Community Health Assessment 2005-2010 Tompkins County NY

Community Health Assessment Tompkins County, New York 2005–2010

Tompkins County Health Department Ithaca, New York

Alice Cole, RN, MSE Public Health Director

Sigrid Connors, MS, RN Director, Community Health Services

Theresa Lyczko, MS, CHES Director, Health Promotion Program

Ted Schiele, MS Planner/Evaluator

April 2005 2 Community Health Assessment

Tompkins County, NY 2005–2010 Community Health Assessment 3

Table of Contents

Table of Contents...... 3 Figures ...... 10 Tables...... 13 Maps ...... 14 Foreword...... 15 Background...... 15 Sources...... 15 Process...... 15 Purpose ...... 15

General Population Description ------16 Neighbors and Region ...... 16 Population Rank...... 16 2000 Census population ...... 16 Urban Population ...... 17 Median Age (Years)...... 17 Education...... 17 Bachelor’s Degree + ...... 17 Drop out rates ...... 18 Management, professional & related job ...... 18 Local Industry...... 18 Unemployment...... 18 Living together...... 19 Family Households ...... 19 Population transience ...... 19 Diversity...... 19 Foreign born...... 19 Asian population ...... 19 Black and Hispanic population...... 20 Income...... 20 Median HHD Income...... 20 Poverty level ...... 21 Figures and Tables ...... 23

Health Care Environment and Availability and Access to Services ------36 Health Care Providers...... 36 Cayuga Medical Center at Ithaca...... 36 Health care providers...... 36 Health Planning Council...... 36 Ithaca Health Care Alliance ...... 36

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Health care maintenance and disease prevention...... 37 Barriers to service access ...... 37 Transportation and location...... 37 Compass II survey...... 37 Cost of insurance premiums...... 38 Poverty and food security...... 38 Local Health Priorities ...... 38 Priorities ...... 39 Opportunities for Action...... 39 Recent initiatives ...... 39

Tompkins County Health Department------41 Service Divisions and Programs ...... 41 COMMUNITY HEALTH SERVICES DIVISION ...... 41 Maternal Child Unit...... 41 WIC ...... 41 Health Promotion Program...... 41 Home Health Care ...... 42 CHILDREN with SPECIAL HEALTH CARE NEEDS ...... 42 Children with Special Health Care Needs ...... 42 Early Intervention Program...... 42 Physically Handicapped Children’s Program ...... 42 Preschool Special Education Program...... 43 ENVIRONMENTAL HEALTH ...... 43 EH Programs...... 43 ADDITIONAL PROGRAMS of TCHD ...... 43 Bioterrorism Preparedness...... 43 Emergency Medical Service...... 44 Medical Examiner...... 44 Vital Statistics...... 44 Key Trends...... 44

Access to Quality Care ------45 Data Analysis...... 45 Insurance coverage across all NYS ...... 45 Health insurance coverage...... 45 Demographic profile of those with insurance ...... 45 Type of coverage in Tompkins County...... 45 CMC patients age 0–17 with no insurance...... 46 Uncompensated care ...... 46 Medicaid eligibles as a percent of the total population...... 46 Medicaid and self-pay births...... 47 Figures and Tables...... 48

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Cancer------57 Data Analysis...... 57 Lung Cancer Mortality...... 57 Cancer Mapping...... 57 Lung Cancer Incidence...... 58 Early Stage Diagnosis of Lung Cancer...... 58 Breast Cancer Mortality ...... 58 Breast Cancer Incidence...... 59 Cervical Cancer Mortality...... 59 Colorectal Cancer Mortality...... 59 Prostate Cancer Incidence...... 60 Community Resources...... 60 Tompkins County Health Department (TCHD) ...... 60 Healthy Living Partnership...... 60 Ithaca Breast Cancer Alliance (IBCA)...... 61 Hospicare...... 61 Cayuga Medical Center at Ithaca (CMC)...... 61 Opportunities for Action ...... 61 Figures and Tables ...... 62

Diabetes------75 Data Analysis...... 75 Diabetes mortality ...... 75 Physician diagnosed Diabetes...... 76 Diabetes related hospitalizations ...... 76 Community Resources...... 77 Diabetes Control Coalition ...... 77 Opportunities for Action ...... 77 Figures and Tables ...... 78

Family Planning------83 Data Analysis...... 83 Birth Rate, ages 15–44 ...... 83 Birth Rate, ages 18–19 ...... 84 Teenage Births, age 15–17 years...... 84 Births to women age 30–44 years ...... 84 Pregnancy Rate ...... 84 Abortions...... 85 Teen Pregnancies...... 85 Community Resources...... 85 Tompkins County Health Department...... 85 Planned Parenthood of the Southern Finger Lakes...... 85 The Teen Pregnancy /Parenting Program ...... 86 Figures and Tables ...... 87

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Heart Disease and Stroke ------96 Data Analysis...... 96 CVD Mortality ...... 96 Diseases of the Heart Mortality ...... 97 Cerebrovascular Disease (stroke) Mortality ...... 97 Risk factors...... 97 Hypertension ...... 97 Blood cholesterol...... 98 Community Resources ...... 98 NYSDOH...... 98 Health Promotion Program, TCHD...... 98 Cayuga Medical Center...... 98 Opportunities for Action...... 99 Healthy lifestyle ...... 99 Figures and Tables...... 100

AIDS – HIV – STD’s------105 Data Analysis...... 105 AIDS Mortality ...... 105 AIDS Cases...... 105 Syphilis Incidence...... 106 Gonorrhea Incidence...... 106 Chlamydial Infections ...... 106 Pelvic Inflammatory Disease...... 106 Safe sex among adults...... 106 Community Resources ...... 107 STD testing and treatment ...... 107 HIV testing and counseling...... 107 HIV case management services...... 107 Syringe exchange program ...... 107 Figures and Tables...... 108

Immunization and Infectious Disease ------116 Data Analysis...... 116 Flu Shot...... 116 Child immunization...... 117 Measles Incidence...... 117 Pertussis Incidence ...... 117 Tuberculosis Incidence...... 117 Hepatitis Incidence...... 118 Changes in reporting parameters for Hepatitis B and C...... 118 Lyme Disease Incidence ...... 118 Rabies Exposure...... 118 Community Outreach...... 118 Flu immunization clinics ...... 118 CNY Immunization Registry ...... 119

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Tick identification ...... 119 Rabies services...... 119 Figures and Tables ...... 120

Injury Prevention------128 Data Analysis...... 128 Population (2001)...... 128 Suicide deaths ...... 128 Homicides ...... 129 Work related injury mortality ...... 129 SPARCS ...... 129 Self-inflicted injuries...... 129 Assault incidence...... 129 Unintentional Injury...... 130 Motor vehicle deaths...... 130 Unintentional injury hospitalizations...... 130 Osteoporosis assessment in TC...... 131 Traumatic brain injury ...... 131 Community Resources...... 131 Child safety seats...... 131 Pedestrian safety ...... 131 Figures and Tables ...... 132

Maternal, Infant and Child Health------146 Data Analysis...... 146 Early prenatal care...... 146 Early prenatal care...... 146 Postneonatal mortality ...... 146 Spontaneous fetal deaths ...... 147 Short Gestation...... 147 Maternal Mortality ...... 147 Birthweight...... 147 Very Low Birthweight ...... 147 Low Birthweight births...... 148 Community Resources...... 148 WIC...... 148 Medicaid Obstetric and Maternal Services (MOMS)...... 148 Maternal Child Home Visiting Program...... 149 Medical Care — Highlights ...... 149 Opportunities for Action ...... 149 Figures and Tables ...... 150

Nutrition and Overweight------160

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Data Analysis...... 160 BRFSS ...... 160 Obese or Overweight ...... 160 Fruit and vegetable consumption ...... 161 HP 2010 ...... 161 Community Resources ...... 162 TCHD ...... 162 WIC ...... 162 Healthy CNY...... 162 Figures and Tables...... 163

Oral Health ------170 Community priority ...... 170 Data Analysis...... 170 NYSDOH /CDC Survey...... 170 Limitations in the survey...... 170 Survey results...... 171 HP 2010 ...... 171 Community Resources ...... 171 Dental Case Manager ...... 171 Figures and Tables...... 172

Physical Activity------174 Data Analysis...... 174 Leisure-time physical activity in past 30 days ...... 174 Community Resources ...... 175 Health Promotion Program...... 175 Activity environment ...... 175 Healthy City initiative...... 175 Opportunities for Action...... 176 Figures and Tables...... 177

Respiratory Diseases------180 Data Analysis...... 180 CLRD Mortality...... 180 CLRD Hospitalizations ...... 180 Tioga County rates...... 180 Asthma mortality...... 181 Asthma diagnosis: BRFSS...... 181 Asthma hospitalizations...... 182 Asthma discharges by age...... 183 Community Resources ...... 183 Unrecorded asthma incidence...... 183 CNY Asthma Coalition...... 184

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Figures and Tables ...... 185

Tobacco Use------196 Data Analysis...... 196 Overall tobacco use ...... 196 Youth Tobacco Survey...... 196 Tobacco use by age, gender, and education...... 197 Tobacco use by educational attainment ...... 197 College student smoking...... 197 Local TCP programs...... 197 Clean Indoor Air Act...... 198 Sales to minors ...... 198 Community Resources...... 199 Figures and Tables ...... 200

Data Sources ------205 Web Sites ...... 205 Tompkins County Health Planning Council...... 205 Tompkins County Office for the Aging ...... 205 Tompkins County Planning Department ...... 205 Tompkins County Bureau of Youth Services ...... 205 Tompkins County Health Department...... 205 Day Care and Child Development Council of Tompkins County, Inc...... 205 Ithaca Health Care Alliance ...... 205 Cayuga Medical Center ...... 205 New York State Department of Health...... 206

Community Health Assessment – Distribution ------207

Index------208

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Figures

Figure 1 — Map of Tompkins County towns and bordering counties...... 23 Figure 2 — Urban population, regional comparison...... 23 Figure 3 — Urban, farm and nonfarm rural populations, regional comparison ...... 24 Figure 4 — Median age, regional comparison and Tompkins excluding students...... 24 Figure 5 — Population age distribution, regional comparison...... 25 Figure 6 — Educational attainment, regional comparison...... 26 Figure 7 — High school dropout rate, regional comparison...... 26 Figure 8 — Unemployment rate, regional comparison...... 28 Figure 9 — Unemployment rate, 4-year trends...... 28 Figure 10 — Change in private nonfarm employment, regional comparison ...... 29 Figure 11 — Percent family households, regional comparison and Tompkins excluding students...... 29 Figure 12 — Population transience, regional comparison...... 30 Figure 13 — Asian population, regional comparison...... 30 Figure 14 — Black and Hispanic population, regional comparison...... 31 Figure 15 — Median household income, regional comparison ...... 32 Figure 16 — Population below poverty by age, regional comparison ...... 32 Figure 17 — Individuals below poverty, regional comparison...... 33 Figure 18 — Families below poverty, regional comparison...... 33 Figure 19 — Population below poverty by household type, regional comparison...... 34 Figure 20 — Population below poverty by family type, regional comparison...... 34 Figure 21 — Percent uninsured, NYS, trends by age ...... 48 Figure 22 — Insurance coverage, regional comparisons...... 49 Figure 23 — Insurance coverage, demographic comparison, Cortland–Tompkins ...... 49 Figure 24 — Insurance coverage, Age 18+ years, Tompkins County...... 50 Figure 25 — Type of insurance coverage among those with coverage, Tompkins County ...... 50 Figure 26 — Children without medical coverage, CMC, percent change over 3 years...... 51 Figure 27 — Self-pay visits, CMC trend 1998–2003...... 52 Figure 28 — Uncompensated care, CMC trend 1994–2003...... 53 Figure 29 — Medicaid eligibles as percent of population, regional comparison ...... 53 Figure 30 — Medicaid eligibles as percent of population, regional trends, 2000–2003...... 54 Figure 31 — Total on Medicaid, Tompkins County trend 1996–2003...... 54 Figure 32 — Medicaid /Self-Pay births, regional comparison ...... 56 Figure 33 — Medicaid /Self-Pay births, trends...... 56 Figure 34 –- Median age, Tompkins, Tompkins excluding students and regional comparison...... 62 Figure 35 –- Lung and bronchus cancer mortality, age adjusted rates, regional comparison...... 63 Figure 36 –- Lung and bronchus mortality, crude rates, 10-year trend ...... 63 Figure 37 –- Lung and bronchus cancer incidence, age-adjusted rates, regional comparison...... 64 Figure 38 –- Lung and bronchus cancer, early stage diagnosis, regional comparison ...... 65 Figure 39 –- Breast cancer mortality in females, age-adjusted rate, regional comparison ...... 66 Figure 40 –- Breast cancer in females, crude rate, 10-year trend...... 66 Figure 41 –- Breast cancer incidence in females, regional comparison...... 67 Figure 42 –- Breast cancer incidence in females, early diagnosis, regional comparison...... 68 Figure 43 –- Cervical cancer mortality in females, age-adjusted rates, regional comparison...... 68 Figure 44 –- Cervical cancer mortality in females, crude rates, 10-year trend...... 69 Figure 45 –- Cervical cancer incidence in females, age-adjusted rates, regional comparison ...... 69 Figure 46 –- Cervical cancer incidence in females, early diagnosis, regional comparison ...... 70 Figure 47 –- Colorectal cancer mortality, age-adjusted rates, regional comparison ...... 70 Figure 48 –- Colorectal cancer mortality, crude rates, 10-year trend...... 71 Figure 49 –- Colorectal cancer incidence, age-adjusted rates, regional comparison...... 71 Figure 50 –- Prostate cancer incidence and mortality, regional comparison...... 73

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Figure 51 — Diabetes mortality, regional comparison...... 78 Figure 52 — Diabetes mortality, 10-year trend...... 79 Figure 53 — Diabetes prevalence age 18+, NYS, 11-year trend (BRFSS) ...... 79 Figure 54 — Physician diagnosed diabetes (BRFSS), regional comparison...... 80 Figure 55 — Physician diagnosed diabetes, Cortland-Tompkins, demographic comparison...... 80 Figure 56 — Diabetes related hospitalizations, regional comparison...... 81 Figure 57 — Diabetes related hospitalizations, 6-year trend by county...... 82 Figure 58 — Diabetes related hospitalizations by age, regional comparison ...... 82 Figure 59 –- Birth rate, age 15–44, regional comparison...... 87 Figure 60 –- Birth rate, age 15–44, 10-year trend...... 87 Figure 61 –- Female population by age, regional comparison...... 88 Figure 62 –- Teenage births, age 15–17, rate per female pop. age 15–17, regional comparison...... 89 Figure 63 –- Teenage births, age 15–17, rate per live births, regional comparison...... 89 Figure 64 –- Teenage births, age 15–17, rate per live births, 10-year trend...... 90 Figure 65 –- Teenage births, age 18–19, rate per female pop. age 18–19, regional comparison...... 90 Figure 66 –- Out-of-Wedlock births, regional comparison ...... 91 Figure 67 –- Births to mothers age 30–44, regional comparison...... 91 Figure 68 –- Births to mothers age 30–44, 10-year trend...... 92 Figure 69 –- Pregnancies, regional comparison ...... 92 Figure 70 –- Pregnancies, 10-year trend ...... 93 Figure 71 –- Induced abortions, regional comparison...... 93 Figure 72 –- Abortions, 10-year trend...... 94 Figure 73 –- Teenage pregnancies, age 15–19, regional comparison ...... 94 Figure 74 –- Teenage pregnancies, age 15–17, regional comparison ...... 95 Figure 75 –- Teenage pregnancies, age 15–17, 10-year trend ...... 95 Figure 76 –- Cardiovascular disease mortality, age-adjusted rates, regional comparison ...... 100 Figure 77 –- Diseases of the Heart mortality, crude rates, 10-year trend...... 101 Figure 78 –- Diseases of the heart mortality, age-adjusted rate, United States, 50-year trend...... 101 Figure 79 –- Cerebrovascular disease mortality, age-adjusted rates, regional comparison...... 102 Figure 80 –- Ever diagnosed with high blood pressure, regional comparison ...... 102 Figure 81 –- Diagnosed with high blood pressure, NYS 8-year trend...... 103 Figure 82 –- Had blood pressure checked, regional comparison ...... 103 Figure 83 –- Had blood cholesterol checked, NYS 14-year trend...... 104 Figure 84 — AIDS mortality, regional comparisons...... 108 Figure 85 — AIDS Mortality, 10-year trend...... 108 Figure 86 — AIDS Cases, regional comparisons ...... 109 Figure 87 — Newborns testing positive for HIV antibodies, regional comparisons ...... 109 Figure 88 — Syphilis cases, Tompkins County 13-year trend...... 110 Figure 89 — Early syphilis incidence, regional comparison...... 110 Figure 90 — Early syphilis incidence, Ages 15–19, regional comparison ...... 111 Figure 91 — Cortland County recorded a single case of congenital syphilis in 2002...... 111 Figure 92 — Tompkins County averaged 34 gonorrhea cases per year 1991–2003...... 112 Figure 93 — Gonorrhea cases, regional comparison ...... 112 Figure 94 — Gonorrhea cases ages 15–19 years, regional comparisons...... 113 Figure 95 — Chlamydial infections, Tompkins County 1991–2003 ...... 113 Figure 96 — Pelvic inflammatory disease hospitalizations, regional comparison...... 114 Figure 97 — Pelvic inflammatory disease hospitalizations, 10-year trend...... 114 Figure 98 — Occurrence of STD prevention counseling, regional comparison...... 115 Figure 99 –- Had a flu shot, age 65+, regional comparison...... 120 Figure 100 –- Had a flu shot, age 18+, regional comparison...... 120 Figure 101 –- Had a pneumonia shot, age 65+, regional comparison...... 121 Figure 102 –- Had a pneumonia shot, age 18+, regional comparison...... 121 Figure 103 –- Measles cases, rate per 100,000 population, 13-year trend ...... 122

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Figure 104 –- Pertussis cases, regional comparison ...... 123 Figure 105 –- Pertussis cases, rate per 100,000 population, 13-year trend ...... 123 Figure 106 –- Hepatitis A cases, rate per 100,000 population, 13-year trend...... 124 Figure 107 –- Hepatitis B cases, rate per 100,000 population, 13-year trend...... 124 Figure 108 –- Hepatitis C cases, rate per 100,000 population, 13-year trend...... 125 Figure 109 –- Tuberculosis cases, rate per 100,000 population, 13-year trend...... 125 Figure 110 –- Lyme disease cases, regional comparison...... 126 Figure 111 –- Lyme disease cases, rate per 100,000 population, 13-year trend...... 126 Figure 112 –- Rabies exposure, rate per 100,000 population, 13-year trend...... 127 Figure 113 — Suicide deaths, regional comparison...... 132 Figure 114 — Suicide deaths, 10-year trend...... 133 Figure 115 — Suicide deaths, ages 15–19 years, regional comparison...... 133 Figure 116 — Suicide deaths, ages 15–19 years, 10-year trend...... 134 Figure 117 — Self-inflicted injury discharges, regional comparison...... 134 Figure 118 — Self-inflicted injury discharges, 10-year trend...... 135 Figure 119 — Self-inflicted injury discharges, Age 15–19, regional comparison ...... 135 Figure 120 — Self-inflicted injury discharges, Age 15–19, 10-year trend ...... 136 Figure 121 — Homicide deaths, regional comparison ...... 136 Figure 122 — Homicide deaths, 10-year comparison...... 137 Figure 123 — Assault discharges, regional comparison...... 137 Figure 124 — Assaults: Upstate rates have fallen 39%; Tompkins’ 3-yr avgs. have fallen 45% ...... 138 Figure 125 — Motor vehicle deaths, regional comparison...... 138 Figure 126 — motor vehicle deaths, 10-year trend...... 139 Figure 127 — Alcohol-related M.V. deaths, regional comparison...... 139 Figure 128 — Drug related hospitalizations, regional comparison...... 140 Figure 129 — Traumatic brain injury, regional comparison...... 140 Figure 130 — Traumatic brain injury, 10-year trend...... 141 Figure 131 — Unintentional injury discharges, regional comparison and 10-year trend...... 141 Figure 132 — Unintentional Injury discharges, Age <10 yr.; regional comparison and 10-year trend...... 142 Figure 133 — Unintentional Injury discharges, Age 10–14 yr.; regional comparison and 10-year trend ...... 143 Figure 134 — Unintentional Injury discharges, Age 15–24 yr.; regional comparison and 10-year trend ...... 143 Figure 135 — Unintentional Injury discharges, Age 25–64 yr.; regional comparison and 10-year trend ...... 144 Figure 136 — Unintentional Injury discharges, Age 65+; regional comparison and 10-year trend...... 145 Figure 137 — Early prenatal care, regional comparison...... 150 Figure 138 –- Early prenatal care, 10-year trend ...... 151 Figure 139 –- Early prenatal care, by Tompkins County ZIP code...... 151 Figure 140 –- Postneonatal mortality, regional comparison...... 152 Figure 141 –- Neonatal mortality, regional comparison...... 153 Figure 142 –- Infant mortality, regional comparison...... 153 Figure 143 –- Postneonatal mortality, 10-year trend...... 154 Figure 144 –- Neonatal mortality, 10-year trend...... 154 Figure 145 –- Spontaneous fetal deaths, 10-year trend...... 155 Figure 146 –- Spontaneous fetal deaths, regional comparison...... 155 Figure 147 –- Short gestation, regional comparison ...... 156 Figure 148 –- Short gestation, 10-year trend ...... 156 Figure 149 –- Low birthweight births, regional comparison...... 157 Figure 150 –- Low birthweight births, 10-year trend...... 157 Figure 151 –- Low birthweight births, by Tompkins County town...... 158 Figure 152 –- Families in poverty, by Tompkins County town...... 158 Figure 153 –- Breastfeeding, Tompkins County...... 159 Figure 154 — Overweight or obese, regional comparison...... 163 Figure 155 — Overweight or obese, Tompkins–Cortland ...... 164 Figure 156 — Underweight /Normal, regional comparison ...... 165

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Figure 157 — Overweight, regional comparison...... 165 Figure 158 — Obese, regional comparison ...... 166 Figure 159 — Eat 5-A-Day, regional comparison ...... 166 Figure 160 — Eat 5-A-Day, Tompkins–Cortland ...... 167 Figure 161 — Trying to lose weight, regional comparison...... 167 Figure 162 — Trying to maintain current weight, regional comparison...... 168 Figure 163 — Changing diet to lose or maintain weight, regional comparison...... 168 Figure 164 — Changing physical exercise to lose or maintain weight, regional comparison ...... 169 Figure 165 — Oral health status of 3rd grade students, Tompkins County...... 172 Figure 166 — Oral health status, Tompkins County children and HP 2010 ...... 173 Figure 167 — Leisure-time physical activity, regional comparison...... 177 Figure 168 — Leisure-time physical activity, Cortland–Tompkins ...... 178 Figure 169 — WWTC Web site home page...... 179 Figure 170 — “Physical Activity Counts” scoresheet...... 179 Figure 171 — Chronic lower respiratory disease mortality, regional comparison...... 185 Figure 172 — Chronic lower respiratory disease mortality, 10-year trend...... 186 Figure 173 — COPD hospitalizations by age, regional comparison...... 186 Figure 174 — Asthma mortality, age adjusted rates, regional comparison ...... 187 Figure 175 — Asthma mortality, crude rates, regional comparison...... 187 Figure 176 — Asthma mortality, 10-year trend...... 188 Figure 177 — Ever had Asthma diagnosis (self-report), regional comparison ...... 188 Figure 178 — Ever had Asthma diagnosis (self-report), Cortland–Tompkins demographic comparison ...... 189 Figure 179 — Current Asthma diagnosis (self-report), regional comparison...... 189 Figure 180 — Current Asthma diagnosis (self-report), Cortland–Tompkins demographic comparison...... 190 Figure 181 — Asthma hospitalizations, regional comparison...... 190 Figure 182 — Asthma hospitalizations, 10-year trend...... 191 Figure 183 — Asthma hospitalizations, comparison by age, Tompkins ...... 191 Figure 184 — Asthma hospitalizations by age, regional comparison ...... 192 Figure 185 — Asthma hospitalizations by age, statewide comparison...... 192 Figure 186 — Asthma hospitalizations age <5, 10-year trend...... 193 Figure 187 — Asthma hospitalizations age 5–14, 10-year trend...... 193 Figure 188 — Asthma hospitalizations age 15–24, 10-year trend...... 194 Figure 189 — Asthma hospitalizations age 25–44, 10-year trend...... 194 Figure 190 — Asthma hospitalizations age 45–64, 10-year trend...... 195 Figure 191 — Asthma hospitalizations age 65+, 10-year trend...... 195 Figure 192 –- Tobacco use, Tompkins County adults ...... 200 Figure 193 –- Cigarette use, Tompkins County adults...... 200 Figure 194 –- Tobacco use, adults, regional comparison...... 201 Figure 195 –- Tobacco use, Tompkins County adults, by age and gender ...... 201 Figure 196 –- Tobacco use, Tompkins County adults, by educational attainment ...... 202 Figure 197 –- Tobacco use, Cornell University students ...... 202 Figure 198 –- Awareness of Tompkins County based tobacco control programs ...... 203 Figure 199 –- Awareness among Tompkins County adults of the NYS Smokers’ Quitline...... 203 Figure 200 –- Attitudes toward the NYS Clean Indoor Air Act, regional comparison...... 204

Tables

Table 1 — Population age distribution by Tompkins County towns...... 25 Table 2 — Top employers in Tompkins County (155+ employees)...... 27 Table 3 — median household income. Source: U.S. Census Bureau, Census 2000...... 31 Table 4 — Female householder, no husband present, with own kids under age 18 ...... 35 Table 5 — Children without medical coverage, CMC ...... 51

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Table 6 — HP 2010 targets for insurance and primary care...... 52 Table 7 — Primary care practices accepting new Medicaid patients, Tompkins County...... 55 Table 8 — Total individuals on Medicaid, Tompkins County...... 55 Table 9 –- Tompkins County population by gender, age, student status ...... 88 Table 10 –- Diseases of the Heart mortality, crude and age-adjusted rates, regional comparison...... 100 Table 11 — Percent sexually active individuals, Cortland–Tompkins...... 115 Table 12 –- Complete immunizations, age 24–35 months, Tompkins County...... 122 Table 13 –- Measles cases, regional comparison...... 122 Table 14 –- Early prenatal care, by Tompkins County ZIP code...... 152 Table 15 –- Lead poisoning incidence, Tompkins County...... 159 Table 16 — Leisure-time physical activity, Cortland–Tompkins...... 178

Maps

Map 1 –- Lung cancer incidence in males, by ZIP code, Tompkins & Schuyler Counties ...... 64 Map 2 –- Lung cancer incidence in females, by ZIP code, Tompkins & Schuyler Counties ...... 65 Map 3 –- Breast cancer incidence in females, by ZIP code, Tompkins & Schuyler ...... 67 Map 4 –- Colorectal cancer incidence in males, by ZIP code, Tompkins & Schuyler ...... 72 Map 5 –- Colorectal cancer incidence in females, by ZIP code, Tompkins & Schuyler ...... 72 Map 6 –- Prostate cancer incidence, by ZIP code, Tompkins County...... 73 Map 7 –- Prostate cancer, areas with elevated late stage incidence, adjusted for age and race ...... 74

Tompkins County, NY 2005–2010 Community Health Assessment 15

Foreword

Background The Community Health Assessment (CHA) describes the health of the community by pre- senting information on the health status, community health needs, resources, and health services infrastructure. It includes a socio-demographic profile of the county and seeks to identify target populations that may be at increased risk of poor health outcomes. The CHA also assesses the larger community environment and how it relates to the health of individuals. New York State public health law requires all local health departments to produce a written community health assessment every six years with biennial updates.

Sources The CHA is comprised of core indicators as determined by the New York State Department of Health (NYSDOH) that assess the community in terms of leading causes of morbidity and mortality. The NYSDOH is largely the source of this data. Local core indicator data is compared with the region when ever possible, the rest of New York State and measured by the Healthy People 2010 goals. US Census data and information from other federal sources are also included. This data is supplemented by local data from agencies and organizations that assess the health and well being of their target populations.

Process The CHA document provides an interpretation and analysis of the data. It is also a continuous, interactive local process with regular electronic updates of the information. This process allows for a continual scan of the local health environment for changes in conditions and emerging health issues which may result in local strategies. As the lead agency for the CHA, the Health Department seeks input from other organizations, consumers, and health care providers in identifying health issues and concerns and determining focus areas. In the CHA, the Health Department also identifies its priorities as reflected in the Municipal Public Health Services Plan (MPHSP) in safeguarding the public health that may not be as apparent to the community at large.

Purpose The CHA may be used for a variety of purposes: • Planning and evaluation of the progress of community and Health Department programs. • Documenting the Health Department’s fulfillment of legal and regulatory requirements. • Cataloguing multiple health-related activities in the community, helping to meet a broad community-wide assurance role. • Justifying budget appropriations and program development. • Reporting on important health outcome measures. • Providing technical assistance to other agencies. • Needs assessment for categorical grants. • Source of information for researchers and policymakers.

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General Population Description

ompkins County covers 476 square miles at the southern end of Cayuga Lake, the longest of New York’s Finger Lakes. Centered in the county and along the lake’s southern shore T is Ithaca, the county’s seat and only city. Ithaca is approximately 24 miles west of the city of Cortland, and 55 miles south and west of Syracuse by road.

Neighbors and Region Tompkins County is bordered by 6 other counties (see Figure 1, page 23.) From the northern-most border, clockwise they are: • Cayuga • Cortland • Tioga • Chemung • Schuyler • Seneca Even though Tompkins County residents and businesses — especially tourism-related businesses — often identify with the Finger Lakes region, for the purposes of many New York State statistical data sets Tompkins County is actually the southwest anchor of the Central New York (CNY) region. The 11-county CNY region includes: • Cayuga • Cortland • Herkimer • Jefferson • Madison • Oneida • Onondaga • Oswego • St. Lawrence • Tompkins Population Rank Throughout this report data for Tompkins County is frequently com- U.S. Census July 2004 pared with 3 neighboring counties and with the CNY region. The 3 are estimates, of 62 counties Cayuga, Cortland and Tioga, the latter of which is not in the CNY region, Cayuga ...... 34 but rather part of the “New York–Penn” region. Chemung...... 52 Cortland...... 32 These counties were chosen over Chemung, Schuyler and Seneca Schuyler...... 61 because the border with Chemung is very short, and the populations of Seneca ...... 57 Schuyler and Seneca are very small, the combined populations of the two Tioga...... 47 equaling just over half of that for Tompkins County. Tompkins...... 29

2000 Census population The population of Tompkins County is 100,135 according to the US Cayuga ...... 81,963 Census Bureau July 2004 estimate, an increase of 3.8 percent from the Cortland...... 48,599 2000 count of 96,501. Tompkins...... 96,501 From 1990 to 2001 Tompkins’ population grew by 2.6 percent. By

Tompkins County, NY 2005–2010 Community Health Assessment 17

Tioga ...... 51,784 comparison, neighboring Cortland County lost 1.0 percent of population CNY...... 1,251,561 between 1990 and 2001; New York state gained 5.7 percent and the NYS...... 18,976,457 United States as a whole gained 14.5 percent.

Urban Population Tompkins County is subdivided into 9 towns and 6 villages. The Percent, 2000 census Census Bureau classifies just over 58 percent of the Tompkins County Cayuga ...... 47.5 population as urban and 42 percent as rural. Only one percent of the latter Cortland ...... 55.2 live on a farm. Cortland County’s farm population is 1.8 percent of total Tompkins ...... 58.4 Tioga ...... 34.8 while in Cayuga County the farm population is 2.5%. (See Figure 2, page CNY...... 61.3 23 and Figure 5, page 25.)

The City of Ithaca is Tompkins’ population center with close to one- third (30.3%) of the county total. The Town of Ithaca is home to nearly 19 percent of the county population; the Town of Dryden 14 percent; the Town of Lansing nearly 11 percent. The six least populated towns combined represent just over one-quarter (25.9%) of the population.

Tompkins County is home to three institutions of higher education: Cornell University, Ithaca College and Tompkins Cortland Community College with a combined population of just over 27,000 students. Many of these students live in the City of Ithaca; college dormitories and apartment complexes with high student populations are also located in the Towns of Ithaca, Dryden and Lansing. Much of the county’s demographic profile reflects the weight of this sector, as will be shown by the following details.

Median Age (Years) Tompkins County’s population is unusually young: more than one Percent, 2000 census quarter (26%) are age 18 to 24 years. This segment accounts for only 16 Cayuga...... 37 percent of the population in Cortland County, 9 percent statewide, and 10 Cortland...... 34 percent nationwide. While the proportion of other age segments trend Tioga ...... 38 Tompkins (all)...... 27 lower when compared with Cortland, the state and nation, the differences Tompkins (excl-stu)..39 are not as striking.(See Figure 5, page 25.) NYS...... 36 The Tompkins County Planning Department has obtained U.S. Cen- sus 2000 data excluding students (Special Tabulation (Tab) #137.) The figures support the anecdotal evidence that Tompkins’ youth stems from the large number of students attending local colleges. Median age for the Tompkins’ entire population is 28.6 years. When students are excluded the median age for the remaining population rises to 38.9 years. The latter is very consistent with neighboring counties and the state as a whole.

Education. Bachelor’s Degree + This is a highly educated population; 9-out-of-10 residents age 25+ Pct of pop age 25+, 2000 years has a high school diploma. Nearly half (47%) of the age 25+

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Tompkins...... 47 population has a 4-year Bachelor’s degree, and the majority of that group Cayuga ...... 16 holds a graduate or professional degree. Cortland ...... 19 Tioga...... 20 By comparison, bachelor’s degrees are held by 19 percent in CNY ...... 22 Cortland County, 27 percent for New York State, and 24 percent for the USA. (See Figure 6, page 26.)

Drop out rates Another point which may be a reflection of the academic environment is that Tompkins’ high school dropout rates are very low, at only 2.5 percent of the 2000 population age 16-19 years. Comparable rates are: Cortland County 5.1%, and New York State 8.8%. (See Figure 7, page 26.)

Management, profes- Likewise, Tompkins County’s workforce is highly skilled: half sional & related job (50%) of employed residents age 16+ years are classified, “Management, Employed pop age 16+ professional & related” according to the 2000 Census, and one-in-six yrs. Pct, 2000 census (17%) are “Education, training & library.” Figures for New York State Tompkins...... 50% NYS ...... 37% are 37 percent for management and professional jobs, and just one-in- fourteen (7%) for educational jobs.

