The State of Health in New Mexico 2011 - New Mexico Department ...

allengesmean opportunities for further reductionsof disease burden.TobaccoTobacco use is the leading preventablecause of death in the United States andNew Mexico. Tobacco use kills anestimated 440,000 people per year in theU.S and about 2,100 people per year inNM. Fortunately, the adult smoking rateshave dropped from 24% in 2001 to 18% in2009. Of concern is the fact that currently24% of high school youth in NM smokecompared to 20% nationally. Should theseyouth continue smoking into adulthood,our statewide adult rates will increase. NewMexicans are protected by stronglegislation, the Dee Johnson Clean IndoorAir Act. Continued efforts to prevent youthfrom initiating smoking behaviors will beimportant in the future.DWI/Motor Vehicle Injury andMortalityMotor vehicle mortality rates for NewMexico have dropped dramatically over thelast several decades. Alcohol-impairedmotor vehicle crash death rates have alsodropped dramatically during this time.Despite these reductions, injuries anddeaths from motor vehicle crashes remaina burden in New Mexico. Motor vehiclecrashes are the leading preventable causeof death in young people. Graduateddrivers’ licenses have been an effective toolfor reducing motor vehicle crashes amongyouth. Numerous efforts have beenimplemented to reduce driving whileintoxicated (DWI) in recent years. Acomprehensive DWI prevention programinvolving enhanced DWI and liquor controllaw enforcement and related media activity,has contributed to a 40% reduction in thealcohol-impaired motor vehicle trafficcrash fatality rate from 2004 to 2008. NewMexico has also done a remarkable jobimproving seat belt use. Safer cars,improved road design and construction,and continuous enforcement of laws andprosecution of offenders may lead tochanging social norms and furtherreductions in motor vehicle crash injuriesand deaths.Violence—Homicide andSuicideThe World Health Organization definesviolence as the intentional use of force orpower, threatened or actual, against oneselfor another person, group, or community.Intentional, most often violent, injuriesconsist primarily of suicides, assaults, andhomicides. New Mexico had the secondhighest violence-related injury death rateamong states nationally in 2007—66%higher than the rate for the U.S. The causesand prevention of violence are complex andrequire intervention at multiple levels.Aging Related Disease andInjury—Alzheimer’s Disease,Falls in the Elderly, SuicideWith the aging of the population as timegoes along, we would anticipate morehealth issues seen in older populations.Three areas where we know we alreadyhave increasing rates are Alzheimer’sdisease, falls in the elderly, and suicideamong the elderly. New Mexico has seendramatic increases in rates of Alzheimer’sdisease similar to those seen nationally.Unintentional fall deaths among the elderlyhave also increased dramatically. Suiciderates increase with age and are very highamong those 65 years of age and older,because older adults are more likely to besuffering from physical illnesses and to bedivorced or widowed.Access to Healthcare in aChanging Healthcare DeliveryEnvironmentWith recent federal legislation to extendhealthcare coverage to most Americans,the impact on public health remainsuncertain. Greater access to healthcareshould mean improved medical care forthose who did not have access previously,however, this legislation will not affectunderlying socioeconomic, community andpopulation dynamics that drive mostconditions and diseases of public healthimportance. With the economic downturn,it is likely that the need for public healthinterventions will increase into theforeseeable future.What is Being Done Statewide DWI preventionprograms have been effectiveand need to continue. Statewide tobacco controlefforts have been useful inreducing tobacco consumption. New efforts to reduce healthcareassociated infections have beenimplemented in the state. Immunization efforts have beensuccessful in eliminating orreducing many preventableinfectious diseases.What Needs to Be Done A comprehensive effort toreverse the obesity andoverweight trend in New Mexico. An in-depth review of theeffectiveness of substanceabuse programs in the state. Development of acomprehensive food safetyprogram in New Mexico.Preface Review of systems and supportfor elderly persons in NewMexico. Planning for how theDepartment of Health cansupport health statusimprovements in a changinghealthcare environment.Preface 5

ds are Largely Stableincluding prescription drug overdoses,contribute significantly to all of theseindicators except deaths from falls.However, prescription drug use may alsobe a factor in fall deaths occurring largelyamong older and elderly adults, sincemany people in these age groups aretaking multiple medications which couldinteract in harmful ways.A number of worsening health trends areassociated with the rising obesity rates. Bothobesity and morbid obesity, typically 100pounds or more overweight, have markedlyincreased with the morbid obesity rate(Figure 3) in NM doubling during the lastdecade. The increasing prevalence of obesityis likely contributing to the worseningdiabetes prevalence rate and the worseningarthritis hospitalization rate in NM.Several trends for indicators that reflectthe quality and appropriateness of healthcare in NM are worsening. This analysisshowed that caesarean section rates areincreasing, vaginal births after C-sectionare decreasing, HIV screening rates aredecreasing, and hospitalization rates foradverse effects of medical and surgicalcare are increasing. The fact that all ofthese rates in NM are worsening suggeststhat evidence-based medical practiceguidelines need to be followed morerigorously, and additional systems, such assurveillance of healthcare-associatedinfections, need to be developed forassuring appropriate care.The last cluster of worsening health trendsis associated at least partly with an agingpopulation. While these rates were ageadjustedsuch that the rate was indexed toa standard US population age structure,some rates of older adult and elderlydisease and death are increasing. Rates forAlzheimer’s disease deaths, fall deaths,arthritis hospitalizations, and septicemiahospitalizations all are associated with anaging population.Future Health TrendsAs mentioned earlier, most health trends didnot significantly change over the last decade.Perhaps some currently unchanging healthtrends may improve during the next decade.With healthcare reform and furtherreductions in the number of people withouthealth care coverage, healthcare sensitiveindicators such as prenatal care in the firsttrimester of pregnancy, asthmahospitalization, hypertension hospitalization,and diabetes hospitalization may improve. Inaddition to improved health care coveragerates, greater adherence to evidence-basedpractice guidelines in New Mexico’shealthcare system will also be required forthese healthcare system sensitive indicatorsto move in the right direction.Also on the wish list for the next decadewould be decreasing obesity and problemdrinking trends in New Mexico. Throughaggressive targeting of these health riskbehaviors—similar to what has alreadyoccurred for smoking—obesity andproblem drinking rates should decrease.Successfully reducing these health riskbehaviors will have a positive snowballeffect on many related health outcometrends and significantly improve the healthstatus of New Mexico.The final item on the next decade healthwish list would be a reduction in the NewMexico poverty rate. The poverty rate, andassociated income inequality, has a greaterimpact on overall health status in NewMexico than any other single indicator.Health TrendsSelected Health Trends inNew Mexico for Various Years1998–2009Improving TrendsTeen birthInfant mortalityOlder adult (65–84 years) mortalityHeart attack mortalityHeart disease hospitalizationCancer hospitalizationHepatitis A and BAdult health care coverageAdult smokingAdult binge drinkingYouth smokingYouth binge drinkingWorsening TrendsCaesarean sectionVaginal birth after Caesarean sectionYoung adult (25–34 years) mortalityUnintentional injury mortalityFalls mortalityPoisoning mortalityAlzheimer’s disease mortalitySuicide attempt hospitalizationAdverse effects of medical andsurgical care hospitalizationArthritis hospitalizationSepticemia hospitalizationAdult diagnosed diabetes prevalenceAdult obesity prevalenceAdult ever tested for HIVYouth obesityStable TrendsPrenatal care in first trimesterChild (1–14 years) mortalityTeen (15–24 years) mortalityAdult (35–64 years) mortalityElderly adult (85 years and older)mortalityMotor vehicle crash mortalitySuicideAlcohol-induced mortalityHeart disease mortalityDiabetes mortalityInfluenza and pneumonia mortalityCancer mortalityDiabetes hospitalizationAsthma hospitalizationTuberculosis infectionHIV new infectionPertussis infectionSalmonellosis infectionAdult physical activityYouth sexual activityHealth Trends 7

TableMothers’ Experience of Pregnancy andChildbearing, NM, 2007–2009Race/EthnicityPregnancy wasunintendedDid not getprenatal care asearly as wantedAbused duringpregnancyExperiencedpostpartumdepressionHispanicAmericanIndianWhite46.5% 48.8% 39.6%23.0% 26.5% 21.6%5.0% 8.7% 3.8%19.9% 24.6% 18.1%Source: NM Pregnancy Risk Assessment and Monitoring System.African-American and Asian/Pacific Islander data not included becauseof small numbers.Figure 1Births Among Teen Girls by RegionAge 15–17, NM, 1992–2007Births per 1,000 teen girls7060504030201001993–1995SouthwestSoutheastBernalillo CountyNortheastNorthwest1996–19981999–2001Source: NM Vital Records and Health Statistics2002–20042005–2007Figure 2Percent of Births with Low/No PrenatalCare by Mother’s Race/Ethnicity, NM, 2007Percent20161284011.1 17.4 7.9 11.9 11.5 7.5All RacesAfrican Hispanic WhiteAmericanAmericanIndian orAlaskan NativeAsian orPacificIslanderSource: NM Vital Records and Health StatisticsHealthy Mothers Make HAbout 30,000 babies are born every year inNew Mexico. Mothers whose pregnanciesare intended, who enter prenatal care inthe first trimester, and whose lives are freefrom domestic violence are better able togrow, deliver, and nurture healthy babies.Under ideal circumstances, babies are bornto mothers who do not use tobacco oralcohol, and who take nutritional supplementscontaining folic acid before and duringpregnancy in order to prevent certain birthdefects. Good mental health is essential.Racial/ethnic disparities affect mothers’experiences of pregnancy and childbearing(Table). The New Mexico Pregnancy RiskAssessment Monitoring System (PRAMS)asks each participating mother if herpregnancy was intended or unintended, ifshe was able to initiate prenatal care asearly as she wanted to, if she wasphysically abused when she was pregnant,and if she experienced symptoms ofpostpartum depression.Teen BirthsThe rate of births to 15–17 year old girls inNew Mexico decreased steadily from52.9/1,000 girls in 1992 to 32.9 in 2007. Thenortheastern region consistently had thelowest teen birth rates, while thesoutheastern region had the highest rates(Figure 1). Hispanic teens have the highestbirth rates both in New Mexico andnationally. Almost half of the population offemales ages 15–17 years in New Mexico isHispanic, yet they account for 70% of thebirths to this age group.Prenatal CareIn 2007, 73% of live births were to motherswho initiated prenatal care in the firsttrimester, up from 65.3% in 2000. Duringthat same year, 11.1% of live births were towomen who received either low or noprenatal care. American Indian mothershad the highest percent of births with lowor no prenatal care, followed by African-American mothers, Hispanic mothers, andWhite mothers. Asian or Pacific Islandermothers were least likely to have receivedlow or no prenatal care (Figure 2).AbuseThe percent of mothers reporting that theywere physically abused during pregnancydeclined steadily from 7.2% in 2003 to 4.4%in 2007. From 2003–2007, mothers with 12or fewer years of education were morethan twice as likely to report being abusedby their partners as those with 13 years ormore. American Indian mothers were mostlikely to have been abused (9.6%) followedby Hispanic mothers (5.7%) and Whitemothers (3.9%).Tobacco and Alcohol UseDuring PregnancyAbstaining from alcohol and tobacco isessential to a healthy pregnancy. During2001–2007, White mothers (13.5%) werealmost twice as likely to smoke duringtheir last three months of pregnancy ascompared to Hispanic mothers (7.4%) andmore than three times as likely asAmerican Indian mothers to do so (4.3%).White mothers were also more likely toconsume alcohol during the last threemonths of pregnancy (7.2%) thanAmerican Indian (4.5%) and Hispanicmothers (3.9%).Maternal DepressionMaternal depression affected an estimated18% of New Mexico mothers in thepostpartum period during 2006–2008.Women on public assistance (24.2%), whoexperience domestic violence (39.8%), whoare teens (26.2% among 15–17 year olds),or who are Native American (22.7%)experienced higher rates of postpartumdepression symptoms compared to all NMmothers.Infant MortalityFrom 2000 to 2009, the infant mortalityrate for all of New Mexico was 5.9 infantdeaths per 1,000 live births. The rate washighest for African American infants at13.5/1,000, followed by American Indianinfants (7.6), Hispanic infants (5.6), Whiteinfants (5.3) and Asian infants (2.1). Duringthat five year period, a total of 857 infantsdied before the age of one year.8 NM State of Health 2011

ealthy BabiesPrematurity andLow Birth WeightFrom 2006–2008, 5,341 low birth weightbabies (

