1. Demographic and Health Profile Starr County 2001 Texas Department of State Health Services Office of Border Health

2. Starr County

3. In population, Starr County ranked 51 th (out of 32 counties) in the Border region and 54 th (out of 254 counties) in Texas There were 54,591 inhabitants in Starr County, compared to 2,176,117 in the Border region, and 21,325,018 in Texas 2.5% of the Border region population lived in Starr County The area in square miles was 1,223 The number of people per one square mile was 44.6 Starr County 2001 Source: TDH, Selected Fact Sheets - 2001

4. Age and Ethnicity 2001

5. Source: TDH, Selected Fact Sheets - 2001 Population by Age 2001

6. Population by Ethnicity 2001 Source: TDH, Selected Fact Sheets - 2001

7. Socio-Economics 2001 Source: TDH, Selected Fact Sheets - 2001

8. Natality There were 1,460 babies born in Starr County in 2001 The percentage of adolescent mothers (<18) was 8.6% which was higher than in the Border region (6.8%) but higher than in Texas (5.4%) The percentage of babies that were born with low birth weight (5.8%) was lower than in the Border region (6.9%) and Texas (7.6%) The percentage of pregnant women that received late or no prenatal care (31.1%) was higher than in the Border region (28.2%) and in Texas (19.7%) The fertility rate (116.2) was higher than in the Border region (104.1) and in Texas (75.4) * In 2001, the natality data of Starr County revealed the following: Source: TDH, Selected Fact Sheets - 2001 * Fertility rates are per 1,000 women ages 15-44

9. Natality 2001 Source: TDH, Selected Fact Sheets - 2001

10. Mortality Cardiovascular Disease accounted for 43.0% of all deaths in Starr County The rate of people that died of Cardiovascular Disease (347.7) was higher than in the Border (272.8) and in Texas (344.2) Cancer accounted for 16.2% of all deaths in Starr County The rate of people that died of Cancer (119.8) was lower than in the Border (159.3) and in Texas (192.7) Source: TDH, Selected Fact Sheets - 2001 Note: Rates are per 100,000 population and adjusted for age In 2001, the mortality data for Starr County revealed the following:

11. Mortality (continued) Chronic Lower Respiratory Disease accounted for 4.8% of all deaths in Starr County Diabetes accounted for 3.7% of all deaths in Starr County The number of deaths resulting from Chronic Lower Respiratory Disease and Diabetes were too small to calculate a meaningful rate for comparison to the Border and Texas Source: TDH, Selected Fact Sheets - 2001

12. Morbidity 2001 * Rates are per 100,000 population Source: TDH, Selected Fact Sheets - 2001

13. Source: TDH, BRFSS 2001 Morbidity 2001

14. Healthy Border / Frontera Saludable Healthy Border 2010 aims to improve health in the United States-Mexico border region, an area defined as 100 kilometers (62 miles) north and south of the United States- Mexico border and close to 2000 miles in length. The Healthy Border 2010 program was established by the U.S.- Mexico Border Health Commission as its binational agenda of health promotion and disease prevention. The Healthy Border 2010 agenda establishes 10-year objectives for binational health promotion and disease prevention in the border region. The program also serves as a basis for the development of bilateral, border-wide and community health improvement plans.

15. Healthy Border / Frontera Saludable Objectives 1.Reduce by 25 percent the proportion of persons lacking access to a primary care provider in underserved areas. 2.Reduce the breast cancer death rate for women by 20 percent. 3.Reduce the cervical cancer death rate for women by 30 percent. 4a. Reduce the diabetes death rate by 10 percent. 4b. Reduce diabetes hospital admissions by 25 percent. 5.Reduce to zero the population residing in counties exceeding EPA air quality standards.

16. Healthy Border / Frontera Saludable Objectives 6.Reduce to zero the proportion of households not connected to either compliant public sewage systems or septic tanks. 7.Reduce by 25 percent the number of persons hospitalized for acute pesticide poisoning. 8.Reduce the incidence of diagnosed HIV infection cases among adolescents and adults by 50 percent. 9a. Reduce the incidence of hepatitis A by 50 percent. 9b. Reduce the incidence of hepatitis B by 50 percent. 10. Reduce the incidence of tuberculosis by 50 percent.