Local Industry Education accounts for 23 percent of Tompkins County’s Local Pct. Local Gross Product Gross Product (LGP), according to Tompkins County Area Develop- by type of enterprise, ’02 ment.1 Other sectors with more than 5 percent of the LGP include manu- Education...... 23.0 facturing, real estate, retail, high tech, government and utilities. Manufacturing...... 12.0 Real Estate...... 9.2 Among the county’s largest private and public-sector employers, Retail Trade...... 7.3 Cornell has by far the biggest workforce with 8600 employees –– 43 per- High-Tech...... 7.0 cent of those employed at the 27 sites with 155 or more employees. (See Health Services ...... 4.8 Table 2, page 27.)

Unemployment The unemployment rate has traditionally been low in Tompkins County — often the lowest in the state. The average unemployment rate for the years 2000–2002 was 3.0 percent in Tompkins, compared with 6.5 percent in Cortland County, 5.6 percent across the CNY region, and 5.2 percent statewide. (See Figure 8, page 28.) Though the numbers are lower, the pattern of unemployment ups and downs across recent years in Tompkins County is similar to that of the region and state, as illustrated in Figure 9 on page 28. Discussions among some professionals suggests that Tompkins’ low unemployment rate is skewed by students taking part-time jobs and low paying work-study jobs at the college they are attending. Among those out of school, jobs that utilize the full potential of an individual’s educational attainment are not always available, leaving many frustrated by underemployment.

1 Tompkins County Area Development Web site http://www.tcad.org/employers.htm. Accessed 12/29/03.

Tompkins County, NY 2005–2010 Community Health Assessment 19

Job growth in Tompkins County has been favorable in comparison with bordering counties. The U.S. Census Bureau reports that Tompkins non-farm employment gained by 3 percent from 2000 to 2001. By comparison, Cortland County gained only 1.3 percent and the state as a whole only one percent. Extremes in our neighborhood were a 4.2 percent loss in Schuyler County, and a 4.4 percent gain in Tioga. (See Figure 10, page 29.) Living together. Family Households Household type in Tompkins County is also indicative of the large student population. Only 53 percent of the full Tompkins County population lives in a family household, as compared to 64 percent in Cortland County and 66 percent statewide. When the student population is excluded from the Tompkins County count the proportion of family households increases to 63 percent, more in line with the comparison counties. (See Figure 11, page 29.) More than one quarter (27%) in Tompkins County live in nonfamily households (19% Cortland, 15% NYS) and 11 percent live in noninstitu- tionalized group quarters (6% Cortland, 2% NYS,) most likely reflecting college dormitory living.

Population transience And the population is highly transient: more than half of Tompkins’ Pop that lived in a different residents (2000 population age 5+ years) had lived in a different county state 5 years ago. Per- or in a different state just five years earlier (34% moved in from a differ- cent, 2000 census ent county and 19% from a different state.) By comparison, just over one- Tompkins...... 19% Cortland...... 3% in-five of Cortland County’s 2000 census had lived in a different county NYS...... 4% or state 5 years earlier (19% and 3%, respectively.) Across New York State between 1995 and 2000, only one-in-six moved from a different county or state of residence (12% and 4%, respectively). (See Figure 12, page 30.)

Diversity. Foreign born Thanks to the influences of Cornell University, a world renowned in- Percent, 2000 census stitution, Ithaca and Tompkins County are anecdotally considered to cra- Tompkins...... 11% dle diverse populations. More than one-in-ten (11%) of Tompkins’ Cortland...... 2% population is foreign-born and 14 percent speak a language other than Broome...... 5% NYS...... 20% English at home. While these groups are not unusual compared to state U.S...... 11% (20% and 28% respectively) or national (11% and 18%) statistics, they do contrast markedly with neighboring Cortland County (2% foreign- born and 4% foreign language.)

Asian population Cornell’s influence has also had a role in building Tompkins Percent, 2000 census County’s Asian population, which accounts for 7.2 percent of the 2000

Tompkins County, NY 2005–2010 20 Community Health Assessment

Tompkins...... 7.2% census. This tops both the state (5.5%) and national (3.6%) proportion of Tompkins Ex.Stu . 3.5% Asian residents. Less than one percent of Cortland County residents are Cortland...... 0.4% Cayuga ...... 0.4% Asian. Tioga...... 0.6% Evidence of the University influence in building the Asian popula- NYS ...... 5.5% tion can be seen when students are factored out of the population data U.S...... 3.6% using the U.S. Census Bureau’s Special Tabulation #137 of the 2000 census.2 The proportion of persons of Asian race in Tompkins County is halved when students are excluded from the sample, from 7.2 to 3.5 percent. This is still high compared to surrounding counties, but more consistent with national figures. (See Figure 13, page 30.)

Black and Hispanic With respect to Black and Hispanic or Latino populations, Tompkins population County’s rural setting appears to trump the influence of Cornell and its neighboring colleges. Eighty-six percent of the population is white, 3.6 percent Black, and 3.1 percent of Hispanic or Latino heritage. When the sample excludes students, Tompkins County’s population is 3.4 percent Black and 2.0 percent Hispanic. Statewide, the figures are 68 percent white, 16 percent Black and 15 percent Hispanic or Latino. The anecdotal sense of Tompkins’ diversity is not without merit, though. Neighboring Cortland County is 97 percent white. The average of the six counties bordering Tompkins County is 95 percent white. (See Figure 14, page 31.)

Income. Median HHD Income At first blush, higher education has not made Tompkins a high in- ...... ($ ,000) come county by statewide standards. Median household income all of Tompkins...... 37.3 New York State is more than 16 percent above that for all Tompkins Tompkins ex. Stu.. 43.7 residents ($37,272). The national median is nearly 13 percent higher than Cortland...... 34.4 Cayuga ...... 37.5 for Tompkins County. Regionally however, median household income NYS ...... 43.4 for neighboring counties is as much as 10 percent below Tompkins U.S...... 42.0 County (see Table 3, page 31.) However, the U.S. Census Bureau’s Special Tabulation #137 of the 2000 census presents a different picture. Special Tab 137, which was requested by the Tompkins County Planning Department, generates statistics from a population sample that effectively removes the county’s college students.3 This shows the median household income for Tomp-

2 In 2003, the Tompkins County Planning Department requested and received a Special Tabulation from the U.S. Bu- reau of the Census. This Special Tabulation (#137) provided separate sets of the 2000 Census data for "college students" and "non-college students" for Tompkins County (by municipality). "College student" was defined as those answering "yes" to question 8a of the Census 2000 "long" form questionnaire ("at any time since February 1, 2000, has this person attended regular school or college?" –- for ages 17+ years.) 3 In 2003, the Tompkins County Planning Department requested and received a Special Tabulation from the U.S. Bu- reau of the Census. This Special Tabulation (#137) provided separate sets of the 2000 Census data for "college stu-

Tompkins County, NY 2005–2010 Community Health Assessment 21

kins County exclusive of college students is $43,730, which is 0.8 percent higher than the state as a whole and 27 percent higher than Cortland County. (See Figure 15, page 32.)

Poverty level The student population in Tompkins County exerts an influence on Individuals with Income the rate of those with income below the poverty level. While among below poverty level neighboring counties, the state, and the nation, Tompkins County has the Tompkins...... 17.6% highest rate of population with income in 1999 below the poverty rate, Tompkins ex stu...8.9% Cortland...... 15.5% the age distribution of those with income below poverty is quite different Tioga ...... 8.4% from the region, state or nation. NYS...... 14.6% In Tompkins County the rate of population in 1999 with income be- U.S...... 12.4% low the poverty rate is more than one-in-six (17.6%.) Yet, in Tompkins more than 4-out-of-5 (83%) of those below poverty are between age 18 and 64 years. Just under 14 percent are children under age 18 years. Among Cortland County’s 15.5 percent of population below poverty, just over 3-in-5 are ages 18–64 years, and 27 percent are children younger than age 18 years. Statewide, 14.6 percent of individuals are below poverty, and of these 56 percent are age 18–64 and 34 percent are under age 18. (See Figure 16, page 32.) Data from Special Tab #137 supports the interpretation outlined above. When students are excluded from Tompkins’ sample population the rate of individuals below poverty is just about halved, falling to 8.9 percent. (See Figure 17, page 33.)

The student influence may also contribute to the patterns seen when poverty level is sorted by household type and by jurisdiction. (See Figure 19, page 34.) Poverty rates among households of unrelated individuals age 15+ years vary widely between jurisdictions in Tompkins County. The highest rates of poverty among these non-family households are found in the City of Ithaca and the Towns of Ithaca and Dryden, all jurisdictions where Cornell students are likely to reside.

Poverty rates among individuals is highest in the City of Ithaca, where 4-in-10 individuals lives below the poverty level. The Town of En- field shows the next highest level of poverty among individuals. Enfield, located in the southwest corner of Tompkins County, is not convenient to any of the college campuses and therefore less likely to attract a significant student population. Therefore, the numbers for Enfield are more likely to be reflective of the town’s long-term residents.

Among selected household types, single moms with young children dents" and "non-college students" for Tompkins County (by municipality). "College student" was defined as those answering "yes" to question 8a of the Census 2000 "long" form questionnaire ("at any time since February 1, 2000, has this person attended regular school or college?" –- for ages 17+ years.)

Tompkins County, NY 2005–2010 22 Community Health Assessment

have the highest rate of living below poverty. (See Figure 20, page 34.) Poverty strikes these families especially hard in the Town of Dryden where nearly 80 percent of families with children under age 5 years and where no husband is present live below poverty. In Enfield, over 60 percent of this family type lives below poverty. In Enfield, female householders with no husband present and kids under age 18 years make up 8.8 percent of all households (see Table 4, page 35.)

Tompkins County, NY 2005–2010 Community Health Assessment 23

Figures and Tables

Figure 1 — Map of Tompkins County towns and bordering counties

Figure 2 — Urban population, regional comparison

Percent Urban 70% 61.3% 58.4% 60% 55.2%

50% 47.5%

40% 34.8%

30%

20%

10%

0% Cayuga Cortland Tompkins Tioga CNY

U.S. Census Bureau, Census 2000

Tompkins County, NY 2005–2010 24 Community Health Assessment

Figure 3 — Urban, farm and nonfarm rural populations, regional comparison

Urban / Rural Pop (U.S. 2000 Census)

100% 20% 12% 26% 50% 80% 43% 63% 41% 0.3%

1.1% 80% 0.4%

1.0% 60% 1.8% 2.5%

87% 40% 79% 1.8% 74%

55% 58% 47% 20% 3.0% 35%

17%

0% USA NYS Broome Cayuga Chenango Cortland Tioga Tompkins

Urban Farm Nonfarm Rural

Figure 4 — Median age, regional comparison and Tompkins excluding students

Median Age: Tomp--Tomp excl students–comparison counties 50

38.9 40 38.0 37.3 35.9 34.2

30 28.6

0 Tompkins All Tompkins Cayuga Cortland Tioga NYS

Excl. Students Tompkins County Planning Department: 2000 U.S. Census Special Tab #137

Tompkins County, NY 2005–2010 Community Health Assessment 25

Figure 5 — Population age distribution, regional comparison

Age (% 2000 pop.) Tomp. - Cort. - NYS - USA Tompkins County 35% Cortland County New York 31%30% USA 30%

27% 26% 26% 26% 25% 25% 24% 22% 22%22%

20% 19% 19%

16% 15% 13%13% 12%

10% 10% 10% 9%

0% % age <18 % age 18-24 % age 25-44 % age 45-64 % age 65+

Source: US Census Bureau, 2000 Census

Table 1 — Population age distribution by Tompkins County towns Percent total population <18 yrs 18–24 yrs 25–44 yrs 45–64 yrs 65+ yrs Media Age Tompkins Cty 100.0% 19.0% 26.0% 26.2% 19.3% 9.6% 28.6 Caroline town 3.0% 27.1 6.6 28.5 27.9 9.9 37.5 Danby town 3.1% 24.5 6.7 30.0 28.9 9.9 39.7 Dryden town 14.0% 25.5 10.0 30.8 24.6 9.2 35.1 Enfield town 3.5% 27.5 7.2 30.3 26.3 8.8 36.4 Groton town 6.0% 28.1 6.4 28.7 23.9 12.8 37.4 Ithaca city 30.3% 9.2 53.8 20.1 10.6 6.3 22.0 Ithaca town 18.9% 15.1 30.1 24.8 17.1 12.9 28.1 Lansing town 10.9% 26.1 7.7 32.7 23.5 10.1 34.8 Newfield town 5.3% 27.2 7.6 31.5 24.9 8.8 35.7 Ulysses town 4.9% 24.7 5.5 25.7 29.5 14.6 41.7

Tompkins County, NY 2005–2010 26 Community Health Assessment

Figure 6 — Educational attainment, regional comparison

Educational Attainment

Total HS+ (Pct pop age 25+) Total BS+ (Pct pop age 25+) 100% 91% 90% 83% 85% 83% 79% 80%

70%

60% 47% 50%

40%

30% 22% 19% 20% 20% 16%

10%

0% Cayuga Cortland Tompkins Tioga CNY U.S. Census, Census 2000

Figure 7 — High school dropout rate, regional comparison

Pct. pop. Ages 16 to 19 who are High School Dropouts 2000

12 10.9 10.3 10 8.8

6 5.1

4 2.5

0 Cayuga Cortland Tompkins Tioga New York

Source: Kids Count. Data obtained Dec. 2002

Tompkins County, NY 2005–2010 Community Health Assessment 27

Table 2 — Top employers in Tompkins County (155+ employees) Source: TCAD 2002 Pct employees of this list of top 27 employers 1 Cornell University 8,600 Ed 42.7% 2 Borg Warner Automotive 1,460 Mfr 7.3% 3 Ithaca College 1,300 Ed 6.5% 4 Ithaca School District 1,050 Ed-PS 5.2% 5 County of Tompkins 760 Gov 3.8% 6 Cayuga Medical Center at Ithaca 700 Health 3.5% 7 Wegmans 640 Retail 3.2% 8 New York State Electric & Gas 575 Utility 2.9% 9 Emerson Power 550 Mfr 2.7% 10 Axiohm, Inc. 480 Mfr 2.4% 11 City of Ithaca 475 Gov 2.4% 12 TST BOCES 325 Ed-PS 1.6% 13 Lakeside Nursing Center 295 Health 1.5% 14 Wilcox Press 260 Mfr 1.3% 15 George Junior Republic 250 Ed 1.2% 16 Cargill, Inc. 243 Mfr 1.2% 17 Tompkins County Trust Co. 224 Fin 1.1% 18 Tops Supermarket 220 Retail 1.1% 19 Therm, Inc. 219 Mfr 1.1% 20 Tompkins Cortland Comm. Col. 210 Ed-PS 1.0% 21 Trumansburg Schools 210 Ed-PS 1.0% 22 CBORD Group 207 Mfr 1.0% 23 Challenge Industries 205 Mfr 1.0% 24 Dryden Schools 191 Ed-PS 0.9% 25 P&C Market 170 Retail 0.8% 26 H&E Machinery 160 Mfr 0.8% 27 Groton Schools 155 Ed-PS 0.8% Total for this list of the top 27 employers 20,134 100.0%

Tompkins County, NY 2005–2010 28 Community Health Assessment

Figure 8 — Unemployment rate, regional comparison

UNEMPLOYED - PERCENT PER 100 PEOPLE IN LABOR FORCE 7.0 6.5

6.0

5.1 5.2 4.9 5.0 4.6 4.2 4.0

3.0 3.0

2.0

1.0

0.0 CAYUGA CORTLAND ONONDAGA TIOGA TOMPKINS CNY NYS

SOURCE: 2000-2002 NYS DEPARTMENT OF LABOR DATA AS OF AUGUST, 2004

Figure 9 — Unemployment rate, 4-year trends

Average Annual Unemployment Rate 8%

Tompkins Cortland County 1% CNY Region NYS

0% 1999 2000 2001 2002

Tompkins County, NY 2005–2010 Community Health Assessment 29

Figure 10 — Change in private nonfarm employment, regional comparison

Private nonfarm employment, percent change 2000-2001

5% 4.4%

4% 2.9% 3.0% 3%

2% 1.3% 1.0% 0.8% 1% 0.2% 0.2% 0%

-1%

-2% -1.6%

-3%

-4% -4.2% -5% NYS Cayuga Broome Chemung Cortland Onondaga Schuyler Seneca Tioga Tompkins

Source: US Census Bureau State & QuickFacts; Accessed 3/16/2005

Figure 11 — Percent family households, regional comparison and Tompkins excluding students

Housing: % Family Households 80 72.6 68.2 70 65.7 62.5 63.8 60 52.5 50

0 Tompkins All Tompkins Cayuga Cortland Tioga NYS Excl. Students Tompkins County Planning Department: U.S. Census 2000 Special Tab #137

Tompkins County, NY 2005–2010 30 Community Health Assessment

Figure 12 — Population transience, regional comparison Where 2000 Pop. lived in 1995

70% Tompkins County Cortland County New York State

60% 58%

50% 45%

40% 38% 34%

30% Pct. Pop. 5+ yrsPct. Pop. 19% 19% 20% 12% 10% 3% 4%

0% Different house in 1995 Different county in 1995 Different state in 1995

P24. RESIDENCE IN 1995 FOR THE POPULATION 5 YEARS AND OVER--STATE AND COUNTY LEVEL [18] - Universe: Population 5 years and over. Data Set: Census 2000 Summary File 3 (SF 3) - Sample Data

Figure 13 — Asian population, regional comparison

% Asian: Tomp--Tomp excl students--near counties 10

8 7.2

6 5.5

4 3.5

0.4 0.4 0.6 0 Tompkins All Tompkins Cayuga Cortland Tioga NYS Excl. Students Tompkins County Planning Department: 2000 U.S. Census Special Tab #137

Tompkins County, NY 2005–2010 Community Health Assessment 31

Figure 14 — Black and Hispanic population, regional comparison

% Black/ African American and % Hispanic/ Latino 18 15.9 %Black/ African American 15.1 15 %Hispanic /Latino 12.3 12.5 12

6 4.0 3.6 3.1 3.4 3 2.0 2.0 1.2 1.0 0.9 0.5 0 Tompkins All Tompkins Cayuga Cortland Tioga NYS U.S.

Excl. Tompkins County Planning Department: Students 2000 U.S. Census Special Tab #137

Table 3 — median household income. Source: U.S. Census Bureau, Census 2000. USA NYS Broome Chenango Cortland Tioga Tompkins Median household in- $41,994 $43,393 $35,347 $33,679 $34,364 $40,266 $37,272 come in 1999 As a percent of Tomp- 112.7% 116.4% 94.8% 90.4% 92.2% 108.0% 100.0% kins

Tompkins County, NY 2005–2010 32 Community Health Assessment

Figure 15 — Median household income, regional comparison Median HHd Income: Tomp--Tomp excl students--near counties 50,000

45,000 43,730 43,393 40,266 40,000 37,272 37,487 34,364 35,000

30,000

25,000

20,000

15,000 Tompkins All Tompkins Excl. Cayuga Cortland Tioga NYS Students Tompkins County Planning Department: 2000 U.S. Census Special Tab #137

Figure 16 — Population below poverty by age, regional comparison

Age of the population living below poverty 90% age <18 yrs age 18 to 64 years age 65+ yrs 83% 80%

70% 64% 61% 59% 60% 56% 56% 55%

50%

37% 40% 35% 34% 35% 30% 27%

% of those in poverty 30%

20% 14% 10% 10% 9% 9% 9% 10% 6% 3% 0% USA NYS Broome Chenango Cortland Tioga Tompkins U.S. Census Bureau. Census 2000. Income data for 1999

Tompkins County, NY 2005–2010 Community Health Assessment 33

Figure 17 — Individuals below poverty, regional comparison

Poverty Status: Pct Individuals Below poverty 20 17.6

15.5 16 14.6

12 11.1

8.9 8.4 8

0 Tompkins All Tompkins Excl. Cayuga Cortland Tioga NYS

Students Tompkins County Planning Department: 2000 U.S. Census Special Tab #137

Figure 18 — Families below poverty, regional comparison Poverty Status: % Families Below poverty 12 11.5

10 9.3

7.8 8 6.8 6.0 6.0 6

0 Tompkins All Tompkins Excl. Cayuga Cortland Tioga NYS

Students Tompkins County Planning Department: 2000 U.S. Census Special Tab #137

Tompkins County, NY 2005–2010 34 Community Health Assessment

Figure 19 — Population below poverty by household type, regional comparison

Percent of selected population living below the poverty level

60% individuals HHd of unrelated individuals 15 years old and over 55.8%

50% 40.2% 40% 34.9%

30% 24.2% % below poverty poverty % below

20% 17.1% 15.7% 15.3% 15.2% 14.8% 13.5% 13.2% 13.2% 12.0% 9.9%

10% 9.1% 7.4% 7.0% 6.7% 6.0% 5.1%

0% Caroline Danby Dryden Enfield Groton Ithaca Lansing Newfield Ulysses City of Ithaca U.S. Census Bureau. Census 2000

Figure 20 — Population below poverty by family type, regional comparison

Percent of selected population living below the poverty level (by household type) 80% 79.3% families

70% families w female householder, no husband present families, no husband, w related children under 5 years 63.1%

60%

50% 48.6%

40.0% 39.6% 40% 37.8% 33.5%

32.4% 31.8%

% below poverty poverty below % 30% 27.6% 26.6% 23.4% 20.7% 20.4% 20% 19.6% 13.5% 13.5% 11.9% 11.5% 10% 7.3% 6.9% 6.9% 6.7% 4.8% 4.2% 4.2% 4.3% 3.9% 0 0 0% Caroline Danby Dryden Enfield Groton Ithaca Lansing Newfield Ulysses City of Ithaca U.S. Census Bureau. Census 2000

Tompkins County, NY 2005–2010 Community Health Assessment 35

Table 4 — Female householder, no husband present, with own kids under age 18 Pct all HHds Tompkins County 5.6% City of Ithaca 5.1% T Caroline 6.8% T Danby 5.6% T Dryden 5.8% T Enfield 8.8% T Groton 7.8% T Ithaca 3.7% T Newfield 8.1% T Ulysses 6.7% Source: U.S. Census, 2000

Tompkins County, NY 2005–2010 36 Community Health Assessment

Health Care Environment and Availability and Access to Services

Health Care Providers

Tompkins County Health Department is a full-service health department providing the full complement of services as required by public health law. Cayuga Medical Center Cayuga Medical Center at Ithaca (CMC), a 204-bed acute care fa- at Ithaca cility serves Tompkins and surrounding counties. It is one of 9 rural referral sites in New York State and the only acute care facility in Tompkins County. In 2003, there were 157,000 patients who used CMC’s comprehensive acute and out patient services. There are 180 physicians affiliated with CMC according to its 2003 annual report. In 2005, CMC through an affiliation with Roswell Park began offering radiation oncology services locally at the medical center’s new radiation medicine facility. For various types of specialized care, residents travel to Syracuse, Rochester, Elmira, Sayre, Pennsylvania and major metropolitan areas. Health care providers Other health care providers and facilities providing direct patient care: • Five skilled nursing facilities totaling 555 certified beds. • Two Certified Home Health Agencies (One is located at TCHD) • Hospicare and Palliative Care Services of Tompkins County (includes a residence) • Ithaca College and Cornell University health centers • Planned Parenthood of the Southern Finger Lakes • Variety of complementary or alternative care practitioners including Ithaca’s Integrative Community Wellness Center • Franziska Racker Centers for children and adults with special needs

Health Planning Council The Health Planning Council (HPC), a program of the Human Services Coalition of Tompkins County conducts comprehensive health planning and promotes the development of health services and resources. TCHD staff is represented on the Board and HPC’s Executive, Acute Care and Long Term Care Committees. In 2004 it secured funds from New York State for implementation projects and launched the “Tompkins Health Network”, a rural health network and a program of HPC with funds from the New York State Office of Rural Health. Ithaca Health Care Tompkins County is home to the Ithaca Health Care Alliance. Alliance Members pay an annual fee and as a result have access to the Ithaca Health Fund. The Fund covers expenses of up to $1,000 for such expenses as broken bones and emergency department visits. The Ithaca

Tompkins County, NY 2005–2010 Community Health Assessment 37

Health Fund makes payments to any practitioner in the world. How- ever, Ithaca area residents may also benefit from discounts with 115 providers and the dental loan fund. www.ithacahealth.org

Health care maintenance and disease prevention Barriers to service Many factors affect access to health care maintenance and disease access prevention. Factors such as transportation, underemployment, parents working multiple jobs, all affect the well being of some residents and contribute to causes that undermine health. Transportation and Transportation and the rural nature of the county have been cited as location a factor by other community agencies as a barrier to service access. For example, the Day Care and Child Development Council’s “Child Care Data Book: Balancing Supply and Demand” (2004) notes that the geographic distribution of (child) care that is available does not always meet the demand of the population needing care. Likewise, many health care services, notably physicians’ offices are located in suburban Lansing and are difficult to reach without a personal vehicle. A few primary care and specialist offices remain in the City of Ithaca and others are located in rural areas. Bus and taxi services are available in the County. However, available bus routes and schedules do not always make this a convenient form of transportation as it might in a metropolitan area.

Compass II survey In 2002, the United Way of Tompkins County sponsored Compass II, “an asset-based analysis of the community to build on the strengths of local individuals, associations, and organizations to promote broad participation in the continuous improvement of community life.” The Human Services Coalition of Tompkins County was the project coordinator. (For the full report go to www.uwtc.org) Through various surveys, focus groups and analyses of other data, Compass II worked to identify: • The needs and resources available in the county, • The gaps between those needs and resources, • Potential solutions to filling the gaps. The Compass II survey identified health care as one of the top issues facing the county. Some highlights on this issue from Compass II: Tompkins County, Final Report Fall 2003: • Sixty-seven percent of key informants rated a lack of specialty care as a critical problem and 65 percent the lack of affordable primary care as a critical problem. • Twenty percent of households indicated that not having enough money to pay the doctor or buy prescription drugs was a critical

Tompkins County, NY 2005–2010 38 Community Health Assessment

problem. However, the availability of care itself does not seem to be a critical issue, the report states. It notes that CMC’s annual evaluation of the number of physicians indicates that the County is in a good position in this regard. Cost of insurance As noted earlier in this assessment and substantiated by the Com- premiums pass II survey, Tompkins County has a greater percentage of its residents covered by insurance compared to the rest of the nation and New York State. However, the issue seems to be cost. Focus groups conducted by Compass II with health care advocates and human service representatives suggested that the high cost of premiums and the burden it places on employers and employees may help to explain why people in the 18 to 64 age range are uninsured. The resulting lack of preventative care for these employees often results in higher costs to individuals and the community. Indeed, Tompkins County residents are not alone in seeing school, municipal, and state taxes rise as a result of increased health care costs for government employees and retirees. Health care costs have an increasing impact on the economic health of communities as well.

Poverty and food Poverty and food insecurity are two factors that undermine health. security The Compass II report noted that nearly 78 percent of key informant respondents and 38.4 percent of household respondents ranked poverty as a critical problem. The survey asked respondents about difficulty in meeting basic needs as a way to determine the level of poverty experienced by residents. Nearly 10 percent of respondents in the household said that not having enough money for food in the past year was a critical problem. Twelve percent said that not having enough money to buy needed clothing and shoes was critical. And 15 percent reported that not having enough money to pay for housing was a critical problem. The report refers to the Hunger Data Book, 2002 by the Nutrition Consortium of NYS (NCNYS). The consortium estimates that 8.6 percent of individuals in Tompkins County are in a position of food insecurity (the limited or uncertain availability of nutritionally adequate foods, or the inability to acquire acceptable foods in socially acceptable ways.)

Local Health Priorities

Community priorities were identified through the Compass II proj-

Tompkins County, NY 2005–2010 Community Health Assessment 39

ect. This analysis of community assets and needs is comprehensive in scope. It included responses from • 500 community households, • 99 community businesses, • 83 service provider organizations, • 22 faith community representatives and • 90 key members of the community. There were 16 focus group participants as well as members of a downtown business organization that served as a focus group. And data and expertise from a variety of county departments, agencies and the Chamber of Commerce informed the project. Priorities The Compass II project did not specifically address dental care access as an issue. However, health and human service agencies, schools and individual providers have identified the need in many of the people they provide care for. (See dental section.) TCHD’s priorities were determined through input from the De- partment’s management and supervisory personnel and presented to the Tompkins County Legislature to inform its strategic planning committee. (See CHAERS section of this document.) It should be noted that community agencies in the County identify issues particular to their target population. And the reader should con- sider these factors with regards to a particular population such as seniors, children, and the disabled population, for example.

Opportunities for Action

Tompkins County has an informal and formal network of agency and service providers that address community issues including health issues. One way the health and human service community stays abreast of current issues and activity is through the Human Services Coalition of Tompkins County’s list serve: www.hsctc.org. Recent initiatives Some recent initiatives that have addressed community health priorities include: • Creation of a dental case manager position at the County De- partment of Social Services to partially address the problem of access to dental care. This was a result of a community task force that met between November 2001 to May 2002. (See dental section.) • Tompkins County Legislature with the help of the Health Plan- ning Council made available a drug discount card for County residents. Tompkins Rx cards were distributed in early 2005. The card provides an average of 20 percent discount on pre-

Tompkins County, NY 2005–2010 40 Community Health Assessment

scription medications. The program was implemented at no cost to county taxpayers or individuals who use the card. • In 2004, the Health Planning Council launched PMAP (Pre- scription Meds Access Program). By December of 2004, staff talked with more than 100 individuals who had difficulty af- fording prescription medications. Sixty-nine were able to obtain drugs valued at more than $12,300 free or at low cost from pharmaceutical companies. • The Commission for a Healthy Central New York is a coalition of eight upstate counties: Cayuga, Cortland, Herkimer, Madi- son, Oneida, Onondaga, Oswego, and Tompkins. The coalition completed a regional health assessment. And, as a result seeks to foster collaborative relationships among regional community leaders and health service providers to improve the health of area residents. Four health priorities have been identified: obesity, stroke, mental health and dental care access.

Tompkins County, NY 2005–2010 Community Health Assessment 41

Tompkins County Health Department

he mission of the Tompkins County Health Department (TCHD) is to promote, preserve and improve the health of the people of Tompkins County consistent with public health T law. TCHD is a full service health department comprised of the Environmental Health, Commu- nity Health Services, and the Children with Special Health Care Needs Divisions. As of March 2005, there were 87 staff providing services and coordinating programs for the benefit of County residents.

Service Divisions and Programs

COMMUNITY HEALTH SERVICES DIVISION Maternal Child Unit Maternal Child Unit (MCU) provides health care services for mothers, infants and children and through its communicable disease program, surveillance and care for all residents. • Mothers • Pre- and post-natal care (MOMS) • Breastfeeding support • Children • Immunizations • Lead poisoning prevention • Newborn and child health assessments • All community residents • Immunizations • Influenza immunization • Communicable disease surveillance and case management • Tuberculosis (TB) surveillance, contact investigation and treatment • Rabies post-exposure immunizations • Anonymous HIV counseling and testing

WIC The Supplemental Nutrition Program for Women, Infants and Children (WIC) improves the nutrition and health status of eligible women, infants and children (up to age 5 years.) WIC achieves this goal though the provision of checks to purchase nutritious foods, nutrition and health education, breastfeeding promotion and support and referrals and connections with local health and human service agencies.

Health Promotion The key role of the Health Promotion Program (HPP) is to educate Program the public, health care practitioners and policymakers about the importance of disease and injury prevention. HPP promotes healthy eating,

Tompkins County, NY 2005–2010 42 Community Health Assessment

physical activity and avoidance of tobacco to reduce the risk of cardiovascular disease, diabetes and cancer. HPP works in partnership with businesses, local media, health providers, schools, health care providers, and human service and community agencies to achieve these objectives. HPP works closely with other CHS programs to market and promote their programs and is actively involved in bioterrorism preparedness. HPP is responsible for coordinating the Municipal Public Health Services Plan (MPHSP) and for developing and maintaining the Community Health Assessment.

Home Health Care Home Health Care (HCC) is a Certified Home Health Agency in accordance with the New York State Department of Health (NYSDOH) and Medicare’s Conditions of Participation. It is an optional program (under Article 6 of public health law) of the TCHD. HHC’s employed and contracted staff includes registered nurses; home health aides and physical, occupational and speech language pathology therapists. HHC provides medically ordered visits for clients in their homes. HHC also partners with local health care providers and agencies to provide other necessary services.

CHILDREN with SPECIAL HEALTH CARE NEEDS The programs in this division serve children who have or are at risk for a chronic physical, developmental, behavioral or emotional condition and who require a broader variety of health and related services to reach their fullest potential. The division has 4 programs:

Children with Special Children with Special Health Care Needs is a federal program that Health Care Needs offers information and referral services concerning health and related issues to families with special needs up to the age of 21. The program guides and assists families with their social-emotional, financial, medical and transportation needs.

Early Intervention Early Intervention Program (EIP) is a federally mandated program, Program regulated by NYSDOH. Children who have a disability or developmental delay are eligible for the program from birth to 36 months.

Physically Handicapped Physically Handicapped Children’s Program ensures access to Children’s Program quality health care for chronically ill and physically handicapped children. This is achieved through program standards requiring access to specialty centers and physician specialists for children enrolled in the program.

Tompkins County, NY 2005–2010 Community Health Assessment 43

Preschool Special Preschool Special Education Program is responsible for the ad- Education Program ministrative and fiscal oversight of special education services and programs provided to children three to five years of age who meet eligibility requirements in accordance with the New York State Educa- tion Department regulatory standards. Each child has his or her own educational plan. The spectrum of services include speech, physical, occupational and counseling therapies along with special education programs.

ENVIRONMENTAL HEALTH This division is an educational and regulatory agency. It protects, preserves and improves the health of the County’s residents through in- spections and permits, responses to public health nuisances and education of facility operators and the public. The programs include: EH Programs • Inspection of public and private water systems and individual sewage systems • Food Protection: inspection of restaurants and temporary food establishments • Rabies control • Inspection of temporary residences: motels/hotels children’s camps, camps and parks, pools and beaches, and mobile home parks • Adolescent Tobacco Use Protection Act (ATUPA) and Clean Indoor Air Act enforcement • West Nile Virus surveillance and prevention • Neighborhood Notification Law for Pesticides enforcement • Lead Poisoning Control: environmental sampling for case investigation • Nuisance resolution and other programs

Technical staff spends two-thirds of their time in three programs: Public and private water systems, individual sewage and food service.

