times more likely to develop cardiovascular disease and stroke; about 65% of deaths in people with diabetes nationwide are due to these conditions. Costs of diabetes extend beyond medical costs, such as costs due to lower productivity, disability and loss of productive life due to premature death. Improvements are necessary at the individual, health system and societal levels to reverse the increasing rates of diabetes in our communities.

Risk and Resiliency Factors

There are many inter-related risk factors that contribute to diabetes-related deaths in complex and not always straightforward ways. They range from personal behaviors, such as not taking personal responsibility for one's self-management, to socio-economic issues, such as living in poverty or living in neighborhoods with no services.

How Are We Doing?

New Mexico age-adjusted diabetes death rates have generally fluctuated around 30 to 35 deaths per 100,000 persons from 1999 to 2010. The number of diabetes deaths ranged from a low of 500 in 2000 to a high of 642 deaths in 2007.

Race/Ethnicity Rates: The NM American Indian population had the highest diabetes death rates; the NM White Non-Hispanic population had the lowest rates; the Hispanic rates were in the middle. For each time period, the Native American rates were three times the White rates and the Hispanic rates were twice the White rates; these differences are all statistically significant. Due to small numbers, it's harder to determine whether statistical differences exist between diabetes mortality rates for Black/African Americans and Asian/Pacific Islanders compared to other groups? rates. Nonetheless, the Black/African American rates were statistically higher than the White rates for the three time periods.

What Is Being Done?

The DPCP provides multiple diabetes prevention and management services and programs. In each case, DPCP works with health care providers and community agencies and coalitions. Services and programs include: professional development trainings and resources for diabetes self-management education (DSME), pre-diabetes, diabetes and tobacco, and diabetes and depression; proven community-based physical activity and nutrition programs to prevent diabetes, such as the National Diabetes Prevention Program, or help people manage their diabetes, such as Kitchen Creations Cooking Schools; and, clinic system projects to improve health indicators such as blood glucose, blood pressure, and cholesterol.

The DPCP and its partners conduct education campaigns about pre-diabetes and diabetes and support built environment improvements so people at risk for or with diabetes can be physically active. The DPCP consults with populations that are disproportionately affected by diabetes to develop programs and services that are culturally appropriate for those populations.

Evidence-based Practices

Diabetes and its complications can be prevented and managed through four main strategies: policy, clinical/health systems, community, and communication. The CDC Division of Diabetes Translation provides the following examples as effective practices.

Policy: Reimbursement policies influence access to services needed by people with diabetes and pre-diabetes. Such policies include: patient insurance copayments; physician reimbursement incentives and performance-based payment; value-based insurance designs; financial reimbursement for diabetes self management education and chronic disease self management programs; reimbursement for community health workers who provide self-management education and support services for people with diabetes; and public insurance medications and testing supplies reimbursement. Health care organization policies that support quality care improvements for people with diabetes/ pre-diabetes are also important.


Clinical/Health Systems: Clinical and health system strategies include improving delivery and quality of care in clinical settings through professional education and evidence-based delivery models. Another strategy includes expanding the role of and supporting allied health professionals, such as pharmacists and community health workers, in providing diabetes self-management education, particularly those who serve high risk populations.

Community: Community-based strategies include: expanding the reach of community diabetes self-management education (DSME) and chronic disease self-management support (CDSMS) programs within vulnerable populations with greatest diabetes burden/risk; implementing worksite policies/ environmental supports that encourage improved control of blood glucose, blood pressure, and cholesterol; and increasing access to tobacco cessation services, such as quit lines, for people with diabetes who smoke.

Communication: Communication efforts include those, such as targeted education campaigns, that reinforce the policy, clinical/health system, and community interventions listed above.

Why Is This Important?

Breast cancer accounts for one-third of all cancer cases in women, but less than 20 percent of the cancer deaths. Among New Mexican women, breast cancer is the most commonly diagnosed cancer, and is the second leading cause of cancer death. Over 50% of all breast cancers diagnosed in New Mexico are detected at early stages (in situ or localized). In New Mexico, the five-year survival rate among women diagnosed with early-stage cancer between 1999 and 2003 was 98%. The survival rate fell to 81% when the cancer was detected at a regional stage, and 25% when detected at a distant stage. The most effective strategy for detecting early-stage breast cancer is undergoing a screening mammogram every one or two years beginning at age 40.

How Are We Doing?

The rate of death from breast cancer among New Mexican women has declined over the past two decades.

What Is Being Done?

The New Mexico Breast and Cervical Cancer Early Detection Program (BCCP) is dedicated to improving access to high-quality breast and cervical cancer screening and diagnostic services for women who are underserved. The BCCP also works to increase public awareness through education about prevention, disease processes, and the importance of annual screening for early detection. Visit the New Mexico Breast and Cervical Cancer Early Detection Program (BCCP) website at: www.cancernm.org/bcc/

Healthy People 2010 Objective 3.3:

Female breast cancer deaths (age adjusted per 100,000 standard population) (ICD-9: 174)
U.S. Target for 2010: 22.3/100,000 women

Why Is This Important?

