Influential Factors in Healthy Living: Regional results

Transcription

1 Community Epidemiology & Influential Factors in Healthy Living: Regional results May 2015 Prepared for Cancer, Cardiovascular Disease and Pulmonary Disease Program, Colorado Department of Public Health and Environment

2 Community Epidemiology & Program Evaluation Group cepeg ucdenver.org Faculty and staff Arnold H. Levinson, PhD MJ, Director Michele Kimminau, General Manager Katherine James, PhD MSPH MSCE (School of Medicine) Ashley Brooks Russell, PHD MPH Sara L. Cooper, PhD MSPH Yaqiang Li, PhD MPH Ming Ma, MD MPH Erin Martinez, MPH Carol Ann Mullins, MSPH Hillary Anderson, MPH Dana Andrews, MPH Korrine J. Thomas, MPH Kim McFann, PhD Ali Billings Vicki Weister Affiliates Patricia Alvarez Valverde, PhD MPH Kathleen Garrett, MA NCC MINT Yvonne Kellar Guenther, PhD William Betts, PhD (School of Medicine) Ernesto A. Moralez, MPH Edie Bridge Adam Atherly, PhD Eline Van Den Broek, MA Mark Gritz, PhD (School of Medicine) Rebecca Sedjo, PhD Tessa L. Crume, PhD MSPH Whitney Jones, PhD MSPA Kristin Kidd, MA The current information was prepared by Kathy James and Yaqiang Li.

3 Influential Factors in Healthy Living (IFHL) surveyed a random sample of Colorado adults in 2014 about selected health behaviors. IFHL was conducted by the Community Epidemiology & Program Evaluation Group (CEPEG), University of Colorado Denver, in response to a request from the Cancer, Cardiovascular Disease and Pulmonary Disease Grants Program ("CCPD") of the Colorado Department of Public Health and Environment (CDPHE). The study domains included four chronic conditions diabetes, high blood pressure (hypertension), high blood cholesterol (hyperlipidemia), and unhealthy weight. Marijuanarelated behaviors and attitudes were also asked, given recent legalization of "recreational" marijuana sales. Interview questions focused on attitudes, health risk behaviors, and both self management and interpersonal (health care, workplace) management of any of the four chronic conditions. Interviews were conducted during December 2013 through April The statewide report is available online. * The current report provides selected results for each of 21 Health Statistics Regions (HSRs) defined by CDPHE. Estimates of diabetes and high blood pressure are based on self report that a medical provider diagnosed the respective condition. Results are weighted to estimate prevalence and confidence intervals for the Colorado adult population. List of Tables 1. Access to Food 2. Locations where fruits and vegetables are purchased 3. Intention to buy fruits and vegetables if available at a local corner grocery or convenience store 4. Physician engagement 5. Marijuana use 6. Physician engagement with high blood pressure 7. Physician engagement with diabetes Abbreviations CI: 95% confidence interval FPL: federal poverty level * s/120814%20ifhl%20report%20final.pdf

