Berrien County 2011 Behavioral Risk Factor Survey. A report on the status of health outcomes and their related behaviors in Berrien County

Transcription

1 2011 Behavioral Risk Factor Survey A report on the status of health outcomes and their related behaviors in

2 Acknowledgements Projects of this magnitude are only possible through the cooperative efforts of many individuals. We especially acknowledge the contributions of more than 1,000 residents of who gave up some of their time and a degree of their privacy to complete the interview being used here to assess the current state of health, access to care, and disease prevention in. The Health Department would like to thank the Board of Commissioners and the Board of Health for acknowledging the importance of collecting health data through the BRFS and providing the resources to complete this survey. We look forward to our continued partnership as we work to improve the health and lives of the residents of. We thank the Michigan Department of Community Health for making it possible for individual counties to piggy-back county-level supplemental samples onto the Michigan BRFS. In addition to the guidance and efforts provided by Michigan State University s Debra Rusz and Dr. Larry Hembroff, we are also appreciative of the Office of Survey Research and the interviewers who collected the survey data represented in this report. The assistance of all these individuals and organizations in making this study possible is gratefully acknowledged. Yasaman Back, MS Epidemiologist Health Department 2

3 Table of Contents Introduction... 4 Methods... 5 Self-Reported Health Status... 8 Quality of Life: Days of Poor Health... 9 Health Care Access Dental Care Mental Health Weight Status Diabetes Hypertension Cholesterol Cardiovascular Disease Physical Activity Fruit and Vegetable Consumption Breast Cancer Screening Cervical Cancer Screening Prostate Cancer Screening Colorectal Cancer Screening HIV Testing Influenza and Pneumonia Vaccinations Cigarette Smoking Alcohol Consumption Life Satisfaction and Support Level of Emotional Stress Disability Functional Limits, Arthritis, & COPD Asthma Aging & End of Life Summary

4 Introduction Background. The Behavioral Risk Factor Surveillance System (BRFSS) is an annual telephone survey conducted in all fifty states that is intended to monitor the health and associated behaviors of the adult American population with respect to national health objectives. It measures certain chronic diseases, behaviors associated with negative health outcomes, and screening rates, among other things. Nationally, the BRFSS is designed and coordinated by the U.S. Centers for Disease Control and Prevention (CDC), and every state conducts the survey annually. Smaller jurisdictions, such as counties, also have the option of conducting a Behavioral Risk Factor Survey (BRFS) at their desired frequency. Each survey includes a standardized core interview, but each jurisdiction is able to add questions of local interest. The use of the standardized core interview allows for comparisons at the national, state, and local level as well as providing scientific rigor to the survey by using validated questions. first conducted the BRFS in 2002 and again in 2005, 2008, and Having data spanning nine years and four points in time allows to begin tracking trends and to see longer-term impacts of health interventions. Purpose. The purpose of the Behavioral Risk Factor Survey in is to: 1. Collect data on chronic health conditions highly associated with behaviors including: Cardiovascular Disease Hypertension Diabetes High Cholesterol 2. Collect data on cancer screening rates for common cancers including: Breast Cancer Cervical Cancer Prostate Cancer Colorectal Cancer 3. Collect behavioral data as it relates to health including: Fruit and Vegetable Consumption Physical Activity Tobacco and Alcohol Use These data are used to track trends over time, make comparisons to other jurisdictions to rank our progress in addressing these common health concerns, and guide the public health efforts in. BRFS data can be used to evaluate county-wide initiatives and spur further investigation into health issues it identifies. It serves as a barometer for the overall health of the county as related to chronic conditions and behaviors. Most importantly, this data helps facilitate conversations between the Health Department, health care providers, community groups, elected officials, and citizens as we all work towards the goal of improving the wellbeing of residents. For this reason BRFS data serve as an important tool for strategic planning for the Health Department. 4

5 Methods Important Disclaimer for 2011 The BRFSS underwent methodological changes in Due to these changes, described below, the 2011 BRFS estimates should not be compared to BRFS estimates from previous years. Furthermore, these methodology changes may impact the magnitude of many of the BRFS estimates, and thus the 2011 estimates should be considered the new BRFSS baseline. These methodology changes will cause breaks in BRFSS trends, but will also greatly improve the accuracy, coverage, validity, and representativeness of the Behavioral Risk Factor Survey. For more information regarding these changes, please visit the following website: brfss.html The Sample. The sample for the 2011 BRFS was created using two methods. County residents were recruited for the BRFS, and this data was combined with data from Berrien County residents that were selected to participate in the 2011 Michigan Behavioral Risk Factor Survey (MiBRFS). The details of sample selection are as follows. MiBRFS is designed to be a representative cross-sectional telephone survey of English-speaking, non-institutionalized adults in Michigan. These individuals are found using random digit dial sampling procedures to ensure that all residents with a land-line telephone have a chance to be included in the study. In 2011, a total of 11,049 interviews were completed (including qualifying partial interviews) with randomly selected individuals18 years of age or older as a part of the MiBRFS sample. The 2011 MiBRFS produced 179 interviews with residents of. requested that an additional 875 interviews be completed within the county with an over-sampling of African Americans beyond what would be expected in the MiBRFS sample. Ultimately, Michigan State University s Office of Survey Research (OSR) completed 875 interviews for as a supplement to the 179 interviews completed in the MiBRFS from within the county for a total of The overall sampling design for this survey was a disproportionate stratified, list-assisted random-digit dial sample. OSR obtained samples for MiBRFS from Genesys as a part of a contract between CDC and Genesys for BRFSS and it obtained the supplemental samples for the from Survey Sampling, Inc., using the same design specifications. OSR arranged for Genesys and Survey Sampling to cross-check the RDD sample of phone numbers against residential directory listings and to provide OSR with the names and addresses associated with the phone numbers in each replicate. OSR mailed advance notice letters to the address listed roughly one week prior to releasing the replicate for calling. 5

6 Methods (continued) The Sample (cont d). When an interviewer reached someone at a selected telephone number, she determined whether or not it was a qualifying household within the county. Then, within the household, one adult was selected randomly to be interviewed. The within household selection procedure OSR used for selecting respondents was a modified version of the Trohldahl-Carter procedure. This procedure asks the adult household informant how many adults (individuals 18 years of age or older) there are living in the household, and, then, how many of these are men. A random number-based algorithm then determined whether the person selected would be the oldest male, the youngest male, the oldest female, the youngest female, etc. This ensured that each adult household member had a chance of being selected. The Interview Instrument. The 2011 BRFS interview instrument included the core set of questions specified by CDC, a second set of questions added by MDCH for the Michigan survey, and a third set of questions of particular interest to. Since these county-requested questions were not in the Michigan BRFS interview, the numbers of respondents to the unique county-added items will be somewhat less than for the other survey questions. Interviewing Protocol. All interviewers were fully trained on telephone interviewing processes, techniques, and protocols. Data collection for this project occurred on a quarterly basis throughout the year. The calling period during each day was set from 8:30 A.M. until 9:30 P.M. Monday through Thursday, 8:30 A.M. until 7 P.M. on Friday, 10 A.M. until 6 P.M. on Saturday, and 12 noon until 9:30 P.M. on Sunday. OSR attempted to schedule interviewers so that approximately 30% of the calling took place during the weekdays daytime and 70% during the weekday evenings and on the weekends. OSR interviewers made a minimum of 15 call attempts to contact sample members if necessary. Call attempts were spread across time blocks of the day and days of the week, at least three of which took place on weekends. If contact was made within the first 15 call attempts, interviewers tried to confirm that they had reached the intended phone number and that it was an eligible household at the beginning of the contact. Once the household was enumerated and a respondent selected, OSR interviewers made up to 15 additional call attempts to contact the respondent to complete the interview unless the respondent or informant for the respondent refused. OSR attempted conversions with all households that initially refused except those where the initial refusal from the respondent or informant appeared to be absolute. Data and Processing. Over the course of the four quarters of 2011, OSR interviewers completed a total of 875 interviews for the Behavioral Risk Factor Survey, which then were supplemented by 179 interviews completed with county residents in the 2011 MiBRFS. 6