Influenza (flu) is a contagious respiratory illness caused by influenza viruses. Illness from influenza viruses can be severe and can lead to complications such as pneumonia and death. (1). Pneumonia is an infection of the lungs due to a variety of causes that can also be severe and lead to complications, including death. Some people, such as older people, young children, and people with certain health conditions, are at higher risk for serious complications and death from influenza and pneumonia. Pneumonia and/or influenza as underlying causes of death were the 10th leading cause of death in New Mexico in 2009, and were the 4th and 7th leading causes for young children (1-4 years) and older adults (85+ years), respectively.

Evidence-based Practices

Yearly influenza vaccination is a proven way to prevent many individuals from getting the flu and to decrease the severity and complications from flu.

Certain vaccines help prevent some types of pneumonia.

Good hygiene practices can also help prevent respiratory infections such as influenza and pneumonia. Good hygiene for prevention of respiratory infections includes washing your hands regularly, cleaning hard surfaces that are touched often (like doorknobs and countertops), and coughing or sneezing into a tissue or into your elbow or sleeve. You can also reduce your risk of getting pneumonia by staying healthy (preventing chronic illnesses such as diabetes and HIV/AIDS) and limiting exposure to cigarette smoke. (2)

Healthy People 2010 Objective 14.29a:

Influenza and pneumococcal vaccination of high-risk adults - Noninstitutionalized adults -Influenza vaccine (age adjusted, ages 65 years and older)
U.S. Target for 2010: 90%

Why Is This Important?

Hepatitis B infection is a common cause of death associated with liver failure, cirrhosis and liver cancer. In New Mexico, approximately 5000 people are living with hepatitis B. Nationwide, hepatitis B infection is the cause of 2000-4000 deaths each year. Rates of new infection and acute disease are highest among adults, but chronic infection is more likely to occur in persons infected as infants or young children.(1)

How Are We Doing?

Hepatitis B vaccination is very effective in preventing infection with hepatitis B virus (HBV) and is one of the recommended childhood vaccinations and is required for school entry in New Mexico. However, new infections with HBV continue to be reported. Transmission most commonly occurs among injecting drug users through shared needles, and sexual and household contacts of someone infected with HBV. Mothers can transmit the virus to their children during birth. Newly infected adults are typically without symptoms. Although new infections are being reported in all age groups, the highest number of new cases is being reported in men between the ages of 25 and 49 years.

Evidence-based Practices

Hepatitis B vaccination is the most effective measure to prevent HBV infection and its consequences. A primary focus of this strategy is universal vaccination of infants to prevent early childhood HBV infection and to eventually protect adolescents and adults from infection. Other components include routine screening of all pregnant women for hepatitis B surface antigen (HBsAg) and postexposure immunoprophylaxis of infants born to HBsAg-positive women, vaccination of children and adolescents who were not previously vaccinated, and vaccination of unvaccinated adults at increased risk for infection.(1) A complete vaccination schedule may be found online at http://www.cdc.gov/mmwr/pdf/rr/rr5416.pdf.

Healthy People 2010 Objective 14.2:

Hepatitis B in infants and young children -Perinatal infections (number of cases, children aged under 2 years)
U.S. Target for 2010: 400

Why Is This Important?

Between 1999 and 2010, unintentional injuries were consistently the leading cause of death among people 1 to 44 years of age in New Mexico. The number of unintentional injury deaths ranged from 891 in 1999 to 1,208 in 2010. Many more people are hospitalized, visit the emergency department, and visit physiciain offices or clinics for unintentional injuries each year.

Healthy People 2010 Objective 15.13:

Deaths from unintentional injuries - (age adjusted per 100,000 standard population)
U.S. Target for 2010: 17.5/100,000 population

Why Is This Important?

Between 1999 and 2010, unintentional injuries were consistently the leading cause of death among people 1 to 44 years of age in New Mexico. The number of unintentional injury hospitalizations among all ages ranged from 4,650 in 1999 to 7,448 in 2006. Even more people visit the emergency department and physician offices or clinics for unintentional injuries each year.

Why Is This Important?

Motor vehicle traffic crashes are the leading cause of injury death for people 1 to 34 years of age and people 55 to 64 years of age in New Mexico. Young people ages 15 to 24 years have the highest motor vehicle crash death rate.

How Are We Doing?

From 1999 through 2006, the motor vehicle traffic crash death rate in New Mexico remained relatively stable. The 2007 motor vehilcle traffic crash death rate in 2007 decreased 20% from the 2006 rate.

Why Is This Important?

Falls are the leading cause of unintentional (accidental) injury death among adults 65 years of age and older in the United States and in New Mexico. The majority of injuries from falls that lead to death were hip fracture and traumatic brain injury. A serious injury from a fall can limit mobility and independent living. Falls also can increase the risk of early death. Many people who fall develop a fear of falling, and may become more sedentary.

