2003 BEHAVIORAL RISK FACTORS OF ARIZONA ADULTS June 2004 Janet Napolitano, Governor State of Arizona Catherine R. Eden, Director Arizona Department of Health Services Rose Conner, Assistant Director Division of Public Health Services Author: Brian A. Bender, MBA, Manager Survey Center ACKNOWLEDGMENTS This report could not have been completed without the input and assistance of the following individuals: Richard S. Porter, Chief Bureau of Public Health Statistics Opinion Research Corporation, Macro International BRFSS Contractor Centers for Disease Control and Prevention Gloria Colclough Bill Garvin A special thank you to Arizona residents for participating in the survey and cooperating with the interviewers. Notice The Arizona Department of Health Services does not discriminate on the basis of disability in the administration of its programs and services as prescribed by Title II of the Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973. If you need this publication in an alternative format, please contact the ADHS Bureau of Public Health Statistics at (602) 542-7333 or E-mail: benderb@azdhs.gov or http://www.azdhs.gov. Funded by the Centers for Disease Control Cooperative Agreement No. U58/CCU922904-01 Permission to quote from or reproduce this publication is granted when due acknowledgment is made. TABLE OF CONTENTS EXECUTIVE SUMMARY ............................................................................................... 1 RISK FACTORS/CHRONIC DISEASE TERM USAGE .................................... 2 RISK FACTORS/CHRONIC DISEASE TERM USAGE (CONT) .................. 3 INTRODUCTION ............................................................................................................... 4 METHODOLOGY .............................................................................................................. 5 I. SURVEY RESULTS: ANALYSIS OF HIGH-RISK GROUPS................................................ 8 A. HEALTH CARE COVERAGE ................................................................................ 9 B-1. PHYSICAL ACTIVITY - CATEGORIES...................................................... 11 B-2. PHYSICAL ACTIVITY - RECOMMENDATIONS ................................... 13 C. DIABETES ..................................................................................................................... 15 D. HYPERTENSION AWARENESS ......................................................................... 17 E. CHOLESTEROL AWARENESS........................................................................... 19 F. FRUIT AND VEGETABLE CONSUMPTION ................................................. 21 G. OBESITY (BMI) .......................................................................................................... 23 H. ASTHMA ........................................................................................................................ 25 I. CIGARETTE SMOKING .......................................................................................... 27 J. ALCOHOL ...................................................................................................................... 29 II. MODULE SURVEY RESULTS: ANALYSIS OF HIGH-RISK GROUPS.......................... 32 A. ARTHRITIS................................................................................................................... 33 III. STATE-ADDED QUESTIONS SURVEY RESULTS: ANALYSIS OF HIGH-RISK GROUPS....................................................................................................................................... 35 A. FAMILY PLANNING & AGING ADULT ........................................................ 37 B. AGING SERVICES & FOLIC ACID................................................................... 38 APPENDIX I: ARIZONA RESPONDENT PROFILE.............................................................. 39 APPENDIX II: 2003 ARIZONA BRFSS QUESTIONS LISTING ........................................... 40 APPENDIX III: 2003 ARIZONA QUESTIONNAIRE............................................................. 41 APPENDIX IV: 2003 BRFSS WEIGHTING FORMULA ........................................................ 52 EXECUTIVE SUMMARY This document reports specific behavioral risk factors and chronic diseases in adults in the State of Arizona for the year 2003. The Annual Survey Results portion of this report contains information on high-risk behaviors and chronic diseases that are surveyed each year. The Module Survey Results portion contains information on high-risk behaviors and chronic diseases that may or may not be surveyed each year. The State-Added Questions Survey Results portion contains information on high-risk behaviors added by request. The Behavioral Risk Factor Surveillance System (BRFSS) program is a rich source of state-level public health data; these data have become integral to health promotion, disease prevention, and intervention planning throughout Arizona. Highlights of the 2003 Behavioral Risk Factors Survey: • 16.7% of respondents reported that they did not have health coverage. • 50% of respondents reported insufficient physical activity at either moderate or vigorous levels. • 6.3% of respondents reported that a doctor told them they had diabetes. • Almost one-quarter of adult Arizonans (22.7%) reported being told by a doctor, nurse, or other health professional that they had high blood pressure. • 94.6% of respondents reported that their last blood cholesterol was checked within the last five years meeting Heart Association guidelines. • Over three-quarters of respondents (76.9%) do not eat five or more servings of fruits and vegetables daily. • 22.1% of male respondents and 18.1% of female respondents had a body mass index that classified them as obese. • 12.5% were told by a doctor, nurse or other health professional that they had asthma. • 20.8% of respondents were current smokers. This is down from 23.4% last year. • Almost one-quarter of male respondents (24.7%) engage in binge drinking. • 56.8% of respondents aged 65+ reported they were told by a doctor they have arthritis. In the adult population the percentage is 26.3%. • One third of respondents reported that they had provided some type of care or assistance to a relative or friend who is 60 years old or older. • 5.8% of respondents age 55+ reported needing someone to help with their personal care needs, such as eating, bathing, dressing, or getting around the house. • Over one-half (54.6%) of respondents did not know that folic acid prevents birth defects. 1 RISK FACTORS/CHRONIC DISEASE TERM USAGE Arthritis Respondents who reported a doctor told them they had arthritis. Binge Drinking Respondents who reported having five or more drinks on an occasion, one or more times in the past month. Current Smoking Respondents who reported smoking 100 cigarettes during their lifetime and who smoke now (regularly or irregularly). Dental Visit Respondents who reported they had not had a dental visit in the past year. Diabetes Respondents who reported a doctor told them they had diabetes. Five A Day Respondents who reported they had not heard of the program “Five A Day for Better Health.” Flu Shot Respondents who reported not receiving a flu shot in the past 12 months. Folic Acid Respondents 18-44 years of age who reported a reason other than preventing birth defects as the reason experts recommend that women take folic acid. Fruits/Vegetables Respondents who reported that they consumed fewer than five servings of fruits and vegetables daily. Health Care Plan Respondents who reported that they did not have health care coverage. HIV/AIDS Testing Respondents 18-64 years of age who reported that they have not been tested for HIV. Limited Activities Respondents who reported they were limited in any activities due to any impairment or health problems. Mammography Female respondents 40 years of age and older who reported that they had never had a mammogram. No Leisure-Time Activity Respondents who reported that they did not participate in physical activity in the past month outside of normal work-related activities. Obese Respondents with a Body Mass Index (BMI) of 30.0 to 99.8. BMI is weight in kilograms divided by height in meters squared (W/H²). Overweight Respondents with a Body Mass Index (BMI) of 25.0 to 29.9. Pap Smear Female respondents who reported that they never had a Pap Smear test. Pneumonia Vaccination Respondents who reported not never receiving a pneumonia vaccination. 2 RISK FACTORS/CHRONIC DISEASE TERM USAGE (CONT) PSA Blood Test Male respondents aged 50 years and older who reported that they had not had a Prostate Specific Antigen (PSA) blood test. Respondent Arizona residents 18 years of age or older. subset(s) of this group may be used. Seatbelt Respondents who reported that they "sometimes", "seldom", or "never" wear seat belts when driving or riding in a car. In some cases various 3 INTRODUCTION In 2002, 42,320 Arizona residents died. The table below lists the top 10 causes of death of Arizona residents in 2002.1 Chronic diseases such as heart disease, cancer, and diabetes are leading causes of disability and death in the United States. Every year, chronic diseases claim the lives of more than 1.7 million Americans. These diseases are responsible for 7 of every 10 deaths in the United States. Chronic diseases cause major limitations in daily living for more than 1 of every 10 Americans, or 25 million people. These diseases account for 75% of the $1 trillion spent on health care each year in the United States.2 Since 1982, through a cooperative agreement with the Centers for Disease Control and Prevention (CDC), the Arizona Department of Health Services (ADHS) has implemented the Behavioral Risk Factor Surveillance System (BRFSS) is an on-going data collection system for gathering information on adult health-related behaviors of non-institutionalized residents 18 years of age and older. The purpose of the BRFSS is to provide data that can be used to plan, implement, and monitor health promotion and disease prevention efforts in Arizona. LEADING CAUSES OF DEATH, ARIZONA 2002 RANK 1 CAUSE OF DEATH Heart Disease NUMBER OF DEATHS AGE ADJUSTED MORTALITY RATE PERCENTAGE OF TOTAL DEATHS 10,551 201.0 24.9 2 Malignant Neoplasms - Cancer 9,148 168.6 21.6 3 Chronic Lower Respiratory Disease 2,530 47.0 6.0 4 Cerebrovascular Disease 2,448 47.0 5.8 5 Unintentional Injury 2,416 45.2 5.7 6 Alzheimer’s Disease 1,413 28.0 3.3 7 Influenza and Pneumonia 1,294 25.0 3.1 8 Diabetes Mellitus 1,201 22.3 2.8 9 Suicide 855 15.9 2.0 10 Chronic Liver Disease & Cirrhosis 647 12.1 1.5 Source: Arizona health status and vital statistics, 2002. * All death rates are age-adjusted to the estimated 2000 U.S. population. References 1. Mrela, CK, ARIZONA HEALTH STATUS AND VITAL STATISTICS, 2002. Bureau of Public Health Statistics, Arizona Department of Health Services. 