This measure is based on survey responses to the question: "Thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?" The value reported in the County Health Rankings is the average number of days a county's adult respondents report that their physical health was not good. The measure is age-adjusted to the 2000 US population.

This measure is based on survey responses to the question: "Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?" The value reported in the County Health Rankings is the average number of days a county's adult respondents report that their mental health was not good. The measure is age-adjusted to the 2000 US population.

Self-reported health status is a general measure of health-related quality of life (HRQoL) in a population. This measure is based on survey responses to the question: "In general, would you say that your health is excellent, very good, good, fair, or poor?" The value reported in the County Health Rankings is the percentage of adult respondents who rate their health "fair" or "poor". The measure is age-adjusted to the 2000 US population. Respondents were adults (age 18 and more).

Low Birthweight is the percentage of live births where the infant weighed less than 2,500 grams (approximately 5 lbs., 8 oz.). Low birthweight (LBW) represents two factors: maternal exposure to health risks and an infant's current and future morbidity, as well as premature mortality risk. From the perspective of maternal health outcomes, LBW indicates maternal exposure to health risks in all categories of health factors, including her health behaviors, access to health care, the social and economic environment she inhabits, and environmental risks to which she is exposed. In terms of the infant's health outcomes, LBW serves as a predictor of premature mortality and/or morbidity over the life course and for potential cognitive development problems.

Primary care physicians include practicing physicians (M.D.'s) specializing in general practice medicine, family medicine, internal medicine, pediatrics, and obstetrics/gynecology. The measure represents the number of primary care physicians and the rate of primary care physicians per 100,000 population. Access to care requires not only financial coverage, but also, access to providers.

Mental health providers include psychiatrists, psychologists, licensed clinical social workers, counselors, and advanced practice nurses who specialize in mental health care. The measure represents the number of mental health providers and rate of mental health providers per 100,000 population.

The measure represents the number of dentists and the rate of dentists per 100,000 population. Dentists are classified by county, but dentists living on the edge of counties or who practice in multiple locations may see patient populations that reside in surrounding counties.

This measure represents the price-adjusted Medicare reimbursements per enrollee and considered as an important measure of the efficiency of a health care system.

Persons without Insurance (Population under 65, 2013 est.) represents the percentage and the number of the population under age 65 that has no health insurance coverage. The Small Area Health Insurance Estimates uses the American Community Survey (ACS) definition of insured: Is this person CURRENTLY covered by any of the following types of health insurance or health coverage plans: Insurance through a current or former employer or union, insurance purchased directly from an insurance company, Medicare, Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability, TRICARE or other military health care, Indian Health Services, VA or any other type of health insurance or health coverage plan?

Persons without Insurance (Population under 19 Years, 2013 est.) represents the percentage and the number of the population under age 19 that has no health insurance coverage. The Small Area Health Insurance Estimates uses the American Community Survey (ACS) definition of insured: Is this person CURRENTLY covered by any of the following types of health insurance or health coverage plans: Insurance through a current or former employer or union, insurance purchased directly from an insurance company, Medicare, Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability, TRICARE or other military health care, Indian Health Services, VA or any other type of health insurance or health coverage plan?

Persons without Insurance (Population 18 to 64 Years, 2013 est.) represents the percentage and the number of the population ages 18 to 64 that has no health insurance coverage in a given county. The Small Area Health Insurance Estimates uses the American Community Survey (ACS) definition of insured: Is this person CURRENTLY covered by any of the following types of health insurance or health coverage plans: Insurance through a current or former employer or union, insurance purchased directly from an insurance company, Medicare, Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability, TRICARE or other military health care, Indian Health Services, VA or any other type of health insurance or health coverage plan?

Premature Deaths (Less Than 75 Years) is the number of deaths under age 75. Measuring premature mortality, rather than overall mortality, reflects the County Health Rankings' intent to focus attention on deaths that could have been prevented.

Years of Potential Life Lost (YPLL) is the years of potential life lost before age 75 (YPLL-75). Every death occurring before the age of 75 contributes to the total number of years of potential life lost. For example, a person dying at age 25 contributes 50 years of life lost, whereas a person who dies at age 65 contributes 10 years of life lost to a county's YPLL. The YPLL measure is presented as a rate per 100,000 population and is age-adjusted to the 2000 US population.

Infant mortality measures the number of deaths among children less than one year of age per 1,000 live births. Infant mortality represents the health of the most vulnerable age group (those under 365 days). Understanding the child mortality rate in a county can help interpret the years of potential life lost (YPLL) rate. We provide both the infant mortality rate and the number of infant deaths.

Child Mortality is the number of deaths among children under age 18 per 100,000 population. Understanding the child mortality rate in a county can help interpret the years of potential life lost (YPLL) rate. We provide both the child mortality rate and the number of child deaths.

