BOUNDARY COUNTY CANCER PROFILE

BOUNDARY COUNTY CANCER PROFILE A fact sheet from the Cancer Data Registry of Idaho, Idaho Hospital Association. Cancer Incidence 2010-2014 Cancer Mortality 2011-2015 BRFSS 2011-2015 CANCER Cancer is a group of more than 100 different diseases, each characterized by uncontrolled growth and spread of abnormal cells. Cancer risk increases with age, and varies by gender and race. As the average age of the population increases, the incidence of cancer will increase as well. It is generally accepted that 65-80% of all cancers are related to personal lifestyle or environmental factors, such as smoking and diet, and are therefore preventable. Other factors such as age, gender, and family history of specific cancers are also associated with cancer and aid in the identification of people at high risk. For some cancers, effective treatment is available. For these cancers, early detection can save lives. For example, there is convincing evidence that screening for colorectal cancer reduces mortality in adults aged 50 to 75 years. Through improved prevention, early detection, and treatment, opportunities exist to lessen the burden of cancer in Idaho. RISK FACTORS AND INTERVENTIONS Aging: Because the population is aging, the number of new cancer cases and cancer deaths that occur each year will continue to increase unless the trend is reversed by significant improvements in prevention, early detection, and treatment. Smoking: Smoking and the use of smokeless tobacco are responsible for the majority of all cancers of the lung, trachea, bronchus, larynx, pharynx, oral cavity, and esophagus. Smoking is the leading cause of preventable death in the United States. Diet: The U.S. Department of Agriculture recommends the following dietary guidelines for managing a healthy diet: eat a variety of foods; maintain a healthy weight; choose a diet with plenty of fruits, vegetables, and whole grain products; limit the use of sugar, sodium (salt), solid fats, and refined grains; and minimize alcoholic beverage consumption. Screening: Early detection is extremely important for those cancers that can be cured and which can be discovered early. FOR MORE INFORMATION Cancer Data Registry of Idaho 615 N. 7 th Street P.O. Box 1278 Boise, ID 83701 208-489-1380 http://www.idcancer.org National Cancer Institute Cancer Information Services 1-800-4CANCER https://www.cancer.gov/contact/contact -center American Cancer Society 2676 South Vista Avenue Boise, ID 83705 208-343-4609 http://www.cancer.org 1

CANCER INCIDENCE 2010-2014 During the five-year period 2010-2014, 37,621 cases of invasive cancer were diagnosed among residents of the state of Idaho, 305 among Boundary County residents. It is estimated that almost one in two Idahoans will develop cancer during their lifetime. Cancer Incidence 2010-2014 Boundary County State of Idaho All Sites/Types 305 37,621 Female Breast 34 5,295 Prostate 65 5,187 Lung & Bronchus 39 4,338 Colorectal 20 3,049 The table, CANCER INCIDENCE 2010-2014, COMPARISON BETWEEN BOUNDARY COUNTY AND THE REMAINDER OF THE STATE OF IDAHO, shows for Boundary County the number of observed cases, person-years, crude rates, age and sex-adjusted rates, expected number of cases based upon age and sex-specific rates in the remainder of Idaho, and p-values for tests comparing the number of observed and expected cases. The table also shows the number of observed