2. CDC. The Burden of Chronic Diseases and Their Risk Factors: National and State Perspectives, February 2002. 4 METHODOLOGY A. SAMPLING DESIGN The Arizona BRFSS is a random sample telephone survey. Using disproportionate stratified sampling, random digit dialing, and a Computer Assisted Telephone Interviewing (CATI) system. The survey has the potential to represent 96.3% of all households in Arizona (i.e., those who have telephones according to Arizona Department of Economic Security data for the year 2000, the latest year available). A sample size of 3,200 interviews over a 12-month period was selected to achieve an acceptable 95% confidence interval of ±3% on risk factor prevalence estimates of the adult population. This means that the estimated prevalence of a given risk factor can be reliably projected across the total population of Arizona residents. Prevalence estimates of individual demographic variables, especially those that yield smaller sample sizes, do not achieve the same level of accuracy as the total sample. A demographic profile of the Arizona population is reported in Appendix I: 2003 Arizona Demographic Profile. B. QUESTIONNAIRE The questionnaire, designed through cooperative agreements with the CDC, was divided into three sections, Core, Optional Modules, and State Added questions. The Core section contained questions on health risk behavior and demographic information; the next section contained optional modules: Arthritis. The last section contained State-added questions consisting of: Family Planning, Aging Adult, Aging Services, Hepatitis C Risk, and Folic Acid. C. BRFSS PROTOCOL The ADHS has contracted with a private survey research firm since August 2000 to contact randomly selected Arizona residences from 9 A.M.– 9 P.M. weekdays, from 11 A.M.–7 P.M. Saturdays, and from 11 A.M.–7 P.M. Sundays. All telephone numbers released in each month’s sample received at least 15 attempts over a minimum 14 day period, including at least three attempts during weekends, three attempts during weekday evenings; and three attempts during the daytime weekday. Furthermore, selected respondents who were not able to complete the interview at the time of selection received a minimum of 10 callbacks during the interviewing period. After a residence had been contacted, one adult (18 years of age or older) was randomly selected from all adults residing in the household to be interviewed. 5 D. DATA ANALYSIS The collected data were compiled and weighted by the CDC. Weighted counts were based on the Arizona population to accurately reflect the population demographics. The weighting factor considered the number of adults and telephone lines in the household, cluster size, stratum size, and age/race/sex distribution of the general population. The weighting formula is described in Appendix IV: BRFSS Weighting Formula. All analyses presented are based on cell size counts of at least eight cases. The demographic information that was collected and presented in these results includes sex, age, education, household income, race, and ethnicity. Comparisons between responses within demographic categories were analyzed for statistical significance at the alpha = .05 level. Throughout the report, statistical difference is noted when analysis provides 95% confidence that the categories described are different. 6 7 I. SURVEY RESULTS: ANALYSIS OF HIGH-RISK GROUPS 8 A. HEALTH CARE COVERAGE Uninsured people are less likely than people with health insurance to have a primary care provider; to have received appropriate preventive care, such as current mammograms; or to have had recent medical visits. Lack of insurance also affects access to care for relatively serious medical conditions. Evidence suggests that the risk of premature death increases considerably for people without health insurance over an extended period and that death rates of hospitalized patients without health insurance are significantly higher than among patients with insurance.1 According to the 2003 Arizona BRFSS, 16.7%∗ of all respondents reported they did not currently have health care coverage (Figure I-A-1). This represents a slight increase from what was reported in 2002. Improving access to health care is an objective of Healthy People 2010, an initiative which sets a goal of increasing the proportion of adults with health insurance to 100%.2 This is also an objective of Healthy Arizona 2010, with a goal of increasing of persons with health care coverage to 90%.3 30% 25% 20% 15% 13.1% 14.1% 1998 1999 17.1% 16.9% 16.1% 16.7% 2000 2001 2002 2003 10% 5% 0% Year Figure I-A-1. Percentage of Arizona BRFSS respondents who reported they did not have health coverage in 1998-2003. Males (16.7%) were about as likely as females (16.6%) to lack health care coverage. Differences in coverage were evident among age, education, income, and race categories (Table I-A-1). Respondents aged 18-24 (28.7%) and 25-34 (25.4%), were less likely to have coverage than other respondents. Generally, as age increased the percentage of respondents without health care coverage decreased. In addition, Arizonans with less education and lower incomes were more likely to lack health care coverage. Respondents with less than a high school education (41.0%) were significantly less likely to have coverage than those with some college or technical training (15.6%) and college graduates (6.2%). Also, as with age and education, as income increased the percentage of respondents reporting they did not have health care coverage decreased. Respondents earning less than $15,000 were the least likely to have health care coverage (40.2%) followed by those earning from $15,000-$24,999 (26.7%). Significant differences also appeared between race and ∗ 95% Confidence Interval: 14.5%-18.9%. 9 ethnic groups. While more than onequarter (29.2%) of Non-Whites lacked health care coverage, only 11.9% of White respondents lacked coverage. Similarly, 33.0% of Hispanics were not covered by health care insurance while only 12.6% of Non-Hispanics lacked coverage. 2003 Arizona BRFSS: Respondents with No Health Care Coverage GROUPS WEIGHTED UNWEIGHTED PERCENT N Sex Male 16.7 171 Female 16.6 287 Age Reference 18-24 28.7 48 1. 25-34 25.4 110 35-44 15.7 91 45-54 16.0 100 55-64 13.5 80 3.4 24 Less than High School 41.0 98 High School Graduate/GED 21.4 147 Some College/Tech School 15.6 147 6.2 65 <$15,000 40.2 117 $15,000-$24,999 26.7 126 $25,000-$34,999 23.6 68 $35,000-$49,999 10.7 47 7.9 50 White 11.9 258 Non-White 29.2 196 Hispanic 33.0 134 Non-Hispanic 12.6 323 2. 3. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000. Arizona Department of Health Services. Healthy Arizona 2010: Collaborating For A Healthier Future, March 2001. 65+ Education College Grad Income ≥$50,000 Race Ethnicity Table I-A-1. 2003 BRFSS results: Arizona respondents with no health care coverage. 10 B-1. PHYSICAL ACTIVITY - CATEGORIES Physical inactivity and its related health problems have significant economic consequences for the U.S. health care system. In the long term, physical inactivity threatens to reverse the decadeslong progress that has been made in reducing the morbidity and mortality related with many chronic conditions, e.g., cardiovascular disease. A physically inactive population is at medical and financial risk for many chronic diseases and conditions including heart disease, stroke, colon cancer, diabetes, obesity, and osteoporosis.1 Regular physical activity greatly reduces the risk of dying of heart disease, the nation’s leading cause of death, and decreases the risk for colon cancer, diabetes, and high blood pressure. It also helps to control weight; contributes to healthy bones, muscles, and joints; helps to relieve the pain of arthritis; reduces symptoms of anxiety and depression; and can decrease the need for hospitalizations, physician visits, and medications. Moreover, physical activity need not be strenuous to be beneficial; people of all ages benefit from moderate physical activity, such as 30 minutes of brisk walking at least five times a week.2 Regular exercise also can contribute to the functional independence of the elderly and improves the quality of life for people of all ages.3 50% 40% 35.5% 30% 20% 20.1% 18.6% 14.6% 11.2% 10% 0% Meet Both Moderate Only Vigorous Only Insufficient Both No Activity Figure I-B-1-1. Percentage of Arizona BRFSS respondents who reported insufficient activity for both moderate or vigorous activity categories. Analysis of the 2003 Arizona BRFSS data indicated that 35.5%∗ of all respondents who reported insufficient activity for both moderate and vigorous physical activity categories. (Figure I-B-11). Males (36.5%) were more likely than females (34.6%) to report insufficient activity for both moderate and vigorous physical activity categories. Regarding age, Arizonans 55-64 years were most likely to report insufficient activity for both physical activity categories (40.7%) and the next largest category were respondents 45-54 years (40.6%). Respondents with a high school education (38.2%) were most likely to report insufficient activity for moderate and vigorous categories followed by respondents with some college or technical school (36.4%). Arizonans with incomes $35,000 to $49,999 and greater than or equal to $50,000 were the most likely to ∗ 95% Confidence Interval: 33.0%-38.0%. 11 report insufficient physical activity (37.1%). The next highest group were those making less than $15,000 (36.2%). White Arizonans were more likely to lack sufficient physical activity (37.6%), compared to Non-White respondents (31.0%). Regarding ethnicity, NonHispanics were higher (36.5%) than Hispanics (32.2%). 