Capital Area Behavioral Risk Factor & Social Capital Survey

Transcription

1 Capital Area Behavioral Risk Factor & Social Capital Survey Ingham County Health Surveillance Book 2016 BRFS - 1

2 Introduction H ealth problems are community issues and require community involvement to solve them. Local health departments cannot do it alone. One of the ten essential services of public health is to inform the public about local health issues and empower them to develop solutions. To that end the Ingham County Health Department, along with the Capital Area United Way, Barry-Eaton District Health Department, and Mid-Michigan District Health Department, conducts community health assessment activities to continually monitor the health behavior and health status of residents in its jurisdiction. One of those assessment activities is the Capital Area Behavioral Risk Factor & Social Capital survey (Capital Area BRF&SC survey). The Capital Area BRF&SC survey is a telephone health survey of households that collects information on health behaviors, preventive health practices, health care access, social cohesion and interactions. Modeled after the Michigan Behavioral Risk Factor Survey and the national Behavioral Risk Factor Surveillance System, information gathered from this survey is used to identify emerging health obstacles, monitor health objectives, and develop and evaluate public health policies/programs in Ingham and surrounding counties in the Capital Area. This section of the Data Book presents the statistics generated from the most recent Capital Area BRF&SC survey conducted between 2011 and Demographics Age Race/Ethnicity Education Employment Annual Household Income Chronic Conditions Mental Health Hypertension Cholesterol Diabetes Asthma Disability Weight Status Nutrition & Physical Activity Fruit & Vegetable Consumption Physical Activity Land Use Alcohol, Tobacco, & Substance Abuse Alcohol Consumption Tobacco Smoking Marijuana Use Prescription Opioid Misuse Cancer Prevention Cervical Cancer Screening Colorectal Cancer Screening Social Capital Community Trust Community Participation BRFS - 2

3 Demographics > Age T he demographic landscape holds vital importance to the development and vitality of Ingham County. Demographic data may appear as just sterile statistics, but it can illuminate aspects of life that are not found anywhere else. It can reveal where and how specific groups of people live, their backgrounds, their economic situation, composition of their family, and other aspects of their life. Figure 1. Age group among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 3

4 Demographics > Age Figure 2. Age group by sex among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 3a. Age group by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 4

5 Demographics > Age & Race/Ethnicity Figure 3b. Age group by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 4. Race/ethnicity among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 5

6 Demographics > Race/Ethnicity Figure 5a. Race/ethnicity by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 6b. Race/ethnicity by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 6

7 Demographics > Education Figure 7. education among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 8. education by sex among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 7

8 Demographics > Education Figure 9. Education level by age group among adults in Ingham County Capital Area BRFS (Ingham only Figure 10. Education level by racial/ethnic groups among adults in Ingham County Capital Area BRFS (Ingham only) BRFS - 8

9 Demographics > Education Figure 11a. Education level by geographic area (among adults in Ingham County Capital Area BRFS (Ingham only) Figure 11b. Education level by geographic area among adults in Ingham County Capital Area BRFS (Ingham only) BRFS - 9

10 Demographics > Employment Figure 12. Employment status among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 13. employment by age group among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 10

11 Demographics > Employment Figure 14. Employment status by sex among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 15. Employment status by racial/ethnic groups among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 11

12 Demographics > Employment Figure 16. Employment status by education among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 17a. Employment status by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 12

13 Demographics > Employment & Income Figure 17b. Employment status by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 18. Annual household income among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 13

14 Demographics > Income Figure 19. Annual household income by age group among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 20. Annual household income by sex among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 14

15 Demographics > Income Figure 21. Annual household income by racial/ethnic groups among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 22. Annual household income by education among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 15

16 Demographics > Income Figure 23a. Annual household income by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 23b. Annual household income by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 16

17 Chronic Conditions > Mental Health M ental health is defined as, a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. 1 Culture, gender, physiology, and societal norms, all influence mental health. Consequently, no assessment of health can be considered comprehensive without assessing both mental and physical health. The mental health status of adults was estimated based on respondents answers to the following question in the Capital Area BRF&SC survey: Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days in the past thirty was you mental health not good? Persons who responded that they experienced fewer than fourteen days of not good mental health were said to have good mental health. Those who reported that they had fourteen or more days of not good mental health in the past thirty days were categorized as having poor mental health. Figure 24. Mental health status among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 17