Figure 1Death Rates of Children Ages 1–14 byRace and Ethnicity, NM, 2000–2009Rate per 100,000 population4030201037.2 23.2 24.4 19.40American African- Hispanic WhiteIndian Americanor AlaskanNativeSource: NM Vital Records and Health Statistics. Asian/Pacific Islanderdata not included because of small numbers.Figure 2Hospitalization Rates of ChildrenAges 1–14 by Race and EthnicityNM, 2000–2009Rate per 10,000 population1401301201101009080706050403020100EndocrineMetabolicImmuneMentalTableImpact of Children with Special Health CareNeeds on their Family, NM, 2005–2006Child’s Special NeedsImpact on FamilyRespiratoryPercentNorthwestNortheastBernalillo CountySoutheastSouthwestDigestive Injury &PoisoningSource: Hospital Inpatient Discharge Database, NM Health PolicyCommission. HIDD does not include data from Indian Health Service(IHS) facilities, which account for a large proportion of hospitalizationsfor NM’s American Indian population.EstimatedNumber ofFamiliesFamilies pay $1,000 ormore out-of-pocket per 19.9 11,737year for careChild’s conditions causefamily financial problems 20.4 12,053Families spend 11 ormore hours per week 13.0 7,671providing health careChild’s condition(s) causefamily members to cutback or stop working25.1 14,807Source: National Survey of Children with Special Health Care Needshttp://cshcndata.org/NM Makes Progress ImprIn 2009, there were 387,339 children ages1–14 years in New Mexico—18.4% of thetotal population. Results from the 2007National Survey of Children’s Healthshowed that 84.4% of New Mexico’schildren were in excellent or very goodhealth. Approximately 24% of New Mexicochildren live in poverty, and from2006–2008, 8.6% lived in families where noparent had full-time employment, whichwas down from 10.0% in 2005–2007. Closeto 33% of children are overweight or obese,and 14% of children ages 1–5 years engagein four or more hours of “screen time”every weekday, including TV and videos.In 2008, it was estimated that 12.8% of NewMexico children did not have healthinsurance.Child DeathsFrom 2005–2009, there were 457 deaths toNew Mexico children ages 1–14 years.Compared to Hispanic and Whitechildren, American Indian children hadthe highest death rate during those years(Figure 1).The leading cause of death for allchildren in New Mexico wasunintentional injury, which accounted for174 deaths during the five year period.Motor vehicle crash deaths, where thechild was either an occupant orpedestrian, were the leading cause ofchild unintentional injury death, followedby drowning and fires.For younger children ages 1–4 years, thesecond and third leading causes of childdeaths were birth defects and homicide.The rates for birth defects during theperiods 2000–2004 and 2005–2009 were2.5/100,000 and 2.6/100,000, respectively.Homicide rates for those same periodsdropped from 2.5 to 1.5/100,000. Forolder children ages 5–14 years, cancerand suicide were the second and thirdleading causes of death. From 2001–2009,the number of deaths of children fromcancer ranged from 3 (2005 and 2009) to11 (2004 and 2008). The number of NewMexico children that committed suicideranged from 3 (2002 and 2006) to 10(2003).Childhood IllnessIn 2008, the vast majority of hospitaldischarge diagnoses for all children werefor respiratory disease (Figure 2). From2004–2008, children ages 1–4 years werehospitalized for respiratory disease at arate of 169/10,000, and those ages 5–14years at a rate of 30/10,000. In 2008, therewere 2,477 hospitalizations for respiratorydisease among children ages 1–14 years.For younger children, the next leadingdiagnoses were injury and poisoning (256hospitalizations) and endocrine/nutritional& metabolic diseases/immunity disorders(265 hospitalizations.) For older children,mental disorders (976 hospitalizations) anddiseases of the digestive system (831hospitalizations) were the second and thirdleading diagnoses.Children with SpecialHealth Care NeedsIn 2005–2006, the second national surveyof Children with Special Health CareNeeds (CSHCN) estimated that 59,535(12.1%) of New Mexico children hadspecial health care needs, compared to13.9% nationally. Nine percent wereAmerican Indian, 10.7% were Hispanic, and15.2% were White. The most commondiagnosis for CSHCN in New Mexico isasthma. Fewer New Mexico special needschildren lived in poverty compared tonationally. About 5% of special needschildren did not have health insurance atthe time of the survey, and 36% hadinsurance that was inadequate. NewMexico compares favorably with the nationin the percentage of CSHCN who arescreened early and continuously for specialhealth care needs at 64%.The health of New Mexico’s special needschildren improved in many areas from2001. Fewer families reported that theirchild’s condition affected their activities agreat deal, and the percent of CSHCNwithout health insurance at the time of thesurvey dropped from 8.9% in 2001 to 5.5% in2005–2006. The percent of children withouta usual source of care, or who relied on theemergency room for care, dropped from8.0% to 4.9%. Fewer families reported that10 NM State of Health 2011

oving Children’s Healththeir child’s condition caused their familyfinancial problems (Table), however thepercent of CSHCN whose families had topay $1,000 or more out-of-pocket for theirchild’s care more than doubled from 9% to20% between the two survey periods.Preventing Childhood InjuriesMost unintentional injuries are preventable,and New Mexico has passed legislation thatprotects children, such as the child boosterseat law in 2005 and the 2007 child helmetlaw. In 2005, New Mexico began requiringignition interlock devices for all convicteddrunk drivers. The New Mexico SAFEKIDS state coalition, established in 1991now manages a network of 12 coalitionsand chapters statewide, with localsponsorship or active membership by theentire network of nine trauma centers.Suicide and HomicideFamily, community, and school violencecontribute to child suicide and homicide.New Mexico Voices for Children works onyouth violence prevention through itsyouth leadership and policy developmentprogram. School districts in New Mexicodevelop and implement comprehensiveSafe School Plans that include violenceprevention activities such as mentoring,mediation, and anti-bullying programs andpolicies. The New Mexico Suicide CrisisLine Network provides 24/7 toll-freecoverage, and the New Mexico BehavioralHealth Collaborative works to address themental health needs of all New Mexicans.There is greater awareness of positiveyouth development approach principlesand more people want practical steps onhow to implement and incorporate themwithin their work and daily lives. Best andpromising practices point toward youthengagement and youth-led projects forpositive youth development, but fundingfor these types of activities is limited.community about reasons for and solutionsto the asthma problem. Regional differencesin need, asthma triggers, resources, asthmaactivities, and access to care andtraining/education were discovered. Thisinformation helped to tailor interventionsthat could have the greatest chance ofsuccess in a given area. One importantpurpose of the asthma summits was tomobilize communities to be a crucial partof the solution to the problems they face.As a result of the statewide asthma summitsthere has been an increase in the use ofasthma action plans for children seen inasthma clinics, leading to improvedcollaboration between pediatric pulmonaryspecialists, school health nurses, primarycare practitioners, and families; extensivecommunity asthma education trainingprovided by Project ECHO and AsthmaAllies; targeted outreach to thenorthwestern and southeastern parts of thestate where asthma rates are highest; andthe establishment of the Asthma Council, aprivate public partnership to addresspediatric asthma.The health of New Mexico’s children isdetermined by a complex interaction ofphysical, social, emotional, economic,educational, and environmental factors.New Mexico continues to work to ensurethat children are fed, housed, educated,safe, and cared for within healthy families.Because no single agency orprogram can address every factorthat affects child health,improvement depends oncontinued successful collaborationamong families, healthprofessionals, educators, andadvocates from thegovernment andprivate sector.Healthy ChildrenWhat is Being Done Early Childhood Action Network(ECAN) is a large network ofearly childhood advocatesthroughout the state who workon and promote early childissues. Family Leadership ActionNetwork (FLAN) is an initiativedesigned to promote parentinvolvement and build familyleadership in shaping thesystem that impacts their livesand their children’s future. Children’s Medical Services workswith the UNM Center forDevelopment and Disability’sLEND Program to train futureleaders in health policy andprograms by enhancing educationabout children and youth withspecial health care needs.What Needs to Be Done Increase the number of childrencovered by New MexiKids(Children’s Medicaid and StateChildren’s Health InsuranceProgram). Promote Early PeriodicScreening, Diagnostic, andTreatment (EPSDT) services forall children. Increase coordinated, familycentered,community-based carefor children and families. Encourage health care providersto practice in underserved areasof New Mexico. Support healthy food choices andphysical activity for children.Respiratory DiseaseNew Mexico initiated a series of sixpediatric asthma summits in five locationsaround the state, to seek input from theHealthy Children 11

Figure 1Past 30-Day Drug Use Among YouthGrades 9–12, NM, 2009100Healthy Youth Become HPercentPercent806040205.6 3.928.0 14.3 8.0 7.73.20Marijuana Pain Ecstasy Inhalants Cocaine Meth-HeroinKiller toamphet-Get HighamineSource: NM Youth Risk and Resiliency SurveyFigure 2Current Alcohol Use Among YouthGrades 6–12, NM, 200910080604020Middle SchoolHigh School10.2 14.7 23.6 33.1 41.2 44.0 45.406th 7th 8th 9th 10th 11th 12thSource: NM Youth Risk and Resiliency SurveyFigure 3Obesity Among Youth, Grades 9–12NM, 2001–2009Percent10080604020010.228.013.52001 2003 2005 2007 2009Source: NM Youth Risk and Resiliency SurveyThe behaviors of New Mexico youth have agreat impact on their health as youngpeople and later as adults. Risk behaviorsinitiated during adolescence are closelyassociated with disease, disability, anddeath among youth and older people.From 2007 to 2009, the three leadingcauses of death among New Mexicoadolescents ages 13–19 years wereinjuries—predominantly motor vehiclecrashes, suicide, and homicide. 1 Thesecauses of death are associated withalcohol use, drug use, suicidal ideationand attempts, physical violence, and otherbehaviors. The chronic diseases that areamong the leading causes of death forolder New Mexicans, including heartdisease, cancer, respiratory disease,stroke, and diabetes, are associated withrisk behaviors that are often initiatedduring adolescence. These behaviorsinclude tobacco use, alcohol use,inadequate physical activity and poornutritional practices. Unsafe sexualbehaviors put young people at risk ofunplanned pregnancy and sexuallytransmitted infections includingHIV/AIDS. All of these behaviors wereexamined among high school and middleschool students with the 2009 NewMexico Youth Risk and Resiliency Survey(YRRS).Alcohol, Tobacco, andOther Drug UseAlcohol use at an early age is associatedwith adverse outcomes later in life, such asalcohol dependence and abuse and chronicliver disease. 2 Alcohol use is also highlyassociated with traffic-related fatalities andother injuries. Most alcohol relatedbehaviors have decreased in prevalence inrecent years among New Mexico highschool students. Current drinking (at leastone drink in the past 30 days) decreasedfrom 50.7% in 2003 to 40.5% in 2009. Overthe same years, binge drinking decreasedfrom 35.4% to 25.0%, and drinking anddriving decreased from 19.1% to 9.7%.Compared to the U.S., NM high schoolstudents had a very high rate of alcoholuse before the age of 13 years (NM 29.4%;U.S. 21.1%).Illicit drug use among adolescents isassociated with heavy alcohol and tobaccouse, 3 violence, and suicide. Drug useamong adolescents in NM remained highin 2009 (Figure 1), although someimportant measures of drug use havedecreased in recent years. Among highschool students from 2003 to 2009, past30-day use of methamphetamine andcocaine both decreased(methamphetamine from 7.3% to 3.9%;cocaine from 8.9% to 5.6%). 14.3% of highschool students used painkillers to gethigh, a very risky behavior because ofopiates present in these prescriptionmedications. New Mexico high schoolstudents had a higher rate than the rest ofthe U.S. for use of cocaine, heroin,methamphetamine, ecstasy and injection ofillegal drugs. Among middle schoolstudents, 15.1% ever used marijuana, 14.2%ever used inhalants, and 5.7% ever usedcocaine.Cigarette smoking increases the risk ofseveral chronic diseases, such as heartdisease, chronic obstructive pulmonarydisease, acute respiratory illness, stroke,and various cancers. 4 Spit tobacco, orsmokeless tobacco, is associated with oralcancer and other oral conditions, heartdisease, and stroke. In 2009, 24.0% of highschool students and 6.8% of middle schoolstudents were current smokers, defined ashaving smoked cigarettes in the past 30days. While several measures of cigarettesmoking have decreased in recent years,use of spit tobacco has increased.For most measures, alcohol, tobacco anddrug use increased dramatically by agegroup over grades 6–8, and increasedmuch less markedly from grades 9–12(Figure 2).Mental HealthThe past 12 month suicide attempt rate in2009 was 9.7% among high school students.While this was substantially lower than the2007 rate (14.3%), it was higher than theU.S. rate (6.3%). Suicidal ideation andpersistent feelings of sadness orhopelessness were more common amonggirls than boys. Among middle school12 NM State of Health 2011

althy Adultsstudents, 6.8% ever tried to kill themselves.As with high school students, suicidalideation was more common among girlsthan boys.Sexual BehaviorsAdolescents who initiate sexual intercourseat an early age are less likely to usecontraception, are at higher risk forunplanned pregnancy, and are likely tohave a greater number of lifetime sexualpartners than those who wait until later toengage in sex. 5 In 2009, 48.0% of highschool students and 10.8% of middle schoolstudents ever had sexual intercourse.Among middle school students, ever havingsexual intercourse was more commonamong boys than girls (14.0% vs. 7.8%), butthere was no statistical difference betweenthe rates for boys and girls in high school.Middle school students had higher rates ofcondom use than high school students.Only 5.5% of sexually active high schoolstudents used both a condom and a highlyeffective form of birth control, such asbirth control pills or injectable birth controllike Depo-Provera.ViolencePhysical fighting was more commonamong New Mexico high school studentsthan U.S. students (37.3% vs. 31.5%).Among middle school students, half(50.4%) had ever been in a physical fight.Fighting was more common among boysthan girls in both high school and middleschool. Teen dating violence in the last 12months decreased among high schoolstudents from 12.6% in 2007 to 9.8% in 2009.Being bullied on school property wasreported by 19.5% of high school studentsand 31.2% of middle school students.Body Weight, Nutrition, andPhysical ActivityObesity in adolescents is associated withdiseases such as type 2 diabetes andhypertension, negative psychological andsocial consequences, 6 and an increasedrisk of adult obesity. Obesity among NewMexico high school students has beenincreasing in recent years. In 2009, 13.5% ofNew Mexico high school students wereobese, up from 10.2% in 2003 (Figure 3).An additional 14.6% were overweight, for atotal of 28.1% whose body weight wasabove the normal range. Boys were morethan two times as likely as girls to be obese(18.3% vs. 8.5%).Poor nutrition is associated with obesity,overweight, and other chronicconditions. 7,8 A diet high in fruits andvegetables may lead to a decreased risk ofbeing obese or overweight, whileconsumption by children of sugarsweetened beverages is a risk factor foroverweight and obesity. In 2009, only 20.9%of high school students ate five or moreservings of fruits or vegetables per day,and 30.4% drank at least one soda per day.Regular physical activity can reduce bodyfat, maintain body weight, and reduce therisk of chronic diseases. 9 At least 60minutes of daily physical activity isrecommended for children aged 6–17years. 23.4% of high school students and30.2% of middle school students achievedthis level of physical activity. In both highschool and middle school, boys were morelikely than girls to attain recommendedlevels of physical activity (HS 29.4% vs.17.5%; MS 35.9% vs. 24.6%). About one-thirdof students in both middle school (33.2%)and high school (32.6%) watched televisionfor 3 or more hours per day on a typicalschool day.In recent years, New Mexico has seenimproving trends in rates of youth alcohol,tobacco, and drug use, and an increase inthe rate of youth obesity. Compared to therest of the United States, New Mexicoyouth have high rates of suicide attemptsand ideation, behaviors associated withviolence, tobacco use, alcohol use, anddrug use. Many students initiate riskbehaviors during the middle school years.While prevention measures among highschool students should be maintained, it isalso important to target prevention effortsamong younger students.Healthy YouthWhat is Being Done Trends in youth health statisticsare being monitored with the NMYouth Risk and Resiliency Survey. Alcohol and drug preventionprograms at the local level. Seventy-nine school basedhealth centers offer services andinformation throughout thestate related to primary care,reproductive health, mentalhealth, and substance use. Suicide prevention programs. Peer-to-peer mentoring.What Needs to Be Done Increase positive youthdevelopment and leadershipprograms, with meaningfulengagement with youth todevelop, implement, andevaluate them. Increase and improve servicesavailable at school based healthcenters, including primary careand confidential health services,in areas such as reproductiveand behavioral health. Increase healthy nutrition andphysical activity interventionstargeting middle school agedyouth.Healthy Youth 13