7 Methods (continued) Weighting marks the first year in which the Behavioral Risk Factor Survey System (BRFSS) collected data from both landline and cell phone respondents. The sample of landline telephone numbers were selected using a list-assisted, random-digit-dialed methodology with a disproportionate stratification based on phone bank density, listedness and population density of African American. The sample of cell phone numbers was randomly selected from dedicated cellular telephone banks sorted on the basis of area code and exchange within the State of Michigan. In 2011 a new weighting methodology known as iterative proportional fitting or raking, was implemented to allow for the incorporation of the cell phone data and to improve the accuracy of prevalence estimates based on MiBRFS data. This new weighting methodology adjusted for the distribution of respondents by telephone source (landline or cell phone), race/ethnicity, education level, marital status, age by gender, gender by race/ethnicity, age by race/ethnicity, and renter/owner status. The final working sample size was Data Analysis. SPSS was used to manage and transform the data and SAS 9.2 was used to analyze the data. All results presented in this report are based on the weighted sample. Throughout the analysis and the reporting, we endeavored to code, categorize, and report results consistently with the procedures adopted by the Michigan Department of Community Health in its reporting of the Michigan Behavioral Risk Factor Survey. This is intended to enable direct comparison of the prevalence rates and findings of the BRFS to those for the state as a whole. Specifically, this means that in calculating the percentages of individuals "at risk" because of a particular health behavior or condition, individuals who refused to answer a question or who responded that they did not know the answer were excluded from the computation of the percentage. This was also done for the responses to the demographic questions. That is, the percentages reported are based on the valid responses to the questions where "don't know" and "refused" are treated as invalid responses. Exceptions to this will be noted in the text and the tables. The percentages of respondents giving each of the answers or who fall into various response or risk categories are reported by categories of respondents based on sex, age, education, and income. The income categories represent that of the respondent s entire household, whereas each of the other variables refers to the characteristics of the respondent. In the breakdowns of results by race, only results for whites and African Americans are presented. There are too few non-white, non-african Americans in the sample to produce stable, reliable statistics for this segment of the county s population. Interpretation of Confidence s. confidence intervals for prevalence estimates were calculated using Microsoft Excel. If the confidence intervals for two estimates from different subpopulations did not overlap, they were considered to be statistically different. 7

8 Self-Reported Health Status Perceived Health Status Fair or Poor* Confidence % Michigan (2011) Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * The percentage of respondents who reported that their health, in general, was either fair or poor. Prior to the BRFSS methodology changes, the prevalence of fair or poor general health among adults was stable over time, but consistently higher than the statewide prevalence. The same trends still hold true in the 2011 Behavioral Risk Factor Survey. When asked to characterize their general health, less than half of adult residents of said their health was either excellent (9.5%) or very good (32.7%), and 36.7% said it was good, while 21.1% described their health as either fair (15.6%) or poor (5.47%). The proportion of adults who rated their health as only fair or poor was significantly higher than the 17.2% reported statewide among respondents in the 2011 Michigan Behavioral Risk Factory Survey. Generally, older respondents were more likely than their younger counterparts to judge their health as only fair or poor. Black respondents were significantly more likely than white respondents to rate their health as only fair or poor. This disparity may be explained in part by the higher rates of obesity, hypertension, and increased number of chronic conditions that were reported by Black respondents. Those who reported less education and lower income were more likely to report their health status as fair or poor. When compared to college graduates, high school graduates were five times more likely to rate their health as fair or poor. Similarly, those with an annual income less than $20,000 were nearly twice as likely to report fair or poor health than those with an annual income more than $50,000. Further analysis shows that individuals who rated their health as fair or poor were significantly more likely to be overweight or obese and to have diabetes, hypertension, or high cholesterol, compared to those who rated their health better. Additionally, those who rated their health as fair or poor were less likely to be physically active or have a diet rich in fruits and vegetables Self-Reported Health Status: Fair or Poor Michigan

9 Quality of Life: Number of Days of Poor Health Reported Fair/Poor Fair/Poor Health Health Status Status by Days of by Poor Days Physical of Poor Health Physical and and Days Mental of Poor Health Mental Health (within last 30 days) Days of Poor Physical Health Days of Poor Mental Health Poor Physical Health* Mean # of Days Poor Mental Health** Activities Limited*** Michigan (2011) Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * The mean # of days (in past 30 days) in which physical health, including illness and injury, was not good. ** The mean # of days (in past 30 days) in which mental health, including stress, depression, and emotions, was not good. *** The mean # of days (in past 30 days) in which poor physical or mental health kept the respondent from doing usual activities, such as self-care, work, or recreation. BRFS respondents were asked additional questions which were used to further assess an individual s healthrelated quality of life by their perceived mental and physical health status over a specified period of time. The questions covered the number of days in the past month of poor physical and mental health, and the number of days during which individuals were unable to perform their usual activities because of poor mental or physical health. The average number of days respondents said their physical health was not good in the past month was 5.1. The average number of days they reported that their mental health was not good was 3.5. And the average number of days they reported that they were limited in their usual daily activities because of physical of mental health was 4.1. These numbers are similar to those reported throughout the rest of the state (4.1 days of poor physical health, 4.1 days of poor mental health, and 2.9 days of activity limitations). The number of days of poor physical health varied across age categories, with those in the age group reporting the most days of poor physical health. The number of days of poor mental health decreased with increased age, as did the number of days of activity limitations due to poor mental or physical health. Males reported a higher number of days of poor physical health, compared to females. The prevalence of poor physical and mental health days and days of limited activities did not vary by race. Respondents with less education and income reported a higher number of days of poor physical health and days of limited activities due to poor physical or mental health. Research has shown that mental health is fundamentally interconnected with health outcomes. As days of poor physical health increased, so did the prevalence of reported fair or poor health, and poor mental health follows a similar pattern. This illustrates that both mental and physical health may be involved in perceived general health status. 0 0 Days 1-2 Days 3-5 Days 6-15 Days 16+ Days Number of Days Within Last Month 9

10 Healthcare Access No Healthcare No Healthcare No Personal Coverage* Access During Healthcare (Among Past 12 Months Provider** Year Olds) Due to Cost*** % Confidence % Confidence % Confidence Michigan (2011) NA NA NA NA NA NA Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * Among those aged 18-64, the percentage who reported having no healthcare coverage, including health insurance, prepaid plans such as HMOs, or government plans, such as Medicare. ** The percentage who reported that they did not have anyone that they thought of as their personal doctor or healthcare provider. *** The percentage who reported that, in the past 12 month, they could not see a doctor when they needed to due to the cost. 10

11 Healthcare Access There are three primary indicators of healthcare access. The most commonly discussed is healthcare coverage. Health insurance or other coverage enables individuals to seek potentially costly healthcare that they may not be able to afford otherwise. Second, having an established relationship with a healthcare provider is important for accessing healthcare as primary care physicians often act as a gateway to health services. The third indicator is whether or not cost (no insurance, high co-pays and deductibles) prevents a person from seeking care when needed, at least occasionally. Since virtually all adults aged 65 or older are covered under Medicare, it is more meaningful to determine what percentage of those 18 to 64 have no coverage. Overall, 16.6% of respondents in, years of age, said that they have no health care coverage. This rate is now similar to that of the State of Michigan (18.3%). Lack of healthcare coverage was most prevalent among the youngest and the oldest, and among those with less education and income. There were no significant differences in insurance coverage according to gender or race. Almost one out of six residents (16.6%) reported not having a personal healthcare provider. The lack of a personal provider was most pronounced in year olds, men, and Black respondents. Males were twice as likely than females to not have a personal provider. Black respondents were more likely than their White counterparts to not have a personal physician. Those with no health insurance were much less likely to have a personal healthcare provider. When asked about the underlying reason for lack of healthcare coverage, 12.5% of residents cited high cost of healthcare access. Cost and its role in access to healthcare seemed to disproportionately affect Black respondents. Black respondents were twice as likely to report high cost as the reason behind their lack of healthcare access compared to White respondents. Respondents who sought healthcare outside of were asked about the underlying reasons behind their decision to do so. Out of those who sought healthcare outside of, 19% cited perceived better care, 15% went out of county for a specialist, and 12% for a better location. Almost half of those who sought out of county healthcare cited another reason. Those who went out of county for perceived better care were much more likely to be male, White, and of higher income and education. Reason For Seeking Healthcare Outside of Perceived Better Care 45% 3% 6% 19% 15% 12% More Convenient Location No specialist in Closer Provider Didn't Accept Insurance Live Elsewhere Sometimes Other Reason 11