ADDITIONAL PROGRAMS of TCHD Bioterrorism Bioterrorism Preparedness focuses on the development and refine- Preparedness ment of a comprehensive response plan for agents of bioterrorism. In 2004, TCHD hired a bioterrorism coordinator who is responsible for meeting NYSDOH grant requirements, planning drills and public education.

Tompkins County, NY 2005–2010 44 Community Health Assessment

Emergency Medical Emergency Medical Service (EMS) in Tompkins County receives Service assistance through a program administered by TCHD. The Tompkins County Department of Emergency Response coordinates EMS activities in the County. Five ambulance agencies provide advanced life support treatment and transport services in the County assisted by 13 first response fire department rescue squads.

Medical Examiner TCHD employs one chief medical examiner and two deputy medical examiners to investigate and certify cause of unattended and suspi- cious deaths.

Vital Statistics Vital Statistics is responsible for filing the records of all births and deaths that occur in Tompkins County with the Bureau of Vital Statis- tics at the NYSDOH. The Vital Statistics office maintains records from 1881 to the present.

Key Trends

Some of the trends that TCHD has identified that will affect the department’s mission and service delivery in the next 5 years include: • Emerging infectious diseases • Aging of the population and associated need for increased services • High-tech health care at home • Need for ancillary providers of services • Increasing requirements for emergency planning and response that impact the delivery of other programs. • Regionalization of services. One example is grant funding for chronic disease programs such as heart health and diabetes that often do not address local need adequately. • Need for contracted ancillary providers of health services: i.e. speech therapists, special education teachers. • Increasing reliance on computers for information storage and retrieval. • Increasing State reporting requirements. • Reduction in State financial support.

For more information on Tompkins County Health Department programs and services, see the Department’s annual report and go to www.tompkins-co.org/health/.

Tompkins County, NY 2005–2010 Community Health Assessment 45

Access to Quality Care

Data Analysis

Insurance coverage Over the 10-year period from 1994–2003, the percent of New York across all NYS State residents under age 18 years without medical insurance has declined nearly 40 percent from a 1997 high. In 2003 fewer than two-in- twenty NYS children were uninsured. However, when the data includes all ages in NYS, the trend is less encouraging with the number of uninsured remaining essentially flat across the years at about 3-in-20 NYS residents. (See Figure 21, page 48.) Health insurance Closer to home, a survey sample combining Tompkins and coverage Cortland County residents age 18–64 years indicates about 13 percent Percent, age 18–64 years have no health insurance coverage. BRFSS, 2003 Information on insurance coverage is collected by NYS through the Cayuga-Seneca -Wayne...... 85.3 Behavioral Risk Factor Surveillance System (BRFSS) surveys. In order Chemung-Schuyler to establish consistent sample sizes and help control sampling error -Tioga ...... 82.1 many rural counties — such as Cortland and Tompkins — are surveyed Cortland together as one. The fact that our two counties are dissimilar in many -Tompkins ...... 86.6 socio-economic ways should be taken into account when using these CNY...... 86.4 NYS...... 83.0 data. HP2010 target.....100.0 Also, sampling error remains a factor when using the data for comparative analyses. Thus, even though our regional comparison suggests that coverage for individuals age 18–64 in Tompkins–Cortland is better than for the state as a whole, strict interpretation would probably show no statistically significant difference. (See Figure 22, page 49.)

Demographic profile of A review of the demographic profile of those age 18–64 in those with insurance Cortland–Tompkins who report having health insurance coverage re- Percent age 18–64, Cort- veals differences which are likely to be statistically significant for both land–Tompkins, 2003 age and education level. While it is probably safe to conclude that those Age 18–34...... 81.2 Age 35–54...... 92.2 age 18–34 are less likely to have health insurance coverage than those Age 55+...... 93.0 in either of the 35–54 or the 55+ groups, there is little doubt that those High school with only a high school education or less are much less likely to be in- or less...... 70.5 sured than those with educational attainment beyond high school. More than HS...... 93.1 The difference between the percent of females covered and the per- Avg. 95% CI = 5.7 cent of males covered is not significant. (See Figure 23, page 49.)

Type of coverage in A survey of Tompkins County residents age 18+, conducted in Tompkins County June 2004 for the Tobacco Control Program, included two questions Pct of those with insur- about health insurance coverage. Of particular interest is the consis- ance coverage, age 18+. tency of the responses with the BRFSS data discussed above. The to- Private ...... 80.5

Tompkins County, NY 2005–2010 46 Community Health Assessment

Medicare...... 11.7 bacco survey recorded 87 percent of respondents as having coverage Medicaid ...... 4.0 and 13 percent without, the same as the BRFSS with rounding. Note that the latter case is reporting ages 18–64 only, while the tobacco survey was all ages 18 and over. (See Figure 24, page 50.) The Tompkins County tobacco survey also asked those who stated that they do have coverage what type it is. Four-out-of-five adults covered in Tompkins County have private insurance. A little over half of the non-privately insured are covered under Medicare, with the remain- der split between Medicaid and other forms. (See Figure 25, page 50.)

CMC patients age 0–17 The Tompkins County Health Planning Council draws data from with no insurance many sources for its publication, “Tracking the Impact of Health Care Reform in Tompkins County.” The edition released April 2004 covers the years 1997–2003. Tracking the Impact, 2004 includes records from Cayuga Medical Center (CMC) showing three years of patients age under 18 who did not have health insurance. See Table 5, page 51 for the raw data. To compare the trends across the years 2001–2003, Figure 26, page 51 graphs the percent change by venue. In all venues except same day surgery the number of children without insurance coverage has declined during the period, with the decline greatest for the inpatient category. The almost 80 percent rise of uninsured children in same day surgery is misleading by comparison since the number count is so small — 4 individuals in 2001, 6 in 2002 and 7 in 2003.

Uncompensated care Another indicator of access to care is self-pay visits to a medical center. The trend at CMC shows a moderate decline in self-pay visits to both the emergency room and the Convenient Care Center located in the Town of Ithaca’s growing population center known as the “North- east.” Self-pay for inpatient visits showed a decline over the last years of the 1990’s, but crept up again from 2002–2003. (See Figure 27, page 52.) The trend in uncompensated care at CMC is displayed in Figure 28, page 53. In 2002 and 2003, uncompensated care at CMC returned to the level seen in 1994–1995 after a rapid spike and gradual decline starting in 1996–1997. This trend coincides with major changes in how hospitals negotiated with insurance providers, including a number of months when CMC was not accepting Blue Cross & Blue Shield.

Medicaid eligibles as a Among the counties cited for comparisons throughout this docu- percent of the total ment, Tompkins County has the lowest rate of Medicaid eligibles, ex- population pressed as a percent of the population. Still, like other counties in our region, the rate increased over the period 2000–2003 — 28 percent for

Tompkins County, NY 2005–2010 Community Health Assessment 47

Tompkins County. To our east in Cortland County, the increase was 47 percent. (See Figure 29 and Figure 30, page 53.) The total number of individuals on Medicaid in Tompkins County slid from 1996–2000, but then turned up again increasing by almost 1,000 from 2002–2003. (See Figure 31, page 54.) Meanwhile, the percentage of local primary care practices accepting new Medicaid patients without restrictions fell dramatically from 2001–2003, to 13 percent as of November 2003. Twenty-two percent were accepting new Medicaid patients with restrictions at that time. (See Table 7, page 55.)

Medicaid and self-pay Across all of Upstate New York, the rate of Medicaid and self-pay births births remained relatively flat over the 10-year trend period 1993–2002. Tompkins County saw evidence of an upward trend in this indicator over the same time period. (See Figure 33, page 56.)

The MOMS program at the Tompkins County Health Department (TCHD) reported that of the live births at CMC 64 percent were covered by Medicaid in 2002, 62 percent in 2003 and 59 percent of live births were covered by Medicaid in 2004. These residents are below 195 percent of the federal poverty level (FPL.) For a family of three, income at 195 percent of the FPL is $29,289.

Tompkins County, NY 2005–2010 48 Community Health Assessment

Figures and Tables

Figure 21 — Percent uninsured, NYS, trends by age Pct Uninsured for Medical Care, NYS by age

21 Under 18 All Persons

17.5 17.3 18 17.0 16.0 16.3 15.5 15.5 15.8 15.2 15.1 15 15.5 15.1 14.1 13.8 12 11.9 10.5 10.8 9 9.9 9.3 9.4

6 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

NYSDOH – BRFSS 2003

Tompkins County, NY 2005–2010 Community Health Assessment 49

Figure 22 — Insurance coverage, regional comparisons

Health Insurance Coverage, 18-64 Years of Age

88 86.6 86.4 85.3 85 83.0 82.1 82

70 Cayuga, Seneca, Chemung, Cortland, CNY NYS Wayne Schuyler, Tioga Tompkins

Expanded BRFSS, 2003 - New York State Dept. of Health. Avg. 95% CI for county groups = 3.9

Figure 23 — Insurance coverage, demographic comparison, Cortland–Tompkins

Health Insurance Coverage, 18-64 Years of Age CORTLAND, TOMPKINS 2003

100 92.2 93.0 93.1 88.7 90 86.6 84.4 81.2 80 70.5 70

30 Total Male Female 18-34 35-54 55+ HS or >High less School Expanded BRFSS, 2003 - New York State Department of Health. Avg 95% CI = 5.6

Tompkins County, NY 2005–2010 50 Community Health Assessment

Figure 24 — Insurance coverage, Age 18+ years, Tompkins County

Do you have health insurance coverage? (Age 18+)

Yes 87%

DK 13% June 2004 Tompkins County Tobacco Survey 0.3%

Figure 25 — Type of insurance coverage among those with coverage, Tompkins County

If yes, what type of coverage?

Private 80.5%

Medicare 11.7% Medicaid Other 3.8% 4.0% June 2004 Tompkins County Tobacco Survey (Age

Tompkins County, NY 2005–2010 Community Health Assessment 51

Table 5 — Children without medical coverage, CMC Children and Health Coverage Patients Age 0--17 at Cayuga Medical Center Unduplicated # of children (age<18) with no insurance 2001 2002 2003 Clinic (incl. OBV) 301 341 285 Emergency Room 146 132 124 Referred 225 194 184 Same day surgery 4 6 7 Inpatient 28 17 17 TOTAL 704 690 617 SOURCE: TC Health Planning Council, Tracking the Impact 1997-2003

Figure 26 — Children without medical coverage, CMC, percent change over 3 years

Unduplicated CMC patients age <18 yrs with no insurance, % Change

Clinic (incl. OBV) Emergency Room Re fe r r e d 80% Same day surgery Inpatient TOTAL

60%

40%

20%

-20%

-40% 2001 2002 2003

SOURCE: Health Planning Council. Trac king the Impac t 1997-2003

Tompkins County, NY 2005–2010 52 Community Health Assessment

Table 6 — HP 2010 targets for insurance and primary care DATA2010 ...the Healthy People 2010 Database - November, 2004 Edition - 01/05/05 - 10:45:38AM http://wonder.cdc.gov/DATA2010/focus.htm Focus area:01-Access to Quality Health Services Base- Target Code Objective Base Yr line 2010 01-01 Persons with health insurance (age adjusted, aged under 65 years) 1997 83% 100% 01-05 Persons with a usual primary care provider 1996 77% 85%

Figure 27 — Self-pay visits, CMC trend 1998–2003

CMC – Pure Self-pay Visits (Pct total visits per venue)

18% Inpatient visits (incl newborns)* Emergency Rm Convenient Care Ctr--Ithaca

15%

12%

0% 1998 1999 2000 2001 2002 2003

SOURCE: Health Planning Council. Tracking the Impact 1997-2003 *In 1999, 14% f or non-Medicare PTs

Tompkins County, NY 2005–2010 Community Health Assessment 53

Figure 28 — Uncompensated care, CMC trend 1994–2003

Cayuga Medical Center Uncompensated Care 10% (Pct of total budget) 9%

8% 7%

3% 2%

0% 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

SOURCE: Health Planning Council. Tracking the Impact 1997-2003

Figure 29 — Medicaid eligibles as percent of population, regional comparison

2003 Medicaid Eligibles as Pct of 2001 Pop

21% 19.7%

18% 16.2%

15% 13.9% 13.7% 12.9% 12.0% 12%

9.1% 9%

0% Tompkins Tioga Onondaga Cortland Cayuga Broome NYS

Avg monthly eligibles for 2003: NYSDOH Rev. 3/8/04 | 2001 pop from Cty Hlth Indicator Profiles, rev. 3/04

Tompkins County, NY 2005–2010 54 Community Health Assessment

Figure 30 — Medicaid eligibles as percent of population, regional trends, 2000–2003

Medicaid Eligibles 2000-2003: Pct of Pop

Cortland Cayuga NYS ex NYC 18% Tioga Tompkins

16% 16.2%

14.0% 14%

11.9% 12% 11.0%

10%

9.1% 8% 7.9% 7.2% 6% 7.1% Source: NYSDOH & U.S. Census for 2000 pop, NYSDOH for 2001 pop. 2001 pop used for 2001, 02, 03. 4% 2000 2001 2002 2003

Figure 31 — Total on Medicaid, Tompkins County trend 1996–2003 Total on Medicaid x Year (Tompkins County) 8500

8000 8,019 7500

7000 7,078 7,075 6500 6,621 6,536 6,569 6,411 6000 6,265

5500

5000 1996 1997 1998 1999 2000 2001 2002 2003 SOURCE: Health Planning Council. Tracking the Impact 1997-2003.

Tompkins County, NY 2005–2010 Community Health Assessment 55

Table 7 — Primary care practices accepting new Medicaid patients, Tompkins County Primary Care Practices Accepting New Medicaid Patients (includes family practice, internal medicine, pediatrics, OB/GYN) Primary Care Pct. Practices Pct. practices taking new Medicaid patients Physicians/ taking ANY new Yes, with Year Unrestricted Practices patients restrictions 1998 65 / 24 95% 54% 0.04 * 1999-May 60 / 23 82% 0% * 0% 2000-June 60 / 24 79% 33% 17% 2001-Oct 60 / 24 70% 38% ** 13% 2003-Nov 59 / 23 78% 13% 22% ** *1999 - at this time there were NO primary care physicians taking new Medicaid PTs Unrestr. **2001 - of the 22 physicians, 9 are in OB/GYN, 6 in Peds. Only 7 are in GP. Restrict'd *1999 - Geographic restrictions **2003 - 22% geographic and 22% other SOURCE: Health Planning Council. Tracking the Impact 1997-2003

Table 8 — Total individuals on Medicaid, Tompkins County Total Individuals on Medicaid (Tompkins County) Average per month 1996 1997 1998 1999 2000 2001 2002 2003 MA (Medicaid only) 4,513 3,147 3,161 3,456 3,347 3,657 4,099 4,867 MA SSI (on MA due to SSI) 1,522 1,521 1,527 1,515 1,503 1,528 1,532 2,417 Total PA (on MA due to cash 1,806 1,576 1,419 1,260 1,170 1,200 1,356

ADC-FC (foster care/ adoptio 146 146 153 134 143 239 248 264 Total on Medicaid 7,078 6,621 6,411 6,536 6,265 6,569 7,075 8,019 SOURCE: Health Planning Council. Tracking the Impact 1997-2003.

Tompkins County, NY 2005–2010 56 Community Health Assessment

Figure 32 — Medicaid /Self-Pay births, regional comparison

MEDICAID/SELF-PAY BIRTHS - PERCENTAGE PER 100 LIVE BIRTHS 50 44.1 45 41.3 40 37.8 35.8 35.5 35

30 28.6

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 33 — Medicaid /Self-Pay births, trends

Medicaid/ Self-Pay Births (Pct live births)

Tompkins Single Year Tomp. 3-Yr Avg Upstate New York 45

39.7 40 37.4 35.9 34.2 34.3 35 33.5 33.3

32.0 30.5 30 30.1 30.1 30.4 28.4 27.9 27.9 28.0 27.5 27.3 27.6 25 27.1

20 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 57

Cancer

ne of every 4 deaths in the United States and New York State is due to cancer. One in three people will be diagnosed with cancer at some point in their lifetime. Cancer occurs Oat any age, but most often in middle-aged and older people. The number of people diagnosed with cancer has increased over the past 40 years. Most of this is due to the increase in the population and because people are living longer. Cancer is a group of more than 100 different diseases caused by abnormal growth of cells in the body. Therefore the cause, detection, treatment and cure vary among the many different cancers. The environment, lifestyle behaviors and genetics can cause cancer. Cigarette smoking is the leading preventable cause of cancer. And for those who do not use tobacco products, dietary choices and physical activity are the most important modifiable determinants of cancer risk demonstrated to date. Many cancer deaths can be prevented and the number of new cases can be reduced with early screening and treatment. It is commonly known that there is scientific agreement that cancer can be caused by long term contact with carcinogens. These include second-hand smoke, sunlight, x-rays, and certain chemicals that can be found in the air, water, food and workplace. While Tompkins County is not generally considered a cancer hotspot, there are certain cancers for which the population may be considered to be at higher than average risk. This section will review available cancer data by cancer type, including lung, breast, cervical colorectal, and prostate cancers. Four cancer sites: breast, prostate, lung and colorectal represent 57.2 percent of all cancer cases and 54.6 percent of all cancer deaths in Tompkins County, according to the American Can- cer Society.

Data Analysis

Lung Cancer Mortality While the current lung cancer mortality rate in Tompkins County is • Avg. age-adj. rate per in line with neighboring counties, it is slightly higher than the state as a 100,000 pop, 2000–2002 whole, and more than 16 percent higher than the target rate established Tompkins ...... 52.3 for Healthy People 2010 (HP2010.) The 10-year trend for Tompkins Cayuga...... 53.4 Cortland...... 53.7 swings widely by single year, and even shows variability when viewed Tioga ...... 55.0 as 3-year averages (see Figure 36, page 63.) CNY...... 59.8 Note that the values shown in Figure 36 are different than those NYS...... 49.5 displayed in the left column and in Figure 35. This is because the trend HP2010 ...... 44.9 lines are based on crude rates, and the county-to-county comparisons are age adjusted to the 2000 U.S. Census. Age adjusted rates for Tomp- kins County are typically higher than the crude rates due to Tompkins’ young, student-rich population (see Figure 34, page 62.) Cancer Mapping The New York State Department of Health (NYSDOH) maps cancer incidence by ZIP code. The maps provide a comparison of actual to expected incidence of a specified cancer, both by ZIP code and for the state as a whole. Neither the maps, nor this document attempt to pro-

Tompkins County, NY 2005–2010 58 Community Health Assessment

vide any explanation or speculation as to the reasons for the variations in cancer incidence displayed by the maps. The NYSDOH web site defines “expected incidence” this way: Expected incidence is the number of people in a given ZIP Code that would be expected to develop cancer within a five-year period if the ZIP Code had the same rate of cancer as the State as a whole. The cancer rate for the entire state and the number of people in a ZIP Code are used to estimate the expected incidence. Age and population size are also taken into account because you would ex- pect to see more people develop cancer in a ZIP Code with a larger population or a higher percentage of older residents. This process is called age adjustment. For the prostate cancer maps, race is also taken into account in determining expected incidence.4

Lung Cancer Incidence A map of lung cancer incidence in males for Tompkins County ZIP • Avg. age-adj. rate per codes is shown on page 64 (Map 1.) Map 2 (page 65) shows incidence 100,000 pop, 1997–2001. for Tompkins females. The difficulty in interpreting these maps is dem- Tompkins...... 61.3 onstrated by the latter: Freeville (ZIP 13068) is shown to have lung Cayuga ...... 74.2 Cortland ...... 72.7 cancer incidence more than 50% below expected, whereas bordering to Tioga...... 70.7 the north, Groton (13073) shows incidence 50%–100% above expected. CNY ...... 81.4 Comparative values for lung cancer incidence in neighboring NYS ...... 67.2 counties is shown in Figure 37, page 64. Early Stage Diagnosis of When cancers are diagnosed at an early stage the chances for sur- Lung Cancer vival are greatly increased. The NYSDOH tracks early stage diagnosis • Pct cases, 1995–1999. of some cancers, and this data for lung cancer is shown in Figure 38, Tompkins...... 36.4 page 65. Cayuga ...... 48.2 Cortland ...... 44.6 CNY ...... 34.4

Breast Cancer Mortality Awareness of breast cancer as an important women’s health issue • Avg. age-adj. rate per has risen dramatically over recent years. Breast cancer rates for mortal- 100,000 female pop., ity and incidence are gender specific and expressed per 100,000 of the 1998–2002 gender-specific population. Rates for female populations are more Tompkins...... 24.0 Cayuga ...... 16.4 commonly tracked than those for male populations Cortland ...... 22.8 In Tompkins County, breast cancer mortality rates are very close Tioga...... 18.9 — and likely statistically equal — to the HP2010 target rate of 22.3 CNY ...... 25.9 deaths per 100,000 female population. Rates for Cortland County and NYS ...... 27.7 for the 11 county Central New York region5 are also similar, while HP2010...... 22.3 those for Cayuga County and Tioga County are somewhat lower. (See

4 http://www.health.state.ny.us/nysdoh/cancer/csii/nyscsii.htm. Accessed 3/25/05. 5 NYSDOH statistical regions close to Tompkins County are as follows (counties bordering Tompkins are in bold): Region 3 (Central New York): Cayuga, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tompkins Region 4 (New York-Penn): Broome, Chenango, Tioga Region 2 (Finger Lakes): Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, Yates

Tompkins County, NY 2005–2010 Community Health Assessment 59

Figure 39, page 66.) The 10-year trend for breast cancer mortality in Tompkins County swings widely between 1993 and 2002. Even reviewing the 3-year averages to moderate the peaks and valleys does not show a steady trend. By contrast, the trend for Upstate suggests a steadily declining mortality rate across a wider portion of the state. (See Figure 40, page 66.) The decline in the mortality rate may be attributed to more effective treatment options that have become available in recent years. Breast Cancer Incidence Incidence of breast cancer in Tompkins County tends to be at or • Avg. age-adj. rate per slightly below that which would be expected based on the frequency of 100,000 female pop., cases statewide. Regionally, the incidence rate for Tompkins County is 1997–2001 below the total for Central New York, though higher than for neigh- Tompkins ...... 133.7 Cortland...... 124.6 boring counties, Cortland and Tioga. (See Map 3, page 67, and Figure Tioga ...... 117.4 41, page 67.) CNY...... 137.6 Similarly, while breast cancer in Tompkins County women is diag- NYS...... 131.4 nosed early at a higher rate than for all CNY counties combined, the rate is not as favorable as that for either Cayuga or Cortland County. (See Figure 42, page 68.)

Cervical Cancer The picture for cervical cancer in Tompkins County is quite favor- Mortality able. The age adjusted rates of both mortality and incidence are below • Avg. age-adj. rate per those of neighboring counties, the CNY region and the state as a whole. 100,000 female popula- In the case of mortality rates, Tompkins is 25 percent below the tion, 1998–2002. Tompkins ...... 1.5 HP2010 target. (See Figure 43, page 68, and Figure 45, page 69.) Cayuga...... 1.3 Cervical cancers are also diagnosed at an early stage significantly Cortland...... 5.7 more frequently in Tompkins County than in bordering counties, the Tioga ...... 0.0 region or statewide. (See Figure 46, page 70.) CNY...... 2.3 The 10-year trend for Tompkins County cervical cancer deaths NYS...... 2.8 HP2010 ...... 2.0 goes almost year-by-year from zero to about 2 per 100,000 female population, and back to zero. As far as identifying a predictable trend, there is little more to be gained from studying the 3-year averages. (See Figure 44, page 69.)

Colorectal Cancer Colorectal cancer mortality in Tompkins County is declining. Mortality Three-year averages in crude mortality rates have dropped nearly 25 • Avg. age-adj. rate per percent since the mid-nineties. (See Figure 48, page 71.) A comparison 100,000 population, of age adjusted death rates within the region shows Tompkins at about 1998–2002. Tompkins ...... 23.4 the same level as other jurisdictions. Still, Tompkins County needs to CNY...... 22.8 cut colorectal cancer mortality by over 40 percent to reach the estab- HP2010 ...... 13.9 lished HP2010 target. (See Figure 47, page 70.) Incidence rates for colorectal cancer among Tompkins County residents are about what would be expected, based on statewide data. Actual age-adjusted rates indicate that cases of colorectal cancer are neither more nor less common in here than throughout the CNY region.

Tompkins County, NY 2005–2010 60 Community Health Assessment

(See Figure 49, page 71; Map 4, page 72; and Map 5, page 72.)

Prostate Cancer The impact of prostate cancer in Tompkins County is not easy to Incidence assess using the available, sometimes inconsistent data. The most recent • Avg. rate per 100,000 state cancer registry data shows that the mortality rate in Tompkins pop, 1997–2001. County is somewhat higher than neighboring counties — about 28 per- Tompkins...... 204.5 Cayuga ...... 99.3 cent higher than Cortland County, and the incidence rate is considera- Cortland ...... 135.8 bly higher — about 51 percent higher than Cayuga County. Tioga...... 175.0 Comparing Tompkins County to the state exclusive of New York NYS ex. NYC.... 166.7 City, the local mortality rate is just over 10 percent higher and the inci- NYS ...... 163.6 dence rate is close to 23 percent higher. However, the ratio of mortality rate to incidence rate is lower for Tompkins County than for Cortland County or the state. (See Figure 50, page 73.) Where the interpretive uncertainty comes is when two cancer maps are compared. The map for prostate cancer incidence by ZIP code shows below expected incidence in the Town of Dryden on the eastern side of the county, and above expected incidence in the Town of Lans- ing to the north (see Map 6, page 73.) However, a second, more gener- alized map dedicated to late stage prostate cancer shows that the entire eastern side of Tompkins County has an above expected incidence, including, one would assume, the Town of Dryden (see Map 7, page 74.)

Community Resources

Tompkins County Health The TCHD heads the local tobacco control partnership and partici- Department (TCHD) pates in central New York regional efforts to reduce exposure to second-hand smoke, encourage tobacco cessation and reduce initiation of tobacco use. It adheres to the New York State Department of Health’s Strategic Tobacco Control Plan to achieve these objectives. (see tobacco) Healthy Living New York State Department of Health provides funding for cervi- Partnership cal screening for women over 18 years of age and includes clinical breast exams and mammogram screening for women over the age of 40 who are uninsured or underinsured. The program also provides colorectal screening for any man or woman over the age of 50 who are uninsured or underinsured. In Tompkins County, the Cayuga Medical Center is the lead agency for the partnership comprised of physicians, community agencies and other health care providers including TCHD. In the 2003–2004 grant year the Partnership exceeded its breast and cervical screening goal by 231%, screening 346 women. The colorectal screening target continues to be a challenge with only 35 people screened in the same time period. The program provides prostate cancer

Tompkins County, NY 2005–2010 Community Health Assessment 61

information but not screening. Ithaca Breast Cancer is a local organization founded by a group of breast cancer survi- Alliance (IBCA) vors in 1994. IBCA’s staff and volunteers provide support, guidance and information on breast cancer and treatment options. Women diagnosed with breast cancer or anyone concerned about or affected by breast cancer are welcomed. Services and programs include, support groups, professional counseling, peer information network, the “Helpline” and a library of books and resources and educational sessions. Hospicare Hospicare now offers palliative care services. These services address the needs of people with life-threatening illnesses who may still be pursuing curative care, or whose longer prognosis makes them ineli- gible for treatment. It is not limited to people with cancer. When I-CAN dissolved a few years ago, Hospicare accepted its library and facilitates support groups for people with cancer. Cayuga Medical Center CMC opened a state-of-the-art radiation medicine facility in Janu- at Ithaca (CMC) ary 2005. It combines the expertise and resources of the medical center and Roswell Park Cancer Institute (RPCI) which has been designated a Comprehensive Cancer Center by the National Cancer Institute. This affiliation is linked by high-speed digital technology that allows physicians in both facilities to treat patients at CMC using the latest radiation protocols and treatments. CMC is in the process of recruiting more on- cologists for other cancer services.

Opportunities for Action

Tompkins County residents must do what they can to prevent cancer. This includes supporting smoke-free environments and quitting tobacco use. In order to assist in making better lifestyle choices such as healthy eating and physical activity, societal support structures must be in place. Schools, colleges, worksites, faith communities, local government, health care providers are all part of this effort. When the Tompkins County population is viewed without the college students, the median age is 38.9 years. As stated earlier, cancer generally occurs in middle aged and older people. As the County’s population ages — and assuming that retirees continue to find Tomp- kins County a desirable place to live — it is important to keep in mind the impact on the health care environment.

Tompkins County, NY 2005–2010 62 Community Health Assessment

Figures and Tables

Figure 34 –- Median age, Tompkins, Tompkins excluding students and regional comparison

Median Age: Tomp--Tomp excl students--near counties 50

38.9 40 37.3 38.0 35.9 34.2

30 28.6

0 Tompkins All Tompkins Cayuga Cortland Tioga NYS

Excl. Students Tompkins County Planning Department: 2000 U.S. Census Special Tab #137

Tompkins County, NY 2005–2010 Community Health Assessment 63

Figure 35 –- Lung and bronchus cancer mortality, age adjusted rates, regional comparison

LUNG & BRONCHUS CANCER - DEATHS AND AGE ADJUSTED DEATH RATES PER 100,000 RESIDENTS 65

59.8 60 55.0 55 53.4 53.7 52.3 49.5 50 44.9 45

20 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL HP2010

SOURCE: 1998-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 36 –- Lung and bronchus mortality, crude rates, 10-year trend

Lung & Bronchus Mortality: Crude rates per 100K pop 70

65 60.9 60.8 60 60.1 59.3 59.2 59.4 59.7 58.7 59.6 60

40 43.6 rate /100K pop rate /100K 40.8 41.8 39.0 35 37.7 36.3 35.7 36.4 30

25 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Tompkins Single Year Tomp 3yr avg Upstate New York

SOURCE: 1998-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 64 Community Health Assessment

Figure 37 –- Lung and bronchus cancer incidence, age-adjusted rates, regional comparison

LUNG & BRONCHUS CANCER - CASES AND INCIDENCE RATES AGE-ADJ PER 100,000 RESIDENTS 90 81.4 80 74.2 72.7 70.7 70 67.2 61.3 60

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 1997-2001 CANCER REGISTRY DATA AS OF AUGUST, 2004. Age adjusted to the 2000 U.S. Census

Map 1 –- Lung cancer incidence in males, by ZIP code, Tompkins & Schuyler Counties

TOMPKINS Lung Cancer Incidence by ZIP Code

Males, Schuyler and Tompkins Counties, NYS 13073 1993-1997 14882

14841 13068

14886

13053 R

14837 E 14878 14818 L 14850

14815 14891 13736

CHUY 14869

S 14817 14867 14865 14805 14870 14812 14883 13864

14864 14824 Comparison of individual ZIP Codes with expected incidence Areas of elevated incidence more than 100% above expected within 15% of expected not likely due to chance 50% to 100% above expected 15 to 50% below expected more than 100% 15 to 49% above expected more than 50% above expected below expected very sparse data 50-100% above expected

Tompkins County, NY 2005–2010 Community Health Assessment 65

Map 2 –- Lung cancer incidence in females, by ZIP code, Tompkins & Schuyler Counties

Lung Cancer Incidence by ZIP Code TOMPKINS Females, 13073 Schuyler and Tompkins Counties, NYS 14882 1993-1997

14841 13068 14886

R 13053 E 14837 L 14878 14818

Y 14850

U H 14815 14891 C 14869 13736 14817 S 14867 14865 14805 14812 14870 14883 13864

14864 14824

Comparison of individual ZIP Codes with expected incidence

more than 100% above expected within 15% of expected very sparse data 50% to 100% above expected 15 to 50% below expected 15 to 49% above expected more than 50% below expected

Figure 38 –- Lung and bronchus cancer, early stage diagnosis, regional comparison

LUNG & BRONCHUS CANCER - PERCENT OF CASES DIAGNOSED AT EARLY STAGE

50 48.2 44.6

40 36.4 34.4

30 26.5

21 20

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 1995-1999 CANCER REGISTRY DATA AS OF MARCH, 2002

Tompkins County, NY 2005–2010 66 Community Health Assessment

Figure 39 –- Breast cancer mortality in females, age-adjusted rate, regional comparison

FEMALE BREAST CANCER - DEATHS AND DEATH RATES AGE-ADJ. PER 100,000 FEMALE RESIDENTS 30 27.7 25.9 25 24.0 22.8 22.3

20 18.9

16.4 15

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL HP2010

SOURCE: 1998-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004. Age-adjusted to 2000 U.S. Census

Figure 40 –- Breast cancer in females, crude rate, 10-year trend

Female Breast Cancer Mortality Rates 42 38.7 38.6 39 36.8 37.2 35.9 37.1 35.4 36 33.6 33.7 32.6 32.2 33

27 26.6 24.8 24 24.5

21 20.5 Crude rate /100K pop 18 18.6 18.2 16.5 16.0 15 14.4 12 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Upstate New York Tompkins Single Year Tomp 3yr Avg

SOURCE: 1998-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 67

Figure 41 –- Breast cancer incidence in females, regional comparison

FEMALE BREAST CANCER - CASES AND INCIDENCE RATES PER 100,000 FEMALE RESIDENTS 145

140 137.6

135 133.7 131.4 129 130 124.6 125

120 117.4

115

110

105

100 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 1997-2001 CANCER REGISTRY DATA AS OF AUGUST, 2004

Map 3 –- Breast cancer incidence in females, by ZIP code, Tompkins & Schuyler

TOMPKINS Breast Cancer Incidence by ZIP Code Schuyler and Tompkins Counties, 13073 14882 New York State 1993-1997 14841 13068 14886

13053 R

E 14837 14878 14818

L 14850

Y U 14815

H 14891 14869 14817 C 14867

S 14865 14805 13736 14812 14870 14883 13864

14864 14824

Comparison of individual ZIP Codes with expected incidence

more than 100% above expected 15 to 50% below expected 50% to 100% above expected more than 50% below expected 15 to 49% above expected very sparse data within 15% of expected

Tompkins County, NY 2005–2010 68 Community Health Assessment

Figure 42 –- Breast cancer incidence in females, early diagnosis, regional comparison

FEMALE BREAST CANCER - PERCENT OF CASES DIAGNOSED AT EARLY STAGE

82.2 80.1 80 76.0

70.9 70 65.1 65.7

30 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 1995-1999 CANCER REGISTRY DATA AS OF MARCH 2002

Figure 43 –- Cervical cancer mortality in females, age-adjusted rates, regional comparison

UTERINE CERVICAL CANCER - DEATHS AND DEATH RATES AGE-ADJ PER 100,000 FEMALE RESIDENTS 6 5.7

3 2.8 2.3 2.0 2 1.5 1.3

0.0 0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL HP2010

SOURCE: 1998-2002 V ITA L STA TISTICS DA TA A S OF A UGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 69