18 Chronic Conditions > Mental Health Figure 25. Mental health status by age group among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 26. Mental health status by sex among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 18

19 Chronic Conditions > Mental Health Figure 27. Mental health status by race/ethnicity among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 28. Mental health status by education level among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 19

20 Chronic Conditions > Mental Health Figure 29. Mental health status by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 20

21 Chronic Conditions > Hypertension H igh blood pressure, or hypertension, is known as the silent killer and is a major risk factor for coronary heart disease, stroke, and heart failure. One in three adults in the U.S. has high blood pressure (also called hypertension), and nearly one-third of them do not know they have it. 1 High blood pressure is called the silent killer because it usually has no symptoms. Yet it is a major risk factor for stroke, heart attack, heart failure and kidney failure, and when it coexists with obesity, smoking, high cholesterol or diabetes, the risk of heart attack and stroke increase several times. 1 Although the cause of high blood pressure is often unknown, certain lifestyle choices can help prevent and control it. 1 The previance of hypertension of adults was estimated based on respondents answers to the following question in the Capital Area BRF&SC survey: Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure? [Women who responded Yes were asked an additional question: Was this only when you were pregnant? Responses to both questions were grouped and categorized into the following categories: Yes, Yes, but only during pregnancy, No, and No, but borderline or pre-hypertensive. The hypertension prevalence presented is based on Yes responses only. Figure 30. Hypertension among adults in Ingham County, Capital Area BRFS (Ingham only) 1. American Heart Assoc. ( BRFS - 21

22 Chronic Conditions > Hypertension Figure 31. Hypertension by age group among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 32. hypertension by sex among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 22

23 Chronic Conditions > Hypertension Figure 33. Hypertension by race/ethnicity among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 34. hypertension by education among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 23

24 Chronic Conditions > Hypertension Figure 35. Hypertension by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 24

25 Chronic Conditions > Cholesterol H igh Cholesterol is the percentage of the adult population who have had their cholesterol checked and were told it was high. High cholesterol is usually defined as total blood cholesterol above 240 mg/dl. Excess cholesterol creates plaque that narrows arteries and reduces blood flow. High cholesterol is a major risk factor for heart disease including heart attack and stroke; 1 high cholesterol doubles the risk of heart attack.. 2 Each year 735,000 US adults have heart attacks, and approximately 525,000 of these are a first heart attack. 3 Genetics can influence high cholesterol, which can be managed through medication and such lifestyle behaviors as diet and physical activity. Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high? The high cholesterol prevalence presented is based on Yes responses only. Figure 36. Cholesterol level among adults in Ingham County, Capital Area BRFS (Ingham only) 1. National Stroke Association Centers for Disease Control and Prevention Centers for Disease Control and Prevention. BRFS - 25

26 Chronic Conditions > Cholesterol Figure 37. Cholesterol level by age group among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 38. Cholesterol level by sex among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 26

27 Chronic Conditions > Cholesterol Figure 39. Cholesterol level by racial/ethnic groups among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 40. Cholesterol level by racial/ethnic groups among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 27

28 Chronic Conditions > Cholesterol Figure 41. Cholesterol level by geographic area among adults in Ingham County Capital Area BRFS (Ingham only) BRFS - 28