2003 Arizona BRFSS: Arizona respondents who reported insufficient activity for both moderate or vigorous activity categories. References 1. 2. 3. U.S. Department of Health and Human Services. Physical Activity Fundamental To Preventing Disease, June 2002. U.S. Department of Health and Human Services. The Burden of Chronic Diseases and Their Risk Factors: National and State Perspectives, February 2002. Katz S, Branch LG, Branson MH, et al., Active Life Expectancy. N Engl J Med, 1983; 309: 1218-1224. GROUPS WEIGHTED UNWEIGHTED PERCENT N Sex Male 36.5 404 Female 34.6 670 18-24 25.2 44 25-34 36.3 170 35-44 36.4 176 45-54 40.6 241 55-64 40.7 186 65+ 33.6 253 Less than High School 29.1 88 High School Graduate/GED 38.2 301 Some College/Tech School 36.4 343 College Grad 34.3 340 <$15,000 36.2 113 $15,000-$24,999 32.9 175 $25,000-$34,999 35.1 145 $35,000-$49,999 37.1 194 ≥$50,000 37.1 342 White 37.6 845 Non-White 31.0 224 Hispanic 32.2 155 Non-Hispanic 36.5 916 Age Education Income Race Ethnicity Table I-B-1. 2003 BRFSS results: Arizona respondents who reported insufficient activity for both moderate or vigorous activity categories. 12 B-2. PHYSICAL ACTIVITY - RECOMMENDATIONS Enhanced health and less risk for all-cause mortality is associated with regular physical activity. Besides the effects on mortality, physical activity has numerous health benefits, including reducing the risk for cardiovascular disease, diabetes, obesity, selected cancers, and musculoskeletal conditions.1 Regular physical activity reduces the risk of heart disease, diabetes, colon cancer, high blood pressure, osteoporosis, arthritis, and obesity. It also improves symptoms associated with conditions such as depression and anxiety. Although vigorous physical activity produces the greatest cardiovascular benefits, moderate levels of physical activity are associated with lower levels of mortality.2 Not At Risk 50.1% At Risk 49.9% Figure I-B-2-1. Percentage of Arizona BRFSS respondents who are at risk for not meeting recommendations for physical activity. Healthy People 2010 Objective #22.2 is 30.0% Analysis of the 2003 Arizona BRFSS data indicated that 49.9%∗ of all respondents were at risk for not meeting recommendations for vigorous or moderate physical activity. (Figure I-B-2-1). This falls short of the Healthy People 2010 Objective of 30.0%.3 Males (50.8%) were more likely than females (49.4%) to report not meeting the recommendations for physical activity. Arizonans aged 65+ years were most likely to not meet physical activity recommendations (57.6%) with the next largest category were respondents 5564 years (56.4%). There was a negative correlation between levels of education and not meeting recommendations for physical activity, respondents with less than a high school education (61.1%) were least likely to meet recommendations for physical activity with college graduates most likely to meet them (44.9%). There also was an inverse relationship between income levels and respondents reporting they did not meet recommendations for physical activity. Arizonans with incomes less than $15,000 were the most likely to report not meeting these recommendations (65.6%), the next highest group were those making $15,000-$24,999 (51.2%). Non-White Arizonans were less likely to meet recommendations (52.5%), compared to White ∗ 95% Confidence Interval: 47.2%-52.5%. 13 respondents (49.3%). Regarding ethnicity, Hispanics were higher (57.9%) than Non-Hispanics (48.2%). 2003 Arizona BRFSS: Arizona respondents who reported not meeting recommendation for physical activity References Sex 1. Centers for Disease Control and Prevention. Increasing physical activity: a report on recommendations of the Task Force on Community Preventive Services. MMWR 2001;50(No. RR-18):7. Male 50.8 568 Female 49.4 948 18-24 37.8 61 Freid VM, Prager K, MacKay AP, Xia H. Chartbook on Trends in the Health of Americans. Health, United States, 2003. Hyattsville, Maryland: National Center for Health Statistics. 2003. 25-34 48.8 216 35-44 46.4 230 45-54 54.4 308 55-64 56.4 261 65+ 57.6 433 Less than High School 61.1 182 High School Graduate/GED 55.9 447 Some College/Tech School 47.2 446 College Grad 44.9 437 <$15,000 65.6 205 $15,000-$24,999 51.2 274 $25,000-$34,999 50.3 197 $35,000-$49,999 48.0 248 ≥$50,000 44.4 408 White 49.3 1,135 Non-White 52.5 368 Hispanic 57.9 261 Non-Hispanic 48.2 1,248 2. 3. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000. GROUPS WEIGHTED UNWEIGHTED PERCENT N Age Education Income Race Ethnicity Table I-B-2. 2003 BRFSS results: Arizona respondents who reported not meeting recommendation for physical activity. 14 C. DIABETES Diabetes is a serious, costly disease and it is on the rise. Currently, 17 million Americans have diabetes, and over 200,000 people die each year of related complications. Diabetes can cause heart disease, stroke, blindness, kidney failure, leg and foot amputations, pregnancy complications, and deaths related to flu and pneumonia. Particularly at risk are the 5.9 million Americans who are unaware that they have the disease.1 “Diabetes is a serious, costly, and increasingly common chronic disease that can cause devastating complications—including heart disease, kidney failure, leg and foot amputations, and blindness—that often result in disability and death. Early detection, improved delivery of care, and better self-management are key strategies for preventing much of the burden of diabetes. Type 2 diabetes, formerly considered “adult onset” diabetes, is now being diagnosed more frequently among children and adolescents. This type of diabetes is linked to two modifiable risk factors: obesity and physical inactivity.”2 20% 15% 10% 5% 2.8% 4.3% 5.9% 6.1% 6.4% 6.3% 2000 2001 2002 2003 0% 1998 1999 Year Figure I-C-1. Percentage of Arizona BRFSS respondents who reported that they were told they had diabetes in 1997-2003. Healthy People 2010 Objective No. 5.3 is 4.0%. According to the 2003 BRFSS, 6.3%∗ of all respondents reported being told by a doctor they had diabetes. This percentage, shown in Figure I-C-1, represents a slight decrease from 2002. The figure continues to exceed the Healthy People 2010 objective for diabetes incidence of 4.0%.3 Males were about as likely (6.4%) as females (6.2%) to be told they have diabetes. There is a general positive relationship between age and the percentage of respondents being told they have diabetes. The age group 65+ were most likely to be told they have diabetes (15.8%), followed by the 55-64 age group (11.4%). Respondents with a high school education were most likely to be told they have diabetes (11.0%); the next highest group were respondents who graduated from high school (6.8%). Respondents earning less than $15,000 had the highest percentage saying they were told they have diabetes (13.5%), followed by respondents earning $25,000-$34,999 (7.3%). Non-White respondents were more likely to be told they have diabetes than White ∗ 95% Confidence Interval: 5.19-7.43. 15 respondents (7.2% and 6.0% respectively). Hispanics were more likely Non-Hispanic respondents to be told they have diabetes (7.3% and 6.1% respectively). Finally, the survey measured use of dilated eye exams among respondents with diabetes. Healthy People 2010 Objective 5.13 set a goal of increasing to 75% the number of diabetics receiving an annual dilated eye examination.3 Arizona fell slightly short of that goal with 69.3% reported having an dilated eye exam in the past year. References 1. 2. 3. Centers for Disease Control and Prevention. Diabetes: Disabling, Deadly, and on the Rise. 2002 U.S. Department of Health and Human Services. The Burden of Chronic Diseases and Their Risk Factors: National and State Perspectives, February 2002. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000. 2003 Arizona BRFSS: Respondents Told They Have Diabetes GROUPS WEIGHTED UNWEIGHTED PERCENT N Sex Male 6.4 118 Female 6.2 145 18-24 * * 25-34 2.3 8 35-44 2.1 16 45-54 5.8 39 55-64 11.4 67 65+ 15.8 131 11.0 46 High School Graduate/GED 6.8 80 Some College/Tech School 5.3 70 College Grad 5.2 65 13.5 46 $15,000-$24,999 7.0 64 $25,000-$34,999 7.3 33 $35,000-$49,999 5.4 34 ≥$50,000 4.0 50 White 6.0 186 Non-White 7.2 77 Hispanic 7.3 45 Non-Hispanic 6.1 218 Age Education Less than High School Income <$15,000 Race Ethnicity Table I-C-1. 2003 BRFSS results: Respondents told they had diabetes. *= Cell size too small. 16 D. HYPERTENSION AWARENESS “About 90% of middle-aged Americans will develop high blood pressure in their lifetime, and nearly 70% of those who have it now do not have it under control.”1 “High blood pressure is known as the “silent killer” and remains a major risk factor for CHD, stroke, and heart failure. About 50 million adults in the United States have high blood pressure. High blood pressure also is more common in older persons. Comparing the 1976–80 National Health and Nutrition Examination Survey (NHANES II) and the 1988–91 survey (NHANES III, phase 1) reveals an increase from 51 to 73 percent in the proportion of persons who were aware that they had high blood pressure. Nevertheless, a large proportion of persons with high blood pressure still are unaware that they have this disorder.”2 Yes 22.7% Yes, but pregnant 0.5% No 76.8% Figure I-D-1. Percentage of Arizona BRFSS respondents who reported that they were told they had high blood pressure in 2003. Healthy People 2010 Objective 12.9 is to reduce proportion of adults with high blood pressure to no more than 16%. According to the 2003 BRFSS, 22.7%∗ of all respondents reported being told by a doctor they had high blood pressure. Males were more likely (25.1%) as females (20.2%) to be told they have high blood pressure. There is a general direct relationship between age and the percentage of respondents being told they have high blood pressure: as age increases so does the percentage of respondents who report being told they have high blood pressure. The age group 65+ were most likely to be told they have high blood pressure (51.6%), followed by the 55-64 age group (37.0%). With regards to education, respondents with a high school education were most likely to be told they have high blood pressure (27.9%); the next highest group were respondents with less than a high school education (25.5%). Respondents earning less than $25,000-$34,999 had the highest percentage saying there were told they have high blood pressure (27.4%), followed by respondents earning $15,000-$24,999 (27.1%). White respondents were more likely to they were told they have high blood pressure than Non-White respondents (24.0% and 19.5% respectively). Non-Hispanics ∗ 95% Confidence Interval: 20.7-24.6%. 