County HealtH Rankings

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1 County HealtH Rankings West Virginia Higher Education Policy Commission

2 2009 County Health Rankngs

3 West Virginia 2009 County Health Rankings 1 Introduction T he West Virginia Higher Education Policy Commission (HEPC) has a dual mission with respect to our training programs in the health professions. We must make available to the students of our state a high quality education in the profession of their choosing, and, at the same time, we must educate the workforce that West Virginia needs to adequately serve its citizens. Training for health professionals is, to some extent, unique in its reliance on experiential education, which means that our educational institutions must also be service providers. Students and faculty diagnose and treat individual patients in hospitals and clinics, and they conduct community-based projects aimed at improving the health of broad populations. Policymakers therefore expect us to make investments strategically, targeting the geographic areas of greatest need, and targeting the health problems of greatest impact. The Division of Health Sciences of the HEPC is establishing a Center for Health Partnerships, which will bring together many agencies and institutions to work toward common goals. Currently, we are planning to focus on three initiatives: perinatal care, elder care, and rural primary care. In order to apply our resources most efficiently and effectively, we need to know what areas of West Virginia have the greatest need for improvement in health status, and which areas are most underserved by providers of health services. The West Virginia 2009 County Health Rankings is an attempt to quantify the answers to these questions and organize the data available to us. We would like to acknowledge the work of the West Virginia Department of Health and Human Resources, particularly the West Virginia Health Statistics Center, headed by Daniel M. Christy, MPH, which made available to us much of the data reported herein. The more focused mission of the Center for Health Partnership will rely on the West Virginia Health Statistics Center and other state agencies for the data necessary to plan, direct, and evaluate our efforts. Higher education, obviously, cannot solve the health problems or meet all of the health service needs of West Virginia. We can, however, instigate a process by which we direct our resources and our energy to endeavors which have the greatest impact on the health of our citizens and their access to care. By engaging our medical schools and other educational programs to work collaboratively with health providers, state agencies, and local communities, we believe the results will be far greater than could be achieved by any one of these entities acting alone. If the higher education community fails to do its part, policymakers will hold us accountable, and the West Virginia 2009 County Health Rankings provides the foundation for this accountability.

4 2009 County Health Rankin 2

5 West Virginia 2009 County Health Rankings 3 West Virginia 2009 County Health Rankings Welcome to this summary of the West Virginia 2009 County Health Rankings. West Virginia 2009 County Health Rankings provide a snapshot of the overall status of population health by county. This report is intended to summarize the current health of each county s population and the current distribution of key factors that determine future health. The West Virginia 2009 County Health Rankings point out general areas where public policy makers working with health professionals can set priorities and dedicate resources. The West Virginia 2009 County Health Rankings ranks counties according to their summary measures of health outcomes and health determinants. Individual major components of outcomes and determinants are also given. Places receive a rank for each population health component. The rankings provide an opportunity to identify areas of potential health improvement. Counties ranked in the first quartile are estimated to be the healthiest. The rankings are based on a statistical model (similar to other states) using existing and available public data. West Virginia 2009 County Health Rankings focuses on two categories of health measures health outcomes and health determinants. Health outcomes are those things that describe how healthy we are as a county population at a given moment. Health determinants are those things that influence future health outcomes. The summary health outcomes ranking is based on weighted scores of three measures: mortality, low birth weight and general health status. The health determinants ranks are based on weighted scores of four major components: 1. Health Care 2. Health Behaviors 3. Socioeconomic Factors 4. Physical Environment This summary report shows the quartile placement of counties as well as individual county rank. Ranking shown by quartile includes a county Index Value, the summary value derived from the statistical model. The report ranks West Virginia counties in several ways: Overall Rank Health Outcomes measures are combined with its Health Determinants measures. Health Outcomes Rank Overall. Health Outcomes Rank Major individual components. Health Determinants Rank Overall. Health Determinants Rank Major individual components.

6 2009 County Health Rankngs Data Sources Data used in West Virginia County Health Rankings come from a variety of secondary sources: West Virginia Vital Statistics Workforce West Virginia West Virginia Bureau for Public Health HIV/AIDS/STD Program West Virginia Division of Criminal Justice Services West Virginia Educational Information System WV Office of Environmental Health Services Behavioral Risk Factor Surveillance System (BRFSS) U.S. Census Bureau U.S. Environmental Protection Agency (EPA) West Virginia Kids Count Fund The West Virginia Rankings estimates health measures calculated from the most recently available and public data. Where county data were not available, the report uses regional data with contiguous counties assigned the same rank on an individual measure. In order to provide the most statistically reliable information, insignificant data based on small numbers or unreliable data were avoided. In some instances, data was aggregated over a number of years for more statistically significant results. In some instances, the differences between rank placements among counties are very small, and the differential may not be precise enough to indicate the differences between counties separated by five or ten spaces. West Virginia County Health Rankings have been drawn upon the ranking models used by the Tennessee Institute of Public Health and the University of Wisconsin Population Health Institute. The West Virginia rankings use many of the same measures that are used by other states to rank their counties with respect to health. Rankings The rankings provide a composite analysis of a wide range of health outcomes and determinants. A total of 33 different variables were analyzed simultaneously to produce an overall score for each county. Not all variables were assigned equal weight in the overall score. The weights were determined by public health research and mirror those used by the Tennessee Institute of Public Health. Since some variables have higher weights than others, a county may rank high in the overall score by scoring well on only a handful of key indicators that are weighted heavily while being average on many more variables. Each county is treated equally in the overall scoring methodology regardless of population size. For some variables, the rankings use regional data because individual county data is not available or the raw numbers are so small that accurate estimates can not be obtained. For data that are not percentages, rates are used instead of gross totals to allow meaningful comparisons between counties that may have vastly different population sizes. To reduce the chance of data suppression and increase stability of the estimates in less populated counties, we combined multiple years of data for most indicators. For example, most of the BRFSS estimates are calculated from 5 years of aggregated data. 4