29 Chronic Conditions > Diabetes D iabetes is becoming increasingly pervasive in the United States. It is a condition in which the body can no longer use blood sugar effectively. It is most often observed in three forms: Type 1, Type 2, and gestational diabetes. Type 1 diabetes is an autoimmune disorder in which the body becomes incapable of producing sufficient insulin (a hormone regulating blood sugar). In type 2 diabetes the body becomes gradually resistant to the insulin it produces. To compensate, the body produces more insulin until it can no longer keep up with the increasing demand. Gestational diabetes is a temporary form of insulin resistance that occurs during pregnancy and usually resolves itself after delivery. Diabetes is a leading cause of death, disability and multiple long-term complications, including: stroke, kidney failure, nerve damage, blindness, and lower limb amputations. The diabetes prevalence of adults was estimated based on respondents answers to the following question in the Capital Area BRF&SC survey: Have you ever been told by a doctor, nurse, or other health professional that you have diabetes? Women who responded Yes were asked an additional question: Was this only when you were pregnant? Responses to both questions were grouped and categorized into the following categories: Yes, Yes, but only during pregnancy, No, and No, but borderline or pre-diabetes. Diabetes prevalence is based on Yes responses only. Figure 42. Diabetes among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 29

30 Chronic Conditions > Diabetes Figure 43. Diabetes by age group among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 44. Diabetes by sex among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 30

31 Chronic Conditions > Diabetes Figure 45. Diabetes by racial/ethnic groups among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 46. Diabetes by education among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 31

32 Chronic Conditions > Diabetes Figure 47. Diabetes by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 32

33 Chronic Conditions > Asthma A sthma is a chronic respiratory disease that often requires limits to be placed on activity; it may require hospitalization, and can even cause death. Asthma attacks can be triggered by a variety of factors, such as cold air, allergens, irritants, and respiratory viral infections. Allergies, a family history of asthma or allergy, low birth weight, and exposure to tobacco smoke are just a few potential risk factors that are associated with the development of asthma. Effective management of asthma controlling exposure to factors that trigger asthma episodes, adequately managing asthma with medicine, monitoring the disease by using objective measures of lung function, and educating asthma patients to become partners in their own care is necessary to interrupt the progression of the disease and improve the quality of life for individuals with asthma. Have you ever been told by a doctor, nurse, or other health professional that you had asthma? Respondents who indicated that they did have asthma were asked an additional question: Do you still have asthma? The responses of those who answered the first asthma question are seen in Fig. #48 ( ever asthma ) and the responses of those who answered the second asthma question are seen in Fig. #49-54 ( current asthma ). Figure 48. Ever asthma status among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 33

34 Chronic Conditions > Asthma Figure 49. Current asthma status among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 50. Current asthma status by age group among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 34

35 Chronic Conditions > Asthma Figure 51. Current asthma status by sex among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 52. Current asthma status by racial/ethnic groups among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 35

36 Chronic Conditions > Asthma Figure 53. Current asthma status by education level among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 54. Current asthma status by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 36

37 Chronic Conditions > Disability D isability occurs in a variety of forms and can afflict anyone at any age. Disability can be the result of impairment of one s vision, hearing, movement, cognition, communication, learning, remembering, mental health, or social relationships.1 Persons with disabilities are less likely to be physically active; have less access to adequate healthcare; and be victims of abuse and violence; compared to those with no disabilities.2 It is important to remember that it is the related conditions like the ones mentioned above, not the disability itself, that causes poor health among disabled persons. The disability status of adults was estimated based on respondents answers to the following question in the Capital Area BRF&SC survey: Are you limited in any way in any activities because of physical, mental, or emotional problems? Respondents can answer either Yes or No. The occurrence of disability is based on Yes responses. Figure 55. Disability among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 37

38 Chronic Conditions > Disability Figure 56. Reason for impairment among disabled adults in Ingham County, Capital Area BRFS (Ingham only) Figure 57. Disability by age group among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 38

39 Chronic Conditions > Disability Figure 58. Disability by sex among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 59. Disability by racial/ethnic groups among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 39

40 Chronic Conditions > Disability Figure 60. Disability by education level among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 61. Disability by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 40