17 were more likely than Non-Hispanic respondents to be told they have high blood pressure (23.9% and 18.2% respectively). References 1. 2. Centers for Disease Control and Prevention. The Power of Prevention: Reducing The Health And Economic Burden Of Chronic Disease. 2003. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000. 2003 Arizona BRFSS: Respondents Told They Have High Blood Pressure GROUPS WEIGHTED UNWEIGHTED PERCENT N Sex Male 25.1 392 Female 20.2 529 18-24 6.2 9 25-34 11.7 46 35-44 10.7 66 45-54 19.1 141 55-64 37.0 213 65+ 51.6 437 Less than High School 25.5 97 High School Graduate/GED 27.9 286 Some College/Tech School 22.1 295 College Grad 17.6 239 <$15,000 21.7 108 $15,000-$24,999 27.1 184 $25,000-$34,999 27.4 124 $35,000-$49,999 21.5 141 ≥$50,000 19.3 229 White 24.0 731 Non-White 19.5 182 Hispanic 18.2 110 Non-Hispanic 23.9 808 Age Education Income Race Ethnicity Table I-D-1. 2003 BRFSS results: Respondents told they had high blood pressure. 18 E. CHOLESTEROL AWARENESS The total cholesterol level in a person’s blood is a risk factor for heart disease and stroke; the higher the total level, the greater the risk. Blood cholesterol is affected by factors such as diet, physical activity, weight, heredity, age and gender, alcohol use, and stress. High cholesterol is defined as 240 mg/dL or more.1 According to the American Heart Association, “All adults age 20 or older should have a fasting lipoprotein profile (total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride) once every five years.”2 80% 70% 68.4% 60% 50% 40% 30% 16.7% 20% 10% 9.4% 5.4% 0% < 1yr 1-2 yrs 2-5 yrs 5+ yrs Figure I-E-1. Percentage of Arizona BRFSS respondents who reported how long has it been since they had their cholesterol checked in 2003. Healthy People 2010 Objective 12.5 is to 80 % have Cholesterol Screening, Within Past Five Years Ages >18. According to the 2003 BRFSS, 5.4%∗ of all respondents reported not having their cholesterol checked within the past five years. The figure exceeds the Healthy People 2010 objective for not having their cholesterol checked within the past five years 20.0%.3 Males were more likely (6.0%) than females (4.9%) to not have had their cholesterol checked within the past five years. There is an inverse relationship between age and the percentage of respondents having their cholesterol checked five or more years ago. The 25-34 year age group were most likely to have had their cholesterol check five or more years ago (9.2%), followed by the 35-44 age group (8.3%). Regarding education, respondents with less than a high school education were most likely to have had their cholesterol checked at least five years ago (7.1%), the next highest group were respondents with some college or technical school (6.7%). Respondents earning $25,000-$34,999 had the highest percentage saying they have not had a cholesterol check within the past five years (6.1%), followed by respondents earning $15,000$24,999 (5.7%). White respondents were more likely to not have had a cholesterol check in the past five years than Non-White respondents (5.9% and 4.2% respectively). Non-Hispanics ∗ 95% Confidence Interval: 4.13-6.75%. 19 (5.6%) were more likely than Hispanic respondents (4.6%) to have had their cholesterol checked five or more years ago. References 1. 2. 3. 2003 Arizona BRFSS: Respondents Who Have Not Had Their Cholesterol Checked Within 5 Years GROUPS WEIGHTED UNWEIGHTED PERCENT N Sex Male 6.0 56 Centers for Disease Control and Prevention. CDC Fact Book 2000/2001. 2000 Female 4.9 76 Get Your Cholesterol Checked: How often should I have my cholesterol checked? Retrieved from the Internet May 15, 2004. http://www.americanheart.org/presenter.jhtml ?identifier=541 18-24 * * 25-34 9.2 20 35-44 8.3 33 45-54 7.2 37 U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000. 55-64 4.0 20 65+ 1.6 21 Less than High School 7.1 18 High School Graduate/GED 3.7 24 Some College/Tech School 6.7 44 College Grad 5.1 46 <$15,000 5.4 15 $15,000-$24,999 5.7 24 $25,000-$34,999 6.1 15 $35,000-$49,999 4.8 19 ≥$50,000 5.6 43 White 5.9 109 Non-White 4.2 23 Hispanic 4.6 14 Non-Hispanic 5.6 118 Age Education Income Race Ethnicity Table I-E-1. 2003 BRFSS results: Respondents Who Have Not Had Their Cholesterol Checked Within 5 Years. *= Cell size too small. 20 F. FRUIT AND VEGETABLE CONSUMPTION Good nutrition, including a diet low in saturated fats and at least five servings of fruits and vegetables each day, plays a key role in maintaining good health. Improving the American diet could extend the productive life span of Americans and reduce the occurrence of chronic diseases, including heart disease, stroke, some types of cancers, diabetes, and osteoporosis.1 It has been known for many years that diet plays a large role in the quality of long-term health. Among adults who do not drink excessively or smoke, diet is the most significant controllable risk factor that determines their health status. It is widely accepted that a significant percentage of all cancer deaths can be attributed to poor dietary habits. One of the most important dietary habits is the consumption of at least five servings of fruits and vegetables per day. Analysis of the 2003 Arizona BRFSS showed that 76.9% of respondents reported that they consume less than five servings of fruits and vegetables per day (Figure I-F-1). This falls short of Healthy Arizona 2010 Objective 2.1, which stresses the importance of vegetable consumption and sets a target of increasing the proportion of Arizonans aged two years and older who consume at least two daily servings of fruit and at least three daily servings of vegetables (with at least one-third being dark green or deep yellow vegetables) to at least 50%.2 110% 90.9% 90% 69.8% 70% 63.1% 74.5% 77.3% 76.9% 2001 2002 2003 50% 30% 10% -10% 1998 1999 2000 Year Figure I-F-1. Percentage of Arizona BRFSS respondents who reported that they consume less than five servings of fruits and vegetables per day in 1998-2003. Males (82.5%) are much less likely to consume less than five servings of fruits and vegetables per day than females (71.6%). Respondents aged 45-54 were least likely to eat five or more servings of fruits and vegetables (80.5%) followed by persons 25-34 years (79.4%). Respondents with less than a high school education were less likely (84.2%) to eat at least five servings of fruits and vegetables than the other categories followed by high school graduates (81.5%). Arizonans making less than $15,000 had the highest percentage of people who did not eat five or more servings of fruits and vegetables (81.1%) followed by the $35,000-$49,999 category (79.4%). White respondents were less likely to eat five servings each day (77.4%) than 21 Non-White respondents (76.7%). Regarding ethnicity, Hispanics (80.2%) were less likely to eat five or more servings of fruits and vegetables than Non-Hispanics (76.3%). References 1. The Burden of Chronic Diseases and Their Risk Factors: National and State Perspectives. CDC. 2002. 2. Department of Health Services. Arizona 2010: Collaborating for a Healthier Future. 2001. 2003 Arizona BRFSS: Respondents Not Consuming At Least Five Servings Of Fruits And Vegetables Per Day GROUPS WEIGHTED UNWEIGHTED PERCENT N Sex Male 82.5 1,007 Female 71.6 1,414 18-24 78.8 152 25-34 79.4 353 35-44 77.0 422 45-54 80.5 485 55-64 74.0 401 65+ 72.3 583 Less than High School 84.2 259 High School Graduate/GED 81.5 697 Some College/Tech School 74.1 724 College Grad 73.7 733 <$15,000 81.1 254 $15,000-$24,999 76.7 436 $25,000-$34,999 74.6 302 $35,000-$49,999 79.4 410 ≥$50,000 77.5 744 White 77.4 1,841 Non-White 76.7 560 Hispanic 80.2 379 Non-Hispanic 76.3 2,032 Age Education Income Race Ethnicity Table I-F-1. 2003 BRFSS survey results: Respondents who reported that they did not consume at least five servings of fruits and vegetables per day. 22 G. OBESITY (BMI) Obesity has reached epidemic proportions among Americans in every age group. Obesity among adults has doubled since 1980. People who are overweight or obese are at greater risk for many diseases such as heart disease, high blood pressure, diabetes, arthritis-related disabilities, and some cancers.1 According to the most recent weight guidance, more than 57% of adults in America were overweight by self-reported height and weight in 2000.1 The body mass index (BMI) is a relationship between weight and height and is used to determine obesity and assess health risk. BMI is calculated using the following formula: (pounds * 0.454) ÷ (inches * 0.0254)² or (Kg/M²). According to the 2003 Arizona BRFSS, 20.1% of respondents met or exceeded the BMI standard for obesity, defined as a BMI ≥ 30.0 (Figure I-G-1). This rate has remained relatively stable since increasing significantly from 12.3% in 1999 to 19.2% in 2000. Healthy People 2010 Objective 19.2 set a goal of reducing obesity to a prevalence of <15% among adults 20 years of age or older.3 30% 20% 13.1% 12.3% 1998 1999 19.2% 18.5% 19.6% 20.1% 2000 2001 2002 2003 10% 0% Year Figure I-G-1. Arizona BRFSS respondents who reported weights exceeding BMI limits of obesity. Healthy People 2010 Objective 19.2 is less than 15.0% 1998-2003. Men were more likely to be obese (22.1%) than women (18.1%). Respondents in the 45-54 age group were the most likely to be obese (24.1%) while the 55-64 age group were next most likely (22.7%). There was a negative relationship with regards to education Arizonans with a college education were the least likely to be obese (15.8%) and the highest group were respondents with less than a high school education (29.0%). Regarding income, the group most likely to be obese were those with incomes less than $15,000 (26.0%) with the least likely occurring among Arizonans with incomes of $25,000-$34,999 (17.6%). Non-Whites were more likely to be obese (24.2%) than Whites (18.6%). Hispanics (24.4%) were more likely to be obese than NonHispanics (19.2%). As with promoting increased number of servings of fruits and vegetables, it 23 will be important to focus efforts to reduce overweight and obesity on all segments of the Arizona population. 