How Are We Doing?

The fall-related death rate among adults 65 years of age and older in New Mexico increased 220% between 1990 and 2010, and has increased five-fold since 1981.

Why Is This Important?

In New Mexico, suicidal behaviors are a serious public health problem and a major cause of morbidity and mortality. In 2009, suicide was the seventh leading cause of all death in New Mexico; and the second leading cause of death among youth and adults 10-44 years. In 2007, suicide accounted for 9.3% of the total Years of Potential Life Lost (YPLL) in NM, third after unintentional injury and cancer deaths. The YPLL is a measure of premature mortality in a population that describes the impact of injury-related deaths on a society compared to other causes of death. Mental disorders increase the risk for both attempted suicide and suicide; approximately 90% of suicide victims have a diagnosable mental health condition, most commonly a mood or substance use disorder.

How Are We Doing?

The suicide rate in NM has consistently been 1.5-2 times the U.S. rate. Suicide rates in NM have not changed significantly over the period 1995-2009, while the U.S. rate has declined slightly. In 2007, the age-adjusted suicide rate in NM was 72% higher than the US age-adjusted rate.

Healthy People 2010 Objective 18.1:

Suicide (age adjusted per 100,000 standard population)
U.S. Target for 2010: 5 per 100,000 population

Why Is This Important?

Adolescent suicide is a public health problem of considerable magnitude in New Mexico. Suicide is the second leading cause of death in youth 15-24 years of age, with 69 deaths reported in 2009. Over the last 15 years, suicide death rates in this age group have remained relatively stable, with NM's rate being about twice the national rate. In 2009, NM high school students reported higher rates of attempted suicide and attempted suicide resulting in an injury compared to U.S rates. Mental disorders increase the risk for both attempted and completed suicide. Other risk factors for completed suicide among youth include substance abuse, a family history of suicidal behavior, parental psychiatric disorders, stressful life events, and access to firearms.

What Is Being Done?

Youth suicide prevention and intervention activities were initially funded by the NM Legislature in June 2005. Implementation of suicide prevention strategies statewide is a significant focus of the New Mexico Department of Health Office of School and Adolescent Health (OSAH).

Healthy People 2010 Objective 18.2:

Adolescent suicide attempts - Students in grades 9 through 12
U.S. Target for 2010: 1%

Why Is This Important?

In New Mexico, child maltreatment includes physical neglect, sexual abuse and physical abuse. Child maltreatment can range from relatively minor (bruises or cuts) to severe (broken bones, acute subdural hematoma, or even death). In addition to these physical effects, additional outcomes of abuse or neglect may include behavioral changes, developmental delays or life-long disabilities. Regardless of the physical effects, the emotional pain and suffering they cause a child should not be minimized. Additionally, adults who experienced abuse or neglect during childhood are more likely to suffer from physical ailments such as allergies, arthritis, asthma, bronchitis, high blood pressure, and ulcers. The effects vary depending on the circumstances of the abuse or neglect and personal characteristics of the child. Also impactful is the child's environment, including the array of services available to the child and family to address the underlying issues which lead to child maltreatment. Consequences of abuse might be mild or severe, may disappear after a short period or last a lifetime. Child maltreatment can impact the child physically, psychologically, behaviorally, or in some combination of all three ways. Ultimately, due to related costs to public entities such as the health care, human services, and educational systems, abuse and neglect impact not just the child and family, but society as a whole.

Evidence-based Practices

New Mexico's Protective Services Division was selected by the Mountain and Plains Child Welfare Implementation Center (which is based at the University of Texas at Arlington) to receive Training and Technical Assistance to develop a new Practice model for the Division. The Practice Model project, called NM Pinon Project for CYFD, has been underway since November 2009 and it involves the entire Protective Services leadership team along with regional and field staff, foster parents, parents, children, youth, tribes, courts, providers and other stakeholders.

The practice model is a framework of how Protective Services' employees, families, and stakeholders should unite in creating a physical and emotional environment that focuses on the safety, permanency, and well-being of children and their families. It contains definitions and explanations regarding how Protective Services as a whole will work internally and partner with families, service providers, tribes and other stakeholders in child welfare services. When Protective completes the Practice Model, we will:

--Define how Protective Services engages families, youth, and the community in developing and delivering services that meet the unique needs of those served by the agency.
--Define standards of practice.
--Define how outcomes will be measured both quantitatively and qualitatively.
--Incorporate a clear, written explanation of how Protective Services will successfully function.
--Promote practice that is evidence informed and guided by values and principles, therefore increasing the likelihood of positive outcomes for children, youth, families, and the community.
--Link Protective Services? policy, practice, training, supervision and quality assurance with its mission, vision, agency values and strategic plan.

Why Is This Important?