cases, person-years, and crude rates for the remainder of the state of Idaho. Comparisons were made for all cancers combined, 23 invasive cancer types, in situ breast cancer, non-malignant brain and other central nervous system tumors and pediatric cancer. Separate comparisons for males, females, and both sexes combined are included. As the table shows, the crude rate of invasive cancer incidence in Boundary County was 559.6 cases per 100,000 personyears for the years 2010-2014. Compared with the crude incidence rate for the remainder of Idaho (469.7), this gives an estimate of the burden of disease in Boundary County. The age- and sex-adjusted incidence rate of invasive cancer in Boundary County, all sites combined, was 426.6 cases per 100,000 persons per year for the years 2010-2014. There were fewer cases of cancer in Boundary County (305) than expected (335.8) based upon rates in the remainder of the state, but the difference was not statistically significant. There are many reasons why cancer incidence rates differ by county, related to smoking, other personal behaviors, socioeconomic status, and other factors. CANCER MORTALITY 2011-2015 In 2008 cancer became the leading cause of death in Idaho. From 2011-2015, 13,470 persons in Idaho died from cancer, 117 in Boundary County. The majority of cancer deaths are from five primary sites: lung, colon, pancreas, female breast, and prostate. Mortality 2011-2015 Boundary County State of Idaho All Deaths 544 62,050 Cancer Deaths % of All Deaths 117 22% 13,470 21.7% Lung & Bronchus 25 3,169 Colorectal 11 1,143 Pancreas 14 984 Female Breast 9 942 The table, CANCER MORTALITY 2011-2015, COMPARISON BETWEEN BOUNDARY COUNTY AND THE REMAINDER OF THE STATE OF IDAHO, shows for Boundary County the number of observed deaths, person-years, crude rates, age and sex-adjusted rates, expected number of deaths based upon age and sex-specific rates in the remainder of Idaho, and p-values for tests comparing the number of observed and expected deaths. The table also shows the number of observed deaths, person-years, and crude rates for the remainder of the state of Idaho. Comparisons were made for all deaths, all cancer deaths, and 21 specific cancer types. Separate comparisons for males, females, and both sexes combined are included. The age- and sex-adjusted cancer mortality rate for Boundary County, all sites combined, was 158.7 deaths per 100,000 persons per year for the years 2011-2015, compared with 166.3 for the remainder of the state. There were fewer cancer deaths in Boundary County (117) than expected (122.6) based upon rates in the remainder of the state, but the difference was not statistically significant. Prostate 14 861 Statistical Note: Rates and percentages based upon 12 or fewer cases or deaths (numerator) should be interpreted with caution. Data Note: Mortality data may differ slightly from published official statistics from the Bureau of Vital Records and Health Statistics. 2

