BRFSS A Report from the Behavioral Risk Factor Surveillance System

Transcription

1 BRFSS A Rport from th Bhavioral Risk Factor Survillanc Systm Halth Risks Among North Carolina Adults: 2005 Dpartmnt of Halth and Human Srvics Octobr 2006

2 Halth Risks Among North Carolina Adults: 2005 A Rport from th Bhavioral Risk Factor Survillanc Systm Dpartmnt of Halth and Human Srvics 1908 Mail Srvic Cntr Raligh, NC Octobr 2006

3 STATE OF NORTH CAROLINA Michal F. Easly, Govrnor DEPARTMENT OF HEALTH AND HUMAN SERVICES Carmn Hookr Odom, Scrtary DIVISION OF PUBLIC HEALTH Lah Dvlin, D.D.S, M.P.H. Stat Halth Dirctor STATE CENTER FOR HEALTH STATISTICS Paul Buschr, Ph.D., Dirctor Contributing Authors Harry Hrrick, M.S.P.H., M.S.W. Brand Robrts, B.A., B.S. Rviwrs Paul Buschr, Ph.D. Kathln Jons-Vssy, M.S. Robrt Woldman, M.A. Spcial Thanks to: BRFSS Survy Lab Suprvisors: Nan Staggrs, Angla Grn, Hnritta Frman, Mary Ann Pittman, Maruja Jordan, and Jacki Stward All th BRFSS Intrviwrs Jan Stafford, Layout Michll Lown, Maps 1,000 copis of this public documnt wr printd at a total cost of $3, or $3.78 pr copy, fundd by a grant from th Cntrs for Disas Control and Prvntion.

4 Tabl of Contnts Introduction... 1 Sampling... 2 Qustionnair... 3 Data Wighting... 3 Analysis and Intrprtation... 5 Prsntation of th Rsults... 6 Strngths and Limitations of th Survy Data... 7 Rsults Gnral Halth Status... 8 Halth Car Accss Physical Activity High Blood Prssur Blood Cholstrol Asthma Arthritis Immunization Smoking Othr Tobacco Indicators Environmntal Tobacco Exposur Houshold Environmntal Tobacco Exposur Work Alcohol Consumption Disability Ostoporosis HIV/AIDS Diabts Prvalnc Diabts Scrning Colorctal Cancr Scrning Prostat Cancr Scrning Nutrition Wight Control Rcognition of Hart Attack and Strok Symptoms Cardiovascular Disas Emotional Support and Lif Satisfaction Car Giving Appndics Appndix A North Carolina Rgional AHECs Appndix B North Carolina BRFSS Rgions Appndix C Wight Control National Map Appndix D Rcognition of Hart Attack and Strok Symptoms National Map iii

5 Tabl of Contnts (Quick Rfrnc Topics in Alphabtical Ordr) Alcohol Consumption Arthritis Asthma Blood Cholstrol Cardiovascular Disas Car Giving Colorctal Cancr Scrning Diabts Prvalnc Diabts Scrning Disability Emotional Support and Lif Satisfaction Gnral Halth Status... 8 Halth Car Accss Hart Attack and Strok Symptoms, Rcognition of High Blood Prssur HIV/AIDS Immunization Nutrition Ostoporosis Physical Activity Prostat Cancr Scrning Tobacco Environmntal Tobacco Exposur Houshold Environmntal Tobacco Exposur Work Othr Tobacco Indicators Smoking Wight Control iv

6 A Rport from th Bhavioral Risk Factor Survillanc Systm Introduction Th Bhavioral Risk Factor Survillanc Systm (BRFSS) is a random tlphon survy of adults. It is dsignd to collct information about halth status, halth bhaviors, and us of halth srvics that rlat to th lading causs of illnss and dath in North Carolina and th Unitd Stats. Th North Carolina Division of Public Halth has participatd in th BRFSS sinc Th BRFSS is a cooprativ agrmnt with th Cntrs for Disas Control and Prvntion (CDC) in which all 50 stats, th District of Columbia, and thr Unitd Stats trritoris now participat. This rport rprsnts th third issu in a sris of comprhnsiv BRFSS rports that hav focusd on th halth risks of North Carolina adults, ags 18 and oldr. Th first two rports prsntd th rsults from th 1999 survy and th 2001 survy. In this rport, w prsnt th rsults from th 2005 North Carolina BRFSS survy. Sinc th last rport was producd, th numbr of compltd intrviws has jumpd from 6,205 in 2001 to 17,261 compltd intrviws in 2005 approaching a thr-fold incras. Much of this xpansion first bgan in 2003 whn 9,455 intrviws wr compltd and thn sharply incrasd again in 2004, whn 15,053 intrviws wr compltd (and sampld from 37 diffrnt gographical strata in th stat). In 2005, th North Carolina BRFSS bcam th scond largst BRFSS survy in th nation, only surpassd by th Washington stat BRFSS (N=23,302). Th aim of North Carolina s sampl xpansion was to provid rliabl halth risk assssmnts for all singl county populations of 100,000 or mor adults, or all multi-county groups with populations of 100,000 or mor adults, thus providing som dgr of local lvl stimats across th ntir stat. In addition, its purpos was to nsur that minority groups such as Amrican Indians and Spanishspaking Hispanics would hav sufficint sampl mmbrs to adquatly rprsnt th halth risks of thir rspctiv populations. Th North Carolina BRFSS program is on of a handful of stat BRFSS programs that conducts all intrviws in-hous, or in-agncy. This affords us bttr control of th data and gratr flxibility in handling midstram changs to th qustionnair. Currntly, th North Carolina BRFSS survy lab mploys about 45 parttim intrviwrs, thr of whom ar flunt in Spanish. Intrviws ar conductd svn days pr wk at varying morning, aftrnoon, and vning tim intrvals. To produc th annual sampl of 17,261 rspondnts in 2005, a grat dal of tim and ffort was involvd. For xampl, in th January 2005 BRFSS study thr was a total of 1,479 loggd-on hours on CATI (a computr-assistd tlphon intrviwing systm which houss th qustionnair and survy rsponss), rsulting in 30,701 sparat dialings for th month. Of thos total dialings, 1,318 intrviws wr compltd in January which yildd about 23 dialings pr compltd intrviw. This 2005 rport covrs th following topics (also covrd in th 2001 rport): gnral halth status, halth car accss, physical activity, high blood prssur, blood cholstrol, asthma, arthritis, immunization, smoking, othr smoking indicators, nvironmntal tobacco xposur, alcohol consumption, disability, ostoporosis, HIV/AIDS, diabts, colorctal cancr scrning, prostat cancr scrning, nutrition, wight control, hart attack/strok symptoms, and cardiovascular disas. Nw topics in this rport (not covrd in prvious rports) includ: diabts scrning, motional support and lif satisfaction, and car giving. N. C. Dpartmnt of Halth and Human Srvics 1