17. Healthy Border / Frontera Saludable Objectives 11.Achieve and maintain an immunization coverage rate of 90 percent for children 19-35 months. 12.Reduce the motor vehicle crash death rate by 25 percent. 13.Reduce the childhood (under 5 years of age) death rate due to unintentional injuries by 30 percent. 14.Reduce the infant mortality rate by 15 percent. 15.Reduce the infant mortality rate due to birth defects by 30 percent.

18. Healthy Border / Frontera Saludable Objectives 16.Increase the proportion of women receiving prenatal care in the first trimester to 85 percent. 17.Reduce the pregnancy rate among 15 to 17 year old women by 33 percent. 18.Reduce the suicide death rate by 15 percent. 19.Reduce the proportion of adults who are obese by 15 percent. 20.Increase to at least 75 percent the proportion of the population served by community water systems with optimally fluoridated water.

19. Healthy Border / Frontera Saludable Objectives 21.Increase to at least 75 percent the proportion of children and adults who use the oral health care system each year. 22.Reduce the asthma hospitalization rate by 40 percent. 23.Reduce the rate of alcohol-related motor vehicle crash deaths by 50 percent. 24.Increase to 89 percent the proportions of adolescents not using alcohol or any illicit drug during the past 30 days. 25.Reduce by 33 percent the proportion of adults and adolescents currently using tobacco.

20. Access to Care Access to quality health care is essential to improving the health of Texas-Mexico border residents. Access to care is required for individuals to obtain preventive health services such as immunizations, regular Pap tests, or early prenatal care. Effective primary care can also educate people about modifiable risk factors such as smoking. Residents with chronic diseases require health care access for effective management of conditions such as diabetes and hypertension. 1.Reduce by 25 percent the proportion of persons lacking access to a primary care provider in underserved areas.

21. In 2001, “Access to Care” data for Starr County revealed the following: 54% did not have health care coverage which was higher than in Texas at 23% * 31% of the population was unable to see a doctor due to cost which was higher than in Texas at 15% * There was a significant difference among men and women as 39% of the women and 23% of the men could not see a doctor due to cost * 42.4% of the population is eligible for Medicaid compared to 12.6% of the Texas population ** Source: * TDH, BRFSS - 2001 and ** TDH, Selected Fact Sheets - 2001 Access to Care

22. 2001 Ratio of Population to Health Professional Starr CountyBorderTexas Physicians3,412:1851:1661:1 Registered Nurses 853:1244:1156:1 Dentists10,918:16,535:12,820:1 Source: TDH, Selected Fact Sheets - 2001

23. Access to Care 2001 Source: TDH, Selected Fact Sheets - 2001

24. Cancer 2.Reduce the breast cancer death rate for women by 20 percent. 3.Reduce the cervical cancer death rate for women by 30 percent.

25. Cancer Smoking cessation Eating more fruits and vegetables More physical activity Weight control Several types of cancer can be prevented by changes in behaviors or dietary habits. As many as 50 percent of all cancers could be prevented by:

26. Cancer Equally vital in the fight against cancer is screening for early detection and treatment. In the Texas-Mexico border region, both breast cancer and cervical cancer are often diagnosed at later stages of development. Detection can be improved through mammograms and breast self-examinations for breast cancer, and through Pap smears for cervical cancer. Enhancing the access of border residents to routine health care services is a key element in reducing cancer mortality.

27. Prevention and early detection of cancer require various types of resources. First is the need to provide culturally and linguistically appropriate information on prevention, early detection, and treatment to the public and to health care professionals. Second, the public must have access to preventive and diagnostic services as well as treatment. Cancer

28. In 2001, “Breast & Cervical Cancer” data for Starr County revealed the following: 56% of women ages 18 and above had never had a mammogram, compared to 19% of the women the same age in Texas * 65.8% of women 40 and older did not have a clinical breast exam and a mammogram in the past 2 years which was significantly higher than the 20% in Texas * The number of deaths due to female breast cancer were too small to calculate a meaningful rate for comparison with the Border and Texas ** In Texas there were 18,846 mammograms performed through the Texas Breast and Cervical Cancer Control Program of which 227 (1.2%) were performed in Starr County ** Source: * TDH, BRFSS - 2001 and ** TDH, Selected Fact Sheets - 2001 Cancer

29. Diabetes The growing prevalence of diabetes is a result of a number of trends, including improper nutrition, obesity, and the aging of population groups with a predisposition to develop diabetes. Despite the growing number of diabetes cases identified annually, it is believed that a large proportion of persons with diabetes remains undiagnosed. 4b. Reduce diabetes hospital admissions by 25 percent. 4a. Reduce the diabetes death rate by 10 percent.

