Maricopa County Special Health Status Report 2011 Behavioral Risk Factor Surveillance System Prepared by the Maricopa County Department of Public Health Office of Epidemiology August 2013 Maricopa County Acknowledgements This report was prepared by the Maricopa County Department of Public Health, Office of Epidemiology, Epidemiology and Data Services Unit. Megan Eguchi, Epidemiologist Amy Prestanski, Epidemiologist Kara Stanley, Epidemiologist Liva Nohre, Epidemiology Supervisor Kate Goodin, Epidemiology and Data Services Program Manager Rebecca Sunenshine, Medical Director and Administrator of Disease Control Division The authors wish to thank the following individuals and organizations for contributing numeric data, consultation, and other information used in this report. Their assistance is appreciated. Judy Bass, James Blackwell Arizona Department of Health Services For additional copies of this report, please call the Maricopa County Department of Public Health, Office of Epidemiology at 602.372.2604. This report may also be found at http://www.maricopa.gov/publichealth/Services/EPI/Reports/ under “Health Statistics and Reports.” Permission to quote or reproduce materials from this report is granted when due acknowledgement is made. Suggested citation: Maricopa County Department of Public Health, Office of Epidemiology. Maricopa County Health Status Special Report 2011, Behavioral Risk Factor Surveillance System. Phoenix (AZ): 2013. Maricopa County Health Status Report 2011 Page i Maricopa County 2011 Behavioral Risk Factor Survey Statistics Maricopa County 2011 Page 1 Maricopa County 2011 Behavioral Risk Factors Survey Statistics Table 1: Self-Reported Health Indicators by Sex, Age Group, and Race/Ethnicity Behavioral Risk Factor Survey Self-Reported Health Male Female 18-24 25-34 35-44 45-54 Indicators Health Status-Excellent, Very 85.5% 82.6% 88.4% 92.7% 84.5% 77.8% Good, or Good Activity Limited Due to Health 19.8% 25.6% 15.7% 14.9% 15.6% 25.9% Problems Health Problems Requiring 6.7% 7.7% 2.7% 0.6% 3.4% 7.9% Special Equipment 1 BMI-Overweight 45.3% 28.0% 30.3% 31.5% 40.2% 41.3% 1 BMI-Obese 25.8% 24.6% 18.9% 24.0% 22.9% 31.3% 1 Overweight and obesity are based on the respondent’s self-reported height and weight White nonHispanic Hispanic Total 79.0% 88.2% 75.1% 84.0% 32.0% 36.2% 25.8% 15.3% 22.7% 15.1% 16.5% 7.1% 6.5% 7.2% 38.0% 29.8% 39.9% 23.7% 35.5% 21.5% 41.4% 35.4% 37.0% 25.2% White nonHispanic Hispanic Total 55-64 65+ 79.9% Table 2: Self-Reported Health Behaviors by Sex, Age Group, and Race/Ethnicity Behavioral Risk Factor Survey Self-Reported Health Behaviors Physical Activity-Met aerobic recommendation Physical Activity-Met muscle strengthening recommendation Physical Activity-Met at least one guideline Fruit and Vegetable Consumption-5 or more servings a day Seat Belt Use-Always 1 Folic Acid Supplement 1 Folic Acid Awareness Ever Had an HIV Test 1 Females 18-44 years old. Male Female 18-24 25-34 35-44 45-54 55-64 65+ 54.8% 50.3% 43.3% 55.2% 52.0% 53.6% 47.2% 60.6% 57.2% 41.4% 52.6% 36.4% 25.4% 35.7% 33.7% 29.6% 37.7% 26.3% 21.5% 31.6% 28.1% 30.9% 63.9% 57.9% 59.6% 63.0% 60.3% 62.6% 54.3% 64.1% 65.3% 49.6% 61.0% 18.3% 24.0% 10.4% 25.1% 27.5% 23.0% 16.9% 18.2% 21.2% 19.4% 21.1% 80.8% N/A N/A 35.3% 89.1% 40.1% 58.6% 33.9% 72.3% 24.4% 80.2% 48.4% 64.8% 56.3% 85.7% 40.2% 62.4% 45.5% 89.7% N/A N/A 38.2% 91.3% N/A N/A 19.7% 89.5% N/A N/A 9.8% 86.2% 51.2% 65.0% 32.0% 80.4% N/A N/A 32.9% 85.0% 40.1% 58.6% 34.6% Note: Results for demographic groups with less than 50 total non-blank responses to the question are not reported and are indicated using “-“. Demographic groups that were not included in the analysis are indicated using “N/A” for “Not Applicable.” See Technical Notes for detailed description of Questionnaire questions