Figure 1Hospitalization Rates by Age andRace/Ethnicity, NM, 2009–2010Influenza SeasonRate per 100,000 populationFigure 2Pertussis Rates by Age, NM, 2007–2009Rate per 100,000 populationNumber of cases16014012010080604020153.0 51.0 37.8 47.5 46.1 106.1 35.8 45.8 60.2 32.200–4 5–24 25–49 50–64 65+ Amer. Asian/ African Hispanic WhiteIndian Pacific Amer.IslanderSource: Infectious Disease Epidemiology Bureau1101009080706050403020100Less than 1 Year1 to 4 Years5 to 9 Years10 to 19 Years20 Years and Older2007 2008 2009Source: NM Electronic Disease Surveillance SystemFigure 3HIV Diagnosis by Race/EthnicityNM, 2002–2009100908070605040302010020022003Age200420052006200720082009Hispanic African AmericanWhiteAsian/Pacific IslanderAmerican Indian/Alaskan NativeSource: Enhanced HIV/AIDS Reporting SystemRace/EthnicityOld Infections, New PrevInfluenzaInfluenza pandemics have been occurringfor at least 500 years, with the firstrecognized pandemic occurring in 1510throughout Africa and Europe. 1 Even beforedocumented influenza pandemics occurred,the term influenza was first used in Italy in1357. 2 Historical records reveal thatinfluenza pandemics occur approximatelyevery 36 years, with the worst pandemicrecorded in history occurring in 1918. Theinfluenza virus itself was not isolated in alaboratory until the 1930s. 1The 2009–2010 pandemic influenza A(pH1N1) virus provided an opportunity tolearn more about pandemic influenza diseasein New Mexico. During the 2009–2010pandemic in New Mexico, there were 1,056influenza hospitalizations identified fromApril 2009 to May 2010. Hospitalization rateswere highest among the 0–4 year age groupand lowest among the 25–49 year age group(Figure 1). Hospitalization rates were highestamong American Indians and lowest amongWhites. Hospitalization rates by geographicregion revealed that Bernalillo County hadthe lowest rate, and the southeastern regionhad the highest rate. Among hospitalizedindividuals, the most common medicalconditions were asthma and chronic lungdisease, chronic cardiovascular disease anddiabetes.In New Mexico, there were 58 influenzadeaths identified from April 2009 to May2010. Death rates were highest among the50–64 year age group and lowest amongthe 5–24 year age group. American Indianshad the highest death rate, while no deathswere identified among Asian/PacificIslanders or African-Americans. Deathrates by geographic region showed thatBernalillo County had the lowest rate andthe southeastern region had the highestrate. Among those who died, the mostcommon medical conditions were asthmaand chronic lung disease, chroniccardiovascular disease and diabetes.Prevention remains a key strategy formanaging influenza. There are 3 mainrecommended prevention strategies: 1) getthe influenza vaccine every year, 2) stopthe spread of germs by washing yourhands, covering your cough/sneeze,avoiding close contact with sick people,staying home if you are sick with influenzalikeillness until at least 24 hours after yourfever is gone, and 3) take influenza antiviraldrugs if your doctor prescribes them. 3PertussisPertussis or “whooping cough” is a highlycontagious respiratory illness caused bythe Bordetella pertussis bacteria which wasfirst isolated in 1906. However, outbreaksof the illness were first described as earlyas the 16th century. The World HealthOrganization estimated that 294,000children died from pertussis in 2002. Sincevaccine-induced immunity to Bordetellapertussis is of limited duration, generallyless than 12 years, most adults have littleor no residual immunity. Most reportedpertussis cases among adolescents andadults are thought to occur because of thisdecline in protective immunity. Younginfants who are too young to have beenfully vaccinated are at high risk of severeand potentially life-threatening illness fromexposure to people with active disease.Whole cell pertussis vaccine, combined asdiphtheria, tetanus and pertussis or DTP,was introduced in 1944. Cases of pertussiswere reduced by more than 90 percentfollowing introduction of DPT. However,pertussis disease rates have steadilyincreased since 1980. National epidemics ofpertussis occur approximately every threeto four years. Improved acellular vaccineswere licensed for the primary childhoodvaccine series in 1996. In the U.S., threeacellular pediatric vaccines (DTaP) hadbeen licensed until 2005 when adolescentand adult formulations (Tdap) were addedfor the first time. Tdap is recommended forchildren 11–18 years, adults 19–64 years,pregnant women, and healthcare workers.Pertussis is seen throughout New Mexicoamong infants, children, adolescents andadults of all ages (Figure 2), as individualsporadic cases, family clusters andcommunity outbreaks. The last deathsreported due to pertussis in NM were in2004 and 2005 when four infants died.14 NM State of Health 2011

ention StrategiesIn 2008, the national Advisory Committeeon Immunization Practices (ACIP)published recommendations for theprevention of pertussis among pregnantand postpartum women and their infants inorder to help prevent such deaths. 4 Theappropriate use of Tdap among women ofchildbearing age who might becomepregnant and among postpartum women isstrongly recommended.In addition, parents can limit infantexposures to persons who have respiratoryillness until they are determined to benoninfectious. When pertussis exposureoccurs, antimicrobial medications canprevent illness among persons exposed topertussis thereby interrupting transmissionof disease. Parents should ensure thatinfants begin the pediatric DTaPvaccination series at the recommended ageof 6–8 weeks for their protection and toreduce the severity of disease if it occurs. Itis known that administration of two or threedoses of pediatric DTP or DTaP canprevent hospitalization for pertussis and itscomplications. In October 2010, ACIPrecommended filling gaps in pertussisvaccination to further protect babies withnew vaccine recommendations for children7–10 years and adults greater than 64 years.Human ImmunodeficiencyVirus (HIV)In the spring of 1981, the Centers forDisease Control and Prevention Morbidityand Mortality Weekly Report included thefirst report of gay men diagnosed with rarediseases. 5 Within months, other reports ofrare conditions, and opportunisticinfections, occurring primarily among gaymen, were published. In 1982, reports ofsimilar infections among hemophiliacs andinjection drug users began to appear. Thesyndrome was named AcquiredImmunodeficiency Syndrome or AIDS. In1983, the virus responsible for AIDS wasidentified, and it came to be known as theHuman Immunodeficiency Virus or HIV.The number of diagnosed cases ofHIV/AIDS and the number of deathsattributed to AIDS rose quickly in the UnitedStates. By 1985, the number of deathsattributed to AIDS surpassed 10,000, and thenumber continued to climb. In 1995, nearly50,000 Americans died of AIDS. 6 Relief wasfound in 1996 with the advent of HighlyActive Antiretroviral Therapy (HAART), andushered in a new era. HAART slowed theprogression of HIV to AIDS considerably,and the number of deaths attributable toAIDS began to decline.Between 1998 and 2002, the annual numberof newly diagnosed HIV infections in NewMexico declined from 160 to a little over 100.While the decline in new diagnosesoccurred in most segments of thepopulation, it was especially evident amongWhite and Hispanic persons. Since 2002,however, the trend has reversed, and morecases of HIV are being diagnosed each year.In 2009, 168 newly diagnosed cases—thehighest number ever—were reported. Thenumber of new cases has increased amongpersons of all racial/ethnic groups, withmarked disparities. Among Whites,infections increased 26 percent, whileinfections in African-Americans increased 63percent, infections in Hispanics increased 91percent, and infections in American Indiansincreased 170 percent (Figure 3).The recent rise in the number of newinfections reinforces the importance ofprevention efforts. During the 2010session, the New Mexico Legislatureamended the HIV Test Act to allow theDepartment of Health to seamlesslyprovide testing, counseling, and referralservices to sexual and needle-sharingpartners of persons diagnosed with HIVinfection. In addition, culturally appropriatebest practices are being developed andimplemented throughout the state. Theseeffective programs need to be madeavailable to populations with increasingincidence rates, including AmericanIndians, African-Americans and Hispanics.Infectious DiseaseWhat is Being Done U.S. recommends influenzavaccine for everyone > 6 monthswho does not have a medicalcontraindication. Initiatives in New Mexicohospitals are vaccinating postpartummothers and others whowill be caring for newborninfants. The HIV Test Act was updatedby the New Mexico Legislatureto allow the provision ofconfidential and voluntarypartner services and HIV testingto sexual or needle-sharingpartners of persons newlydiagnosed and reported withHIV. Community-based providershave developed, and aredelivering, evidence-based HIVprevention programs that areculturally appropriate forAmerican Indian, AfricanAmerican and Hispaniccommunities.What Needs to Be Done Inform the public and convincethem of the value of influenzavaccination for all individuals >6 months without medicalcontraindication. Decrease pertussis through theappropriate use of standardizedand improved laboratory tests,increased use of age-specificvaccinations, and correctapplication of treatment andprophylaxis guidelines. Increase the availability ofculturally appropriate andeffective HIV preventioninterventions specific forAmerican Indian, AfricanAmerican and Hispaniccommunities in New Mexico.Infectious Disease 15

Figure 1Current Smoking Among AdultsNM, 2001–2009Percent25201510523.817.928.002001 2003 2005 2007 2009Source: NM Behavioral Risk Factor Surveillance SystemFigure 2Youth Tobacco Use in Past 30 DaysGrades 9–12, NM and U.S., 2009Scale?3020100U.S.NM19.5 24.0 8.9 11.8 14.0 18.1Cigarettes Spit or Chew CigarsSources: Sources: NM Youth Risk and Resiliency Survey and CDC YouthRisk and Behavior SurveillanceTableSmoking by Selected Population GroupsNM, 2005–2008Population Group Percent WhoSmokeBisexual 39.1%Household income

pact of Tobacco in NMprohibits the sale of tobacco products tominors, which is monitored and enforcedthrough the Synar Program. Work is alsounderway to ensure that school districtsare properly implementing state-mandatedpolicies prohibiting tobacco use on schoolproperty, including clear procedures forcommunicating and enforcing the policies.School and community-based programs arefunded across the state to focus onreaching, involving, and mobilizing youthto reshape their environment to one wheretobacco-free is the norm. These efforts arecoordinated with a statewide mass mediacampaign that uses TV, the internet, andcutting-edge social media and marketing.Reducing Secondhand SmokeExposureThe Dee Johnson Clean Indoor Air Act,which made most indoor workplaces andpublic places in the state smoke-free, hasbeen in effect for three years. The lawapplies to all non-tribal bars, restaurants,workplaces, and public places in the state.About eight percent of people, those wholive, work or visit tribal lands, remainunprotected from secondhand smoke.Several American Indian tribes andorganizations are funded to providesecondhand smoke education andtechnical assistance to tribes interested inassessing casino employee and patronattitudes and pursuing the development ofsmoke-free policies. Other groups areworking with owners and managers ofmulti-unit housing (i.e., apartments)complexes in the adoption of voluntarysmoke-free policies. About 85% of NewMexicans do not allow smokinganywhere in their home,however, people who live inapartments may still beexposed to their neighbors’secondhand smoke.state funds media efforts, cessationservices, and a telephone line to helpsmokers quit. Over 12,000 New Mexicanscalled 1-800-QUIT NOW, the state’s freetobacco helpline, in fiscal year 2010. Thehelpline offers a personalized quitting plan,a trained quitting coach, multiple calls perenrollee, referral to local resources, andfree nicotine patches or gum.Health care providers, including doctors,nurses, pharmacists, and dentists, arebeing trained to screen patients for tobaccouse and to provide brief interventions forthose who smoke. In 2009, 79% of adultsmokers who saw a health care provider inthe past year were advised to quit smoking,compared to only 49% in 2001. The recent75-cent increase in the cigarette excise taxmay also motivate some smokers to quit.Tobacco use in New Mexico and nationallycontinues to be a significant public healthissue, as it remains the single mostpreventable cause of death and disease.The health, social, and economic effects oftobacco use and secondhand smokeexposure require comprehensive policy,educational and clinical approaches forpreventing use, support for quittingtobacco, and changes to social norms.New Mexico has made significant stridesin reducing adult tobacco use andexposure to secondhand smoke in the pastdecade. Further reducing youth tobaccouse in the state should continue to bea priority to prevent youth frombecoming addicted andsuffering the negative healthconsequences of lifetimesmoking.Tobacco UseWhat is Being Done New Mexico’s free tobaccohelpline, 1-800-QUIT NOW, isavailable to everyone, includesfree nicotine patches or gum,and is primarily serving peoplein greatest need. Health care systems and healthcare providers have madesignificant progress in screeningpatients for tobacco use andoffering quitting assistance. Youth are being reached withproven tobacco use preventionapproaches including youthadvocacy, media literacy, andcutting edge social media andmarketing.What Needs to Be Done Increasing the tax on othertobacco products, such as chew,snuff, and dip, to match theproportion of tax on cigarettesto encourage quitting instead ofswitching to lower-pricedtobacco products. Protecting people living,working, and visiting triballands from exposure tosecondhand smoke. Supporting policy interventionsmade possible by the newFamily Smoking Prevention andTobacco Control Act, such asprotecting young people byregulating the time, place, andmanner in which tobacco can beadvertised and sold.Supporting People inQuitting TobaccoIn 2009, about half of NewMexico adult and youth smokerstried quitting in the past year. TheTobacco Use 17