2002 Arizona BRFSS: Respondents Classified As Obese GROUPS References 1. 2. The Burden of Chronic Diseases and Their Risk Factors: National and State Perspectives. CDC. 2002. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000. WEIGHTED UNWEIGHTED PERCENT N Sex Male 22.1 285 Female 18.1 375 18-24 12.2 25 25-34 21.6 85 35-44 20.7 118 45-54 24.1 151 55-64 22.7 139 65+ 18.6 141 Less than High School 29.0 78 High School Graduate/GED 23.7 211 Some College/Tech School 19.0 214 College Grad 15.8 156 <$15,000 26.0 89 $15,000-$24,999 22.4 134 $25,000-$34,999 17.6 77 $35,000-$49,999 19.8 108 ≥$50,000 19.9 196 White 18.6 467 Non-White 24.2 186 Hispanic 24.4 109 Non-Hispanic 19.2 549 Age Education Income Race Ethnicity Table I-G-1. 2003 BRFSS results: Respondents classified as obese, defined as BMI ≥ 30.0. 24 H. ASTHMA Asthma is a chronic disease of the airways that causes persistent and distressing episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. Asthma can be difficult to diagnose and to distinguish from other respiratory illnesses. 1 Asthma is a serious and growing health problem. According to estimates 14.9 million persons in the United States have asthma. Asthma is responsible for around 500,000 hospitalizations, 5,000 deaths, and 134 million restricted activity days annually. Yet, people with asthma can avoid most of the problems caused by asthma if they and their health care providers managed the disease according to accepted guidelines.2 Asthma is a complicated disease that requires a long-term and multifaceted answer. This includes educating, treating, and providing continuing medical care and monitoring for people with asthma, changing behaviors that lead to asthma or exacerbates it, and eliminating or avoiding triggers.1 20% 15% 11.1% 13.9% 12.4% 12.5% 10% 5% 0% 2000 2001 2002 2003 Year Figure I-H-1. Percentage of Arizona BRFSS respondents who reported being told that they had asthma in 2000-2003. According to the 2003 BRFSS, 12.5%∗ of all respondents reported being told that they had asthma. Females were more than likely (13.3%) than males (11.6%) to be told they have asthma. The age group 18-24 were most likely to be told they have asthma (14.3%), followed by the 65+ age group (13.0%). Regarding education, respondents with some college or technical school were most likely to be told they have asthma (13.9%), the next highest group were respondents with a high school education (12.2%). Respondents with incomes of $25,000-$34,999 had the highest percentage saying there were told they have asthma (17.5%), followed by respondents earning less than $15,000 (14.0%). White respondents were more than 40 percent more likely to be told ∗ 95% Confidence Interval: 10.8%-14.1%. 25 they have asthma than Non-White respondents (13.7% and 9.5% respectively). Non-Hispanics were more than twice as likely as Hispanic respondents to be told they have asthma (14.0% and 6.5% respectively). References 1. 2. Asthma: Asthma Speaker's Kit for Health Care Professionals. Retrieved from the Internet May 20, 2004. http://www.cdc.gov/asthma/speakit/intro.ht U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000 2003 Arizona BRFSS: Respondents Told They Have Asthma GROUPS WEIGHTED UNWEIGHTED PERCENT N Sex Male 11.6 142 Female 13.3 296 18-24 14.3 35 25-34 12.7 63 35-44 12.0 72 45-54 12.1 82 55-64 11.3 64 65+ 13.0 118 Less than High School 12.1 45 High School Graduate/GED 12.2 116 Some College/Tech School 13.9 150 College Grad 11.4 126 <$15,000 14.0 60 $15,000-$24,999 11.9 87 $25,000-$34,999 17.5 63 $35,000-$49,999 11.5 60 ≥$50,000 11.4 110 13.7 349 9.5 85 6.5 39 14.0 397 Age Education Income Race White Non-White Ethnicity Hispanic Non-Hispanic Table I-H-1. 2003 BRFSS results: Respondents told they had asthma. 26 I. CIGARETTE SMOKING “Tobacco use is the single most preventable cause of death and disease in the United States. Tobacco use increases the risk for lung and other cancers and for cardiovascular and respiratory diseases. The American Cancer Society estimates that cigarette smoking is responsible for one of every five deaths in the United States, or more than 440,000 deaths each year. If current smoking patterns continue, an estimated 25 million people alive today will die of smokingrelated illnesses.”1 “Direct medical expenditures attributed to smoking total more than $75 billion per year. In addition, smoking costs an estimated $80 billion per year in lost productivity.”2 Clearly, smoking is an important public health issue. Healthy People 2010 set a target of no more than 12% current smokers 18 years of age or older.3 According to the 2003 Arizona BRFSS, 20.8%∗ of respondents identified themselves as current smokers. For the coming decade, Healthy Arizona 2010 has identified tobacco use as one of its 12 focus areas, and has set a target of reducing adult smokers to 14% of the state population. Continued efforts to prevent initial smoking behavior in adolescents, as well as efforts to promote smoking cessation in current smokers using techniques that have documented effectiveness, may decrease the rate of Arizona smokers to meet the Healthy Arizona 2010 target. 40% 35% 30% 25% 20% 15% 10% 5% 0% 21.8% 20.0% 18.5% 1998 1999 2000 21.5% 23.4% 2001 2002 20.8% 2003 Year Figure I-I-1. Percentage of Arizona BRFSS respondents who reported that they were current smokers in 1998-2003. Healthy People 2010 Objective 27.1a is 12.0%. Percentage of male respondents who were smokers exceeded female respondents reporting they were smokers (23.6% and 18.1%, respectively). Regarding age, the 45-54 year group were more likely to smoke (26.9%) and the next highest group was the 18-24 group (26.1%). Respondents with a high school education were more likely to be current smokers (27.1%) followed by respondents with less than a high school education (23.2%). Those with incomes of $25,000$34,999 were most likely to smoke (29.1%) followed by those making less than $15,000 (26.7%). White Arizonans were slightly more likely to be current smokers (21.4%) than Non- ∗ 95% Confidence Interval: 18.5%-23.2%. 27 White respondents (20.0%). Regarding ethnicity, Non-Hispanic likely to be smokers (21.8%) than Hispanic Arizonans (17.5%). References 1. 2. 3. The Burden of Chronic Diseases and Their Risk Factors: National and State Perspectives. CDC. 2002. Centers for Disease Control and Prevention. The Power of Prevention: Reducing The Health And Economic Burden Of Chronic Disease. 2003. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000. 2003 Arizona BRFSS: Respondents Who Are Current Smokers GROUPS WEIGHTED UNWEIGHTED PERCENT N Sex Male 23.6 259 Female 18.1 356 18-24 26.1 48 25-34 23.2 96 35-44 22.0 118 45-54 26.9 163 55-64 19.4 105 9.5 82 Less than High School 23.2 80 High School Graduate/GED 27.1 202 Some College/Tech School 23.1 211 College Grad 12.2 119 <$15,000 26.7 83 $15,000-$24,999 24.8 131 $25,000-$34,999 29.1 97 $35,000-$49,999 24.2 111 ≥$50,000 15.5 136 White 21.4 487 Non-White 20.0 125 Hispanic 17.5 66 Non-Hispanic 21.8 548 Age 65+ Education Income Race Ethnicity Table I-I-1. 2003 BRFSS results: Respondents who reported that they are current smokers and have smoked at least 100 cigarettes in their life. 28 J. ALCOHOL Each year, about 100,000 deaths in the United States are related to alcohol consumption.1 Longterm heavy drinking increases risk for high blood pressure, heart rhythm irregularities (arrhythmias), heart muscle disorders (cardiomyopathy), and stroke. Long-term heavy drinking also increases the risk of developing certain forms of cancer, especially of the esophagus, mouth, throat, and larynx.2 Alcohol use has been linked with a substantial proportion of injuries and deaths from motor vehicle crashes, falls, fires, and drownings.3 Clearly, alcohol consumption is an important public health issue. Healthy People 2010 to reduce the percentage of the population engaging in binge drinking of alcoholic beverages to no more than 6% for persons 18 years of age or older.5 According to the 2003 Arizona BRFSS, 16.6%∗ of respondents reported having five or more drinks on an occasion, one or more times in the past month. AT RISK 16.6% NOT AT RISK 83.4% Figure I-J-1. Arizona BRFSS respondents who are at risk for binge drinking, 2003. Healthy People 2010 Objective 26.11c is 6.0%. Male respondents were almost three times more at risk than female respondents for binge drinking (24.7% and 8.7%, respectively). Regarding age there is a negative relationship between age and risk for binge drinking, the 18-24 year group were more likely to binge drink (27.6%) and the next highest group was the 25-34 year group (22.4%). Respondents with some college or technical school were more likely to binge drink (19.0%) followed by respondents who were high school graduates (18.9%). Regarding income, those with incomes $35,000 to $49,999 are at greater risk for binge drinking (20.2%) followed by those with incomes greater than or equal to $50,000 (18.3%). Non-White Arizonans were more likely to be at risk for binge drinking (19.3%) than White respondents (15.5%). Regarding ethnicity, Hispanic respondents were about one-third more likely to be at risk for binge drinking (22.0%) than Non-Hispanic Arizonans (15.1%). ∗ 95% Confidence Interval: 14.4%-18.7%. 29 References 1. 2. 3. McGinnis, J.M., and Foege, W.H. Actual causes of death in the United States. Journal of the American Medical Association 270:2207-2212, 1993. 2003 Arizona BRFSS: Respondents At Risk For Binge Drinking GROUPS WEIGHTED UNWEIGHTED PERCENT N Sex NIAAA. Alcohol and cancer. Alcohol Alert. No. 21. Rockville, MD: NIH, 1993. Male 24.7 266 8.7 147 NIAAA. Ninth Special Report to the U.S. Congress on Alcohol and Health From the Secretary of Health and Human Services. NIH Pub. No. 97-4017. Rockville, MD: NIH, 1997. Age 18-24 27.6 49 25-34 22.4 94 35-44 21.2 90 45-54 15.6 89 55-64 8.0 46 65+ 5.1 43 Less than High School 15.8 39 High School Graduate/GED 18.9 115 Some College/Tech School 19.0 142 College Grad 12.4 116 <$15,000 10.9 38 $15,000-$24,999 15.4 70 $25,000-$34,999 17.4 57 $35,000-$49,999 20.2 86 ≥$50,000 18.3 130 White 15.5 288 Non-White 19.3 122 Hispanic 22.0 92 Non-Hispanic 15.1 318 Female Education Income Race Ethnicity Table I-J-1. 