and for unweighted frequencies for each question and group. Maricopa County 2011 Page 2 Maricopa County 2011 Behavioral Risk Factors Survey Statistics Table 3: Medical Provider Diagnosed Conditions by Sex, Age Group, and Race/Ethnicity Behavioral Risk Factor Survey Has a Medical Provider Ever Told You that You Have/Had Coronary Heart Disease Heart Attack Stroke Diabetes High Blood Pressure High Cholesterol Asthma Chronic Obstructive Pulmonary Disorder Cancer Depressive Disorder Female 18-24 25-34 35-44 45-54 55-64 65+ 3.8% 4.9% 3.4% 10.6% 26.9% 43.2% 12.2% 2.6% 3.1% 2.8% 7.8% 24.7% 35.3% 14.9% 0.0% 1.1% 1.9% 0.5% 10.3% 13.2% 0.2% 1.1% 0.8% 1.8% 10.0% 20.7% 16.0% 1.4% 0.5% 1.5% 5.8% 15.9% 36.0% 10.1% 3.1% 5.0% 3.9% 12.5% 32.6% 37.6% 16.2% 3.7% 5.0% 3.3% 14.3% 37.4% 55.8% 9.7% 11.7% 12.7% 8.2% 22.3% 54.3% 59.1% 14.9% White nonHispanic 4.0% 4.0% 3.1% 7.6% 26.1% 40.8% 14.3% 3.6% 5.2% 0.6% 0.6% 4.4% 5.4% 3.4% 12.1% 11.2% 10.6% 13.3% 23.5% 2.0% 13.6% 1.4% 14.7% 2.7% 18.2% 15.9% 20.0% 15.8% 19.8% 35.4% 15.7% Male Hispanic Total 1.7% 2.6% 3.2% 11.0% 22.1% 39.1% 10.5% 3.2% 4.0% 3.1% 9.2% 25.8% 39.3% 13.5% 5.4% 1.3% 4.4% 17.5% 20.1% 3.4% 11.8% 12.3% 17.0% Table 4: Self-Reported Alcohol and Cigarette Usage by Sex, Age Group, and Race/Ethnicity Behavioral Risk Factor Survey Alcohol and Smoking Male Binge Drinking Heavy Drinking Current Smoker Former Smoker 23.7% 7.4% 20.3% 27.8% Female 18-24 25-34 35-44 45-54 55-64 65+ 12.7% 6.1% 16.7% 19.8% 19.2% 3.6% 19.9% 10.8% 34.2% 9.7% 27.7% 11.1% 14.4% 5.9% 18.0% 16.5% 17.6% 9.4% 16.7% 27.2% 15.6% 5.9% 18.5% 31.8% 4.0% 4.2% 7.8% 49.2% White nonHispanic 17.9% 7.1% 22.2% 27.3% Hispanic Total 22.7% 6.1% 11.6% 18.0% 18.2% 6.7% 18.5% 23.8% Note: Results for demographic groups with less than 50 total non-blank responses to the question are not reported and are indicated using “-“. Demographic groups that were not included in the analysis are indicated using “N/A” for “Not Applicable.” See Technical Notes for detailed description of Questionnaire questions and for unweighted frequencies for each question and group. Maricopa County 2011 Page 3 Maricopa County 2011 Behavioral Risk Factors Survey Statistics Table 5: Vaccination Status by Sex, Age Group, and Race/Ethnicity Behavioral Risk Factor Survey Vaccinations Male Yearly Influenza Vaccine Pneumonia Vaccine 29.5% 30.8% Female 18-24 25-34 35-44 45-54 55-64 65+ 36.0% 31.3% 25.3% 18.1% 19.6% 19.1% 22.3% 18.6% 34.0% 21.7% 41.0% 35.1% 60.0% 71.8% White nonHispanic 34.3% 36.4% Hispanic Total 24.9% 19.4% 32.8% 31.0% Hispanic Total 62.9% 57.4% 77.1% 73.1% Table 6: Health Care Coverage and Utilization by Sex, Age Group, and Race/Ethnicity Behavioral Risk Factor Survey Health Care Coverage and Male Utilization 1 Health Care Coverage 72.2% Usual Source of Health Care 67.7% Time Since Last Routine 55.0% Checkup-within past year Could Not Afford Needed 19.3% Health Care 1 Males and females 18-64 years old. Female 18-24 25-34 35-44 45-54 55-64 65+ 82.3% 78.5% 73.5% 57.2% 74.8% 56.8% 76.8% 71.0% 79.1% 79.9% 82.2% 81.1% N/A 95.7% White nonHispanic 83.8% 80.3% 65.4% 50.7% 45.0% 56.8% 59.8% 69.4% 84.2% 62.7% 52.8% 60.2% 19.3% 19.2% 19.8% 21.2% 27.8% 19.3% 6.7% 15.4% 29.3% 19.3% Note: Results for demographic groups with less than 50 total non-blank responses to the question are not reported and are indicated using “-“. Demographic groups that were not included in the analysis are indicated using “N/A” for “Not Applicable.” See Technical Notes for detailed description of Questionnaire questions and for unweighted frequencies for each question and group. Maricopa County 2011 Page 4 Technical Notes Behavioral (BRFSS) Statistics Behavioral Risk Factor Surveillance System (BRFSS) data are presented in Tables 1 through 6. All BRFSS statistics were derived from data in the Arizona