7 For qustions about this rport or for mor information about BRFSS in North Carolina, contact Bob Woldman, M.A., BRFSS Coordinator,, 2422 Mail Srvic Cntr, Raligh N.C , (919) , An lctronic vrsion of this rport is availabl on th wb sit: For mor information about th BRFSS, visit th CDC s BRFSS wb sit: Th CDC s BRFSS At-A-Glanc publication is availabl at brfss.htm. Sampling Houshold tlphon sampl fram Bginning in 2003, th CDC (Cntrs for Disas Control and Prvntion) protocol for slcting houshold tlphon numbrs discontinud th inclusion of 0 blocks in th sampling fram; 0 blocks ar computr gnratd listings of 100 conscutiv phon numbrs that contain no publishd houshold tlphon numbrs. Now, only 1+ blocks ar sampld; ths ar also computr gnratd listings of 100 conscutiv phon numbrs, but thy contain at last on publishd houshold tlphon numbr. Ths 1+ blocks ar thn assignd to two strata: 1) high dnsity or listd numbrs and 2) low dnsity or unlistd numbrs. Th sampling ratio for ths two strata is 1.5:1, in which th high dnsity stratum (listd) is sampld at th rat of 1.5 tims that of th low dnsity stratum (unlistd). This approach has srvd to lowr cost and improv intrviwr fficincy. At th prsnt tim, only housholds with landlin tlphons ar includd in th BRFSS sampling fram. Howvr, bcaus of th incrasing numbr of wirlss-only housholds (cllular, mobil) in th Unitd Stats, and thir potntial impact on biasing halth stimats if not includd (s, Tlphon Covrag and Halth Survy Estimats: Evaluating th Nd for Concrn About Wirlss Substitution, Am J Public Halth. 2006;96: ), pilot studis ar now undrway at th CDC and in Washington stat to tst diffrnt approachs to scrning and intrviwing cll phon usrs for inclusion in th BRFSS survy. North Carolina gographic sampl fram In ordr to provid local-lvl stimats for th ntir stat, 37 diffrnt gographical strata wr formd. Ths 37 strata wr usd in th 2004 and 2005 survy dsigns. Svral diffrnt approachs wr usd to form ths 37 gographical units. First, 12 nw larg-population countis wr addd to th xisting group of 10 (stat s largst) countis ovr-sampld in th 2001 survy. Ths nw singl-county strata, introducd in 2004, ar Alamanc, Cabarrus, Catawba, Davidson, Irdll, Johnston, Orang, Pitt, Randolph, Robson, Rowan, and Union. Th original 10 countis ar Buncomb, Cumbrland, Durham, Forsyth, Gaston, Guilford, Mcklnburg, Nw Hanovr, Onslow, and Wak. Scond, th rmaining 78 countis wr groupd into 13 clustrs or multi-county groups. Population siz and gographical contiguity wr two primary factors usd in dtrmining how to form ths multi-county strata. In som cass, countis that shar halth information wr groupd togthr,.g., th mountain countis that ar srvd by th Mountain AHEC (Ara Halth Education Cntr) rgional cntr. Othr countis ar groupd togthr using clustr analysis (SAS Proc Clustr*). In this instanc, social and conomic information *SAS/STAT Usr s Guid, Vrsion 8. SAS Institut Inc., Cary N.C., N. C. Dpartmnt of Halth and Human Srvics 2