Figure 44 –- Cervical cancer mortality in females, crude rates, 10-year trend

Uterine Cervical Cancer Female Mortality Rates 4.5

4.0 3.3 3.5 3.1 3.1 3.0 2.9 2.7 3.0 2.6 2.5 2.5 2.4 2.5

2.0

1.5

1.0 Crude rate /100K female pop female /100K rate Crude 0.5

0.0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Upstate New York Tompkins Single Year Tomp 3yr Avg

SOURCE: 1998-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 45 –- Cervical cancer incidence in females, age-adjusted rates, regional comparison

UTERINE CERVICAL CANCER - CASES AND INCIDENCE RATES AGE-ADJ PER 100,000 FEMALE RESIDENTS

14 12.7

10.1 10 8.5 8.1 8 7.0

6 5.4

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 1997-2001 CANCER REGISTRY DATA AS OF AUG, 2004. Age Adjusted to the 2000 U.S. Census

Tompkins County, NY 2005–2010 70 Community Health Assessment

Figure 46 –- Cervical cancer incidence in females, early diagnosis, regional comparison

UTERINE CERVICAL CANCER - PERCENT OF CASES DIAGNOSED AT EARLY STAGE 100

90 87.5

80 80

70 63.6 62.8

60 55.8

50 50

30 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 1995-1999 CANCER REGISTRY DATA AS OF MARCH 2002

Figure 47 –- Colorectal cancer mortality, age-adjusted rates, regional comparison

COLORECTAL CANCER - DEATHS AND DEATH RATES AGE-ADJ PER 100,000 RESIDENTS 30

25.8

25 23.4 22.8 21.6 20.7 19.8 20

15 13.9

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL HP2010

SOURCE: 1998-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004. Age Adjusted to the 2000 U.S. Census

Tompkins County, NY 2005–2010 Community Health Assessment 71

Figure 48 –- Colorectal cancer mortality, crude rates, 10-year trend

Colorectal Cancer Mortality Rates 30.0

27.6 27.2 26.9 27.0 25.6 24.6 24.7 24.4 24.3

24.0 23.2 23.3

22.8 22.8 21.0 21.8

20.4 Crude rate/100K pop 19.0 19.2 18.0 18.7

17.4

15.0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Upstate New York Tompkins Single Year Tomp 3yr Avg

SOURCE: 1998-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 49 –- Colorectal cancer incidence, age-adjusted rates, regional comparison

COLORECTAL CANCER - CASES AND INCIDENCE RATES AGE-ADJ PER 100,000 RESIDENTS 68

65 64.5 64.3 63.3 62.9 62.3 62 60.1

50 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 1997-2001 CANCER REGISTRY DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 72 Community Health Assessment

Map 4 –- Colorectal cancer incidence in males, by ZIP code, Tompkins & Schuyler

TOMPKINS Colorectal Cancer Incidence by ZIP Code Males, Schuyler and Tompkins Counties, 13073 New York State 14882 1993-1997 14841 13068 14886

R 13053

E 14837

L 14878 14818

14850

Y U

H 14815 14891 14869 13736 C 14817

S 14867 14865 14805 14870 14812 14883 13864 14864 14824

Comparison of individual ZIP Codes with expected incidence

more than 100% above expected 15 to 50% below expected 50% to 100% above expected more than 50% below expected 15 to 49% above expected very sparse data within 15% of expected

Map 5 –- Colorectal cancer incidence in females, by ZIP code, Tompkins & Schuyler

TOMPKINS Colorectal Cancer Incidence by ZIP Code Females, Schuyler and Tompkins Counties, 13073 14882 New York State 1993-1997 14841 13068 14886

R 13053

E 14837 14878

L 14818

14850

Y U

H 14815 14891 14869 13736

C 14817 14867 S 14865 14805 14870 14812 14883 13864

14864 14824

Comparison of individual ZIP Codes with expected incidence more than 100% above expected 15 to 50% below expected 50% to 100% above expected more than 50% below expected 15 to 49% above expected very sparse data within 15% of expected

Tompkins County, NY 2005–2010 Community Health Assessment 73

Figure 50 –- Prostate cancer incidence and mortality, regional comparison

Prostate Cancer, 1997–2001 250

204.5 200 175.0 166.7 163.6

150 135.8

99.3 100

49.1 50 33.5 30.3 30.5 26.1 24.5

0 Tompkins Cortland Cayuga Tioga NYS Excl NYC NYS Prostate Cancer Incidence Rate Mortality Rate

New York State Cancer Registry. Revised June 2004

Map 6 –- Prostate cancer incidence, by ZIP code, Tompkins County

Prostate Cancer Incidence by ZIP Code 13073 Adjusted for Age and Race 14882 Tompkins County 1994-1998 14886 13068

Comparison of individual zip codes 13053 with expected incidence more than 100% above expected 14850 50% to 100% above expected 15% to 49% above expected within 15% of expected 15% to 50% below expected 14817 more than 50% below expected 14867 13736 very sparse data 14883 13864

Tompkins County, NY 2005–2010 74 Community Health Assessment

Map 7 –- Prostate cancer, areas with elevated late stage incidence, adjusted for age and race

Areas with Elevated Late Stage Prostate Cancer Incidence Adjusted for Age and Race

New York State 50% to 1994-1998 100% TOMPKINS above expected Areas of elevated incidence not likely due to chance

Tompkins County, NY 2005–2010 Community Health Assessment 75

Diabetes

iabetes is a heterogeneous group of metabolic disorders characterized by high blood glucose levels. Type 1 and Type 2 are the most common forms. Type 1 accounts for 5 to D 10% of the cases and 85 – 90% are Type 2. The rest are either gestational diabetes or diabetes secondary to other conditions. Complications that can result from poorly managed diabetes represent a significant cause of morbidity and mortality that include heart disease, stroke, blindness, kidney failure, leg amputations, pregnancy complications and deaths related to flu and pneumonia. Many adults have pre- diabetes, a condition in which blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes. People with pre-diabetes are at increased risk for developing Type 2 diabetes and for heart disease and stroke. Over the past decade, primary prevention research studies have demonstrated that modest lifestyle changes can prevent or delay the onset of Type 2 adults among high-risk adults. A disheartening trend has been the increase of Type 2 diabetes diagnosed in children and adolescents. There is no New York State or local data as there is for adults. Anecdotal data from providers and school health officials substantiate this observable trend, however.

Data Analysis

Diabetes mortality Diabetes mortality rates — situations where diabetes is indicated as Rate per 100,000 pop., the primary reason for death — when adjusted for age, do not vary 2000–2002. widely within the Central New York (CNY) region. Most CNY rates ...... Age-adj. (Crude) cluster around 20 per 100,000 residents. The Adirondack counties in the Tompkins .. 18.6 (15.0) Cayuga...... 19.1 (22.5) CNY region have markedly higher rates — the rate for St. Lawrence Cortland...... 19.2 (19.2) county is 26.8. Tioga ...... 17.6 (18.8) Within the close regional comparison used throughout this docu- CNY...... 20.7 (22.4) ment, Tompkins has the second lowest age adjusted rate of diabetes NYS...... 19.7 (20.5) mortality. (See Figure 51, page 78.) HP 2010...... 45.0 ( –- ) Tompkins’ crude rate is the lowest thanks to the county’s median age which is over 7 years younger than the state as a whole. See table at left. Early on in the 10-year span from 1993–2002, the crude rate for diabetes mortality dropped 61 percent in Tompkins County, hitting its low in 1996. Since then the yearly rate has varied. A review of the trend by 3-year averages shows that the local rate remained relatively steady from 1996–2002. Over the complete 10-year cycle the rate for all of Upstate has climbed steadily with an overall rise of nearly 22 percent. (See Figure 52, page 79.)

Across New York State, diabetes prevalence among adults more than doubled from 1996–2003 to 7.4 percent according to behavioral Risk Factor Surveillance System (BRFSS) surveys. (See Figure 53,

Tompkins County, NY 2005–2010 76 Community Health Assessment

page 79.) BRFSS data are self-reported responses to random telephone surveys. Diabetes prevalence is based on respondents who report that a doctor has told them that they have diabetes. Physician diagnosed Local BRFSS data for 2003 show that the Tompkins–Cortland Diabetes sampling group has the lowest prevalence of diabetes in the CNY re- BRFSS 2003, Percent. gion: half the CNY rate. (See Figure 54, page 80.) Note that these data Tomp-Cort ...... 4.0 are not age adjusted which, as noted above, may skew the Tompkins Cayuga-Sen-Way ... 7.4 Che-Sch-Tioga ...... 8.3 County data downward and to a lesser extent, the Cayuga County data CNY...... 8.1 upward. The Healthy People 2010 target for diabetes prevalence is 2.5 NYS ...... 7.2 percent...... 95% C.I. =2.0 Another caution when interpreting BRFSS results is that unlike vi- ...... 0.6 for NYS. tal statistics and SPARCS counts, these data are subject to sampling er- HP 2010 ...... 2.5 ror, which varies depending on the sample size. BRFSS error is expressed using a 95% confidence interval (C.I.) In the situation under discussion here there appears to be no significant difference in diabetes prevalence among all groups shown except for Cortland–Tompkins. Within the Tompkins–Cortland sampling group there are apparent differences in diabetes diagnosis by age and by education. Although some of the sample sizes are especially small and the CI’s high, it is very tempting to conclude that individuals age 55+ are significantly more likely to have had a physician tell them they have diabetes than those from age 18–54 years. Though not quite as pronounced, there is a strong suggestion that those with only a high school education or less are more likely to have been diagnosed than those whose education went beyond high school. (See Figure 55, page 80.)

Diabetes prevalence is also recorded using diabetes related hospitalizations. While these data are not subject to sampling error, they are limited to situations requiring admission to a hospital. Not included are emergency room treatments or, of course, individuals managing their diabetes to the degree that hospitalization is not required. Diabetes related Regional comparisons for diabetes related hospitalizations are pre- hospitalizations sented in three tables: average rate for 1998–2003, trends for 1998– Rate per 10,000 pop., 2003, and average rate by age, 2000–2003. (See Figure 56, Figure 57, 1998–2003 Figure 58, page 81 and following.) There is no adjustment for age in Tompkins...... 5.9 Cayuga ...... 15.1 the first two. Cortland ...... 12.5 In almost all of these data sets, the rates of diabetes related hospi- Tioga...... 5.2 talizations in Tompkins County is by comparison, extremely low. The CNY ...... 13.3 exception is Tioga County, which runs very close to Tompkins in all NYS ...... 18.9 sets. In the first set, all diabetes related hospitalizations 1998–2003 (Figure 56) Tompkins’ rate is better than half that of Cortland, Cayuga and CNY, and more than one-third the statewide rate. One instance where Tioga County has more favorable data than Tompkins County is in the comparisons by age (Figure 58.) Here the

Tompkins County, NY 2005–2010 Community Health Assessment 77

sharp rise in hospitalizations for those age 65+ in Tompkins County follows closely the pattern seen in the other counties and regionally. The sharp difference is not seen in Tioga. A lower rate of hospitalizations in the younger age groups is also seen in Tioga as compared to Tompkins County, most prominently in the under age 18 group. Note should also be taken of the trend in hospitalizations 1998– 2003 (Figure 57.) While Tompkins and Tioga are both running far below Cayuga and Cortland, the latter two have shown some downward turns while the former two have maintained a slight, though steady upward trend.

Community Resources

Diabetes Control TCHD’s Health Promotion Program and the diabetes educator at Coalition Cayuga Medical Center (CMC) collaborate with regional partners in a diabetes control coalition funded by the New York State Department of Health. For the past 5 years, TCHD and CMC have targeted primary care providers. Diabetes care manuals were given to providers for distribution to their patients and enrollment in diabetes education classes at CMC increased as result of the effort. In the past year effort have been directed to reach the community with educational sessions on pre- diabetes.

Opportunities for Action

Reducing obesity in adults and children through regular physical activity and healthy eating are the most effective strategies in reducing diabetes in the community.

Tompkins County, NY 2005–2010 78 Community Health Assessment

Figures and Tables

Figure 51 — Diabetes mortality, regional comparison

DIABETES -- AGE-ADJ. DEATH RATES PER 100,000 RESIDENTS

20.7 21 19.7 19.2 19.1 18.6 17.6 18

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 79

Figure 52 — Diabetes mortality, 10-year trend

Diabetes Crude death rate / 100,000 pop.

30 Upstate NY Tompkins Single Year Tompkins 3-Yr Avg

27.0 25 22.8

20 19.2 17.5 16.7 14.6 15

13.4 12.2 13.4 10 10.4

5 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 53 — Diabetes prevalence age 18+, NYS, 11-year trend (BRFSS) Diabetes prevalence among adults age 18+ yrs, Percent, NYS 8

7 7.4 7.2 6 6.6 6.3 6.0 5 5.7

4 4.8 4.4 4.2 3.8 3 3.6

0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 BRFSS (data accessed Dec 2004.)

Tompkins County, NY 2005–2010 80 Community Health Assessment

Figure 54 — Physician diagnosed diabetes (BRFSS), regional comparison Physician Diagnosed Diabetes 10

1 7.4 8.3 4.0 8.1 7.2 - Cayuga, Seneca, Chemung, Cortland, CNY NYS Wayne Schuyler, Tioga Tompkins

Expanded BRFSS, 2003 - NYSDOH. Avg 95% C.I. for counties = 2.0; 95% C.I. for NYS = .06

Figure 55 — Physician diagnosed diabetes, Cortland-Tompkins, demographic comparison.

Physician Diagnosed Diabetes Cortland, Tompkins 13 11.7 12 11 10 9 8 7.4 7 6 4.8 5 4.0 4 3.3 3.0 3 2.4 2 1 0.4 0 Total Male Female 18-34 35-54 55+ HS or less >High Sch. Expanded BRFSS, 2003 - NYSDOH. See table for 95% C.I.

Tompkins County, NY 2005–2010 Community Health Assessment 81

Physician Diagnosed Diabetes Cortland, Tompkins Expanded BRFSS, 2003 – NYSDOH Demographic n¹ Yes n No Groups %² % C.I.³ Total 33 4 611 96 1.5 Male 15 4.8 247 95.2 2.5 Female 18 3.3 364 96.7 1.6 18-34 1 0.4 175 99.6 0.8 35-54 9 3 237 97 2 55+ 23 11.7 193 88.3 4.9 HS or less 19 7.4 193 92.6 3.6 >High Sch. 14 2.4 418 97.6 1.4 Avg. 2.3 ¹Pcts based on row denominators of less than 50 are unstable and should be used with caution ²Weighted Percent ³95% Confidence Interval

Figure 56 — Diabetes related hospitalizations, regional comparison

Diabetes Related Hospitalizations: Rate per 10,000 residents, 1998-2003.

21 18.9 18 15.1 15 13.3 12.5 12

5.9 6 5.2

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY Rate NYS Rate

SOURCE: SPARCS Data current through September 2004. County rates are avg 1998–2003

Tompkins County, NY 2005–2010 82 Community Health Assessment

Figure 57 — Diabetes related hospitalizations, 6-year trend by county

Diabetes related hospitalizations: Crude rate / 10,000 residents

21 CAYUGA CORTLAND TIOGA TOMPKINS

14.1 14.1 12 13.0 11.6 11.8 9 10.5 6.5 6.4 6.8 5.7 6 5.0

5.0 3

0 1998 1999 2000 2001 2002 2003

SPARCS data current through September 2004

Figure 58 — Diabetes related hospitalizations by age, regional comparison Diabetes Related Hospitalizations, Avg rate / 100,000 pop., 2000-2003 600 585 Age <18 yrs Age 18–34 yrs Ages 35–64 Ages 65+

500

397 400 385 336

300 236 232 193 200 162 149 148

95 88 82 100 71 68 58 56 39 34 39 22 23 14 16 0 CAYUGA CORTLAND TOMPKINS TIOGA CNY Rate NYS Rate SPARCS data current thru Sept 2004

Tompkins County, NY 2005–2010 Community Health Assessment 83

Family Planning

he teenage pregnancy rate continues to decline in the County, the region, the rest of New York State, and the country. The CDC attributes this decline to several possible factors Tthat could reasonably be applied to this County. One is that current educational efforts have focused on the importance of pregnancy prevention through abstinence and responsible behavior. The adoption of new easier to use effective birth control methods by sexually active teenagers is another factor. Also, economic opportunity may have given teenagers a reason to place a greater focus on higher education and work.6 Trends in the three components of pregnancy rates — live births, induced abortions and fetal losses — have declined in the country since 1990. The generally downward trend in live births (fertility rate) reflects generally stable or declining birth rates for women in all age groups under 30 years. The only age groups for which birth rates have consistently increased are women aged 30 years and over.

Data Analysis

Birth Rate, ages 15–44 Among counties, the birth rate for Tompkins County is the lowest • Rate of births per 1,000 in the state. It is nearly half that of New York State, 42 percent of the females age 15–44, rate for Central New York7, and 22 percent below the county with the 2000–2002. next-to-lowest rate. The birth rate is calculated as the number of births Tompkins ...... 31.1 Cayuga...... 54.7 per 1,000 females age 15–44 years. (see Figure 59, page 87.) Cortland...... 47.8 Tompkins County’s high student population is the most likely Tioga ...... 57.4 cause of the low birth rate. One-in-four of the women in Tompkins CNY...... 54.0 County are age 18–24 years. In Cortland County, about one-in-six NYS...... 60.4 women are in this age group. Upstate the number is less than one-in- ten. (See Figure 61, page 88.) • Percent of female popu- It is fair to postulate that a high number of the Tompkins women in lation who are age 18– this age group are students, that these students are not having babies, 24, 2002 estimate. Tompkins ...... 25.2 and that they will leave Tompkins County before they do settle down to Cayuga...... 9.0 have a family. Cortland...... 17.3 This postulate is supported by Tompkins demographic data that Tioga ...... 7.8 separates the college students from the general population. These data NYS (ex. NYC) ...... 9.0 are in the U.S. Census Bureau’s Special Tabulation #137 for the 2000 census.8 Although this tabulation does not break out narrow age or gen-

6 Centers for Disease Control and Prevention, National Vital Statistics Reports, Vol.47, No.29, December 15, 1999. 7 NYSDOH statistical regions close to Tompkins County are as follows (counties bordering Tompkins are in bold): Region 3 (Central New York): Cayuga, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tompkins Region 4 (New York-Penn): Broome, Chenango, Tioga Region 2 (Finger Lakes): Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne, Yates

8 In 2003, the Tompkins County Planning Department requested and received a Special Tabulation from the U.S. Bu- reau of the Census. This Special Tabulation (#137) provided separate sets of the 2000 Census data for "college stu-

Tompkins County, NY 2005–2010 84 Community Health Assessment

der segments, it does show that 38 percent of Tompkins residents under age 21 are college students, and 27 percent of those age 21–64 years are college students.

Birth Rate, ages 18–19 Finally, the birth rate for Tompkins County women age 18–19 • Rate of births per 1,000 years is less than one-third that of Cortland County, one-fifth that of females age 18–19, CNY, and one-sixth that of the state as a whole. (See Figure 65, page 2000–2002. 90.) Tompkins...... 8.8 Cayuga ...... 55.4 In summary, piecing together an high percentage of women in the Cortland ...... 28 age 18–24 group, a high percentage of college students in the under age Tioga...... 68.7 21 years group, and a very low birth rate for age 18–19 women pro- CNY ...... 43.6 vides a plausible explanation that Tompkins County’s very low birth NYS ...... 53.0 rate is a result of the high college student population. Similar to trends elsewhere, Tompkins County’s overall birth rate for women age 15–44 years is falling. In the 10 year period from 1993– 2002, the rate fell over 9 points, or almost 25 percent. Most of that decline came from 1993–1998, with the rate essentially level since then. The Upstate NY birth rate has dropped about 5 points, or 8 percent over the same 10 year period. (See Figure 60, page 87.)

Teenage Births, age 15– Tompkins County’s birth rate among teens age 18–19 — cited ear- 17 years lier — is the lowest in the state. The birth rate for girls age 15–17 years • Rate per 1,000 females is also among the lowest in the state. And, as a percentage of all births, age 15–17, 2000–2002 live births to girls age 15–17 has shown a downward trend. (See Figure Tompkins...... 8.7 Cortland ...... 14.2 62, page 89, and Figure 64, page 90.) CNY ...... 17.8 As a percentage of live births, out-of-wedlock births are also low in Tompkins County; about 28 percent less than the rate for the Central New York region. (See Figure 66, page 91.) Births to women age 30– The trend in births to women age 30–44 years has increased 44 years slightly in Tompkins County over the ten year period 1993–2002, while • Percent of all live births, in neighboring Cortland County the increase has been more pronounced 2000–2002. (up 9.5 percent in Tompkins and 15 percent in Cortland County. See Tompkins...... 47.1 Cayuga ...... 38.1 Figure 68, page 92.) Still, Figure 68 and Figure 67 (page 91) show that Cortland ...... 33.7 the rate of births to women age 30–44 is quite a bit higher in Tompkins Tioga...... 36.4 County than in nearby counties or the CNY region as a whole. In fact, CNY ...... 38.4 this rate is higher in Tompkins than all other Upstate counties west of NYS ...... 46.5 Albany, Saratoga and the Hudson Valley.

Pregnancy Rate Continuing its streak of extremes in the family planning category, • Rate per 1,000 females Tompkins County has the state’s lowest pregnancy rate; a rate 15 per- dents" and "non-college students" for Tompkins County (by municipality). "College student" was defined as those answering "yes" to question 8a of the Census 2000 "long" form questionnaire ("at any time since February 1, 2000, has this person attended regular school or college?" –- for ages 17+ years.)

Tompkins County, NY 2005–2010 Community Health Assessment 85

age 15–44 years, 2000– cent below the next higher Otsego County (Cooperstown,) 34 percent 2002. lower than the CNY region, and less than half of the state as a whole. Tompkins ...... 44.1 Cayuga...... 65.8 (See Figure 69, page 92.) Cortland...... 60.3 The trend for pregnancies has been a steady decline in Tompkins Tioga ...... 68.0 County — about 30 percent from 1993–2002. Upstate has seen an 11 CNY...... 66.7 percent decrease over that 10-year period. (See Figure 70, page 93.) NYS...... 90.3 Abortions Opposite the pregnancy rate, Tompkins County has the second • Rate per 1,000 live highest rate of induced abortions statewide, exclusive of New York births, 2000–2002. City. Outside NYC, Erie County (Buffalo) has the highest rate — about Tompkins ...... 415 4 percent above Tompkins, while the abortion rate for the five boroughs Cayuga...... 198 Cortland...... 251 is 76 percent above Tompkins. The abortion rate is calculated as a ratio Tioga ...... 183 of induced abortions to live births. CNY...... 226 After peaking in the mid-1990’s, Tompkins County’s abortion rate NYS...... 486 has trended toward a decline. Since the abortion rate is tied to the number of births, a downward trend in both birth and abortion rates pre- sumes an overall decline in the number of abortions in Tompkins County.

Teen Pregnancies The pregnancy rate among teenage girls age 15–17 years is low in • Rate per 1,000 females Tompkins County, though comparisons with other regions are not as age 15–17 years, 2000– extreme as for some of the statistics described earlier. However, the 2002. downward trend for pregnancies among Tompkins’ 15–17 year olds is Tompkins ...... 21.5 Cayuga...... 25.9 dramatic, dropping by nearly half from a high in 1995 to 2002. For all Cortland...... 21.6 of Upstate the rate fell 38 percent from 1993–2002. Tioga ...... 24.8 In every Upstate county, the current rate of pregnancies among CNY...... 29.1 girls age 15–17 is comfortably below the Healthy People 2010 NYS...... 41.2 (HP2010) target rate of 43.0. (See Figure 75, page 95, and Figure 75, HP2010 ...... 43.0 page 95.)

Community Resources

Tompkins County Health Tompkins County Health Department community health nurses Department discuss family planning practices with Medicaid Obstetrics and Mater- nal Services (MOMS) clients and provides education on the topic at childbirth education classes and post-natal visits. Planned Parenthood of Planned Parenthood of the Southern Finger Lakes (PPSFL) pro- the Southern Finger vides sexuality education programs for the community and in-service Lakes training for professionals. Programs may be arranged for schools, community groups, faith communities, youth services agencies, families and parents. Mothers and Babies perinatal network of the Southern Tier pro-

Tompkins County, NY 2005–2010 86 Community Health Assessment

vides some of the same services as PPSFL. The Teen Pregnancy The Teen Pregnancy/Parenting Program is a voluntary program of /Parenting Program the Day Care and Child Development Council. It provides case management to pregnant and/or parenting teens under the age of 21 in Tompkins County. TP3 provides information on all pregnancy choices and supports teens in their decisions. Among the varied services it provides, TP3 maintains a teen parent panel, which speaks out on the hard- ships of being a parent at a young age.

Tompkins County, NY 2005–2010 Community Health Assessment 87

Figures and Tables

Figure 59 –- Birth rate, age 15–44, regional comparison

BIRTHS - RATE PER 1,000 FEMALES AGE 15-44

60.4 60 57.4 54.7 54.0

50 47.8

31.1 30

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 60 –- Birth rate, age 15–44, 10-year trend

Birth Rate Per 1,000 Females Age 15–44 (1993-2002) 65

62.9 60 61.8 60.9 59.7 59.1 59.3 59.7 58.9 58.4 55 57.8

45 39.6 40 37.6

33.6 33.5 Rate/ 1,000 Females age 15--44 35 31.8 32.0 31.4 31.0 31.0 30.2 30

25 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Tompkins Single Year Tomp 3Yr Avg Upstate New York

SOURCE: VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 88 Community Health Assessment

Figure 61 –- Female population by age, regional comparison

Pct Total Female Population By Age, 2002 30%

25% 25.2%

20% 17.3% 17.0% 15.8% 15.4% 15% 13.8% 13.8% 12.5% 11.8% 11.5% 11.0% 10.5%

10% 9.0% 9.0% 7.8% 4.6% 4.6%

5% 4.0% 3.9% 3.3%

0% CAYUGA CORTLAND TOMPKINS TIOGA NYS Ex. NYC

Age 15–17 18–24 25–34 35–44

SOURCE: NATIONAL CENTER FOR HEALTH STATISTICS

Table 9 –- Tompkins County population by gender, age, student status Tompkins County Population Characteristics Source: Excluding Pct All U.S. Census 2000, All college Res that Sp. Tab #137 residents students are 96,501 69,295 College Sex Students Male 47,667 49% NA Female 48,834 51% NA Age Under 21 32,036 33% 19,975 29% 38% 21 – 64 55,208 57% 40,140 58% 27% 65 or older 9,257 10% 9,180 13% 1%

Tompkins County, NY 2005–2010 Community Health Assessment 89

Figure 62 –- Teenage births, age 15–17, rate per female pop. age 15–17, regional comparison

TEENAGE BIRTHS (AGE 15-17) - RATE PER 1,000 FEMALES AGE 15-17

20 17.8 18 16.9 17.3

16 14.2 13.6 14

10 8.7

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 63 –- Teenage births, age 15–17, rate per live births, regional comparison

TEENAGE BIRTHS (AGE 15-17) - PERCENTAGE PER 100 LIVE BIRTHS

5.0

4.0 3.6 3.3 3.0 3.0 2.5 2.5

2.0 1.8

1.0

0.0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 90 Community Health Assessment

Figure 64 –- Teenage births, age 15–17, rate per live births, 10-year trend

Teenage (Age 15-17) Birth Percentage per 100 Live Births

4.0 3.8 3.3 3.1 3.0 3.0 2.7

2.1

2.0 2.3 2.0 1.7 1.6

rate /100 live births 1.0

0.0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Single Year Tomp 3Yr Avg Upstate New York

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 65 –- Teenage births, age 18–19, rate per female pop. age 18–19, regional comparison

TEENAGE BIRTHS (AGE 18-19) - RATE PER 1,000 FEMALES AGE 18-19

68.7 70

60 55.4 53.0

50 43.6

30 28.0

8.8 10

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 91

Figure 66 –- Out-of-Wedlock births, regional comparison

OUT-OF-WEDLOCK - PERCENTAGE PER 100 LIVE BIRTHS

40 35.9 36.3 34.3 34.9

29.5 30 25.1

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 67 –- Births to mothers age 30–44, regional comparison

Births to mothers age 30–44 (Per 100 county Live Births; Avg for 2000--2002 ) 50

25 47.09 46.52

20 38.38 38.12 36.44 33.69 15

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY Region NYS Overall

SOURCE: NYSDOH Vital Records last updated Sept. 2004

Tompkins County, NY 2005–2010 92 Community Health Assessment

Figure 68 –- Births to mothers age 30–44, 10-year trend

Pct of live births to mothers age 30--44 yrs

55 TOMPKINS Tomp 3yr Avg CORTLAND TIOGA

50 48.01 47.72 47.24 47.49 47.60 46.74 46.54 45.02 43.88 45 42.10

39.68 38.53 40 38.16 37.79 37.03 37.41 36.87 36.33 34.71 35.21 35 Pct live births live Pct 35.84 35.11 33.27 33.57 32.06 32.37 30 31.54 31.22

29.20 28.70 25

20 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: NYSDOH Vital Records last updated Sept. 2004

Figure 69 –- Pregnancies, regional comparison

PREGNANCIES - RATE PER 1,000 FEMALES AGE 15-44

100

90.3 90

68.0 70 65.8 66.7

60.3 60

50 44.1

30 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 93

Figure 70 –- Pregnancies, 10-year trend

Pregnancy Rate Per 1,000 Females Age 15-44

90 83.5 85 81.2 79.6 78.4 80 77.0 75.7 75.1 75.7 74.5 74.0 75

65 58.3 60

rate /1,000 pop 55 51.9 48.4 48.4 50 46.7 46.9 46.3 45.9 45.2

45 41.1

40 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Tompkins Single Year Tomp 3Yr Avg Upstate New York

SOURCE: VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 71 –- Induced abortions, regional comparison

INDUCED ABORTIONS - RATIO PER 1,000 LIVE BIRTHS

525 486.0

450 414.7

375

300 278.6 250.6 226.4 225 197.7 182.8

150

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL Upstate NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 94 Community Health Assessment

Figure 72 –- Abortions, 10-year trend

Abortions per 100 Live Births (1993-2002) 52

48.8 48.9 48 47.2

44.1 46.9 44 46.2 44.1

40 41.5

36 37.4 32.1 35.7 30.9 30.8 30.3 32 29.7 27.5 27.0 27.0 26.9 28 26.3

24 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Tompkins Single Year Tomp 3Yr Avg Upstate New York SOURCE: VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 73 –- Teenage pregnancies, age 15–19, regional comparison

TEENAGE PREGNANCIES (AGE 15-19) - RATE PER 1,000 FEMALES AGE 15-19

70 67.1

50 48.2 45.8 45.9

40 35.9

21.7 20

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 95

Figure 74 –- Teenage pregnancies, age 15–17, regional comparison

TEENAGE PREGNANCIES (AGE 15-17) - RATE PER 1,000 FEMALES AGE 15-17

45 43.0 41.2 40

30 29.1 25.9 24.8 25 21.6 21.5

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL HP2010

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 75 –- Teenage pregnancies, age 15–17, 10-year trend

Pregnancy Rate Per 1,000 Females Age 15-17 (1993-2002) 45 41.9 41.5 42

39 37.5 37.2 36.5 36 38.1 37.9 36.9 31.7 33 34.5 33.8 30.2 29.3 30 30.7 27.5 29.4 27 25.9 rate /100K pop

24 25.0 21

20.4 18 20.3 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Upstate New York Tompkins Single Year Tomp 3Yr Avg

SOURCE: VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 96 Community Health Assessment

Heart Disease and Stroke

ardiovascular disease (CVD) is any disease of the circulatory system. Most of the deaths from CVD relate to coronary heart disease (CHD) or heart attack, stroke (cerebrovascu- C lar disease) and other diseases of the circulatory system including heart failure and diseases of the artery.9 CVD remains the leading cause of death in the United States despite improvements in prevention, detection, and treatment. New York ranks 16th in the United States in age-adjusted deaths due to CVD. CVD is no longer thought of most as a disease that affects men as they age; more than half the deaths occur among women. While the premature mortality rate is higher in men, more women than men have died from heart disease in every year since 1984 and this trend is increasing. Cardiovascular diseases are the leading causes of death in New York State, killing more than 70,000 residents each year (43% of all deaths). For every person who dies from a heart attack or angina, 18 people live with these conditions. For every person who dies from a stroke, seven people cope with the consequences of a non-fatal event. Many of these survivors are disabled and cannot lead productive lives. They also are at high risk for additional events. CVD remains the leading cause of disability among working adults. Stroke alone accounts for the disability of more than one million Ameri- cans.10 The health burden of CVD is matched by its economic burden. In 2002, the estimated direct and indirect (medical care + lost productivity) cost of cardiovascular disease in New York was almost $16 billion. This is approximately $860 for each person in New York. More than 20,000 coronary artery bypass surgeries are performed each year in the state, with a mean cost of approximately $32,000. A conservative estimate of the cost for treating one person with heart disease over 20 years is $121,200. These medical expenses include diagnostic tests, surgeries, hospital and doctor visits, physical therapy and drugs.11

Data Analysis

CVD Mortality The cardiovascular disease age adjusted death rate for the County is • Avg. age-adj. rate per 278.5 per 100,000 population. The rate is lower than that of New York 100,000 pop, 2000–2002. State and neighboring counties except for Tioga County which has an age Tompkins...... 279 adjusted CVD death rate of 265.7 per 100,000. (See Figure 76, page Cayuga ...... 297 Cortland ...... 345 100.) Tioga...... 266 Note that the crude rates for CVD death Tompkins County are con- CNY ...... 316 siderably lower than are the age adjusted rates, a reflection of the young NYS ...... 341 population. (The median age in Tompkins County is 28.6 years.)

9 from “The Burden of Cardiovascular Disease in New York: Mortality, Prevalence, Risk Factors and Selected Popu- lations,” April 20, 2004. 10 http://www.health.state.ny.us/nysdoh/heart/heart_disease.htm 11 NYSDOH and CDC.