12 Dental Care No Dental Care Coverage* No Dental Visit in Past Year** % Confidence % Confidence % No Teeth Cleaning in Past Year*** Michigan (2010) NA Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * The percentage who reported having no dental coverage. **The percentage who reported that they had not visited a dentist or dental clinic for any reason in the previous year. *** The percentage who reported that they did not have their teeth cleaned by a dentist or dental hygienist in the previous year. Confidence In 2011, 42.8% of respondents reported that they did not have dental care coverage. Younger individuals were more likely to report not having dental coverage. Males were significantly more likely than females to report not having dental insurance. There were no significant differences in dental insurance coverage according to race. The prevalence of no dental coverage generally declined with increasing education and household income levels. An estimated 32.1% of Berrien County residents did not visit a dentist in the past year and 29.2% reported not having a teeth cleaning. Respondents in the 2011 Michigan Behavioral Risk Factor survey reported similar results: 27.5% did not visit a dentist and 29.2% did not have a dental cleaning within the past year. The likelihood of having a dental visit or a teeth cleaning within the past year did not differ significantly by gender. Black respondents were more likely than White respondents to report not having a dental visit or a teeth cleaning within the past year. Generally, the prevalence of no dental visit or dental teeth cleaning within the past year declined with increasing education and household income levels. Only half (49.7%) of people without dental insurance reported visiting a dentist in the past year, compared to 81.9% of those with dental insurance. Periodontal disease is associated with certain chronic conditions, such as diabetes, cardiovascular disease and stroke. In 2011, those who had diabetes were more likely to have not visited the dentist in the past year compared to those without diabetes (50.5% vs. 28.5%). Moreover, those who reported not having a dental cleaning within the last year were significantly more likely to rate their health as fair or poor compared to those who received a timely cleaning. 12

13 Mental Health Being Treated for Mental Health Condition* % Confidence Male Female White Black <High School High School Grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * The percentage of respondents who reported that they were currently taking medicine or receiving treatment from a doctor or other health professional for any type of mental health condition or emotional problem. Interviewers asked respondents if they were currently taking medicine or receiving treatment from a doctor or other health professional for any type of mental health condition or emotional problems. Among respondents, 10.3% said they were currently being treated for a mental health condition. This figure is likely an underestimate of the true burden of mental/ emotional health conditions in the population as not all individuals with these conditions receive treatment. An estimated 18% of residents reported ever being diagnosed with a depressive disorder; less than half (49.4%) of whom reported currently taking medication or receiving treatment for a mental health condition. Of those reporting 16 or more days of poor mental health per month, 35% indicated receiving treatment for a mental health condition; 27% of those reporting the same amount of poor physical health days indicated receiving treatment. Those experiencing only 1-2 days, and those reporting 16 or more days of poor physical or mental health, were more likely to be receiving treatment for a mental health condition. Days of Poor Physical Health Treatment for Mental Health Condition by Days of Received Poor Physical Treatment Health for and Mental Days Health of Poor Condition Mental Health (within last 30 days) Days of Poor Mental Health 0 Days 1-2 Days 3-5 Days 6-15 Days 16+ Days Number of Days Within Last Month There are a variety of factors that could explain why those reporting a moderate number of mental health days are receiving less mental health treatment. Barriers to accessing the appropriate level of treatments could be one issue. Another possible explanation may be that people with moderate mental illness may not seek care because their condition is not perceived as severe enough to demand professional care. Furthermore, the association between treatment for a mental health condition and days of poor mental health nearly mirrored the association between treatment for a mental condition and days of poor physical health, adding further evidence to the close association of mental and physical health. 13

14 Weight Status Not Overweight or Obese* Overweight** Obese*** % Confidence % Confidence % Confidence Michigan (2011) 34.6 NA - NA Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * The percentage or respondents whose BMI was less than ** The percentage of respondents whose BMI was greater than or equal to 25.0, but less than ***The percentage of respondents whose BMI was greater BMI Weight Category Not Overweight/ Obese Overweight Obese BMI= weight (lb)*703 BMI= height (in)^2 14

15 Weight Status The proportion of obese individuals has been slowly rising in. As of 2011, nearly 40% of the population was obese, while approximately one in three (31.1%) individuals were considered overweight. The prevalence of obesity in was higher than the rest of the state (39.9% vs. 31.1%). Weight status did not significantly differ by gender. However, females were four times more likely to be morbidly obese (BMI 40) than males. Black respondents were significantly more likely to be obese, when compared to White respondents. Black respondents were also three times more likely to be morbidly obese compared to White respondents. The decrease in obesity among individuals 75 years or older may be a sign of the increased mortality associated with being obese Overweight & Obese Berrien Michigan Prior to the BRFSS methodology changes, the prevalence of overweight or obese among Berrien County adults was slowly rising over time and was slightly higher than the statewide prevalence. In 2011, s rate of overweight and obese was slightly higher than of the state as a whole (71% vs. 66%). Overall, obesity affects s population across many different demographics and various levels of education and income, and is truly an equal opportunity health condition. Being overweight or obese is associated with a number of chronic health problems including cardiovascular disease, diabetes, hypertension, and cancer. The onset of the conditions often occurs after years of being overweight/obese which makes the prevalence of obesity and morbid obesity among year olds (34.9%) particularly alarming. Those in this age range are most often in the child-bearing years of their lives; not only can obesity have a detrimental effect on pregnancy outcomes, but it can also set the grounds for unhealthy eating behaviors and lifestyle choices that may negatively impact the health of their families in the future. The graph below indicates the prevalence of five chronic conditions (hypertension, diabetes, high cholesterol, heart attack, stroke) measured by BMI category. Obese individuals were twice as likely to report suffering from three or more chronic health conditions, compared to those who were not overweight or obese (43% vs. 19%). Compared to overweight individuals, obese individuals were also significantly more likely to report suffering from three or more chronic health conditions (43% vs. 28%). Number of Chronic Conditions Weight Status by Number of Chronic Conditions by Weight Status Not Overweight or Obese Overweight Obese 15

16 Diabetes Ever Told Have Diabetes* % Confidence Michigan (2011) Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * The percentage who responded yes to the question, Have you ever been told by a doctor, nurse or other health professional that you have diabetes? This does not included pre-diabetes and women told they have diabetes only during pregnancy Diagnosed with Diabetes Among all respondents, 14.5% said they have been told by a doctor that they have diabetes. This excludes those women who were only told they have pregnancy-induced diabetes. The Diabetes prevalence in was higher than the 10% rate of Diabetes reported statewide by the 2011 Michigan BRFS. The likelihood of being diagnosed with diabetes increased with age, especially for those beyond 55 years of age. There were no significant differences between males and females or between White and Black respondents. Respondents with less than a high school education were twice as likely to report having been diagnosed with diabetes than college graduates. In general, the prevalence of diabetes increased as education and income decreased. Of those told they have diabetes, 30% were first told they have the disease before age 40, while 76.8% were told after the age of 60. The average age at which individuals were told they have diabetes was 50 years old. One in five individuals with diabetes reported seeing a doctor for their diabetes at least once in the past twelve months. Overall, 15% of respondents reported not visiting a health professional for their diabetes in the past twelve months. Males were significantly more likely than females to have had a doctor s visit regarding their diabetes. Approximately two-thirds (67%) of Black respondents reported taking a course on managing their diabetes, compared to 57% of White respondents. Compared to males, females were significantly more likely to report taking a diabetes management course. Diabetes is often developed over time and can be worsened by poor lifestyle conditions. Those who were overweight were more than twice as likely as those who were not overweight to report that they had diabetes (12.3% vs. 5.3%). Individuals who were obese were five times more likely than those not overweight to have been told they have diabetes (23.5% vs. 5.3%). Respondents with diabetes were significantly more likely to report not having any leisure-time physical activity, when compared to those without diabetes Not Overweight Overweight Obese 16