According to results from the 2006-2007 National Survey on Drug Use and Health (NSDUH), 9.1% of New Mexico youth 12-17 years old had at least one major depressive episode in the past 12 months. Persistent feelings of sadness or hopelessness are a risk factor for depression. Students who reported these feelings of sadness or hopelessness were more likely than other students to report suicide attempts, cigarette smoking, binge drinking and illicit drug use.

Why Is This Important?

Life Expectancy is often used to gauge the overall health of a community. Shifts in life expectancy are often used to describe trends in mortality. Being able to predict how populations will age has enormous implications for the planning and provision of services and supports. Small increases in life expectancy translate into large increases in the population. As the life expectancy of a population lengthens, the number of people living with chronic illnesses tends to increase because chronic illnesses are more common among older persons.

How Are We Doing?

Prevention and control of infectious diseases has had a profound impact on life expectancy during the 20th century. In the United States life expectancy at birth from 1900 to 2000 increased from 48 to 74 years for men, and from 51 to 79 years for women. In contrast to life expectancy at birth, which increased sharply early in the century, life expectancy at age 65 improved primarily after 1950. Among U.S. men, life expectancy at age 65 rose from 12 to 16 years from 1950 to 2000, and among women from 12 to 19 years. Improvements in nutrition, hygiene, and medical care contributed to decreases in death rates throughout the lifespan.

What Is Being Done?

Now that people are living longer, it is important to look at ways that those added years can be lived in good health. Exercise, healthy diet and weight, not smoking, moderate use of alcohol and injury prevention habits such as wearing seat belts all contribute to a healthy life span.

Improvements in life expectancy increase the proportion of older individuals living in society. Policy-makers must be aware of this trend in order to provide viable and attractive options for elderly persons who require assistance with activities of daily living.

Why Is This Important?

Smoking is the leading preventable cause of death in the United States. One in five adults and one in four youth smoke in New Mexico. About half of all lifetime smokers will die early because of their decisions to smoke. In New Mexico, about 2,100 people die from tobacco use annually and another 42,000 are living with tobacco-related diseases. Annual smoking-related costs in New Mexico are $928 million ($461 million in direct medical costs and $467 million in lost productivity).

Evidence-based Practices

Addressing tobacco use is best done through a coordinated effort to establish smoke-free policies and social norms, to promote and assist tobacco users to quit, and to prevent initiation of tobacco use. This comprehensive approach combines educational, clinical, regulatory, economic, and social strategies. Research has documented strong or sufficient evidence in the use of the following strategies:

- Increasing the unit price of tobacco products

- Restricting minors' access to tobacco products; restricting the time, place, and manner in which tobacco is marketed and sold

- Strategic, culturally appropriate, and high impact health communication messages (mass media), including paid TV, radio, billboard, print, and web-based advertising at state and local levels

- Ensuring that all patients seen in the health care system are screened for tobacco use, receive brief interventions to help them quit, and are offered more intensive counseling and low- or no-cost cessation medications; providing insurance coverage of tobacco use treatment; phone- and web-based cessation services are effective and can reach large numbers of tobacco users;

- Passage of laws and policies in a comprehensive tobacco control effort to protect the public from secondhand exposure

- Focusing tobacco prevention and cessation interventions on populations at greatest risk in an effort to reduce tobacco-related health disparities

Sources: CDC. Best Practices for Comprehensive Tobacco Control Programs - 2007 (published October 2007). (www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm)
The Guide to Community Preventive Services: Tobacco Use - 2010 (www.thecommunityguide.org/tobacco/index.html)

Why Is This Important?

Smoking is the leading preventable cause of death in the United States. One in five adults and one in four youth smoke in New Mexico. About half of all lifetime smokers will die early because of their decisions to smoke. In New Mexico, about 2,100 people die from tobacco use annually and another 42,000 are living with tobacco-related diseases. Annual smoking-related costs in New Mexico are $928 million ($461 million in direct medical costs and $467 million in lost productivity).

Why Is This Important?

Physical activity among adults has numerous benefits, including: reducing risk of heart disease and stroke, improving physical fitness, bone health and mental health, preventing high blood pressure, abnormal cholesterol, prediabetes and diabetes, maintaining health weight and increasing mobility. Among older adults, physical activity in crucial in preventing falls.

How Are We Doing?

Since 2001, the percentage of adults in New Mexico who meet physical activity recommendations has remained static, which is similar to the trend in the US.

Evidence-based Practices

To increase physical activity using informational approaches, the Task Force on Community Preventive Services recommends community-wide campaigns and point-of-decision prompts. To increase physical activity using behavioral or social approaches, the Task Force recommends school-based physical education, individually-adapted health behavior change programs, and social support interventions in community settings. To increase physical activity using environmental or policy approaches, the Task Force recommends creation of or enhanced access to places for physical activity combined with informational outreach activities, and point-of-decision prompts. For more information, please see the Guide to Community Preventive SErvices: Waht Works to Promote Health? Chapter 2, Physical Activity, http://www.thecommunityguide.org/library/book/index.html.