8 from th North Carolina Halth Statistics Pockt Guid, 2001*, wr usd to join countis togthr that had similar charactristics, such as th prcnt of th county s population nrolld in Mdicaid. For ths multicounty groups th aim was to achiv a high dgr of commonality or homognity btwn countis, rgarding social and conomic conditions. In th nd, ths 13 multi-county strata containd as fw as thr countis in th Pidmont rgion (Chatham, L, and Moor), or as many 15 countis in th Mountain AHEC rgion (Chrok, Clay, Graham, Haywood, Hndrson, Jackson, Macon, Madison, McDowll, Mitchll, Polk, Ruthrford, Swain, Transylvania, and Yancy). Third, two strata wr formd from cnsus tracts in (1) Graham, Jackson, and Swain countis in th mountains, and (2) Hok and Scotland countis in th southast, that containd a high proportion of Amrican Indian housholds. Thus, th 37 strata wr drivd: 22 individual countis, 13 multi-county groups, and 2 cnsus tract clustrs. Qustionnair Th 2005 BRFSS qustionnair containd about 200 qustions. Th Cor Componnt of th qustionnair, a CDC-dsignatd st of standard qustions askd by all stats, containd 82 qustions. Th Optional CDC Moduls sction, which ar CDC-dsignd sts of qustions on spcific topics (.g., cardiovascular disas, oral halth), containd 50 qustions. And th final sction of th qustionnair, known as th Stat-Addd sction, containd 69 qustions. Th Stat-Addd sction occurs at th nd of th qustionnair and is rsrvd for stats to ask qustions that ar spcific to th public halth prioritis or nds of thos stats. Most rspondnts wr askd fwr than half of th 200 qustions that wr includd in th 2005 qustionnair. Prsons who ar young, thos with no halth problms such as asthma, or non-smokrs or nondrinkrs ar groups likly to rciv th fwst numbr of qustions sinc many qustions will b skippd. For this halthy group th avrag tim to complt an intrviw is about 10 minuts; for th unhalthy group,.g., oldr adults with diabts, th intrviw may tak as long as 20 to 25 minuts to complt. In 2005, th North Carolina BRFSS collaboratd with rsarchrs from th Univrsity of North Carolina at Chapl Hill on th topic of halth car accss: 12 qustions wr addd to th survy for this purpos. A scond collaborativ vntur occurrd with rsarchrs from th Univrsity of Florida Halth Scincs Cntr at Gainsvill, Florida, on th topic of car giving for prsons with a long trm illnss or disability: 11 qustions wr addd to th survy for this study. Th dtaild North Carolina BRFSS qustionnairs can b accssd at: brfss/qustions.html. Data Wighting Th final BRFSS sampl data ar wightd to adjust for unqual probabilitis of slction du to th disproportionat sampling mthod and du to popl living in housholds with diffrnt numbrs of tlphons and diffrnt numbrs of adults. Th final sampl data ar also wightd to account for unqual non-rspons rats among diffrnt dmographic groups. For xampl, if whit fmals ags 65 and oldr wr 8 prcnt of th sampl rspondnts, but this group was 6 prcnt of th total population of th stat, thn a factor of 0.75 would b ntrd into th last wighting procss for ths rspondnts to account for this discrpancy. On might xpct this group to b mor likly to b at hom and mor likly to hav a tlphon than som othr dmographic groups, and thrfor mor likly to complt an intrviw. Thus th wighting procdur maks th BRFSS data mor rprsntativ of th total population of adults in th stat. All of th prcntags shown in th main tabls of this rport wr calculatd using th wightd data. *S wb sit ( N. C. Dpartmnt of Halth and Human Srvics 3

9 Th following tabl prsnts for th 2005 survy th unwightd numbr of rspondnts, th unwightd prcnt of rspondnts, and th wightd prcnt of rspondnts by slctd dmographic charactristics. Distribution of th 2005 North Carolina Survy Sampl by Slctd Charactristics Unwightd Unwightd Wightd Numbr Prcnt Prcnt Total 17, Sx Mals 6, Fmals 11, Ag , , , , , Unknown/Rfusd Rac Whit 13, African Amrican 3, Asian Amrican Indian Othr Minoritis Unknown/Rfusd Hispanic Origin Ys Spanish spaking Ys English spaking No 16, Unknown/Rfusd Education Lss than H.S. 2, H.S. or G.E.D. 5, Som Post-H.S. 4, Collg Graduat 5, Unknown/Rfusd Houshold Incom Lss than $15,000 2, $15,000 24,999 3, $25,000 34,999 2, $35,000 49,999 2, $50, , Unknown/Rfusd 2, N. C. Dpartmnt of Halth and Human Srvics 4