7 West Virginia 2009 County Health Rankings 5 Each county was assigned a z-score for each measure, representing the number of standard deviation units that a place is from the mean of all counties. To avoid an overall rank being strongly influenced by one extreme component score, the z-scores are truncated at -3.0 or 3.0 if the actual score fell outside of this range. Counties were ranked based on their z-scores. Z-scores from multiple indicators were combined to calculate indexes and counties were ranked based off of these indexes. Weighted averages of the truncated scores were used to calculate the overall summary outcomes and determinants rankings and the rankings for the four major categories of determinants, in accordance with the weights given. If ties occur in assigning ranks for any individual measure (i.e., if the z-scores and underlying data were identical), then the same rank is given to the places that are tied; for example, if the top two places are tied, these two would each be given a rank of one, while the third placeholder would be given a rank of three. Health Outcomes Three components were used to represent health outcomes: mortality, low birth weight, and health status, which are each assessed with a single measure (years of potential life lost, birth weights, and self-reported health status, respectively). While many other health outcomes could be included here, these three address both length and quality of life. Years of Potential Life Lost (YPLL) measures the premature mortality in a county. Every death occurring before the age of 75 contributes to the total number of years of potential life lost. Low birth weight is a widely used to measure infant health. Low birth weight is defined as a birth weight under 2,500 grams (5 pounds, 8 ounces). General Health Status is a measure of self-reported health-related quality of life in a population. This measure is based on responding Fair or Poor to the following question: Would you say that in general your health is: Excellent, Very Good, Good, Fair, or Poor? The percentage reported in the Rankings is the percentage of people reporting fair or poor health. This measure is age-adjusted to the 2000 U.S. population. Health Determinants The selection of determinant measures for West Virginia County Health Rankings was largely guided by the Tennessee County Health Rankings model. Health determinant measures are divided into four major components: health care, health behaviors, socioeconomic factors related to health, and the physical environment. Each of these four major components comprises multiple health determinants. The component are includes measures of access and whether people are receiving recommended treatment. No health insurance- Responding No to the following question: Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare? The results reported for this section have been limited to adults aged

8 2009 County Health Rankngs Health Care Continued Medical doctors per capita - Number of licensed, practicing medical doctors per 100,000 population by county of practice. Dentists per capita - Number of licensed, practicing dentists per 100,000 population by county of practice. Pneumococcal vaccinations - percentage of people who did not receive pneumonia vaccine. Influenza vaccinations - percentage of population who had not had a flu shot during the past 12 months. Diabetes - Responding Yes to the following question: Have you ever been told by a doctor that you have diabetes? Women told they had diabetes only during pregnancy are treated as an answer of No. Those with pre-diabetes and borderline diabetes also are treated as an answer of No. Mammography - percentage of women aged 40 and above who did not receive a mammogram within the past two years The health behaviors component includes measures that reflect healthy lifestyles and personal healthrelated decisions. Cigarette smoking - Smoking at least 100 cigarettes in one s lifetime and currently smoking every day or some days. Smoking during pregnancy - percentage of the women in the population who smoked during their pregnancy. Women giving birth in a hospital are asked about their smoking status after delivering the baby. Physical inactivity - Responding No to the following question: During the past month, other than your regular job, did you participate in any physical activities or exercise such as running, calisthenics, golf, gardening, or walking for exercise? Overweight and obesity - Body Mass Index (BMI) is a calculation that standardizes the meaning of the terms obesity and overweight, thereby improving the accuracy of comparisons. BMI is body weight in kilograms divided by height in meters squared (BMI=kg/m2). Obesity is defined as a BMI of 30.0 or higher and overweight as a BMI of Low fruit and vegetable consumption - percentage of the population that consumes less than 5 servings of fruits and/or vegetables per day. This measure is obtained from the answers to questions asking about what types of food are eaten daily. Binge drinking - percentage of the population that consumes of five or more alcoholic drinks for males, or four or more alcoholic drinks for females, on a single occasion during the past one month. Teen birth rate - average annual birth rate per 1,000 females aged Sexually transmitted disease - Sexually Transmitted Disease is a measure of the average annual number of reported cases of chlamydia, gonorrhea, and syphilis as the crude rate per 100,000 in the population. 6

9 West Virginia 2009 County Health Rankings 7 Violent crime - annual number of reported violent crimes per 1,000 adults in the population. Motor vehicle crash deaths - number of Vehicle Crash Fatalities per 100,000 population. This component includes measures of socioeconomic status known to be associated with health. High school graduation rate - percentage of senior students at the beginning of school year who graduated a year after. Level of education - percentage of year olds with high school diploma. Unemployment - percentage of workforce population who are not currently employed. Children in poverty - percentage of children (under 18) who are in poverty. Divorce rate - rate of divorce cases per 1,000 population. Single-parent families - number of households run by a single parent (male householder with no wife present or female householder with no husband present) with one or more of their own children under 18 years as a percentage of the total number of households. This component includes measures of air quality, water quality, and the built environment Air quality cancer risk - Estimated lifetime cancer risk due to inhalation of air pollutants based on EPA modeling of emissions. Air quality hazard index - Estimated respiratory risk due to inhalation of air pollutants based on EPA modeling of emissions. Fine particle matter in air - Average data on PM2.5. Ozone level - Annual fourth-highest daily maximum 8 hour ozone concentration, expressed in parts per million. Nitrate level in water >2 - Presence of nitrates in drinking water (mg/l). Nitrate Levels in Water measures the presence of nitrates in the private and municipal water supply above the Preventative Action Level of 2 mg/l. The percentage reported here is the estimated percentage of the population that, at any point in the calendar year, was exposed to nitrate levels in the water above 2mg/L. Housing built before percentage of housing units that were built before Residents of these units are more likely to be exposed to lead paint. Lead poisoned children - percentage of lead tests on children under age six that tested positive for lead poisoning.