17 Hypertension % Confidence % Confidence Michigan (2011) Male Female White Black <High School High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * The percentage who responded yes to the question, Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure? ** The percentage of those who responded yes to having ever been told they have high blood pressure (excluding those who only had this during pregnancy), who responded yes to the question Are you currently taking medicine for your high blood pressure" Ever Told Have Hypertension* Hypertension and Physical Inactivity Hypertension No Leisure-Time Physical Activity Taking Medication (if have)** 23.4 No Hypertension High blood pressure, or hypertension, is an important risk factor for cardiovascular health problems. Over time, hypertension can lead to significant morbidity and mortality due to stroke, kidney failure, and heart and blood vessel disease. More than one third (35.8%) of BRFS respondents reported being told they have hypertension, and 81% of these reported that they were currently taking medications to control their blood pressure. These rates are similar to those reported in the 2011 Michigan BRFS, which found a Hypertension rate of 34.2% for Michigan residents; 76.5% of whom reported taking medication for their high blood pressure. Generally, the risk of developing hypertension increased with age. The prevalence of hypertension increased as education and income decreased. Those in the lowest income category were much more likely to have hypertension, compared to those in the highest. Black respondents were significantly more likely to report having been diagnosed with Hypertension, compared to White respondents (46.3% vs. 34.1%). Black respondents were significantly less likely to report taking medications to control their blood pressure, compared to White respondents (84.2% vs. 69.9%). The prevalence of high blood pressure and the percentage taking medication to control their hypertension were similar between and the rest of the state. Eight out of ten (81%) respondents reported taking medication for their high blood pressure, which is the most effective fast-acting treatment. Fruit and vegetable consumption was relatively equal between hypertensive and non-hypertensive respondents. However, those who reported having hypertension were more likely to lead lifestyles without any leisure-time physical activity (42.2% vs. 23.4%), and they were also significantly more likely to be obese.(53.1% vs. 32.6%). 17

18 Cholesterol Ever Had Checked* Told High (If Ever Checked)** % Confidence % Confidence Michigan (2011) Male Female White Black <High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, ** The percentage who said yes to the question, Have you ever had your blood cholesterol checked?" ** The percentage who said yes to the question, Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high?". High cholesterol can be associated with other health issues and lifestyle factors. Overall, 83.4% of respondents in indicated that they had ever had their cholesterol checked. This figure is similar to that reported by Michigan BRFS (81.1%). Both the percentage of respondents who have had their cholesterol checked and the percentage who have been told their cholesterol is high generally increased with age. Cholesterol testing did not vary significantly by gender or education level. However, those with an annual income above $35,000 a year were most likely to report ever having their cholesterol checked. Of those who had their cholesterol tested, about half (49.8%) were told that their cholesterol was high (hypercholesterolemia). This figure is significantly higher than the State of Michigan (41.8%). Black respondents were less likely to report having had their cholesterol checked than White respondents, but their likelihood of being diagnosed with high cholesterol was not significantly different. Compared to females, males were significantly more likely to report having high cholesterol (56.1% vs. 44.5%). Those with health insurance were more likely to have their cholesterol checked compared to those without health insurance (85.4% vs. 68.7%). Those with a personal healthcare provider were nearly twice as likely to have their cholesterol checked, compared to those without a personal provider (90.9% vs. 45.3%). Those who were overweight or obese were much more likely to report having high cholesterol. Those who did not report any leisure-time physical activity were significantly more likely to report having high cholesterol, compared to those who took part in leisure-time physical activity (68.5% vs. 42.2%). Respondents with hypercholesterolemia were significantly more likely to report that they sometimes, usually, or always worry about being able to afford nutritious foods (25.4% for those with high cholesterol and 16.4% for those without high cholesterol). 18

19 Cardiovascular Disease Cardiovascular Disease Among Adults 35 Years of or Older Ever Told Angina Ever Told Heart Attack* or Coronary Heart Disease** Ever Told Stroke*** % Confidence % Confidence % Confidence Michigan (2011) Male Female White Black <High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * The percentage who reported having been told by a doctor that they had a heart attack. ** The percentage who reported having been told by a doctor that they had angina or coronary heart disease (CHD). *** The percentage who reported having been told by a doctor that they had a stroke Coronary Heart Disease, Hypertension, and High Cholesterol 65.7 Hypertension 77.2 Have Coronary Heart Disease High Cholesterol Do Not Have Coronary Heart Disease Among those 35 or older in Berrien County, 6.3% reported ever having a heart attack, 7.2% had been told they have angina or coronary heart disease, and 4.8% reported history of a stroke. When compared to the rest of the state, had similar percentages of heart attacks and strokes. However, Berrien County s prevalence of coronary heart disease was higher than the state s prevalence (7.2% vs. 5.0%). The percentage of individuals who have ever had any of the three types of cardiovascular problems generally increased with age, especially after age 55. The percentage of individuals who had ever had a heart attack, angina, or stroke was greater among those with lower income and education. Individuals who were obese were more likely to report having had a heart attack compared to those with lower BMIs. Cardiovascular disease is often associated with other health problems or lifestyle factors. Respondents with coronary heart disease reported substantially higher rates of hypertension and high cholesterol. Respondents who reported eating more fruits and vegetables were much less likely to report having had a heart attack, coronary heart disease, or stroke. Those who reported having no leisure-time physical activity were significantly more likely to report heart attacks, coronary heart disease, or strokes. 19

20 Physical Activity No Leisure Time Physical Activity* % Confidence Michigan (2011) Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * Among all adults, the proportion who reported not participating in any leisure-time physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise during the past month. Interviewers asked all respondents if, other than their regular job, they had participated in any physical activities or exercises in the past month, such as running, calisthenics, golf, gardening, or walking for exercise. Nearly one-third (30.2%) of Berrien County BRFS respondents said that they did not partake in any leisure-time physical activity. The percentage of respondents who reported no physical activity was significantly higher for than the State of Michigan (23.6%). Generally, physical inactivity increased with age. Those with less than a high school education were more likely to be inactive compared to their counterparts. Those with incomes greater than $75,000 were least likely to be inactive. Those classified as obese were about twice as likely to be physically inactive (40.7%) as those who were those classified as overweight (20.4%) and those classified as not overweight or obese (25.3%). Numerous studies have shown the health benefits of even moderate physical activity, particularly in reducing the risk of cardiovascular health problems. Research indicates that the risks of such problems are appreciably greater for those who lead sedentary lifestyles, compared to those who engage in physical activity. Those who reported having no leisure-time physical activity were significantly more likely to report heart attacks, coronary heart disease, and strokes Physical Activity and Cardiovascular Disease Heart Attack Angina/Coronary Heart Disease Stroke Leisure-Time Physical Activity No Leisure-Time Physical Activity 20

21 Physical Activity Adequate Aerobic Physical Activity ( 150 min/week) Adequate Muscle Strengthening Activity ( 150 min/week) Overall Adequate Physical Activity ( 150 min/week) % Confidence % Confidence % Confidence Michigan (2011) Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * Among all adults, the proportion who reported that they do either moderate physical activities for at least 150 minutes per week, vigorous activities for at least 75 minutes per week, or an equivalent combination of mederate and vigorous physical activities. ** The proportion who reported that they do muscle strengthening activities on two or more days per week. *** The proportion who reported that they do either moderate physical activities for 75 minutes per week, or an equivalent combination of moderate and vigorous activities and also participate in muscle strengthening activities on two or more days per week. In 2008, The U.S. Department of Health and Human Services released the new physical activity guidelines for Americans. To assess the physical activity level of residents, BRFS interviewers asked respondents about the frequency and length of aerobic physical activity and muscle strengthening activities. Performing 150 or more minutes per week of each of these activities was considered adequate for that type of activity. An overall Adequate Physical Activity measure was then calc ulated by the summation of adequate aerobic and muscle strengthening activities. An estimated 45.1% of BRFS respondents met the adequate aerobic physical activity requirements. One in five (20.8%) residents met adequate muscle strengthening activity requirements. Only 16.1% of Berrien County BRFS respondents met the requirements for overall adequate physical activity. This rate was significantly lower than the rest of the state (19.7%). Overall, lagged behind the State of Michigan in measures of adequate aerobic, muscle strengthening, and overall adequate amount of physical activity. Compared to males, females were more likely to meet adequate muscle strengthening activities and significantly more likely to meet the level for overall adequate physical activity. 21