Tompkins County, NY 2005–2010 Community Health Assessment 97

Diseases of the Heart Heart disease and stroke are the two commonly reviewed compo- Mortality nents of CVD. The rate of deaths from diseases of the heart in Tompkins • Avg. age-adj. rate per County is the lowest in the Central New York (CNY) region. Tioga 100,000 pop, 2000–2002. County, which is outside of the CNY region, has the lowest age adjusted Tompkins...... 207 Cayuga...... 230 rate of heart disease deaths in the state. (See Table 10, page 100.) Cortland...... 267 While the crude death rate for Tompkins County is not a good way Tioga ...... 198 to compare against other counties and regions due the Tompkins’ low CNY...... 240 median age, it is a valid way to view trends in county death rates across NYS...... 284 years. For the 10 year period from 1993 to 2002 the crude rate for deaths HP2010 ...... 166 due to heart disease in Tompkins County declined 36.3 points, or close to 19 percent. Upstate New York rates dropped 41.5 points, or just over 12 Cerebrovascular percent. (See Figure 77. Page 100.) Disease (stroke) There is still room for improvement even with Tompkins’ low rate. Mortality • Avg. age-adj. rate per The Healthy People (HP) 2010 objective is to reduce coronary heart dis- 100,000 pop, 2000–2002. ease deaths to 166 per 100,000 population. Diseases of the heart age- Tompkins...... 50.0 adjusted mortality rates in the U.S. have declined 59 percent, from 587 Cayuga...... 42.8 per 100,000 in 1950 to 241 per 100,000 in 2002. (See Figure 78, page Cortland...... 56.9 100.) Tioga ...... 47.3 CNY...... 54.3 The HP 2010 objective is to reduce stroke deaths to 48 per 100,000 NYS...... 38.4 population. Tompkins County’s age-adjusted death rate for cerebrovas- HP2010 ...... 48.0 cular disease is 50. This is 30 percent higher than New York State as a whole and about mid-range among neighboring Central New York counties. (see Figure 79, page 100.)

Risk factors Epidemiological and statistical studies have identified a number of factors that can impact the risk of heart disease and stroke. Two discussed here are blood pressure and blood cholesterol levels. The HP 2010 objective is to increase to 95 percent the proportion of adults who have had their blood pressure measured in the preceding two years and can state whether their blood pressure was normal or high. Hypertension In Tompkins and Cortland Counties, 17.6 percent of adults report having been told by a medical professional that they have high blood pressure, according to the most recent results from the Behavioral Risk Factor Surveillance System (BRFSS.) This is the only data currently available on blood pressure measurement for Tompkins County and is open to broad interpretation because it is self-reported and it represents both Tompkins and Cortland Counties. Compared to neighboring counties this rate is quite low (see Figure 80, page 102.)

Tompkins County, NY 2005–2010 98 Community Health Assessment

In New York State, between 1995–2003, the percent of adults diagnosed with high blood pressure increased. (see Figure 81, page 103.) This increase could be a reflection of the introduction of the new classification of elevated blood pressure—“prehypertension”—defined as sys- tolic pressure between 120–139 mm Hg and diastolic pressure 80–90 mm Hg. The HP 2010 objective is to reduce to 16 percent the proportion of adults with high blood pressure. Blood cholesterol In 2003, 67 percent of Tompkins and Cortland County residents re- • Report having checked ported having had their blood cholesterol levels checked in the past 5 in last 5 years. Expanded years (see Figure 82, page 103.) This is the lowest number of all avail- BRFSS, 2003 able CNY counties, though statistical differences are not significant. The Tompkins– Cortland ...... 67% number for all New York residents is 77 percent, 14 percent higher than CNY Avg...... 73% Tompkins-Cortland. The HP 2010 objective is to increase to 80 percent NYS ...... 77% the number of adults who have had their blood cholesterol levels checked HP2010...... 80% in the past 5 years.

Community Resources

NYSDOH The New York State Department of Health is working to reduce cardiovascular risk through its comprehensive plan that promotes healthier behaviors and reduce known disease risks. The plan promotes interventions in four sectors: communities, schools, worksites and health care settings. Its aim is to decrease tobacco use, increase daily physical activity, increase consumption of fruits and vegetables and low-fat milk and reduce high blood pressure. Health Promotion The Health Promotion Program (HPP) at the Tompkins County Program, TCHD Health Department (TCHD) completed a five-year grant in March 2004 addressing worksite wellness. The goal was to encourage a worksite environment that provides support for healthy eating and regular physical activity. The program continues to provide technical assistance upon request and maintains a web site: www.tompkins-co.org/wellness for on- line support and information. ( See other sections in this document for information on physical activity, tobacco, nutrition.) TCHD responds to community requests for blood pressure screenings, information and presentations on nutrition, physical activity campaigns, women and heart disease, and tobacco control. Cayuga Medical Center Cayuga Medical Center (CMC) in Ithaca offers a full-range of non- invasive cardiac diagnosis treatments using the most advanced ultrasound and imaging technology currently available. Cardiac catheterization began in 2000. Residents travel to out-of-town hospitals specializing in heart surgery for those procedures. There are five cardiologists practicing

Tompkins County, NY 2005–2010 Community Health Assessment 99

in Tompkins County.

Opportunities for Action

Healthy lifestyle County residents should maintain awareness of the causes of cardiovascular disease and expand opportunities for heart healthy choices. These include incorporating physical activity and healthy eating into daily routines and avoiding tobacco. Monitoring blood pressure and cholesterol levels and taking action to lower elevated levels will reduce the future risk of heart disease in many adults. Physicians and other health professionals have a unique and important role to play in the effort against heart disease and stroke. The evidence is clear that people advised by their doctors to be active, eat more healthfully or avoid tobacco are more likely to do so.

Tompkins County, NY 2005–2010 100 Community Health Assessment

Figures and Tables

Figure 76 –- Cardiovascular disease mortality, age-adjusted rates, regional comparison

CARDIOVASCULAR DISEASE - DEATH RATES (ADJ.) PER 100,000 RESIDENTS 400

344.9 341.0 350 315.7 297.4 300 278.5 265.7

250

200

150

100

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 NYS VITAL STATISTICS DATA AS OF AUGUST, 2004. AGE ADJ TO 2000 CENSUS

Table 10 –- Diseases of the Heart mortality, crude and age-adjusted rates, regional comparison DISEASES OF THE HEART - DEATHS AND DEATH RATES PER 100,000 RESIDENTS SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004 ADJUSTED RATES ARE AGE ADJUSTED TO THE 2000 U.S. POPULATION REG-3 CENTRAL NEW YORK DISEASES OF THE HEART DEATHS TOTAL POP CRUDE AGE ADJ. CNY Rank COUNTY 2000–02 2001 RATE RATE (Adj Rate) CAYUGA 671 81,412 274.7 230.4 4 CORTLAND 396 48,639 271.4 266.9 8 HERKIMER 752 64,170 390.6 276.8 11 JEFFERSON 748 110,212 226.2 243.4 6 LEWIS 188 26,941 232.6 213.4 2 MADISON 494 69,795 235.9 235.2 5 ONEIDA 2,451 234,635 348.2 255.5 7 ONONDAGA 3,282 459,288 238.2 214.6 3 OSWEGO 922 122,639 250.6 276.3 10 ST. LAWRENCE 937 111,385 280.4 272.0 9 TOMPKINS 495 97,998 168.4 206.5 1 CNY TOTAL 11,336 1,427,114 264.8 240.1 –- TIOGA (REG-4) 320 51,535 207.0 198.2

Tompkins County, NY 2005–2010 Community Health Assessment 101

Figure 77 –- Diseases of the Heart mortality, crude rates, 10-year trend Diseases of the Heart Deaths (Crude Rates) 400

350

333 300 324 323 323 317 313 305 303 294 292 250

200

Rate/ 100K pop 196 199 193 186 190 150 170 175 171 162 159

100

50 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Tompkins Tomp 3Yr Avg Upstate

Figure 78 –- Diseases of the heart mortality, age-adjusted rate, United States, 50-year trend

Mortality: Diseases of the Heart, All persons United States, age-adjusted, selected years 700

587 600 559

493 500 412

400 322 293 258 300 248 241

200

100 1950 1960 1970 1980 1990 1995 2000 2001 2002

National Center for Health Statistics. Health, United States, 2004. With Chartbook on Trends in the Health of Americans.

Tompkins County, NY 2005–2010 102 Community Health Assessment

Figure 79 –- Cerebrovascular disease mortality, age-adjusted rates, regional comparison

CEREBROVASCULAR DISEASE - DEATH RATES (ADJ.) / 100,000 RESIDENTS 60 56.9 54.3 50.0 50 47.3 48.0 42.8

40 38.4

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL HP 2010

SOURCE: 2000-2002 NYS VITAL STATISTICS DATA AS OF AUGUST, 2004. AGE ADJ TO 2000 CENSUS

Figure 80 –- Ever diagnosed with high blood pressure, regional comparison Ever been told have high blood pressure by a medical professional (% Yes) 35

30 28.2 27.3 25.8 26.3 25

20 17.6

- Broome Cayuga, Seneca, Chemung, Chenango, Cortland, Way ne Schuyler, Tioga Madison Tompkins Ex panded BRFSS, 2003 - NYS Dept of Health

Tompkins County, NY 2005–2010 Community Health Assessment 103

Figure 81 –- Diagnosed with high blood pressure, NYS 8-year trend

PCT of Adults Diagnosed with High Blood Pressure, NYS 1995-2003 30

27 26.0 25.3

23.4 24 22.7 22.8 22.0

15 1995 1996 1997 1999 2001 2003

Figure 82 –- Had blood pressure checked, regional comparison Had Blood Cholesterol Checked in past 5 years (% Yes) 85

71.3 75.7 72.7 67.0 76.5 80.0 25 Broome Cayuga, Chemung, Cortland, NYS HP 2010 Seneca, Schuyler, Tompkins Wayne Tioga

Expanded BRFSS, 2003 - NYS Dept of Health

Tompkins County, NY 2005–2010 104 Community Health Assessment

Figure 83 –- Had blood cholesterol checked, NYS 14-year trend

PCT Adults Age 18+ Who Had Cholesterol Checked in the Past 5 Yrs, NYS 1990-2003 80 77.3 76.5

75 72.7 72.5 72.5

68.5 70 68.3 68.0

65.2 65

60 1990 1991 1992 1993 1995 1997 1999 2001 2003

Tompkins County, NY 2005–2010 Community Health Assessment 105

AIDS – HIV – STD’s

espite the burdens, costs, complications, and preventable nature of STD’s, they remain a significant public health problem, largely unrecognized by the public, policymakers, D and public health and health care professionals in the United States. STD's cause many harmful, often irreversible, and costly clinical complications, such as reproductive health problems, fetal and perinatal health problems, and cancer. In addition, studies of the worldwide human immunodeficiency virus (HIV) pandemic link other STD's to a causal chain of events in the sexual transmission of HIV infection.12

Data Analysis

AIDS Mortality The face of AIDS and HIV in Tompkins County appears to be Total cases, 2000–2002 contradictory when viewed using the county and regional comparisons Tompkins ...... 1 employed throughout this document — Cayuga, Cortland and Tioga Cayuga...... 3 counties, the total for the 11-county Central New York (CNY) region,13 Cortland...... 1 Tioga ...... 2 and the total for New York State (NYS.) Broome...... 11 In the comparison, Tompkins County has the lowest death rate Jefferson...... 1 from AIDS — half of the rate for Cortland, and one quarter of that for Oneida...... 8 Cayuga, for Tioga and for CNY. Yet the statistics for the comparison Onondaga...... 33 group puts Tompkins in the mid-range for AIDS cases, and near the top for incidence of newborns that test positive for HIV antibodies, the latter indicating infection of the mother and possibly the infant.14 (See Figure 84 through Figure 87, pages 108–109.) AIDS Cases The caveat is however that statistics expressed as rates per 100,000 Rate per 100,000 pop, population should always be interpreted cautiously in situations where 2000–2002 the actual numbers are low. In the case of AIDS deaths over the 3-year Tompkins ...... 4.4 rating period 2000–2002, there were just 23 deaths among the almost 1 Cayuga...... 7.4 Cortland...... 3.4 million population of CNY excluding Onondaga County. Onondaga, Tioga ...... 1.3 with close to half-a-million residents, tallied 33 AIDS deaths 2000– CNY...... 6.0 2002. NYS...... 25.5 One of the CNY AIDS deaths was in Tompkins County, which also recorded 13 AIDS cases and 2 HIV-positive newborns over the 3- year rating period. Over the 10-year period 1993–2002 Tompkins County showed a marked drop in the number of AIDS deaths. This pattern was consistent with the trend across all of Upstate (see Figure 85, page 108.)

12 Healthy People 2010 13 CNY region counties are Cayuga, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tompkins. Tioga is in the “New York–Penn” region along with Broome and Chenango. 14 NYSDOH tests specimens from the Newborn Screening Program for HIV antibodies. The seropositive rate is the percent of positive results. The presence of HIV antibodies in newborns indicates infection of the mother and not necessarily infection of the infant.

Tompkins County, NY 2005–2010 106 Community Health Assessment

Syphilis Incidence The incidence of Early Syphilis across Central New York is extremely rare outside of Onondaga County. In the 3 years of 2000–2002, NYS Department of Health (DOH) data shows 21 CNY cases, 15 of which were in Onondaga. This source also shows that CNY had no Early Syphilis cases among youth age 15–19 years. (See Figure 89 and Figure 90, pages 110 and 111.) Congenital Syphilis is expressed as a rate per 100,000 births. In all of CNY 2000–2002, just one case was reported — in Cortland County. (See Figure 91, page 111.) Another source of Syphilis incidence is the Tompkins County Health Department annual report. This data shows that total Syphilis incidence dropped dramatically from 1992–2000, then began an upswing 2001–2003. Again, the numbers are not high —3 cases in 2003 — but the new trend should be noted. (See Figure 88, page 110.)

Gonorrhea Incidence In Upstate New York, Gonorrhea incidence appears to be highest in counties with major urban areas such as Rochester, Buffalo, Syracuse and Albany. Monroe County has the highest rate of Gonorrhea incidence statewide, followed by Bronx, Erie and Onondaga. By comparison, the rate of Gonorrhea incidence in Tompkins County is quite low. The pattern is essentially repeated for the age 15–19 population, though the numbers are much higher. (See Figure 93 and Figure 94, pages 112 and 113.) Tompkins County Health Department data shows that locally, Gonorrhea cases have varied widely over the 13 years 1999–2003, from 61 cases in 1999 to 15 cases in 2003. The average during this period was 34 cases per year. (See Figure 92, page 112.)

Chlamydial Infections Though state DOH data on Chlamydial infections are not available — Chlamydial infections became a reportable disease in September 2002 — local health department records show a dramatic increase in this STD from 1999–2003. (See Figure 95, page 113.) Pelvic Inflammatory The state also tracks Pelvic Inflammatory Disease with STD’s. Disease Hospital discharge rates for this condition among women of child- Discharge rate /100,000 bearing age were in steady decline across Upstate 1993–2002, yet took females age 15–44. an upswing locally in the early part of this decade (see Figure 96 and Tompkins...... 30.8 Yates...... 81.4 Figure 97, page 114.) Interestingly, the highest Upstate rates appear in Franklin...... 71.1 the very rural Yates and Franklin Counties.

Safe sex among adults One of the questions of the expanded Behavioral Risk Factor Sur- veillance System (BRFSS) 2003 survey asked if a medical professional has ever counseled on condom use for STD prevention. Local results

Tompkins County, NY 2005–2010 Community Health Assessment 107

are shown in Figure 98, page 115. While the percent of those respond- ing “yes” was higher for Cortland-Tompkins — the BRFSS grouped the two counties as a way to help control for the error inherent in small population samples — than for other counties close-by, it is still quite low, and 25 percent less than for the state as a whole. The BRFSS survey data also indicates that in the Tompkins- Cortland bi-county region more than 4 out of 5 adults age 18-64 are sexually active. (See Table 11, page 115.)

Community Resources

STD testing and Planned Parenthood of the Southern Finger Lakes provides STD treatment testing and treatment for men and women. TCHD contracts with the agency to provide those services for its eligible clients. Planned Parent- hood also provides confidential HIV testing and counseling.

Gannett Health Center at Cornell University and Hammond Health Center at Ithaca College provide STD, sometimes referred to as STI (sexually transmitted infections), testing and treatment for their student HIV testing and counseling populations. The health centers also provides confidential HIV testing and counseling.

TCHD provides free and anonymous testing on site and at sites in the community. There were no positive results in 2003 as reported in TCHD’s annual report.

HIV case management In 2002, AIDS WORK merged with the Southern Tier AIDS Pro- services gram (STAP). In March of 2005, the agency reported that it was providing case management services to 43 HIV positive clients from Syringe exchange Tompkins and Cortland Counties. And 62 participants were enrolled in program STAP’s syringe exchange program.

Tompkins County, NY 2005–2010 108 Community Health Assessment

Figures and Tables

Figure 84 — AIDS mortality, regional comparisons

AIDS - CRUDE DEATH RATES PER 100,000 RESIDENTS

12 11.1

10 9.3

2 1.2 1.3 1.3 0.7 0.3 0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL UPSTATE NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 85 — AIDS Mortality, 10-year trend

AIDS Death Rate per 100,000 pop.

14 Tompkins Single Year Tompkins 3-Yr Avg Upstate New York

12 12.4 10.1 12.0 10 8.4

6 4.0 3.7 3.5 3.2 3.1 4 2.8

0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 109

Figure 86 — AIDS Cases, regional comparisons

AIDS CASES - RATE PER 100,000 POPULATION 30.0

25.5 25.5 25.0

20.0

15.0

10.0 7.4 6.0 4.4 5.0 3.4 1.3

- CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL UPSTATE NYS TOTAL

SOURCE: 2000-2002 BUREA U OF HIV /A IDS EPIDEMIOLOGY DA TA A S OF A UGUST, 2004

Figure 87 — Newborns testing positive for HIV antibodies, regional comparisons

HIV POSITIVE NEWBORNS - RATE PER 1,000 NEWBORNS TESTED

4.0

3.5 3.4

3.0

2.5

2.0

1.5 1.4

0.9 1.0 0.8 0.6 0.4 0.5 0.0 - CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL UPSTATE NYS TOTAL

SOURCE: 1999-2001 BUREA U OF HIV /A IDS EPIDEMIOLOGY DA TA A S OF A UGUST, 2004

Tompkins County, NY 2005–2010 110 Community Health Assessment

Figure 88 — Syphilis cases, Tompkins County 13-year trend

Syphilis (Tompkins County 1991-2003) 9 Syphilis 3-Year Average Rate/100K 8.5 8 7.4 7

6 5.3 5

4 3.1 3 Rate/100K residents 2.0 2 2.1 1.1 1 0.0 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

TCHD Annual Report, 2001-2003

Figure 89 — Early syphilis incidence, regional comparison

EARLY SYPHILIS - RATE PER 100,000 POPULATION

5.0 4.7

4.5

4.0

3.5

3.0

2.5

2.0

1.5 1.4

1.0 0.5 0.4 0.5 0.3 0.0 0.0 - CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL UPSTATE NYS TOTAL

SOURCE: 2000-2002 BUREAU OF STD CONTROL DATA AS OF AUGUST, 2002

Tompkins County, NY 2005–2010 Community Health Assessment 111

Figure 90 — Early syphilis incidence, Ages 15–19, regional comparison

EARLY SYPHILIS (AGE 15-19) - RATE PER 100,000 POP. AGE 15-19

4.0 3.7

3.5

3.0

2.5

2.0

1.5 1.0 1.0

0.5 0.0 0.0 0.0 0.0 0.0 - CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL UPSTATE NYS TOTAL

SOURCE: 2000-2002 BUREAU OF STD CONTROL DATA AS OF AUGUST, 2002

Figure 91 — Cortland County recorded a single case of congenital syphilis in 2002.

CONGENITAL SYPHILIS - RATE PER 100,000 BIRTHS

70.0

59.7 60.0

50.0

40.0

30.0

20.0 13.6

10.0 3.7 2.0 0.0 0.0 0.0 - CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL UPSTATE NYS TOTAL

SOURCE: 2000-2002 BUREAU OF STD CONTROL DATA AS OF AUGUST, 2002

Tompkins County, NY 2005–2010 112 Community Health Assessment

Figure 92 — Tompkins County averaged 34 gonorrhea cases per year 1991–2003.

Gonorrhea (Tompkins County 1991-2003) 70 64.8 60 52.1 50 46.8 40

30 30.8 31.9 30.8

Rate/100K residents 20 19.1 19.4 10 15.3

0 1991 1993 1995 1997 1999 2001 2003

Gonorrhea 3-Year Average Rate/100K

TCHD Annual Report, 2001-2003

Figure 93 — Gonorrhea cases, regional comparison

GONORRHEA - RATE PER 100,000 POPULATION

350.0

298.7 300.0

250.0

200.0

150.0 112.6 93.9 100.0

37.3 50.0 26.9 12.3 17.5 - CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL UPSTATE NYS TOTAL

SOURCE: 2000-2002 BUREAU OF STD CONTROL DATA AS OF AUGUST, 2002

Tompkins County, NY 2005–2010 Community Health Assessment 113

Figure 94 — Gonorrhea cases ages 15–19 years, regional comparisons

GONORRHEA (AGE 15-19) - RATE PER 100,000 POPULATION AGE 15-19

1,400.0 1257.2

1,200.0

1,000.0

800.0

600.0

390.3 400.0 339.2

190.7 200.0 82.4 67.4 35.3 - CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL UPSTATE NYS TOTAL

SOURCE: 2000-2002 BUREAU OF STD CONTROL DATA AS OF AUGUST, 2002

Figure 95 — Chlamydial infections, Tompkins County 1991–2003

Chlamydial Infections (Tompkins County 1991-2003) 200 180 160 140 120 100 80 60 Rate/100K residents 40 20 0 1991 1993 1995 1997 1999 2001 2003

Chlamydial Infections 3-Year Average Rate/100K

TCHD Annual Report, 2001-2003

Tompkins County, NY 2005–2010 114 Community Health Assessment

Figure 96 — Pelvic inflammatory disease hospitalizations, regional comparison

PELVIC INFLAMMATORY DISEASE - DISCHARGE RATE PER 100,000 FEMALES AGE 15-44 140.0 128.7

120.0

100.0

80.0

62.4 60.0 43.2 42.6 34.3 40.0 30.8

20.0 15.9

- CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL UPSTATE NYS TOTAL

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004

Figure 97 — Pelvic inflammatory disease hospitalizations, 10-year trend

Pelvic Inflammatory Disease Discharge Rate Per 100,000 Female Pop. Age 15-44

90 Tompkins Single Year Tompkins 3-Yr Avg Upstate New York 82.1 80

70 73.1 68.4 57.7 60 53.8 48.0 47.1 50 43.8 42.4 40.9 40 36.4 40.6 39.8 29.5 30 29.1 20 22.4 21.8 11.2 10 7.4 7.5 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 115

Figure 98 — Occurrence of STD prevention counseling, regional comparison

Ever Counseled by Medical Professional on Prevention of STD's Through Condom Use, Aged 64 or Younger, Pct 'Yes' 25.0

20.0 20.0

15.2 15.0 13.2 12.2 10.4

Percent 'Yes' Percent 10.0

5.0

- Cayuga, Seneca, Chemung, Cortland, CNY NYS Wayne Schuyler, Tioga Tompkins

Expanded BRFSS, 2003 - New York State Department of Health

Table 11 — Percent sexually active individuals, Cortland–Tompkins Sexually Active, Age 18-64 Years Old CORTLAND, TOMPKINS 2003 Dem Groups n¹ Yes %² n No % C.I.³ Total 389 82.7 102 17.3 4.0 Male 175 83.7 40 16.3 5.7 Female 214 81.7 62 18.3 5.5 18-34 141 82.2 32 17.8 6.5 35-54 190 88.2 36 11.8 4.1 55+ 58 71.2 34 28.8 9.5 HS or less 113 82.1 33 17.9 7.0 >High School 276 82.9 69 17.1 4.8 Expanded BRFSS, 2003 - NYS Dept of Health ¹Use pcts based on row denominators <50 with caution ²Weighted Percent ³95% Confidence Interval

Tompkins County, NY 2005–2010 116 Community Health Assessment

Immunization and Infectious Disease

Data Analysis

Flu Shot An annual influenza vaccination is recommended for the majority Pct who had a flu shot in of the population, especially those age 65 and over and those for whom the past 12-months chronic conditions put them at increased risk for developing complica- • those age 65+ tions from the flu. The Healthy People 2010 (HP2010) target is for 90 Tompkins– Cortland ...... 70% percent of individuals age 65+ to be vaccinated annually, and 60 per- Avg. of CNY...... 70% cent of people age 18–64. Although very young children are an in- NYS ...... 68% creasingly important segment of the high risk group, there is no HP2010...... 90% HP2010 target for those under age 18. • those age 18+ The New York State Department of Health (NYSDOH) tracks flu Tompkins– immunizations through the Behavioral Risk Factor Surveillance System Cortland ...... 31% Avg. of CNY...... 33% (BRFSS.) The BRFSS is a randomly selected telephone interview that covers a wide variety of lifestyle and behavior factors. In the most re- –Source: BRFSS, 2003 cent BRFSS survey, taken in 2003, data for Tompkins County was pooled with data from Cortland County in an effort to increase sample sizes and thereby achieve a more consistent margin of sampling error. In the case of some smaller populations, data from three counties was pooled. According to the BRFSS polls, flu shot rates for ages 65+ in Tompkins and Cortland Counties are in line with neighboring counties, the average rate across the Central New York (CNY) region, and the state as a whole (see Figure 99, page 120.) None of the areas included in Figure 99 have achieved the HP2010 target rate.

Tracking of individuals who have ever received a pneumonia vaccination is also carried out through the BRFSS. Figure 101, page 121 shows local and regional results for people age 65+. These rates are also relatively uniform across the region, and all about 20 percent or more below the HP2010 target of 90 percent.

Immunization status is an important health indicator because it is closely linked to rates of specific childhood disease — diseases that cause disability or death. The following childhood diseases are preventable with proper immunization: • diphtheria • pertussis • tetanus • measles mumps rubella • polio • Haemophilius influenza type B (Hib)

Tompkins County, NY 2005–2010 Community Health Assessment 117

Child immunization One of the HP2010 objectives is to “achieve and maintain effective • Rate of complete immu- vaccination coverage levels for universally recommended vaccines nization for children age among young children.” In 2003, the Tompkins County Health De- 24–35 months, Tompkins partment (TCHD) had a 90 percent rate of complete immunization for County. 2000 ...... 93% those children ages 24–35 months who participated in the Department’s 2001 ...... 93% program. The HP2010 target is 90 percent. Table 12, page 122 shows 2002 ...... 88% recent child immunization rates for Tompkins County. 2003 ...... 90% HP2010 ...... 90%

Measles Incidence The incidence of measles is very low in the region, in Tompkins • Tompkins County cases County, and in New York State. There were no cases in the County 1991–2000 ...... 0 from 1991 to 2002 and only 6 cases statewide in 2002. (See Table 13, 2001 ...... 0 page 122.) 2002 ...... 0 2003 ...... 1 In 2003 Tompkins County had one measles case. That person had an unknown immunization history and no known exposure to another case. Contacts were appropriately immunized and medical providers were alerted. (See Figure 103, page 122.)

Pertussis Incidence Pertussis remained relatively quiet in Tompkins County throughout • Tompkins County cases the 1990’s, with only 10 cases reported from 1991–2000. In July 2002 1991–2000 ...... 10 an outbreak began and a total of 88 cases were logged by the end of the 2001 ...... 0 year. Ongoing transmission of pertussis occurred in early 2003 with a 2002 ...... 88 2003 ...... 17 total of 103 cases reported in the 15-month period from July 2002 to September 2003. (See Figure 105, page 123.) Most cases in the 2002–2003 outbreak occurred in adolescents age 10–14 years who had been previously vaccinated. There are several ex- planations for the increased incidence: • Waning immunity in adolescents • No licensed pertussis containing vaccine for children 7+ years of age • Increased vigilance of local health care providers in assessing, testing and reporting suspected pertussis cases. There were few pertussis cases in the CNY region or the state as a whole over the 3-year period 2000–2002 (see Figure 104, page 123.) There were no reported pertussis outbreaks in contiguous counties in 2003.

Tuberculosis Incidence Tuberculosis incidence in Tompkins County has had peaks and • Tompkins County cases valleys over the last decade-plus. From 1991–2003 there were 49 cases, 1991–2000 ...... 40 with high points in 1993 and 2000. (See Figure 109, page 125.) 2001 ...... 4 In 2004, there were 4 new active TB cases in the County. Three of 2002 ...... 1 the four people were foreign-born; none were epidemiologically linked.

Tompkins County, NY 2005–2010 118 Community Health Assessment

2003...... 4

Hepatitis Incidence There was a steady decline in the appearance of Hepatitis A and Hepatitis B in Tompkins County from the mid-1990’s to 2003. By contrast, Hepatitis C, with a very low incidence rate throughout the 1990’s and into the new decade, shows a dramatic increase in 2003. (See Figure 106, Figure 107 and Figure 108, beginning on page 124.) Changes in reporting The 2003 increase in Hep. C cases shown in Figure 108, page 125 parameters for Hepatitis occurred due to a NYSDOH request that all positive results for Hepati- B and C tis C antibody be reported. New tests became available and NYSDOH changed the confirmed case definition in 2003. Most of the cases in • Hepatitis B cases in 2003 were subsequently downgraded by NYSDOH to “suspect” or Tompkins County, 2003 Acute ...... 1 “unknown.” Chronic ...... 4 With respect to Hepatitis B, the data may have included chronic Pregnant...... 8 cases of Hep. B under new case definitions of 2003. Now there are 3 categories for Hepatitis B reports: Acute, Chronic and Pregnant. Also, some cases reported as “confirmed” have been downgraded by the NYSDOH to “suspect” or “unknown.”

Lyme Disease Incidence When viewed by 3-year averages, the presence of Lyme Disease in • Avg. cases per year, Tompkins County was relatively steady over the period 1991–2003. A 2000–2002 peak in 1994 does not appear to have signaled a trend, and time will tell Tompkins...... 5.3 if a second peak in 2003 has the same fate (see Figure 111, page 126.) Cayuga ...... 2.0 Cortland ...... 0.3 Although Tompkins County had the highest rate of Lyme Disease Broome ...... 2.0 of the eleven Central New York (CNY) counties (see Figure 110, page Tioga...... 3.0 126,) the disease is off the radar locally when compared to counties Columbia...... 747.0 close to the historic center of the problem. Two New York counties on Dutchess...... 1309.0 the east shore of the Hudson River, Columbia and Dutchess, had a combined average rate of 592 cases per 100,000 for 2000–2002.

Rabies Exposure The number of incidences of rabies exposure swung widely through most of the 1990’s in Tompkins County, but has showed a steady increase over the present decade. (See Figure 112, page 127.)

Community Outreach

Flu immunization clinics TCHD conducts annual flu immunization clinics in community settings targeting people 50 years of age and older and those with chronic disease whose health would be compromised by complications from the flu. In 2003, the Department provided 50% more immunizations to Tompkins County residents (3,513) than it did in 2002. This increase was due in large part to the marketing and education campaign

Tompkins County, NY 2005–2010 Community Health Assessment 119

directed to the target population. Residents 50 years of age and over were urged to get a flu shot at the clinics or their physician’s office. Due to the national vaccine shortage in 2004, the New York State Health Department required all local health departments and health care providers to limit vaccine to nursing homes and assisted care facilities, homebound residents and people over 65 years of age and other high risk groups. In 2004, TCHD provided 2,331 influenza immunizations.

CNY Immunization TCHD has been in active participant in the central New York Im- Registry munization Registry since its inception in 1995. The Registry’s goal is to provide easy access to immunization records for parents, providers, and schools across the region. To date, both pediatric practices, five of nine family medicine practices, two of six school districts, and Head Start participate in the registry. Parents are encouraged to have their children vaccinated at their physician’s office. Physicians may obtain vaccine at no cost through the Vaccine for Children’s (VFC) program for their uninsured or underinsured patients who are 19 years of age and younger. Approximately 26 provider offices and 6 health care facilities, including TCHD participate in VFC program. Tick identification To eliminate the possibility of Lyme Disease, TCHD provides tick identification services. Ticks are sent to an NYSDOH lab for identification. Rabies services Calls to TCHD concerning rabid wild animals and pets are handled by the Department’s Environmental Health (EH) division. EH also conducts a series of pet rabies vaccination clinics twice a year. The Com- munity Health Services (CHS) division provides post-exposure rabies immunization to community residents.

Tompkins County, NY 2005–2010 120 Community Health Assessment

Figures and Tables

Figure 99 –- Had a flu shot, age 65+, regional comparison

Had a Flu Shot in the Past 12 Months, Aged 65 and Older (% Yes) 100

90.0 90

79.8 80 74.0 71.9 70.4 69.7 70 68.0 65.7

40 Broome Cayuga, Chemung, Cortland, Onondaga CNY Avg NYS HP2010 Seneca, Schuyler, Tompkins Wayne Tioga

Expanded BRFSS, 2003 - NYS Dept of Health

Figure 100 –- Had a flu shot, age 18+, regional comparison

Had a Flu Shot in the Past 12 Months, Age 18+ (% Yes) 45

33.7 34.6 35 32.4 33.1 31.1 30 28.5

- Broome Cayuga, Chemung, Cortland, Onondaga CNY Avg. Seneca, Wayne Schuyler, Tompkins Tioga

Expanded BRFSS, 2003 - NYS Dept of Health

Tompkins County, NY 2005–2010 Community Health Assessment 121

Figure 101 –- Had a pneumonia shot, age 65+, regional comparison

Ever Had a Pneumonia Shot, Aged 65 and Older (% Yes) 100

90.0 90

80 75.6 75.4 75.4 72.9 70.4 70

60.6 60

40 Broome Cayuga, Chemung, Cortland, Onondaga CNY Avg. HP2010 Seneca, Schuyler, Tompkins Wayne Tioga

Expanded BRFSS, 2003 - NYS Dept of Health

Figure 102 –- Had a pneumonia shot, age 18+, regional comparison

Ever Had a Pneumonia Shot, Age 18+ (% Yes) 40

35 31.1 30 26.6 25.6 25.2 25 22.4 21.2 20

- Broome Cayuga, Chemung, Cortland, Onondaga CNY Avg. Seneca, Wayne Schuyler, Tompkins Tioga

Ex panded BRFSS, 2003 - NYS Dept of Health

Tompkins County, NY 2005–2010 122 Community Health Assessment

Table 12 –- Complete immunizations, age 24–35 months, Tompkins County Rate of complete immunization for children age 24–35 months Tompkins County 2000 2001 2002 2003 HP2010 93% 93% 88% 90% 90% Source: TCHD Annual Reports

Table 13 –- Measles cases, regional comparison MEASLES CASES POPULATION RATE REGION/COUNTY 2000 2001 2002 TOTAL 2001 /100K TOMPKINS 0 0 0 0 97,998 0 CNY TOTAL* 8 0 0 8 1,427,114 0.19 ROS TOTAL 10 4 1 15 11,022,323 0.05 NYS TOTAL 23 11 6 40 19,084,350 0.07 *CNY cases were in 2000: 4 cases in Onondaga + 4 cases in Oswego Co's.