Why Is This Important?

Physical activity is crucial to maintaining physical health. Among adolescents, regular physical activity helps improve bone health, body weight and composition, physical fitness and mental health. In addition, active adolescents are more likely to become active adults.

What Is Being Done?

NM Healthier Weight Council's Community and Regional Planning Advisory Group is working to increase awareness among elected officials, health professionals, community planners, and other key stakeholders on the impact of the built environment on physical activity.

Evidence-based Practices

To increase physical activity using informational approaches, the Task Force on Community Preventive Services recommends community-wide campaigns and point-of-decision prompts. To increase physical activity using behavioral or social approaches, the Task Force recommends school-based physical education, individually-adapted health behavior change programs, and social support interventions in community settings. To increase physical activity using environmental or policy approaches, the Task Force recommends creation of or enhanced access to places for physical activity combined with informational outreach activities, and point-of-decision prompts. For more information, please see the Guide to Community Preventive SErvices: Waht Works to Promote Health? Chapter 2, Physical Activity, http://www.thecommunityguide.org/library/book/index.html.

Healthy People 2010 Objective 22.6:

Moderate physical activity in adolescents (students in grades 9 through 12)
U.S. Target for 2010: 35%

Why Is This Important?

Fruits and vegetables contain essential vitamins, minerals, fiber, and other compounds that may help prevent many chronic diseases. Compared with people who consume a diet with only small amounts of fruits and vegetables, those who eat more generous amounts as part of a healthful diet are likely to have reduced risk of chronic diseases, including stroke and perhaps other cardiovascular diseases, and certain cancers (1). Fruits and vegetables also help people to achieve and maintain a healthy weight, because they are relatively low in energy density (2). To promote health and prevent chronic diseases, the 2005 Dietary Guidelines for Americans recommend 2 cups of fruit per day for a standard 2,000 calorie diet, with recommendations based on an individual's age, gender, and activity level (3).

Evidence-based Practices

For persons to make healthy food choices, healthy food options must be available and accessible. Families living in low-income neighborhoods and rural areas of the state often have less access to healthier food and beverage choices than those in more urban, higher-income areas. Here are some things communities may do.(4)
- Making healthy food choices available and affordable in public venues
- Restricting availability of less healthy options in public venues
- Improve Geographic Availability of Supermarkets in Underserved Areas
- Provide Incentives to Food Retailers to Locate in and/or Offer Healthier Food and Beverage Choices in Underserved Areas
- Improve Availability of Mechanisms for Purchasing Foods from Farms
- Provide Incentives for the Production, Distribution, and Procurement of Foods from Local Farms- Institute Smaller Portion Size Options in Public Service Venues
- Limit Advertisements of Less Healthy Foods and Beverages- Discourage Consumption of Sugar-Sweetened Beverages- Increase Support for Breastfeeding

Healthy People 2010 Objective 19.6:

Vegetable intake - At least three daily servings, with at least 1/3 being of dark green or deep yellow (age adjusted, ages 2 years and older)
U.S. Target for 2010: 50%

Why Is This Important?

Fruits and vegetables contain essential vitamins, minerals, fiber, and other compounds that may help prevent many chronic diseases. Compared with people who consume a diet with only small amounts of fruits and vegetables, those who eat more generous amounts as part of a healthful diet are likely to have reduced risk of chronic diseases, including stroke and perhaps other cardiovascular diseases, and certain cancers (1). Fruits and vegetables also help people to achieve and maintain a healthy weight, because they are relatively low in energy density (2). To promote health and prevent chronic diseases, the 2005 Dietary Guidelines for Americans recommend 2 cups of fruit per day for a standard 2,000 calorie diet, with recommendations based on an individual's age, gender, and activity level (3).

Evidence-based Practices

For persons to make healthy food choices, healthy food options must be available and accessible. Families living in low-income neighborhoods and rural areas of the state often have less access to healthier food and beverage choices than those in more urban, higher-income areas. Here are some things communities may do.(4)
- Making healthy food choices available and affordable in public venues
- Restricting availability of less healthy options in public venues
- Improve Geographic Availability of Supermarkets in Underserved Areas
- Provide Incentives to Food Retailers to Locate in and/or Offer Healthier Food and Beverage Choices in Underserved Areas
- Improve Availability of Mechanisms for Purchasing Foods from Farms
- Provide Incentives for the Production, Distribution, and Procurement of Foods from Local Farms- Institute Smaller Portion Size Options in Public Service Venues
- Limit Advertisements of Less Healthy Foods and Beverages
- Discourage Consumption of Sugar-Sweetened Beverages

Why Is This Important?

Caring and supportive relationship in the family refer to the interactions between youth and parents or guardians that convey love, acceptance, and affirmation. Students who report high levels of this relationship are less likely to use alcohol, drugs, or tobacco; to be involved in violence; to experience suicidal ideation; or to engage in high risk sexual practices.