22 Fruit and Vegetable Consumption Daily Fruit and Vegetable Consumption Mean Daily Intake* Median Daily Intake** 5 Times / Day*** Confidence Confidence % % % Confidence Michigan (2011) NA NA Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, *Among adults, the mean number of times per day during the past 30 days in which fruit (100% pure fruit juices or fresh, frozen, or canned fruit) or vegetables (cooked or canned beans, dark green vegetables, or other vegetables) were consumed. ** Among adults, the median number of times per day during the past 30 days in which fruit (100% pure fruit juices or fresh, frozen, or canned fruit) or vegetables (cooked or canned beans, dark green vegetables, or other vegetables) were consumed. ***Among adults, the proportion whose total reported consumption of fruits (including juice) and vegetables was five or more times per day. 22

23 Fruit and Vegetable Consumption A healthy diet rich in fruits and vegetables may reduce the risk of cancer and other chronic conditions. Adequate fruit and vegetable consumption is defined as consuming fruits (including 100% fruit juice, and fresh, frozen, and canned fruit) and vegetables (including cooked or canned beans, dark green vegetables, orange-colored vegetables, and other vegetables) on an average of five or more times per day. In 2011, residents reported consuming an average of 3.2 daily fruits or vegetables, but only 17.1% met the recommended intake of five fruits and vegetables per day. The rate of respondents meeting the recommended amount of fruits and vegetables per day is about the same as the 17.8% reported by the State of Michigan. While s rate of adequate fruit and vegetable consumption was similar to the rest of the state, it s important to note that nearly 83% of adults missed the mark on this important health measure. Adults tended to consume less fruits and vegetables than adults 35 and older. Females were significantly more likely to eat the recommended five or more fruits and vegetables per day, compared to males (20.8% vs. 12.7%). White respondents were more likely to eat the recommended amount of fruits and vegetables per day, compared to Black respondents (16.9% vs. 11.4%). Those with the lowest education levels and the lowest household incomes consumed the fewest servings of fruits and vegetables. The mean number of daily fruits and veggies consumed increased with education and income. Respondents who consumed the recommended five or more fruits and vegetables per day were less likely to report having high blood pressure. Nearly eight out of every ten (82.9%) respondents reported eating less than the recommended five fruits and vegetables each day, regardless of their BMI. Obese respondents indicated eating fewer than the recommended amount of fruits and vegetables per day compared to overweight and healthy weight individuals. The prevalence of eating fewer than five servings of fruits and vegetables is similar regardless of BMI or a respondent s indication of trying to reduce calorie and fat intake. However, compared to overweight individuals attempting to lose weight, obese individuals attempting to do so were twice as likely to report sometimes or always worrying about money for nutritious meals. Compared to those who consumed the recommended five or more fruits and veggies per day, those who didn t were significantly more likely to report always or usually worrying about affording nutritious foods. Despite living in a county that produces a large variety of crops, residents are falling well short of eating the recommended five fruit and vegetables per day. Lack of access to affordable and healthy fresh foods is likely underlying many residents eating habits. Increasing access to locally grown produce will benefit both the health and economic vitality of our communities. 23

24 Breast Cancer Screening Breast Cancer Screening Among Women 40 Years of or Older Had Clinical Ever Had a Had Mammogram Breast Exam and Mammogram* in Past Year** Mammogram in Past Year*** % Confidence % Confidence % Confidence Michigan (2012) White Black <High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, *The percentage of females who indicated ever having a mammogram. **The percentage of females who reported having a mammogram within the past year. *** The percentage of women who reported having both a mammogram and a clinical breast exam within the past year. was not a factor in breast cancer screening status. and income were not significantly associated with having ever had a mammogram; but women with higher education and income were more likely to have had one in the past year. Women who had health insurance were much more likely to have ever have a mammogram and to have had the test within the past year, compared to their counterparts. Respondents with personal healthcare providers were significantly more likely to ever have a mammogram on time, compared those without personal health care providers. Compared to their counterparts, women who ate the recommended five fruits and vegetables a day were significantly more likely to ever have a mammogram that was within the past year; this suggest that a generally healthy lifestyle may be associated with breast health awareness Mammograms are an important screening tool for detecting breast cancer. They are recommended annually for all women 40 and older. Overall, 92.0% of the female respondents 40 or older in Berrien County indicated that they had had at least one mammogram and nearly seven out of ten (68.2%) indicated they had had a mammogram within the past year. led the State of Michigan in rates of women who had a mammogram in the past year (68.2% vs. 59.2%) and women who and a clinical breast exam and mammogram within the past year (64.8% vs. 50.4%). The prevalence of ever having a mammogram was similar for and the State of Michigan. Women in their 40's were less likely than older women to have ever had a mammogram. Access to Healthcare and Mammogram Status in Women 40 Years of or Older Ever Had Mammogram 71.0 Have Health Insurance Do Not Have Health Insurance Had Mammogram in Past Year Have a Primary Healthcare Provider 10.8 No Primary Healthcare Provider 24

25 Cervical Cancer Screening Cervical Cancer Screening Among Women 18 Years of or Older Ever Had a Pap Test* % Confidence % Confidence Michigan (2012) White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * The percentage of females who indicated ever having a Pap test. Had Pap Test Within Past 3 Years** ** The percentage of females who reported having a Pap test within the past 3 years. Respondents with a personal a healthcare provider were not any more likely than those without to report ever receiving a pap test. However, those with a personal provider were significantly more likely to receive a pap test within the past three years. It should be noted that this report used the least restrictive recommendation of appropriate timing of pap tests based on recommendations that testing should occur at three-year intervals Cervical cancer is quite treatable if caught in its early stages. Pap tests screen women for cancerous or precancerous cervical cells and play an important role in women s reproductive health. Recommendations on the frequency of receiving a Pap test range from one to three years. Interviewers asked all female respondents how long it had been since their last Pap test. Among all women, 18 years of age or older, 99.2% reported that they had ever received this screening; a rate that is significantly higher than the rest of the State (92.1%). Excluding w o m e n w h o h a v e h a d a hysterectomy, nearly three in four women (74.4%) claimed to have had the test within the past three years. This prevalence was not significantly different than the 79.4% reported by the Michigan BRFS. Women with greater incomes were more likely than their counterparts to have had a Pap test in the past three years. White females were more likely to report ever having a pap. However, Black females were more likely than white females to report having had a Pap test within the past three years. Pap Test Within Recommended Timeframe * by, in Women 40 Years of or Older White 71.9 Black 89.0 *Had Pap Test in Past Three Years 25

26 Prostate Cancer Screening Prostate Cancer Screening Among Men 50 Years and Older Ever Had DRE* Had DRE in Past Year** Ever Had PSA Test*** Had PSA Test in Past Year**** % Confidence % Confidence % Confidence % Confidence Michigan (2012) NA NA NA White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, *The percentage of men 50 years old or older who reported ever having a digital rectal exam (DRE). **The percentage of men 50 years old or older who reported having a digital rectal exam (DRE) in the past year. ***The percentage of men 50 years of age or older who reported ever having a prostate-specific antigen (PSA) test. ****The percentage of men 50 years of age or older who reported having a prostate-specific antigen (PSA) test within the past year. Prostate cancer is the most common form of cancer among men in. The two most common screening tests to detect prostate problems are the digital rectal exam (DRE) and the Prostate-Specific Antigen test (PSA). The DRE is recommended to begin at age 50. The value of the PSA test has currently become controversial and some authoritative groups, including the National Institute of Health (NIH), do not recommend it as a general screening tool. Overall, 92.1% of men over 50 years of age reported having ever had at least one digital rectal exam. Of these men, over half (56.7%) reported having the exam within the past year. Eight out of ten (81.5%) men above the age of 50 reported having ever had a PSA test. Of these, 78.1% had a PSA test in the past year. The prevalence of ever having a PSA test is higher in compared to the rest of the state (81.5% vs. 72.2%). As age increased, men were more likely to have a DRE or a PSA test. Respondents with health insurance were nearly twice as likely to report ever having a DRE exam, compared to those without health insurance (83.1% vs. 33.7%). They were also more likely to have had their DRE exam on time (within the past year). Those with a personal healthcare provider were much more likely to report ever having a DRE exam, compared to respondents without personal providers (85.5% vs. 24.7%). However, they were equally likely to report having their DRE exam within the past year. Respondents who reported participating in leisure-time physical activity and those who reported eating the recommended amount of fruits and vegetables per day were significantly more likely to report ever having a DRE exam, compared to their counterparts; suggesting that a generally healthy lifestyle or concern about one s health may be associated with prostate health awareness. 26