Figure 103 –- Measles cases, rate per 100,000 population, 13-year trend

Measles (Tompkins County 1991-2003) 2.0

1.5

1.0

Rate/100K residents 0.5

0.0 1991 1993 1995 1997 1999 2001 2003

Rate/100K 3-Year Average Rate/100K

TCHD Annual Report, 2001-2003

Tompkins County, NY 2005–2010 Community Health Assessment 123

Figure 104 –- Pertussis cases, regional comparison

PERTUSSIS CASES 2000-2002 - RATE PER 100,000 POPULATION 35

29.9 30

4.2 5 2.0 1.3 2.0 0.0 0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 BUREAU OF COMMUNICABLE DISEASE CONTROL DATA AS OF AUGUST, 2004

Figure 105 –- Pertussis cases, rate per 100,000 population, 13-year trend

PERTUSSIS (Tompkins County 1991-2003) 100 89.8 90 80 70 60 50 40

Rate/100K residents 30 17.3 20 3.2 10 1.1 1.1 2.1 2.1 1.1 0.0 0.0 0.0 0.0 0.0 0 1991 1993 1995 1997 1999 2001 2003

Rate/100K 3-Year Average Rate/100K

TCHD Annual Report, 2001-2003

Tompkins County, NY 2005–2010 124 Community Health Assessment

Figure 106 –- Hepatitis A cases, rate per 100,000 population, 13-year trend

HEPATITIS A (Tompkins County 1991-2003) 14 12.8 HP 2010 target: 4.5 new cases/100,000

12 10.6

8 6.4 5.3 6 5.3 6.4

Rate/100K residents 4 3.1 3.1 4.3 3.2 2 1.0 2.1 0 0.0 1991 1993 1995 1997 1999 2001 2003

Rate/100K 3-Year Average Rate/100K

TCHD Annual Report, 2001-2003

Figure 107 –- Hepatitis B cases, rate per 100,000 population, 13-year trend

HEPATITIS B, ACTIVE (Tompkins County 1991-2003) 12 HP 2010 Targets for new cases/100,000 Age 19–24: 2.4; Age 25–39: 5.1; Age 40+: 3.8 10

9.6 8

7.4 6

4 5.3 5.3 5.3 5.3 Rate/100K residents

2 3.2 2.1 2.1 2.1 0 1.0 1991 1993 1995 1997 1999 2001 2003

Rate/100K 3-Year Average Rate/100K

TCHD Annual Report, 2001-2003

Tompkins County, NY 2005–2010 Community Health Assessment 125

Figure 108 –- Hepatitis C cases, rate per 100,000 population, 13-year trend

HEPATITIS C (Tompkins County 1991-2003) 70 HP 2010 Target: 1 new case/100,000 68.4 60

Rate/100K residentsRate/100K 20

6.4 4.3 5.3 10 2.1 3.2 0.0 0.0 0.0 1.1 1.0 0.0 0.0 0 1991 1993 1995 1997 1999 2001 2003

Rate/100K 3-Year Average Rate/100K

TCHD Annual Report, 2001-2003

Figure 109 –- Tuberculosis cases, rate per 100,000 population, 13-year trend

Tuberculosis (Tompkins County 1991-2003) 14 HP 2010 Target: 1 new case/100,000

12 12.8 10

8 8.3 6 4.3

Rate/100K residents 4 4.1 4.1 2 3.2 3.2 3.2 3.2 2.1 2.1 0 1.0 1991 1993 1995 1997 1999 2001 2003

Rate/100K 3-Year Average Rate/100K

TCHD Annual Report, 2001-2003

Tompkins County, NY 2005–2010 126 Community Health Assessment

Figure 110 –- Lyme disease cases, regional comparison

LYME DISEASE - RATE PER 100,000 POPULATION

6 5.8 5.4

5 4.5

4 3.3

3 2.5 2.1 2 1.7

1 0.7

0 CAYUGA CORTLAND JEFFERSON MADISON ONONDAGA TOMPKINS TIOGA CNY TOTAL

SOURCE: 2000-2002 BUREAU OF COMMUNICABLE DISEASE CONTROL DATA AS OF AUGUST, 2004

Figure 111 –- Lyme disease cases, rate per 100,000 population, 13-year trend

Lyme Disease (Tompkins County 1991-2003) 16

14 14.9 12

10 8.3 10.2 8 9.6 8.5 6 7.4 7.4 7.4 6.4 6.4

Rate/ 100Kresidents 4 5.3 5.1 4.1 2

0 1991 1993 1995 1997 1999 2001 2003 Rate/100K 3-Year Average Rate/100K

TCHD Annual Report, 2001-2003

Tompkins County, NY 2005–2010 Community Health Assessment 127

Figure 112 –- Rabies exposure, rate per 100,000 population, 13-year trend

Rabies Exposure (Tompkins County 1991-2003) 125 108.2 113.3 100 110.2 88.2 78.6 78.6 75.5 75 72.5 61.6 54.2

50 Rate/100K residents 35.1 25 30.8 12.8

0 1991 1993 1995 1997 1999 2001 2003

Rate/100K 3-Year Average Rate/100K

TCHD Annual Report, 2001-2003

Tompkins County, NY 2005–2010 128 Community Health Assessment

Injury Prevention

he importance of this category of indicators is to determine underlying causes of injuries in a community that impact the health and well being of its citizens. However, the only T measures for injury incidence are hospitalization and death rates. Hospitalizations include only inpatients; those patients treated in the emergency department and then released are not included. And there is no way to determine the number or type of injuries that occur in people who do not seek treatment at the hospital or at their physician’s office.

Data Analysis

Population (2001) An important point to remember when reviewing statistical rates • NYSDOH ...... x 1,000 such as the mortality rates discussed below, is that the raw numbers in Tompkins...... 98.0 play are often very low. In these cases one or two incidents can cause a Cayuga ...... 81.4 wide swing in the rate per population constant. As the jurisdictional Cortland...... 48.6 Tioga...... 51.5 population increases — town–county–region–state — the effect be- CNY...... 1,427.1 comes less pronounced. Still, even in Tompkins County with a popula- Upstate ...... 8,239.7 tion of nearly 100,000, one exceptional incident can translate as a major NYS ...... 19,084.4 change in accidental injury mortality rates.

Suicide deaths The rate of suicide deaths in Tompkins County is relatively high. • Age-adj. rates per When adjusted for age, the rate per 100,000 population is the twelfth 100,000 pop, 2000–2002. highest in the state. The counties with a higher rate are all significantly Tompkins...... 12.0 less populous. (Franklin County’s age adjusted suicide rate of 16.2 is Cayuga ...... 4.8 Cortland ...... 6.6 based on a population of 51,000.) Tioga...... 6.1 While those familiar with the local terrain might speculate that CNY ...... 9.1 there is a link between the County’s famous gorges and the suicide rate, NYS ...... 6.6 in fact of the 60 suicides from 1998–2003 only 7 were recorded as jumps. Over one-third (22) were gunshot wounds. Across Upstate New York the crude suicide rate remained flat over the 10 year period, 1993–2002. During the same period Tompkins County ranged from a crude rate of 4.1 in 1995 to 13.3 in 2001. The trend of 3-year averages, calculated to smooth out the extremes, increased by more than 60 percent from 1993–2003. (See Figure 113, page 132, and Figure 114, page 133.) New York State also provides data for suicide deaths among young adults age 15–19 years. In Tompkins County the suicide rate for this age group is much more consistent with rates across the rest of the region. However, while the 10-year trend for all of Upstate is flat to declining, the 3-year averages for Tompkins County show a significant rise in young adult suicides. (See Figure 115, page 133, and Figure 116, page 134.)

Tompkins County, NY 2005–2010 Community Health Assessment 129

Homicides The homicide rate in Tompkins County is the highest among the • Rates per 100,000 pop, regional counties that are the basis of comparisons throughout this 2000–2002. document — Cayuga, Cortland, Tioga, and CNY total. A broader view Tompkins ...... 3.3 shows that in counties where homicide rates are higher there is often a Oneida...... 3.5 Onondaga...... 4.9 large city. The standard comparisons are shown in Figure 121, page Seneca ...... 7.1 136, and some additional comparisons are shown at left. Monroe ...... 6.8 The 1993-2003 trend for homicides in Tompkins County is shown Broome...... 1.9 in Figure 122, page 137. The rates are so erratic from year-to-year that Chemung...... 0.8 not even the 3-year averages offers any hints of what has been or what’s to come. Across the whole of Upstate NY the trend was decid- edly downward from 1993–1999, but since has taken an upward tick.

Work related injury The NYSDOH data for this indicator was not available at the time mortality this report was prepared.

SPARCS The Statewide Planning and Research Cooperative System (SPARCS) collects data on hospital inpatient discharges and the New York State Department of Health (NYSDOH) provides the data as a way of tracking injury incidence. If hospital admission was not required — emergency room treatment and release for example — the event is not recorded in these data sets. An ICD-9 code is assigned to every case at discharge. The code, which indicates the primary reason for hospitalization, forms the basis of the injury data.

Self-inflicted injuries An interesting contrast can be found in comparing the suicide rates ICD code: E950-E959 outlined above with non-fatal, self-inflicted injuries (expressed as hos- • Hospitalization rate per pital discharge rates per 100,000 population.) Because while Tompkins’ 100,000 pop, 2000–2002. suicide rates are high (fatal, self-inflicted injuries) the latter statistics Tompkins ...... 51.7 are quite the opposite in some respects. Cayuga...... 69.2 Cortland...... 53.5 For example, Cayuga County has one of the very lowest suicide Tioga ...... 31.7 rates in the state, yet among the highest self-inflicted injury rates. On CNY...... 60.1 the other hand the rate for Tompkins County is below that of the CNY NYS...... 41.9 region. Furthermore, the local rate has shown a marked decline — close to 24 percent — over the 1993–2002 trend period. (See Figure 117, page 134, and Figure 118, page 135.) The pattern of comparisons is similar for self-inflicted injury rates among the age 15–19 population group. (See Figure 119, page 135, and Figure 120, page 136.)

Assault incidence The NYSDOH tracks assault victims through hospital discharges. ICD code: E960-E969 When compared regionally as rates per 100,000 population, Tompkins

Tompkins County, NY 2005–2010 130 Community Health Assessment

County shows a low incidence of assault. And while the local 10-year trend has not fallen as many points as that of Upstate NY, Tompkins’ 3- year averages for assault incidence declined 45 percent from 1993– 2002. (See Figure 123 and Figure 124, page 138.)

Unintentional Injury Motor vehicle deaths Motor vehicle death rates in Tompkins County are relatively low by regional comparison. The 10-year trend shows that a decline through the latter half of the 1990’s plateaued in the early years of the new decade. The annual rate for all of Upstate has remained relatively flat over the 1993–2002 period. (See Figure 125 and Figure 126, page 138.) Alcohol-related motor vehicles deaths and injuries are shown in Figure 127, page 139. The current rate for Tompkins County is as much as 41 percent lower than others in the regional comparison, though it is just above the statewide rate of just under 50 fatal and non- fatal alcohol-related motor vehicle injuries per 100,000 population.

Unintentional injury The NYSDOH reports non-motor vehicle related unintentional in- hospitalizations jury data in 5 different age groupings: under age 10 years, age 10–14, ICD Code: E800–E949 age 15–24, age 25–64, and age 65 years and over. The data is displayed • Difference of Tompkins in Figure 131, page 141, through Figure 135, page 144. County rate compared to In regional comparisons, and across the age groups under age 65 rate for total CNY (2000– 2002): years, Tompkins County typically has a relatively low incidence of All ages...... –30% hospitalizations due to unintentional injury. And in fact, in most age Age <10 yr...... –19% groups the local rates are considerably below the CNY total. Statewide, Age 10–14 ...... –45% Tompkins County has among the lowest rates of unintentional injury in Age 15–24 ...... –46% all age categories under age 65 (the lowest statewide for the age 15–24 Age 25–64 ...... –27% Age 65+...... +1% group.) This pattern is broken in the age 65+ group where Tompkins is about equal to the CNY total, and the 23rd highest out of New York’s 62 counties. (See Figure 136, page 145.) Reading the 3-year averages for Tompkins County in order to smooth out the swings in annual data, local 10-year trends are not consistently up or down across the age groups. In fact, while all under age 65 trend lines for Upstate show declines over the 1993–2002 period, for Tompkins this is only evident for 2 of 4 under age 65 groups. Trends for age <10 years and age 25–64 show increases in unintentional injury hospitalizations during the early years of this decade. In the case of the age 65+ group, an upward trend is visible in the Upstate data, and a wide increase for Tompkins is seen over the later 1990’s. Note that in the case of Tompkins County, the rate of 2,471 hospitalizations per 100,000 persons age 65+ years indicates about one hospitalized due to unintentional injury for every four in the over 65

Tompkins County, NY 2005–2010 Community Health Assessment 131

population. Again, refer to the data displayed in Figure 131, page 141, through Figure 136, page 145.

Osteoporosis The County Office for the Aging reports that there are 11,967 resi- assessment in TC dents in Tompkins County sixty years of age and older. In its “2004 Senior Needs Assessment Survey” COFA reports that 20.10% of survey respondents reported that they had osteoporosis. This percentage would translate into an actual number of 2,040 residents with the condition. Given that falls are the most common injury in seniors, the incidence of osteoporosis may offer some explanation for the injury rate in this population. For more information on the health of seniors in Tompkins County: www.tompkins-co.org/cofa

Traumatic brain injury Traumatic brain injuries are much less common in Tompkins ICD-9 codes 800-801.9, County than in other of the comparison areas. The local rates remained 803-804.9, 850- relatively steady over the trend period, 1993–2002. (See Figure 129, 854.1,950.1-950.3, page 140, and Figure 130, page 141.) 959.01 and 995.55.

Community Resources

Child safety seats The Tompkins County Sheriff’s Department with funds from the Governor’s Council on Traffic Safety provides car and booster seats to children whose families are financially unable to purchase them. And all parents in the County may have the Sheriff’s Department check their children’s car seats for proper installation. Pedestrian safety Concern about pedestrian safety in the City of Ithaca has been increasing recently. Mayor Carolyn Peterson has appointed a Pedestrian Awareness Committee to study problems and find solutions to the pedestrian situation in the city.

Tompkins County, NY 2005–2010 132 Community Health Assessment

Figures and Tables

Figure 113 — Suicide deaths, regional comparison

SUICIDE - DEATHS AND DEATH RATES PER 100,000 RESIDENTS

12.0 12

10 9.1

8 6.6 6.6 6.1 6 4.8

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004 A GE A DJUSTED TO THE 2000 UNITED STA TES POPULA TION

Tompkins County, NY 2005–2010 Community Health Assessment 133

Figure 114 — Suicide deaths, 10-year trend

Suicide Deaths: Crude Rate Per 100,000 Population Upstate New York Tompkins Single Year Tomp 3-Yr Avg 14 13.3

12 10.4 10.6 10 8.3 9.3 8 8.2 6.6 7.3 7.4 6

4 4.1 2

0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004. Tompkins 2003 data: TCHD Annual Report, 2003.

Figure 115 — Suicide deaths, ages 15–19 years, regional comparison

ADOLESCENT/YOUNG ADULT SUICIDE (AGE 15-19) - DEATHS AND DEATH RATES PER 100,000 RESIDENTS AGE 15-19 10

9 8.6 8.2 8.4 8 7.1 7

6 5.5

1 0.0 0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 134 Community Health Assessment

Figure 116 — Suicide deaths, ages 15–19 years, 10-year trend

Adolescent/ Young Adult (Age 15-19) Suicide Death Rate Per 100,000 Residents Age 15-19

18 16.4

8.7 10 8.1 8.2 8.2 8

2 0.0 0.0 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Upstate New York Tompkins Single Year Tomp 3-Yr Avg

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004

Figure 117 — Self-inflicted injury discharges, regional comparison

SELF-INFLICTED INJURY - DISCHARGE RATE PER 100,000 POPULATION 80

69.2 70

60.1 60 53.5 51.7 50 41.9 40 31.7 30

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 135

Figure 118 — Self-inflicted injury discharges, 10-year trend

Self-Inflicted Injury Discharge Rate Per 100,000 Population

100 88.3 90

77.9 80 72.3 68.7 70 64.1 62.5

64.6 60 62.2 49.0 50

40 43.4

30 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Upstate New York Tompkins Single Year Tomp 3-Yr Avg

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004

Figure 119 — Self-inflicted injury discharges, Age 15–19, regional comparison

SELF-INFLICTED INJURY (AGE 15-19) - DISCHARGE RATE PER 100,000 POPULATION AGE 15-19 200 179.8 180

160

140 126.6 120 98.8 100 92.1 75.9 80 71.4

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 136 Community Health Assessment

Figure 120 — Self-inflicted injury discharges, Age 15–19, 10-year trend

Self-Inflicted Injury (Age 15-19) Discharge Rate Per 100,000 Population Age 15-19

155 148.6 139.6

135

115

95 104.8

90.4 90.0 75 80.4 76.8 74.0 72.5 55

49.5 35 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Upstate New York Tompkins Single Year Tomp 3-Yr Avg

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004

Figure 121 — Homicide deaths, regional comparison

HOMICIDE - DEATHS AND DEATH RATES PER 100,000 RESIDENTS 6

5.0 5

4 3.3 2.9 3

2 1.3

1 0.5

0.0 0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 SPA RCS DA TA A S OF A UGUST, 2004 ADJUSTED RATES ARE AGE ADJUSTED TO THE 2000 UNITED STATES POPULATION

Tompkins County, NY 2005–2010 Community Health Assessment 137

Figure 122 — Homicide deaths, 10-year comparison

Homicide Death Rate Per 100,000 Population

7 Upstate New York Tompkins Single Year Tomp 3-Yr Avg

6.2 6

5 5.1

4 4.1

2 2.1 2.1 2.0

1 1.0 1.0

0 0.0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004. Tompkins 2003 data: TCHD Annual Report.

Figure 123 — Assault discharges, regional comparison

ASSAULT - DISCHARGE RATE PER 100,000 POPULATION 50 44.4 45

25 22.3

20 16.0 15 9.6 10 7.8

5 3.2

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 138 Community Health Assessment

Figure 124 — Assaults: Upstate rates have fallen 39%; Tompkins’ 3-yr avgs. have fallen 45%

Assault Discharge Rate Per 100,000 Population

35 38.4 35.0 30 32.8

25 27.9 26.1 17.6 24.0 23.4 20 22.7 22.5 23.3 13.5 15 11.4 10.3 9.3 9.4 9.4 9.3 8.2 10 5.0 5

0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Upstate New York Tompkins Single Year Tomp 3-Yr Avg

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004

Figure 125 — Motor vehicle deaths, regional comparison

MOTOR VEHICLE - DEATHS AND DEATH RATES PER 100,000 RESIDENTS 20 17.6 18

12 11.4

10 9.5 8.3 8 6.7 6.6 6

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004 ADJUSTED RATES ARE AGE ADJUSTED TO THE 2000 UNITED STATES POPULATION

Tompkins County, NY 2005–2010 Community Health Assessment 139

Figure 126 — motor vehicle deaths, 10-year trend

Motor Vehicle Death Rate Per 100,000 Population

16 Upstate New York Tompkins Single Year Tomp 3-Yr Avg

14.5 14

11.4 11.4 12 11.1

9.3 9.4 8 8.3

7.2 6 6.2 6.1

4 4.1

2 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004. Tompkins 2003 data: TCHD Annual Report.

Figure 127 — Alcohol-related M.V. deaths, regional comparison

ALCOHOL RELATED MOTOR VEHICLE DEATHS AND INJURIES - RATE PER PER 100,000 POPULATION 100 91.1 90 83.7 83.7 78.9 80 70

60 53.4 49.2 50

30 20

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 1999-2001 NYS DEPARTMENT OF MOTOR VEHICLES DATA AS OF AUGUST,

Tompkins County, NY 2005–2010 140 Community Health Assessment

Figure 128 — Drug related hospitalizations, regional comparison

DRUG RELATED - DISCHARGE RATE PER 10,000 POPULATION 35 30.5 30

15 10.3 10.7 10 6.2 5.7 5.4 5

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004

Figure 129 — Traumatic brain injury, regional comparison

TRAUMATIC BRAIN INJURY - DISCHARGE RATE PER 100,000 POPULATION 80

70 66.7 66.3

60 54.8

40.1 40 35.4

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 141

Figure 130 — Traumatic brain injury, 10-year trend

Traumatic Brain Injury Discharge Rate Per 100,000 Population

100

60 56.9

50 47.6 52.0 40 47.8 43.6 43.4

30 35.3 33.3

20 25.5 16.7 10 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Upstate New York Single Year Tomp 3-Yr Avg

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004

Figure 131 — Unintentional injury discharges, regional comparison and 10-year trend

UNINTENTIONAL INJURY - DISCHARGE RATE / 100,000 POP.

800 695 700 620 594 600 536

500 437

400 303 300

200

100

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004.

Tompkins County, NY 2005–2010 142 Community Health Assessment

Unintentional Injury Discharge Rate Per 100,000 Population

800 Upstate NY Tompkins Single Year Tomp. 3-Yr Avg

700

600

500 495.8 509.8 422.0 401.9 473.8 484.1 390.1 400 432.5 439.8

300 322.8

200 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004.

Figure 132 — Unintentional Injury discharges, Age <10 yr.; regional comparison and 10-year trend

UNINTENTIONAL INJURY (AGE <10) - DISCHARGE RATE / 100,000 POP. AGE <10 300 286

250 226 206 200 183 165

150 106 100

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004.

Unintentional Injury (Age < 10 yrs.) Discharge Rate / 100,000 Pop 400 353.7 326.4 350 311.3 279.8 300 252.6 257.1 236.5 233.2 250 227.1 226.9

200

150

100

50 Upstate NY Tompkins Single Year Tomp. 3-Yr Avg 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004.

Tompkins County, NY 2005–2010 Community Health Assessment 143

Figure 133 — Unintentional Injury discharges, Age 10–14 yr.; regional comparison and 10-year trend

UNINTENTIONAL INJURY (AGE 10–14) - DISCHARGE RATE / 100,000 POP. AGE 10–14 300 259 262 250 237

200

150 131 111 103 100

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004.

Unintentional Injury (Age 10–14 yrs.) Discharge Rate / 100,000 Pop

400 364.6 344.7 350 314.2

300 268.4 264.6 248.0 248.8 238.8 233.9 250 220.0

200

150

100

50 Upstate NY Tompkins Single Year Tomp. 3-Yr Avg 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004.

Figure 134 — Unintentional Injury discharges, Age 15–24 yr.; regional comparison and 10-year trend

UNINTENTIONAL INJURY (AGE 15–24) - DISCHARGE RATE / 100,000 POP. AGE 15–24 450 392 400 348 350 294 300 239 250 224

200 158 150

100

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004.

Tompkins County, NY 2005–2010 144 Community Health Assessment

Unintentional Injury (Age 15–24 yrs.) Discharge Rate / 100,000 Pop 600 558.9 517.8 508.6 500 429.5 413.3 397.3 371.7 373.9 400 368.9 358.8

300

200

100 Upstate NY Tompkins Single Year Tomp. 3-Yr Avg 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004.

Figure 135 — Unintentional Injury discharges, Age 25–64 yr.; regional comparison and 10-year trend

UNINTENTIONAL INJURY (AGE 25–64) - DISCHARGE RATE / 100,000 POP. AGE 15–24 450 401 388 400 384 354 350

300 284

250 214 200

150

100

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004.

Unintentional Injury (Age 25–64 yrs.) Discharge Rate / 100,000 Pop 600 525.7 513.0 491.1 500 444.9 430.0 403.7 400.4 391.7 389.8 390.6 400

300

200

100 Upstate NY Tompkins Single Year Tomp. 3-Yr Avg 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004.

Tompkins County, NY 2005–2010 Community Health Assessment 145

Figure 136 — Unintentional Injury discharges, Age 65+; regional comparison and 10-year trend

UNINTENTIONAL INJURY (AGE 65+) - DISCHARGE RATE / 100,000 POP. AGE 65+ 3000 2,736

2,471 2,442 2500 2,360 2,148

2000

1500

1,021 1000

500

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000- 2002 SPARCS DATA AS OF AUGUST, 2004.

Unintentional Injury (Age 65+ yrs.) Discharge Rate / 100,000 Pop 2700 2600 2500

2400 2300

2200 2100

2000 1900 1800 Upstate NY Tompkins Single Year Tomp. 3-Yr Avg 1700 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004.

Tompkins County, NY 2005–2010 146 Community Health Assessment

Maternal, Infant and Child Health

Data Analysis

Early prenatal care Early prenatal care — mothers who visit a health care provider • Avg. rate per 100 live within the first 3 months of a pregnancy — is an important health indi- births, 2000–2002. cator for infants and mothers. It is considered a significant measure of Tompkins...... 77 healthy birth outcomes. The healthy People 2010 (HP2010) target, re- Cayuga ...... 79 Cortland ...... 83 corded as a percentage of live births, is 90. Onondaga...... 76 Tompkins County women get early prenatal care at about the same Tioga...... 80 rate as women in neighboring counties, and the Central New York (CNY) CNY ...... 77 region as a whole. Over a ten year span from 1993 to 2002, the rate for NYS ...... 73 Tompkins County has remained relatively steady; up a little in the mid HP2010...... 90 nineties, down a little in the latter part of the period. (See Figure 137 and Figure 138, page 150.) Considering this pattern, the HP2010 target may be considered an elusive goal for Tompkins County. Early prenatal care Data for early prenatal care is also available by ZIP code for Tomp- • Avg. rate per 100 live kins County. In Figure 139, page 151, where ZIP codes have been com- births, 1993–2002. bined by Town, it can be seen that this health indicator is relatively Groton...... 79.5 uniform across the county; a little higher in Groton, a little lower in Tompkins total .... 75.1 Caroline ...... 70.6 Caroline. Table 14, page 152 shows the data in greater detail. Note that these data are averaged over the period 1993–2002.

Postneonatal mortality Infant mortality refers to deaths of children under age one year. This •(Age 28 days–1 yr.) indicator is further divided into Neonatal (age 0–28 days) and Postneo- Avg. rate per 1,000 live natal (age 28 days to one year) mortality. These data are recorded as rate births, 2000–2002. of deaths per 1,000 live births. Tompkins...... 3.6 Cayuga ...... 1.1 In Tompkins County the postneonatal mortality rate is 63 percent Cortland ...... 1.2 higher than the total for Region 3, Central New York (CNY.) Statewide, Tioga...... 1.7 Tompkins has the eighth highest postneonatal mortality rate, based on the CNY ...... 2.2 average for 2000–2002. Since postneonatal mortality is a component of NYS ...... 1.8 infant mortality, the latter rate is also elevated in comparison to neigh- HP2010...... 1.2 boring counties. (See Figure 140, page 152 through Figure 142, page 153.) A review of the ten years between 1993 and 2002 shows wide fluc- tuations in Tompkins’ postneonatal mortality rate (see Figure 143, page 154,) with an especially apparent spike in the year 2000. Because the relatively small, single county numbers are prone to show prominent dips and spikes, it is often useful to look at trends by 3-year averages. How- ever, even here the rates remain above the Upstate New York totals over the 10 year period. Neonatal mortality trends are shown in Figure 144, page 154. Infant mortality is the total of neonatal and postneonatal deaths.

Tompkins County, NY 2005–2010 Community Health Assessment 147

Spontaneous fetal Spontaneous fetal deaths are deaths that occur at 20 or more weeks deaths of gestation and are reported as a rate per 1,000 live births. Although the • Avg. rate per 1,000 live records show a couple of years when the spontaneous fetal death rate was births, 2000–2002. relatively high in Tompkins County (1993 and 2000,) the general trend is Tompkins...... 3.6 Cayuga...... 4.9 for this rate to be below those for neighboring counties, the CNY region, Cortland...... 8.9 and the state as a whole. (See Figure 145, page 155 and Figure 146, page Tioga ...... 2.2 155.) CNY...... 6.9 Tompkins County is also under the HP2010 target rate of 4.1 spon- NYS...... 7.7 taneous fetal deaths per 1,000 live births. HP2010 ...... 4.1

Short Gestation Pregnancies that last under 37 weeks (about eight and a half months) • Avg. rate per 100 live are tabulated as “Short gestation,” and expressed as a rate per 100 live births, 2000–2002. births. In Tompkins County the rate for short gestations is below that of Tompkins...... 9.9 neighboring counties, though it is likely that the difference is not signifi- CNY...... 11.3 NYS...... 11.5 cant. Tompkins County is not yet as low as the HP2010 target, and the 10 HP2010 ...... 7.6 year trend, which is essentially flat, shows no track toward achieving that target. (See Figure 147, page 156 and Figure 148, page 156.)

Maternal Mortality Maternal mortality is very rare in New York State. In fact, among • Avg. rate per 100,000 the 55 Upstate counties only 20 maternal deaths were recorded during the live births, 2000–2002. 3-year period, 2000–2002. Unfortunately, one of those deaths occurred in Tompkins...... 39.6 Tompkins County in 2002. Records show maternal mortality here was Onondaga...... 11.5 CNY...... 8.0 zero from 1991–2001. NYS...... 16.1 Incidence rates for maternal mortality are calculated per 100,000 live HP2010 ...... 3.3 births. In Tompkins County where there were 2,525 births from 2000– 2002, one maternal death resulted in an average rate of 39.6. Taking into account the raw data of one death in 12 years, the 2000–2002 rate should probably be interpreted cautiously.

Birthweight Birth weight is recorded at every delivery, making this one of the most reliable of all community health indicators. The cut-off number for classification as “Low Birthweight” (LBW) is 2500 grams (about five and a half pounds.) Infants weighing in under 1500 grams (about 3-1/3 pounds) are considered to be “Very Low Birthweight,” or VLBW. Both indicators are described as a rate per 100 live births. Very Low Birthweight In Tompkins County the rate for VLBW is right in line with neigh- • Avg. rate per 100 live boring counties, the CNY region and the state as a whole. And this rate births, 2000–2002 has remained essentially constant over the 10 year period, 1993–2002. Tompkins...... 1.5 The Tompkins County rate needs to decline by about 40% to reach the CNY...... 1.5 HP2010 ...... 0.9 HP2010 target. For the LBW indicator Tompkins shows somewhat better regionally, though it still surpasses the HP2010 target. The 10 year trend is flat. (See

Tompkins County, NY 2005–2010 148 Community Health Assessment

Figure 149, page 157, and Figure 150, page 157.) Low Birthweight births LBW data is also available in greater detail within the county. • Avg. rate per 100 live Figure 151, page 158, shows 10-year data by Tompkins County town. births, 1993-2002. For the most part there is little variation among towns. The exception is Tompkins...... 6.3 the Town of Danby, and to a lesser extent the Towns of Enfield and T-Caroline...... 7.6 T-Danby...... 10.2 Caroline. All areas are above the HP2010 target of 5.0 percent low birth- T-Enfield ...... 8.2 weight births, though some by such a narrow margin that it maybe within HP2010...... 5.0 a margin of error. It is difficult to attempt an explanation for these data. Typically, low birthweight births can be an indicator of lower socio-economic status. Low birthweight can also result from later initiation of prenatal care, maternal smoking or maternal age. In this case, poverty data does not seem to correlate (see Figure 152, page 158.) However, caution is advised in this comparison since the poverty data shown is from 1999 (2000 U.S. Census) and the LBW data is averaged over 10 years, from 1993–2002. Also, as pointed out in an earlier section, the influence of students on Tompkins County poverty statistics can add to uncertainty in how to interpret data.

Community Resources

WIC In Tompkins County, the federally funded Supplemental Nutrition Program for Women, Infants and Children (WIC) is administered by the Tompkins County Health Department. TC WIC nutrition staff emphasize the benefits of breastfeeding with all prenatal women. Using a locally de- veloped questionnaire, detailed information in breastfeeding is collected from all prenatal women who enroll in WIC. Data collected from 1997–2003 is shown in Figure 153, page 159. The 7-year trend shows some increase in the number of WIC mothers who initiate breastfeeding, though a decrease in the women who are still breastfeeding at 6 months. Though these data provide a valuable addition to the cache of community health indicators the reader should remember that they only represent those women who are eligible and have enrolled in the TC WIC program. This is the only measure available and does not account for breastfeeding initiation and maintenance of other women not enrolled in WIC.

Medicaid Obstetric and Maternal Services (MOMS) This program located at the Tompkins County Health Department

Tompkins County, NY 2005–2010 Community Health Assessment 149

(TCHD) provides services for prenatal women and their partners. Income eligibility for this program is less stringent than typical Medicaid requirements. Clients receive education through class instruction and nurses provide one on one counseling. The unduplicated client count in 2002 was 509; in 2003 it was 574. The total number of births to women in Tompkins County in 2002 was 794; in 2003 it was 920.

Maternal Child Home Visiting Program Nurses in TCHD’s Maternal Child Unit visit mothers, babies, and children in their homes upon physician requirement. During home visits, nurses assess blood pressure, pulse respiration, lung sounds, weights, and fetal heart sounds. Mothers are taught about healthy pregnancy, breastfeeding, infant care, childhood health and development, immunization, chronic disease. In 2002 the unduplicated client count was 196 with 572 home visits. In 2003 the client count was 141 with 407 home visits.

Medical Care — Highlights There are 2 obstetrical/gynecological medical practices in Ithaca and one family practice office that provide obstetrical care. Cayuga Medical Center at Ithaca’s Special Care Nursery acquired a Level II designation from the New York State Department of Health. This means that babies born at the medical center who require short-term assistance breathing and other neonatal services such as oxygen support and intravenous therapy can receive their care in Tompkins County. As of 2003, the Special Care Nursery cares for babies born up to eight weeks premature or at a minimum weight of 1,500 grams (the equivalent weight of 3 pounds, 5 ounces). Babies weighing less than 1,500 grams or who need surgery are transferred to a regional medical center with Level III Nursery designation. TCHD partners with Mothers and Babies Perinatal Network of the Southern Tier regarding access to prenatal care and smoking cessation among prenatal women. They provide the education and support to make smoking cessation a success.

Opportunities for Action

I’m not going to include any here, unless we state the obvious of continuing to work on achieving the HP 2010 goal of 90% prenatal care and continuing to urge pregnant women to quit smoking. Alice, Sigrid, any comments here?