Department of Health Services (ADHS) final annual files. The information presented in this report includes data collected from Maricopa County residents during telephone survey interviews conducted by ADHS. Arizona residents from other counties were not included. The BRFSS is a state-based, cross-sectional, random telephone survey of household residents aged 18 years and older conducted throughout the year. It has been conducted in Arizona since 1982. The BRFSS gathers information on risk factors related to both chronic and infectious diseases. Prior to 2011, surveys were collected using only landline respondents. Beginning in 2011, the BRFSS also included individuals who receive 100 percent of their calls on cell-phones. According to the CDC, cell-phone respondents are more likely to be younger, single, Hispanic, and to rent rather than own homes. In addition, a new weighting methodology was utilized beginning in 2011. Data from prior years were weighted using post stratification weighting methodology, while 2011 data were weighted using iterative proportional fitting, or “raking.” Due to these changes, 2011 data cannot be compared to prior years. For more information, see the CDC website: http://www.cdc.gov/brfss/annual_data/annual_2011.htm. Tables 1 through 6 are organized such that similar questions are shown together. Each table lists a short description of the topic for each question and the estimated percent of Maricopa County residents that met the condition, by sex, selected age groups, and selected races. Groups with less than 50 total respondents are omitted from the report due to small sample size (i.e. American Indian, Black, and Asian residents are not shown). Additionally, if there were less than 50 non-blank responses for a specific question, the results for that question were omitted. Not all questions are included in the questionnaire every year, such as questions regarding health screenings. Therefore, data that was included in prior years may not be included in the current report. Unless otherwise stated below, respondents could have responded with either “Yes” or “No” to each question. Respondents also could have responded to all questions with “Don’t know/not sure” or respondents could have refused to answer. Each question covered in this report is described below: Table 1 includes self-reported health indicators. • Results for Health Status were derived from responses to the question “Would you say that in general your health is: Excellent, Very Good, Good, Fair, or Poor.” Respondents who answered “Excellent,” “Very Good,” or “Good” are shown. • Results for Activity Limited Due to Health Problems were determined using the question “Are you limited in any way in any activities because of physical, mental, or emotional problems”? Respondents who answered “Yes” are shown. • Results for Health Problems Requiring Special Equipment were summarized from responses to the question “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? (Include occasional use or use in certain circumstances.)” Respondents who answered “Yes” are shown. • Results for BMI: Overweight and Obese were derived from calculated BMI (body mass index) based on the respondent’s self-reported height and weight. Individuals with a BMI greater than 25 and less than 30 were classified as overweight, and individuals with a BMI of 30 or greater were classified as obese. Maricopa County Health Status Report 2010 Page 5 Table 2 includes self-reported health behaviors. • Results for Physical Activity were derived using a series of questions. The first question asked “During the past month, other than your regular job, did you participate in any physical activities or exercises?” If the respondent replied “Yes” then he/she was asked, “What type of physical