A poor state of health

Missouri ranks poorly in several health categories, according to national study.

Missouri likes its cigarettes. Exercise? Not so much.

The Show Me State ranked 48th in the nation in smoking prevalence in last year, according to the latest study released by the United Health Foundation. Experts say Missouri's addiction -- 27.2 percent of the population smokes -- is probably a major reason why the state also scored low in many other major health categories. The state was tied with West Virginia for 48th. Only Kentucky had a higher prevalence of smokers.

The state also ranked 43rd in cardiovascular deaths and 36th in overall health.

"It's pretty graphic to see how we're stacking up compared to other states," said Deborah Markenson, administrator of the section of chronic diseases with the Missouri Department of Health and Senior Services. "These risk factors are preventable. People don't have to smoke; they choose to smoke."

Before this week, Cape Girardeau residents John and Jennifer McQueen were two of Missouri's millions of smokers. But both are trying to quit. He smoked three packs per day; she smoked two.

John, 27, has smoked about 14 years and quit once before for about two years.

"The first time that I quit, I smoked so much that it became a problem both physically and mentally," said John. "It gets to where you always have to have a cigarette.

"You have to have one first thing in morning and all through the day, you smoke in the middle of night when you wake up. There were times when I just couldn't breathe."

But the state's health has more problems than just cigarettes.

The state ranks among the worst states in physical activity, obesity, heart disease, cancer and stroke deaths.

Bollinger County Health Center administrator Beverly Piepenbrok sees the prevalence of those risk factors and chronic ailments in her county every day.

For a 10-year-period from 1993-2003 Bollinger County was well above the state average for deaths from heart disease.

"It's the lifestyle factors that play on all these chronic diseases, especially the lack of physical activity and obesity," said Piepenbrok. "I think that there is lack of opportunity in Bollinger County for physical activity. We're very sparsely populated and most people don't farm like we used to. I don't think we're doing things physically like we used to do and we haven't adjusted our eating patterns."

Piepenbrok said the lack of large population centers in the rural county makes it difficult for people to find exercise opportunities like public walking tracks or gyms. Piepenbrok said these conditions help lead to the county's elevated percentage of overweight people.

"It's a nationwide problem and I think there's lots of factors," Piepenbrok said. "You can just walk down the street and see the problems."

The prevalence of smoking in the state hasn't changed much from 1990 to 2003, moving down .5 percent. The state was 11th in smoking prevalence in 1990, but other states have reduced smoking at much faster rates.

Factors contributing to that scenario are numerous and based largely on public policy, said Markenson.

"While other states have been investing in tobacco prevention efforts, they have been impacting the number of people smoking in their state," said Markenson.

Missouri ranks near the bottom in tobacco-settlement dollars spent on smoking cessation and prevention, Markenson said. It also has one of the lowest taxes on tobacco in the country.

Markenson said "clear evidence" suggests increased prices of cigarettes leads to lower prevalence of current smokers. Fewer young people start smoking as well.

A new hot line has been started which helps counsel people hoping to quit, which Markenson said pertains to 50 percent of smokers in the state.

The McQueens are trying to quit with each other's support. They figure helping each other might make the process easier. But quitting is still hard.

"I'm cool, but she's freaking out," said John.

In Cape Girardeau County, health officials are less worried about smoking and more worried about overweight adults and children. Like Scott County, Cape Girardeau County ranked in the top 40 percent of counties for deaths from heart disease from 1993-2003.

A Cape Girardeau County Health Department survey ranked mortality from heart disease and stroke as the county's chief concern, along with the increase in obese children.

The county's study, released earlier this year, said that 6.8 percent of children in the WIC program in the county were overweight, with the problem affecting white infants at a higher rate.

While the WIC population doesn't represent all demographics, it still gives health officials a clue to the scope of the childhood obesity problem, said Janet Wernsman, the department assistant director.

"Nationwide this is ... what's happening in the rest of the country," said Wernsman. "We're right up there with the best of them, I guess."

She said health center staff has observed a clear increase in the childhood weight problem in their non-WIC population as well.

The problem isn't only seen in children, though. The Cape Girardeau County study reported 39.1 percent of adults in the county are overweight, while 35.3 percent of the state population was overweight.

However the county was below the state rank in the more serious obese category, with a prevalence of 18.9 percent compared with 23.4 percent of the state.

But while solutions are fairly clear for stopping smoking, Markenson said, they don't come so easily with fighting the state's growing bulge.

"Tobacco is more straightforward; we know it's not healthy," Markenson said. "Obesity is far more complex. There's a whole set of interrelated factors that lead to the increase in this epidemic we've seen in the last 15 years."

According to data from the Centers for Disease Control and Prevention, no state in the United States reported over 20 percent of its population suffering from obesity in 1997. By 2001, 27 states had an obesity rate over 20 percent.

Missouri rates 30th among states in obesity, something health officials are hoping to change. In Bollinger County, Piepenbrok is working to get the funding for walking trails in decentralized locations in the county, where residents can have easier access to them.

Bollinger County has already purchased a treadmill and placed it in a church where rural residents can have easy access to it, and a Marble Hill doctor's office has a gym where the general public can sign up for memberships to use treadmills, free weights, exercise bikes and other equipment.

And at the state level, the health department is exploring policies that will encourage Missourians to be more active and eat better, including individual education, promoting activity through community organizations and promoting sound health policies in schools, said Markenson.

"There are solutions in hand, but they're not always simple, easy ones," said Markenson. "We really have to think in this society, 'What have we been doing in the last 15 years that has led to this problem?'"

msanders@semissourian.com

335-6611, extension 182