4 Food Access Table 1. Access to Food by Health Statistics Region (HSR), Colorado adults, 2014 % (CI) HSR grocery store within half mile grocery store within 10 miles corner store within half mile corner store within 10 miles have a garden (38.3, 72.3) 63.5 (43.1, 83.9) 60.0 (43.3, 76.7) 61.3 (40.3, 82.4) 57.3 (40.9, 73.7) (59.9, 79.1) 96.3 (92.6, 99.9) 75.3 (66.6, 84) 95.4 (91.3, 99.6) 43 (31.7, 54.4) (41, 65.7) 94.3 (84.7, 100) 55.7 (43.4, 68.1) 93.4 (83, 100) 52.7 (40.5, 64.8) (47.1, 65.3) 91.7 (84.6, 98.7) 73.9 (66.2, 81.6) 86.6 (77.6, 95.6) 34.2 (25.8, 42.6) (21.3, 71.9) 62.3 (37.1, 87.5) 53.3 (28.4, 78.1) 70.3 (46.3, 94.3) 45.6 (20.9, 70.3) (36, 68.1) 73.5 (55, 92) 59.8 (43.9, 75.6) 77.6 (60.6, 94.7) 40.8 (25.2, 56.3) (45.2, 68.7) 95.8 (92, 99.6) 78.5 (69.5, 87.5) 96.3 (91.6, 100) 38.9 (27.2, 50.6) (35.9, 72.5) 67.4 (43.9, 91) 61.9 (44.1, 79.7) 74.0 (48.4, 99.6) 38.4 (20.4, 56.4) (30.8, 65.5) 63.6 (43.5, 83.6) 55.9 (39.4, 72.4) 88.1 (78, 98.1) 59.6 (43.1, 76.1) (22.4, 57.2) 95.2 (91.3, 99.2) 48.5 (30.8, 66.2) 96.2 (92.6, 99.8) 51.0 (33.3, 68.7) (18.8, 53) 56.4 (30.7, 82) 45 (26, 64.1) 87.3 (73.6, 100) 41.4 (22.3, 60.5) (32.7, 63.3) 85.2 (72, 98.4) 55.3 (39.9, 70.7) 98.6 (97.1, 100) 53.6 (38.3, 68.9) (35.9, 67.8) 82.3 (70, 94.7) 60.5 (45.6, 75.5) 79.1 (63.7, 94.5) 29.3 (15.2, 43.5) (63.4, 79.9) 98.6 (96.8, 100) 84.8 (78.4, 91.3) 97.7 (95.4, 100) 30.3 (22, 38.7) (67.7, 82.5) 99 (97, 100) 85.9 (80, 91.9) 95.3 (88.6, 100) 32.4 (24.7, 40.2) (56.3, 74.3) 97.0 (92.6, 100) 67.0 (58.2, 75.8) 90.2 (82.1, 98.2) 38.1 (29.1, 47.2) (7.7, 36.2) 34 (15, 53) 41.3 (20.2, 62.5) 89.6 (81.2, 97.9) 24.2 (10.3, 38.1) (51.7, 73.7) 89.3 (80, 98.6) 70.9 (60.4, 81.4) 89.3 (78.9, 99.8) 54.3 (42.7, 65.9) (37.9, 69.6) 89.9 (78.5, 100) 66.5 (51.9, 81.1) 99.4 (98.1, 100) 52.1 (36.2, 68) (78.2, 89.7) 99.8 (99.4, 100) 88.3 (83.6, 93) 94.8 (89.1, 100) 31.5 (23.7, 39.3) (60, 74.5) 96.4 (92.5, 100) 82.5 (76.8, 88.1) 97.5 (93.1, 100) 37.3 (29.8, 44.9) Between 92% and 100% of respondents from all regions reported buying fruits and vegetables from a grocery store in the past 12 months, with no statistical difference among HSRs. Secondary locations for buying fruits and vegetables differed among HSRs (Table 2).