10 2009 County Health Rankngs West Virginia County Health Rankings Data element Description Data source Overall subweights Percent of Year Weight Overall score Health Outcomes Mortality (YPLL) Years of Potential Life Lost to age West Virginia Vital Statistics (YPLL-75) per 100,000 population Low Birth Weight % of children born weighting less West Virginia Vital Statistics than 2,500 grams General health status % of people reporting fair or BRFSS poor health in BRFSS Health Determinants Health Care No health insurance The percentage of population without BRFSS health care coverage of any kind, including prepaid plans, HMOs, or government plans such as Medicare. Medical doctors Number of licensed, practicing medical 2008 WORKFORCE West Virginia doctors per 100,000 population by county of practice. Dentists per capita Number of licensed, practicing 2008 WORKFORCE West Virginia dentists per 100,000 population by county of practice. Pneumococcal Percent of people who did not receive BRFSS vaccinations pneumoniavaccine Influenza vaccinations % of population who had not had a BRFSS flu shot during the past 12 months Diabetes % ever been told by a doctor that BRFSS they have diabetes Mammography % of women aged 40 and above who 2002,2004,2006 BRFSS did not receive a mammogram within the past two years Health Behaviors Cigarette smoking % of populations who are at-risk smokers BRFSS (Smoke some days or everyday) Smoking during % of births given by smoking mothers 2006 West Virginia Vital Statistics pregnancy to total number of births Physical inactivity % of adult population who did not exercise BRFSS during the past month of the survey Overweight and obesity % of adult population who are BRFSS overweight or obese (body mass index greater than 25) Low fruit and % of adult population who consume 2002,2003,2005 BRFSS vegetable consumption fewer than 5 servings of fruits and/or vegetables per day Binge drinking % of the population that drinks more BRFSS than four or five alcoholic beverages in one day, at least once per month Teen birth rate Births per 1000 Females Kids Count

11 West Virginia 2009 County Health Rankings 9 Data element Description Data source Overall subweights Percent of Year Weight Overall score Health Behaviors Continued Sexually transmitted Rate of reported cases of Sexually WVBPH HIV/AIDS/STD disease TransmittedDiseases per Program 100,000 population Violent crime Violent Crime Rate per 1,000 population 2004 WVDCJS Motor vehicle crash Number of Vehicle Crash Fatalities 2006 West Virginia Vital Statistics deaths per 100,000 population socioeconomic Factors High school graduation % of senior students at the WV Education Information rate beginning of school year who System graduated a year after Level of education % of year olds with 2000 Census high school diploma Unemployment % of workforce population who 2006 Bureau of Labor Statistics are not currently employed Children in poverty % of children (under 18) who 2005 Kids Count are in poverty Divorce rate Rate of divorce cases per 006 West Virginia Vital ,000 population Statistics Single-parent families 2000 Kids Count Physical environment Air quality cancer risk Estimated lifetime cancer risk due to 1999 EPA inhalation of air pollutants based on EPA modeling of emissions Air quality hazard Estimated respiratory risk due to 1999 EPA index inhalation of air pollutants based on EPA modeling of emissions Fine particle matter Average data on PM2.5 was 2005 WVDEP in air available for monitoring sites in counties Ozone level Annual fourth-highest daily maximum 2005 WVDEP hour ozone concentration, expressed in parts per million Nitrate level in water >2 Presence of nitrates in drinking WVOEHS water (mg/l) Housing built % of housing units built before CDC before 1950 Lead poisoned % of children (<72 months) confirmed 2006 CDC children elevated by blood lead level total 100