27 Colorectal Cancer Screening Colorectal Cancer Screening Among Men and Women 50 Years and Older Had Blood Stool Test Within Past Ever Had Blood Ever Had Stool Test* Two Years** Colonoscopy*** % Confidence % Confidence % Confidence % Years**** Confidence Michigan (2012) NA NA NA Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, *The percentage of respondents 50 years old or older who reported ever having a blood stool test using a home kit. **The percentage of respondents 50 years old or older who reported having a blood stool test within the past 2 years. ***The percentage of respondents 50 years of age or older who reported ever having a colonoscopy. Had Colonoscopy in Past Ten ****The percentage of respondents 50 years of age or older who reported having a colonoscopy within the past 10 years. It is recommended that adults begin having regular colonoscopies and fecal occult blood tests to check for colorectal cancers at age 50. Among all respondents 50 years old or older, 44.2% said that they had ever had a blood stool test; over half of which claimed to have had the procedure within the last two years. This prevalence was similar to the statewide rate. Approximately one third (35.4%) of the respondents 50 years old or older said they have had at least one colonoscopy; 93.2% of these respondents said they last had the procedure within the past ten years. Generally, the likelihood of having either a blood stool test or a colonoscopy increased with age. Respondents who were 70 years of age or older were much more likely to have had a blood stool test or a colonoscopy compared to those younger than 50. There were no significant gender, education, or income trends in receiving these tests. Respondents with health insurance and personal health care providers were significantly more likely to report having a colonoscopy and having had the procedure within the last ten years. Obese respondents were significantly more likely to report ever having a colonoscopy, compared to healthy weight respondents (71% vs. 61%). Respondents who reported eating the recommended five or more fruits and vegetables per day were significantly more likely to report ever having a colonoscopy compared to their counterparts. This may suggest that these individuals have generally healthy lifestyle habits, or that they may be more concerned with their colorectal health. 27

28 HIV Testing HIV Testing Among Adults Years Old 61.0% When Last Tested for HIV? 11% 10% 18.0% Ever Tested for HIV* % Confidence Michigan (2011) Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, *The percentage of respondents years of age who reported that they had ever been tested for HIV, not counting tests that were a part of a blood donation. Within Past Year Within Past 2 Years (1 year, but less than 2 years ago) Within Past 5 Years (2 years but less than 5 years ago) 5 or More Years Ago has one of the highest rates of HIV/AIDS infections in the state. Black females make up the largest group of infected individuals. Nearly all the cases have resulted from sexual behaviors, the majority of which are heterosexual encounters. An important aspect of reducing transmission is for individuals to be periodically tested for HIV infection. All respondents under age 65 were asked if they had ever been tested for HIV (excluding tests that may have been conducted as a part of blood donation). Among respondents in this age group, 49.7% indicated that they have been tested. This is significantly higher than the rest of the state. Respondents 25 to 34 years old were most likely to report having ever been tested for HIV. Females and males reported being tested at similar rates. Black respondents were significantly more likely to report having ever been tested than white respondents. Those with less than a high school education and those with incomes below $20,000 were much more likely than their counterparts to report having ever been tested. Having a personal healthcare provider or health care insurance did not have a significant effect on HIV testing. Whether tested or not, 2.7% reported having been tested for HIV because one or more of the following risk factors applied to them: Intravenous drug use in past year. Treated for an STD in past year. Given or received money or drugs in exchange for sex in past year. Had anal sex without a condom in past year. BRFS respondents were asked about the timeframe during which they had their last HIV test. One in ten (11%) reported having their last HIV test within the past year. Another 10% of respondents said that their last HIV test was longer than one year, but less than two years ago, and 18% reported their last test was longer than two, but less than five years ago. The majority of respondents (61%) said that they were last tested for HIV five or more years ago. When asked about knowledge of HIV/AIDS counseling services at Health Department, 17.8% reported knowing a lot, 32.6% knew some, and 50.6% did not know about the services. 28

29 % Confidence % Michigan (2011) Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * The percentage of respondents 65 or older who reported that they had a flu vaccine, either by injection in the arm or sprayed in the nose during the past 12 months. ** The percentage of respondents 65 or older who reported that they ever had a pneumococcal vaccine. Immunizations Among Adults 65 Years Old or Older Ever Had Had Flu Vaccine in Pneumonia Past Year* Vaccine** Access to Primary Healthcare Provider and Percent of Adults (65+ yrs old) Who Received a Flu or Pneumonia Vaccine Influenza and Pneumonia Vaccinations 18.0 Confidence 31.4 Have a Primary Healthcare Provider No Primary Healthcare Provider Received the Flu Vaccine Within Past Year Ever Received the Pneumonia Vaccine Interviewers asked all respondents if they had an influenza vaccine or the flu vaccine nasal spray in the past twelve months. Overall, 42.2% of all respondents said they had received the flu vaccine in the past year, but among those 65 or older, 60.5% said they had. This is the same as seen throughout the rest of the state in adults 65 or older. Among respondents 65 or older: Males and females were equally likely to have received an influenza vaccine. Black respondents were significantly less likely than white respondents to have been vaccinated for the flu. Influenza vaccination rates increased with increased education and income. Among those under age 65, only 35.8% reported having received a flu vaccine, even though it is recommended that everyone above six years of age receive the vaccine. Interviewers also asked all respondents if they had ever had a pneumonia vaccine. This shot is usually given only once or twice in a person s lifetime. Overall, 35.8% of all respondents reported that they had ever received a pneumococcal vaccine. Among those 65 or older, the percentage who reported having had a pneumococcal vaccine was 66.5%, which is similar to the rest of the state. Among those under age 65, only 23.3% reported having received a pneumonia vaccination. L ik e l i hood of p neumococcal vaccination did not differ by race or gender. Among those under age 65, only 23.3% reported having received a pneumonia vaccine. Finally, adults (65+ years of age) who had a primary healthcare provider were significantly more likely to report receiving the influenza or pneumococcal vaccination within the past year. 29

30 Cigarette Smoking Current Smoker* Former Smoker** Never Smoked % Confidence % Confidence % Confidence % Michigan (2011) Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * The percentage of respondents who reported they smoked at least 100 cigarettes in their life, and currently smoke every day or some days. ** The percentage of respondents who reported they smoked at least 100 cigarettes in their life, but do not smoke now. Tried to Quit Smoking One Day or Longer in Past Year *** Confidence *** Among current smokers, the proportion who reported that during the past 12 months they had tried to quit smoking for one day or longer. Cigarette smoking has been causally linked to many cancers (especially lung cancer), heart disease, respiratory problems, and various other health issues. In fact, cigarette smoking is the leading cause of preventable death in the United States. Just as continued smoking increases individuals' risks of experiencing one or more of these health problems, quitting smoking reduces the risks. Overall, 21.8% of Berrien County adults are current smokers, 27.9% are former smokers, and 50.1% have never smoked. Over half of adults who were smokers reported that they tried to quit smoking at least one day or longer in the past year. s rates of all of these cigarette smoking factors were comparable to those reported by the state in the 2011 MiBRFS. The percentage of adults who never smoked was highest among adults under 35, especially for those under 25. This is a particularly noteworthy since few individuals start smoking after age 21. There were no significant differences in smoking status between males and females regarding current smoking, but females were more likely to have never smoked. Black respondents were significantly more likely to report being a current smoker. In addition, White respondents were significantly more likely to report being former smokers. Those with a college education were much less likely to be current smokers and more likely to have never smoked compared to those with less than a college education. Generally, rates of current smoking decreased as income increased. Current smokers were significantly more likely to report not having health insurance or a personal health care provider, when compared to respondents who never smoked. Compared to those current smokers, those who never smoked were significantly more likely to eat the recommended five or more fruits and vegetables per day. This may suggest that those who choose to never smoke are also more likely to make other healthy lifestyle decisions such as eating a healthy diet. 30