5 Table 2. Secondary locations where fruits and vegetables were purchased in the past 12 months, by HSR, Colorado adults, 2014 % (CI) HSR farmers market warehouse farm corner store (12.2,45.1) (7.1,32.3) (10.7,41) (9.4,40.4) (39.9,62.7) (31.7,53.9) (33.7,56.7) (7.6,25.0) (35.0,59.5) (57.8,81.4) (24.1,46.1) (1.6,11.9) (38.6,56.8) (56.9,73.8) (21.7,37.4) (10.8,25.4) (5.4,31.3) (33.3,79.4) (6.7,37.4) (0,56.0) (39.3,71.6) (12.0,41.1) (38.5,70.9) (5.1,23.8) (39.1,63.1) (33.9,57.5) (33.8,57.3) (23.0,46.7) (14.8,50.3) (5.8,38.2) (19.1,55.4) (9.4,42.8) (36.7,70.8) (11.6,45.5) (30.5,65.3) (9.2,43.9) (40.3,75.8) (8.2,39.2) (50.3,84.2) (0.3,17.1) (15.6,46.0) (17.7,51.6) (23.1,59.3) (5.6,28.0) (42.1,72.2) (42.7,73.1) (38.2,68.7) (2.3,22.9) (41.2,73.7) (19.2,49.8) (27.4,58.8) (7.1,30.4) (32.6,51.7) (47.7,66.8) (27.0,45.0) (10.6,25.1) (31.3,48.0) (53.0,69.4) (20.0,34.9) (9.5,22.2) (53.6,71.6) (49.4,67.9) (36.6,55.5) (5.3,18.3) (17.2,52.1) (19.4,56.4) (16.8,56.0) (1.9,34.9) (24.8,47.2) (46.4,69.6) (26.1,48.6) (7.6,25.0) (30.0,61.2) (39.0,70.4) (33.7,65.5) (0,12.5) (32.4,48.9) (41.5,58.6) (19.4,33.9) (10.7,24.5) (33.2,48.7) 64.9 (57.4,72.4) 33.1 (25.7,40.5) 13.0 (7.8,18.3) In most HSRs, a majority of respondents (> 92%) went to the grocery store by driving; the second most common travel mode was walking.

6 Perceptions of fruit and vegetable availability, variety, quality and cost Nearly three fourths (72.5%, 70.2% to 74.8%) would like a larger variety of fruits and vegetables available in their neighborhood. This desire was more highly endorsed in several regions: o Region 1: 89.1% (78.4%, 99.9%) o Region 5: 90.1% (82.9%, 97.3%) o Region 9: 89.2% (81.2%, 97.1%) o Region 17: 89.7% (82.5%, 97.0%) Nearly three fourths (71.7%, 69.3% to 74.0%) would like fruits and vegetables to be more available in their neighborhood. This desire was more highly endorsed in several regions: o Region 1: 87.9% (77.1%, 98.7%) o Region 5: 86.5% (76.7%, 96.3%) o Region 9: 90.6% (84.5%, 96.6%) o Region 18: 83.6% (75.8%, 91.4%) Two thirds (66.6%, 64.2% to 69.1%) would like better quality fruits and vegetables available in their neighborhood. This desire was more highly endorsed in two regions: o Region 8: 86.4% (76.7%, 96.1%) o Region 9: 82.2% (72.0%, 92.4%) More than one third (38.8%, 36.2% to 41.5%) said the cost of fruits and vegetables keeps them from buying. This view was more highly endorsed in two regions: o Region 1: 58.3% (41.6%, 75.1%) o Region 6: 75.1% (64.0%, 86.2%) The average number of fruit and vegetable servings did not differ among regions, nor did perceived ease of getting to the grocery store. Table 3. Would buy fruits and vegetables if available at local corner store or convenience store, by HSR, Colorado adults, 2014 HSR % (CI) HSR % (CI) (31.9, 65.9) (17.9, 46.9) (30.1, 53.2) (18.1, 49.2) (7.7, 25.3) (25.7, 44.1) (38.2, 56.8) (29.6, 46.2) (38.7, 81.2) (17.1, 34.8) (24.4, 56.2) (16.5, 55.8) (32.6, 56.9) (21.7, 43.2) (39.6, 75.6) (12.2, 40.1) (42.9, 75.8) (27.7, 44.6) (23.6, 60.3) (17.2, 30.6) (30.1, 70.5)