10 For th BRFSS and almost all othr survys of its typ, th highst prcntag of unknowns or rfusals ar most oftn associatd with incom-rlatd qustions. In 2005, about half of th rspondnts (n=1,195) in th Unknown/Rfusd catgory did not know thir total houshold incom and th othr half (n=1,380) simply rfusd to answr th qustion. Whn combind, this group rprsntd about 15 prcnt of all thos who rspondd to th incom qustion (s Tabl on pag 4). Though a larg prcntag, this is a noticabl improvmnt ovr th corrsponding rat of 19 prcnt rportd in th 2001 rport (s Halth Risks Among North Carolina Adults: 2001 availabl on th Stat Cntr s wb sit at BRFSS2001.pdf). Analysis and Intrprtation Th dmographic charactristics shown in th main tabls of this rport ar gnrally th charactristics of th prson rsponding to th survy. Howvr, incom rflcts th rportd annual incom of th houshold from all houshold mmbrs and sourcs. Unlss othrwis spcifid, rspondnts who answrd that thy did not know or who rfusd to answr wr not includd in th calculation of th prcntags. Thrfor, th sampl sizs usd to calculat th stimats in this rport vary. Th main data tabls in this rport show th 95 prcnt confidnc intrval associatd with ach prcntag (labld C.I. ). All survy rsults, no mattr how larg or small th sampl, ar subjct to som dgr of sampling rror. Th 95 prcnt confidnc intrval shows th rang within which w would xpct th tru valu for th ntir population to fall 95 prcnt of th tim. For smallr sampl sizs (for xampl, for a particular gographic stratum), th confidnc intrvals will b widr. Th confidnc intrvals shown in this rport may not b xactly th sam as thos that CDC calculats for th sam masurs. W us a mthod that may rsult in non-symmtrical confidnc intrvals, which is mor appropriat whn th prvalnc is clos to 0 or 100 prcnt. Givn th complx natur of th BRFSS sampl (i.., it is not a simpl random sampl), th SUDAAN softwar was usd to calculat th confidnc intrvals for th stimats. This softwar taks th complx sampling dsign into account whn computing th rrors of th stimats. In gnral, any prcntag with a numrator of lss than 50 will hav a rlativly larg dgr of sampling rror and should b considrd cautiously. Tsts of th statistical significanc of a diffrnc btwn two prcntags (for xampl, btwn th prcntags for two ag groups) can b prformd aftr calculating th standard rror of th diffrnc. Th data usr should contact BRFSS staff of th for assistanc with this calculation. Though not xactly tchnically corrct, a rough approximation of th statistical significanc of a diffrnc btwn two prcntags can b drivd by comparing th confidnc intrvals shown in th data tabls of this rport. If th confidnc intrvals of th two prcntags bing compard do not ovrlap, thn it is likly that th diffrnc btwn th two prcntags is statistically significant at th 95 prcnt confidnc lvl. Statd anothr way, on can b 95 prcnt crtain that a diffrnc that larg would not b obsrvd just du to random variation in th two prcntags. Undrstanding how rats may vary from on group to anothr rquirs an undrstanding of how risk may b affctd by ag, ducation or socioconomic status, or othr conditions, and th amplifid ffct that such factors may hav in combination. For xampl, th prcntag of prsons ags 65+ is much highr in th lowr ducation groups as compard to thos with highr ducation. Thrfor, to som xtnt th rsults for th lowr ducation groups ar affctd by th ag of ths populations. For xampl, chronic disas rats ar N. C. Dpartmnt of Halth and Human Srvics 5

11 much highr among prsons of lowr ducation. This is du to th ffcts of both ag and socioconomic status. Nationwid data for CDC cor and optional moduls wr usd to gnrat Unitd Stats maps. A clustring program was usd to crat fiv groups for th national maps for qustions with full participation and four groups for national maps showing data for lss than all of th stats, i.., thos stats who chos to includ th CDC optional modul in thir 2005 survy. Prsntation of th Rsults Thr ar two sts of data tabls in this rport, dmographic and gographic, for ach topic prsntd. For th dmographic tabls, th lft-hand column shows th dmographic groups, including, at th bottom of th tabl, th slctd risk masur of whthr or not th rspondnt has halth insuranc. Lack of halth insuranc will likly rmain a ky political and public halth issu through th nd of this dcad. Th scond column in th dmographic tabls shows th total numbr of rspondnts who answrd th qustion. With a fw xcptions whr a man valu is shown, column thr (N) shows th numbr who answrd Ys to th risk bing masurd. Columns four and fiv show th wightd prcntag of Ys rsponss and th 95 prcnt confidnc intrval for this wightd prcntag. (Not that th wightd prcntag cannot b calculatd dirctly from th unwightd numrator and dnominator that ar shown in th tabl.) Th gographic tabls ar arrangd in th sam mannr as th dmographic tabls, but w show only th total numbr of rspondnts from ach gographic stratum thr ar no dmographic brakouts. Th county nam(s) for ach stratum ar numratd, xcpt in four cass. Two multi-county groups in th northast rgion of th stat ar dfind in th rport as, Northast N.C. I and Northast N.C. II. Northast N.C. I countis ar: Brti, Gats, Halifax, Hrtford, Northampton, and Warrn. Northast N.C. II countis ar: Baufort, Camdn, Chowan, Edgcomb, Martin, Pasquotank, Prquimans, Tyrrll, and Washington. For a multi-county group in th northwst rfrrd to as, Appalachian, Avry, Wilks, Appalachian srvs as a district rfrnc for Allghany, Ash, and Watauga countis. Th MAHEC stratum includs all of th countis in th Mountain AHEC rgion, xcpt Buncomb County. Along with singl-county and multi-county strata, th gographic tabls also fatur thr statwid rgions: th Wstrn rgion, th Pidmont rgion, and th Eastrn rgion. Ths ar standard classifications of county/ rgions that hav bn usd prviously in BRFSS rports and on our wb sit (s Appndix B). Bsids ths rgional dsignations, th rport also faturs th countis srvd by th stat s nin AHEC (Ara Halth Education Cntr) rgional cntrs. Thy ar: Mountain AHEC, Charlott AHEC, Northwst AHEC, Grnsboro AHEC, Wak AHEC, Southrn Rgional AHEC, Ara L AHEC, Eastrn AHEC, and Coastal AHEC. (S Appndix A for a stat map showing th rgional boundaris and countis srvd.) In addition to th data tabls, w show trnds from th North Carolina BRFSS dating back to th 2000 survy, our baslin masur. Two sts of trnds ar prsntd graphically, on for rac and Hispanic thnicity and on for ag. Data from th two strata with a high proportion of Amrican Indians ar not shown sparatly du to small numbrs, though ths data hlp incras th sampl siz for th Amrican Indian racial group. For th ag trnds, 18 to 24 yar olds wr combind with 25 to 34 yar olds in ordr to limit th total numbr of ag groups to fiv (having mor than fiv trnd lins in a singl chart maks it difficult to dciphr individual trnds). For rac trnds, four groups wr constructd: 1) non-hispanic (NHP) whits; 2) NHP African Amricans; 3) NHP othr minoritis (prdominantly Amrican Indian); and Hispanics (both English and N. C. Dpartmnt of Halth and Human Srvics 6