2003 BRFSS results: Respondents at risk for binge drinking. 30 31 II. MODULE SURVEY RESULTS: ANALYSIS OF HIGH-RISK GROUPS 32 A. ARTHRITIS Arthritis and other rheumatic conditions affect nearly 43 million Americans or about one out of six people. Arthritis is the leading cause of disability in the United States, encompassing more than 100 diseases that affect the joints, the tissues surrounding the joints, and other connective tissue. Arthritis and its related disability are increasing. In 2020, an estimated 60 million Americans, or almost 20% of the population, will be affected by arthritis, and nearly 12 million will experience activity limitations. The pain and disability that accompany arthritis can be reduced through early diagnosis and proper management, including weight control, physical activity, and self-management programs that increase people’s ability to manage their condition.1 Arthritis results in 44 million physician visits and 750,000 hospitalizations annually. The estimated total cost associated with arthritis (including medical care and lost productivity) exceeds $65 billion annually.1 40% 35% 30% 25% 20% 15% 10% 5% 0% 20.2% 2000 23.7% 2001 27.7% 26.3% 2002 2003 Year Figure II-A-1: 2000-2003 Percentage of Arizona BRFSS respondents reported being told by a doctor that they have arthritis. Over one-quarter (26.3%∗) of adult Arizonans have been told by a doctor that they have arthritis. More women than men have been told they have arthritis (29.8% vs. 22.6%). As expected, there is a positive relationship with regards to age, as age increases so does the percentage of people being told they have arthritis. Those over age 65 were highest (56.8%) followed by those in the 55-64 age group (35.9%). Respondents with a high school education were the most likely to be told they have arthritis (28.4%); next were those with some college or technical school (28.1%). About one-third of Arizonans with incomes less than $15,000 (33.5%) reported being told they have arthritis, followed by those earning from $25,000 to $34,999 with 28.0%. However, arthritis affected Non-Whites less than White respondents: 29.8% of White respondents were diagnosed with arthritis compared to 17.8% of Non-Whites, Non-Hispanics were considerably more likely than Hispanics to be diagnosed with arthritis (28.9% and 16.0% respectively). ∗ 95% Confidence Interval: 24.2%-28.4%. 33 Increasing the length of healthy life for all Americans is one of the objectives contained in the Healthy People 2010 program. The combination of public health programs, improved social conditions, and private medical care, have contributed to the lengthening of life expectancy from 47 years in 1900 to 75 years in 1989. However, increased life expectancy has included periods of lower health-related quality of life for some people.2 The 2003 Arizona BRFSS asked respondents if they are limited in any activities because of physical, mental, or emotional problems. Almost thirty percent responded that their activities because of arthritis or joint symptoms. 2003 Arizona BRFSS: Respondents Reporting Being Told They Have Arthritis GROUPS WEIGHTED UNWEIGHTED PERCENT N Sex Male 22.6 361 Female 29.8 704 18-24 8.3 11 25-34 9.1 48 35-44 15.7 88 45-54 32.3 200 55-64 35.9 239 65+ 56.8 472 Less than High School 22.8 104 Age Education High School Graduate/GED 28.4 318 References Some College/Tech School 28.1 340 1. The Burden of Chronic Diseases and Their Risk Factors: National and State Perspectives. CDC. 2002. College Grad 23.6 300 <$15,000 33.5 143 Centers for Disease Control and Prevention. CDC Surveillance Summaries, May 27, 1994 MMWR 1994 43 (No. 20). $15,000-$24,999 27.9 210 $25,000-$34,999 28.0 142 $35,000-$49,999 25.1 167 ≥$50,000 23.4 268 White 29.8 894 Non-White 17.8 163 Hispanic 16.0 91 Non-Hispanic 28.9 968 2. Income Race Ethnicity Table II-A-1. 2003 BRFSS results: Respondents reporting being told they have arthritis. 34 III. STATE-ADDED QUESTIONS SURVEY RESULTS: ANALYSIS OF HIGH-RISK GROUPS 35 A. FAMILY PLANNING & AGING ADULT FAMILY PLANNING The 2003 BRFSS included questions regarding Family Planning. When respondents were asked about the last pregnancy , 53.2% responded that they wanted to be pregnant then. 70% 60% 50% 40% 30% 20% 10% 0% 53.2% 22.0% Wanted to be pregnant sooner 15.7% 9.1% Wanted to be pregnant Wanted to be pregnant later then Didn't want to be pregnant Figure III-A-1. 2003 Arizona BRFSS: Thinking back to your last pregnancy, just before you got pregnant, how did you feel about becoming pregnant? AGING ADULT About one-third of the survey respondents (33.0%) reported they provided care or assistance to a relative or friend that was 60 years or older in the last 30 days. Yes 33.0% No 67.0% Figure III-A-2. 2003 Arizona BRFSS: During the past 30 days, did you provide any type of care or assistance to a relative or friend who is 60 years old or older? 37 B. AGING SERVICES & FOLIC ACID AGING SERVICES The 2003 Arizona BRFSS included a set of questions regarding aging services. Only a small percentage (5.8%) of Arizonans aged 55+ need someone to assist them with routine needs. 94.2% 100% 80% 60% 40% 20% 5.8% 0% Yes No Figure III-B-1. 2003 Arizona BRFSS: Because of any impairment or health problem, do you need someone to help in handling your routine needs, such as everyday household chores, shopping, or getting around for other purposes? FOLIC ACID The 2003 BRFSS included questions on folic acid. Less than one-half (45.4%) of Arizonans knew that folic acid prevents birth defects. 60% 45.4% 50% 40% 30% 24.4% 24.1% 20% 6.1% 10% 0% Make Strong Bones Prevent Birth Defects Prevent High BP Other Reason Figure III-B-1. 2003 Arizona BRFSS: Why do health professionals suggest taking folic acid? 38 APPENDIX I: ARIZONA RESPONDENT PROFILE 2003 Arizona Respondent Profile GROUPS WEIGHTED PERCENTAGE UNWEIGHTED N Sex Male 49.4 1,229 Female 50.6 2,006 18-24 12.7 196 25-34 19.2 453 35-44 19.6 556 45-54 16.5 615 55-64 12.7 551 65+ 18.4 833 9.9 316 High School Graduate or GED 27.1 881 Some College or Tech School 31.7 1,004 College Grad 31.0 1,023 9.3 339 $15,000-$24,999 16.1 575 $25,000-$34,999 11.3 410 $35,000-$49,999 16.8 533 ≥$50,000 35.3 985 Unknown/Refused 11.2 393 White 70.6 2,449 Non-White 28.4 751 Hispanic 20.7 479 Non-Hispanic 78.8 2,739 Age Education Less than High School Income < $15,000 Race Ethnicity Source: 2003 Arizona BRFSS Sample 39 APPENDIX II: 2003 ARIZONA BRFSS QUESTIONS LISTING CORE SECTIONS Section 1: Health Status Section 2: Health Care Access Section 3: Exercise Section 4: Diabetes Section 5: Hypertension Awareness Section 6: Cholesterol Awareness Section 7: Fruits and Vegetables Section 8: Weight Control Section 9: Asthma Section 10: Immunization Section 11: Tobacco Use Section 12: Alcohol Consumption Section 13: Excess Sun Exposure Section 14: Demographics Section 15: Arthritis Section 16: Falls Section 17: Disability Section 18: Physical Activity Section 19: Veteran’s Status OPTIONAL MODULES Module 13: Arthritis STATE ADDED QUESTIONS Section 1: Section 2: Section 3: Section 4: Section 5: Family Planning Aging Adult Aging Services Hepatitis C Risk Folic Acid 40 APPENDIX III: 2003 ARIZONA QUESTIONNAIRE Section 1: Health Status 1.1. Would you say that in general your health is: Excellent 1 Very good 2 Good 3 Fair 4 Poor 5 Don't know/Not sure 7 Refused 9 1.2. Now 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? Number of days None 8 8 Don't know/Not sure 7 7 Refused 9 9 1.3. Now 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? Number of days None 8 8 Don't know/Not sure 7 7 Refused 9 9 1.4. During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation? Number of days None 8 8 Don't know/Not sure 7 7 Refused 9 9 Section 2: Health Care Access 2.1. Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare? Yes 1 No 2 Don't know/Not sure 7 Refused 9 2.2. Do you have one person you think of as your personal doctor or health care provider? Yes, only one 1 More than one 2 No 3 Don't know/Not sure 7 Refused 9 2.3. Was there a time in the past 12 months when you needed to see a doctor but could not because of the cost? Yes 1 No 2 Don't know/Not sure 7 Refused 9 Section 3: Exercise 3.1. During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise? Yes 1 No 2 Don't know/Not sure 7 Refused 9 Section 4: Diabetes 4.1. Have you ever been told by a doctor that you have diabetes? Yes 1 Yes, only during pregnancy 2 No 3 Don’t know/Not sure 7 Refused 9 Section 5: Hypertension Awareness 5.1. Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure? Yes 1 Yes, only during pregnancy 2 No 3 Don’t know/Not sure 7 Refused 9 5.2 Are you currently taking medicine for your high blood pressure? Yes 1 No 2 Don't know/Not sure 7 Refused 9 Section 6: Cholesterol Awareness 6.1. Blood cholesterol is a fatty substance found in the blood. Have you ever had your blood cholesterol checked? Yes 1 No 2 Don't know/Not sure 7 Refused 9 41 APPENDIX III: 2003 ARIZONA QUESTIONNAIRE 6.2. About how long has it been since you last had your blood cholesterol checked? Within the past year 1 Within the past 2 years 2 Within the past 5 years 3 4 5 or more years ago Don't know/Not sure 7 Refused 9 6.3. Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high? Yes 1 No 2 Don't know/Not sure 7 Refused 9 Section 7: Fruits and Vegetables 7.1. How often do you drink fruit juices such as orange, grapefruit, or tomato? Per day 1 __ __ Per week 2 __ __ Per month 3 __ __ Per year 4 __ __ Never 5 5 5 Don't know/Not sure 7 7 7 Refused 9 9 9 7.2. Not counting juice, how often do you eat fruit? Per day 1 __ __ Per week 2 __ __ Per month 3 __ __ Per year 4 __ __ Never 5 5 5 Don't know/Not sure 7 7 7 Refused 9 9 9 7.3. How often do you eat green salad? Per day 1 __ __ Per week 2 __ __ Per month 3 __ __ Per year 4 __ __ Never 5 5 5 Don't know/Not sure 7 7 7 Refused 9 9 9 7.4. How often do you eat potatoes not including french fries, fried potatoes, or potato chips? Per day 1 __ __ Per week 2 __ __ Per month 3 __ __ Per year 4 __ __ Never 5 5 5 Don't know/Not sure 7 7 7 Refused 9 9 9 7.5. How often do you eat carrots? Per day 1 __ __ Per week 2 __ __ Per month 3 __ __ Per year 4 __ __ Never 5 5 5 Don't know/Not sure 7 7 7 Refused 9 9 9 7.6. Not counting carrots, potatoes, or salad, how many servings of vegetables do you usually eat? Per day 1 __ __ Per week 2 __ __ Per month 3 __ __ Per year 4 __ __ Never 5 5 5 Don't know/Not sure 7 7 7 Refused 9 9 9 Section 8: Weight Control 8.1. Are you now trying to lose weight? Yes 1 No 2 Don't know/Not sure 7 Refused 9 8.2. Are you now trying to maintain your current weight that is to keep from gaining weight? Yes 1 No 2 Don't know/Not sure 7 Refused 9 8.3. Are you eating either fewer calories or less fat to... lose weight? keep from gaining weight? Yes, fewer calories 1 Yes, less fat 2 Yes, fewer calories and less fat 3 No 4 Don't know/Not sure 7 Refused 9 8.4. Are you using physical activity or exercise to … lose weight? keep from gaining weight? Yes 1 No 2 Don't know/Not sure 7 Refused 9 42 APPENDIX III: 2003 ARIZONA QUESTIONNAIRE 8.5. In the past 12 months, has a doctor, nurse or other health professional given you advice about your weight? Yes, lose weight 1 Yes, gain weight 2 Yes, maintain current weight 3 No 4 Don't know/Not sure 7 Refused 9 Section 9: Asthma 9.1. Have you ever been told by a doctor, nurse, or other health professional that you had asthma? Yes 1 No 2 Don't know/Not sure 7 Refused 9 9.2. Do you still have asthma? Yes 1 No 2 Don't know/Not sure 7 Refused 9 Section 10: Immunization 10.1. During the past 12 months, have you had a flu shot? Yes 1 No 2 Don't know/Not sure 7 Refused 9 10.2. Have you ever had a pneumonia shot? This shot is usually given only once or twice in a person’s lifetime and is different from the flu shot. It is also called the pneumococcal vaccine. Yes 1 No 2 Don't know/Not sure 7 Refused 9 Section 11: Tobacco Use 11.1. Have you smoked at least 100 cigarettes in your entire life? Yes 1 No 2 Don't know/Not sure 7 Refused 9 11.2. Do you now smoke cigarettes every day, some days, or not at all? Every day 1 Some days 2 Not at all 3 Refused 9 11.3. During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking? Yes 1 No 2 Don't know/Not sure 7 Refused 9 Section 12: Alcohol Consumption 12.1. A drink of alcohol is 1 can or bottle of beer, 1 glass of wine, 1 can or bottle of wine cooler, 1 cocktail, or 1 shot of liquor. During the past 30 days, how often have you had at least one drink of any alcoholic beverage? Days per week 1 __ __ Days per month 2 __ __ No drinks in past 30 days 8 8 8 Don't know/Not sure 7 7 7 Refused 9 9 9 12.2. On the days when you drank, about how many drinks did you drink on the average? Number of drinks Don't know/Not sure 7 7 Refused 9 9 12.3. Considering all types of alcoholic beverages, how many times during the past 30 days did you have 5 or more drinks on an occasion? Number of times None 8 8 Don't know/Not sure 7 7 Refused 9 9 43 APPENDIX III: 2003 ARIZONA QUESTIONNAIRE Section 13: Excess Sun Exposure The next question is about sunburns including anytime that even a small part of your skin was red for more than 12 hours. 13.1. Have you had a sunburn within the past 12 months? Yes 1 No 2 Don't know/Not sure 7 Refused 9 13.1. Including times when even a small part of your skin was red for more than 12 hours, how many sunburns have you had within the past 12 months? One 1 Two 2 Three 3 Four 4 Five 5 Six 6 Don't know/Not sure 7 Refused 9 Section 14: Demographics 14.1. What is your age Code age in years Don’t know/Not sure 0 7 Refused 0 9 14.2. Are you Hispanic or Latino? Yes 1 No 2 Don't know/Not sure 7 Refused 9 14.3. Which one or more of the following would you say is your race? White 1 Black/African American 2 Asian 3 Native Hawaiian/Other Pacific Islander 4 American Indian, Alaska Native 5 Other [specify] 6 Don’t know/Not sure 7 Refused 9 14.4. Which one of these groups would you say best represents your race? White 1 Black/African American 2 Asian 3 Native Hawaiian/Other Pacific Islander 4 American Indian, Alaska Native 5 Other [specify] (Recall other specify) 6 Don’t know/Not sure 7 Refused 9 14.5. Are you: Married 1 Divorced 2 Widowed 3 Separated 4 Never been married 5 Member of an unmarried couple 6 Refused 9 14.6. How many children less than 18 years of age live in your household ? Number of children None 8 8 Refused 9 9 14.7. What is the highest grade or year of school you completed? ≤ Kindergarten 1 Elementary 2 Some high school 3 High school graduate 4 Some college/tech school 5 College graduate 6 Refused 9 14.8. Are you currently: Employed for wages 1 Self-employed 2 Out of work for more than 1 year 3 Out of work for less than 1 year 4 Homemaker 5 Student 6 Retired 7 Unable to work 8 Refused 9 44 APPENDIX III: 2003 ARIZONA QUESTIONNAIRE 14.9. Is your annual household income from all sources: < $10,000 01 $10,000 to < $15,000 02 $15,000 to < $20,000 03 $20,000 to < $25,000 04 $25,000 to < $35,000 05 $35,000 to < $50,000 06 $50,000 to < $75,000 07 ≤ $75,000 08 Don’t know/Not sure 77 Refused 99 14.10. About how much do you weigh without shoes? Weight __ __ __ pounds Don’t know/Not sure 7 7 7 Refused 9 9 9 14.16. During the past 12 months, has your household been without telephone service for 1 week or more? Yes 1 No 2 Don't know/Not sure 7 Refused 9 14.11. How much would you like to weigh? Weight __ __ __ pounds Don’t know/Not sure 7 7 7 Refused 9 9 9 14.18. To your knowledge, are you now pregnant? Yes 1 No 2 Don't know/Not sure 7 Refused 9 Section 15: Arthritis 15.1. During the past 30 days, have you had any symptoms of pain, aching, or stiffness in or around a joint? Yes 1 No 2 Don't know/Not sure 7 Refused 9 15.2. Did your joint symptoms first begin more than 3 months ago? Yes 1 No 2 Don't know/Not sure 7 Refused 9 15.3. Have you ever seen a doctor or other health professional for these joint symptoms? Yes 1 No 2 Don't know/Not sure 7 Refused 9 14.12. About how tall are you without shoes? Height __/__ __ ft/inches Don’t know/Not sure 7 7 7 Refused 9 9 9 14.13. What county do you live in? FIPS county code __ __ __ Don’t know/Not sure 7 7 7 Refused 9 9 9 14.14. Do you have more than one telephone number in your household? Do not include cell phones or numbers that are only used by a computer or fax machine. Yes 1 No 2 Don't know/Not sure 7 Refused 9 14.15. How many of these are residential numbers? Residential phone numbers __ Don’t know/Not sure 7 Refused 9 14.17. Indicate sex of respondent Male 1 Female 2 15.4. Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia? Yes 1 No 2 Don't know/Not sure 7 Refused 9 45 APPENDIX III: 2003 ARIZONA QUESTIONNAIRE 15.5. Are you now limited in any way in any of your usual activities because of arthritis or joint symptoms? Yes 1 No 2 Don't know/Not sure 7 Refused 9 15.6. Do arthritis or joint symptoms now affect whether you work, the type of work you do, or the amount of work you do? Yes 1 No 2 Don't know/Not sure 7 Refused 9 Section 16: Falls 16.1. In the past 3 months, have you had a fall? Yes 1 No 2 Don't know/Not sure 7 Refused 9 16.2. Were you injured? By injured, we mean the fall caused you to limit your regular activities for at least a day or to go see a doctor. Yes 1 No 2 Don't know/Not sure 7 Refused 9 Section 17: Disability 17.1. Are you limited in any way in any activities because of physical, mental, or emotional problems? Yes 1 No 2 Don't know/Not sure 7 Refused 9 17.2. Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone? Yes 1 No 2 Don't know/Not sure 7 Refused 9 Section 18: Physical Activity 18.1. When you are at work, which of the following best describes what you do? Would you say? Mostly sitting or standing 1 Mostly walking 2 Mostly heavy labor /physically demanding work 3 Don't know/Not sure 7 Refused 9 18.2. Now, thinking about the moderate activities you do in a usual week, do you do moderate activities for at least 10 minutes at a time, such as brisk walking, bicycling, vacuuming, gardening, or anything else that causes some increase in breathing or heart rate? Yes 1 No 2 Don't know/Not sure 7 Refused 9 18.3. How many days per week do you do these moderate activities for at least 10 minutes? Days per week Don't know/Not sure 7 7 Don’t do any mod activity 8 8 Refused 9 9 18.4. On days when you do moderate activities for at least 10 minutes at a time, how much total time per day do you spend doing these activities? Hours and minutes per day __:__ __ Don’t know/Not sure 7 7 7 Refused 9 9 9 18.5. Now, thinking about the vigorous activities you do in a usual week, do you do vigorous activities for at least 10 minutes at a time, such as running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate? Yes 1 No 2 Don't know/Not sure 7 Refused 9 18.6. How many days per week do you do these vigorous activities for at least 10 minutes at a time? Days per week Don't know/Not sure 7 7 Don’t do any mod activity 8 8 Refused 9 9 18.7. On days when you do vigorous activities for at least 10 minutes at a time, how much total time per day do you spend doing these activities? Hours and minutes per day __:__ __ Don’t know/Not sure 7 7 7 Refused 9 9 9 Section 19: Veteran’s Status 19.1. Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit? Yes 1 No 2 Don't know/Not sure 7 Refused 9 46 APPENDIX III: 2003 ARIZONA QUESTIONNAIRE 19.2. Which of the following best describes your service in the United States military? Currently on active duty 1 Currently in a National Guard or Reserve unit 2 Retired from military service 3 Medically discharged from military service 4 Discharged from military service 5 Don't know/Not sure 7 Refused 9 19.3. In the last 12 months have you received some or all of your health care from VA facilities? Yes, all of my health care 1 Yes, some of my health care 2 No, no VA health care received 3 Don't know/Not sure 7 Refused 9 Section 20: HIV/AIDS 20.1. A pregnant woman with HIV can get treatment to help reduce the chances that she will pass the virus on to her baby. True 1 False 2 Don't know/Not Sure 7 Refused 9 20.2. There are medical treatments available that are intended to help a person who is infected with HIV to live longer. True 1 False 2 Don't know/Not Sure 7 Refused 9 20.4. Have you ever been tested for HIV? Yes 1 No 2 Don't know/Not sure 7 Refused 9 20.5. Not including blood donations, in what month and year was your last HIV test? / Code month and year Don’t know/Not sure 7 7 7 7 7 7 Refused 9 9 9 9 9 9 20.6. Not including blood donations, which of these would you say was the MAIN reason for your last HIV test? It was required 01 Someone suggested you should be tested 02 You thought you may have gotten HIV through sex or drug use 03 Wanted to find out whether you had HIV 04 Worried that you could give HIV to someone 05 You were pregnant 06 Part of a routine medical check-up 07 Tested for some other reason 08 Don’t know/Not sure 77 Refused 99 20.7. Where did you have your last HIV test–at a private doctor or HMO office, at a counseling and testing site, at a hospital, at a clinic, in a jail or prison, at home, or somewhere else? Private doctor or HMO 01 Counseling and testing site 02 Hospital 03 Clinic 04 In a jail or prison 05 Home 06 Somewhere else 07 Don’t know/Not sure 77 Refused 99 20.3. How important do you think it is for people to know their HIV status by getting tested? Very important 1 Somewhat important 2 Not at all important 3 Depends on risk 8 Don’t know/Not sure 7 Refused 9 47 APPENDIX III: 2003 ARIZONA QUESTIONNAIRE 20.8. You have used intravenous drugs in the past year You have been treated for a sexually transmitted or venereal disease in the past year You have given or received money or drugs in exchange for sex in the past year You had anal sex without a condom in the past year Do any of these situations apply to you? Yes 1 No 2 Don't know/Not sure 7 Refused 9 20.9. In the past 12 months has a doctor, nurse or other health professional talked to you about preventing sexually transmitted diseases through condom use? Yes 1 No 2 Don't know/Not sure 7 Refused 9 Module 1: Diabetes MOD1_1. How old were you when you were told you have diabetes? Code age in years __ Don’t know/Not sure 98 Refused 99 MOD1_2. Are you now taking insulin? Yes 1 No 2 Don't know/Not sure 7 Refused 9 MOD1_3. Are you now taking diabetes pills? Yes 1 No 2 Don't know/Not sure 7 Refused 9 MOD1_4. About how often do you check your blood for glucose or sugar? Times per day 1 __ __ Times per week 2 __ __ Times per month 3 __ __ Times per year 4 __ __ Never 5 5 5 Don't know/Not sure 7 7 7 Refused 9 9 9 MOD1_5. About how often do you check your feet for any sores or irritations? Times per day 1 __ __ Times per week 2 __ __ Times per month 3 __ __ Times per year 4 __ __ Never 5 5 5 Don't know/Not sure 7 7 7 Refused 9 9 9 MOD1_6. Have you ever had any sores or irritations on your feet that took more than four weeks to heal? Yes 1 No 2 Don't know/Not sure 7 Refused 9 MOD1_7. About how many times in the past 12 months have you seen a doctor, nurse, or other health professional for your diabetes? Number of times __ None 88 Don’t know/Not sure 98 Refused 99 MOD1_8. A test for hemoglobin "A one C" measures the average level of blood sugar over the past three months. About how many times in the past 12 months has a doctor, nurse, or other health professional checked you for hemoglobin "A one C"? Number of times None 8 8 Never heard of hemoglobin "A one C" test 9 8 Don’t know/Not sure 7 7 Refused 9 9 MOD1_9. About how many times in the past 12 months has a health professional checked your feet for any sores or irritations? Number of times None 8 8 Don't know/Not sure 7 7 Refused 9 9 48 APPENDIX III: 2003 ARIZONA QUESTIONNAIRE MOD1_10. When was the last time you had an eye exam in which the pupils were dilated? This would have made you temporarily sensitive to bright light. Within past month 1 Within past 2 years 2 ≥ 2 years 3 Never 8 Don’t know/Not sure 7 Refused 9 MOD1_11. Has a doctor ever told you that diabetes has affected your eyes or that you had retinopathy? Yes 1 No 2 Don't know/Not sure 7 Refused 9 MOD1_12. Have you ever taken a course or class in how to manage your diabetes yourself? Yes 1 No 2 Don't know/Not sure 7 Refused 9 Module 13: Arthritis MOD13_1. Thinking about your arthritis or joint symptoms, which of the following best describes you today? Can do everything I would like to do 1 Can do most things I would like to do 2 Can do some things I would like to do 3 4 Can hardly do anything I would like to do Don't know/Not sure 7 Refused 9 MOD13_2. Has a doctor or other health professional ever suggested losing weight to help your arthritis or joint symptoms? Yes 1 No 2 Don't know/Not sure 7 Refused 9 MOD13_3. Has a doctor or other health professional ever suggested physical activity or exercise to help your arthritis or joint symptoms? Yes 1 No 2 Don't know/Not sure 7 Refused 9 MOD13_4. Have you ever taken an educational course or class to teach you how to manage problems related to your arthritis or joint symptoms? Yes 1 No 2 Don't know/Not sure 7 Refused 9 State Added: Family Planning AZ1_1. Have you or your partner been pregnant in the last five years? Yes 1 No 2 Don't know/Not sure 7 Refused 9 AZ1_2a. Thinking back to your last pregnancy, just before you got pregnant, how did you feel about becoming pregnant? Wanted to be pregnant sooner 1 Wanted to be pregnant later 2 Wanted to be pregnant then 3 Didn’t want to be pregnant 4 Don't know/Not sure 7 Refused 9 AZ1_2b. Thinking back to just before you got pregnant with your current pregnancy, how did you feel about becoming pregnant? Wanted to be pregnant sooner 1 Wanted to be pregnant later 2 Wanted to be pregnant then 3 Didn’t want to be pregnant 4 Don't know/Not sure 7 Refused 9 State Added: Aging Adult AZ2_1. Are you aware of a senior center in your community? Yes 1 No 2 Don't know/Not sure 7 Refused 9 AZ2_2. Are you aware of a senior center in your community? Yes-Participated 1 Yes-Volunteered 2 No 3 Don't know/Not sure 7 Refused 9 49 APPENDIX III: 2003 ARIZONA QUESTIONNAIRE AZ2_3. Sometimes people provide care or assistance to others who are elderly, ill or disabled. During the past 30 days, did you provide any type of care or assistance to a relative or friend who is 60 years old or older? Yes 1 No 2 Don't know/Not sure 7 Refused 9 AZ2_4. In the past 30 days, how much time have you missed at work or other responsibilities in order to provide the care? None 1 Less than a day 2 One to 5 days 3 More than 5 days 4 Don't know/Not sure 7 Refused 9 State Added: Aging Services AZ3_1. During the past 60 days, how often did you have difficulty arranging for transportation to get to the places you want or need to go? Almost always 1 Sometimes 2 Rarely 3 Never 4 Don't know/Not sure 7 Refused 9 AZ3_2a. Because of any impairment or health problem, do you need someone to help with your personal care needs, such as eating, bathing, dressing, or getting around the house? Yes 1 No 2 Don't know/Not sure 7 Refused 9 AZ3_2b. Who usually helps you with your personal care needs, such as eating, bathing, dressing, or getting around the house? Husband 1 Wife 2 Partner 3 Parent 4 Son 5 Son-in-law 6 Daughter 7 Daughter-in-law 8 Other relative 9 Other Paid Relative 10 Unpaid volunteer 11 Paid employee/home health service 12 Friend or neighbor 13 Comb family and/or friends and/or pd help 14 Other 15 No one helps me 16 Don't know/Not sure 77 Refused 99 AZ3_2c. Is the assistance you receive to meet your personal care needs from all sources: Usually adequate 1 Sometimes adequate 2 Rarely adequate 3 Don't know/Not sure 7 Refused 9 AZ3_3a. Because of any impairment or health problem, do you need someone to help in handling your routine needs, such as everyday household chores, shopping, or getting around for other purposes? Yes 1 No 2 Don't know/Not sure 7 Refused 9 50 APPENDIX III: 2003 ARIZONA QUESTIONNAIRE AZ3_3b. Who usually helps you with handling your routine needs, such as everyday household chores, shopping, or getting around for other purposes? Husband 1 Wife 2 Partner 3 Parent 4 Son 5 Son-in-law 6 Daughter 7 Daughter-in-law 8 Other relative 9 Other Paid Relative 10 Unpaid volunteer 11 Paid employee/home health services 12 Friend or neighbor 13 Comb family and/or friends and/or pd help 14 Other 15 No one helps me 16 Don't know/Not sure 77 Refused 99 AZ3_3c. Is the assistance you receive to meet your routine needs from all sources: Usually adequate 1 Sometimes adequate 2 Rarely adequate 3 Don't know/Not sure 7 Refused 9 AZ4_4. How often do you take this vitamin pill or supplement? Times per day 1 __ __ Times per week 2 __ __ Times per month 3 __ __ Don't know/Not sure 7 7 7 Refused 9 9 9 AZ4_5. Some health experts recommend that women take 400 micrograms of the B vitamin folic acid, for which one of the following reasons... To make strong bones 1 To prevent birth defects 2 To prevent high blood pressure 3 Some other reason 4 Don't know/Not sure 7 Refused 9 State Added: Folic Acid AZ4_1. Do you currently take any vitamin pills or supplements? Yes 1 No 2 Don't know/Not sure 7 Refused 9 AZ4_2. Are any of these a multivitamin? Yes 1 No 2 Don't know/Not sure 7 Refused 9 AZ4_3. Do any of the vitamin pills or supplements you take contain folic acid? Yes 1 No 2 Don't know/Not sure 7 Refused 9 51 APPENDIX IV: 2003 BRFSS WEIGHTING FORMULA FINALWT = STRWT * 1 OVER NPH * NAD * POSTSTRAT FINALWT is the final weight assigned to each respondent. STRWT accounts for differences in the basic probability of selection among strata (subsets of area code/prefix combinations). It is the inverse of the sampling fraction of each stratum. There is almost never a complete correspondence between strata, which are defined by subsets of area code/prefix combinations, and regions, which are defined by the boundaries of government entities. 1/NPH is the inverse of the number of residential telephone numbers in the respondent=s household. NAD is the number of adults in the respondent’s household. POSTSTRAT is the number of people in an age-by-gender or age-by-race-by-gender category in the population of a region or a state divided by the sum of the products of the preceding weights for the respondents in that same age-by-gender or age-by-race-by-gender category. It adjusts for non-coverage and non-response and, before 1995, also adjusts for different probabilities of selection by region, where applicable. 52 Arizona Department of Health Services Bureau of Public Health Statistics 150 North 18th Avenue, Suite 550 Phoenix, Arizona 85007 (602) 542-7333