7 Physician Engagement Table 4. Selected interactions with health care provider, by HSR, Colorado adults, 2014 % (CI) see doctor HSR every year (72.7, 95.3) (58.4, 80.6) (67.3, 90.7) (66.2, 83.4) (41.2, 96) (75.5, 98.1) (77.9, 95.4) (61.2, 94.1) (70.3, 96.4) (73.5, 95.1) (41.8, 88.9) (76.1, 94.9) (89.7, 98.6) (82.4, 95.3) (71.9, 86.7) (72.2, 88) (51.9, 97.2) (78.1, 94.5) (56.3, 86.6) (67.1, 83) (67.1, 81.7) saw doctor in past 12 months 52.5 (35.5, 69.6) 60.0 (48.4, 71.6) 72.2 (60.3, 84.2) 57.4 (48.1, 66.7) 44.6 (21.6, 67.6) 58.3 (41.8, 74.9) 80.5 (71.1, 89.8) 54.9 (36.1, 73.6) 60.1 (43, 77.2) 69.2 (52.2, 86.2) 65.6 (47, 84.1) 80.2 (70.4, 90.1) 75.9 (61.7, 90) 65.9 (56.4, 75.4) 67.6 (59.6, 75.5) 67.5 (58.5, 76.4) 72.5 (50.2, 94.7) 77.3 (67.4, 87.1) 50.7 (34.8, 66.6) 63.2 (54.6, 71.8) 63.5 (55.5, 71.4) doctor asked whether sad / depressed in past 12 months 15.2 (3.4, 27.1) 37.1 (25.3, 48.8) 26.3 (15.8, 36.8) 39.3 (29.9, 48.7) 23.3 (8.4, 38.2) 29.3 (14.9, 43.7) 30.5 (19, 42) 35.3 (14.7, 55.8) 30.4 (13.5, 47.3) 23.6 (8.1, 39.1) 29.9 (13.3, 46.5) 38.5 (23.1, 53.9) 36.6 (20.1, 53.2) 40.2 (30.6, 49.9) 33.7 (25.5, 42) 33.4 (24.4, 42.3) 32.8 (17.4, 48.2) 28.0 (17.5, 38.5) 26.9 (13, 40.7) 45.2 (36.3, 54.1) 27.2 (20.1, 34.4) ever diagnosed with depression 20.4 (6.6, 34.2) 20.5 (11, 30) 11.2 (4.7, 17.6) 21.3 (14.3, 28.4) 8.8 (2, 15.6) 21.2 (9.3, 33.1) 22.6 (13.5, 31.8) 26.2 (10.4, 41.9) 21.7 (7.5, 35.8) 20.9 (6.2, 35.5) 15.9 (5.8, 26.1) 24.6 (11.7, 37.4) 27.8 (11.8, 43.8) 22.3 (14.6, 30) 29.7 (22.1, 37.2) 20.5 (13.2, 27.9) 25.2 (3.6, 46.8) 26.6 (16.3, 36.9) 40.3 (24.6, 56) 23.2 (16.5, 29.9) 27.4 (20.4, 34.4) provider advised about weight 14.9 (4.2, 25.6) 30.8 (20.2, 41.4) 24 (13.9, 34) 22.4 (15.5, 29.3) 14.8 (5.2, 24.4) 35.4 (20, 50.9) 34.2 (22.9, 45.5) 24.6 (10, 39.2) 14.4 (4, 24.7) 28.8 (12, 45.6) 25.3 (11, 39.6) 19.9 (8.7, 31.2) 28.6 (13.9, 43.3) 32.7 (23.6, 41.7) 32.6 (24.8, 40.4) 24.5 (16.6, 32.4) 25.0 (8.2, 41.9) 39.3 (27.9, 50.7) 26.3 (12.8, 39.9) 22.2 (15.5, 28.9) 32.3 (25.1, 39.5)

8 Marijuana Use Table 5. Ever used marijuana, by HSR, Colorado adults, 2014 % HSR (CI) (18.7, 52.2) (46.2, 68.2) (23.6, 47.5) (40.5, 58.7) (14.3, 66.6) (15.6, 44.7) (33.3, 57.4) (34.5, 70.9) (46.4, 77.8) (34.3, 69.6) (43.1, 80.3) (45.7, 76.1) (34, 66.3) (28.5, 47.1) (36, 52.9) (45.6, 64.2) (33.8, 74.2) (27.2, 50.4) (33.6, 65.5) (47.4, 64.4) (44.7, 60.3)