12 Spanish spakrs). Along with ths four rac/thnic groups, w also show th North Carolina statwid trnd. Trnds for Hispanics wr rstrictd to th 2001 survy and forward, sinc th 2000 sampl was too small to provid maningful comparisons. Also, th BRFSS survy was first conductd in Spanish in 2002 and th inclusion of Spanish-spaking Hispanics has a markd ffct on som of th indicators.* Thr or mor yars of North Carolina BRFSS data wr rquird to show trnds. Som of th BRFSS qustions ar not askd vry yar. Strngths and Limitations of th Survy Data Thr ar som significant advantags of th tlphon survy mthodology, including bttr quality control ovr data collction mad possibl by a computr-assistd-tlphon-intrviwing systm (CATI), rlativly low cost, and spd of data collction. Th BRFSS mthodology has bn usd and valuatd by th CDC and participating stats sinc Th survy qustions, qustionnair dsign, data collction procdurs, intrviwing tchniqus, and diting procdurs hav bn carfully dvlopd to improv data quality and lssn th potntial for bias. Th data collction is ongoing and ach yar nw annual rsults bcom availabl. On limitation of a tlphon survy is th lack of covrag of prsons who liv in housholds without a tlphon. Housholds without a tlphon ar, on avrag, of lowr incom. Thrfor, for many of th halth risks shown in this rport, th rsults ar likly to undrstat th tru lvl of risk in th total population of adults in North Carolina. Sinc approximatly 95 prcnt of housholds in North Carolina do hav on or mor tlphons, th dgr of undrstatmnt is probably not larg. A scond limitation is du to th fact that th data is slf-rportd by th rspondnts. W xpct that rspondnts tnd to undrrport halth risk bhaviors, spcially thos that ar illgal or socially unaccptabl. Th survy rsults prsntd hr ar purly dscriptiv. It is not possibl to infr causs of th obsrvd diffrncs from th information prsntd hr. For xampl, thr ar larg diffrncs btwn whits and African Amricans on som of th masurs. It should not b infrrd that th diffrncs ar du to rac alon. Social and conomic factors associatd with rac oftn account for a larg part of th diffrncs obsrvd btwn racial groups. Rcnt studis also indicat that racism may b a contributing factor to halth disparitis. Th rsults prsntd hr for a singl yar of data must b approachd with caution du to small numbrs in som of th dmographic sub-catgoris or gographic strata. Th confidnc intrvals ar providd as a mans of intrprting th accuracy of ths stimats. *S SCHS Studis No. 143 Spanish-Spaking Hispanics in North Carolina: Halth Status, Accss to Halth Car, and Quality of Lif Rsults from th 2002 and 2003 N.C. BRFSS Survys at N. C. Dpartmnt of Halth and Human Srvics 7

13 Gnral Halth Status Prcivd fair or poor ovrall halth Ovr 40 prcnt of thos from th lowst incom housholds rportd bing in fair/poor halth, compard to lss than 7 prcnt from th highst incom housholds. Almost 33 prcnt of Spanish-spaking Hispanics rportd bing in fair/poor halth, compard to about 19 prcnt of English-spaking Hispanics. Avrag (man) numbr of days during prvious 30 days whn physical halth was not good Spanish-spaking Hispanics rportd far fwr poor physical halth days (1.8 days) than thir English-spaking countrparts (3.7 days); this is in sharp contrast to th prvious findings on prcivd halth. Avrag (man) numbr of days during prvious 30 days whn mntal halth was not good By rac, th highst risk of poor mntal halth days was vidnt among Amrican Indians. Avrag (man) numbr of days during prvious 30 days whn poor physical or mntal halth prvntd usual activitis Among all dmographic groups, th gratst disparity in th rport of poor physical/mntal halth days prvnting usual activitis was associatd with houshold incom. North Carolina Trnds Th gap in rats of prcivd fair/poor halth, btwn non-hispanic whits and African Amricans, has rmaind fairly constant sinc th start of th dcad (Figur 1a). By ag, th six-yar trnds in prcivd fair/poor halth show a slight dclin for th oldst ag group and a slight incras for th youngst ag group, yar olds (Figur 1b). Figur Fair or 1a. Poor Fair Halth or Poor by Halth Rac/Ethnicity: by Rac/Ethnicity: NC BRFSS N.C BRFSS P r c n t *2002: initiatd Initiatd Spanish intrviws s NC Total NHP Whit NHP Black NHP Othr Hispanic NHP: non-hispanic N. C. Dpartmnt of Halth and Human Srvics 8