31 Alcohol Consumption Non-Drinker* Alcohol Consumption Light/Moderate Drinker** Heavy Drinker*** % Confidence % Confidence % Confidence % Binge Drinker**** Confidence Michigan (2011) NA NA NA Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * The percentage of respondents who reported consuming no alchohol in the previous month. ** The percentage of respondents who reported drinking some alcohol but less than 2 drinks per day for men and less than 1 drink per day for women. *** The percentage of respondents who reported drinking 2 or more alcoholic drinks per day for men and more than 1 drink per day for women for the previous month. **** The percentage of respondents who reported drinking 5 or more alcoholic drinks per occasion (for men) or 4 or more drinks per occasion (for women) at least once in the previous month. Alcohol abuse has been associated with serious health problems such as high blood pressure, stroke, cirrhosis of the liver, and some types of cancer. Almost half (48.1%) of Berrien County respondents reported consuming at least some alcohol in the month prior to the interview. There were no significant differences among gender or race for non-drinkers and those reporting light/ moderate drinking. Black respondents were twice as likely as White respondents to report being a heavy drinker. Overall, 15.7% of adults were binge drinkers; a figure lower than the rest of the state. Males were twice as likely to report binge drinking, compared to females. Generally, rates of binge drinking increased with increased education and income. Binge drinkers were twice as likely to not have health insurance, compared to non binge drinkers (21.2% vs. 10.8%). They were also significantly more likely to lack a personal healthcare provider (35.1% vs. 15.3%). Compared to non binge drinkers, binge drinkers were less likely to eat the recommended five or more fruits and vegetables per day (92.4% vs. 81.0%). They were also twice as likely to report that they always or usually worry about affording nutritious foods (17.7% vs. 7.0%). Binge drinkers were more likely to report a lack of leisure-time physical activity, when compared to non binge drinkers (38.6% vs. 28.5%), and they were also more likely to have high cholesterol (54.8% vs. 49.2%) Binge Drinking by Male Female 31

32 Life Satisfaction and Support Dissatisfied or Very Dissatisfied with Life Rarely or Never Receive Social and Emotional Support That is Needed % Confidence % Confidence Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * The percentage or respondents who reported they were dissatisfied or very dissatisfied with life. **The percentage of respondents who reported that they rarely or never receive the social and emotional support they need. Interviewers asked all respondents how satisfied they are generally with their lives. 92% of respondents said they were satisfied or very satisfied with their lives. However 7.9% of respondents indicated that they were either dissatisfied or very dissatisfied with life. Respondents who reported having some college education and those in the 35 to 44 age group were most likely to be dissatisfied with life. Males were twice as likely to be dissatisfied with life, compared to females (10.7% vs. 5.3%). Those with annual incomes between $35,000 to $49,999 and greater than $75,000 were much less likely to report being dissatisfied with life. Overall, 10.5% of respondents reported rarely or never receiving necessary emotional support. Respondents in between the ages of and those older than 75 were most likely to report rarely or never receiving social and emotional support that was needed. Generally, respondents with higher incomes were less likely to a lack in social or emotional support. Those who reported being more satisfied with life were significantly more likely to report getting the support they need. Of those who said they were very satisfied with life, 92% said they sometimes, usually, or always get the support they need. Respondents who were not receiving the social/ emotional support they needed were three times more likely to report their health as fair or poor compared to those who received the support they needed. Compared to their counterparts, those who reported not receiving the necessary amount of social and emotional support were significantly more likely to have high blood pressure (42% vs. 32%) and high cholesterol (55.2% and 48%). Respondents who reported that they rarely or never received the social and emotional support they needed were more likely to not have health insurance or a primary healthcare provider. Respondents who lacked support were less likely to eat the daily recommended amount of fruits and veggies and significantly more likely to report always or usually worrying about being able to afford nutritious foods. This disparity may be a reflection of the effects of income and education levels. However, it can also suggest that emotional and social support may be an important part of a healthy diet and lifestyle Social Support, Fruit and Vegetable Consumption, and Affording Nutritious Foods Rarely or Never Receive Social Social/Emotional Support Receive Adequate Social/Emotional Support Do Not Eat Recommended 5+ Fruits/Veggies per Day Always/Usually Worry About Affording Nutritious Foods 32

33 Level of Emotional Stress Level of Emotional Stress* Slight Emotional Stress in Average Moderate Emotional Stress in Average Severe Emotional Stress in Average No Emotional Stress in Average Month Month Month Month Confidence Confidence Confidence Confidence % % % % Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, *Level of emotional stress was calculated by consideration of 6 emotional stress indicators: nervousness, hopelessness, restlessness, worthlessness, depression, and everything feeling like an effort. The indicators were ranked on a scale and modified into categorical variables. The indicators were then summed and ranked on a scale in which 0 emotional indicators= None, 1 emotional indicator= Slight, 2-3 indicators= Moderate, and 4-6 indicators= Severe. Emotional stress is an important factor in overall mental and physical health. BRFS respondents were asked several questions to gauge their level of emotional stress. Males were more likely to be moderately stressed than females. Respondents with less income and education were more likely to report severe emotional stress. In fact, those with annual incomes less than $20,000 were nearly seven times more likely to report having severe emotional stress, compared to those who reported annual incomes above $75,000. Individuals who reported having severe emotional stress in an average month had much higher rates of depression and treatment of a mental health condition than those who reported having slight or no emotional stress in an average month. They were also significantly more likely to rate their general health as fair or poor (58.1% vs. 14.7%). Compared to those who reported no emotional stress, respondents with severe emotional stress were significantly more likely to be obese (66.8% vs. 34.2%) and to have high blood pressure (75.4% vs. 32.8%). When compared to individuals with no emotional stress, those with severe emotional stress were significantly more likely to have report eating less than the recommended five or more fruits and vegetables per day and having no leisure-time physical activity. A healthy diet and physical activity tend to be associated with improved mental health, but it is difficult to tease out whether diet and activity are contributing to the emotional stress, if the emotional stress is contributing to poor diet and low activity, or if there is other confounding variables such as income and education. 33

34 Disability Have Some % Use Special Disability* Equipment** % Confidence % Confidence Michigan (2011) Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * The percentage of respondents who reported being limited in any activities because of physical, mental, or emotional problems. ** The percentage of respondents who reported that they required use of special equipment (such as a cane, a wheelchair, a special bed, or a special telephone) due to a health problem. Compared to individuals without disabilities, those with disabilities dealt with many more mental and physical health problems. Those with disabilities were more likely to say that their health was only fair or poor (45.9% vs. 11.4%). They were also three times more likely to be depressed (16% vs. 5.9%) and five times more likely to report receiving treatment for a mental health condition (25.1% vs. 5.5%). Compared to their counterparts, respondents with disabilities were significantly more likely to report being severely stressed in an average month (6.5% vs. 1.2%), and they were nearly twice as likely to report that they rarely or never received the social or emotional support they needed (17.6% vs. 8.3%). Interviewers asked all respondents if they are limited in any way because of physical, mental, or emotional problems. The disabilities covered by this question included cognitive impairments such as dyslexia, mental impairments such as panic attacks and phobias, and physical impairments, including blindness, deafness, paralysis, amputation, etc. Among all respondents, roughly one in four (25.8%) said that they were limited because of one of these types of problems and 9.3% of all respondents reported a health problem requiring them to use special equipment, such as a cane, wheelchair, special bed, or telephone. These rates are similar to those reported by the state. In general, the prevalence of disability increased with age, as did the percentage of respondents needing special equipment, especially among those 55 years of age and older. The prevalence of disability, especially a disability which requires special equipment, was greater among those with the lowest levels of income and education. Those with disabilities were more likely to be obese, compared to those without disabilities. Compared to their counterparts, individuals who were limited because of a disability reported higher rates of hypertension. They were also less likely to have any leisure-time physical activity and less likely to eat the recommended number of fruits and vegetables per day. Respondents with disabilities were just as likely to have insurance coverage, compared to those without disabilities. They were also more likely to have a personal healthcare provider Disability and Social/Emotional Support Rarely or Never Receive Social/Emotional Support 17.6 Some Disability 8.3 No Disability 34