9 Chronic Disease Table 6. Provider advice for managing high blood pressure, by HSR, Colorado adults reporting diagnosis of high blood pressure and having visited a health care provider in the past 12 months, 2014 % (CI) HSR eat well exercise more lose weight reduce salt reduce alcohol stop smoking (16.5, 69.6) 30.8 (12.2, 49.5) 30.0 (10.3, 49.7) 50.8 (25.2, 76.4) 6.9 (0, 15.8) 11.9 (0, 26.3) (2.2, 30.8) 67.5 (48.3, 86.8) 32.5 (9.7, 55.4) 16.4 (1.4, 31.3) 2.5 (0, 5.6) 4.5 (0, 9.7) (47.5, 82.9) 88.7 (78.6, 98.7) 56.7 (36.1, 77.4) 58.7 (39.4, 77.9) 21.2 (0.6, 41.8) 6.0 (0, 14.8) (26.0, 61.9) 70.0 (53.6, 86.4) 54.2 (37.0, 71.5) 47.7 (29.9, 65.4) 16.2 (1.7, 30.7) 16.0 (1.3, 30.6) (9.3, 63.7) 62.6 (40.0, 85.3) 36.0 (14.1, 57.9) 52.9 (28.1, 77.8) 5.8 (0, 16.9) 2.9 (0, 8.6) (23.8, 69.6) 53.0 (29.9, 76.0) 42.9 (20.5, 65.2) 64.2 (42.9, 85.4) 9.5 (1.1, 18) 26.4 (6.5, 46.2) (21.1, 65.6) 73.5 (57.7, 89.2) 28.5 (12.7, 44.4) 65.8 (48.4, 83.3) 29.3 (8.1, 50.5) 24.3 (9.0, 39.7) (9.7, 76.4) 57.8 (25.6, 89.9) 72.7 (50.0, 95.5) 54.8 (22.2, 87.3) 35.2 (0.8, 69.6) 17.4 (0, 41.5) (12.4, 62.2) 55.5 (30.5, 80.6) 48.9 (24.0, 73.9) 42.0 (17.2, 66.8) 19.5 (0, 42.6) 23.5 (0.2, 46.7) (4.8, 44.0) 57.9 (35.1, 80.7) 45.8 (23.3, 68.3) 23.4 (7.0, 39.8) 6.6 (0, 16.7) 25.6 (6, 45.2) (0, 47.2) 35.8 (9.2, 62.3) 28.1 (2.9, 53.3) 27.9 (2.9, 52.9) 19.0 (0, 40.9) 3.8 (0, 10.3) (0, 34.7) 42.1 (7.6, 76.6) 15.8 (0, 33.9) 41.0 (6.9, 75.2) 37.2 (0, 79.5) 2.2 (0, 5.7) (16.9, 51.9) 30.8 (12.2, 49.5) 49.8 (30.8, 68.7) 55.1 (36.7, 73.5) 7.3 (0, 15.2) 11.0 (1.1, 20.9) (35.1, 67.7) 72.2 (58.8, 85.6) 75.0 (64.3, 85.8) 62.7 (47.2, 78.3) 22.3 (8.6, 36.1) 29.7 (13.9, 45.5) (33.9, 65.7) 63.5 (48.1, 78.8) 48.3 (32.5, 64.2) 43.9 (28.1, 59.8) 15.9 (3.7, 28.2) 20.8 (7.2, 34.4) (6.4, 46.2) 41.7 (20.3, 63.1) 17.1 (5.6, 28.6) 21.1 (5.7, 36.5) 10.2 (0.2, 20.2) 0.8 (0, 1.9) (0, 50.0) 58.0 (22.9, 93.2) 32.0 (4.5, 59.6) 22.8 (0, 46.5) 19.8 (0, 43.7) 15.4 (0, 37.1) (10.6, 49) 64.6 (45.9, 83.3) 51.4 (31.1, 71.7) 60.8 (41.2, 80.3) 11.4 (0.2, 22.7) 17.5 (1.3, 33.7) (11, 53.4) 59.5 (38.5, 80.4) 44.7 (22.9, 66.4) 37.7 (17.0, 58.3) 16.8 (0, 36.2) 34.9 (12.9, 56.9) (31.6, 62.4) 56.3 (41.0, 71.5) 46.9 (31.5, 62.3) 48.6 (33.3, 63.9) 22.9 (8.7, 37.0) 23.1 (10.3, 36.0) (21.2, 51.0) 67.1 (52.9, 81.2) 43.3 (28.2, 58.5) 49.7 (34.3, 65.1) 10.8 (1.5, 20.1) 11.9 (2.0, 21.9)