14 Fair or Figur Poor 1b. Halth Fair by or Ag: Poor NC Halth BRFSS by Ag: N.C. BRFSS P r c n t yrs yrs yrs yrs 65+ yrs Tabl 1a. Halth Status of N.C. Adults, 2005 Days Poor Physical or Poor Physical Halth Poor Mntal Halth Mntal Halth Prvntd Fair or Poor Gnral Halth Days/Month Days/Month Usual Activitis* Total Total Total Total Rsp. N % 95% C.I. Rsp. Man 95% C.I. Rsp. Man 95% C.I. Rsp. Man 95% C.I. TOTAL GENDER Mal Fmal RACE Whit African Amrican Asian Amrican Indian Othr Minoritis HISPANIC English Spaking Spanish Spaking Non-Hispanic AGE EDUCATION Lss Than H.S H.S. or G.E.D Som Post-H.S Collg Graduat HOUSEHOLD INCOME Lss than $15, $15,000-24, $25,000-34, $35,000-49, $50, HEALTH INSURANCE Ys No *Rspondnts who rportd no mntal or physical halth problms in th past month wr not askd this qustion; howvr, thy ar includd in th dnominator. N. C. Dpartmnt of Halth and Human Srvics 9

15 Gnral Halth Status (cont.) Gographical Variation Prcivd fair or poor ovrall halth Across individual countis, Robson had th highst rat (26.0%) for this indicator. Among multi-county groups, th highst rat of prcivd fair/poor halth was obsrvd in th Northast N.C. I rgion (31.8%) of th stat, which consists of Brti, Gats, Halifax, Hrtford, Northampton, and Warrn countis. Nationally, th rats of prcivd fair/poor halth rang from a low of 11.1 prcnt in Nw Hampshir to 34.1 prcnt in Purto Rico; North Carolina had th 11 th highst rat (18.6%) among stats (Figur 1c). Avrag (man) numbr of days during prvious 30 days whn physical halth was not good Th avrag numbr of poor physical halth days was highst in Gaston County (5.0 days). Thr was a gnral trnd for rspondnts from both astrn and wstrn countis to rport highr numbrs of poor physical halth days than thos from th cntral or Pidmont countis. Avrag (man) numbr of days during prvious 30 days whn mntal halth was not good Th highst risk of poor mntal halth days tndd to occur in th astrn rgion of th stat, particularly among th multicounty group of Bladn, Brunswick, Columbus and Pndr (4.5 man days). Avrag (man) numbr of days during prvious 30 days whn poor physical or mntal halth prvntd usual activitis Th man numbr of poor physical/mntal halth days prvnting usual activitis was 2 days for th stat as a whol; th high/low rang for all gographic strata tndd to fall within on day of this avrag. Figur 1c. Prcivd Fair/Poor Halth, Unitd Stats, 2005 Prcivd Fair/Poor Halth Unitd Stats, 2005 District of Columbia (12.5%) Prcnt Alaska Hawaii Virgin Islands Purto Rico Sourc: BRFSS Numbr of Participating Stats: 53 Not to Scal (Including Purto Rico, Virgin Is. & D.C.) Unitd Stats 14.9 North Carolina 18.6 N. C. Dpartmnt of Halth and Human Srvics 10

16 Tabl 1b. Halth Status of N.C. Adults, 2005 Days Poor Physical or Poor Physical Halth Poor Mntal Halth Mntal Halth Prvntd Fair or Poor Gnral Halth Days/Month Days/Month Usual Activitis* Total Total Total Total Rsp. N % 95% C.I. Rsp. Man 95% C.I. Rsp. Man 95% C.I. Rsp. Man 95% C.I. TOTAL COUNTIES/REGIONS Alamanc Buncomb Cabarrus Catawba Cumbrland Davidson Durham Forsyth Gaston Guilford Irdll Johnston Mcklnburg Nw Hanovr Onslow Orang Pitt Randolph Robson Rowan Union Wak Cartrt,Currituck, Cravn,Dar,Hyd, Pamlico Northast N.C. I Northast N.C. II Franklin,Nash,Wilson Duplin,Grn, Harntt,Jons, Lnoir, Sampson, Wayn Bladn,Brunswick, Columbus,Pndr Caswll,Granvill, Prson,Vanc Chatham,L,Moor Anson,Hok, Montgomry,Richmond, Scotland,Stanly Davi,Rockingham, Stoks,Surry,Yadkin Appalachian,Avry, Wilks Alxandr,Burk, Caldwll,Clvland, Lincoln MAHEC (xcluding Buncomb County) REGIONS Eastrn Pidmont Wstrn AHEC REGIONS Mountain Northwst Charlott Grnsboro Southrn Rgional Coastal Wak Ara L Eastrn *Rspondnts who rportd no mntal or physical halth problms in th past month wr not askd this qustion; howvr, thy ar includd in th dnominator. N. C. Dpartmnt of Halth and Human Srvics 11