30. Improving nutrition and increasing physical activity (thereby reducing the prevalence of overweight and obesity) has been shown to reduce the number of persons who develop Type 2 diabetes. Diabetes

31. 20% were told that they had high blood pressure, which was lower than the 24% in Texas * 33% were told that they had high cholesterol which was higher than the 30% in Texas * 14% were told that they had diabetes, compared to 6% in Texas * The number of deaths due to diabetes were too small to calculate a meaningful rate for comparison with the Border and Texas ** In 2001, “Diabetes” data for Starr County revealed the following: Source: * TDH, BRFSS - 2001 and ** TDH, Selected Fact Sheets - 2001 Diabetes Note: Rates are per 100,000 population and adjusted for age

32. Environmental Health 5.Reduce to zero the population residing in counties exceeding EPA air quality standards. 6.Reduce to zero the proportion of households not connected to either compliant public sewage systems or septic tanks. 7.Reduce by 25 percent the number of persons hospitalized for acute pesticide poisoning.

33. Human exposures to hazardous agents in the air, water, soil and food, and physical hazards in the environment are major contributions to illness, disability and death worldwide. Pollutants and contaminants that arise on one side of the border can easily affect the air, water, and soil of the other side, as well as affect the health of persons living along the opposite border. In 2001, no air quality data was available for Starr County. Environmental Health

34. 8.Reduce the incidence of diagnosed HIV infection cases among adolescents and adults by 50 percent. HIV/AIDS is no longer restricted to specific population groups: HIV infection and AIDS have been reported in almost every age and socio-economic group, and in all large cities in the Texas-Mexico border. As with all other communicable diseases, HIV/AIDS transmission is not restrained by political boundaries. HIV / AIDS

35. HIV prevention requires a broad range of medical and counseling services, accompanied by information, education and other activities. Many strategies have been developed to reduce the spread of HIV infection, including the promotion of safer sex practices and the reduction of needle sharing. In addition, HIV counseling, education and information should be appropriate for local cultures and languages. An important issue, however, is access to care, as knowledge of HIV status is a key part of halting the transmission of HIV. On of the major barriers to care is the lack of HIV trained providers on both sides of the border. HIV / AIDS

36. The HIV rate for Starr County (7.3) was lower than in the Border (10.8) and in Texas (14.3) * The AIDS rate for Starr County (3.7) was lower than the rate in the Border (11.1) and in Texas (14.0) * In 2001, “HIV/AIDS” data for Starr County revealed the following: Source: TDH, Selected Fact Sheets - 2001 HIV / AIDS Note: Rates are per 100,000 population

37. 9a. Reduce the incidence of Hepatitis A by 50 percent. 9b. Reduce the incidence of Hepatitis B by 50 percent. 10.Reduce the incidence of Tuberculosis by 50 percent. 11.Achieve and maintain an immunization coverage rate of 90 percent for children 19-35 months. Immunizations and Infectious Diseases

38. Increased vaccination coverage has produced dramatic declines in the incidence of some infectious diseases. For example, measles and mumps cases have decreased significantly in the past decade. The strategy is to detect, control and prevent infectious diseases, and then to maximize the vaccination coverage rate in the “at-risk” population. Immunizations and Infectious Diseases

39. For diseases that are not preventable or only partially preventable by vaccine, a different approach is required. Reducing tuberculosis rates requires active surveillance, including testing of “at-risk” populations, providing curative therapy to tuberculosis patients, ensuring that therapy is completed and investigating close contacts of tuberculosis patients. Lack of access to care can delay the detection of tuberculosis cases, and limit direct observation of therapy by health care providers. Immunizations and Infectious Diseases

40. 53% of people 65 and older not get a flu shot during the past 12 months compared to 59% in Texas * 67% of people aged 65 and older had never had a pneumonia vaccine compared to 44% for the same age group in Texas * The Hepatitis A rate (1.8) was lower than in the Border (3.7) and in Texas (5.4) ** The Hepatitis B rate (0.0) was lower than in the Border (1.5) and in Texas (3.3) ** The Tuberculosis rate (34.8) was higher than in the Border (12.7) and in Texas (7.7) ** In 2001, “Immunizations and Infectious Diseases” data for Starr County revealed the following: Source: * TDH, BRFSS - 2001 and ** TDH, Selected Fact Sheets - 2001 Immunizations and Infectious Diseases Note: Rates are per 100,000 population

41. Immunizations and Infectious Diseases

42. 12.Reduce the motor vehicle crash death rate by 25 percent. Injury and Violence Prevention 13.Reduce the childhood (under 5 years of age) death rate due to unintentional injuries by 30 percent.