Tompkins County, NY 2005–2010 150 Community Health Assessment

Figures and Tables

Figure 137 — Early prenatal care, regional comparison

EARLY PRENATAL CARE - PERCENTAGE PER 100 LIVE BIRTHS 95

90.0 90

85 82.7

79.5 80 78.9 77.1 77.2 75.6 75 73.3

60 TOMPKINS CAYUGA CORTLAND ONONDAGA TIOGA CNY NYS HP2010

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 151

Figure 138 –- Early prenatal care, 10-year trend

Early Prenatal Care Birth Percentage per 100 Live Births 90

60 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Tompkins Single Year Tomp 3Yr Avg Upstate

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 139 –- Early prenatal care, by Tompkins County ZIP code

Trimester Prenatal Care Began: Cumulative 1993-2002 By ZIP Code

100%

90%

79.5% 80% 78.8% 77.1% 76.2% 75.4% 75.1% 74.9% 74.1% 70.6% 70%

60% 57.0% Pct 1st-3rd Month 1st-3rd Pct

50%

40%

30% DRYDEN GROTON CAROLINE ITHACA NEWFIELD LANSING ULYSSES DANBY Missing or Total area area area area area area area area Mismatch Source: NYS Vital Records (9/2004)

Tompkins County, NY 2005–2010 152 Community Health Assessment

Table 14 –- Early prenatal care, by Tompkins County ZIP code Total Births 1st-3rd Month 1993–2002 Freq Pct 1,194 900 75.4% DRYDEN-ETNA-FREEVILLE DRYDEN area

708 563 79.5% GROTON-MC LEAN GROTON area

327 231 70.6% BROOKTONDALE-BERKSHIRE-SLATERVILLE SPRINGS CAROLINE area 5,042 3,777 74.9% ITHACA ITHACA area

772 572 74.1% NEWFIELD NEWFIELD area

398 307 77.1% LANSING LANSING area

391 298 76.2% TRUMANSBURG-MECKLENBURG-JACKSONVILLE ULYSSES area 99 78 78.8% WEST DANBY-SPENCER-WILLSEYVILLE DANBY area 79 45 57.0% Missing Zipcode-Zipcode and County Mismatched Missing or Mismatch

9,010 6,771 75.1% TOTAL Total NYS Vital Statistics (Sept 2004)

Figure 140 –- Postneonatal mortality, regional comparison

POSTNEONATAL MORTALITY - RATE PER 1,000 LIVE BIRTHS 5.0

4.0 3.6

3.0

2.4 2.2

2.0 1.8 1.7

1.2 1.2 1.1 1.0

- TOMPKINS CAYUGA CORTLAND ONONDAGA TIOGA CNY TOT NYS TOT HP2010

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 153

Figure 141 –- Neonatal mortality, regional comparison

NEONATAL MORTALITY - RATE PER 1,000 LIVE BIRTHS 8 7.4

6 5.8

4.9 5 4.4 4.4 4.2 4 3.6

2.9 3

0 TOMPKINS CAYUGA CORTLAND ONONDAGA TIOGA CNY TOTAL NYS TOTAL HP2010

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 142 –- Infant mortality, regional comparison

INFANT MORTALITY - RATE PER 1,000 LIVE BIRTHS 9.8 10.0

7.9 8.0 8.0

6.0 6.1 6.0 6.0 4.8 4.5

4.0

2.0

- TOMPKINS CAYUGA CORTLAND ONONDAGA TIOGA CNY TOT NYS TOT HP2010

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 154 Community Health Assessment

Figure 143 –- Postneonatal mortality, 10-year trend

Postneonatal Mortality Rate Per 1,000 Live Births [HP2010 1.2] 8

5 4.2 3.9 4 3.6 3.1 2.8 2.6 2.5 3 2.3

0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Tompkins Single Year Tomp 3yr Avg Upstate

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 144 –- Neonatal mortality, 10-year trend

Neonatal Mortality Rate Per 1,000 Live Births [HP2010 2.9] 8

4 4.4 4.2 4.2 3 3.2 3.2 3.1 2.9 2 2.3

0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Tompkins Single Year Tomp 3yr Avg Upstate

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 155

Figure 145 –- Spontaneous fetal deaths, 10-year trend

Spontaneous Fetal Deaths (SFDs) [20+ Weeks Gestation Percentage per 100 Live Births] + [SFDs 20+ Weeks] 12

10 10.0 8 8.4

6 6.8 6.5 6.0 6.1 6.1 5.6 5.7 5.7 5.8 5.2 4 4.8 4.6 4.4 3.6 2 2.2 2.3

1.2 1.2 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Tompkins Single Year Tomp 3yr Avg Upstate

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 146 –- Spontaneous fetal deaths, regional comparison

SPONTANEOUS FETAL DEATHS (20+ WEEKS GESTATION) RATE PER 1,000 LIVE BIRTHS + SPONT FETAL DEATHS 20+ WKS 10 8.9

8 7.7 6.8 6.9

6 4.9 4.1 4 3.6

2.2 2

0 TOMPKINS CAYUGA CORTLAND ONONDAGA TIOGA CNY TOT. NYS TOT. HP2010

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 156 Community Health Assessment

Figure 147 –- Short gestation, regional comparison

SHORT GESTATION (<37 WEEKS) - PERCENTAGE PER 100 LIVE BIRTHS 14

12.2 12.1 12 11.3 11.5 11.0 11.0 9.9 10

8 7.6

0 TOMPKINS CAYUGA CORTLAND ONONDAGA TIOGA CNY TOTAL NYS TOTAL HP2010

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 148 –- Short gestation, 10-year trend

Short Gestation (<37 Weeks) Birth Percentage per 100 Live Births 12

6 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Tompkins Single Year Tomp 3yr Avg Upstate

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 157

Figure 149 –- Low birthweight births, regional comparison

LOW BIRTHWEIGHT BIRTHS (<2500 GRAMS) - PERCENTAGE PER 100 LIVE BIRTHS 10

7.9 7.8 8 7.7 7.3 7.0 6.5 6.2 6 5.0

0 TOMPKINS CAYUGA CORTLAND ONONDAGA TIOGA CNY TOTAL NYS TOTAL HP2010

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Figure 150 –- Low birthweight births, 10-year trend

Low Birth Weight (<2500 Grams) Birth Percentage per 100 Live Births 9

8 7.5 7.3 7.2 7.3 7 7 7 6.8 7 6.5 6.4 7.1 6.6 6.5 6.5 6 6.3 6.1 6.1 5.9 5.7 5.6 5

4 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Upstate Tompkins Single Year Tomp.3Yr Avg

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004

Tompkins County, NY 2005–2010 158 Community Health Assessment

Figure 151 –- Low birthweight births, by Tompkins County town

Low Birthweight: 1993-2002 (Pct < 2500 grams) 12%

10.2% 10%

8.2% 8% 7.6%

6.5% 6.4% 6.3% 6.0% 6.0% 5.7% 5.7% 6% 5.5% 5.0%

0% C-Ithaca T-Caroline T-Danby T-Dryden T-Enfield T-Groton T-Ithaca T-Lansing T- T-Ulysses Tompkins HP2010 Newfield (all) NYS Vital Statistics (10/2004)

Figure 152 –- Families in poverty, by Tompkins County town

Percent of selected population living below the poverty level (by household type) 80% families families w female householder, no husband present 70% families, no husband, w related children under 5 years

60%

50%

40% % below poverty poverty % below 30%

20% 13.5% 11.9% 7.3% 6.9% 6.9% 4.8% 4.2% 4.2% 4.3%

10% 3.9%

0% Caroline Danby Dryden Enfield Groton Ithaca Lansing Newfield Ulysses City of Ithaca

Tompkins County, NY 2005–2010 Community Health Assessment 159

Figure 153 –- Breastfeeding, Tompkins County

Breastfeeding rates for Tompkins County WIC Pgm 90% Women who 79% initiated 80% 76% breastfeeding 74% 73% 74% 73% 71% Women 70% breastfeeding after 6 months* 60% 3yr avg for feeding after 6mo 50% 49%

44% 44% 40% 40% 40% HP2010 targets: 35% Initiating 30% 31% breastfeeding: ––-75% Breastfeeding after 6 months: 20% ––-50% 1997 1998 1999 2000 2001 2002 2003

Data collected from breastfeeding questionnaire administered and analyzed by TC WIC

Table 15 –- Lead poisoning incidence, Tompkins County Lead Prevention Program in Tompkins County Year 1998 1999 2000 2001 2002 2003 Children (<6yrs) tested for lead 1,081 NA NA 1,272 1,273 1,258 Blood level >10 mcg/dl 6 8 3 14 6 Blood level >20 mcg/dl 2 1 - 2 - - Sites inspected related to >10 cases 6 7 3 13 8 Abatements completed - - - - - Interim comtrols completed - - 1 - - Lead source identified 4 9 6 Source: TCHD Annual Reports (EH, MCU)

Tompkins County, NY 2005–2010 160 Community Health Assessment

Nutrition and Overweight

utrition is essential for growth and development, health, and well being. Behaviors to promote health should start early in life with breastfeeding and continue through life N with the development of healthful eating habits. Nutritional, or dietary, factors contribute substantially to the burden of preventable illnesses and premature deaths in the United States. Indeed, dietary factors are associated with 4 of the 10 leading causes of death: coronary heart disease (CHD), some types of cancer, stroke, and type 2 diabetes. Dietary factors also are associated with osteoporosis, which affects more than 25 million persons in the United States and is the major underlying cause of bone fractures in postmenopausal women and elderly persons. (Healthy People 2010) The Dietary Guidelines for Americans, 2005 recommends consuming fewer calories, be- coming more physically active and making wiser choices within and among food groups. Visit www.health.gov/dietaryguidelines to see the full report.

Data Analysis

BRFSS Relatively little data is available by which to judge the state of nutritional behavior and bodyweight levels in a community. Currently the state provides only data collected through the Behavioral Risk Factor Surveillance System (BRFSS) surveys. The most recent local level survey was conducted in 2002 and carries a citation date of 2003. The BRFSS only surveys adults age 18 years and over. In the most recent survey Cortland and Tompkins Counties were surveyed together and are reported as a single data point. Many other rural counties were also grouped in twos and threes for the survey and the data is reported as such. This is done in order to maintain a consistency, to the extent possible, of sample size across the state. This in turn is a way to improve the confidence intervals and thereby the reliability of the data as true and not just do to random occurrence. Almost all data detailing the current national “obesity epidemic” is obtained through self-reporting systems like the BRFSS survey. A common concern of these survey data is that respondents stretch their answers towards “normal”; that is, overweight and obesity are under- reported. Even given the inherent statistical problems, the data is worth reviewing on a comparative basis. Local level data is not available over a span of years, so only regional comparisons are offered along with some breakout by demographic groups within the Cortland–Tompkins sample set.

Obese or Overweight About half of the Cortland–Tompkins population is overweight or Cortland–Tompkins, obese according to the 2003 BRFSS. This is the best score regionally

Tompkins County, NY 2005–2010 Community Health Assessment 161

BMI=25+, 2003 and statewide though the closer comparisons may not be statistically Male ...... 61.6 significant. (See Figure 154, page 163.) Female ...... 41.7 High school edu A demographic breakout for Cortland–Tompkins is shown graphi- or less...... 61.8 cally in Figure 155, page 164. The data is also presented in table form Edu more than to show the 95% confidence intervals (C.I.) which vary widely among high school ...... 47.2 the different groups. [95% C.I. 5.8–7.9] Still, two of the comparisons appear to be statistically significant: the gender gap and the education gap. Cortland–Tompkins men have a higher incidence of overweight than do women. Similarly, those whose education went no farther than high school are more likely to be overweight than those with schooling beyond high school. Additional graphics showing regional comparisons for different Body Mass Index (BMI) levels are shown in Figure 156, Figure 157 and Figure 158, starting on page 165.

Fruit and vegetable The BRFSS tracks nutritional behavior through questions about consumption fruit and vegetable consumption and about an individual’s attempts to loose or maintain weight. A number of years ago the National Cancer Institute (NCI) established that consuming a minimum of 5 servings a day of fruits and vegetables was important for maintaining health. More recently the recommendation has been upgraded to eating from 5–9 servings a day, with the emphasis on the higher level. The BRFSS asks respondents whether or not they eat at least 5 fruit or vegetable servings a day. Regionally the responses do not vary within the margins of error, with plus-or-minus a quarter of the population confirming that they eat “five-a-day.” The rate for Cortland–Tompkins is 27 percent. See Figure 159, page 166 for details. One thing that is indisputable regarding this data is that fruit and vegetable consumption is extremely low based on the NCI recommendation. Of further interest — due to statistical significance — is the demographic differences within Cortland–Tompkins. There may be a significant difference between those age 18–34 years and those age 55 and over, with greater numbers of the older population eating their 5-a-day. More well defined is the difference between education levels: those with high school or less appear to be far less likely to include the recommended numbers of fruits and vegetables in their diet than those with an education beyond high school. (See Figure 160, page 167.) The implication would be that any interventions to increase fruit and vegetable consumption may better serve the constituency by targeting younger populations and those with fewer years of school. HP 2010 Healthy People 2010 (HP2010) has set targets for fruit and vegeta- Target daily consumption ble consumption among those age 2 years and older. They are for 50 Veg: 3 srvgs ...... 50% percent of the population to eat at least 3 servings of vegetable daily

Tompkins County, NY 2005–2010 162 Community Health Assessment

Fruit: 2 srvgs...... 75% and 75 percent to eat a minimum of 2 daily servings of fruit.

Community Resources

TCHD TCHD’s Health Promotion Program promotes worksite programs that encourage healthy eating. Technical assistance is provided upon request or through the web site. Employers can learn how to implement a “5 a day Challenge,” institute a healthy “snack bowl” or how to include healthy menu choices at worksite functions. www.tompkins- co.org/wellness WIC The Supplemental Nutrition Program for Women, Infants and Children at TCHD strives to improve the nutrition and health status of participating women, infants and children through the provision of nutritious foods, nutrition and health education, breastfeeding promotion and support and connections with health and human service organizations. Healthy CNY In 2004, The Commission for a Healthy Central New York conducted a regional health assessment of eight counties: Cayuga, Cortland, Herkimer, Madison, Oneida, Onondaga, Oswego, and Tomp- kins Counties. Obesity was identified as a problem in the region. The Commission is seeking to establish collaborative relationships of stakeholders and health care providers to tackle the problem on a regional basis.

Tompkins County, NY 2005–2010 Community Health Assessment 163

Figures and Tables

Figure 154 — Overweight or obese, regional comparison

Overweight or Obese, BMI (Body Mass Index) 25 or More (% Yes) 70

65 63.3 59.2 59.5 60 57.6 56.7 55 51.6 50

25 Cayuga, Sen, Chem, Schuy, Cortland, Onondaga NYS Ex. NYC NYS Total Way ne Tioga Tompkins

95% C.I. Counties ~ 4.5; NYS = 1.2 Expanded BRFSS, 2003 - NYS Dept of Health

Tompkins County, NY 2005–2010 164 Community Health Assessment

Figure 155 — Overweight or obese, Tompkins–Cortland Overweight or Obese, BMI (Body Mass Index) 25 or More CORTLAND, TOMPKINS 2003 70 61.6 61.8 59.3 58.3 60 51.6 50 47.2 41.7 43.2 40

- Total Male Female 18-34 35-54 55+ HS or less >HS ed.

Overweight or Obese, BMI (Body Mass Index) 25 or More CORTLAND, TOMPKINS 2003 Dem Groups n¹ Yes %² n No % C.I.³ Total 326 51.6 294 48.4 4.7 Male 163 61.6 99 38.4 6.8 Female 163 41.7 195 58.3 6.2 18-34 67 43.2 103 56.8 8.6 35-54 134 59.3 104 40.7 6.7 55+ 125 58.3 85 41.7 7.4 HS or less 125 61.8 77 38.2 7.9 >HS ed. 201 47.2 217 52.8 5.8 Expanded BRFSS, 2003 - NYS Dept of Health ¹Use pcts based on row denominators <50 with caution ²Weighted Percent ³95% Confidence Interval

Tompkins County, NY 2005–2010 Community Health Assessment 165

Figure 156 — Underweight /Normal, regional comparison

Underweight/ Normal BMI <25

50 48.4 42.4 43.3 40.8 40.5 40 36.7

- Cayuga, Sen., Chemung, Cortland, Onondaga NYS Ex. NYC NYS Total Wayne Schuyler, Tompkins Tioga

95% C.I. County groups 4.5; NYS 1.1 Expanded BRFSS, 2003 - NYS Dept of Health

Figure 157 — Overweight, regional comparison

Overweight - BMI 25-29

40.2 39.2 40 36.3 36.8 36.1 32.0 30

- Cayuga, Sen., Chemung, Cortland, Onondaga NYS Ex. NYC NYS Total Wayne Schuyler, Tompkins Tioga

95% C.I. County groups 4.5; NYS 1.1 Expanded BRFSS, 2003 - NYS Dept of Health

Tompkins County, NY 2005–2010 166 Community Health Assessment

Figure 158 — Obese, regional comparison

Obese - BMI 30+ 40

25 22.9 23 20.8 20.6 19.6 20.3 20

- Cayuga, Sen., Chemung, Cortland, Onondaga NYS Ex. NYC NYS Total Wayne Schuyler, Tompkins Tioga 95% C.I. County groups 3.7; NYS 0.9 Expanded BRFSS, 2003 - NYS Dept of Health

Figure 159 — Eat 5-A-Day, regional comparison Eat 5 Fruit or vegetable servings per day (% Yes) 35

5 27.6 24.0 23.0 27.0 26.6 - Broome Cayuga, Seneca, Chemung, Cortland, CNY Wayne Schuyler, Tioga Tompkins

95% C.I. = 4.0 Expanded BRFSS, 2003 - NYS Dept of Health

Tompkins County, NY 2005–2010 Community Health Assessment 167

Figure 160 — Eat 5-A-Day, Tompkins–Cortland

Eat Five Fruits or Vegetable Servings per Day CORTLAND, TOMPKINS 2003

5 27.0 23.7 30.1 23.0 28.0 33.3 17.4 31.4 - Total Male Female 18-34 35-54 55+ HS or less >High School 95% C.I. ~ 5.5 Expanded BRFSS, 2003 - NYS Dept of Health

Figure 161 — Trying to lose weight, regional comparison

Trying to Lose Weight (% Yes) 55

15 42.9 48.8 46.4 40.2 48.3 46.6 10 Broome Cayuga, Chemung, Cortland, Onondaga CNY Seneca, Schuyler, Tompkins Wayne Tioga

95% C.I. = 4.6 Expanded BRFSS, 2003 - NYS Dept of Health

Tompkins County, NY 2005–2010 168 Community Health Assessment

Figure 162 — Trying to maintain current weight, regional comparison

Trying to Maintain Current Weight (of Those not Trying to Lose Wt.) % Yes 80

10 59.1 62.5 64.1 58.4 55.4 60.2 - Broome Cayuga, Chemung, Cortland, Onondaga CNY Seneca, Schuyler, Tompkins Wayne Tioga 95% C.I. = 6.3 Expanded BRFSS, 2003 - NYS Dept of Health

Figure 163 — Changing diet to lose or maintain weight, regional comparison

Eating Fewer Calories or Less Fat to Lose or Maintain Weight (% Yes) 85

77.8 72.0 71.2 76.3 76.2 71.8 50 Broome Cayuga, Chemung, Cortland, Onondaga CNY Seneca, Schuyler, Tompkins Wayne Tioga 95% C.I. = 4.4 Expanded BRFSS, 2003 - NYS Dept of Health

Tompkins County, NY 2005–2010 Community Health Assessment 169

Figure 164 — Changing physical exercise to lose or maintain weight, regional comparison

Using Physical Exercise to Lose or Maintain Weight (% Yes) 85

77.8 72.0 71.2 76.3 76.2 71.8 50 Broome Cayuga, Chemung, Cortland, Onondaga CNY Seneca, Schuyler, Tompkins Wayne Tioga 95% C.I. = 4.4 Expanded BRFSS, 2003 - NYS Dept of Health

Tompkins County, NY 2005–2010 170 Community Health Assessment

Oral Health

he New York State Department of Health (NYSDOH) reports that dental caries is the most common chronic childhood disease. It impacts children’s functions including eat- T ing, growth, speaking, and learning. Oral diseases in adults negatively impact their em- ployability and systemic health. Although dental caries is preventable, almost 80% of children will have experienced tooth decay by the time they finish high school.

Community priority

In Tompkins County, dental health and insufficient access to dental health care has long been identified as a priority health issue. (The 1998 Community Health Assessment listed it as such based on community input.) School nurses, teachers, principals continually report that certain children in their schools are in need of dental care. Community health nurses at TCHD have identified clients similarly. And various community health and human service agencies respond to regular inquiries from people in need of emergency dental care. In most cases the callers have not been able to afford preventative care and are compelled to seek care when the condition is acute. People unfamiliar with the services that TCHD provides call the health department in the hope or expectation of a no-cost public dental clinic. In 2001, the Tompkins County Department of Social Services (DSS) convened a task force of interested and concerned community members, dental health providers and health and human service agency and school representatives to address the problem. After seven months of study and discussion the task force agreed on several recommendations that were presented to the Tompkins County Legislature for decision and action.

Data Analysis

NYSDOH /CDC Survey The NYSDOH collaborated with the Centers for Disease Control and Prevention (CDC) to establish a surveillance system for monitoring oral health status, risk factors, workforce and the use of dental services. To collect data on tooth decay or dental caries in children, NYS- DOH conducted surveys in 2003 of 3rd grade children in counties in New York State. A sample of schools was selected in each county; pa- rental permission was required for participation. The 3rd graders were categorized into two socioeconomic strata based on participation in the free or reduced cost school lunch program. A dental hygienist or dentist conducted the oral screening. Limitations in the survey There are several limitations in the NYSDOH surveys. • First, the screenings were conducted without the benefit of ra- diographs. Therefore the findings may differ from those ob- served by clinicians. • Second, the possibility of bias from selective participation should be considered in applying the results to all children.

Tompkins County, NY 2005–2010 Community Health Assessment 171

• Third, direct comparisons with other areas should be avoided because of the differences in the underlying samples and populations and data collection methods. • Finally, smaller numbers of schools and children in some areas may have resulted in unstable rates and invalid standard areas. Survey results Results of the oral health survey of grade 3 students in Tompkins County are shown in Figure 165, page 172. The indicators are defined as follows: • Caries experience (history of tooth decay) reflects the presence of a cavity or a filling, or a history of extraction of a permanent tooth. It indicates that opportunities for primary prevention may have been missed. • Untreated caries reflects the presence of a cavity. It indicates that treatment has not been obtained in a timely manner. • Dental Sealants is reflection of use of preventive services. The data suggests that access to dental care in Tompkins County does vary based on the economic status of the child.

HP 2010 Additional data also shows the spread between the oral health of Tompkins County children and the Healthy People 2010 (HP2010) targets for caries and sealants. The caries experience data for Tompkins County is about 34 percent above the HP2010 target, untreated caries is 60 percent higher than the HP2010 target, and use of sealants about 29 percent below the target rate for children. (See Figure 166, page 173.)

Community Resources

Dental Case Manager The Tompkins County Legislature responded to the Dental Care Task Force mentioned above by permitting a grant application for the funding of a dental case manager program. Funding was awarded to TCHD and the case manager is based at DSS. The program is designed to enhance access to dental care for people who qualify for Medicaid and for a small number of senior citizens. Along with case management, the program provides appointment reminders and transportation as needed. Participants receive dental exams, cleanings, x-rays, fillings, sealants, and emergency care. Dentures are also provided if necessary.

Tompkins County, NY 2005–2010 172 Community Health Assessment

Figures and Tables

Figure 165 — Oral health status of 3rd grade students, Tompkins County

Oral Health Status, Students Grade 3, Tompkins County, Nov. 2003

100% Free/ Reduced Lunch Other 89% 90%

80% 76%

70% 67% 64% 63% 60% 57% 49% 50% 38% 40% 40% pct students grade 3 30% 26% 27% 21% 20%

10%

0% Caries Untreated 1+ sealants on Dental visit Insurance Flouride Experience Caries permanent within past 12 coverage supplement molar(s) mos. use

Tompkins County, NY 2005–2010 Community Health Assessment 173

Figure 166 — Oral health status, Tompkins County children and HP 2010

Oral Health Status, Tompkins County children

90% Est Pct of Children Tompkins HP2010

80% 84.0%

70% 63.1% 60% 56.1% 50% 50% 42% 40% 35.9% 33.7% 35.6%

30% Estimated pct of children pct Estimated 21% 20%

10%

0% Caries Untreated 1+ sealants on Dental visit Insurance Flouride Experience Caries permanent within past 12 coverage supplement molar(s) mos. use

Tompkins County, NY 2005–2010 174 Community Health Assessment

Physical Activity

egular physical activity, fitness, and exercise are critically important for the health and well being of people of all ages. There is ample evidence that people who exercise R regularly may benefit by lowering their risk of developing heart disease, stroke, Type 2 diabetes, high blood pressure and colon cancer. It also contributes to psychological well-being and reduces feelings of stress. And regular physical activity is integral in maintaining a healthy weight. The 2005 U.S. Dietary Guidelines includes the recommendation of regular physical activity as a means to reduce the risk of obesity along with a healthy diet. Despite the well-known benefits of physical activity, most adults and many children lead a relatively sedentary lifestyle and are not active enough to achieve these health benefits. A sedentary lifestyle is defined as engaging in no leisure-time physical activity (exercises, sports, physically active hobbies) in a two-week period.15

Data Analysis

Relatively little data is available by which to judge the state of physical activity (PA) in a community. Currently the state provides only data collected through the Behavioral Risk Factor Surveillance System (BRFSS) surveys. The most recent local level survey was conducted in 2002 and carries a citation date of 2003. The BRFSS only surveys adults age 18 years and over. In the most recent survey Cortland and Tompkins Counties were surveyed together and are reported as a group. Other rural counties were also grouped for the survey and the data is reported as such. This is done in order to maintain a consistency, to the extent possible, of sample size across the state. This in turn is a way to improve the confidence intervals and thereby the reliability of the data. Leisure-time physical The PA question in the BRFSS survey asks if the respondent has activity in past 30 days participated in any leisure time activity or exercise in the past 30 days. Cort-Tomp ...... 79.9 In the regional comparison which has been routinely employed Cay-Sen-Way ...... 77.1 throughout this document, Cortland–Tompkins have the highest level of Che-Sch-Tio ...... 75.3 CNY...... 74.6 PA as seen in the bar chart, Figure 167, page 177, and at left. NYS Excl. NYC..... 77.6 Note that for strict interpretation of this data the confidence interval NYS ...... 74.6 (C.I.) should be included. Most of the county groupings have a 95% C.I. of about 3.5. The statewide C.I. is 1.0. Accordingly, a strict interpretation may confirm that Cortland–Tompkins residents have a higher level of leisure-time PA than that state as a whole, after accounting for sampling error. However, this level of certainty is risky when making

15 U.S. Department of Health and Human Services. Leisure-time physical activity among adults: United States, 1997- 98. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2002.

Tompkins County, NY 2005–2010 Community Health Assessment 175

regional comparisons. A breakdown of this indicator along demographic lines is also available (see Figure 168, page 178, and Table 16, page 178.) The data table includes confidence intervals, which are quite high for some of the categories. Never-the-less, there can be little doubt of the striking difference in PA participation levels between those with better than a high school education and those with only high school or less — the former being almost 40 percent greater than the latter. Taking sampling error into account, the gap between males and females — 82.1 vs. 77.8 percent — is probably not significant. And though the differences among age groups also probably lacks statistical significance, the visible trend toward less activity for older groups is not inconsistent with anecdotal evidence.

Community Resources

Health Promotion The Tompkins County Health Department’s (TCHD) Health Pro- Program motion Program (HPP) encourages regular physical activity in its outreach efforts regarding the prevention of cardiovascular disease and diabetes. It provides technical assistance to worksites interested in worksite wellness programs that promote physical activity among their employees. HPP maintains a web site with information on worksite physical activity campaigns and incentive programs. www.tompkins- co.org/wellness. (See Figure 169 and Figure 170, page 179.) Activity environment Tompkins County has a rich infrastructure that provides ample opportunity for participation in a variety of seasonal and year-round activities. These include (but are not limited to) 4 state parks, city parks, ice arenas, a skateboard park, numerous walking trails and fitness clubs. The Cayuga Waterfront Trail is a recent endeavor that will eventually connect with the City of Ithaca downtown, the Farmers’ Market, But- termilk Falls State Park and the Black Diamond Trail. The Chamber of Commerce with local businesses, TCHD, community members and planners as participants heads the effort. Tompkins County has numerous clubs and organizations to suit a variety of interests. These include track, rowing, cycling, running, hik- ing and triathlon, clubs and hockey, softball, swimming and tennis associations available to a range of age groups. Healthy City initiative City of Ithaca Mayor Carolyn Peterson invited a number of health professionals, citizens, agency representatives to participate in a “Healthy City” initiative. Promoting regular physical activity to the people who live, work and visit Ithaca is a primary focus.

Tompkins County, NY 2005–2010 176 Community Health Assessment

Opportunities for Action

As noted above, Tompkins County offers numerous opportunities not all of which are mentioned here, to be physically active. And yet there are many residents who remain sedentary. Worksites, schools, community groups, faith communities can provide a supportive environment where daily physical activity becomes the norm. This can be achieved through worksite policies; physical education classes that focus on activities that appeal to students of all abilities and interests and neighborhood walking groups.

Tompkins County, NY 2005–2010 Community Health Assessment 177

Figures and Tables

Figure 167 — Leisure-time physical activity, regional comparison

Participated in Leisure-Time Physical Activity or Exercise During the Past 30 Days (Pct 'Yes') 81 79.9 80

78 77.1 77

76 75.3

Percent 'Yes' Percent 75 74.6 74.6

71 Cayuga, Seneca, Chemung, Schuyler, Cortland, Tompkins CNY NYS Wayne Tioga

Expanded BRFSS, 2003 - New York State Department of Health

Tompkins County, NY 2005–2010 178 Community Health Assessment

Figure 168 — Leisure-time physical activity, Cortland–Tompkins Participated in Leisure-time Phys Activ or Exercise during past 30 days CORTLAND, TOMPKINS 2003 100 87.5 90 82.1 83.6 79.9 77.8 79.5 80 73.2 70 62.9 60 50 40 30 20 10 - Total Male Female 18-34 35-54 55+ HS or less >High School Expanded BRFSS, 2003 - NYS Dept of Health

Table 16 — Leisure-time physical activity, Cortland–Tompkins Participated in Leisure-Time Physical Activity or Exercise During the Past 30 Days CORTLAND, TOMPKINS 2003 Dem Groups n¹ Yes %² n No % C.I.³ Total 505 79.9 138 20.1 3.5 Male 209 82.1 53 17.9 4.9 Female 296 77.8 85 22.2 5.0 18-34 147 83.6 29 16.4 5.8 35-54 196 79.5 50 20.5 5.5 55+ 157 73.2 58 26.8 6.5 HS or less 132 62.9 79 37.1 7.7 >High School 373 87.5 59 12.5 3.4 NYS Total 18,057 74.6 6,115 25.4 1.0 Expanded BRFSS, 2003 - NYS Dept of Health ¹Use pcts based on row denominators <50 with caution ²Weighted Percent ³95% Confidence Interval

Tompkins County, NY 2005–2010 Community Health Assessment 179

Figure 169 — WWTC Web site home page

Figure 170 — “Physical Activity Counts” scoresheet

PERSONAL SCORESHEET Name: ______

Phone: ______Date: ______

Mark daily activities down • Point AC columns: Count 1 point • Goal• P for every 10 minutes • FOR THIS WEEK of moderate• ☞ What Counts for Physical Activity* activity Mon Tue Wed Thu Fri Sat Sun Walking (3 mph or faster; that's 1/2 mile 10 ~or about 1,000 steps~ in 10 minutes) (W) Minutes Active Cleaning chores (C) OF ACTIVITY Biking (road, trail, or stationary)(B) 10 Stairwalking (S) Minutes Jogging (J) OF ACTIVITY Jumping rope or other • 10 in-place aerobics (R) Minutes Active Yard work • OF ACTIVITY (shoveling, raking, hoeing, etc.)(Y) ☞ Mark • additional • Active Team Sports • points here• (soccer, hockey, basketball, etc.)(T) to track up• Swimming Laps (L) to 1 hour• of phyiscal• *Use the (letter) code to mark your daily activity• activities in the chart (right). Try a variety, or stick aday with one that works best for you. Point Total for this week• www.tompkins-co.org/wellness/worksite/ (Count up your physical activity:1 point for every • Healthy Heart Worksite Project, Health Promotion Program, Tompkins County Health Department 02/02 10 minutes of moderately strenuous activity)

Tompkins County, NY 2005–2010 180 Community Health Assessment

Respiratory Diseases

Data Analysis

The International Classification of Diseases (ICD) was revised in 1994. During the transition between ICD9 and ICD10 codes, certain conditions are dual coded. Therefore in this document hospitalization data for categories of respiratory diseases are interchangeably referred to as Chronic lower Respiratory Disease (CLRD) and Chronic Obstruc- tive Pulmonary Disease (COPD.) For the most part Tompkins County shows relatively low incidence in these categories and in asthma. CLRD Mortality It is interesting to note that the Central New York (CNY) region — Age-adj. rates /100,000 driven by Cortland, St. Lawrence and Oswego Counties — has the pop., 2000–2002. highest age adjusted CLRD mortality rate among the eight NYSDOH Tompkins...... 42.7 designated regions. In fact, Cortland County is the highest statewide. Cayuga ...... 57.0 Cortland ...... 71.2 By contrast, Tompkins County has among the lowest age-adjusted Tioga...... 48.9 rates of CLRD death. And though local CLRD deaths have varied over CNY ...... 53.6 the 10-year period 1993–2002, the end of the period is about the same NYS ...... 34.8 as the start. Upstate rates over the period have plateaued after a rise over the latter part of the 1990’s. (See Figure 171 and Figure 172, page 185.) The Healthy People 2010 (HP2010) target, expressed as deaths from COPD, rate age-adjusted per 100,000 population age 45 years and over, is 60.0. CLRD Hospitalizations Hospitalizations caused by COPD are also relatively low in Tomp- Rate per 100,000 pop., kins County in comparison to neighboring counties, the region and 2000–2003. state. The rate in Tioga County however, is about half that in Tomp- ...... All Ages kins. Tompkins...... 184 Cayuga ...... 400 The vast majority of CLRD/COPD hospitalizations occur for indi- Cortland ...... 400 viduals age 65 and over. COPD hospitalizations by age are shown in Tioga...... 94 Figure 173, page 186. When reviewing these data remember that the CNY ...... 335 base of each rate is specific to the segmented population; rates across NYS ...... 391 age groups should not be compared directly, but relatively. Accordingly, where Tompkins County has seen a per-100,000 rate of 184 COPD hospitalizations for the population that includes all age groups, the per-100,000 rate is over 1,000 for the smaller population subset of those age 65+. The actual number counts in these cases, averaged across 2000–2003, are 190 for all ages and 104 for age 65+. Still, although the actual count for the 65+ population is within sight of half that of the general population, within their group of fewer members the relative impact is more than 5 times greater.