activity or exercise did you spend the most time doing during the past month”, “How many times per week or per month did you take part in this activity during the past month”, and “When you took part in this activity, for how many minutes or hours did you usually keep at it?” The same questions were asked for the second most frequent activity that the respondent reported. Respondents were also asked “During the past month, how many times per week or per month did you do physical activities or exercises to strengthen your muscles? Do not count aerobic activities like walking, running, or bicycling. Count activities using your own body weight like yoga, sit-ups or push-ups and those using weight machines, free weights, or elastic bands.” Based on responses to the above questions, the respondent’s total minutes of activity per week were calculated. o The respondent Met Aerobic Recommendations if he/she participated in at least 150 minutes of moderate-intensity aerobic activity per week or at least 75 minutes of vigorous-intensity aerobic activity. An equivalent combination of the two was also considered sufficient to fulfill the recommendation. o The respondent Met Strengthening Recommendations if he/she participated in muscle-strengthening activities at least two times per week. o If the respondent met either the aerobic recommendation, the muscle strengthening recommendation, or met both recommendations, then he/she was considered to have Met at least one guideline. • Results for Fruit and Vegetable Consumption were calculated based on several questions: “During the past month, how many times per day, week, or month did you drink fruit juices such as orange, grapefruit, or tomato?”, “During the past month, how many times per day, week, or month did you eat fruit, beans, dark green vegetables, and orange-colored vegetables?” and “Not counting what you just told me about, during the past month, about how many times per day, week, or month did you eat other vegetables? Examples of other vegetables include tomatoes, tomato juice or V-8 juice, corn, eggplant, peas, lettuce, cabbage, and white potatoes that are not fried, such as baked or mashed potatoes” Respondents whose calculated result showed consumption of five or more servings of fruits and vegetables per day are shown. • Results for Seat Belt Use were determined using responses to the question “How often do you use seat belts when you drive or ride in a car?” The respondent had the option of answering “Always,” “Nearly Always,” “Sometimes,” “Seldom,” or “Never.” Respondents who answered “Always” are shown. • Results for Folic Acid Supplement were obtained from responses to the question “Do you currently take any multivitamins or supplements that contain folic acid?” Women aged 18-44 years who responded “Yes” are shown. • Results for Folic Acid Awareness were derived from responses to the question “Some health experts recommend that women take 400 micrograms of the B-vitamin folic acid every day. They recommend this for which one of the following reasons?” The respondent could answer “To make strong bones”, “To prevent birth defects”, “To prevent high blood pressure”, or “Some other reason”. Women aged 18-44 years who were aware that folic acid is taken to prevent birth defects are shown. • Results for Ever Had an HIV Test were derived from responses to the question “Have you ever been tested for HIV? Do not count tests you may have had as part of a blood donation. Include testing fluid from your mouth.” Respondents who answered “Yes” are shown. Table 3 includes a list of medical conditions diagnosed by a medical provider. • Results for Coronary Heart Disease, Heart Attack, Stroke, Diabetes, High Blood Pressure, High Cholesterol, Asthma, Chronic Obstructive Pulmonary Disease, Cancer, and