43. The risk of death due to a motor vehicle crash is greatest among adolescents and young adults (15 to 24 years of age) and the elderly population (75 or more years of age). Motor vehicle deaths can be prevented by increasing the use of automobile seat belts, reducing the consumption of alcohol by automobile drivers, enhancing the enforcement of traffic laws (particularly maximum speed limits), and improving the quality of roads, lighting and other safety enhancements. Injury and Violence Prevention

44. Unintentional injuries are an important cause of death among young children, but particularly so for those 1 to 4 years of age. Important causes of injury deaths include motor vehicle crashes, drowning, poisonings, and fires. Important preventive measures would be restricting unsupervised access to swimming pools or other bodies of water, and improved safeguards against access to household toxic substances by young children. Injury and Violence Prevention

45. 23% of the people (age 18 and over) did not always use a seat belt when they drove or rode in a car * The number of deaths resulting from motor vehicle crashes were too small to calculate a meaningful rate for comparison to the Border and Texas ** In 2001, “Unintentional Death” data for Starr County revealed the following: Source: * TDH, BRFSS - 2001 and ** TDH, Selected Fact Sheets - 2001 Injury and Violence Prevention

46. 14.Reduce the infant mortality rate by 15 percent. Maternal, Infant and Child Health 15.Reduce the infant mortality rate due to birth defects by 30 percent. 17.Reduce the pregnancy rate among 15 to 17 year old women by 33 percent. 16.Increase the proportion of women receiving prenatal care in the first trimester to 85 percent.

47. Screening of pregnant women and young children is essential to prevent or mitigate many serious health problems. Screenings, as part of prenatal care, can identify many important maternal health conditions or risk factors for poor infant outcome, including pregnancy-related hypertension and diabetes, cigarette smoking and others. Maternal, Infant and Child Health

48. The use of alcohol, tobacco and illegal substances during pregnancies is associated with many developmental problems in infancy and childhood, partly as the result of very low birth weight and premature delivery. The use of alcohol during pregnancy can cause fetal alcohol syndrome, a leading cause of mental retardation. Most neural tube defects are preventable, but the intervention requires nutritional supplements prior to conception. Maternal, Infant and Child Health

49. 89% of childbearing aged women (18-44) did not take supplements containing folic acid, compared to 46% of the women the same age in Texas * The number of infant deaths were too small to calculate a meaningful rate for comparison with the Border and Texas ** 68% of pregnant women in Starr County received prenatal care during the first trimester, which was lower than the 80.3% in Texas ** In 2001, “Maternal, Infant, and Child Health” data for Starr County revealed the following: Source: * TDH, BRFSS - 2001 and ** TDH, Selected Fact Sheets - 2001 Maternal, Infant and Child Health Note: Rates are per 100,000 population and adjusted for age

50. 18.Reduce the suicide death rate by 15 percent. Mental Health Mental disorders are health conditions characterized by altered thinking, mood, or behavior that are associated with distress or impaired functioning. These conditions can lead to a variety of problems including disability, pain, or death. The prevalence of mental illness in the border population is unknown, but annually, about 22 percent of the U.S. population is affected by a mental disorder.