41 Chronic Conditions > Weight Status O ur weight is determined by the energy (measured in calories) consumed in food and the energy we expend. If we take in more energy than we spend, we gain weight. If we spend more energy than we take is (by being physically active, for example), we loose weight. The Body Mass Index (BMI), which takes into account the height of an individual in addition to their weight, is used to describe our size. Carrying excess weight, known as overweight and obesity, is associated with an increased risk of developing a variety of diseases, including: hypertension, elevated cholesterol, type 2 diabetes, coronary heart disease, stroke, osteoarthritis, sleep apnea and respiratory problems, several cancers, and disability.1, 2, 3 Additionally, overweight and obesity is strongly associated with shortened lifespan. Nationally an estimated 300,000 obesity-related deaths occur each year. 3 The weight status of adults was estimated based on respondents answers to the following question in the Capital Area BRF&SC survey: How tall are you without your shoes? and How much do you weigh, in pounds, without your shoes? Respondents answers were recorded and BMI was calculated using the appropriate BMI. Adults with a BMI less than 18.5 are considered underweight; a normal weight adult has a BMI between 18.5 and 24.9; 25.0 to 29.9 is the BMI for an overweight person; and adults with a BMI of 30.0 or more is considered obese. Underweight and normal weight adults were grouped together so that three groups are reported for weight status: underweight/normal weight, overweight, and obese. Figure 62. Weight status among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 41

42 Chronic Conditions > Weight Status Figure 63. Weight status among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 64. Weight status by age group among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 42

43 Chronic Conditions > Weight Status Figure 65. Weight status by sex among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 66. Weight status by racial/ethnic groups among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 43

44 Chronic Conditions > Weight Status Figure 67. Weight status by education among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 68. Weight status by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 44

45 Nutrition & Physical Activity M ost adults consume a diet heavy in carbohydrates and fats, but have limited (both in amount and type) fruit and vegetable consumption. Fruits and vegetables provide numerous nutrients and fiber. A diet high in fruits and vegetables is associated with decreased risk for chronic diseases, like cancer, diabetes and obesity. Consuming a variety of fruits and vegetables are necessary to consume the whole spectrum of nutrients necessary for optimum health. The fruit and vegetable consumption of adults was estimated based on respondents answers to the following question in the Capital Area BRF&SC survey: How many servings of fruit and vegetables do you usually eat in a day? Based on the number of servings reported, respondents were grouped into three categories: those consuming no fruits or vegetables, those consuming at least one serving of fruit or vegetable a day; and those having five or more servings a day. Five servings (two and a half cups) of fruits and vegetables is the minimum recommended serving for the 1,200-calorie diet level. Figure 69. Fruit and vegetable consumption among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 45

46 Nutrition & Physical Activity Figure 70. Fruit and vegetable consumption by age group among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 71. Fruit and vegetable consumption by sex among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 46

47 Nutrition & Physical Activity Figure 72. Fruit and vegetable consumption by race/ethnicity among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 73. Fruit and vegetable consumption by race/ethnicity among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 47

48 Nutrition & Physical Activity Figure 74a. Fruit and vegetable consumption by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 74b. Fruit and vegetable consumption by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 48

49 Nutrition & Physical Activity P hysical activity is any movement produced by the contraction of skeletal muscle that increases energy expenditure above normal levels, therefore it is not simply exercise.1 Walking, gardening, playing baseball or tag with the grandchildren, are all examples of physical activity. The benefits of physical activity are numerous. Physically active persons have: 20%- 35% lower risk for CVD, CHD, and stroke 30%-40% lower risk for type 2 diabetes and metabolic syndrome 30% lower risk for colon cancer 20% lower risk for breast cancer 20%- 30% lower risk for depression, distress/well-being, and dementia.1 In light of the numerous benefits, physical activity guidelines, policies, and programs should be an essential component of any comprehensive disease prevention and health promotion strategy. The physical activity status of adults was estimated based on respondents answers to the following question in the Capital Area BRF&SC survey: Now, thinking about the moderate activities you do in a usual week, do you do moderate activities for at least 10 minutes at a time, such as brisk walking, bicycling, vacuuming, gardening, or anything else that causes some increase in breathing or heartrate? Now, thinking about the vigorous activities you do in a usual week, do you do vigorous activities for at least 10 minutes at a time, such as running, aerobics, heavy yard work, or anything else that causes large increases in breathing or heart rate? Adequate physical activity is defined in this report as performing moderate activities for at least 150 minutes per week or vigorous activities for at least 75 minutes per week. Figure 75. Physical activity (moderate or vigorous) levels among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 49