17 Halth Car Accss No halth insuranc covrag Clos to 1 in 5 North Carolina adults (19.1%), or an stimatd 1.2 million adults, had no halth insuranc covrag in Ovr 40 prcnt of thos with lss than a high school ducation had no halth insuranc covrag. Compard to fmals (16.6%), mals (21.8%) wr significantly mor likly not to hav halth insuranc. Dos not hav a prsonal doctor About 82 prcnt of Spanish-spaking Hispanics rportd not having a prsonal doctor, narly twic th rat of most othr high-risk dmographic groups, such as young adults. As rportd in th 2001 rport (S footnot*; rfrrd to hraftr as th 2001 rport or ), 24.2 prcnt of thos with th lowst ducation had no prsonal doctor, but in 2005, th rat for this group jumpd to 40.8 prcnt. Could not s a doctor in past yar du to cost Among th rac groups, Amrican Indians rportd th highst rat (27.5%) of not bing abl to s a doctor in th past yar bcaus of cost. Cost was a prohibitiv factor for 41.3 prcnt of thos with no halth insuranc, compard to 9.5 prcnt of thos with halth insuranc a diffrnc of almost 32 prcntag points. North Carolina Trnds Lack of halth insuranc for all North Carolina adults has incrasd from about 13 prcnt in 2000 to about 19 prcnt in Much of this incras is du to th xcptionally high rats of uninsuranc among Spanish-spaking Hispanics (Figur 2a). Th first yar that th BRFSS survy was conductd in Spanish was 2002, so th 2000 and 2001 data do not includ Spanish-spaking Hispanics. Sinc 2000, th rat of no halth insuranc covrag has incrasd dramatically for yar olds, and appars to b on ris for 35 to 44 yar olds, as wll (Figur 2b). No Halth Figur Insuranc 2a. No Halth Covrag Insuranc by Rac/Ethnicity: Covrag by Rac/Ethnicity: NC BRFSS N.C. BRFSS P r c n t NC Total NHP Whit NHP Black NHP Othr Hispanic NHP: non-hispanic *2002: 2002: initiatd Initiatd Spanish intrviws s Halthy Popl 2010 Objctivs: 1) Incras th prcntag with halth insuranc to 100% (N.C.: 1999=89.7%; 2000=88.9%; 2001=85.8%; 2005=80.9%). 2) Incras th proportion of prsons with a usual primary car providr to 85% (N.C.: 2001=80.7%; 2005=77.2%). *Halth Risks Among North Carolina Adults: 2001, A Rport from th Bhavioral Risk Factor Survillanc Systm, DHHS, Stat Cntr for Halth Statistics, August 2003 N. C. Dpartmnt of Halth and Human Srvics 12

18 P r c n t Figur 2b. No Halth Insuranc by by Ag: Ag: N.C. BRFSS NC BRFSS yrs yrs yrs yrs 65+ yrs Tabl 2a. Halth Car Accss of N.C. Adults, 2005 No Currnt Halth Insuranc Dos Not Hav a Prsonal Doctor Could Not S a Doctor Du to Cost Total Total Total Rsp. N % 95% C.I. Rsp. N % 95% C.I. Rsp. N % 95% C.I. TOTAL GENDER Mal Fmal RACE Whit African Amrican Asian Amrican Indian Othr Minoritis HISPANIC English Spaking Spanish Spaking Non-Hispanic AGE EDUCATION Lss Than H.S H.S. or G.E.D Som Post-H.S Collg Graduat HOUSEHOLD INCOME Lss than $15, $15,000-24, $25,000-34, $35,000-49, $50, HEALTH INSURANCE Ys N/A N/A N/A N/A No N/A N/A N/A N/A N. C. Dpartmnt of Halth and Human Srvics 13

19 Halth Car Accss (cont.) Gographical Variation No halth insuranc covrag Among individual countis, no halth insuranc covrag rangd from a high of 26.1 prcnt in Durham to a low of 12.7 prcnt in Onslow. By stat rgions, th rat of no halth insuranc was highst in th Wstrn rgion. By AHEC rgions, lack of insuranc was highst in th Mountain countis. (S Appndix A for county listing). Nationally, North Carolina had th 11 th highst rat (19.1%) of no halth insuranc, whil Minnsota and Purto Rico had th lowst rat (7.0%). Th U.S. mdian rat was 14.5 prcnt (Figur 2c). Dos not hav a prsonal doctor Among individual countis, th adult populations of Cumbrland (29.7%), Durham (29.8%), Orang (27.9%), and Robson (28.4%) wr most likly not to hav a prsonal doctor. Among multi-county strata, th coastal countis of Cartrt, Currituck, Cravn, Dar, Hyd, and Pamlico had th highst rat of not having a prsonal doctor (27.2%). Among AHEC rgions, th Southrn Rgion (Bladn, Cumbrland, Harntt, Hok, Moor, Richmond, Robson, Sampson, and Scotland) had th highst rat (27.2%). Could not s a doctor in past yar du to cost Th highst prcntag of thos that could not afford to s a doctor bcaus of cost wr found in th countis of Alamanc (19.0%), Gaston (19.2%), and Robson (20.8%). Among multi-county strata, th Northast N.C. I countis of Brti, Gats, Halifax, Hrtford, Northampton, and Warrn had th highst risk for this indicator (22.0%). Similarly, among statwid rgions, th Eastrn rgion (17.1%) had th highst rat of any rgion, significantly highr than th Pidmont rgion (14.5%). Figur 2c. No Halth Insuranc, Unitd Stats, 2005 No Halth Insuranc Unitd Stats, 2005 District of Columbia (9.7%) Prcnt Alaska Hawaii Virgin Islands Purto Rico Sourc: BRFSS Numbr of Participating Stats: 53 Not to Scal (Including Purto Rico, Virgin Is. & D.C.) Unitd Stats North Carolina 19.1 N. C. Dpartmnt of Halth and Human Srvics 14