CANCER INCIDENCE 2010-2014 COMPARISON BETWEEN BOUNDARY COUNTY AND THE REMAINDER OF THE STATE OF IDAHO Boundary County Remainder of Idaho Cancer Observed Person Crude A.A.I. Expected Observed Person Crude Site/Type Sex Cases Years Rate (1) Rate (1,2) Cases (3) P-Value (4) Cases Years Rate (1) All Sites Combined Total 305 54,500 559.6 426.6 335.8 0.095 37,316 7,944,308 469.7 All Sites Combined Male 185 27,555 671.4 482.9 186.8 0.936 19,394 3,977,725 487.6 All Sites Combined Female 120 26,945 445.4 356.7 152.0 0.008 << 17,922 3,966,583 451.8 Bladder Total 18 54,500 33.0 24.3 17.3 0.926 1,856 7,944,308 23.4 Bladder Male 15 27,555 54.4 38.1 14.5 0.966 1,464 3,977,725 36.8 Bladder Female 3 26,945 11.1 8.6 3.4 1.000 392 3,966,583 9.9 Brain - malignant Total 3 54,500 5.5 4.5 4.2 0.773 512 7,944,308 6.4 Brain - malignant Male 1 27,555 3.6 2.9 2.7 0.515 310 3,977,725 7.8 Brain - malignant Female 2 26,945 7.4 6.3 1.6 0.963 202 3,966,583 5.1 Brain and other CNS - non-malignant Total 12 54,500 22.0 18.0 7.5 0.155 892 7,944,308 11.2 Brain and other CNS - non-malignant Male 1 27,555 3.6 2.9 2.6 0.519 307 3,977,725 7.7 Brain and other CNS - non-malignant Female 11 26,945 40.8 34.0 4.8 0.020 >> 585 3,966,583 14.7 Breast Total 34 54,500 62.4 48.1 47.2 0.055 5,307 7,944,308 66.8 Breast Male - 27,555 - - 0.4 1.000 46 3,977,725 1.2 Breast Female 34 26,945 126.2 100.1 45.1 0.106 5,261 3,966,583 132.6 Breast - in situ Total 5 54,500 9.2 7.2 9.1 0.220 1,041 7,944,308 13.1 Breast - in situ Male - 27,555 - - 0.0 1.000 2 3,977,725 0.1 Breast - in situ Female 5 26,945 18.6 14.9 8.8 0.256 1,039 3,966,583 26.2 Cervix Female 1 26,945 3.7 3.4 1.8 0.911 244 3,966,583 6.2 Colorectal Total 20 54,500 36.7 27.9 27.3 0.182 3,029 7,944,308 38.1 Colorectal Male 13 27,555 47.2 34.1 15.3 0.669 1,599 3,977,725 40.2 Colorectal Female 7 26,945 26.0 20.6 12.2 0.159 1,430 3,966,583 36.1 Corpus Uteri Female 10 26,945 37.1 28.8 9.2 0.879 1,050 3,966,583 26.5 Esophagus Total 4 54,500 7.3 5.5 3.7 0.993 396 7,944,308 5.0 Esophagus Male 3 27,555 10.9 7.8 3.2 1.000 330 3,977,725 8.3 Esophagus Female 1 26,945 3.7 2.9 0.6 0.875 66 3,966,583 1.7 Hodgkin Lymphoma Total - 54,500 - - 1.4 0.484 207 7,944,308 2.6 Hodgkin Lymphoma Male - 27,555 - - 0.8 0.875 114 3,977,725 2.9 Hodgkin Lymphoma Female - 26,945 - - 0.6 1.000 93 3,966,583 2.3 Kidney and Renal Pelvis Total 9 54,500 16.5 12.6 11.8 0.525 1,307 7,944,308 16.5 Kidney and Renal Pelvis Male 7 27,555 25.4 18.4 7.9 0.927 829 3,977,725 20.8 Kidney and Renal Pelvis Female 2 26,945 7.4 5.9 4.1 0.453 478 3,966,583 12.1 Larynx Total 2 54,500 3.7 2.7 1.8 1.000 195 7,944,308 2.5 Larynx Male 2 27,555 7.3 5.0 1.6 0.959 162 3,977,725 4.1 Larynx Female - 26,945 - - 0.3 1.000 33 3,966,583 0.8 Leukemia Total 14 54,500 25.7 20.3 11.4 0.516 1,317 7,944,308 16.6 Leukemia Male 8 27,555 29.0 22.0 6.9 0.774 756 3,977,725 19.0 Leukemia Female 6 26,945 22.3 18.3 4.6 0.642 561 3,966,583 14.1 Liver and Bile Duct Total 3 54,500 5.5 4.1 5.2 0.488 558 7,944,308 7.0 Liver and Bile Duct Male 2 27,555 7.3 5.2 3.8 0.545 394 3,977,725 9.9 Liver and Bile Duct Female 1 26,945 3.7 2.8 1.5 1.000 164 3,966,583 4.1 Lung and Bronchus Total 39 54,500 71.6 52.2 40.4 0.907 4,299 7,944,308 54.1 Lung and Bronchus Male 21 27,555 76.2 52.7 22.0 0.936 2,200 3,977,725 55.3 Lung and Bronchus Female 18 26,945 66.8 51.4 18.5 1.000 2,099 3,966,583 52.9 Melanoma of the Skin Total 9 54,500 16.5 13.2 19.1 0.017 << 2,220 7,944,308 27.9 Melanoma of the Skin Male 5 27,555 18.1 13.5 12.1 0.037 << 1,306 3,977,725 32.8 Melanoma of the Skin Female 4 26,945 14.8 12.6 7.3 0.288 914 3,966,583 23.0 Myeloma Total 2 54,500 3.7 2.7 4.7 0.301 506 7,944,308 6.4 Myeloma Male 2 27,555 7.3 5.0 3.1 0.783 315 3,977,725 7.9 Myeloma Female - 26,945 - - 1.7 0.379 191 3,966,583 4.8 Non-Hodgkin Lymphoma Total 12 54,500 22.0 16.8 14.0 0.726 1,550 7,944,308 19.5 Non-Hodgkin Lymphoma Male 11 27,555 