50 Nutrition & Physical Activity Figure 76. Physical activity (moderate or vigorous) levels by age group among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 77. Physical activity (moderate or vigorous) levels by sex among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 50

51 Nutrition & Physical Activity Figure 78. Physical activity (moderate or vigorous) levels by race/ethnicity among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 79. Physical activity (moderate or vigorous) levels by education among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 51

52 Nutrition & Physical Activity Figure 80. Physical activity (moderate or vigorous) levels by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 81. Community Design: Reasons, related to community neighborhood design, given for not being more active among those getting less than adequate physical activity, Capital Area BRFS (Ingham only) BRFS - 52

53 Alcohol, Tobacco, and Substance Abuse T he prevalence of alcohol consumption in adults was estimated based on respondents answers to the following question in the Capital Area BRF&SC survey: During the past 30 days have you had at least one drink of any alcoholic beverage such as beer, wine, a malt beverage, or liquor? Those who responded No were classified as having no drinks in the past 30 days and they were asked no additional questions about their alcohol use. Respondents who answered Yes to that question were also asked additional questions: Considering all types of alcoholic beverages, how many times during the past 30 days did you have [if male] five or more drinks on any occasion? [if female] four or more drinks on any occasion? In this report we report the prevalence of heavy drinking and binge drinking. These terms are not interchangeable. Heavy drinking refers to the numbers of drinks consumed per week whereas refers to the number of drinks consumed in one occasion. The criteria for heavy and binge drinking for men and women are as follows: For men heavy drinking = 15+ drinks per week binge drinking = 5+ drinks per occasion (approximately 2 hours) For women heavy drinking = 8+ drinks per week binge drinking = 4+ drinks per occasion (approximately 2 hours) Approximately half of alcohol consumed by adults in the United States is done so as a binge drink.2 Binge drinking, though, is not usually related to alcohol dependence. The majority of persons who binge drink are not alcoholics.2 Although binge drinking is of particular concern because of its association with injury, high risk behavior, and death; heavy drinking is associated with complications in chronic conditions (i.e. liver disease or diabetes). BRFS - 53

54 Alcohol, Tobacco, and Substance Abuse Figure 82. Heavy drinking among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 83. Binge drinking among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 54

55 Alcohol, Tobacco, and Substance Abuse Figure 84. Alcohol consumption by age group among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 85. Alcohol consumption by sex among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 55

56 Alcohol, Tobacco, and Substance Abuse Figure 86. Alcohol consumption by race/ethnicity among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 87. Alcohol consumption by education level among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 56

57 Alcohol, Tobacco, and Substance Abuse Figure 88a. Alcohol consumption by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 88b. Alcohol consumption by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 57

58 Alcohol, Tobacco, and Substance Abuse I n 1964, the first Surgeon General s report on the harmful effects of smoking was released. Fifty-two years later the national smoking rate has declined. However it is still the leading cause of preventable death.1 Between the first Surgeon General s report and now, it is estimated that 12 million people have died prematurely because of smoking.1 Tobacco use has been linked to a variety of conditions, including cardiovascular disease ands emphysema, in addition to multiple cancers. The smoking status of adults was estimated based on respondents answers to the following questions in the Capital Area BRF&SC survey: Have you smoked at least 100 cigarettes (five packs) in your entire life? Those who responded No were classified as non-smokers and they were asked no additional questions about their personal tobacco use. Respondents who answered Yes were asked the following additional question: Do you now smoke cigarettes every day, some days, or not at all? Persons who responded not at all to the second question were labeled former smokers and those responding every day or some days were labeled as current smokers. Therefore, from the two questions we derived three categories: nonsmokers, former smokers, and current smokers. Figure 89. Tobacco smoking among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 58

59 Alcohol, Tobacco, and Substance Abuse Figure 90. Tobacco smoking by age group among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 91. Tobacco smoking by sex among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 59

60 Alcohol, Tobacco, and Substance Abuse Figure 92. Tobacco smoking by sex among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 93. Tobacco smoking by race/ethnicity among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 60