Figure 1Leading Causes of Death, Primary andSubstance Abuse-Related, NM, 2003–2007180.2 Heart Disease160.9 Malignant neoplasms69.563.247.836.332.718.2AccidentsSuicideChronic lower repsiratory diseaseCerebrvascular diseaseDiabetes mellitusSubstance abuse-related15.5 Chronic liver disease and cirrhosisSubstance Abuse-Related CauseOther Leading Causes0 20 40 60 80 100 120 140 160 180 200Rate per 100,000Source: NM Vital Records and Health Statistics; rates age-adjusted to the2000 U.S. Standard PopulationFigure 2Top Ten Causes of Alcohol-RelatedDeath, NM and U.S., 2007–200914.47.35.35.15.14.23.42.00.70.6Alcohol-related liver diseaseHomicideAlcohol poisoningHypertensionAlcohol abuseSuicideFall injuriesMotor-vehicle traffic crashesPoisoning (not alcohol)Alcohol dependenceAlcohol-RelatedChronic DiseaseAlcohol-RelatedInjury0 3 6 9 12 15Rate per 100,000Source: NM Vital Records and Health Statistics; rates age-adjusted to the2000 U.S. Standard PopulationFigure 3Unintentional/Undetermined OverdoseDeath Rates by County, NM, 2007–2009RIO ARRIBAGUADALUPE*TAOSEDDYBERNALILLOGRANTSAN MIGUELVALENCIAHIDALGO*SOCORROCHAVESNMCATRON*TORRANCESIERRASANTA FELEACOLFAXLINCOLNQUAY*DEBACA*OTEROSANDOVALDONA ANALOS ALAMOSCURRYSAN JUANCIBOLAMCKINLEYUS (2006)MORA*ROOSEVELT*UNION*LUNA*HARDING*0 10 20 30 40 50Rate per 100,000Source: Vital Records and Health Statistics; rates age-adjusted to the2000 U.S. Standard Population* Less than five deaths per 100,000 over three years; there were nodeaths in Harding CountySubstance Abuse AffectsThe consequences of substance abuse aresevere in New Mexico. Substance abuseis one of the state’s leading causes ofdeath (Figure 1), and New Mexicoconsistently ranks among the worst in thenation for death from drugs and alcohol.The devastation caused by substanceabuse is also associated with domesticviolence, crime, poverty, motor vehiclecrashes, chronic liver disease, infectiousdiseases, mental illness, and othermedical problems.The cost of substance abuse in the U.S. isestimated in the hundreds of billions ofdollars per year, and includes the costs ofmedical care, treatment services, criminaljustice, and lost productivity. 1 In 2006, theestimated cost of alcohol abuse in NewMexico was more than $2.5 billion, or$1,250 per person. 2 This economic burdenfalls heavily on New Mexico, since it isone of the nation’s poorest states—withthe third highest percentage of peopleliving in poverty in 2008–2009 (19.3%) 3 —and has among the highest rates of healthproblems associated with substanceabuse. Vulnerable populations whoexperience considerable negativeconsequences from substance abuseinclude youth, pregnant women, injectiondrug users, and prison inmates.Higher Rates of SubstanceAbuse among Youth in NewMexico Compared to U.S.Substance abuse prevention amongadolescents is critical considering thenegative long-term consequences of earlysubstance use. 4,5 In the 2009 New MexicoYouth Risk and Resiliency Survey, 41% ofhigh school students reported that theyhad a drink of alcohol in the past monthwhile 26% reported having at least fivedrinks on one occasion, similar to U.S.rates (42% and 24%, respectively).However, a larger proportion of studentsreported having their first drink beforeage 13 years (29%) compared to studentsnationwide (21%). Rates of illicit drug useamong New Mexico youth are alsorelatively high. Marijuana use in the pastmonth was reported by 28% of students,compared with 21% nationwide. NewMexico students also reported higher useof cocaine, heroin, methamphetamine andEcstasy than students nationally.Prescription drug abuse among youth hasemerged as a concern in New Mexico. In2007, 12% of New Mexico high schoolstudents reported current nonmedical useof prescription painkillers, which roseslightly to 14% in 2009.Alcohol-Related Death RatesRemain High DespiteDecreases inDWI-Related DeathAlcohol-related health problems canresult from either chronic or acute abuseof alcohol. Chronic heavy drinking,defined as drinking more than two drinksper day for men and more than one drinkper day for women, is often associatedwith alcoholism or alcohol dependence,and can cause or contribute to a numberof diseases, including alcohol-relatedchronic liver disease (Figure 2). For thepast 15–20 years, New Mexico’s deathrate from these diseases has consistentlybeen first or second in the nation, and 1.5to 2 times the national rate. Furthermore,while the national death rate from alcoholrelatedchronic diseases fell during thisperiod, New Mexico’s rate increased. 6 RioArriba and McKinley counties have deathrates for diseases associated with chronicalcohol abuse that are 4–5 times thenational rate.Acute or episodic heavy drinking,defined as having five drinks or more onan occasion for men and four drinks ormore on an occasion for women, issometimes called binge drinking, and is ahigh-risk behavior associated withnumerous injury outcomes, includingmotor vehicle crash fatalities, homicide,and suicide (Figure 2). New Mexico’sdeath rate for alcohol-related injury alsohas consistently been among the worst inthe nation, ranging from 1.4 to 1.8 timesthe national rate over the past 15–20 years.While New Mexico’s alcohol-impairedmotor vehicle crash death rate hasdeclined almost 70% during this period,death rates from other alcohol-relatedinjuries have remained stable.18 NM State of Health 2011

All New MexicansOverdose Death Rates fromIllicit and Prescription DrugsIncreaseIn 2008, the most common drug typescausing overdose death in New Mexicowere prescription opioids (i.e., methadone,oxycodone), heroin, tranquilizers andmuscle relaxants (i.e., benzodiazepines),cocaine and antidepressants. The overdosedeath rate from the combination of illicitand prescription drugs increased 150% inthe past five years from 1.4 per 100,000 in2004 to 3.6 in 2008. The New Mexicocounties with the highest drug overdosedeath rates during 2007 to 2009 were RioArriba, Guadalupe and Taos (Figure 3).How Do We Tackle the Problemof Substance Abuse?Given the tremendous burden fromsubstance abuse problems, prevention andtreatment is of critical importance in NewMexico. Primary prevention attempts to stopa problem before it starts. In New Mexico,primary prevention of alcohol-related healthproblems has focused on regulating accessto alcohol and altering the alcoholconsumption behavior of high-riskpopulations. Regulatory efforts haveincluded increasing the price of alcohol—which is effective in deterring alcoholabuse, 7 establishing a minimum legaldrinking age, regulating the density of liquoroutlets, and increasing penalties for buyersand servers of alcohol to minors. In addition,efforts to reduce drug overdose deathinclude innovative drug legislation such asthe 911 Good Samaritan Law and statewideprograms to dispose of leftover medications.DWI-related law enforcement (e.g.,sobriety checkpoints) when accompaniedby media activity can be an important formof primary prevention, increasing theperceived risk of arrest after drinking anddriving among the general population.Media is also used to raise awarenessabout methamphetamine, and might beused to communicate the dangers ofprescription medication abuse.Secondary prevention efforts try to detectand treat emergent cases before theycause harm. In New Mexico, brief clinicalinterventions have targeted at-riskdrinkers to address problem drinkingbefore it causes serious harm. Evidence ismounting for the effectiveness ofscreening and brief intervention for drugabuse in the medical setting as well.Tertiary prevention involves the treatmentof individuals diagnosed with substanceuse disorders so they can recover to thehighest health while minimizing the effectsof the disease and preventingcomplications. There are 145 facilities inNew Mexico that provide substance abusetreatment services, including eightfacilities that offer substitution therapysuch as methadone and buprenorphine. 8Roughly 160,000 New Mexicans areestimated to have a substance abuse ordependence problem, while just one in tenpeople in need of treatment receives it. 9Nationally, the most common reasons thatpeople who need treatment do not receiveit are because they are not ready to stopusing, have no health insurance and can’tafford the cost, or are concerned about thepossible negative effect on their job. 10Proximity to Mexico and presence of twomajor interstate highways makes drugtrafficking a significant contributor to thedrug problem in New Mexico. Lawenforcement efforts reduce the supply ofdrugs, but reducing the demand for drugsremains an important priority. Treatment isthe primary approach to help drugdependentpersons, an estimated 33,000New Mexicans age 12 or older, 9 overcomedrug addiction thereby reducing demand.Harm reduction is another important part ofthe substance abuse prevention model.Syringe exchange, which prevents thetransmission of blood-borne pathogensamong injection drug users, is one strategythat might be considered primary orsecondary prevention. A harm reductionapproach might also be used by practitionerstreating addiction. Harm reduction programsin New Mexico deliver disease and overdoseprevention education, acu-detox, healthpromotion, social service and treatmentreferral, and, in some locations, primarymedical care to injection drug users.Substance AbuseWhat is Being Done A comprehensive driving whileimpaired (DWI) preventionprogram contributed to a 39%decrease in New Mexico’salcohol-impaired motor vehicletraffic crash fatality rate from2004 to 2008. More than $15 million is spenteach year to help fund localDWI programs. Roughly 15,000 people wereenrolled in substance abusetreatment in 2009, including amix of mental health services inoutpatient, inpatient andresidential settings. Harm reduction programs areproviding education on diseaseand overdose prevention, referralsto treatment, and naloxonetraining to drug users and theirfamily members and friends. Trainings on guidelines foreffective and safe opioidprescribing among pain patientsand those who are opioiddependent.What Needs to Be Done Increase the price of alcoholicbeverages, which decreasesexcessive alcohol consumption. Increase support in adult primarycare settings for screening andbrief interventions to addresspotential alcohol-relatedproblems. Make medication-assistedtreatment more widely availableand ideally, “upon demand.” Educate the general populationabout the importance of safemedication use, secure storagein the home and proper disposalof leftover medicine. Support ongoing and newevidence-based programs forsubstance abuse prevention,treatment and recovery, ensuringthorough program evaluation.Substance Abuse 19

TableLeading Causes of DeathNM and U.S., 2007Cause ofDeathRankNumber ofDeathsDeathRatesNM U.S. NM U.S. NM U.S.Heart 1 1 3,305 616,067 159.2 190.9Disease*Cancer* 2 2 3,238 562,875 157.3 178.4Accidents 3 5 1,329 123,706 66.7 40.0Chronic 4 4 884 127,706 43.6 40.8LungDisease*Stroke 5 3 804 135,952 39.2 42.2Diabetes* 6 6 673 71,382 32.7 22.5*Denotes a chronic diseaseSource: National Center for Health Statistics, 2010. Rates per 100,000population; rates age-adjusted to the 2000 U.S. Standard PopulationFigure 1Adult Health Status by Income, NM, 2009PercentPercent1009080706050403020100Figure 2Percent of Adults Who Are Up-to-Datewith Recommended Cancer Screenings byHealth Insurance Status, NM, 2006–20081009080706050403020100Excellent Very GoodGoodLess than $15,000$15,000–$24,999$25,000–$34,999$35,000–$49,999$50,000+FairSource: NM Behavioral Risk Factor Surveillance SystemPoorInsuredUninsured74.4 44.3 78.3 72.9 59.1 23.4BreastCancerCervicalCancerColorectalCancerBreast cancer data: Women age 40 and older who have had a mammogramin the past 2 years. Cervical cancer data: Women ages 18+ who have hada Pap test within the past 3 years. Colorectal cancer data: Women andmen ages 50+ who have had a fecal occult blood test in the past yearand/or endoscopy of the colon in the past 10 yearsSource: NM Behavioral Risk Factor Surveillance SystemThree Stages of Chronic DWhat is Chronic Disease?Chronic disease refers to a group ofillnesses that are not contagious, areprolonged in duration, and are rarely curedcompletely. Examples of chronic diseasesinclude heart disease, cancer, stroke,emphysema, diabetes, obesity, asthma, andarthritis. Chronic diseases make up five ofthe six leading causes of death in the U.S.and NM (Table), and are responsible forover 60% of all deaths in our state. 1 Heartdisease is the leading cause of death forboth women and men, followed by cancer.Although chronic diseases are morecommon among older adults, they affectpeople of all ages. In addition to escalatingmedical costs, chronic diseases generatesignificant costs due to absenteeism anddecreased productivity in the workplace.Arthritis is the top cause of disability forNew Mexican adults, including those whoare of working age. Many New Mexicanssuffer from multiple chronic diseases, andas the population ages this trend isexpected to increase.Stage 1—Primary PreventionPrimary prevention means keeping healthyso that chronic diseases don’t develop inthe first place. Although some chronicdiseases are unavoidable, it has beenrecognized for many years that the leadingpreventable behavioral causes of chronicdisease include tobacco use, lack ofadequate physical activity, and poornutrition. 2,3 Given that most people areaware of these risks, why don’t all NewMexicans lead a healthy lifestyle?Because the choices we make are shapedby the choices we have. 4 Making healthychoices isn’t just about awareness or selfdiscipline.Many factors affect anindividual’s ability to adopt healthylifestyles, such as access to recreationalareas, affordable healthy foods, clean air,and work, and educational opportunities.Some neighborhoods have easy access tofresh, affordable produce; others have onlyfast food, liquor outlets and conveniencestores. 5 Some neighborhoods have cleanparks and safe places to walk, jog, bike orplay, while others don’t. And it isn’t easy toget exercise if you have to work multiplejobs just to get by, or if you can’t easily getaffordable day care for your kids. Adultshave a myriad of responsibilities to balanceand prioritize, and those with the fewestresources are most likely to put the needsand demands of family and jobs ahead oftheir own health.In our society, wealth is the strongestpredictor of health and longevity. 6 A recentstudy found that living at less than 200% ofthe federal poverty level imposes a greatersocietal health burden in the U.S. thaneither tobacco use or obesity. 7 However, itisn’t just a question of “the rich” versus“the poor.” On average, middle classAmericans live shorter lives and are lesslikely to report good health than those whoare wealthy. 6,8 Recent data for NM 9 confirma strong association between income andself-reported health status for adults(Figure 1), much of which is driven by thepresence or absence of chronic disease.Chronic stressors such as racism anddiscrimination impose additional healthburdens that cannot be completely offsetby higher income or education. 6Popular conceptions link health primarilyto medical care, lifestyle, and genes. Whilethese factors play a role, keeping peoplehealthy will only happen on a large scale byimproving the social conditions in which allNew Mexicans are born, live, learn, work,and play. It’s time we expand the way wethink about health to include how to keepit, not just how to get it back. 10Stage 2—Secondary PreventionThe goal of secondary prevention is todetect chronic disease in its earliest stages,before noticeable symptoms develop, whenit is most likely to be treated successfully.This generally takes the form of screeningprograms for persons who feel fine but areat-risk for a condition due to their age, sex,occupation, or other factors. Screeningonly makes sense for those diseases forwhich early detection and treatment havebeen shown to result in improved healthoutcomes. Examples of effective screeningtests include Pap smears for early cervicalcancer, routine mammography for early20 NM State of Health 2011