35 Functional Limits, Arthritis, & COPD Functional Limits Most of s BRFS respondents reported not needing any assistance with daily functions such as eating, getting out of bed, getting out of a chair, getting dressed, bathing, and using the bathroom. Respondents who reported lower income and education were generally more likely to need assistance with daily functions. One in eleven (8.8%) residents reported needing assistance with one or more of these activities for at least three months. One in ten respondents (9.9%) reported falling at least once in the past three months. Over one-third of those who reported experiencing a fall in the past three months noted that the fall resulted in an injury that caused them to visit a doctor or limited their regular activities for at least one day. Arthritis and Chronic Obstructive Pulmonary Disease (COPD) Arthritis Approximately one-third (33.5%) of residents reported having arthritis. 64% of those 75 years of age or older reported having arthritis. There were no differences in the likelihood of arthritis by race or gender. Generally, the likelihood of arthritis decreased with increased income and education. Compared to their counterparts, individuals with arthritis were significantly more likely to report their health as fair or poor. They were also more likely to report being severely stressed in an average month and three times as likely to report rarely or never receiving the social and emotional support that they needed (18.8% vs. 6.2%) Arthritis by Perceived Health Status, Emotional Stress, and Social/Emotional Support Arthritis General Health is Perceived as Fair or Poor 6.2 No Arthritis Rarely or Never Receive Social/Emotional Support Severely Stressed (Emotionally) 1.1 Chronic Obstructive Pulmonary Disease (COPD) 11.4% of BRFS respondents reported ever being diagnosed with COPD. The likelihood of COPD decreased with increased income and education. Respondents who reported having COPD were significantly more likely to report receiving a flu vaccine within the last twelve months compared to those without COPD (66% compared to 40%). Compared to respondents without COPD, those with the condition were twice as likely to perceive their health as fair or poor (46.4% vs. 17.0%). They were also significantly more likely to be severely stressed in an average month and to report that they rarely or never received the social and emotional support that they needed COPD and Influenza Vaccination Received Flu Vaccine Within Past Year COPD No COPD 35

36 Asthma Asthma and Healthcare Access Have Asthma No Health Insurance Asthma Ever* % Confidence Michigan (2011) Male Female White Black <High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, * The percentage who reported they were ever told by a doctor, nurse, or other health care professional that they have asthma Do Not Have Asthma No Personal Healthcare Provider Overall, 14.7% of BRFS respondents reported that they had been diagnosed with asthma. This figure is approximately the same as was reported for the State of Michigan in Generally, those 34 years of age or younger were more likely to report having been told they have asthma than those older than 35. Those years of age had the highest prevalence. Males had a significantly higher asthma prevalence than females. There were no clear education and income differences in those suffering from asthma Asthma and Depression Ever Diagnosed With a Depressive Disorder 28.1 Have Asthma Asthma is chronic health condition that can affect many aspects of an individual s life and general lifestyle. Individuals with asthma were much more likely to rate their general health as only fair or poor, compared to those without asthma (29.9% vs. 19.7%). They were also more likely to be diabetic (20.2% vs. 13.7%). Compared to non-asthmatics, those with asthma were significantly more likely to report being depressed (28.1% vs. 5.0%). Respondents with asthma were also much more likely to report that they rarely or never receive the social and emotional support that they need, compared to their counterparts (29.2% vs. 7.4%). Compared to respondents who did not report having asthma, asthmatics were nearly twice as likely to report not having health insurance (20.2% vs. 11.2%) and significantly more likely to report not having a personal 17.2 healthcare provider (26.2% vs. 17.2%). Respondents with asthma were more likely to report receiving a pneumonia vaccine within the past year, compared to those without asthma (78.4% vs. 65.6%). However, there were no significant differences in influenza vaccination rates within the two groups. 5.0 Do Not Have Asthma 36

37 Aging & End of Life Aging and End of Life Care Completed Advanced Discussed End of Life With Loved Provided Assistance in Past Directives* Ones** Month*** Confidence Confidence Confidence % % % Male Female White Black < High school High school grad Some college College grad < $20, $20,000 - $34, $35,000 - $49, $50,000 - $74, $75, *The percentage of respondents who had reported that they had advanced directives in place. Advanced directives are any directives which allow people to make their health care choices known in advance of an incapacitating illness or death. **The percentage of respondents who reported they had talked about their wishes for care at the end of their life with their loved ones. ***The percentage of respondents who reported that in the past month they had provided regular care or assistance to a friend or family member with health problems, a long-term illness, or disability. Compared to White respondents, Black respondents were significantly more likely to report having provided assistance to a loved one in the past month (27.7% vs. 39.3%). Compared to their counterparts, respondents who indicated that they had completed advanced directives were not more likely to report their general health as fair or poor. In fact, they were less likely to report being depressed and to have high cholesterol, and just as likely to have diabetes. However, those who had made end of life plans may have more access to healthcare and a stronger social support system and than those who did not Approximately one quarter (24%) of residents reported having advanced directives in place, allowing them to make their health care choices known in advance of an incapacitating illness or death. 65.9% of respondents reported having discussed end of life with loved ones, and about 30% reported having provided regular care or assistance to a friend or family member in the past month. Older, White, and female respondents were more likely to report having completed advanced directives and having discussed end of life care with loved ones, compared to their counterparts. Those with higher income and education were more likely to report having completed advanced directives and having had discussions on end of life care with friends and family. Those with an annual income less than $20,000 reported having provided regular care or assistance to a loved one much more frequently than those with an annual income above $75,000. They were also significantly less likely to have end of life plans set in place Advanced Directives, Social/Emotional Support, and Healthcare Access 0.0 Provided Care/Assistance in Past Month by Provided Regular Assistance To Loved One in Past Month 27.7 White Completed Advanced Directives Do Not Have Health Insurance No Primary Healthcare Provider Black Have Not Completed Advanced Directives Rarely or Never Receive Social/Emotional Support 37

38 Summary The BRFS highlights some of the most prevalent health issues facing our community. The survey has shown that among our residents: 71% are overweight or obese 15% have been diagnosed with diabetes 36% have hypertension 50% have high cholesterol 83% eat fewer than five servings of fruits/vegetables per day 30% are not physical active at all Unfortunately, all of these outcomes are worse among individuals with lower household incomes and educational levels. Additionally, the data indicates that a person who has been diagnosed with one chronic condition is much more likely to be diagnosed with further co-morbid conditions and rate their physical health, mental health, and overall life satisfaction poorly. Although some of the major health outcomes reported here indicate a dire need for intervention to reverse the trends we are seeing, there are some bright spots. Compared to the State of Michigan, residents were much less likely to report that cost was a barrier to accessing a healthcare provider. had much higher HIV testing rates compared to the rest of the state. Residents of reported significantly higher rates of key breast and prostate cancer screenings than the State of Michigan. Of particular note was the exceptional rate of appropriately timed cervical cancer screenings in Black female residents of. Among all females, Black respondents were significantly more likely than White respondents to report having a pap smear test within the past three years. Given that many health problems are interrelated by nature, addressing root causes of disease is likely the best way of improving the overall health of our community. A positive first step in reducing chronic disease is understanding the forces and social determinants that cause people to behave in a certain way, and addressing issues such as access to resources important for good health. These efforts, however, are often complicated, demand long-term planning, and require diverse community partnerships. The Health Department is committed to continuing our collaborative work with community-based organizations, healthcare partners, and most importantly, the residents of Berrien County, to address the underlying causes of chronic disease and to improve the health of our residents. We look forward to working with you and investing in our community. 38

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