12 2009 County Health Rankngs 10 Ranking County Health Mortality low Birth general Health Health Health Health socioeconomic Physical Outcomes (22.5%) Weight status (5%) Determinants Care Behaviors Factors (20%) enviro (50%) (22.5%) (50%) (5%) (20%) (5%) 1 Monongalia Monongalia Monongalia Roane Monongalia Pendleton Monongalia Raleigh Pendleton Raleigh 2 Pendleton Grant Pendleton Grant Jefferson Putnam Ohio Randolph Putnam Grant 3 Putnam Jefferson Putnam Morgan Ohio Monongalia Harrison Taylor Monongalia Hardy 4 Grant Pendleton Brooke Taylor Berkeley Ritchie Pendleton Pendleton Jefferson Lincoln 5 Jefferson Hancock Tyler Jefferson Wood Mineral Cabell Mercer Ritchie Mingo 6 Tucker Putnam Hancock Monroe Harrison Randolph Grant Putnam Mineral Hampshire 7 Hardy Morgan Pleasants Lewis Hancock Hardy Jackson Greenbrier Tucker Clay 8 Morgan Tucker Marshall Braxton Brooke Raleigh Marion Jackson Monroe Greenbrier 9 Hancock Roane Doddridge Tucker Kanawha Jackson Lewis Hardy Gilmer Putnam 10 Monroe Berkeley Jackson Berkeley Cabell Grant Kanawha Ritchie Pleasants Boone 11 Jackson Taylor Wood Hampshire Putnam Monroe Wood Wirt Hardy Webster 12 Randolph Monroe Tucker Hardy Pleasants Preston Mineral Tyler Morgan Logan 13 Roane Wood Jefferson Webster Tyler Tucker Berkeley Barbour Preston Wirt 14 Taylor Marshall Grant Monongalia Wetzel Doddridge Wirt Mineral Brooke Morgan 15 Wood Hardy Monroe Hancock Hampshire Pleasants Tucker Wood Doddridge Wayne 16 Upshur Jackson Marion Pendleton Morgan Harrison Pocahontas Summers Jackson Nicholas 17 Hampshire Upshur Upshur Upshur Marshall Tyler Brooke Preston Tyler Calhoun 18 Marshall Brooke Randolph Putnam Marion Hampshire Hancock Monroe Hampshire Gilmer 19 Berkeley Braxton Taylor Greenbrier Hardy Mason Ritchie Lewis Grant Braxton 20 Ritchie Hampshire Hardy Barbour Pendleton Greenbrier Mason Mason Berkeley Randolph 21 Mineral Randolph Berkeley Harrison Pocahontas Jefferson Putnam Monongalia Mason Monongalia 22 Marion Ohio Wirt Randolph Upshur Morgan Hardy Grant Randolph Roane 23 Harrison Marion Morgan Jackson Grant Wirt Randolph Pleasants Boone Mineral 24 Doddridge Harrison Braxton Wood Mineral Pocahontas Marshall Upshur Ohio Pocahontas 25 Greenbrier Greenbrier Ohio Ritchie Doddridge Gilmer Morgan Harrison Harrison Doddridge 26 Preston Doddridge Mineral Ohio Lewis Upshur Doddridge Cabell Nicholas Fayette 27 Brooke Preston Wayne Marshall Ritchie Marion Hampshire Doddridge Logan Ritchie 28 Ohio Lewis Gilmer Preston Mason Taylor Preston Pocahontas Marshall Monroe 29 Tyler Barbour Wetzel Marion Preston Nicholas Jefferson Marion Raleigh Pendleton 30 Braxton Tyler Greenbrier Calhoun Tucker Boone McDowell Wetzel Hancock Harrison 31 Barbour Minerall Preston Boone Randolph Hancock Greenbrier Hampshire Pocahontas Upshur 32 Lewis Wetzel Roane Clay Barbour Barbour Fayette Hancock Upshur Jackson 33 Gilmer Ritchie Hampshire Gilmer Calhoun Lewis Wetzel Kanawha Marion McDowell 34 Raleigh Gilmer Nicholas Raleigh Clay Wood Raleigh Roane Barbour Tyler 35 Wetzel Webster Harrison Mineral Gilmer Roane Wyoming Tucker Roane Lewis 36 Kanawha Kanawha Mason Kanawha Roane Ohio Pleasants Nicholas Wood Barbour 37 Webster Clay Kanawha Wetzel Taylor Marshall Upshur Calhoun Taylor Brooke 38 Wirt Calhoun Barbour Fayette Jackson Mercer Mercer Webster Wir Mason 39 Nicholas Nicholas Cabell Brooke Wirt Summers Summers Wayne Wetzel Preston 40 Mason Cabell Clay Nicholas Wayne Berkeley Monroe Boone Clay Kanawha 41 Pocahontas Wirt Ritchie Lincoln MerceR Kanawha Nicholas Morgan Braxton Jefferson 42 Clay Boone Raleigh Summers Fayette Brooke Tyler Marshall Wyoming Pleasants 43 Pleasants Raleigh Boone Mingo Greenbrier Wetzel Mingo Clay Greenbrier Summers 44 Boone Pocahontas Calhoun Pocahontas Monroe Webster Braxton Gilmer Webster Taylor 45 Cabell Mason Pocahontas Doddridge Summers Cabell Calhoun Jefferson Lincoln Tucker 46 Calhoun Pleasants Wyoming Wyoming Braxton Clay Roane Fayette Fayette Marion 47 Fayette Fayette Lewis Cabell Nicholas Wayne Gilmer Ohio Summers Berkeley 48 Wayne Lincoln Webster Mason Webster Fayette Webster Braxton Wayne Marshall 49 Lincoln Wyoming Mercer Tyler Raleigh Braxton Boone Lincoln Mingo Cabell 50 Summers Wayne Fayette Wirt Boone Calhoun Logan Berkeley Lewis Hancock 51 Wyoming Summers Lincoln Logan Lincoln Lincoln Wayne Wyoming Kanawha Ohio 52 Mercer Mercer Mingo Mercer Logan Logan Clay McDowell Mercer Wyoming 53 Mingo Mingo Summers Wayne Mingo Wyoming Lincoln Mingo Cabell Wetzel 54 Logan Logan Logan McDowell Wyoming Mingo Taylor Brooke Calhoun Mercer 55 McDowell McDowell McDowell Pleasants McDowell McDowell Barbour Logan McDowell Wood

13 West Virginia 2009 County Health Rankings 11 County Overall Quartile Health Mortality low Birth general Health Health Health Health socioeconomic Physical Ranking Outcomes (22.5%) Weight status (5%) Determinants Care Behaviors Factors (20%) enviro (50%) (22.5%) (50%) (5%) (20%) (5%) Monongalia Pendleton Putnam Grant Jefferson Tucker Hardy Morgan Hancock Monroe Jackson Randolph Roane Taylor Wood Upshur Hampshire Marshall Berkeley Ritchie Mineral Marion Harrison Doddridge Greenbrier Preston Brooke Ohio Tyler Braxton Barbour Lewis Gilmer Raleigh Wetzel Kanawha Webster Wirt Nicholas Mason Pocahontas Clay Pleasants Boone Cabell Calhoun Fayette Wayne Lincoln Summers Wyoming Mercer Mingo Logan McDowell

14 2009 County Health Rankngs BARBOUR County Health Rankings Barbour County 31 Health Outcomes 29 Mortality (years of potential life lost per 100,000 population) Low Birth Weight 9.5% 8.5% 20 General health status (% Fair or Poor Health) 23.9% 26.5% 32 Health Determinants 32 Health Care 55 No health insurance 21.8% 34.2% 54 Doctors per 100,000 population Dentists per 100,000 population Without pneumococcal vaccinations 64.7% 80.6% 54 Without influenza vaccinations for the last 12 months 66.6% 76.8% 54 Diabetes 10.7% 11.5% 43 No mammography within past 2-year Women Aged % 22.2% 12 Health Behaviors 13 Cigarette smoking 27.0% 21.3% 5 Mothers smoking during pregnancy 27.2% 23.4% 13 Physical inactivity 27.0% 32.4% 51 Overweight and obesity 28.9% 34.2% 49 Low fruit and vegetable consumption (<5 fruit/veg a day) 20.0% 22.2% 16 Binge drinking 10.5% 7.7% 11 Teen birth rate (per 1,000 females aged 15-19) Sexually transmitted disease (per 100,000 population) Violent crime per (per 1,000 population) Motor vehicle crash deaths (per 100,000 population) socioeconomic Factors 34 High school graduation rate 84.0% 80.0% 48 Population (age 25 & over) with a HS diploma 24.8% 27.3% 27 Unemployment Rate 4.6% 5.4% 38 Children (age 0-17) in poverty 25.5% 31.7% 42 Divorce rate (per 1,000 population) Single-parent families 24.7% 22.6% 22 Physical environment 36 Air quality cancer risk Air quality hazard index Fine particle matter in air Ozone level * Nitrate level in water >2 * 34.4% 0.0% 1 Housing built before % 32.5% 41 Lead poisoned children 0.8% 3.9% 52 12