isease Preventionbreast cancer, and take-home fecal bloodtesting kits for early colorectal cancer. 11 If ascreening test is abnormal, it is generally a“first step” that requires additional testingto confirm the diagnosis, followed bytimely and appropriate treatment, whennecessary. Early detection and treatment ofthese cancers leads to large improvementsin survival. Five-year survival rates forbreast, cervical and colorectal cancers are88–98% if they are discovered at an earlystage, but only 9–25% if diagnosed afterspreading far from the original site. 12 In thecases of cervical and colorectal cancerscreening, pre-cancerous conditions canalso be detected which, when treated, canactually result in the prevention of thesecancers developing. Unfortunately, manyNew Mexicans are not up-to-date withrecommended cancer screenings. Lack ofhealth insurance is a major barrier toaccessing secondary preventive servicesfor breast and colorectal cancer (Figure2). 13 However, even many persons withhealth insurance are not being screened asrecommended. The result is that too manyNew Mexicans are diagnosed with, and diefrom, later-stage cancers that might havebeen detected and treated earlier, orpossibly prevented altogether.Appropriate screening for cardiovasculardisease risk factors, such as high bloodpressure, cholesterol, obesity, and diabetes,is also important. This screening is bestconducted at a person’s medical home,where consideration of individual riskfactors, meaningful follow-up of results, andtimely re-screening are most likely.Stage 3—Tertiary PreventionTertiary prevention means avoiding orpostponing disease progression andcomplications once chronic diseasesymptoms are apparent and a diagnosishas been made. The same positive socialfactors that allow people to stay healthybecome even more important for personstrying to manage heart disease, diabetes,and other chronic conditions. A personwho is trying to control high blood sugar,high blood pressure, excess weight,and/or high cholesterol needs adequatetime, income, and access to healthy foodsand places to be physically active. This isoften beyond the reach of persons withlimited resources. Similarly, avoiding airpollution or second hand smoke that cantrigger a heart attack is more challengingfor a low income person with diabetes wholives in an industrialized neighborhood orwhose best employment option is at acasino that permits smoking.In addition to living and working in healthpromotingenvironments, persons withchronic disease can benefit by learningskills to manage their symptoms, tocommunicate effectively with their healthcare team, and to manage their fear, angerand frustration. 14 Having access to chronicdisease self-management programs thatprovide opportunities to learn and practicethese skills help people lead lives that areless limited by their illness.Despite the importance of healthy lifestyleand self-management skills, these arerarely sufficient for adequate treatmentand control of a chronic disease over thelong term. Chronic diseases are generallyprogressive by nature, and most willrequire ongoing medical management forthe prevention or early detection ofcomplications. Tertiary prevention relieson the ability to access and afford visits tohealthcare providers, prescription and nonprescriptiondrugs, medical supplies, andmonitoring tests. Examples include routinescreening for and management of earlykidney, eye, and foot problems amongpeople with diabetes, and preventingrecurrence of heart attack with anticlottingmedications. As the provisions ofthe Patient Protection and Affordable CareAct of 2010 are implemented over the nextseveral years, it is anticipated thatincreased coverage for affordable primarycare and clinical preventive services will berealized for many more New Mexicans.Healthcare coverage does not guaranteehealth care access, however, and NewMexico’s rural character and shortage ofhealthcare providers may continue topresent barriers to care.Chronic DiseaseWhat is Being Done Step Into Cuba is an example ofa creative rural communityeffort which promotes walkingthrough trail enhancement andwalking groups. The DOH Breast & Cervical CancerEarly Detection Program and newColorectal Cancer Programprovide cancer screening foruninsured and underinsured lowincomeNew Mexicans. New Mexico Area HealthEducation Centers and the Cityof Albuquerque’s Department ofSenior Affairs are deliveringevidence-based Chronic DiseaseSelf-Management Programs intheir communities. The Southwest Tribal TobaccoCoalition is working withAmerican Indian communities toraise awareness of the increasedrisk for heart attacks experiencedby people with diabetes who areexposed to commercialsecondhand tobacco smoke.What Needs to Be Done Use community planning todesignate zoning areas thatencourage walking and biking inthe course of everydayactivities. Create economicincentives that encourage thedevelopment of retail groceryinvestments in low incomecommunities. Provide resources and incentivesto businesses, such as taxbreaks, to encourage thedevelopment of healthy worksiteenvironments and effectivehealth promotion activities. Reduce the poverty rate, whichwill provide more New Mexicanswith the time and income topurchase and prepare healthyfoods and to be more physicallyactive.Chronic Disease 21

Figure 1Leading Causes of Unintentional InjuryDeath, NM, 2005–2009Injury HurtsRate per 100,000Poisoning31%Motor Vehicle Crash30%FallsOther25%10%Drowning 2%Suffocation on 2%Source: NM Vital Records and Health StatisticsFigure 2Motor Vehicle Crash Death RatesNM, 1990–2009Rate per 100,000 population302520151053,5002,8002,1001,400700029.228.001990 1995 2000 2005 2009Figure 3Hospitalization Rates Due to Fallsby Age, NM, 2005–200938.4 56.70–14 15–64266.265–74717.575–84Source: Hospital Inpatient Discharge Database, NM Health PolicyCommission15.2Source: NM Vital Records and Health Statistics; rates are age-adjusted tothe 2000 U.S. Standard Population3,211.285+Unintentional injury is the leading cause ofdeath among 1 to 44 year olds in NewMexico and in the United States. In NewMexico, unintentional injury is the thirdleading cause of death among the totalpopulation, accounting for two-thirds of allinjury deaths. These are often called“accidents” although most are predictableand often preventable. New Mexico’sunintentional injury death rate at 65.6 per100,000 population in 2007 was 1.7 timeshigher than the national rate. Poisoning,largely drug overdose, was the leadingcause of unintentional injury death in NewMexico from 2005 through 2009. Thesecond and third leading causes ofunintentional injury death were motorvehicle crashes and falls, respectively(Figure 1). From 2005 through 2009 thesethree causes accounted for 85.4% of allunintentional injury deaths. However, theleading causes of unintentional injurydeath varied by age group. Motor vehiclecrashes and drowning led among children0–4 years of age. Motor vehicle crasheswere the main cause of death among the5–24 year age group. Poisoning led amongthe 25–64 year age group. Falls were theleading cause among persons 65 years ofage and older.The unintentional injury death rate amongmales (86.2/100,000 population) was doublethe rate among females (43.5/100,000population) from 2005 through 2009.Poisoning (1,347 deaths) was the leadingcause of unintentional injury death amongmales during this 5-year period, followed bymotor vehicle traffic crashes (1,296) andfalls (731). For females, falls (807 deaths)were the leading cause of unintentionalinjury death, followed by motor vehicletraffic crashes (586) and poisoning (578).American Indians had the highestunintentional injury death rate at83.5/100,000 population, followed byHispanics (65.5/100,000 population) andWhites (58.4/100,000 population). African-Americans and Asians had the lowestunintentional injury death rates(36.6/100,000 population and 26.7/100,000population, respectively). The leadingcauses of unintentional injury death variedby race/ethnicity. Motor vehicle crasheswere the leading cause of unintentionalinjury death among American Indians andAsian/Pacific Islanders. Poisoning was theleading cause of unintentional injury deathamong Hispanics and African Americans.The leading cause of unintentional injurydeath among Whites was falls.Falls were the leading cause ofunintentional injury hospitalizations in NewMexico from 2005 to 2009. Fall-relatedhospitalizations increased dramatically withage (Figure 2). Hip fracture is the mostcommon type of injury experienced byolder adults who fall and requirehospitalization. In 2009, hip fracture wasthe primary diagnosis for 47 percent of fallrelatedhospitalizations for people ages 65years or older in New Mexico.TransportationThe big success story in unintentional injuryprevention over the last 25 years has beenthe reduction in deaths and injuries frommotor vehicle crashes. The state hasinvested in seat belt and child safety seatlaws, enacted a child helmet use law, settighter penalties against drinking whiledriving, and improved roadway design andsafety features. From 1990 through 2009, theNM motor vehicle crash death rate declined48% (Figure 2). The state’s seat belt use ratehas been at or over 90% since 2004. Still,motor vehicle crashes were the cause of30.1% of all unintentional injury deaths from2005 through 2009. In 2008, alcohol wasinvolved in 39% of all fatal crashes.22 NM State of Health 2011

Traumatic Brain InjuryTraumatic brain injuries (TBI) are amongthe most disabling of injuries, as they canlead to loss of independence and create theneed for costly caregiver and supportservices. Death rates due to TBI vary bygender and age. In New Mexico, the TBIrelateddeath rate from 2004 through 2008was highest among persons 85 years of ageand older with an average annual rate of119.3 deaths/100,000 population. Theaverage annual TBI-related death rate formales was 3.6 times higher than that forfemales. Males were more likely to die fromTBI due to firearms, while women weremore likely to die from a TBI due to a fall.PoisoningPoisoning deaths, largely due to drugoverdose, became the leading cause ofunintentional injury death in NM in 2006,with a rate of 17.9 deaths/100,000population and have continued to rise to arate of 19.2/100,000 population in 2009.Prior to 2006, motor vehicle crashes werethe leading cause of unintentional injurydeath. The highest unintentional poisoningdeath rate occurred among people 45–54years of age (37.1/100,000 population).Unintentional drug poisoning includesdrug overdoses resulting from drugmisuse, drug abuse and taking too much ofa drug for medical reasons.FallsFall injury is the third leading cause ofunintentional injury death and the leadingcause of injury hospitalization in NewMexico. These injuries particularly impactolder adults (Figure 3). From 2005 through2009, over 13,500 New Mexicans werehospitalized due to a fall. Of thosehospitalized, approximately 70% were ages65 years and older. During this same timeperiod, 1,343 New Mexicans 65 years ofage and older died due to a fall. For manyolder persons, injuries due to falls, such asa hip fracture or traumatic brain injury, areso disabling that they never return toindependent living in the community. Fallsalso have psychological consequences.Many people who fall, even those who arenot seriously injured, develop a fear offalling. This fear can result in depression,isolation and reduced mobility, which leadto a decline in physical function and anincreased risk of falling. The most effectivestrategies for prevention of older adult fallsinclude home safety, physical activity thatfocuses on maintenance of strength andbalance, and medication safety.Unintentional injuries, like intentionalinjuries, are very costly to the state andfamilies. The harm caused by car crashes,drug overdose and falls is expensive whenone considers the cost of hospitalizationand emergency medical services, inabilityto work, support for those disabled, lawenforcement and the judicial process, andloss of tax income from those no longerable to work. The emotional costs tofamilies cannot be measured. Sciencebasedprevention strategies provide thebest hope for reducing the burden of injuryand promoting an injury-free environmentfor all New Mexicans.Unintentional InjuryWhat is Being Done Provision of home safetytraining to child daycareproviders throughout NewMexico since 2001. Development of a web-basedinjury prevention curriculumcovering core injury preventionapproaches and injuryprevention topics areas ofconcern to all New Mexicans. Implementation of a statewidecapacity development projectwith regional and communitybasedpartners to enhancecommunity-level injuryprevention programs and toinitiate new ones. Initiation of statewide sexualassault and violence primaryprevention training programsusing evidence-based models. Training to prevent falls amongolder adults.What’s Needs to Be Done Incorporate older adult fallsprevention into clinical settings. Increase appropriate use ofhelmets and infant and childsafety seats. Establish a program to ensurethat cribs are available for allNM infants and to educateparents to place their infants incribs to sleep. Expand home visiting programsfor new parents, continuing toimprove and refine the injuryprevention trainings for thehome visitors. Distribute information statewideregarding the duty of the publicto report suspected child abuseand neglect and how to do so.Unintentional Injury 23

Figure 1Suicide Rates by YearNM and U.S., 1995–2009Rate per 100,000 population25201511.81018.711.317.4New Mexico5United States28.001995 1997 1999 2001 2003 2005 2007 2009Sources: NM Vital Records and Health Statistics, CDC, National Centerfor Health Statistics; rates are age-adjusted to the 2000 U.S. StandardPopulationFigure 2Suicide Rates by Race/Ethnicityand Age, NM, 2005–2009Rate per 100,000 population50403020100American IndianWhiteHispanic5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84Sources: NM Vital Records and Health Statistics; rates are age-adjustedto the 2000 U.S. Standard PopulationFigure 3Homicide Rates by Sex andRace/Ethnicity, NM, 2007–2009Rate per 100,0002520151050MaleFemaleTotal85+20.1 6.1 12.9 20.4 2.6 11.9 14.9 4.2 9.6 5.8 2.7 4.2AmericanIndianBlack Hispanic WhiteSources: NM Vital Records and Health Statistics; rates are age-adjustedto the 2000 U.S. Standard PopulationBurden of Violence in NThe World Health Organization definesviolence as “the intentional use ofphysical force or power, threatened oractual, against oneself, another person, oragainst a group or community, that eitherresults in or has a high likelihood ofresulting in injury, death, psychologicalharm, maldevelopment or deprivation.” 1Intentional, violent injuries include selfdirectedinjuries due to suicidalbehaviors, as well as interpersonalviolence, such as intimate partnerviolence, child maltreatment, and sexualassault.Violence is a significant public healthproblem in New Mexico. In 2007, the totalviolence-related death rate in NM was29.1 per 100,000, 66% higher than thenational rate of 17.5 per 100,000. NewMexico had the second highest violencerelateddeath rate among states. 2 Suicidewas the second leading cause of death forpersons ages 10–44 years and homicidewas the third leading cause of death forchildren, adolescents, and young adultsages 1–34 years. 3Mortality data are the most collected andavailable source of violence-related data;however, deaths represent only a fractionof the health and societal impact ofviolence. The health effects of violencemay last for years following the initialinjury, accounting for significant,permanent disabilities such as spinal cordand brain injuries, and limb loss. Victimsof violence are also at an increased riskfor psychological and behavioralproblems, such as depression, anxiety,post-traumatic stress disorder, substanceuse disorders, and suicidal behaviors; andreproductive health problems, such asunwanted pregnancy and sexuallytransmitted infections.According to a 2007 study, the annualestimated cost of violence in the U.S. was$70 billion; the vast majority of the costswere associated with lost productivity,followed by medical care expenditures. 4Sixty-eight percent of the costs fromassaults and 63% of the costs from selfinflictedinjuries were incurred by youngmales ages 15–44 years.SuicideSuicide was the ninth leading cause ofdeath in New Mexico, accounting for atotal of 372 deaths in 2009. The suicide ratewas 17.4 per 100,000. Over the past 15years, the NM suicide rate has consistentlybeen 1.5 to 2 times the U.S. rate (Figure 1).Males have a higher risk of suicide thanfemales. From 2007–2009, the suicide ratefor NM males (29.9 per 100,000) wasalmost four times that for females (8.1 per100,000). Male suicide rates ranged from32.6 to 39.8 per 100,000 among men ages15–74 years, increasing sharply in men 75years and over. Female suicide ratespeaked at 15.1 per 100,000 among womenages 45–54 years.Overall suicide death rates weresignificantly higher among Whites (20.8per 100,000) and American Indians (20.1per 100,000) compared to Hispanics (14.9per 100,000). However, suicide ratesdiffered by racial/ethnic background andage group. Among persons less than 35years of age from 2005–2009, AmericanIndian youth 15–24 years (29.7 per100,000) and young adults 25–34 years(35.8 per 100,000) had the highest suiciderates. In contrast, adult suicide rates inpersons 35 years and older were highestamong Whites, ranging from 27.3 per100,000 among persons ages 35–44 yearsto 48.3 per 100,000 among adults 85 yearsand older (Figure 2).According to results from the 2007 NewMexico Violent Death Reporting System,the majority of male suicide decedents diedfrom a firearm injury (51%), whereas themajority of females died by poisoning(58%). The most common circumstancerelated to suicide deaths among males wasa current depressed mood (40.2%); amongfemales, it was a current mental healthproblem (50.7%).Current suicidal thoughts and a previoussuicide attempt are the best predictors ofsuicidal behavior. 5 According to the 2006NM Behavioral Risk Factor SurveillanceSystem (BRFSS), 5.8% of adults reportedthat they felt so low at times during the past24 NM State of Health 2011