Depressive Disorder were obtained from similar questions that asked “Have you ever Maricopa County Health Status Report 2010 Page 6 been told by a doctor that you have…?” Adults that responded “Yes” are shown for each of the conditions. Diabetes and High Blood Pressure do not include females who were only told they had the condition during a pregnancy. Diabetes does not include respondents who stated they have been told they have pre-diabetes or borderline diabetes. Results for High Cholesterol were calculated only amongst respondents who responded “Yes” to “Have you ever had your cholesterol checked?” Table 4 includes a list of behaviors related to alcohol and tobacco. • Results for Binge Drinking and Heavy Drinking were derived from several questions. The first question asked “During the past 30 days, have you had at least one drink of any alcoholic beverage such as beer, wine, a malt beverage, or liquor?” If the respondent answered “Yes,” he/she was then asked additional questions. o Results for Binge Drinking were determined by asking “Considering all types of alcoholic beverages, how many times during the past 30 days did you have X or more drinks on an occasion?” The value of X was five if the respondent was male and four if the respondent was female. Binge Drinking includes residents that had five or more drinks on one occasion for males, or four or more drinks on one occasion for females. o Results for Heavy Drinking were determined by asking two questions: “During the past 30 days, how many days per week or per month did you have at least one drink of any alcoholic beverage?” and “During the past 30 days, on the days when you drank, about how many drinks did you drink on average.” Heavy Drinking includes residents who had more than two drinks per day if male or more than one drink per day if female. • Results for Current Smoker and Former Smoker were derived from two questions. The first question asked “Have you smoked at least 100 cigarettes in your entire life?” One hundred cigarettes is equivalent to five packs. If the participant answered “Yes,” he/she was then asked the second question. The second question asked “Do you now smoke cigarettes every day, some days, or not at all?” Adults who reported smoking “Every day” or “Some days” were categorized as Current Smokers while adults who reported smoking “Not at all” were categorized as Former Smokers. Table 5 includes adult vaccinations that are recommended by the Advisory Committee for Immunization Practices (ACIP). • Results for Yearly Influenza Vaccine were determined using responses to the question “During the past 12 months, have you had either a seasonal flu shot or a seasonal flu vaccine that was sprayed in your nose?” Respondents who said “Yes” are shown. • Results for Pneumonia Vaccine were obtained from responses to the question “Have you ever had a pneumonia shot?” Respondents who said “Yes” are shown. Table 6 includes questions related to health care coverage and utilization for residents. • Results for Health Care Coverage were obtained from responses to the question “Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare or Indian Health Service?” Respondents 18-64 who answered “Yes” are shown. Respondents aged 65 years and older were omitted because the majority of this population is covered under a government plan such as Medicare. • Results for Usual Source of Health Care were determined using the question “Do you have one or more persons you think of as your personal doctor or health care provider?” The respondent could have answered “Yes, only one”, “More than one”, or “No”. Respondents who said “Yes, only one” or “More than one” are shown. • Results for Time Since Last Routine Checkup were obtained from responses to the question “About how long