39.9 29.0 8.3 0.431 872 3,977,725 21.9 Non-Hodgkin Lymphoma Female 1 26,945 3.7 3.0 5.8 0.042 << 678 3,966,583 17.1 Oral Cavity and Pharynx Total 7 54,500 12.8 9.8 9.5 0.541 1,050 7,944,308 13.2 Oral Cavity and Pharynx Male 6 27,555 21.8 16.1 6.7 1.000 711 3,977,725 17.9 Oral Cavity and Pharynx Female 1 26,945 3.7 2.9 2.9 0.427 339 3,966,583 8.5 Ovary Female 5 26,945 18.6 14.8 4.3 0.863 505 3,966,583 12.7 Pancreas Total 14 54,500 25.7 19.0 10.0 0.266 1,075 7,944,308 13.5 Pancreas Male 6 27,555 21.8 15.5 5.5 0.927 559 3,977,725 14.1 Pancreas Female 8 26,945 29.7 23.0 4.5 0.178 516 3,966,583 13.0 Prostate Male 65 27,555 235.9 163.0 51.3 0.074 5,122 3,977,725 128.8 Stomach Total 3 54,500 5.5 4.1 3.8 0.933 418 7,944,308 5.3 Stomach Male 1 27,555 3.6 2.6 2.7 0.489 277 3,977,725 7.0 Stomach Female 2 26,945 7.4 5.8 1.2 0.687 141 3,966,583 3.6 Testis Male - 27,555 - - 1.4 0.482 242 3,977,725 6.1 Thyroid Total 1 54,500 1.8 1.7 9.7 0.001 << 1,268 7,944,308 16.0 Thyroid Male 1 27,555 3.6 3.0 2.4 0.618 288 3,977,725 7.2 Thyroid Female - 26,945 - - 7.2 0.001 << 980 3,966,583 24.7 Pediatric Age 0 to 19 Total - 14,448 - - 2.4 0.180 397 2,353,958 16.9 Pediatric Age 0 to 19 Male - 7,524 - - 1.4 0.503 223 1,204,329 18.5 Pediatric Age 0 to 19 Female - 6,924 - - 1.0 0.709 174 1,149,629 15.1 Notes: 1. Rates are expressed as the number of cases per 100,000 persons per year (person-years). 2. Age and sex-adjusted incidence (A.A.I.) rates for county use age and sex-specific crude rates for the remainder of the state as standard. 3. Expected cases are based upon age and sex-specific rates for the remainder of the state of Idaho (compare to observed). 4. P-values compare observed and expected cases, are two tailed, based upon the Poisson probability distribution. "<<" denotes significantly fewer cases observed than expected, ">>" denotes significantly more cases observed than expected (p=.05). Statistical Note: Rates based upon 12 or fewer cases (numerator) should be interpreted with caution. 3

CANCER MORTALITY 2011-2015 COMPARISON BETWEEN BOUNDARY COUNTY AND THE REMAINDER OF THE STATE OF IDAHO Boundary County Remainder of Idaho Cause of Death Observed Person Crude A.A.M. Expected Observed Person Crude Cancer Site/Type Sex Deaths Years Rate (1) Rate (1,2) Deaths (3) P-Value (4) Deaths Years Rate (1) All Causes of Death Total 544 54,806 992.6 771.2 540.4 0.890 61,506 8,027,946 766.1 All Causes of Death Male 292 27,694 1,054.4 805.4 286.6 0.765 31,774 4,019,514 790.5 All Causes of Death Female 252 27,112 929.5 727.6 256.9 0.792 29,732 4,008,432 741.7 All Malignant Cancers Total 117 54,806 213.5 158.7 122.6 0.654 13,353 8,027,946 166.3 All Malignant Cancers Male 61 27,694 220.3 157.1 70.2 0.298 7,266 4,019,514 180.8 All Malignant Cancers Female 56 27,112 206.6 159.7 53.3 0.743 6,087 4,008,432 151.9 Bladder Total 2 54,806 3.6 2.7 3.3 0.722 360 8,027,946 4.5 Bladder Male 2 27,694 7.2 5.2 2.6 1.000 272 4,019,514 6.8 Bladder Female - 27,112 - - 0.8 0.913 88 4,008,432 2.2 Brain and Other Nervous System Total 3 54,806 5.5 4.2 3.9 0.910 441 8,027,946 5.5 Brain and Other Nervous System Male 1 27,694 3.6 2.7 2.6 0.545 284 4,019,514 7.1 Brain and Other Nervous System Female 2 27,112 7.4 5.8 1.4 0.786 157 4,008,432 3.9 Breast Total 9 54,806 16.4 12.5 8.5 0.943 941 8,027,946 11.7 Breast Male - 27,694 - - 0.1 1.000 8 4,019,514 0.2 Breast Female 9 27,112 33.2 25.9 8.1 0.836 933 4,008,432 23.3 Cervix Female - 27,112 - - 0.6 1.000 75 4,008,432 1.9 Colorectal Total 11 54,806 20.1 15.1 10.3 0.909 1,132 8,027,946 14.1 Colorectal Male 5 27,694 18.1 13.0 6.0 0.878 632 4,019,514 15.7 Colorectal Female 6 27,112 22.1 17.2 4.4 0.544 500 4,008,432 12.5 Corpus Uteri Female - 27,112 - - 1.0 0.757 110 4,008,432 2.7 Esophagus Total 6 54,806 10.9 8.1 3.4 0.267 371 8,027,946 4.6 Esophagus Male 4 27,694 14.4 10.3 2.9 0.647 298 4,019,514 7.4 Esophagus Female 2 27,112 7.4 5.6 0.6 0.275 73 4,008,432 1.8 Hodgkin Lymphoma Total - 54,806 - - 0.2 1.000 26 8,027,946 0.3 Hodgkin Lymphoma Male - 27,694 - - 0.1 1.000 11 4,019,514 0.3 Hodgkin Lymphoma Female - 27,112 - - 0.1 1.000 15 4,008,432 0.4 Kidney Total 2 54,806 3.6 2.7 3.3 0.705 361 8,027,946 4.5 Kidney Male 2 27,694 7.2 5.1 2.4 1.000 244 4,019,514 6.1 Kidney Female - 27,112 - - 1.0 0.713 117 4,008,432 2.9 Larynx Total 1 54,806 1.8 1.3 0.5 0.846 59 8,027,946 0.7 Larynx Male 1 27,694 3.6 2.6 0.5 0.761 50 4,019,514 1.2 Larynx Female - 27,112 - - 0.1 1.000 9 4,008,432 0.2 Leukemia Total 8 54,806 14.6 11.1 4.9 0.247 548 8,027,946 6.8 Leukemia Male 3 27,694 10.8 7.9 3.0 1.000 321 4,019,514 8.0 Leukemia Female 5 27,112 18.4 14.6 1.9 0.095 227 4,008,432 5.7 Liver and Bile Duct Total 2 54,806 3.6 2.7 4.6 0.331 490 8,027,946 6.1 Liver and Bile Duct Male 2 27,694 7.2 5.1 3.1 0.783 320 4,019,514 8.0 Liver and Bile Duct Female - 27,112 - - 1.5 0.439 170 4,008,432 4.2 Lung and Bronchus Total 25 54,806 45.6 33.2 29.5 0.467 3,144 8,027,946 39.2 Lung and Bronchus Male 11 27,694 39.7 27.4 16.9 0.175 1,695 4,019,514 42.2 Lung and Bronchus Female 14 27,112 51.6 39.4 12.8 0.820 1,449 4,008,432 36.1 Melanoma of the Skin Total 1 54,806 1.8 1.4 2.8 0.468 310 8,027,946 3.9 Melanoma of the Skin Male - 27,694 - - 1.9 0.293 204 4,019,514 5.1 Melanoma of the Skin Female 1 27,112 3.7 2.9 0.9 1.000 106 4,008,432 2.6 Myeloma Total 1 54,806 1.8 1.3 2.5 0.575 270 8,027,946 3.4 Myeloma Male 1 27,694 3.6 2.5 1.6 1.000 161 4,019,514 4.0 Myeloma Female - 27,112 - - 0.9 0.782 109 4,008,432 2.7 Non-Hodgkin Lymphoma Total 1 54,806 1.8 1.4 4.9 0.084 538 8,027,946 6.7 Non-Hodgkin Lymphoma Male - 27,694 - - 3.0 0.099 309 4,019,514 7.7 Non-Hodgkin Lymphoma Female 1 27,112 3.7 2.9 2.0 0.815 229 4,008,432 5.7 Oral Cavity and Pharynx Total 2 54,806 3.6 2.7 1.9 1.000 205 8,027,946 2.6 Oral Cavity and Pharynx Male 1 27,694 3.6 2.6 1.4 1.000 148 4,019,514 3.7 Oral Cavity and Pharynx Female 1 27,112 3.7 2.9 0.5 0.777 57 4,008,432 1.4 Ovary Female 2 27,112 7.4 5.6 3.3 0.704 375 4,008,432 9.4 Pancreas Total 14 54,806 25.5 18.7 9.0 0.150 970 8,027,946 12.1 Pancreas Male 7 27,694 25.3 17.7 5.2 0.535 529 4,019,514 13.2 Pancreas Female 7 27,112 25.8 19.8 3.9 0.200 441 4,008,432 11.0 Prostate Male 14 27,694 50.6 36.6 8.1 0.071 847 4,019,514 21.1 Stomach Total 2 54,806 3.6 2.7 1.8 1.000 199 8,027,946 2.5 Stomach Male 1 27,694 3.6 2.6 1.3 1.000 135 4,019,514 3.4 Stomach Female 1 27,112 3.7 2.9 0.6 0.854 64 4,008,432 1.6 Notes: 1. Rates are expressed as the number of cases per 100,000 persons per year (person-years). 2. Age and sex-adjusted mortality (A.A.M.) rates for county use age and sex-specific crude rates for the remainder of the state as standard. 3. Expected cases are based upon age and sex-specific rates for the remainder of the state of Idaho (compare to observed). 4. P-values compare observed and expected cases, are two tailed, based upon the Poisson probability distribution. "<<" denotes significantly fewer cases observed than expected, ">>" denotes significantly more cases observed than expected (p=.05). Statistical Notes: Rates based upon 12 or fewer cases (numerator) should be interpreted with caution. Mortality statistics presented differ from BVRHS official statistics due to differences in methodology. Data Source: Bureau of Vital Records and Health Statistics (BVRHS), Division of Public Health, Idaho Department of Health and Welfare, 2015. 4