M Affects Everyoneyear that they thought about committingsuicide, and 5.2% reported ever attemptingsuicide in their lifetimes. New Mexicoadults with major depression reportedsuicidal thoughts (29.0%) more often thanadults without depression (3.3%). Theywere also more likely to report ever havingattempted suicide (19.5%) compared to nondepressedadults (3.9%).Suicidal behaviors were also commonamong NM high school and middleschool youth. According to results fromthe 2009 NM Youth Risk and ResiliencySurvey, 15.9% of NM high school youthreported that they seriously consideredattempting suicide and 9.7% reportedattempting suicide in the previous year.Females were more likely to reportsymptoms of depression (37.3%) and toseriously consider committing suicide(20.0%) than males (22.3% and 11.9%,respectively). American Indian youth(19.9%) reported attempting suicide morefrequently than Hispanic (7.6%) and Whiteyouth (7.3%). Almost seven percent (6.8%)of middle school students reported evertrying to kill themselves; this behaviorwas more common among females (9.0%)than males (4.7%).AssaultIn 2009, there were 173 assault deaths inNew Mexico, resulting in a homicide rateof 8.4 per 100,000. From 2007–2009, themale homicide rate (12.0 per 100,000) wasmore than 3 times that of females (3.8 per100,000). African-American (20.4 per100,000) and American Indian (20.1 per100,000) males had the highest homiciderates (Figure 3). Homicide was morecommon among young adult males; malesages 25–34 years (20.5 per 100,000) hadthe highest rate.A subcategory of homicide deaths includesdeaths secondary to child maltreatment. InNew Mexico, there were 80 homicide deathsamong children 0–17 years from 2005–2009;among these, the underlying cause of deathwas listed specifically as neglect,abandonment, and other maltreatmentsyndromes for six (7.5%) decedents.Firearms were the most commonmechanism of injury for both male (47%)and female (46%) homicide decedents in2007. The most common circumstancerelated to homicide death among males wasan interpersonal conflict (41.1%), whereasamong females, the circumstances weremost likely to be related to intimate partnerviolence (35.9%).According to results from the Survey ofViolence Victimization in New Mexico, onein four females (24%) and one in twentymales (5%) aged 18 years and olderreported being the victim of rape orattempted rape in their lifetimes, comparedto national rates of 18% and 3%, respectively. 6In 2005, the incidence rate of completedrape was 5.7 per 1,000 among adult womenand 1.7 per 1,000 among adult men. Morefemale victims of rape reported beingphysically attacked compared to males; andtwice as many female rape victims reportedthat their attackers threatened to kill themor someone close to them. Both male andfemale rape victims were twice as likely asnon-victims to suffer from a seriousdisabling injury in their lives, and more than6 times more likely to suffer from one ormore chronic mental health conditions.The lifetime prevalence of domesticviolence among NM adults 18 years andolder was 24% 6 . On average, victims ofdomestic violence reported 5.5victimizations each by their offender in thepast year. In 2008, 72% of the victimsidentified by law enforcement werefemales; most of the victims were betweenthe ages of 19 and 35 years (51%); half wereHispanic, and 15% were American Indian. 7Both self-directed and interpersonalviolence affect many people in NewMexico. Comprehensive public healthapproaches to the prevention of suicidalbehaviors and assault are necessary tohave an impact on the health and wellbeingof New Mexicans.What is Being DoneViolence The NM Injury PreventionStrategic Plan promotescollaboration, capacity-building,and resource sharing to reduceintentional injury. The NM Behavioral HealthCollaborative established aworkgroup to coordinateAmerican Indian youth suicideprevention efforts among tribes,the state, the Indian HealthService and other partners. The NM Coalition AgainstDomestic Violence advocates forvictims of domestic violence andtheir families by providingtrainings, building alliances,securing resources, anddeveloping policies to eliminatedomestic violence. The NM Department of Health,the NM Coalition of SexualAssault Programs, and the UNMPrevention Research Centerdeveloped a 3-year strategicplan for the primary preventionof sexual violence.What Needs to Be Done Broadly implement the U.S.Preventive Services Task Forcerecommendations to screenadolescents 12–18 years and alladults for major depressivedisorders in primary care, schoolbased,and other settings. Ensure systems are in place foraccurate diagnosis,psychotherapy, and follow-up byforming partnerships betweenprimary care settings andbehavioral health core serviceagencies. Develop and evaluate effective,culturally-based initiatives forAmerican Indian youth suicideprevention. Target suicide preventionprograms to high risk adultpopulations, especially White men45 years and older and veterans.Violence 25

Figure 1Serious Psychological Distress by Socio-Demographic Characteristics, NM, 20071.3 $50,000+3.5 $20,000–$49,999Household8.2$10,000–$19,999Income21.3 Under $10,00023.1 Unable to work3.2 Retired2.8 Homemaker/studentEmploymentStatus12.7 Unemployed2.3 Employed1.9 College/tech school graduate3.7 Some college/tech school EducationLevel4.8 High school graduate8.4Some high school0 5 10 15 20 25PercentSource: NM Behavioral Risk Factor Surveillance SystemFigure 2Chronic Conditions by SeriousPsychological Distress Status, NM, 2009PercentFigure 3High School Youth Violence Behaviorby Symptoms of Depression, NM, 2009Percent5040302010050403020100YesNo48.3 32.5 17.5 6.5 15.9 5.6PhysicalfightVictim ofintimate partnerviolenceVictim ofsexualviolenceSource: NM Youth Risk and Resiliency SurveySPDNo SPD42.9 26.3 16.4 13.9 39.3 24.5 15.9 7.3 11.4 5.1 7.5 2.2Arthritis Asthma Hypertension Diabetes CHD StrokeSource: NM Behavioral Risk Factor Surveillance System; prevalencerates age-adjusted to the 2000 U.S. Standard PopulationMental Health MattersMental illness, a term referring to alldiagnosable mental disorders, is commonaround the world and in the United States.According to the U.S. Surgeon General,mental disorders are health conditionscharacterized by “alterations in thinking,mood, or behavior (or some combinationthereof) associated with distress and/orimpaired functioning.” 1Approximately one out of every 4 adults inthe U.S. has a mental disorder in a givenyear; 13 million or 5.8% suffer from serious,debilitating disorders that are associatedwith suicide attempts, significant roleimpairment, or lost work productivity. 2Mental disorders are common in childhoodand adolescence too; approximately oneout of every five children have a mentalhealth diagnosis associated with someimpairment. 1 Adult mental illness iscommonly preceded by psychiatricconditions that begin during childhood.Mental illness affects not only the mentaland physical health and well-being ofindividuals, but also has a tremendousimpact on families and societies. Accordingto the 2004 update of the Global Burden ofDisease report, unipolar depression wasthe third leading cause of disease burdenglobally, and the number one cause ofyears of healthy life lost as a result ofdisability (YLD). 3 In addition, depressionaccounted for 65.5 million disabilityadjustedlife years (DALYs), or 4.3% of thetotal DALYs. The DALY is a summarymeasure of population health thatcombines years of life lost from prematuredeath and years of life lived in less thanoptimal health due to disease and injury.Although depression was the leading causeof YLD for males and females, the burdenamong females was 50% higher thanmales. 3 Other psychiatric conditionscontributing to a higher burden in femaleswere anxiety disorders and seniledementias. In contrast, one quarter of themale burden was due to alcohol and druguse disorders, six times higher than theburden of these conditions among females.Individuals with serious mental illness havehigher mortality rates than the generalpopulation. They also tend to die earlierthan persons without a mental disorder.Treatment of mental illness can reducemorbidity and improve quality of life.However, only 41.1% of U.S. adults with a 12-month Diagnostic and Statistical Manual ofMental Disorders, Fourth Edition (DSM-IV)disorder used mental health services in theprior year. 4 According to the NationalSurvey on Drug Use and Health (NSDUH),4.7% of NM adults perceived an unmet needfor treatment or counseling for mentalhealth problems in the past year. 5 Barriersto receiving treatment for mental healthproblems include cost and insurance issues,not feeling a need for treatment or thinkingthat it could be handled without treatment,and stigma associated with mental illness.According to results from the 2007 NMBehavioral Risk Factor Surveillance System(BRFSS), about two-thirds (66.2%) of adultsagreed strongly with the statement,“Treatment can help people with mentalillness lead normal lives.” Another quarter(25.4%) of adults agreed slightly. However,only about a quarter of adults (26.7%)agreed strongly that “People are generallycaring and sympathetic to people withmental illness.” Another third of adults(32.9%) agreed slightly with this statement.Mental HealthPhysicians and researchers often use a14-day minimum to define clinicaldepression and anxiety; thus a BRFSSmeasure of frequent mental distress (FMD)was defined using this time period. 6 In 2008,11.5% of adults reported FMD, i.e. that theirmental health was not good for 14 or moredays during the past 30 days. Conversely,most NM adults (88.5%) reported less than14 days of poor mental health, including“stress, depression, and problems withemotions.” Although the number of days ofpoor mental health during the past 30 daysranged from 0 to 30 days, the averagenumber reported was 3.8 days.Mental DisordersEstimates of the prevalence of mentaldisorders in the general population comefrom both national and state surveys that26 NM State of Health 2011

use both screening and diagnosticmeasures to quantify mental illness.According to results from the 2006–2007NSDUH, 9.1% of NM youth 12–17 years hadat least one major depressive episode(MDE) in the past 12 months; 9.3% ofyoung adults 18–25 years and 7.4% of adults26 years and older also met the DSM-IVcriteria for MDE in the past year. 7 Theprevalence of serious psychological distressin the past 12 months among adults 18–25years was 9.3% compared to 7.4% for adults26 years and older. 7 Serious psychologicaldistress (SPD) is a population-basedmeasure used to identify adults that have ahigh likelihood of a mental illness andassociated functional limitations.Results from the 2007 BRFSS showed nosignificant differences in the frequency ofpast month SPD by gender, age group, orrace/ethnicity. However, the frequency ofSPD was significantly and inversely relatedto household income (Figure 1). Twentyonepercent of adults with annualhousehold incomes

Figure 1Teen Birth Rates, Age 15–17, by Mother’sRace/Ethnicity, NM, 2002–2009Births per 1,000 teen girls60504030201002002–2004 2003–2005 2004–2006 2005–2007 2006–2008 2007–2009HispanicAfrican-AmericanAmerican IndianWhiteor Alaska NativeAsian or Pacific IslanderSources: NM Vital Records and Health Statistics, National Center forHealth StatisticsFigure 2Infant Mortality Rates by Race/EthnicityNM, 2002–2009Deaths per 1,000 births16128402002–2004 2003–2005 2004–2006 2005–2007 2006–2008 2007–2009HispanicAfrican-AmericanAmerican IndianWhiteor Alaska NativeAsian or Pacific IslanderSources: NM Vital Records and Health Statistics, National Center forHealth StatisticsFigure 3Motor Vehicle Crash Death Rates byRace/Ethnicity, NM, 2002–2009Rate per 100,000 population60504030201002002–2004 2003–2005 2004–2006 2005–2007 2006–2008 2007–2009HispanicAfrican-AmericanAmerican IndianWhiteor Alaska NativeAsian or Pacific IslanderSources: NM Vital Records and Health Statistics, National Center forHealth Statistics; rates age-adjusted to 2000 U.S. Standard PopulationReducing the Burden ofPopulation groups defined by race orethnicity, gender, sexual orientation,geographic area, country of origin orsocioeconomic characteristic may havepoorer or better health than other populationgroups. These differences are called healthdisparities and have been defined in variousways: “differences in the incidence,prevalence, mortality and burden of diseaseand other adverse health conditions betweenspecific population groups” or moresuccinctly as “population-specific differencesin the presence of disease, health outcomesor access to health care.” Although healthdisparities exist across gender,socioeconomic and other strata, some of themost visible differences in health arebetween racial and ethnic groups.Many factors contribute to health disparitiesincluding access to health care, behavioralchoices, the ability to understand and usehealth information (health literacy), poverty,environmental conditions, language barriersand other social and cultural factors. Ashealth disparities result from many factors,reducing health disparities will involvemulti-faceted approaches involving multiplesectors.New Mexico’s Population andHealth DisparitiesNew Mexico is considered a “majorityminority”state where minority groupsconstitute a majority of the population.According to the New Mexico Quickfacts,in 2009 Hispanics constituted 45.6% of thepopulation. Whites were the second largestgroup at 40.9% of the population followedby American Indian and Alaska Natives at9.7%, African-Americans at 3.1% andAsians/Pacific Islanders at 1.7%. Althoughsmall in comparison to the three largerpopulations, the number of African-Americans and Asian/Pacific Islanders isgrowing in New Mexico.Given New Mexico’s racial and ethnicdiversity, it should not be a surprise to learnthat these populations exhibit differences inthe burden of disease. Since 2003 theDepartment of Health has documentedvarious health disparities, and in 2006 beganproducing an annual report, the Racial andEthnic Health Disparities Report Card, topresent information on the differences inthe health of the different racial and ethnicgroups in New Mexico. Of the 20 indicatorsin the Report Card, there were eight in the2010 report card for which one populationgroup had rates at least three times higherthan that of the group with the lowest rate(the disparity ratio). Three of these rateswith large disparities relate to infectiousdisease (hepatitis B, chlamydia andHIV/AIDS), two to maternal and childhealth (teen birth and infant mortality), twoto substance abuse (alcohol-related death,drug-induced death), and one to chronicdisease (diabetes death).Reducing Health Disparities inNew MexicoIt is important to remember that disparitymeans difference and is comparative. Toindicate that health disparities exist in NewMexico does not mean that the health ofNew Mexicans is not improving. A disparitymay persist or even increase despiteimprovements in health if there aredifferences between populations in the rateof improvement. Unfortunately as the Racialand Ethnic Health Disparities Report Carddemonstrates, health disparities in NewMexico are persisting and even increasingdespite improving rates in some cases.Three health status indicators affecting aconsiderable proportion of the population forwhich New Mexico continues to experiencelarge disparities are teen birth, diabetesdeath and alcohol-related death. Teen birthrates are an example of improving rates butcontinuing disparity. Although the overallteen birth rate in New Mexico hasdecreased from being 60% higher than thenational rate to being 45% higher, thedisparity between populations in NMremains striking. The Hispanic teen birthrate was almost four times the White rateand was five times greater than theAsian/Pacific Islander teen birth rate(Figure 1). The rates translate to thefollowing comparison: out of every thousandHispanic girls ages 15 to 17 years in NewMexico, 47 gave birth compared to 9 out of athousand Asian/Pacific Islander females and12 out of a thousand White girls. During the28 NM State of Health 2011