Premature age-adjusted mortality measures the number of deaths among residents under the age of 75 per 100,000 population. Premature age-adjusted mortality is a common and important population health outcome measure. We provide both the premature age-adjusted mortality rate and the number of premature age-adjusted deaths.

Drug Poisoning Mortality represents the number of drug poisoning deaths per 100,000 population. We provide both the drug poisoning mortality rate and the number of drug poisoning deaths. This measure includes accidental, intentional, and of undetermined poisoning by and exposure to:

1. Nonopioid analgesics, antipyretics and antirheumatics.
2. Antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified.
3. Narcotics and psychodysleptics (hallucinogens), not elsewhere classified.
4. Other drugs acting on the autonomic nervous system.
5. Other and unspecified drugs, medicaments and biological substances.

Diabetics is the prevalence of diagnosed diabetes in a given county. Respondents were considered to have diagnosed diabetes if they responded "yes" to the question, "Has a doctor ever told you that you have diabetes?" Women who indicated that they only had diabetes during pregnancy were not considered to have diabetes.

Diabetic Monitoring is the percentage of diabetic fee-for-service Medicare patients ages 65 - 75 whose blood sugar control was monitored in the past year using a test of their glycated hemoglobin (HbA1c) levels.

Teen Births are the number of births per 1,000 female population, ages 15-19 and this measure is associated with unsafe sexual activity. Teen birth data are readily available and reliable for nearly all counties. We provided both the number of births and birth rates per 100,000 females aged 15 - 19.

Sexually Transmitted Infections (STI) are measured as the chlamydia incidence (number of new cases reported) per 100,000 population. We provided both the rate of Chlamydia cases per 100,000 population and the number of Chlamydia cases.

HIV prevalence measures the number of diagnosed cases of HIV in a county per 100,000 population. HIV is an important marker for a range of risky health behaviors. The County Health Rankings use disease-specific measures for ranking calculations only when no other reliable source for risk factor or outcome data is available. We provided both the HIV prevalence rate per 100,000 population and the number of HIV cases.

Adult Smoking is the percentage of the adult population that currently smokes every day or most days and has smoked at least 100 cigarettes in their lifetime.

Excessive Drinking is the percentage of adults that report either binge drinking, defined as consuming more than 4 (women) or 5 (men) alcoholic beverages on a single occasion in the past 30 days, or heavy drinking, defined as drinking more than one (women) or 2 (men) drinks per day on average.

Limited Access to Healthy Foods is the percentage of the population who are low income and do not live close to a grocery store. Living close to a grocery store is defined differently in rural and nonrural areas; in rural areas, it means living less than 10 miles from a grocery store; in nonrural areas, less than 1 mile. Low income is defined as having an annual family income of less than or equal to 200 percent of the federal poverty threshold for the family size.

Percentage of population with adequate access to locations for physical activity. Access to Exercise Opportunities measures the percentage of individuals in a county who live reasonably close to a location for physical activity. Locations for physical activity are defined as parks or recreational facilities. Parks include local, state, and national parks. Recreational facilities include businesses identified by the following Standard Industry Classification (SIC) codes and include a wide variety of facilities including gyms, community centers, YMCAs, dance studios and pools.

Adult Obesity is the percentage of the adult population (age 20 and older) that reports a body mass index (BMI) greater than or equal to 30 kg/m2. Obesity is often the result of an overall energy imbalance due to poor diet and limited physical activity. Obesity increases the risk for health conditions such as coronary heart disease, type 2 diabetes, cancer, hypertension, dyslipidemia, stroke, liver and gallbladder disease, sleep apnea and respiratory problems, osteoarthritis, and poor health status.

Physical Inactivity is the percentage of adults aged 20 and over reporting no leisure-time physical activity. Examples of physical activities provided include running, calisthenics, golf, gardening, or walking for exercise.

Children Eligible for Free Lunch is the percentage of children enrolled in public schools eligible for free lunch. Eligibility for free lunch is a way of measuring the effect of poverty on children.

The Food Environment Index ranges from 0 (worst) to 10 (best) and equally weights two indicators of the food environment: Limited access to healthy foods and Food insecurity.

1. Limited access to healthy foods estimates the percentage of the population who are low income and do not live close to a grocery store. Living close to a grocery store is defined differently in rural and nonrural areas; in rural areas, it means living less than 10 miles from a grocery store whereas in nonrural areas, it means less than 1 mile. Low income is defined as having an annual family income of less than or equal to 200 percent of the federal poverty threshold for the family size.
2. Food insecurity estimates the percentage of the population who did not have access to a reliable source of food during the past year. A 2-stage fixed effect model was created using information from the Community Population Survey, Bureau of Labor Statistics, and American Community Survey.