15 West Virginia 2009 County Health Rankings 13 Berkeley County 19 BERKELEY Health Outcomes 10 Mortality (years of potential life lost per 100,000 population) Low Birth Weight 9.5% 7.7% 10 General health status (% Fair or Poor Health) 23.9% 17.5% 4 Health Determinants 40 Health Care 13 No health insurance 21.8% 17.5% 6 Doctors per 100,000 population Dentists per 100,000 population Without pneumococcal vaccinations 64.7% 67.7% 41 Without influenza vaccinations for the last 12 months 66.6% 64.0% 18 Diabetes 10.7% 8.1% 6 No mammography within past 2-year Women Aged % 23.1% 14 Health Behaviors 50 Cigarette smoking 27.0% 30.7% 40 Mothers smoking during pregnancy 27.2% 20.5% 7 Physical inactivity 27.0% 29.2% 32 Overweight and obesity 28.9% 30.8% 36 Low fruit and vegetable consumption (<5 fruit/veg a day) 20.0% 16.6% 48 Binge drinking 10.5% 11.6% 44 Teen birth rate (per 1,000 females aged 15-19) Sexually transmitted disease (per 100,000 population) Violent crime per (per 1,000 population) Motor vehicle crash deaths (per 100,000 population) socioeconomic Factors 20 High school graduation rate 84.0% 83.5% 32 Population (age 25 & over) with a HS diploma 24.8% 22.4% 40 Unemployment Rate 4.6% 3.9% 6 Children (age 0-17) in poverty 25.5% 15.3% 3 Divorce rate (per 1,000 population) Single-parent families 24.7% 26.8% 50 Physical environment 47 Air quality cancer risk Air quality hazard index Fine particle matter in air Ozone level * Nitrate level in water >2 * 34.4% 167.0% 52 Housing built before % 18.5% 7 Lead poisoned children 0.8% 0.3% 24

16 2009 County Health Rankngs BOONE Boone County 44 Health Outcomes 42 Mortality (years of potential life lost per 100,000 population) Low Birth Weight 9.5% 9.6% 31 General health status (% Fair or Poor Health) 23.9% 33.7% 50 Health Determinants 30 Health Care 49 No health insurance 21.8% 25.8% 40 Doctors per 100,000 population Dentists per 100,000 population Without pneumococcal vaccinations 64.7% 71.4% 51 Without influenza vaccinations for the last 12 months 66.6% 66.2% 25 Diabetes 10.7% 13.3% 51 No mammography within past 2-year Women Aged % 29.6% 36 Health Behaviors 40 Cigarette smoking 27.0% 32.4% 42 Mothers smoking during pregnancy 27.2% 35.6% 43 Physical inactivity 27.0% 30.5% 37 Overweight and obesity 28.9% 34.6% 51 Low fruit and vegetable consumption (<5 fruit/veg a day) 20.0% 17.6% 40 Binge drinking 10.5% 9.4% 26 Teen birth rate (per 1,000 females aged 15-19) Sexually transmitted disease (per 100,000 population) Violent crime per (per 1,000 population) Motor vehicle crash deaths (per 100,000 population) socioeconomic Factors 23 High school graduation rate 84.0% 82.0% 40 Population (age 25 & over) with a HS diploma 24.8% 36.0% 8 Unemployment Rate 4.6% 4.4% 13 Children (age 0-17) in poverty 25.5% 27.9% 32 Divorce rate (per 1,000 population) Single-parent families 24.7% 23.5% 32 Physical environment 10 Air quality cancer risk Air quality hazard index Fine particle matter in air Ozone level * Nitrate level in water >2 * 34.4% 0.0% 1 Housing built before % 23.8% 17 Lead poisoned children 0.8% 0.0% 1 14

17 West Virginia 2009 County Health Rankings 15 Braxton County 30 BRAXTON Health Outcomes 19 Mortality (years of potential life lost per 100,000 population) Low Birth Weight 9.5% 7.6% 8 General health status (% Fair or Poor Health) 23.9% 30.0% 46 Health Determinants 49 Health Care 44 No health insurance 21.8% 28.8% 45 Doctors per 100,000 population Dentists per 100,000 population Without pneumococcal vaccinations 64.7% 67.6% 38 Without influenza vaccinations for the last 12 months 66.6% 68.0% 36 Diabetes 10.7% 10.9% 35 No mammography within past 2-year Women Aged % 32.3% 40 Health Behaviors 48 Cigarette smoking 27.0% 37.2% 51 Mothers smoking during pregnancy 27.2% 33.3% 40 Physical inactivity 27.0% 31.1% 43 Overweight and obesity 28.9% 30.8% 36 Low fruit and vegetable consumption (<5 fruit/veg a day) 20.0% 21.1% 21 Binge drinking 10.5% 8.8% 17 Teen birth rate (per 1,000 females aged 15-19) Sexually transmitted disease (per 100,000 population) Violent crime per (per 1,000 population) Motor vehicle crash deaths (per 100,000 population) socioeconomic Factors 41 High school graduation rate 84.0% 78.0% 53 Population (age 25 & over) with a HS diploma 24.8% 32.7% 12 Unemployment Rate 4.6% 5.2% 33 Children (age 0-17) in poverty 25.5% 36.6% 49 Divorce rate (per 1,000 population) Single-parent families 24.7% 23.0% 25 Physical environment 19 Air quality cancer risk Air quality hazard index Fine particle matter in air Ozone level * Nitrate level in water >2 * 34.4% 0.0% 1 Housing built before % 24.0% 18 Lead poisoned children 0.8% 1.0% 35