Tioga County rates At this time, mention should be made of a statistical uncertainty

Tompkins County, NY 2005–2010 Community Health Assessment 181

which is particularly evident in the data for CLRD and asthma hospitalizations. The Tioga County rates for these indicators are by comparison as to beg an explanation.. For the residents of western Tioga County, Robert Packer Hospital in Sayre, Pennsylvania is likely to be the destination of choice for medical services. The hospital is one mile away from the state border. The statistical uncertainty comes into play because NYSDOH hospitalization data does not include data from hospitals in other states, even if the patient is a resident of New York State. As such, this data is lost with respect to the statistics quoted throughout this section and the entire document. Mortality rates are not affected by this circumstance, and the exact degree to which the hospital discharge rates are affected has not been investigated for the purposes of this document.

Asthma mortality While our region sees annual age-adjusted rates for CLRD deaths averaging around 50–60 per 100,000 population, age-adjusted asthma death rates rarely break 2 per 100,000. Among the counties and regions compared throughout this document, Cortland County has the highest age-adjusted rate for asthma mortality, and Cayuga County the lowest, the latter being about one-fifth of the former. Still, the number counts are small — total deaths for 2000–2002 are 3 in Tompkins County, 3 in Cortland County, one in Cayuga and 2 in Tioga. See Figure 174, page 187 for age-adjusted death rates and Figure 175 for crude (not adjusted) rates. The latter adds the Upstate region to the mix. The reason for this — which will become more evident as hospitalization data are reviewed later in this section — is to provide a statewide comparison that excludes the asthma-heavy weight of New York City. The 10-year trend for asthma mortality in Tompkins County is shown in Figure 176, page 188. While the entire Upstate region shows an overall decrease in asthma mortality rates, the path for Tompkins County cannot be reasonably determined from these data.

Asthma diagnosis: The extent of the population that is living with asthma is revealed BRFSS through the Behavioral Risk Factor Surveillance System (BRFSS) survey and through hospital discharge records. The BRFSS asks respondents if they have ever been diagnosed with asthma by a medical professional and if they are currently diagnosed as having asthma. The limitations of the BRFSS — discussed in sections throughout this document — are evident here, too. These are the high levels of sampling error and the grouping of counties into single data sets (as a way to reign in the error potential.) From the 2003 BRFSS survey, Tompkins County grouped with

Tompkins County, NY 2005–2010 182 Community Health Assessment

Cortland County has the highest level of ever-diagnosed in CNY (see Figure 177, page 188.) When the 95% Confidence Intervals (C.I.) are taken into account, the best interpretation of Figure 177 is that all populations in the comparison have an equal percent of diagnosis. As for the Cortland–Tompkins sample group, it is difficult to reconcile this with other county specific asthma data, for example Figure 181 and Figure 184 that show hospitalization rates for Cortland are much higher that for Tompkins. As for those with a current asthma diagnosis, the BRFSS data shows no real difference across the regional comparison; about 8–9 percent of the population reports being currently diagnosed with asthma (see Figure 179, page 189.)

Looking within the Tompkins–Cortland sampling area, some demographic differences may prove to be statistically significant for ever-diagnosed and/or currently-diagnosed. These cautiously include: more females diagnosed than males, fewer age 55+ than age 18–34 ever-diagnosed, and that a current diagnosis is less prevalent among those with an education above high school. (See Figure 178, page 189, and Figure 180, page 190.)

The asthma hospitalization rate in the New York City (NYC) region is 3-times that of the Upstate New York area. The NYC region includes the counties of Bronx, Kings (Brooklyn), New York (Manhattan), Queens and Richmond (Staten Island.) The Upstate area excludes the NYC counties and the Long Island counties of Nassau and Suffolk. As suggested above, the extremely high rate of asthma hospitalizations in NYC skews the total rate for New York State (NYS) making the latter less useful as a reference point for comparison with local rates. For that reason Upstate area totals replaces NYS totals in some of the asthma hospitalizations presentations. Refer to Figure 181, page 190 and Figure 185, page 192 for clarification. Asthma hospitalizations Tompkins County has among the lowest rates of asthma hospitali- Avg. discharge rate per zations in the state — less than half that of the total CNY rate. (Tioga 100,000 pop, 2000–2002. has the lowest rate statewide. See the discussion about the uncertainty Tompkins...... 56.1 of some Tioga County rates on page 180, above.) The 10-year trend for Cayuga ...... 132.2 Cortland ...... 115.1 asthma hospitalizations has shown a steady decline. From 1993–2002 Tioga...... 29.1 the Upstate rate has dropped 33 percent, and Tompkins County’s 3-year CNY ...... 116.5 average rate has declined 31 percent. Most of that decline came in the NYS ...... 205.9 first half of the period and the Tompkins 3-year average has been relatively flat since 1997. (See Figure 182, page 191.) The single year difference between the high mark in 1993 and the low in 2002 is actually greater, however see-sawing rates from 1997– 2002 suggest the 3-year average is a better tool for reading the long- term trend in Tompkins County.

Tompkins County, NY 2005–2010 Community Health Assessment 183

trend in Tompkins County.

As was described for COPD/CLRD, hospital discharge rates for asthma vary widely by age group (see discussion for CLRD Hospitali- zations, page 180.) However, whereas CLRD hospitalization rates where highest among the age 65+ population, the asthma rates are highest among children age under 5 years. Asthma discharges by Figure 183, page 191 displays Tompkins County discharge rates age across all age groups with a comparative reference to CNY. The full Tompkins 2000–2002. six-way regional comparison is shown in Figure 184, though for only 3 Avg. number /yr. (Rate) age groups: under 5, 5–14, and 65+ years. When reviewing the com- Age <5...... 10 (245) 05–14 ...... 5 (49) parisons by age remember that comparisons across ages demonstrate 15–24 ...... 3 (10) the differing degree of impact — or probability of impact — the disease 25–44 ...... 15 (57) has on a particular age group, not a difference in volume of incidents. 45–64 ...... 11 (57) See Asthma discharges by age at left to compare the numbers for count Age 65+...... 11 (118) vs. rate in Tompkins County.

As discussed above, overall asthma hospitalizations have been declining or steady over the 10-year trend period, 1993–2002 (see Figure 182, page 191.) The course of hospitalizations by age group are relatively consistent with the overall finding. The 3-year average discharge rates for Tompkins County children under age 5 dropped through the mid-1990’s and then flattened or rose slightly from 1997–2002. Three-year rates for the age 5–14 group fell steadily and markedly from 1996 through the period, though the single year rate doubled from 2001–2002 (see Figure 186, page 193 and Figure 187.) Ages 15–24 and 45–64 have also shown declines in asthma hospitalization discharge rates (see Figure 188 and Figure 190.) Upstate rates have followed similar patterns. In opposition to the Tompkins County and Upstate area trends, asthma discharge rates for the local age 25–44 group and age 65 and over group have seen increases over the 10-year review period. (See Figure 189, page 194 and Figure 191, page 195.)

Community Resources

Unrecorded asthma The low asthma hospitalization rate in Tompkins County may lead incidence to the assumption that asthma is not a problem here. It should be noted that hospitalization data is the only source of measurable data. One explanation for the low rates in this county is that asthma is medically well managed here, particularly pediatric asthma. However, there are certain schools within the county where children lack the necessary

Tompkins County, NY 2005–2010 184 Community Health Assessment

medical equipment to manage their asthma due to their family’s financial circumstances. These children often require more frequent and direct care from school nurses to help them manage their condition.

CNY Asthma Coalition In early 2005, TCHD’s Health Promotion Program began working with the Central New York Asthma Coalition. The American Lung As- sociation in Syracuse serves as the lead agency with funds provided by the NYSDOH. Activities are in discussion at the time this document is being prepared.

Tompkins County, NY 2005–2010 Community Health Assessment 185

Figures and Tables

Figure 171 — Chronic lower respiratory disease mortality, regional comparison

CHRONIC LOWER RESPIRATORY DISEASE AGE-ADJ. DEATH RATES PER 100,000 RESIDENTS 80 71.2 70

60 57.0 53.6 48.9 50 42.7 40 34.8

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004. Age adjusted rates adjusted to 2000 U.S. Census

Tompkins County, NY 2005–2010 186 Community Health Assessment

Figure 172 — Chronic lower respiratory disease mortality, 10-year trend

Chronic Lower Respiratory Disease Death Rate Per 100,000 Pop

55 Upstate NY Tompkins Tompkins 3-Yr Avg 50

45 40 40 35 35 33 33 35 35 30 33 33

25 27 24 20

10 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 VITAL RECORDS DATA AS OF AUGUST, 2004

Figure 173 — COPD hospitalizations by age, regional comparison

Hospitalizations Due to Chronic Obstructive Pulmonary Disease (COPD) By Age Avg Rate / 100,000 pop. 2000–2003 1800 1752 1592 Age <18 yrs Age 18–64 yrs Age 65+ 1600

1400 1337 1223 1200 1027 1000

800

600 469

400 327 244 226 211 196 182 145 200 136 93 88 56 31 0 CAYUGA CORTLAND TOMPKINS TIOGA CNY NYS Source: NYS SPARCS data 2000–2003, as of Sept 2004

Tompkins County, NY 2005–2010 Community Health Assessment 187

Figure 174 — Asthma mortality, age adjusted rates, regional comparison

ASTHMA – AGE-ADJ. DEATH RATES PER 100,000 RESIDENTS 2.5

2.1

2 1.7

1.5 1.3 1.2 1.1

0.5 0.4

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004. Age adjusted rates adjusted to 2000 U.S. Census

Figure 175 — Asthma mortality, crude rates, regional comparison

ASTHMA – CRUDE DEATH RATES PER 100,000 RESIDENTS 2.5

2.1

2 1.8

1.5 1.3 1.3 1.2

1.0 1

0.5 0.4

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL UPSTATE NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004.

Tompkins County, NY 2005–2010 188 Community Health Assessment

Figure 176 — Asthma mortality, 10-year trend Asthma Mortality rate / 100K pop

2.5 Upstate NY Tompkins Tompkins 3-Yr Avg

1.5

0.5

0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 V ITA L RECORDS DA TA A S OF A UGUST, 2004

Figure 177 — Ever had Asthma diagnosis (self-report), regional comparison

Lifetime Asthma Diagnosed by a Medical Professional 18

2 10.9 12.9 13.9 12.3 11.5 - Cayuga, Chemung, Cortland, CNY NYS Seneca, Wayne Schuyler, Tioga Tompkins

Expanded BRFSS, 2003 - NYSDOH. Avg 95% C.I. for counties = 3.0; 95% C.I. for NYS = 0.7

Tompkins County, NY 2005–2010 Community Health Assessment 189

Figure 178 — Ever had Asthma diagnosis (self-report), Cortland–Tompkins demographic comparison

Lifetime Asthma Diagnosed by a Medical Professional Cortland, Tompkins 20 18 17.2 15.4 16 14.6 14.7 13.9 13.5 14 12 10.2 9.6 10 8 6 4 2 0 Total Male Female 18-34 35-54 55+ HS or >High less School Expanded BRFSS, 2003 - NYSDOH. Avg 95% C.I. = 4.6

Figure 179 — Current Asthma diagnosis (self-report), regional comparison

Current Asthma Diagnosed by a Medical Professional 12

7.9 9.2 8.6 9.1 7.9 - Cayuga, Chemung, Cortland, CNY NYS Seneca, Wayne Schuyler, Tioga Tompkins

Expanded BRFSS, 2003 - NYSDOH. Avg 95% C.I. for counties = 2.5; 95% C.I. for NYS = 0.6

Tompkins County, NY 2005–2010 190 Community Health Assessment

Figure 180 — Current Asthma diagnosis (self-report), Cortland–Tompkins demographic comparison

Current Asthma Diagnosed by a Medical Professional Cortland, Tompkins 14

11.5 12 11.0 10.2 10 8.6 7.9 8 7.2 7.2 5.9 6

0 Total Male Female 18-34 35-54 55+ HS or >High less School Expanded BRFSS, 2003 - NYSDOH. Avg 95% C.I. = 3.6

Figure 181 — Asthma hospitalizations, regional comparison

ASTHMA - DISCHARGE RATE PER 100,000 POPULATION 205.9 210

180

150 132.2

115.1 116.5 120

56.1 60

29.1 30

0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL NYS TOTAL

SOURCE: 2000-2002 VITAL STATISTICS DATA AS OF AUGUST, 2004.

Tompkins County, NY 2005–2010 Community Health Assessment 191

Figure 182 — Asthma hospitalizations, 10-year trend Asthma discharge rate / 100K pop 180 Upstate NY Tompkins Tompkins 3-Yr Avg 160 169.7 140

120

100 113.9 80.9 80 68.3 84.3 61.4 66.3 79.9 78.5 60 68.5 56.1 40 50.9 51.7 50.4

0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 SPA RCS DA TA A S OF A UGUST, 2004

Figure 183 — Asthma hospitalizations, comparison by age, Tompkins

ASTHMA - Discharge rate / 100,000 pop. – BY AGE

400 CNY Tompkins 398 350

300

250 245 200 184 150

100 109 118 99 80 50 57 57 49 46 10 0 Age <5 Age 5–14 Age 15-24 Age 25-44 Age 45–64 Age 65+

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004.

Tompkins County, NY 2005–2010 192 Community Health Assessment

Figure 184 — Asthma hospitalizations by age, regional comparison

Asthma Hospitalizations By Age: Discharge rate / 100,000 pop. (2000–2002)

550 514 Age <5 Age 5–14 Age 65+ 500

450 398 400 336 350 328 291 300 245 250 183 188 184 200 147 150 118 92 98 99 94 100 63 49 50 13 0 CAYUGA CORTLAND TOMPKINS TIOGA CNY TOTAL UPSTATE

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004.

Figure 185 — Asthma hospitalizations by age, statewide comparison

Asthma Hospitalizations By Age: Discharge rate / 100,000 pop. (2000–2002)

1200 Age <5 Age 5–14 Age 65+ 1040

1000

800 661

600

398 398 403 400 328 248 223 184 200 147 99 94

0 CNY TOTAL UPSTATE NYC TOTAL NYS TOTAL

SOURCE: 2000-2002 SPARCS DATA AS OF AUGUST, 2004.

Tompkins County, NY 2005–2010 Community Health Assessment 193

Figure 186 — Asthma hospitalizations age <5, 10-year trend Asthma discharge rate / 100K pop -- AGE <5

500 Upstate NY Tompkins Tompkins 3-Yr Avg 450

400

350 348

300 285 273 303 250 258 200 236 239 242

150 188 188

100

0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 SPA RCS DA TA A S OF A UGUST, 2004

Figure 187 — Asthma hospitalizations age 5–14, 10-year trend Asthma discharge rate / 100K pop -- AGE 5–14

250 Upstate NY Tompkins Tompkins 3-Yr Avg

200

150 140 131

100 122 76 95 86 75 80 50

39 29 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 SPA RCS DA TA A S OF A UGUST, 2004

Tompkins County, NY 2005–2010 194 Community Health Assessment

Figure 188 — Asthma hospitalizations age 15–24, 10-year trend Asthma discharge rate / 100K pop -- AGE 15–24

120 Upstate NY Tompkins Tompkins 3-Yr Avg

100

44 40 40 40 42

29 20 25 14

15 10 7 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 SPA RCS DA TA A S OF A UGUST, 2004

Figure 189 — Asthma hospitalizations age 25–44, 10-year trend Asthma discharge rate / 100K pop -- AGE 25–44

120 Upstate NY Tompkins Tompkins 3-Yr Avg

100

80 78

60 53 54 63 59 56 40 38 34 36 20 22

0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 SPA RCS DA TA A S OF A UGUST, 2004

Tompkins County, NY 2005–2010 Community Health Assessment 195

Figure 190 — Asthma hospitalizations age 45–64, 10-year trend Asthma discharge rate / 100K pop -- AGE 45–64

160 Upstate NY Tompkins Tompkins 3-Yr Avg

140

120 121 108 100 83 77 80 78 67 60 75 69

40 49 35 20

0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 SPA RCS DA TA A S OF A UGUST, 2004

Figure 191 — Asthma hospitalizations age 65+, 10-year trend Asthma discharge rate / 100K pop -- AGE 65+

250 Upstate NY Tompkins Tompkins 3-Yr Avg

200

150 131 129 113 138 124 100 97

86 50 55 54

33 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

SOURCE: 2000-2002 SPA RCS DA TA A S OF A UGUST, 2004

Tompkins County, NY 2005–2010 196 Community Health Assessment

Tobacco Use

obacco use is the single most preventable cause of death and disease, causing more than 440,000 premature deaths annually in the United States and nearly 25,000 deaths in New T York State, according to the U.S. Centers for Disease Control and Prevention (CDC.) Smoking can cause chronic lung disease, coronary heart disease, and stroke, as well as cancer of the lungs, larynx, esophagus, mouth, and bladder. In addition, smoking contributes to cancer of the cervix, pancreas, and kidneys. Secondhand smoke, a known human carcinogen, is associated with an increased risk for lung cancer and coronary heart disease in nonsmoking adults. The CDC reports that exposure to secondhand smoke results in an estimated 3,000 lung cancer deaths and 35,000 coronary heart disease deaths annually among adult nonsmokers in the U.S. The public financial burden of smoking is staggering. The CDC calculates that direct medical expenditures attributed to smoking total more than $75 billion per year nationwide. In addition, smoking costs an estimated $80 billion per year in lost productivity. According to the New York State Department of Health, direct medical expenses and lost productivity costs amount to $9.82 per pack of cigarettes sold in the state, a total of $11.7 billion in 1998. A significant portion of these costs comes directly out of local budgets in the form of payments to Medicaid.

Data Analysis

One-in-five Tompkins County adults uses tobacco. Of these, 90 percent smoke cigarettes. Those who do not smoke cigarettes use spit tobacco, cigars or other tobacco products. (See Figure 192 and Figure 193, page 200.) These data come from a survey of Tompkins County residents conducted in June 2004 for the Tobacco Control Program of Tompkins County (now called Tobacco Free Tompkins.) Overall tobacco use The survey conducted in Tompkins County was one of six con- Pct residents age 18+ yrs tracted by Central New York (CNY) counties in the spring of 2004. All who use tobacco at least surveys were funded by community coalition grants from the New York some days, 2004 State Department of Health (NYSDOH) Tobacco Control Program Cayuga ...... 25.6 Cortland...... 27.5 (TCP) in the respective county. The Tompkins County Health Depart- Madison...... 22.0 ment (TCHD) has the TCP grant in Tompkins County. Onondaga...... 20.0 Among the participating counties — Cayuga, Cortland, Madison, Oswego ...... 23.9 Onondaga, Oswego and Tompkins — Tompkins County both had the Tompkins...... 19.8 next-to-lowest rate of cigarette use and tied for the highest rate of cigar use among adult residents. (See Figure 194, page 201.) An individual is identified as a smoker if they (1) have smoked at least 100 cigarettes in their lifetime, and (2) currently smoke every day or some days.

Youth Tobacco Survey The Tompkins County Youth Services Department (TCYS) is con- ducting a survey of students in grades 6–12 in April 2005. The survey will provide valuable, up-to-date data on youth tobacco use in the

Tompkins County, NY 2005–2010 Community Health Assessment 197

County. Statewide data on youth tobacco use is available from the NYS- DOH biennial Youth Tobacco Survey (YTS.) The most recent survey, conducted in 2002 among youth grades 6–12, shows some reductions in tobacco use among both middle and high school students. For the state excluding New York City (NYC), significant differences from the 2000 survey were seen among high school students for both ever use of cigarettes — from 63.5 percent to 57.3 percent — and current use of cigarettes — from 32.9 percent to 22.6 percent. Currently, among New York’s middle school students outside of NYC 29.0 percent report ever using cigarettes and 7.0 percent report they currently use cigarettes. In NYC the figures are more favorable, at 26.1 percent and 5.1 percent, respectively according to the 2002 survey. The full report of the YTS is available on the NYSDOH web site, http://www.health.state.ny.us/.

Tobacco use by age, Returning to Tompkins County adults age 18+, the highest rate of gender, and education tobacco use is among men age 25–34 years: 44 percent. Among women, those age 55–64 are most likely to be tobacco users, though the 3-point difference between this group and women age 25–34 may not be significant. (See Figure 195, page 201.) Tobacco use by One of the more interesting bits of information to emerge from the educational attainment 2004 TCP survey of Tompkins County adults is the differences in to- • Tompkins County adults bacco use by educational attainment. age 18+, 2004 As can be seen in Figure 196, page 202, those who have some Less than high school...... 14% college — though less than 4 years — are twice as likely to be tobacco High school grad ...26% users than those who did not receive their high school diploma. High Less than 4 yrs school grads with no college are nearly as likely to be users as those in college...... 28% the some-college group. Those with 4 or more years of college are the 4+ yrs college...... 11% least likely to use tobacco.

College student Gannett Health Services at Cornell University has studied smoking smoking habits among its student population and found that self-description and actual behavior do not always coincide. For example, while 5 percent of students report smoking more than 6 cigarettes a week, only 4 percent describe themselves as smokers. More dramatic, 19 percent of students report smoking between 1 and 6 cigarettes a week, yet only 9 percent describe themselves as an “occasional smoker.” Eighty-four percent describe themselves as non-smokers, yet only 76 percent report smoking no cigarettes per week. (See Figure 197, page 202.)

Local TCP programs The NYSDOH TCP began a new round of 5-year grants in August 2004. In Tompkins County, Cornell Cooperative Extension of Tomp- kins County is the funded Youth Partner and coordinates the teen-based

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Reality Check program. TCHD coordinates the Community Partner (coalition) program under subcontract to the Cortland County Health Department. Both the Community and Youth Partner programs develop their workplans around the TCP’s Draft Strategic Plan for Tobacco Control. The most recent version is dated January 2005. The six goals of the Strategic Plan are: • Eliminate exposure to secondhand smoke. • Decrease the social acceptability of tobacco use. • Promote cessation from tobacco use. • Prevent the initiation of tobacco use among youth and young adults. • Build and maintain an effective tobacco control infrastructure. • Contribute to the science of tobacco control.

According to the June 2004 survey neither Reality Check nor the community coalition are well recognized in Tompkins County (see Figure 198, page 203.) Broadening local awareness of their organizations is an important part of the local TCP activities. Another major activity planned by the community partner program is promoting use of the NYS Smokers’ Quitline, a free resource that two-thirds of Tompkins County adults are not familiar with. (See Figure 199, page 203.) Use of Quitlines as a cessation tool has been shown to be effective and is recommended based on strong evidence by The Task Force on Community Preventive Services (www.the commu- nityguide.org/tobacco/.)

Clean Indoor Air Act The Expanded Clean Indoor Air Act (CIAA) that bans smoking in Percent adults age 18+ almost every workplace in NYS effective July 24, 2003, has been well who favor or strongly fa- received by Tompkins County adults by comparison with other CNY vor the CIAA, 2004. communities. While the proportion of those favoring or strongly favor- Cayuga ...... 55.4 Cortland...... 59.5 ing the Act nears three-quarters in Tompkins, within the other five Madison...... 60.9 counties that participated in the 2004 community surveys, favorable Onondaga...... 62.5 impressions fall short of the two-thirds mark. (See Figure 200, page Oswego ...... 59.6 204.) Tompkins...... 71.6 Just as the CIAA was nearing its July 2003 effective date, a Tompkins County Legislator introduced a local law that included the same provisions for smoke free worksites as the state law. Given the possibility that the state law might be weakened in future state Legisla- tive sessions, this was done to insure that Tompkins County worksites would remain smoke free. Local Law No. 3 of 2003 was passed by the county Legislature in August of 2003.

Sales to minors Tompkins County bars installation of cigarette vending machines

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in any location except bars, and requires that access to all retail tobacco products be restricted to a locked cabinet or to employee-only areas. Compliance with the provisions of the Adolescent Tobacco Use Pre- vention Act (ATUPA) that bans sale of any tobacco products to minors age 17 and under is checked annually by the TCHD Environmental Health (EH) division. ATUPA violations have declined in recent years, a tribute to the county’s strict enforcement policies. EH also monitors compliance with the CIAA and LL No. 3.

Community Resources

The NYSDOH-TCP funded partners — the Youth Partner program Reality Check and the Communitiy Partner coalition, Tobacco Free Tompkins — are working within the community to increase awareness of the health risks of tobacco both to smokers and nonsmokers, especially those living with a smoker. Key demographic targets are pre- venting initiation of tobacco use by youth and cessation among the population groups shown by the 2004 survey to be most at risk. Mothers and Babies Perinatal Network of the Southern Tier has an active program targeting smoking among pregnant women and new mothers. The Tompkins County WIC program also addresses smoking with those enrolled in their program. Tompkins County is also in the catchment area for the state TCP's south-central area Cessation Center. United Health Services in Broome County coordinates the Cessation Center, which focuses on training health care providers to directly address tobacco use and cessation with their patients.

Tompkins County, NY 2005–2010 200 Community Health Assessment

Figures and Tables

Figure 192 –- Tobacco use, Tompkins County adults Overall Tobacco Use, Tompkins County Adults 2004

Use None 80.1%

Cigarettes Only 12.4% Use Both 5.8%

Use Other 1.7% Community Tobacco Survey, Tobacco Control Program (TC), June 2004

Figure 193 –- Cigarette use, Tompkins County adults Cigarette Use, Tompkins County Adults 2004

Former Never 21.2% 60.6%

Everyday 14.6%

Somedays 3.6%

Community Tobacco Survey, Tobacco Control Program (TC), June 2004

Tompkins County, NY 2005–2010 Community Health Assessment 201

Figure 194 –- Tobacco use, adults, regional comparison

Tobacco Use, Percent Age 18+, CNY counties, 2004

30 Current Smokers (%) Use smokeless (% at least some days) Use cigars (% at least some days)

24.7 25 23.9 21.4 20.2 20 18.2 17.2

10 6.5 6.5 4.5 5 3.3 3.1 3.6 3.2 1.7 0.9 1.0 0.4 0.7 0 Cayuga Cortland Madison Onondaga Oswego Tompkins

Community Tobacco Surveys, Tobacco Control Programs of CNY, May–June 2004

Figure 195 –- Tobacco use, Tompkins County adults, by age and gender

Tobacco Use Among Tompkins County Adults, 2004 - By Age and Gender -

44% Males Females

29% 27% 27%

22% 21% 18%

14%

10% 9% 7% 5% 0% 10% 20% 30% 40% 50% 18-24 25-34 35-44 45-54 55-64 65+

Survey of Tompkins County residents age 18+, Tobacco Control Program, TCHD, June 2004

Tompkins County, NY 2005–2010 202 Community Health Assessment

Figure 196 –- Tobacco use, Tompkins County adults, by educational attainment

Tobacco use by education, Tompkins County 2004 30% 28% 26%

24%

18% 14% 11% 12%

Community Tobacco Survey, Tobacco Control Program (TC), June 2004

Figure 197 –- Tobacco use, Cornell University students

Cornell University Tobacco Web Survey (Fall 2002) 90% 84% 80% 76% 70% 60% 50% 40% 30% 19% 20% 9% 10% 5% 4% 0% Regular Smoker (>6 cigs/ wk) Occasional smoker (1-6 cigs/ Non-smoker/ experimental wk) smoker/ ex-smoker All students (actual behavior) All students (self-described) Source: Gannett Health Services, Cornell University

Tompkins County, NY 2005–2010 Community Health Assessment 203

Figure 198 –- Awareness of Tompkins County based tobacco control programs

Awareness of Tobacco Organizations Among Tompkins County Residents

100% Heard of it Have Not

84.9% 79.0% 80%

60%

40%

21.0% 20% 15.1%

0% Tobacco Control Coalition of Tompkins County Reality Check

Surv ey of Tompkins County residents age 18+, Tobacc o Control Program, TCHD, June 2004

Figure 199 –- Awareness among Tompkins County adults of the NYS Smokers’ Quitline

Awareness of the New York State Smokers' Quitline, Tompkins County adults, 2004

70% 66.1%

60%

50%

40% 32.5% 30%

20%

10% 1.3% 0% Heard of It Have Not Don't know Survey of Tompkins County residents age 18+, Tobacco Control Program, TCHD, June 2004

Tompkins County, NY 2005–2010 204 Community Health Assessment

Figure 200 –- Attitudes toward the NYS Clean Indoor Air Act, regional comparison

Favor or strongly favor the 2003 NYS Clean Indoor Air Act 80 71.6 70 62.5 59.5 60.9 59.6 60 55.4

0 Cayuga Cortland Madison Onondaga Oswego Tompkins

Community Tobacco Surveys, Tobacco Control Programs of CNY, May–June 2004

Tompkins County, NY 2005–2010 Community Health Assessment 205

Data Sources

he Tompkins County Health Department collaborates with local agencies, health care providers, and other county agencies and exchanges data with them to gain a comprehen- T sive picture of the county’s assets and resources, gaps in services and needs of particular populations. For more information:

Web Sites

Tompkins County www.hsctc.org Health Planning Council

Tompkins County Of- 2004 Tompkins County Senior Needs Assessment fice for the Aging www.tompkins-co.org/cofa

Tompkins County County Comprehensive Plan – 2004 – The plan contains the principles, Planning Department policies and actions that will guide the county in decisions that influence regional development involving intergovernmental cooperation af- fecting the quality of life in neighborhoods and the community. www.tompkins-co.org/planning

Tompkins County Bu- Healthy Youth, Vital Communities 2004 –2006 – Assessment of data reau of Youth Serv- for collaborative planning. ices www.tompkins-co.org/youth

Tompkins County www.tompkins-co.org/health/ Health Department

Day Care and Child Child Care Data Book: Balancing Supply and Demand – May 2004 Development Council www.daycarecouncil.org of Tompkins County, Inc.

Ithaca Health Care Al- www.ithacahealth.org liance

Cayuga Medical Cen- www.cayugamed.org ter

Tompkins County, NY 2005–2010 206 Community Health Assessment

New York State De- www.health.state.ny.us partment of Health

Tompkins County, NY 2005–2010 Community Health Assessment 207

Community Health Assessment – Distribution

• Tompkins County Public Library • Tompkins County Legislature • Tompkins County Bureau of Youth Services • Tompkins County Office for the Aging • Tompkins County Health Planning Council • Cayuga Medical Center at Ithaca • Available upon request electronically

Tompkins County, NY 2005–2010 208 Community Health Assessment

Index

Acceptability, 197 Low birthweight, 148, 157, 158 Access to health care, 37, 38, 42 Media, 41 Assessment, 15, 38, 39, 131, 162 Medicaid, 45, 46, 47, 53, 54, 55, 56, 85, 148, 171, 196 Barriers, 37 Medical examiner, 44 BRFSS, 45, 75, 76, 79, 80, 97, 98, 106, 116, 160, 161, Morbidity, 15, 75 174, 181, 182 Mortality, 15, 57, 58, 59, 60, 63, 66, 68, 69, 70, 71, 73, 75, Business community, 38 78, 79, 96, 97, 100, 101, 102, 108, 128, 129, 146, 147, Cayuga Medical Center, 36, 37, 46, 47, 51, 52, 53, 60, 61, 152, 153, 154, 180, 181, 185, 186, 187, 188 77, 98, 149, 205, 207 New York State Department of Health, 15, 42, 43, 44, 57, Clinic, 170 58, 60, 77, 83, 96, 98, 105, 116, 118, 119, 128, 129, 130, 149, 170, 180, 184, 196, 197, 206 Collaboration, 39, 162, 205 Nutrition, 41, 98, 148, 162 Colleges and universities, 17, 18, 19, 20, 21, 36, 61, 83, 84, 107, 197, 202 Oral health, 170, 172, 173 Communicable & infectious diseases, 41 Organizations, 38, 61 Diversity, 19, 20, 30, 31, 57, 74, 175 Outreach, 175 Education level, 17, 18, 43 Partner, 197 Emergency medical services, 44 Partners, 42, 77, 148, 149 Families, 19, 33, 83, 158 Poverty, 21, 32, 33, 34, 38, 47, 148, 158 Fee, 36 Preventive health care, 83, 128, 170, 171, 174, 196, 198 Gaps, 37, 205 Primary care, 55 Government, 18, 38, 39, 43, 61, 170, 171, 198, 207 Priorities, 38, 39 Health care providers, 15, 36, 41, 42, 60, 61, 117, 118, 162, Providers, 36, 38, 55, 119, 146, 199 205 Quality, 42, 205 Health education, 41, 162 Resources, 15, 36, 37, 61, 205 Health Planning Council, 36, 39, 46, 205, 207 Schools, 17, 18, 20, 21, 26, 38, 39, 41, 45, 75, 76, 84, 85, Health Promotion Program, 41, 77, 98, 162, 175, 184 98, 119, 160, 161, 170, 175, 176, 182, 183, 196, 197 Healthy People 2010, 15, 45, 52, 57, 58, 59, 75, 76, 85, 97, Sex, 106 98, 105, 116, 117, 146, 147, 148, 149, 160, 161, 171, Sexually transmitted diseases, 105, 106, 107, 115 173, 180 Tompkins County Health Department, 36, 39, 41, 42, 43, High-risk populations, 75, 199 44, 47, 60, 77, 85, 98, 106, 107, 117, 118, 119, 148, HIV, 41, 105, 107, 109 149, 162, 170, 171, 175, 184, 196, 197, 198, 205 Hospitals, 46, 76, 96, 98, 128, 129, 180, 181, 183 Towns, 17, 21, 46, 60, 146, 148 Households, 19 Transportation, 37, 42, 171 Housing, 38 Tuberculosis, 41, 117 Income, 20, 21, 31, 32, 47 Unemployment, 18 Infant mortality, 146 Vaccination, 116, 117, 119 Injury prevention, 41 Worksite, 57, 98, 162, 175, 176, 198 Institutions, 17 ZIP code, 57, 58, 60, 64, 65, 67, 72, 73, 146, 151, 152 Insurance, 38, 45, 46, 49, 50, 52

Tompkins County, NY 2005–2010