Health Disparities in NM2007–2009 time period out of theapproximately 4,600 births to females ages15–17 years, 69% were to Hispanic girls.Deaths due to diabetes serve as an exampleof a persisting disparity with worsening rates.All populations in New Mexico showed anincrease in rates during 2007–2009 and allnon-White populations exhibited higher ratesthan Whites. American Indians had thehighest rate of deaths due to diabetes, whichwas three times higher than that of Whites.For every 100,000 American Indians therewere 73 deaths due to diabetes compared to22 deaths due to diabetes for every 100,000Whites.Alcohol-related deaths remain a seriousproblem in New Mexico and anotherexample of increasing rates and persistingdisparity. The New Mexico rate was 88%higher than the national rate. Alcoholrelateddeath rates increased in all racialand ethnic groups except for African-Americans, who had the lowest rate.American Indians had the highest rate foralcohol-related deaths, three times that ofAfrican-Americans, twice that of Whitesand 1.7 times that of Hispanics. Nearly 200deaths per year among American Indianswere classified as alcohol-related.Infant mortality is an indicator whichinvolves a smaller number of cases andexhibits the paradox of improving rates butincreasing disparities,. There are less than200 total infant deaths each year in NewMexico. New Mexico’s infant mortality rateimproved so that it was lower than thenational rate. However the disparity betweenAfrican-Americans and Whites increasedsince the White rate declined more rapidlythan the African-American rate. For every1,000 births to White mothers there wereonly 4 deaths while for African-Americansthere were 13 deaths for every 1,000 birthsor three times as many (Figure 2). Since2003, White infant mortality has decreased24% compared to an 8% decrease for African-American infant mortality.The motor vehicle crash death rate is anindicator for which the rates have improvedand the disparity has decreased. The overalldeath rate from motor vehicle crashes hasdeclined such that the New Mexico rate hasimproved since 2003 from 45% higher thanthe national rate to 15% higher. In addition,the rates for American Indians, Hispanicsand Whites have all improved with AmericanIndians having improved the most,decreasing from 47.5 deaths per 100,000 to30.3 deaths per 100,000 (Figure 3). Althoughthis is a significant improvement, theAmerican Indian death rate from motorvehicle crashes remained 1.8 times that ofHispanics and 2.3 times that of Whites.Reducing or eliminating health disparitiesinvolves focusing on specific healthdisparities and assessing the contributionsof multiple factors including cultural,economic and environmental influences tothe disparity. Resources and interventionsneed to be targeted toward the populationgroup at the wrong end of the disparity. Thedecline in motor vehicle deaths required amulti-faceted approach suggesting thatreducing disparities requires efforts inmany arenas. Coordinated efforts involvingresources and strategies from multiplepublic and private agencies need to bedeveloped to address the multipleinfluences contributing to disparities.Health DisparitiesWhat is Being Done Improved reporting anddissemination of health data byrace and ethnicity to aid ininformed decisionmaking. Improving the capacity of publicand private health care agenciesto provide culturally appropriateservices including trainedmedical interpretation,programs, and materials toclients with limited Englishproficiency. Development of innovativeoutreach strategies includingculturally appropriate mediastrategies such as fotonovelasand films to reach underservedpopulations. In 2010, a report on health dataand disparities among thelesbian, gay, bisexual andtransgender community in NMwas published.What Needs to Be Done Developing more integratedcross-agency approachesincluding public-privatepartnerships to address themultiple factors contributing tospecific disparities. Increased efforts by both publicand private health agencies toreach underserved communitiesthrough the use of allied healthprofessionals outside of theclinical setting. Development of patientinformation materials for lowliteracypopulations in order tobetter disseminate informationto the public on both theprevention and optimalmanagement of adverse healthconditions. Targeting resources andinterventions toward populationgroups with higher rates ofdeath and disease.Health Disparities 29

Figure 1Heart Attack Death Rates byRace/Ethnicity, NM, 2006–200930A Healthy Environment iRate per 100,000252015105022.4 15.2 27.8 23.7 26.1American Asian or Black or Hispanic White,Indian or Pacific AfricanNon-HispanicAlaska Native Islander AmericanSource: NM Vital Records and Health Statistics; rates age-adjusted to2000 U.S. Standard PopulationFigure 3Elevated Blood Lead Rates AmongChildren Under 6 Years, NM, 2006–2009Rate per 1,000 children testedFigure 2Asthma Hospitalization Rates AmongChildren 1–14 Years, NM, 2008Rate per 10,00060504030201019.2 15.4 12.3 16.4 51.7 9.60New NW NM NE NM Bernalillo SE NM SW NMMexicoCountySource: Hospital Inpatient Discharge Database, NM Health PolicyCommissionThese data are hospital inpatient discharges where asthma is the firstlisteddiagnosis. They include state residents who were discharged fromNM non-federal hospitals. Because many American Indians are admittedto federal IHS hospitals, they are not included in these rates.4.54.03.53.02.52.01.51.00.50.04.0 3.5 3.0 1.92006 2007 2008 2009Source: NM Lead Poisoning Surveillance and Prevention ProgramA healthy environment is essential to thehealth of New Mexicans. Environmentalhealth addresses the interaction betweenhuman health and the chemical, physical,and biological agents found in both ournatural and human-made surroundings.The environment can include the indoorand outdoor air we breathe; water we usefor drinking, cooking, and bathing; food weeat; products we use; buildings we live andwork in; designs of our cities and towns;and recreational areas we use.How Air Quality CanAffect HealthThe air we breathe contributes to ourrespiratory and cardiovascular health.Particle pollution, or particulate matter,consists of particles that are in the air,such as dust, dirt, soot and smoke, andlittle drops of liquid. Some particles arelarge or dark enough and can be seen, likesoot or smoke. Other particles are toosmall to be seen. Short-term exposure toelevated particle pollution significantlycontributes to increased mortality as aresult of cardiovascular events and alsocan result in increased hospital admissionsfor several cardiovascular and pulmonarydiseases. Regional differences in heartattack death rates, therefore, may beinfluenced by particle pollution. In NewMexico, the heart attack death rate isgreatest in the northwestern andsoutheastern regions of the state andparticle pollution may play a role. Longtermexposure to high levels of particlepollution can reduce overall lifeexpectancy by a few years. 1 Research alsoindicates that exposure to air pollution canincrease the risk of infant mortality. 2Known risk factors for heart disease, suchas race/ethnicity, also play a role in NewMexico (Figure 1). Air quality for the stateis generally good, but some areas (e.g.,parts of southern New Mexico and SanJuan County) have relatively high levels ofair pollutants. Industries that adverselyaffect air quality include power plants, oiland gas development, aggregate crushingoperations, and confined animal feedingoperations. Because there are few airquality monitors in the state, methods arebeing developed to forecast episodes ofpoor air quality including high ozone anddust concentrations. Air quality healthadvisories can then be developed forpotentially affected communities.How Water Quality CanAffect HealthClean water is essential to a healthypopulation. Unclean and unhealthy watercan contribute to gastrointestinal diseases,various cancers, birth defects, anddevelopmental problems in children.Routine sampling and analysis of the state’swater reveals that the quality is generallygood, but problems can occur.One such problem arises frombacteriological contamination, which maylead to boil-water advisories. When a boilwateradvisory is issued, the Departmentof Health provides educational materialsfor the public and advises regional publichealth officials to be on alert for cases ofgastrointestinal illness. Nitrates fromfertilizers, animal waste, or improperlymaintained septic tanks can alsocontaminate drinking water sources.New Mexico has relatively high levels ofuranium in groundwater from naturallyoccurring deposits as well as from miningand milling of uranium ore. Arsenic isanother naturally-occurring contaminantof New Mexico groundwater. Exposure torelatively high arsenic levels in drinkingwater is associated with bladder cancer.Compliance with the new EnvironmentalProtection Agency (EPA) drinking waterstandard for arsenic of 10 ug/L has beena challenge for nearly 100 water systemsserving about 40% of the state population.This standard requires that watersystems modify their source watersupplies and/or install arsenic-removaltreatment technology, such as reverseosmosis. In addition, many NewMexicans get their water from untestedprivate wells. Exposure control measuressuch as removal of uranium and arsenicfrom sources of drinking water continueto be promoted by creating anddisseminating fact sheets and othereducational materials among potentiallyexposed New Mexicans.30 NM State of Health 2011

s Essential to NMAsthmaIt is estimated that about 125,000 adults and39,000 children in New Mexico had asthmain 2008. Work being done to reduce theburden of asthma includes collecting andanalyzing health surveillance data andworking with partners throughout NewMexico to develop effective and sustainableinterventions. One primary goal of state andlocal agencies, physician groups, and nonprofitorganizations is to reduce the rates ofasthma emergency room visits, asthmahospitalization, and asthma deaths insoutheastern New Mexico where the ratesare highest. In 2008, the state asthmahospitalization rate for those under age 15was 19.2 per 10,000 population, while the ratein the southeastern region was 51.7 (Figure2). Three additional areas of focus include: 1)increasing health care provider training onthe latest National Heart, Lung, and BloodInstitute asthma guidelines, 2) increasingasthma education in elementary schools, and3) promoting indoor air quality assessmentsin public schools with the goal of reducingasthma triggers on school campuses.Assessing EnvironmentalExposureExposure to many toxic substances can bedetermined through testing of biologicalsamples, such as blood, hair, or urine. Aspart of New Mexico’s notifiable diseasesurveillance, laboratory results that indicateexposure to mercury, arsenic, uranium, lead,pesticides, and nitrates are collected andinvestigated. Lead exposure, for example,can be determined through blood testing.Lead comes from a variety of sources in theenvironment, including older lead-basedpaints, ceramics with lead-based glazes,some imported toys and jewelry, fishingweights and bullets. In recent years, thepercent of children tested for lead hasincreased while the proportion of childrenfound to have high blood lead levels hasfallen (Figure 3). In 2006, four of every 1,000children tested under the age of 6 years hadelevated lead levels, but in 2009, only two ofevery 1,000 children had elevated lead levels.The northwestern and southeastern regionsof the state had the highest rates of elevatedlead levels in young children. Even smallamounts of lead can affect brain developmentin fetuses, infants, and children. The centralfocus of health efforts includes the collectionand analysis of lead-testing data combinedwith case management for lead-poisonedchildren, and educational outreach to preventexcessive lead exposure.Exposure to mercury also is an ongoingconcern. Mercury can affect the nervoussystem, especially in fetuses, infants, andchildren. According to the EPA, coal-firedpower plants are the largest single source ofU.S. mercury emissions. Because mercuryconcentrates in the bodies of certain fish,fish consumption guidelines for selectedrivers and lakes are issued periodically.Tracking Environmentally-Related DiseaseLinking environmental hazard or humanexposure data with health data is needed todetermine how the environment may affecthealth. Examples of this type of analysisinclude the connections between air qualityand asthma emergency room visits, orbetween arsenic levels in drinking waterand bladder cancer. The EnvironmentalPublic Health Tracking website has beendeveloped to disseminate this type ofinformation to New Mexicans. Thisinformation can help residents avoidpotentially harmful exposures and becomeinformed about environmental health.Environmental HealthWhat is Being Done Asthma education for patientsand health care providertraining are being focused inthe southeast where rates arehighest. A web data query systemavailable to the public has beendeveloped to provide NewMexico environmental andhealth data. Lead exposure is being assessed,and individuals with high bloodlead levels receive site visitswith the goal of eliminating thesource of exposure.What Needs to Be Done Increase appropriate asthmaself-management education inorder to reduce hospitaladmissions. Educate communities at risk foradverse environmentalexposures so that they canprotect themselves. Develop additionalenvironmental health advisories,such as when increased ozoneconcentrations occur.Environmental Health 31