18 2009 County Health Rankngs BROOKE Brooke County 27 Health Outcomes 18 Mortality (years of potential life lost per 100,000 population) Low Birth Weight 9.5% 10.3% 39 General health status (% Fair or Poor Health) 23.9% 19.4% 8 Health Determinants 42 Health Care 17 No health insurance 21.8% 21.1% 22 Doctors per 100,000 population Dentists per 100,000 population Without pneumococcal vaccinations 64.7% 63.4% 28 Without influenza vaccinations for the last 12 months 66.6% 63.2% 17 Diabetes 10.7% 11.3% 41 No mammography within past 2-year Women Aged % 15.6% 1 Health Behaviors 54 Cigarette smoking 27.0% 30.2% 39 Mothers smoking during pregnancy 27.2% 22.9% 12 Physical inactivity 27.0% 27.8% 30 Overweight and obesity 28.9% 29.6% 27 Low fruit and vegetable consumption (<5 fruit/veg a day) 20.0% 16.7% 47 Binge drinking 10.5% 20.0% 55 Teen birth rate (per 1,000 females aged 15-19) Sexually transmitted disease (per 100,000 population) Violent crime per (per 1,000 population) Motor vehicle crash deaths (per 100,000 population) socioeconomic Factors 14 High school graduation rate 84.0% 93.7% 3 Population (age 25 & over) with a HS diploma 24.8% 20.3% 46 Unemployment Rate 4.6% 6.9% 51 Children (age 0-17) in poverty 25.5% 17.4% 6 Divorce rate (per 1,000 population) Single-parent families 24.7% 21.9% 16 Physical environment 37 Air quality cancer risk Air quality hazard index Fine particle matter in air Ozone level * Nitrate level in water >2 * 34.4% 0.0% 1 Housing built before % 36.1% 46 Lead poisoned children 0.8% 0.0% 1 16

19 West Virginia 2009 County Health Rankings 17 Cabell County 45 CABELL Health Outcomes 40 Mortality (years of potential life lost per 100,000 population) Low Birth Weight 9.5% 11.0% 47 General health status (% Fair or Poor Health) 23.9% 20.1% 10 Health Determinants 45 Health Care 5 No health insurance 21.8% 22.1% 25 Doctors per 100,000 population Dentists per 100,000 population Without pneumococcal vaccinations 64.7% 63.2% 26 Without influenza vaccinations for the last 12 months 66.6% 66.6% 27 Diabetes 10.7% 9.6% 20 No mammography within past 2-year Women Aged % 28.6% 34 Health Behaviors 26 Cigarette smoking 27.0% 23.0% 7 Mothers smoking during pregnancy 27.2% 24.9% 17 Physical inactivity 27.0% 20.4% 2 Overweight and obesity 28.9% 25.9% 9 Low fruit and vegetable consumption (<5 fruit/veg a day) 20.0% 20.7% 24 Binge drinking 10.5% 13.0% 47 Teen birth rate (per 1,000 females aged 15-19) Sexually transmitted disease (per 100,000 population) Violent crime per (per 1,000 population) Motor vehicle crash deaths (per 100,000 population) socioeconomic Factors 53 High school graduation rate 84.0% 76.9% 54 Population (age 25 & over) with a HS diploma 24.8% 20.0% 48 Unemployment Rate 4.6% 4.3% 12 Children (age 0-17) in poverty 25.5% 26.2% 28 Divorce rate (per 1,000 population) Single-parent families 24.7% 28.6% 53 Physical environment 49 Air quality cancer risk Air quality hazard index Fine particle matter in air Ozone level * Nitrate level in water >2 * 34.4% 0.0% 1 Housing built before % 33.5% 43 Lead poisoned children 0.8% 0.4% 25

20 2009 County Health Rankngs CALHOUN Calhoun County 46 Health Outcomes 38 Mortality (years of potential life lost per 100,000 population) Low Birth Weight 9.5% 9.4% 30 General health status (% Fair or Poor Health) 23.9% 26.5% 32 Health Determinants 50 Health Care 45 No health insurance 21.8% 32.6% 49 Doctors per 100,000 population Dentists per 100,000 population Without pneumococcal vaccinations 64.7% 69.5% 43 Without influenza vaccinations for the last 12 months 66.6% 65.5% 21 Diabetes 10.7% 8.4% 7 No mammography within past 2-year Women Aged % 37.4% 46 Health Behaviors 37 Cigarette smoking 27.0% 34.3% 46 Mothers smoking during pregnancy 27.2% 35.7% 45 Physical inactivity 27.0% 31.8% 47 Overweight and obesity 28.9% 26.5% 11 Low fruit and vegetable consumption (<5 fruit/veg a day) 20.0% 17.1% 42 Binge drinking 10.5% 9.8% 29 Teen birth rate (per 1,000 females aged 15-19) Sexually transmitted disease (per 100,000 population) Violent crime per (per 1,000 population) Motor vehicle crash deaths (per 100,000 population) socioeconomic Factors 54 High school graduation rate 84.0% 76.8% 55 Population (age 25 & over) with a HS diploma 24.8% 37.6% 4 Unemployment Rate 4.6% 6.8% 50 Children (age 0-17) in poverty 25.5% 34.0% 46 Divorce rate (per 1,000 population) Single-parent families 24.7% 20.0% 5 Physical environment 17 Air quality cancer risk Air quality hazard index Fine particle matter in air Ozone level * Nitrate level in water >2 * 34.4% 0.0% 1 Housing built before % 31.0% 38 Lead poisoned children 0.8% 0.0% 1 18