61 Alcohol, Tobacco, and Substance Abuse Figure 94. Tobacco smoking by education level among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 95a. Tobacco smoking by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 61

62 Alcohol, Tobacco, and Substance Abuse Figure 95b. Tobacco smoking by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 62

63 Alcohol, Tobacco, and Substance Abuse M arijuana refers to the dried leaves, flowers, stems, and seeds from the hemp plant, Cannabis sativa. The plant contains the mind-altering chemical delta-9-tetrahydrocannabinol (THC) and other related compounds. Although Marijuana is an illicit drug, it is very popular and the risk associates with is use is declining. This is due in large part to the legalization of marijuana for medical use or adult recreational use in states across the country, including Michigan. Questions about marijuana use was included in the Capital Area BRF&SC survey to add to the body of information available about marijuana use at the local level. Those questions were: During the past 30 days, on how many days did you use marijuana? Respondents who indicated that they did have asthma were asked an additional question: Did you use marijuana for medicinal reasons or recreational reasons, or both? The responses for the first question were categorized into ever or never use for Figs #96, and for frequency of use for Fig. #97. Figure 96. marijuana use among adults in Ingham County, Capital Area BRFS (Ingham only) National Institute on Drug Abuse BRFS - 63

64 Alcohol, Tobacco, and Substance Abuse Figure 97. Frequency of use among adults who use marijuana in Ingham County, Capital Area BRFS (Ingham only) Figure 98. Reason for use among adults who use marijuana in Ingham County, Capital Area BRFS (Ingham only) BRFS - 64

65 Alcohol, Tobacco, and Substance Abuse Figure 99. marijuana use by age group among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 100. marijuana use by sex among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 65

66 Alcohol, Tobacco, and Substance Abuse Figure 101. marijuana use by race/ethnicity among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 102. marijuana use by education among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 66

67 Alcohol, Tobacco, and Substance Abuse Figure 103. marijuana use by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 67

68 Alcohol, Tobacco, and Substance Abuse O pioids are a class of drugs that include the illegal drug heroin as well as powerful pain relievers available legally by prescription, such as oxycodone (OxyContin ), hydrocodone (Vicodin ), codeine, morphine, fentanyl, and many others. Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but they are frequently misused (taken in a different way or in a greater quantity than prescribed, or taken without a doctor s prescription) because they produce euphoria in addition to pain relief. Regular use even as prescribed by a doctor can produce dependence, and when misused or abused, opioid pain relievers can lead to fatal overdose. The current epidemic of prescription opioid abuse has led to increased use of heroin, which presents similar dangers. Information is available about opioid abuse, for cases of arrest, overdoses attended to by emergency services, and deaths, but that does not give a complete sense of the scope of the problem. To supplement information already available, a question about the misuse of prescribed opioids was included in the Capital Area BRF&SC survey. That question was: On how many occasions, if any, have you taken narcotics on your own--that is, without a doctor telling you to take them during the last 30 days? The responses for this question was categorized into ever or never and frequency of use. Figure 104. Rx opioid misuse among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 68 National Institute on Drug Abuse

69 Alcohol, Tobacco, and Substance Abuse 105. Rx opioid misuse among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 69

70 Cancer Prevention > Cervical Cancer C ervical* cancer can usually be cured if it is found and treated in the early stages. Unlike other common forms of cancer, cervical cancer is believer to be caused by a viral infection (human papillomavirus or HPV) that are transmitted through sexual contact. Because it usually takes several years for cervical cancer to develop, screening for cervical cancer, via the Pap test, is essential to improve morbidity and prevent mortality. The prevalence of cervical cancer screening (via the Pap test) was estimated based on female respondents answers to the following question in the Capital Area BRF&SC survey: A Pap test is a test for cancer of the cervix. Have you had a Pap test in the past 3 years? Responses were grouped into the following categories: Yes or No. *The cervix is the lower, narrow end of the uterus and it leads from the uterus to the vagina. Figure 106. Cervical cancer screening among adult women in Ingham County, Capital Area BRFS (Ingham only) BRFS - 70