Why Is This Important?

Obesity is associated with an increased risk for a number of chronic diseases, including heart disease, stroke, diabetes, and some cancers (endometrial, colon, kidney, esophageal, and post-menopausal breast cancer.) In both New Mexico and the United States, the percentage of adults who are obese, based on telephone survey data, has more than doubled since 1990. Excess weight also contributes to the development of arthritis, a chronic disease that is the leading cause of disability amongst adults in the nation and the state. An estimated $324 million is spent in New Mexico annually on adult obesity-attributable medical expenditures; of these, $51 million is spent within the Medicare population, and $84 million is spent within the Medicaid population.

How Are We Doing?

Mirroring national trends, New Mexico's rate of obesity continues to climb.

What Is Being Done?

-The New Mexico Healthier Weight Council is implementing the New Mexico Plan to Promote Healthier Weight: 2006-2015. Over 90 council members represent diverse organizations statewide.

-The New Mexico Interagency for the Prevention of Obesity is conducting obesity prevention efforts at both the state and community levels, in collaboration with partners in Las Cruces and statewide advocacy groups. Interagency members represent 40 state programs across eight state departments.

-The Clinical Prevention Initiative Healthier Weight Workgroup has produced a toolkit using materials that were carefully developed, adapted or borrowed to support NM health care providers in promoting healthier weight with their adult patients. Workgroup members are currently training healthcare professionals on how to best utilize the materials in their day-to-day practice. The culturally and linguistically relevant materials are founded on the evidence-based National Institutes of Health "Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults."

-Materials prepared for the Albuquerque Prescription Trails Pilot Program are designed for healthcare providers to write prescriptions for walking and wheelchair rolling. A guide includes routes in the community by zip code.

-Action Communities for Health, Innovation and Environmental Change is focused on creating healthier environments and policies to address poor nutrition, physical inactivity, tobacco use, obesity, diabetes, and cardiovascular disease through collaborative partnerships between the Department of Health, YMCA of Central New Mexico, and allies in Albuquerque.

-The national initiative, Fruits & Veggies - More Matters, is promoted statewide to increase the consumption of fruits and vegetables. Substituting fruits and vegetables for foods high in fat and added sugars can be part of a successful weight management strategy.

Evidence-based Practices

To help communities in this effort, CDC initiated the Common Community Measures for Obesity Prevention Project (the Measures Project). The objective of the Measures Project was to identify and recommend a set of strategies and associated measurements that communities and local governments can use to plan and monitor environmental and policy-level changes for obesity prevention. This report describes the expert panel process that was used to identify 24 recommended strategies for obesity prevention and a suggested measurement for each strategy that communities can use to assess performance and track progress over time. The 24 strategies are divided into six categories: 1) strategies to promote the availability of affordable healthy food and beverages), 2) strategies to support healthy food and beverage choices, 3) a strategy to encourage breastfeeding, 4) strategies to encourage physical activity or limit sedentary activity among children and youth, 5) strategies to create safe communities that support physical activity, and 6) a strategy to encourage communities to organize for change. For more information, please see Kahn, et al., Recommended Community Strategies and Measurements to Prevent Obesity in the United States, http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5807a1.htm.

Why Is This Important?

Overweight and obese youth are more likely to grow up to be overweight or obese as adults. In addition, they are at increased risk of exhibiting chronic disease risk factors such as diabetes, high blood pressure and high cholesterol as youth and into adulthood. Overweight and obese youth also experience discrimination from their peers.

Evidence-based Practices

To help communities in this effort, CDC initiated the Common Community Measures for Obesity Prevention Project (the Measures Project). The objective of the Measures Project was to identify and recommend a set of strategies and associated measurements that communities and local governments can use to plan and monitor environmental and policy-level changes for obesity prevention. This report describes the expert panel process that was used to identify 24 recommended strategies for obesity prevention and a suggested measurement for each strategy that communities can use to assess performance and track progress over time. The 24 strategies are divided into six categories: 1) strategies to promote the availability of affordable healthy food and beverages), 2) strategies to support healthy food and beverage choices, 3) a strategy to encourage breastfeeding, 4) strategies to encourage physical activity or limit sedentary activity among children and youth, 5) strategies to create safe communities that support physical activity, and 6) a strategy to encourage communities to organize for change. For more information, please see Kahn, et al., Recommended Community Strategies and Measurements to Prevent Obesity in the United States, http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5807a1.htm.

Why Is This Important?

Lack of health insurance coverage has been associated with delayed access to health care and increased risk of chronic disease and mortality. People without health insurance are much less likely than those with insurance to receive recommended preventive services and medications, are less likely to have access to regular care by a personal physician and are less able to obtain needed health care services. Consequently, the uninsured are more likely to succumb to preventable illnesses, more likely to suffer complications from those illnesses, and more likely to die prematurely.

How Are We Doing?