21 West Virginia 2009 County Health Rankings 19 Clay County 42 CLAY Health Outcomes 37 Mortality (years of potential life lost per 100,000 population) Low Birth Weight 9.5% 9.8% 32 General health status (% Fair or Poor Health) 23.9% 26.5% 32 Health Determinants 46 Health Care 52 No health insurance 21.8% 32.6% 49 Doctors per 100,000 population Dentists per 100,000 population Without pneumococcal vaccinations 64.7% 69.5% 43 Without influenza vaccinations for the last 12 months 66.6% 65.5% 21 Diabetes 10.7% 8.4% 7 No mammography within past 2-year Women Aged % 37.4% 46 Health Behaviors 43 Cigarette smoking 27.0% 34.3% 46 Mothers smoking during pregnancy 27.2% 36.0% 46 Physical inactivity 27.0% 31.8% 47 Overweight and obesity 28.9% 26.5% 11 Low fruit and vegetable consumption (<5 fruit/veg a day) 20.0% 17.1% 42 Binge drinking 10.5% 9.8% 29 Teen birth rate (per 1,000 females aged 15-19) Sexually transmitted disease (per 100,000 population) Violent crime per (per 1,000 population) Motor vehicle crash deaths (per 100,000 population) socioeconomic Factors 40 High school graduation rate 84.0% 86.7% 19 Population (age 25 & over) with a HS diploma 24.8% 36.3% 7 Unemployment Rate 4.6% 6.4% 47 Children (age 0-17) in poverty 25.5% 37.4% 51 Divorce rate (per 1,000 population) Single-parent families 24.7% 24.5% 39 Physical environment 7 Air quality cancer risk Air quality hazard index Fine particle matter in air Ozone level * Nitrate level in water >2 * 34.4% 0.0% 1 Housing built before % 17.8% 6 Lead poisoned children 0.8% 0.0% 1

22 2009 County Health Rankngs DODDRIDGE Doddridge County 24 Health Outcomes 26 Mortality (years of potential life lost per 100,000 population) Low Birth Weight 9.5% 10.7% 45 General health status (% Fair or Poor Health) 23.9% 22.8% 25 Health Determinants 14 Health Care 26 No health insurance 21.8% 17.9% 7 Doctors per 100,000 population Dentists per 100,000 population Without pneumococcal vaccinations 64.7% 59.8% 11 Without influenza vaccinations for the last 12 months 66.6% 60.3% 11 Diabetes 10.7% 9.2% 14 No mammography within past 2-year Women Aged % 25.6% 28 Health Behaviors 27 Cigarette smoking 27.0% 27.0% 28 Mothers smoking during pregnancy 27.2% 42.6% 53 Physical inactivity 27.0% 29.5% 33 Overweight and obesity 28.9% 30.0% 30 Low fruit and vegetable consumption (<5 fruit/veg a day) 20.0% 18.5% 36 Binge drinking 10.5% 7.5% 8 Teen birth rate (per 1,000 females aged 15-19) Sexually transmitted disease (per 100,000 population) Violent crime per (per 1,000 population) Motor vehicle crash deaths (per 100,000 population) socioeconomic Factors 15 High school graduation rate 84.0% 90.1% 7 Population (age 25 & over) with a HS diploma 24.8% 30.6% 14 Unemployment Rate 4.6% 4.9% 26 Children (age 0-17) in poverty 25.5% 29.0% 38 Divorce rate (per 1,000 population) Single-parent families 24.7% 22.4% 21 Physical environment 25 Air quality cancer risk Air quality hazard index Fine particle matter in air Ozone level * Nitrate level in water >2 * 34.4% 16.0% 36 Housing built before % 35.6% 45 Lead poisoned children 0.8% 0.0% 1 20

23 West Virginia 2009 County Health Rankings 21 Fayette County 47 FAYETTE Health Outcomes 47 Mortality (years of potential life lost per 100,000 population) Low Birth Weight 9.5% 10.1% 38 General health status (% Fair or Poor Health) 23.9% 28.4% 42 Health Determinants 48 Health Care 32 No health insurance 21.8% 27.0% 42 Doctors per 100,000 population Dentists per 100,000 population Without pneumococcal vaccinations 64.7% 60.1% 15 Without influenza vaccinations for the last 12 months 66.6% 66.9% 30 Diabetes 10.7% 11.3% 42 No mammography within past 2-year Women Aged % 26.9% 31 Health Behaviors 46 Cigarette smoking 27.0% 27.3% 32 Mothers smoking during pregnancy 27.2% 28.9% 28 Physical inactivity 27.0% 31.2% 46 Overweight and obesity 28.9% 33.5% 48 Low fruit and vegetable consumption (<5 fruit/veg a day) 20.0% 18.8% 33 Binge drinking 10.5% 11.9% 45 Teen birth rate (per 1,000 females aged 15-19) Sexually transmitted disease (per 100,000 population) Violent crime per (per 1,000 population) Motor vehicle crash deaths (per 100,000 population) socioeconomic Factors 46 High school graduation rate 84.0% 82.3% 38 Population (age 25 & over) with a HS diploma 24.8% 31.4% 13 Unemployment Rate 4.6% 5.3% 36 Children (age 0-17) in poverty 25.5% 33.3% 45 Divorce rate (per 1,000 population) Single-parent families 24.7% 27.8% 52 Physical environment 26 Air quality cancer risk Air quality hazard index Fine particle matter in air Ozone level * Nitrate level in water >2 * 34.4% 1.0% 33 Housing built before % 37.9% 48 Lead poisoned children 0.8% 0.6% 28

24 2009 County Health Rankngs GILMER gilmer County 33 Health Outcomes 34 Mortality (years of potential life lost per 100,000 population) Low Birth Weight 9.5% 9.9% 33 General health status (% Fair or Poor Health) 23.9% 26.5% 32 Health Determinants 25 Health Care 47 No health insurance 21.8% 32.6% 49 Doctors per 100,000 population Dentists per 100,000 population Without pneumococcal vaccinations 64.7% 69.5% 43 Without influenza vaccinations for the last 12 months 66.6% 65.5% 21 Diabetes 10.7% 8.4% 7 No mammography within past 2-year Women Aged % 37.4% 46 Health Behaviors 44 Cigarette smoking 27.0% 34.3% 46 Mothers smoking during pregnancy 27.2% 28.2% 27 Physical inactivity 27.0% 31.8% 47 Overweight and obesity 28.9% 26.5% 11 Low fruit and vegetable consumption (<5 fruit/veg a day) 20.0% 17.1% 42 Binge drinking 10.5% 9.8% 29 Teen birth rate (per 1,000 females aged 15-19) Sexually transmitted disease (per 100,000 population) Violent crime per (per 1,000 population) Motor vehicle crash deaths (per 100,000 population) socioeconomic Factors 9 High school graduation rate 84.0% 88.6% 10 Population (age 25 & over) with a HS diploma 24.8% 30.0% 16 Unemployment Rate 4.6% 4.4% 13 Children (age 0-17) in poverty 25.5% 29.8% 40 Divorce rate (per 1,000 population) Single-parent families 24.7% 23.0% 25 Physical environment 18 Air quality cancer risk Air quality hazard index Fine particle matter in air Ozone level * Nitrate level in water >2 * 34.4% 0.0% 1 Housing built before % 30.4% 36 Lead poisoned children 0.8% 0.0% 1 22