Cancer Screening and Risk Factors The Bureau of Vital Records and Health Statistics (BVRHS), Division of Public Health, Idaho Department of Health and Welfare, under a cooperative agreement with the Centers for Disease Control and Prevention, has conducted telephone Behavioral Risk Factor Surveys (BRFS) since 1984 of random samples of adult Idahoans to measure population prevalences of risk factors for the major causes of death, including cancer. The BVRHS provided data sets containing Behavioral Risk Factor Surveillance System (BRFSS) data from 2011 through 2015 to CDRI staff, who performed the analyses reported in these County Profiles. Analysis weights were poststratified to 2015 population estimates by age group, sex, and county, beginning with the BRFSS raked weights. Not all questions were asked in all years. A minimum of 50 respondents was required to generate county-level statistics. Results may differ from IDHW reports due to differences in methods. The cancer screening and risk factor measures were selected to assist in monitoring Comprehensive Cancer Alliance for Idaho objectives. Wald log-linear chi-square statistics were used to test for independence of the selected measures and other variables such as age and race, taking into account the complex survey design. Access to Care Cancer Screening and Risk Factor Prevalence Estimates, 2011-2015 State of Idaho HD 1 HD 2 HD 3 HD 4 HD 5 HD 6 HD 7 Cancer Screening Boundary County Access to Care Health Insurance, Age <65 (2014-2015) 81.4% 81.1% 86.1% 74.2% 86.1% 72.6% 83.8% 82.5% 77.4% Not See Doctor Due to Cost Past Year (2014-2015) 14.5% 13.3% 11.8% 21.1% 13.5% 15.3% 11.8% 13.1% 7.6% Cancer Screening Mammogram Past 2 Years, Age 50-74 (2012, 2014) 69.7% 72.5% 69.8% 62.1% 73.9% 68.6% 67.2% 68.2%. Pap Test Past 3 Years, Cervix Intact Age 21-65 (2012, 2014) 76.4% 77.2% 80.8% 67.2% 80.9% 75.1% 75.9% 74.9%. Colorectal Cancer Screening, Age 50-75 (2012, 2014) 61.9% 60.6% 65.3% 56.4% 67.8% 57.9% 59.5% 60.6% 47.2% Tobacco Use Current Smoker (2013-2015) 15.6% 18.1% 15.0% 18.9% 14.3% 17.8% 13.5% 11.2% 16.5% Current Smokeless Tobacco User, Males (2012-2015) 9.3% 10.0% 15.2% 10.9% 8.0% 10.3% 6.6% 7.5% 9.7% Other Cancer-Related Sunburn in Previous 12 Months (2014) 50.2% 45.9% 52.0% 45.4% 53.2% 47.8% 52.1% 53.9%. Artificial Tanning Appliance Use (2011, 2014) 5.1% 6.6% 3.9% 3.9% 3.4% 5.4% 6.6% 8.2% 4.4% Weight Classification by Body Mass Index (2013-2015) 32.6% 33.6% 35.7% 26.4% 35.9% 30.1% 32.6% 32.3% 26.5% Meet Physical Activity Guidelines (2011, 2013, 2015) 21.5% 21.1% 18.2% 19.1% 25.6% 19.1% 20.7% 19.6% 12.7% Home Ever Tested for Radon (2012, 2014) 15.7% 22.8% 9.8% 11.0% 15.3% 14.0% 17.5% 18.2% 7.4% Health Insurance 2014-2015 Statewide, 81.4% of adults aged 18-64 reported having health care coverage. Health care coverage differed significantly by race/ethnicity, with 84.0% of white non-hispanics, compared to 63.8% of Hispanics and 85.7% of Native Americans, having