The percentage of adults in New Mexico without health care coverage is higher than the percentage for the U.S.

What Is Being Done?

New Mexico's Human Services Department administers several programs aimed at reducing the number of uninsured New Mexicans. These programs include health insurance coverage for pregnant women, children, working disabled individuals, financially-eligible families, employees of nonprofits and small businesses.

The New Mexico Medical Insurance Pool provides access to health insurance coverage to New Mexicans who are denied health insurance and considered uninsurable and also provides health benefit portability coverage to those who have exhausted COBRA benefits.

Why Is This Important?

Women who receive early and consistent prenatal care (PNC) enhance their likelihood of giving birth to a healthy child. Health care providers recommend that women begin prenatal care in the first trimester of their pregnancy.

Healthy People 2010 Objective 16.6a:

Prenatal care - Beginning in first trimester
U.S. Target for 2010: 90%

Why Is This Important?

By two years of age, it is recommended that all children should have received 4 doses of diphtheria-tetanus-pertussis (DTaP), 3 doses of polio, 1 dose of measles-mumps-rubella (MMR), 3 doses of Hepatitis B, 3 doses of Haemophilis Influenza, type B (Hib), and 1 dose of Varicella vaccine. This series is referred to in shorthand as "4:3:1:3:3:1."
This graph shows estimated levels of 4:3:1:3:3:1 coverage by New Mexico County, which helps target interventions where they are most needed.

Evidence-based Practices

The New Mexico Department of Health provides quality improvement visits to Vaccines for Children providers to promote best practices for immunizations. Measuring and tracking coverage rates helps providers diagnose missed opportunities for immunizations. NMSIIS, the state on-line immunization registry, tracks immunizations received so that children can be recalled to be brought up-to-date for any needed shots.

The CDC Community Guide at http://www.thecommunityguide.org/vaccines/universally/index.html provides evidence-based recommendations for universally-recommended immunizations.

Why Is This Important?

Recommended immunizations for adults aged 65 years and older include a yearly immunization against influenza (flu) and a one-time immunization against pneumococcal disease. Most of the deaths and serious illnesses caused by influenza and pneumococcal disease occur in older adults and others at increased risk for complications of these diseases because of other risk factors or medical conditions. Barriers to adult immunization include not knowing immunizations are needed, misconceptions about vaccines, and lack of recommendations from health care providers.

Evidence-based Practices

Last season's (Fall 2010 - Spring 2011) vaccine protected against three different flu viruses: an H3N2 virus, an influenza B virus and the 2009 H1N1 virus that caused so much illness the previous season. Adults should get vaccinated this year even if they got a 2009 H1N1 or a seasonal vaccine last year because the vaccine viruses have been updated. Immunity sets in about two weeks after vaccination, and the flu vaccine provides protection that lasts throughout the entire flu season.

Adults in New Mexico can get their flu shots from their primary care provider, at special flu clinics held across the state, or at many commercial pharmacies.

Providers can learn more about evidence-based immunization strategies for reaching adults at http://www.cdc.gov/vaccines/recs/rate-strategies/adultstrat.htm

Healthy People 2010 Objective 14.29a:

Influenza and pneumococcal vaccination of high-risk adults - Noninstitutionalized adults -Influenza vaccine (age adjusted, ages 65 years and older)
U.S. Target for 2010: 90%

Why Is This Important?

Recommended immunizations for adults aged 65 years and older include a yearly immunization against influenza (flu) and a one-time immunization against pneumococcal disease. Most of the deaths and serious illnesses caused by influenza and pneumococcal disease occur in older adults and others at increased risk for complications of these diseases because of other risk factors or medical conditions. Barriers to adult immunization include not knowing immunizations are needed, misconceptions about vaccines, and lack of recommendations from health care providers.

How Are We Doing?

In New Mexico, only one out of two Hispanics age 65 or older has ever received a pneumococcal vaccination, and only two of three Hispanics aged 65 and older received an influenza vaccination during the past year. From 2007-2009, 76% of the deaths due to pneumonia and influenza in New Mexico were to individuals age 65 or older.

What Is Being Done?

The New Mexico Department of Health received a federal grant to address the health disparity in the Hispanic population. In order to focus the project's efforts, DPP/OHE decided to focus on Luna County in the south (predominantly of Mexican Heritage) and Rio Arriba County in the north (predominantly descendents of Spanish ancestry).

Evidence-based Practices

Immunizations are one of the most effective public health tools for preventing and eradicating disease; yet adult immunizations have not reached the coverage levels of childhood immunizations, particularly among members of minority groups. The low rates of immunization among adults is the result of many factors including: lack of access to preventive health services; the belief that adult immunizations are not necessary; and/or they lack basic knowledge about the high risks of disease and death linked to pneumonia/influenza in the elderly. Consequently, the community engagement model employed through this project recognizes that solutions must go beyond the purely medical and address influencing factors found in the local socioeconomic and cultural environment. Local Public Health offices including vaccination clinics at Senior Centers, a shot nurse and clerk were also dispatched to area homes to vaccinate senior shut-ins in their homes. These are among the most vulnerable to influenza and pneumonia.

