Monday, Sept. 20, 2004 | 10:59 a.m.
Women go on drinking binges, die from cigarette smoking and kill themselves more in Nevada than in most other states, according to a study released by the federal government earlier this month.
The study found that Nevada women had America's highest rate of deaths from lung cancer and from chronic lower respiratory diseases, both of which are attributed chiefly to smoking.
The state was second-worst for suicide and fourth-worst for binge drinking in the Women's Health and Mortality Chartbook, released on Sept. 1 by the National Center for Health Statistics at the federal Centers for Disease Control.
The report was based on birth and death certificates and federally coordinated state surveys taken between 1999 and 2002 in the 50 states, the District of Columbia and Puerto Rico.
The grim picture for women here doesn't end with debauchery and despair. Compared with their peers in other states, women in Nevada were also less likely to have health insurance and less likely to get preventive medical attention such as Pap smears and prenatal care.
But there was also good news in the report: Nevada was one of the best states when it came to diabetes and obesity among women, with the third-lowest rate of diabetes-related deaths and the fifth-lowest incidence of obesity.
"I'm amazed -- skeptical, really" -- at the diabetes and obesity numbers, said Sean Ameli, a cardiologist and president of the Southern Nevada chapter of the American Heart Association. "But if you really look at everything else, those numbers show that with regard to overall health, and for women especially, Nevada is one of the worst states."
Ameli noted that despite the high rankings, Nevada still was not meeting federal targets for reducing diabetes and obesity. It was possible, he said, that the state was simply the pick of a bad litter.
"We have such an epidemic of obesity and diabetes in the United States that you can be in the top five and still have a big problem," Ameli noted.
Nevada's women were in the bottom 10 for health insurance coverage, Pap smears for uterine cancer, routine check-ups and prenatal care, according to the report. Those categories are directly related, said survey author Kate Brett, a research epidemiologist at the federal agency in Washington. Women who aren't insured are unlikely to get the preventive care that can be lifesaving for them and their children, she explained.
Nevada's low rankings for these categories reflect the state's lack of services for the working poor, said Jan Gilbert of the Progressive Leadership Alliance of Nevada. "It seems to me this is about low-wage working women," she said.
Low-income children can participate in the state's Nevada Checkup program, and there is a program for children and pregnant women who are poor enough to qualify for Medicaid. But many Nevada women work at jobs that pay the bills, but don't pay for insurance, and the state has not filled that need, Gilbert said.
As a result, many women end up going to the emergency room to give birth, never having seen a doctor during their pregnancy, said Fran Courtney, director of clinic and nursing service for the Clark County Health District.
When that happens, not only does it burden the emergency system, there can be complications that affect both mother and baby -- complications that could have been avoided with prenatal care, Courtney said. But Nevada has no free prenatal care programs.
Smoking is another area where government intervention is needed, said Maria Azzarelli, tobacco control coordinator for the Clark County Health District. But Nevada has a state law that prevents local jurisdictions from restricting smoking.
"We can't change the social norms if the rules say it's OK to smoke everywhere here," Azzarelli said. "Policy change is needed. The nonsmoking lifestyle is not valued."
Nationwide, smoking among women has been increasing for decades, possibly as an unhealthy side effect of women's increasing empowerment and equality with men, she said.
"For a long time women in this state have smoked at higher rates than the rest of the country and had higher rates of lung disease," Jill Winter of the Nevada Women's Lobby noted. "We have an economy in which people drink and smoke, not just visitors but residents as well."
Nevada men are also some of America's heaviest smokers, numerous studies have shown. In fact, many of the problems shown in the report are not necessarily confined to women -- too many men here also lack health insurance, binge drink and commit suicide, according to studies.
But many health issues are particular to women, Winter noted. "For most of our lives, we have health care needs that are different and more complex than for men," because of women's reproductive function, she said. "It's a biological fact."
The study's purpose was to help each state's federally sponsored women's health coordinator determine priorities, Brett, the study's author, said. Statistically, women differ from men by many health measures, she noted. Women are less likely to exercise and more likely to be obese. Women still smoke less than men, but they are rapidly catching up, she said.
In the study, Arizona was the state with the lowest incidence of diabetes-related death, followed by Florida.
Colorado, Hawaii, Massachusetts and Connecticut were better than Nevada when it came to obesity.
Wisconsin -- the state whose baseball team is named for its beer-making tradition -- was by far the worst state for binge drinking, while North Dakota and Massachusetts were also worse than Nevada.
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