51. Of the principal mental disorders, major depression is thought to be one of the most important. Suicide, a major public health problem, occurs most frequently as a consequence of a mental disorder, usually due to major depression and bipolar disorder (manic-depression). Mental Health

52. 28% of the people in Starr County reported having 2 or more days of poor mental health 30 days prior to the survey There was little difference between men (24%) and women (22%) * The number of deaths due to suicide were too small to calculate a meaningful rate for comparison with the Border and Texas ** In 2001, “Mental Health” data for Starr County revealed the following: Source: * TDH, BRFSS - 2001 and ** TDH, Selected Fact Sheets - 2001 Mental Health Note: Rates are per 100,000 population and adjusted for age

53. 19.Reduce the proportion of adults who are obese by 15 percent. Nutrition and Overweight

54. In June 1998, the federal government announced guidelines which created a new definition of a healthy weight – a BMI of 24 or less. Thus, a BMI of 25 to 29.9 is now considered overweight. Individuals who fall into the BMI range of 25 to 34.9, and have a waist size of over 40 inches for men and 35 inches for women, are considered to be at especially high risk for health problems. * BMI is calculated as weight in pounds divided by the square of the height in inches and the resulting number then multiplied by 704.5. For example: a woman that is 5’5” and weighs 125 pounds would be considered normal in weight because her BMI would be 20.8. If she weighed 150 pounds she would be considered overweight because her BMI would then be 25; and, if she weighed 180 pounds, she would be considered obese because her BMI would then be 30. Nutrition and Overweight

55. 29% of the people in Starr County reported engaging in more than 20 minutes of physical activity most days of the week, which was better than the 21% for Texas 27% of males and 31% of females exercised more than 20 minutes per day Only 6% of people in Starr County reported eating 5 or more servings of fruits and/or vegetables each day, which was much lower than the 23% in Texas In 2001, “Nutrition and Overweight” data for Starr County revealed the following: Source: TDH, BRFSS 2001 Nutrition and Overweight

56. 20.Increase to at least 75 percent the proportion of the population served by community water systems with optimally fluoridated water. Oral Health 21.Increase to at least 75 percent the proportion of children and adults who use the oral health care system each year.

57. Treatment of dental cavities Preventive services such as dental sealants Dental restorative treatments such as replacement of temporary teeth Screening and diagnosis of oral and pharyngeal cancers Identification and referral for treatment of oral birth defects such as cleft lip and cleft palate Oral health is an essential component of health. Essential dental services include: Oral Health

58. The level of dental caries in children has declined in recent decades, due to the increased use of toothpaste containing fluoride as well as community water fluoridation. Dental caries remain a significant problem for certain subgroups of the population, in particular for low-income groups. A continued focus on oral health by governmental agencies and professional organizations will help to improve oral health. Increasing the number of dental personnel and community-based treatment programs will provide affordable access to dental care for the underserved population. Oral Health

59. 82% of the people reported brushing their teeth 2 or more times a day * 72% of the men and 91% of the women reported brushing their teeth 2 or more times a day * 37% reported using dental floss to clean between teeth at least once per day * 34% of the men and 40% of the women reported using dental floss at least once per day * In 2001, “Oral Health” data for Starr County revealed the following: Source: TDH, BRFSS 2001 Oral Health

60. 22.Reduce the asthma hospitalization rate by 40 percent. Respiratory Disease Increases in asthmatic symptoms have been associated with a variety of pollutants. Illness and disability from asthma are related to air pollutants (e.g., ozone and particulate matter), allergens, and exposure to some pesticides. For 2001, no data on asthma was available for Starr County.

61. 23.Reduce the rate of alcohol-related motor vehicle crash deaths by 50 percent. Substance Abuse 24.Increase to 89 percent the proportion of adolescents not using alcohol or any illicit drug during the past 30 days.

62. 16% reported having 5 or more drinks in the past 30 days, compared to 18% in Texas 31% of the men and 4% of the women reported drinking at least 5 alcoholic beverages in the last 30 days 5% reported having 60 or more drinks in the past 30 days, compared to 8% in Texas 8% of the men and 1% of the women had at least 60 alcoholic beverages in the past 30 days 3% reported driving after “perhaps” too much to drink in the past 30 days, compared to 4% in Texas In 2001, “Substance Abuse” data for Starr County revealed the following: Source: TDH, BRFSS 2001 Substance Abuse

63. 25.Reduce by 33 percent the proportion of adults and adolescents currently using tobacco. Tobacco Use

64. 55% of the men and 15% of the women reported having smoked at least 100 cigarettes in their lifetime 62% reported smoking every day or some days, which was much higher than the 22% in Texas 62% of the men and 62% of the women reported smoking every day or some days 19% of the men and 1% of the women reported using chew and/or snuff tobacco In 2001, “Tobacco Use” data for Starr County revealed the following: Source: TDH, BRFSS 2001 Tobacco Use

65. Please visit our website at: www.dshs.state.tx.us/borderhealth