health insurance. Spanish-speaking respondents were significantly less likely to be insured (36.7%) than Englishspeaking respondents (83.0%). Health care coverage differed significantly by age of respondent, with 77.0% of persons aged 18-29, and 86.4% of persons aged 50-64, having health insurance. Health care coverage differed significantly by county, with a range of 61.0% (Jerome County) to 90.1% (Elmore County) having health insurance. Not See Doctor Due to Cost Past Year 2014-2015 Statewide, 14.5% of adults aged 18+ reported they needed to see a doctor but could not because of cost sometime in the past 12 months. Inability to see a doctor due to cost differed significantly by race/ethnicity (13.4% of white non-hispanics, 23.8% of Hispanics, and 13.2% of Native Americans). Inability to see a doctor due to cost differed significantly by annual household income (30.2% for less than $15,000, 7.2% for greater than $50,000). Inability to see a doctor due to cost differed significantly by county, with a range of 7.0% (Elmore County) to 23.1% (Jerome County). ** Current for colorectal cancer screening means a blood stool test in the past year, sigmoidoscopy in the past 5 years and blood stool test in the past 3 years, or a colonoscopy in the past 10 years. Mammogram 2012, 2014 Statewide, 69.7% of women aged 50-74 reported having a mammogram in the past 2 years. Insured women were about twice as likely to have had a mammogram in the past 2 years (73.4% versus 39.2%). Mammography rates differed significantly by county, with a range in screening of 55.1% (Gem County) to 79.5% (Nez Perce County). In 2014, Idaho ranked 50 th among states and the District of Columbia for mammography screening rates among women aged 40+ and 50-74. Pap Test 2012, 2014 Statewide, 76.4% of women aged 21-65 (with intact cervix) reported having a Pap test in the past 3 years. Women with health insurance were significantly more likely to have timely Pap screening than uninsured women (78.5% versus 69.4% screened in the past 3 years). Pap screening differed significantly by county, with a range of 63.4% (Madison County) to 90.6% (Nez Perce County). In 2014, Idaho had the lowest Pap screening rate among states and the District of Columbia. Colorectal Cancer Screening 2012, 2014 Statewide, 61.9% of adults aged 50-75 reported receiving colorectal cancer screening based on the most recent guidelines.** Persons with health insurance were over twice as likely to be current for colorectal cancer screening. In 2014, Idaho ranked 44 th among states and the District of Columbia in the percentage of adults aged 50-75 and older who reported being current with colorectal cancer screening recommendations. 5

Cancer Screening and Risk Factors Tobacco Use Current Smoking 2013-2015 Statewide, 15.6% of adults aged 18 and older were current smokers. Smoking prevalence differed significantly by age of respondent, with 20.2% of persons aged 30-39, and 7.9% of persons aged 65 and older, reporting current smoking. Smoking prevalence was lower among white non-hispanics (15.3%) than among Native Americans (36.1%). Smoking prevalence differed significantly by county, with a range of 4.2% (Madison County) to 30.0% (Elmore County). Counties with higher rates of current smoking had higher rates of lung cancer. Smokeless Tobacco Use, Males 2012-2015 Statewide, 9.3% of males aged 18 and older were current users of smokeless