has it been since you last visited a doctor for a routine checkup, not an exam for a specific injury, illness or condition?” The respondent had the Maricopa County Health Status Report 2010 Page 7 • option to answer “Within past year,” “Within past 2 years,” “Within past 5 years,” “5 or more years ago,” “or “Never.” Respondents that answered “Within past year” are shown. Results for Could Not Afford Needed Health Care were obtained from the question “Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?” Adults that answered “Yes” are shown. BRFSS data were weighted to account for unequal probabilities of being selected and to adjust the numbers of those selected to reflect the actual state population estimates. Table 7 shows the frequency of responses prior to weighting. The total number of respondents per demographic group is shown in the first row, next to “Total Observations”. In 2011, a total of 1,626 residents of Maricopa County participated in the BRFSS survey. The remainder of the table lists the specific question and the corresponding unweighted frequencies for each demographic group. The unweighted frequency represents the actual number of individuals who responded in the affirmative (based on the descriptions provided above) to each question, prior to weighting. Weighted frequencies are not shown. For more information on the BRFSS visit the CDC’s BRFSS website: http://www.cdc.gov/brfss/index.htm or Arizona Behavioral Risk Factor Survey at: http://www.azdhs.gov/phs/phstats/brfs/index.htm. Maricopa County Health Status Report 2010 Page 8 Table 7 Total Maricopa County Residents by Reported Question-2010 BRFSS People Fitting Criteria Male Female 18-24 25-34 35-44 45-54 55-64 65+ Total Observations 664 962 103 187 234 250 323 529 General Health Status 563 779 88 173 206 205 258 412 Activity Limitations 155 266 14 26 35 60 99 187 Require Special Equipment 57 106 3 2 8 18 41 91 BMI-Overweight 297 257 29 55 79 92 106 193 BMI-Obese 161 192 14 33 49 69 79 109 Physical Activity-Aerobic 362 508 49 100 123 133 154 311 Physical Activity-Strength 242 260 41 64 79 90 96 132 Physical Activity-At least one 418 554 63 112 140 153 178 326 Fruit and Vegetables 112 228 12 48 58 61 59 102 Seat Belt Use 528 843 74 151 196 214 286 450 Folic Acid Supplement N/A 84 37 39 N/A N/A N/A Folic Acid Awareness N/A 114 43 62 N/A N/A N/A Ever Had HIV Test 175 236 26 101 98 86 58 42 Coronary Heart Disease 36 42 0 1 2 7 13 55 Heart Attack 44 47 1 2 1 11 15 61 Stroke 28 42 1 3 3 10 13 40 Diabetes 76 94 1 2 13 22 43 89 High Blood Pressure 219 327 7 11 38 78 125 287 High Cholesterol 265 348 22 61 81 151 295 Asthma 80 139 16 28 29 37 35 74 COPD 42 64 1 2 8 13 15 67 Cancer 122 164 2 2 6 36 55 185 Depressive Disorder 84 211 15 24 48 57 73 78 Binge Drinking 116 97 22 58 39 42 32 20 Heavy Drinking 42 59 5 17 15 23 22 19 Current Smoker 119 120 20 37 42 42 52 46 Former Smoker 224 262 8 22 32 63 108 253 Yearly Influenza Vaccine 241 407 20 40 58 78 127 325 Pneumonia Vaccine 219 369 15 24 32 48 100 369 Health Care Coverage <65 365 508 75 145 190 199 264 N/A Usual Source of Health Care 515 828 63 111 180 199 282 508 Last Checkup 414 687 50 93 130 147 233 448 Unable to Afford Health Care 88 141 20 35 37 63 47 27 Results for demographic groups with less than 50 total non-blank responses to the question are not reported. Maricopa County Health Status Report 2010 Page 9 White NonHispanic 1,258 1,066 342 130 429 255 705 398 782 265 1,076 64 85 292 66 68 55 121 428 505 167 90 265 236 164 82 191 409 536 498 664 1079 875 144 Hispanic 214 150 39 15 70 69 86 54 100 42 169 N/A N/A 59 6 11 9 28 58 59 27 5 9 34 40 12 26 39 49 44 112 136 119 59 Total 1,626 1,342 421 163 554 353 870 502 972 340 1,371 84 114 411 78 91 70 170 546 613 219 106 286 295 213 101 239 486 648 588 873 1343 1101 229