10 Table 7. Provider advice for managing diabetes, by HSR, Colorado adults reporting diagnosis of diabetes and having visited a health care provider in the past 12 months, 2014 % (CI) HSR eat well exercise more lose weight more sleep (91.8, 100) 97.4 (93.7, 100) 70.5 (46.9, 94) 49.5 (22.3, 76.8) (20.1, 88.9) 73.4 (48.8, 98.1) 49 (13.2, 84.7) 27.9 (0, 58.2) (17.5, 84.1) 80.6 (57.7, 100) 73.6 (48.8, 98.3) 9.7 (0, 24.2) (66.8, 92.8) 92.6 (85.4, 99.7) 0.5 (0, 1.4) 42.2 (17.8, 66.7) (21.1, 82.7) 60.0 (28.8, 91.3) 34.4 (15.0, 53.9) 40.0 (9.6, 70.3) (50.3, 96.8) 79.1 (57.5, 100) 44.1 (13.1, 75.2) 60.9 (32.5, 89.3) (44.0, 91.0) 74.3 (52.6, 95.9) 32.0 (7.0, 57.0) 70.1 (50.3, 89.8) (62.0, 100) 87.1 (71.4, 100) 27.5 (5.9, 49.2) 65.1 (26.7, 100) (0.7, 50.7) 42.6 (9.5, 75.6) 27.6 (0, 59.4) 24.6 (0, 49.3) (32.6, 94.1) 72.3 (44.3, 100) 33.8 (3.3, 64.3) 33.1 (0, 66.9) (65.4, 100) 85.5 (61.2, 100) 42.1 (10, 74.1) 50.8 (2.4, 99.1) (8.0, 95.0) 63.8 (19.9, 100) 13.4 (0, 32.0) 28.9 (0, 69.9) (55.0, 99.4) 77.2 (55.0, 99.4) 45.5 (2.4, 88.6) 29.3 (3.6, 55.1) (71.5, 94.7) 86.9 (77.1, 96.8) 40.7 (11.9, 69.4) 0.9 (0, 2.7) (45.0, 87.0) 78.3 (59.7, 96.9) 85.2 (74.6, 95.9) 72.6 (49.5, 95.7) (31.7, 92) 54.0 (23.9, 84) 60.9 (39.1, 82.7) 34.4 (6.7, 62.1) (0, 44.5) 8.9 (0, 24.3) 0.7 (0, 2.1) 5.2 (0, 16.2) (9.3, 66.2) 33.7 (7.5, 60.0) 60.8 (32.3, 89.3) 52.6 (23.7, 81.5) (56.3, 100) 19.2 (0, 41.7) 84.5 (59.5, 100) 27.6 (0.1, 55.0) (20.3, 73.1) 27.8 (5.8, 49.7) 66.4 (38.6, 94.1) 47.6 (20.5, 74.7) (40.3, 81.2) 24.7 (6.2, 43.1) 17.7 (0, 38.6) 26.6 (8.9, 44.3)