Figure 1Adults Who Have Changed or Quit a JobBecause Chemicals, Smoke, Fumes or DustCaused Their Asthma or Made It WorseNM, 2007–2008PercentFigure 2Occupational Injury Death RatesNM and U.S., 1998–2008Rate per 100,0008765432New MexicoU.S.101998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008Source: BLS Census of Fatal Occupational InjuryRate per 100,0003025201510528.5 9.519.00Both Sexes Male FemaleSource: New Mexico Poison & Drug Information CenterFigure 3Work-related Pesticide-Associated Calls toNMPDIC by Region, NM, 2001–2006543214.7 3.9 3.0 2.40Southwestern Central Eastern NorthernSource: NM Poison and Drug Information Center (NMPDIC)Healthy Workplaces AreInjuries and illnesses due to work arecostly to workers, employers and society,both economically and in terms of humansuffering. In New Mexico almost $272million or $354 for each covered workerwas paid out in benefits for workers’compensation insurance in 2008. 1 Thislikely represents a fraction of the costs ofwork-related illness and injury as costs areshifted to insurance systems other thanworkers’ compensation. Furthermore, notall employees are covered by Workers’Compensation. Laws in New Mexicoexclude employers with fewer than threeemployees, domestic workers, farm andranch laborers, and real estatesalespersons from mandatory workers’compensation coverage.How the Workplace CanAffect HealthWork can expose people to many factorsthat affect their health. In 1970 the UnitedStates Congress passed the OccupationalSafety and Health Act (OSH Act) “toassure so far as possible every workingman and woman in the Nation safe andhealthful working conditions and topreserve our human resources.” 2Many toxic substances such as lead andother heavy metals, cancer-causingsubstances such as benzene and asbestos,and physical hazards in the workplacesuch as noise and vibration frommachinery are required to be monitoredunder the OSH Act.As the epidemiology of occupational illnessand injury progresses, a broadening rangeof effects due to hazardous exposures arebeing observed at ever lower doses. Forinstance, recent associations have beenmade between chronic, low-doseexposures to lead and neurological effectsin workers that may lead to memory loss. 3For this reason, New Mexico now reportsadult blood lead levels between 10 and 24µg/dl to the National Institute forOccupational Safety and Health (NIOSH).Aside from physical and pathologicaleffects, there is evidence linkingoccupational injury to psychologicaldistress. Analysis of the National HealthInterview Survey found that workers withpsychological distress had a significantlyhigher risk of being injured on the jobthan workers without distress. 4 Anotherstudy of workers with work-related injuriesfound impacts of the injury on mentalhealth. 5 The Whitehall studies from GreatBritain have provided evidence for theassociation between holding a job that haslow reward for high effort and elevatedrisks for coronary heart disease,psychiatric disorders, fatigue,musculoskeletal and gastrointestinalsymptoms, and sleep disturbances. 6Work-related asthma is an underrecognizedand under-diagnosed condition.NM adult survey data from 2007–2008indicated that, while up to 70% of peoplewith asthma felt that their asthma waseither caused or made worse by theirworkplace, only 8% had ever discussed anassociation between work and asthma withtheir doctors. Work-related asthma canpermanently affect career paths if a workerbecomes sensitized to substances that canbe inhaled at the workplace. Almost 29% ofNew Mexicans who had asthma in theirlifetime stated that they had changed orquit a job because chemicals, smoke,fumes or dust caused their asthma or madetheir asthma worse (Figure 1). AlthoughNew Mexico does not have many of theheavy manufacturing industries frequentlyassociated with asthma aggravating orinducing agents, workers may still beexposed to substances such as wood dustor welding fumes in construction,disinfectants used in health care, animaldander and grain dust in agriculture, orcleaning agents used in service industries.These are but a few agents on theextensive list of known workplaceasthmagens.New Mexico has consistently had higherrates of work-related injury fatalities thanthe nation as a whole (Figure 2) and ishome to several high-hazard industries forwork-related injury fatality, such astransportation, mining, agriculture andconstruction. Other contributing riskfactors for occupational injury fatality inour state include being a non-UnitedStates citizen, age 65 years and older,32 NM State of Health 2011

Good for Businessinjury occurrence in rural counties, andself-employment. 7New Mexico also has consistently highrates of acute work-related pesticideassociatedillnesses and injuries reportedto poison control centers. 8 Thesouthwestern region of NM had thehighest rate of calls per 100,000 workers(Figure 3). Insecticides, dominated byorganophosphates, are the most frequentlyreported pesticides with 63% of all callsbeing insecticide-related. 9 This promptedfurther study of agricultural exposures inthe southwestern NM. A survey offarmworkers in 2008 showed that trainingwas effective at increasing their knowledgeabout pesticides and at increasing certainself-reported behaviors that are protectiveagainst pesticide exposures. However, onlyhalf of workers had ever had any kind oftraining, much less the EnvironmentalProtection Agency’s mandated WorkerProtection Standard (WPS) training, andwomen had significantly less training thanmen. 10 Training gaps were addressed in2010 by compiling an inventory of pesticideexposure prevention training providers insouthwestern NM and surveyingemployers on factors around training. Theinventory is distributed to employers andfarmworker advocate groups.Workplace InvestigationsThe NM Department of Health and theNM Environment Department respond toreports of occupational illness and injury.One recent investigation was in responseto reported cases of Mycobacterium aviumComplex (MAC) infection in spamaintenance workers. Workers hadsymptoms indicative of “hot-tub lung”, ahypersensitivity pneumonitis-like lungdisease that can arise from exposure toMAC-containing aerosols during the use orcleaning of spa tubs. The investigationrequired coordination of several programswithin DOH, the NM EnvironmentDepartment, as well as experts withinNIOSH and the Centers for DiseaseControl and Prevention Laboratories.production, oil and gas extraction is animportant industry for the State. 11 Basedon occupational injury and illness data,the New Mexico Occupational Health andSafety Bureau (NM-OSHA) has madeboth oil and gas drilling and petroleumrefining priorities in both theirenforcement and cooperative initiatives.Local emphasis programs (LEPs) havebeen established by NM-OSHA to addresshealth and safety hazards in theseindustries. Additionally, the NM “Oil andGas Safe Site” program has beenestablished to help companies objectivelyevaluate their health and safety programs,and to acknowledge those companies whohave met or exceeded established criteriafor implementing those programs.Another area of concern for NM-OSHA isthe increasing rate of ergonomic-relatedinjuries in health care and social assistanceindustries. Much of the associated injuriesare attributable to tasks involving liftingand repositioning patients.The effect of work exposures on injury anddisease has been recognized for centuries.As the nature of work grows more complexin our society, our understanding of theinteractions between health and theworkplace also increases in complexity. Inorder to implement effective occupationalillness and injury prevention strategies,everyone including workers, employers,physicians and regulators need to be awareof both the positive and detrimental effectsof work on health.Occupational HealthWhat is Being Done Increasing reporting ofoccupational illnesses andinjuries by health care providers. Promoting pesticide exposureprevention training forfarmworkers. Providing information andeducation on currentoccupational health concernsto health care providersthroughout the state throughProject ECHO’s OccupationalTelemedicine program.What Needs to Be Done Focus surveillance in industriesthat national and state dataindicate to be high hazard, suchas oil and gas extraction andhealth care. Improve awareness andrecognition of occupationallyrelated conditions among nonoccupationalhealth careproviders. Find ways to collect data onunderserved worker populations,such as workers on tribal lands,migrant workers and the selfemployed. Collect respondents’ occupationand industry in New Mexicoadult survey data to shed lighton associations betweenoccupation, risk behaviors andadverse health outcomes.Ranking 4th for marketed natural gasproduction and 7th for crude oilOccupational Health 33

Figure 1Lack of Adult Health Care CoverageNM and U.S., 2000–2009Percent30252015105068.340.079.342.660.017.777.342.071.842.653.832.320002001200220032004NM 18–64U.S. 18–64NM 65+U.S. 65+20052006Source: NM Behavioral Risk Factor Surveillance SystemFigure 2Adults Receiving Health Screening orPrevention by Health Care CoverageNM, 2008–2009CoverageNo coverage20072008200965+ withpneumoniavaccinationCholesterolcheck withinpast 5 years50+ andhave hadendoscopy50+ andhave hadmammogramOral healthvisit withinpast yearAdult diabetic received allrecommended preventitiveservices in past year0 10 20 30 40 50 60 70 80 90 100PercentSource: NM Behavioral Risk Factor Surveillance SystemFigure 3Adults Experiencing Barriers to Healthcareby Disability Status, NM, 200814.624.87.120.414.72.913.313.417.54.6No disabilityDisabilityCost asbarrierDistanceTransportationDesign offacilityAttitude ofhealthcareprofessionals0 10 20 30 40 50 60 70 80 90 100PercentSource: NM Behavioral Risk Factor Surveillance SystemCoverage Improves; BarrIn 1978, nearly all nations of the worldsigned the World Health OrganizationDeclaration of Alma Ata, 1 proclaiming theright of all people to primary care. Primarycare is defined as basic or general healthcare focused on the point at which a patientideally first seeks assistance from themedical care system. In 2007, 36% of thetotal New Mexico population resided indesignated primary care HealthProfessional Shortage Areas (HPSA). Allor part of thirty-one of the thirty-threecounties were designated a primarymedical HPSA.The ability to access health care is centralto maintaining one’s health. Importanthealth maintenance information and tools,such as mammograms, PAP tests,measurements of blood pressure and bloodcholesterol, and many others, are onlyavailable through health care providers.For most individuals and families, the highcost associated with accessing health carecan only be managed through some form ofhealth care plan, be it private healthinsurance, employer-provided insurance, orsome form of public sponsored coverage.Lack of health care coverage has beenassociated with delayed access to healthcare and increased risk of late stagediagnosis of chronic disease and mortality. 2Individuals without health care coverage aremuch less likely than those with coverage toreceive recommended preventive services,are less likely to have access to regular careby a personal physician, and are less able toobtain needed medication or health careservices. Consequently, the uninsured aremore likely to succumb to preventableillnesses, more likely to suffer complicationsfrom those illnesses, and are more likely todie prematurely. 2,3The New Mexico Department of Healthroutinely monitors health care coverage asan important measure of the ability of thestate’s population to obtain importanthealth information and medical care.Throughout the past decade, NewMexicans were less likely than those livingin the rest of the country to have any formof health care coverage. However, whilelack of coverage has remained stableacross the country it has declined in NewMexico in recent years, with moreindividuals possessing some form ofcoverage (Figure 1). Adults 65 years of ageor older qualify for federally sponsoredMedicare. Nearly all adults in this agegroup have access to health care.According to the American CommunitySurvey, coverage of New Mexico childrenunder the age of 19 years was lower thanthe national percentage but improved from86.2% in 2008 to 87.7% in 2009. 4Health care coverage impacts anindividual’s ability to access recommendedhealth screening tools and preventivehealth care. For each preventive measureor health screen, Figure 2 presents thepercentage of adults who have received thegiven service by health care coveragestatus. For example, nearly 68.3% of adultsage 65 or older who have coverage havereceived the recommended pneumococcalvaccination while only 40.0% of thosewithout coverage have received thevaccination. Adults who are covered by ahealth plan are significantly more likely tohave received these potentially life-savingservices by the recommended age andwithin the recommended timeframe.In 2009, 46.5% of adults without coverageexperienced a time in the previous 12months in which they needed medicalcare but could not get it because of thecost, while cost prevented 9.5% of adultswith coverage from obtaining neededmedical care.Barriers to AccessingHealth CareThe 2008 New Mexico BRFSS Surveyincluded a set of supplemental questionsabout barriers to health care. Amongadults who did not have any form ofcoverage, 60% reported that the cost ofpremiums was the primary reason for nothaving coverage, and an additional 22%percent lost coverage when they lost orchanged their job. Other reasons for lackof coverage included aging out of eligibilityfor Medicaid, rejection by a healthinsurance company, or lack of U.S.residency status.34 NM State of Health 2011

iers to Access PersistIn addition to lack of health care coverage,there are other barriers to accessing healthcare. Distance to health care providers,transportation issues, the design of theprovider’s office, and for some, the attitudeof the health care provider or their staff,may serve as barriers to care (Figure 3). InNew Mexico, many communities have fewhealth care providers and distances toneighboring communities are great forthose living in rural areas. In 2008, adultsresiding in rural areas were more likelythan those living in metropolitan areas toreport that distance and transportationwere sometimes, often, or always aproblem in seeking care.Disability and Access to CareDisability is also an important factorregarding access to care. In 2008, adultswith a disability were five times more likelythan adults without disability to reportoffice design as a barrier, nearly four timesmore likely to report transportation as abarrier, three times more likely to reportdistance as a barrier, and over one and ahalf times more likely to report negativeattitude of medical or office staff as abarrier.Community-BasedPrimary CareFor more than 20 years, there has been aneffort to build a system of community-basedprimary care centers for New Mexico’sunderserved. This has been a collaborativeeffort, linking federal, state, and localprograms with community groups and nonprofitagencies. The impact has beenconsiderable; there are primary care centersin 95 communities serving more than300,000 patients through more than 1 millionvisits each year. Roughly 88% of thesepatients have annual incomes below 200% ofthe Federal Poverty Level and 43% arewithout any form of health care coverage.Improving AccessPrimary care centers are serving asignificant portion of the unmet need inNew Mexico, making clear the necessity ofcontinuing to build the primary care centersector. Under the Federal Primary CareCooperative Agreement, NMDOH willcontinue its work facilitating the expansionof primary care centers.While the focus of these centers is onmedical services, there is an increasedemphasis on expansion of dental servicesin the primary care setting. Fewer thanhalf of primary care clinic sites have dentalservice capacity. But even with this limitedcapacity, primary care centers providemore than 20% of all Medicaid dentalservices in New Mexico.The community-based primary care sectorin New Mexico is a major public healthsuccess story. Few other states have aswidespread a system caring for such alarge percentage of the state’s underservedpopulation. The sector has been built uponlocal initiative, community governance,federal, state, and local financial support,and staffing by government healthprofessional programs.Access to Health CareWhat is Being Done Preparations are underway forthe initiation of the new federalHealth Care Reform. Health insurance has been madeavailable to qualified familieswith children. Low-interest loans are beinggranted for community-basedprimary care center facilitiesand equipment. Planning assistance is beinggiven to community groups andagencies developing orexpanding community-basedprimary care centers. Tax incentives and educationloan repayment programsencourage medical professionalsto settle and work in underservedareas.What Needs to Be Done Careful study of and integrationwith federal Health Care Reformof New Mexico primary care andother medical resources. Expansion of primary carecenters to meet the needs ofmore underserved people. Expansion of dental services forprimary care center clients. Expansion of basic behavioralhealth services within theprimary care setting. Expansion of health promotionand disease prevention servicesand chronic diseasemanagement capacity in theprimary care centers.Access to Health Care 35

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The State of Healthin New Mexico 2011New Mexico Department of Health