tobacco. Smokeless tobacco use differed significantly by age group, ranging from 13.3% of males aged 30-39 to 4.2% of males aged 65 and older. Smokeless tobacco use differed significantly by county, with a range of 1.0% (Franklin County) to 22.0% (Owyhee County). Other Cancer-Related Sun Exposure 2014 Statewide, 50.2% of adults aged 18 and older reported having sunburn in the past 12 months. Sunburn rates were higher for white non-hispanics (52.7%) than for Hispanics (37.7%) or Native Americans (37.6%). Males (54.2%) were more likely than females (46.2%) to have had sunburn in the past 12 months. Sunburn rates differed significantly by age group, with 70.7% of persons aged 18-29 and 19.4% of persons aged 65 and older having sunburn in the past 12 months. Sunburn rates differed significantly by county, with a range of 33.5% (Lemhi County) to 68.8% (Latah County) having sunburn in the past 12 months. Artificial Tanning Appliance Use 2011, 2014 Statewide, 5.1% of adults aged 18 and older reported using an artificial tanning appliance, such as a tanning bed, in the past 12 months. Females (7.8%) were significantly more likely than males (2.4%) to have used an artificial tanning appliance in the past 12 months. Tanning appliance use differed significantly by age group, with 10.6% of persons aged 18-29 and 1.0% of persons aged 65 and older, using an appliance in the past 12 months. Tanning appliance use differed by county, with a range of less than 1% (Gem and Power Counties) to over 9% (Fremont and Madison Counties) using an artificial tanning appliance in the past 12 months. Weight Classification by Body Mass Index 2013-2015 Statewide, 32.6% of adults aged 20 and older were in the healthy weight range as measured by body mass index (BMI 18.5-24.9). BMI differed significantly by race/ethnicity, with 33.4% of white non-hispanics, compared to 25.4% of Hispanics and 25.1% of Native Americans, being in the healthy weight range. Males (25.9%) were significantly less likely to be in the healthy weight range than females (39.4%). BMI differed significantly by age of respondent, with 44.6% of persons aged 18-29, and 26.6% of persons aged 50-64, being in the healthy weight range. BMI differed significantly by county, with a range of 17.9% (Gem County) to 49.5% (Blaine County) of adults being in the healthy weight range. Counties with higher percentages of adults in the healthy weight range had significantly lower rates of colorectal cancer (p=.004). Physical Activity 2011, 2013, 2015 Statewide, 21.5% of adults aged 18 and older met aerobic and strength physical activity guidelines during the past month or week. Physical activity differed significantly by age of respondent, with 25.2% of persons aged 18-29, and 18.8% of persons aged 50-64, meeting guidelines. The percentage of adults meeting physical activity guidelines differed significantly by county, with a range of 7.5% (Oneida County) to 29.7% (Blaine County). Home Radon Testing 2012, 2014 Statewide, 15.7% of adults have ever tested their house for radon. Radon test usage varied significantly by race/ethnicity, with 16.8% of white non-hispanics, 6.0% of Hispanics, and 15.9% of Native Americans having ever tested their house for radon. Radon test usage was higher for persons aged 50-64 than for younger persons. Home radon testing differed significantly by county, with a range of 4.7% (Lewis County) to 44.2% (Blaine County). 6