20 Tabl 2b. Halth Car Accss of N.C. Adults, 2005 No Currnt Halth Insuranc Dos Not Hav a Prsonal Doctor Could Not S a Doctor Du to Cost Total Total Total Rsp. N % 95% C.I. Rsp. N % 95% C.I. Rsp. N % 95% C.I. TOTAL COUNTIES/REGIONS Alamanc Buncomb Cabarrus Catawba Cumbrland Davidson Durham Forsyth Gaston Guilford Irdll Johnston Mcklnburg Nw Hanovr Onslow Orang Pitt Randolph Robson Rowan Union Wak Cartrt,Currituck,Cravn, Dar,Hyd,Pamlico Northast N.C. I Northast N.C. II Franklin,Nash,Wilson Duplin,Grn,Harntt,Jons, Lnoir,Sampson,Wayn Bladn,Brunswick,Columbus, Pndr Caswll,Granvill,Prson, Vanc Chatham,L,Moor Anson,Hok,Montgomry, Richmond,Scotland,Stanly Davi,Rockingham,Stoks, Surry,Yadkin Appalachian,Avry,Wilks Alxandr,Burk,Caldwll, Clvland,Lincoln MAHEC (xcluding Buncomb County) REGIONS Eastrn Pidmont Wstrn AHEC REGIONS Mountain Northwst Charlott Grnsboro Southrn Rgional Coastal Wak Ara L Eastrn N. C. Dpartmnt of Halth and Human Srvics 15

21 Physical Activity No lisur-tim physical activity in th past month Fmals (28.3%) wr significantly mor likly than mals (22.7%) to rport no lisur-tim activitis. Th risk of no lisur-tim activity dos not appar to b associatd with ag, particularly among youngr ag groups. Th highst rats wr found among rspondnts from th lowst lvls of houshold incom and ducation, and among Spanish-spaking Hispanics. Not gtting rcommndd physical activity Thr was littl chang in th 2005 statwid rat (57.9%) of not gtting th rcommndd physical activity and th comparabl rat rportd in 2001 (57.6%). About 80 prcnt of Spanish-spaking Hispanics rport not gtting th rcommndd amount of physical activity outsid of work (i.., modrat physical activity for 30 or mor minuts pr day for 5 or mor days pr wk, or vigorous activity for 20 or mor minuts pr day on 3 or mor days pr wk). No vigorous physical activity in th past month An stimatd 77.8 prcnt of North Carolina adults did not participat in vigorous physical activity. Among th ag group most apt to ngag in vigorous activity, narly two-thirds (64.5%) of 18 to 24 yar olds did not participat in any vigorous activity in th past month.. North Carolina Trnds Th six-yar trnds for no lisur tim activity show a modst dclin for th stat as a whol, and for non-hispanic African Amricans and whits (Figur 3a). By ag, th largst dclin in no lisur activity ovr th priod was vidnt among 55 to 64 yar olds (Figur 3b). Figur No 3a. Lisur No Lisur Activity by Activity Rac/Ethnicity: by Rac/Ethnicity: NC BRFSS N.C. BRFSS P r c n t NC Total NHP Whit NHP Black NHP Othr Hispanic NHP: non-hispanic *2002: initiatd Initiatd Spanish intrviws s Halthy Popl 2010 Objctiv: Rduc th proportion of adults who ngag in no lisur-tim physical activity to 20% (N.C.: 2001=26.4%; 2005=25.6%). N. C. Dpartmnt of Halth and Human Srvics 16

22 Figur No Figur 2b: Lisur No 3b. Halth Activity No Lisur Insuranc by Ag: Activity Covrag NC BRFSS by Ag: by Ag: N.C. N.C. BRFSS BRFSS P r c n t yrs yrs yrs yrs 65+ yrs Tabl 3a. Physical Activity of N.C. Adults, 2005 No Lisur-Tim Not Gtting Rcommndd No Vigorous Lisur-Tim Physical Activity Physical Activity Physical Activity Total Total Total Rsp. N % 95% C.I. Rsp. N % 95% C.I. Rsp. N % 95% C.I. TOTAL GENDER Mal Fmal RACE Whit African Amrican Asian Amrican Indian Othr Minoritis HISPANIC English Spaking Spanish Spaking Non-Hispanic AGE EDUCATION Lss Than H.S H.S. or G.E.D Som Post-H.S Collg Graduat HOUSEHOLD INCOME Lss than $15, $15,000-24, $25,000-34, $35,000-49, $50, HEALTH INSURANCE Ys No N. C. Dpartmnt of Halth and Human Srvics 17