Why Is This Important?

Medicaid provides health coverage for those New Mexicans living below a certain percentage of the federal poverty level, and provides coverage for almost half of New Mexico's children. People with health coverage are more likely to receive preventive medical care and are consequently less likely to suffer from preventable illnesses and complications of those illnesses.

Why Is This Important?

The number in the population for every primary care provider represents the number of persons a single primary care provider is required to serve. Lower numbers represent better access to primary care.

Why Is This Important?

Oral health is essential to overall health. Good oral health improves a person's ability to speak, smile, smell, taste, touch, chew, swallow, and make facial expressions to show feelings and emotions. (1, 2) The significant improvement in the oral health of Americans over the past 50 years is a public health success story. Most of the gains are a result of effective prevention and treatment efforts. One major success is community water fluoridation, which now benefits about 7 out of 10 Americans who get water through public water systems.

Why Is This Important?

The risk factors for childhood lead poisoning include living in housing built before 1950, being African American, and living in a family with a poverty-level income. Studies have documented low blood-lead testing rates among children living in households with these risk factors. This measure identifies counties with higher percentages of children who may be at increased risk for lead poisoning. When compared with lead-testing rates by county, populations with inadequate lead testing of young at-risk children may be identified in order to improve testing in these regions.

Why Is This Important?

Poverty in the early years of a child's life, more than at any other time, has especially harmful effects on continuing healthy development and well-being, including developmental delays and infant mortality. Well-being in later childhood, such as teen pregnancy, substance abuse, and educational attainment, are also influenced by early childhood poverty. Children born into poverty are less likely to have regular health care, proper nutrition, and opportunities for mental stimulation and enrichment.

How Are We Doing?

New Mexico was one of the most impoverished states in the nation, ranking near the bottom (47th) of all states in the percent of its children living in poverty.

Why Is This Important?

New Mexico's population is very diverse, which sometimes leads to barriers to obtaining culturally-sensitive health care. Because of this and other social factors, there are real disparities in the health of New Mexicans of various race/ethnic groups. Reducing racial- and ethnically-based health disparities is an overarching goal of the U.S. Public Health Services/ Healthy People 2010 initiative.

How Are We Doing?

According to 2009 state population estimates, 43.4% of New Mexicans were White, and 41.3% were Hispanic. (The Hispanic category does not include Black, American Indian or Asian or Pacific Islander populations.) The American Indian or Alaska Native population comprise 11% of New Mexico's population; the Black or African American population made up 2.7%; and the Asian or Pacific Islander population constituted another 1.7%. (Due to rounding, the percentages do not total 100%.)

What Is Being Done?

With our partners (the Governor, legislators, local and tribal governments, public and private organizations, health care providers, health care institutions and concerned New Mexicans), the New Mexico Department of Health is working to prevent disease, promote health, improve access to information and care, deliver appropriate care and develop strategies to reduce disparities where they exist.

Why Is This Important?

Education level is strongly related to health status for a variety of reasons. Education is associated with better earning potential and higher income which enables purchase of better housing in safer neighborhoods, healthier food, health insurance coverage and more timely medical care. Persons who have clear goals and a sense of control over their own lives tend to have both a higher education level and better health (Lachman & Weaner, 1998). Short-term health problems associated with not graduating from high school include substance use, pregnancy, and psychological, emotional, and behavioral problems. For adolescent females, teenage pregnancy is the leading reason for not graduating; an estimated 30% - 40% of female teenaged dropouts are mothers. Early parenting also affects young males who leave school to support a child. Mental illness and emotional disturbance also account for a significant proportion of students who don't graduate (Freudenberg & Ruglis, 2007).

Why Is This Important?

Household income is strongly related to health status for all persons in the household. Those living at or near the poverty level tend to have poorer health status, in part because they cannot always afford health care. Health status also depends on meeting a family's needs for adequate housing and nutrition. Lack of income may also keep children from having access to quality education, safe areas to play, and expose them to other risk factors. In addition, common reasons for unemployment include chronic mental or physical illness that limits a person's ability to work outside the home.

How Are We Doing?

In 2010, the statewide unemployed rate has continued to rise, from 3.7 percent in January 2008 to 8.4 percent in December 2010 (not seasonally adjusted). The seasonally adjusted rates showed the same increase. Seasonally adjusted rates control for with seasonal increases in unemployment that typically occur during the summer months.

Why Is This Important?

The age distribution of a population is related to several health measures, such as the prevalence of chronic disease and the demand for family planning and immunization services. Younger populations, that is, those with a higher percentage of children and young adults, will appear to be healthier when looking at death and hospitalization rates that have not been age-adjusted. For this reason, it is important to use age-adjusted rates when comparing areas that have different age distributions.