25 West Virginia 2009 County Health Rankings 23 grant County 4 GRANT Health Outcomes 2 Mortality (years of potential life lost per 100,000 population) Low Birth Weight 9.5% 6.1% 2 General health status (% Fair or Poor Health) 23.9% 22.5% 23 Health Determinants 10 Health Care 6 No health insurance 21.8% 17.9% 7 Doctors per 100,000 population Dentists per 100,000 population Without pneumococcal vaccinations 64.7% 67.4% 36 Without influenza vaccinations for the last 12 months 66.6% 60.1% 9 Diabetes 10.7% 8.9% 12 No mammography within past 2-year Women Aged % 18.5% 5 Health Behaviors 22 Cigarette smoking 27.0% 24.9% 10 Mothers smoking during pregnancy 27.2% 33.6% 41 Physical inactivity 27.0% 23.9% 9 Overweight and obesity 28.9% 28.7% 25 Low fruit and vegetable consumption (<5 fruit/veg a day) 20.0% 22.0% 18 Binge drinking 10.5% 11.4% 42 Teen birth rate (per 1,000 females aged 15-19) Sexually transmitted disease (per 100,000 population) Violent crime per (per 1,000 population) Motor vehicle crash deaths (per 100,000 population) socioeconomic Factors 19 High school graduation rate 84.0% 85.2% 26 Population (age 25 & over) with a HS diploma 24.8% 29.2% 19 Unemployment Rate 4.6% 5.6% 40 Children (age 0-17) in poverty 25.5% 23.2% 15 Divorce rate (per 1,000 population) Single-parent families 24.7% 19.7% 4 Physical environment 2 Air quality cancer risk Air quality hazard index Fine particle matter in air Ozone level * Nitrate level in water >2 * 34.4% 0.0% 1 Housing built before % 17.1% 5 Lead poisoned children 0.8% 0.0% 1

26 2009 County Health Rankngs GREENBRIER greenbrier County 25 Health Outcomes 25 Mortality (years of potential life lost per 100,000 population) Low Birth Weight 9.5% 8.5% 19 General health status (% Fair or Poor Health) 23.9% 28.6% 43 Health Determinants 20 Health Care 31 No health insurance 21.8% 25.4% 36 Doctors per 100,000 population Dentists per 100,000 population Without pneumococcal vaccinations 64.7% 63.1% 23 Without influenza vaccinations for the last 12 months 66.6% 70.6% 47 Diabetes 10.7% 11.8% 46 No mammography within past 2-year Women Aged % 24.6% 17 Health Behaviors 7 Cigarette smoking 27.0% 25.6% 17 Mothers smoking during pregnancy 27.2% 26.7% 23 Physical inactivity 27.0% 30.7% 40 Overweight and obesity 28.9% 27.8% 19 Low fruit and vegetable consumption (<5 fruit/veg a day) 20.0% 20.3% 25 Binge drinking 10.5% 8.3% 13 Teen birth rate (per 1,000 females aged 15-19) Sexually transmitted disease (per 100,000 population) Violent crime per (per 1,000 population) Motor vehicle crash deaths (per 100,000 population) socioeconomic Factors 43 High school graduation rate 84.0% 82.3% 37 Population (age 25 & over) with a HS diploma 24.8% 26.6% 29 Unemployment Rate 4.6% 5.8% 43 Children (age 0-17) in poverty 25.5% 24.7% 21 Divorce rate (per 1,000 population) Single-parent families 24.7% 23.9% 35 Physical environment 8 Air quality cancer risk Air quality hazard index Fine particle matter in air Ozone level * Nitrate level in water >2 * 34.4% 13.0% 34 Housing built before % 27.7% 28 Lead poisoned children 0.8% 0.9% 32 24

27 West Virginia 2009 County Health Rankings 25 Hampshire County 17 HAMPSHIRE Health Outcomes 20 Mortality (years of potential life lost per 100,000 population) Low Birth Weight 9.5% 7.7% 11 General health status (% Fair or Poor Health) 23.9% 21.4% 15 Health Determinants 18 Health Care 27 No health insurance 21.8% 21.2% 23 Doctors per 100,000 population Dentists per 100,000 population Without pneumococcal vaccinations 64.7% 65.2% 34 Without influenza vaccinations for the last 12 months 66.6% 58.7% 3 Diabetes 10.7% 9.9% 26 No mammography within past 2-year Women Aged % 27.1% 32 Health Behaviors 31 Cigarette smoking 27.0% 24.8% 8 Mothers smoking during pregnancy 27.2% 23.4% 13 Physical inactivity 27.0% 24.6% 12 Overweight and obesity 28.9% 25.8% 6 Low fruit and vegetable consumption (<5 fruit/veg a day) 20.0% 27.9% 1 Binge drinking 10.5% 15.6% 52 Teen birth rate (per 1,000 females aged 15-19) Sexually transmitted disease (per 100,000 population) Violent crime per (per 1,000 population) Motor vehicle crash deaths (per 100,000 population) socioeconomic Factors 18 High school graduation rate 84.0% 80.8% 46 Population (age 25 & over) with a HS diploma 24.8% 28.7% 21 Unemployment Rate 4.6% 3.7% 3 Children (age 0-17) in poverty 25.5% 25.5% 23 Divorce rate (per 1,000 population) Single-parent families 24.7% 25.1% 43 Physical environment 6 Air quality cancer risk Air quality hazard index Fine particle matter in air Ozone level * Nitrate level in water >2 * 34.4% 0.0% 1 Housing built before % 16.9% 4 Lead poisoned children 0.8% 1.3% 39

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