71 Cancer Prevention > Cervical Cancer Figure 107. Cervical cancer screening by age group among adult women in Ingham County, Capital Area BRFS (Ingham only) Figure 108. Cervical cancer screening by race/ethnicity among adult women in Ingham County, Capital Area BRFS (Ingham only) BRFS - 71

72 Cancer Prevention > Cervical Cancer Figure 109. Cervical cancer screening by education among adult women in Ingham County, Capital Area BRFS (Ingham only) Figure 110. Cervical cancer screening by geographic area among adult women in Ingham County, Capital Area BRFS (Ingham only) BRFS - 72

73 Cancer Prevention > Colorectal Cancer I n both men and women, colorectal cancer is the third most commonly diagnosed cancer and the third leading cause of cancer death. Significant progress in the prevention and early detection of colorectal cancer is possible by increasing access to and utilization of colorectal cancer screening tests. The U.S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer using high-sensitivity fecal occult blood testing, sigmoidoscopy, or colonoscopy beginning at age 50 years and continuing until age 75 years. The prevalence of sigmoidoscopy or colonoscopy for colon cancer was estimated based on respondents answers to the following question in the Capital Area BRF&SC survey: Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the colon for signs of cancer or other health problems. Have you ever had either of these exams? Responses were grouped into the following categories: Yes or No. Figure 111. Colorectal cancer screening among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 73

74 Cancer Prevention > Colorectal Cancer Figure 112. Colorectal cancer screening by age group among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 113. Colorectal cancer screening by sex among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 74

75 Cancer Prevention > Colorectal Cancer Figure 114. Colorectal cancer screening by race/ethnicity among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 115. Colorectal cancer screening by education among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 75

76 Cancer Prevention > Colorectal Cancer Figure 116. Colorectal cancer screening by geographic area among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 76

77 Social Capital S ocial capital refers to features of social organization, such as trust and relationships that increase a society s productive potential. Social capital includes the neighbor who knows all the kids on the block and can be depended on to be there for them in an emergency or during a conflict. The neighbor who volunteers to coordinate the neighborhood watch program and organizes block parties is also creating social capital. So are the service clubs and organizations that sponsor community activities or agencies and companies that work cooperatively to strengthen our social connections. The web of relationships that generate social capital is not only essential to the effective functioning of individuals, groups, and communities, but also has a powerful impact on our personal and communal health. The questions used for social capital were adapted from a series of questions from the Social Capital Benchmark Survey created by Robert Putnam, author of Bowling Alone, at the Kennedy School of Government at Harvard University. These questions were: Generally speaking, would you say that most people can be trusted or that you can t be too careful in dealing with people? First, think about people in your neighborhood generally speaking, would you say that you can trust them a lot, some, only a little, or not at all? How about, the police in your local community would you say that you can trust them a lot, some, only a little, or not at all? How about white people? How about African Americans or Blacks? How about Hispanics or Latinos? About how many times in the past 12 months have you Worked on a community project? Attended any public meeting in which there was a discussion of town or school affairs? Attended a political meeting or rally? Volunteered? BRFS - 77

78 Social Capital Figure 117. Community trust in general in Ingham County, Capital Area BRFS (Ingham only) Figure 118. Trust in police among adults Ingham County, Capital Area BRFS (Ingham only) BRFS - 78

79 Social Capital Figure 119. Trust in minorities among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 120. Trust in White, not Hispanic persons among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 79

80 Social Capital Figure 121. Trust in Black/African American persons among adults in Ingham County, Capital Area BRFS (Ingham only) Figure 122. Trust in Hispanic/Latino persons among adults in Ingham County, Capital Area BRFS (Ingham only) BRFS - 80

81 Figure 123. Adults who attended community project in Ingham County, Capital Area BRFS (Ingham only) Social Capital Figure 124. Adults who attended public meeting in Ingham County, Capital Area BRFS (Ingham only) BRFS - 81

82 Social Capital Figure 125. Adults who attended political meeting in Ingham County, Capital Area BRFS (Ingham only) Figure 126. Adults who volunteered in Ingham County, Capital Area BRFS (Ingham only) BRFS - 82

83 BRFS - 83

84 BRFS - 84