Arizona Behavioral Risk Factor Survey Annual report

              1995 ARIZONA
BEHAVIORAL RISK FACTOR SURVEY
ANNUAL REPORT
EPIDEMIOLOGIC REPORT
Fife Symington, Governor
State of Arizona
Jack Dillenberg, D.D.S., M.P.H., Director
Arizona Department of Health Services
Permission to quote from or reproduce from this publication is granted when due
acknowledgment is made.
1995 ARIZONA
BEHAVIORAL RISK FACTOR SURVEY
ANNUAL REPORT
Arizona Department of Health Services
Epidemiology and Disease Control
Office of Chronic Disease Epidemiology
1400 West Washington, Suite 127
Phoenix, Arizona 85007
(602) 542-7335
Funded by the Centers for Disease Control
i
Cooperative Agreement No. U58/CCU900587-13
BEHAVIORAL RISK FACTOR SURVEY (BRFS)
1995 ANNUAL REPORT
ARIZONA DEPARTMENT OF HEALTH SERVICES
DISEASE PREVENTION SERVICES
CO-AUTHORS:
Brian A. Bender, Manager
Telephone Survey Center
Office of Chronic Disease Epidemiology
Richard S. Porter, Chief
Office of Chronic Disease Epidemiology
Notice
The Arizona Department of Health Services does not discriminate on the basis of disability in the administration of
its programs and services as prescribed by Title II of the Americans with Disabilities Act of 1990 and Section 504 of
the Rehabilitation Act of 1973.
If you need this publication in an alternative format, please contact the ADHS Office of Chronic Disease
Epidemiology at (602) 542-7333.
ACKNOWLEDGMENTS
This report could not have been completed without the input and assistance from the
following individuals.
1995 BRFS Interviewers
Kathleen Cook, Supervisor
Socorro Candelaria
Janice McNally
Ed Molina
Sylvester Deaner
Sean Ives
Centers for Disease Control and Prevention
Office of Surveillance and Analysis
Michael Gay, M.A.Ed.
Bill Garvin
Claude Comeau (Consultant)
A special thank you to the Arizona residents for participating in the survey and
cooperating with the interviewers.
TABLE OF CONTENTS
CO-AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
1
ACKNOWLEDGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii
EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1995 BEHAVIORAL RISK FACTOR SURVEY HIGHLIGHTS . . . . . . . . . . . . . 2
RISK FACTORS DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1. INTRODUCTION & DATA UTILIZATION . . . . . . . . . . . . . . . . . . . . . . . . . 4
2. METHODOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
A. SAMPLING DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
B. QUESTIONNAIRE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
C. DATA ANALYSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
D. DEMOGRAPHICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
3. SURVEY RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
A. ALCOHOL - CHRONIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
B. ALCOHOL - BINGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
C. ALCOHOL - DRINKING AND DRIVING . . . . . . . . . . . . . . . . . . 11
D. DIABETES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
E. FRUITS AND VEGETABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
F. HEALTH CARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
G. MAMMOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
H. MAMMOGRAPHY AND BREAST EXAM . . . . . . . . . . . . . . . . . 17
I. OVERWEIGHT (OBESITY) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
J. SEAT BELT USE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
K. EXERCISE (SEDENTARY LIFESTYLE) . . . . . . . . . . . . . . . . . . 22
L. SMOKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
EXECUTIVE SUMMARY
In 1981, the Centers for Disease Control and Prevention (CDC) began developing a Behavioral Risk
Factor Surveillance System (BRFSS) as a method of assessing the prevalence of high risk health
behaviors at the state level. Arizona's BRFS was established in 1982 by the Arizona Department of
Health Services (ADHS) through a cooperative agreement with the CDC.
2
Arizona has actively participated in the BRFSS program since 1984. Since then, the personal health
habits of the adult population of Arizona have been monitored annually through an ongoing monthly
telephone survey.
Data from BRFS have been used by state and local health agencies for program planning. The ADHS
integrated BRFS data into its planning functions and as a reference to other epidemiological
applications. In addition, BRFSS data has supported county health department staff in determining and
justifying budgetary needs for health promotion and education. The BRFS program continues to be a
rich source of unique state level public health data which have become an integral part of overall health
promotion and disease prevention/intervention planning.
This report examines behaviors reported in 1995 related to the development of cardiovascular disease
(smoking, overweight and sedentary lifestyles), alcohol abuse (binge, chronic and drinking and driving),
health care access, fruit and vegetable consumption, the use of seat belts, mammography, diabetes, and
weight control. The data have been analyzed by the CDC and weighted to match the state's 1995
census data for age and gender, thus providing estimates of the risk factor prevalence among Arizona
adults.
3
1995 BEHAVIORAL RISK FACTOR SURVEY HIGHLIGHTS
Behavioral Risk Factor Survey
Risk Factors by Demographics - Arizona - 1995
Risk
Factors
(Prevalence)
Reported Groups at Highest Risk
Sex/Age
Race/
Ethnicity
Marital
Status Income
Employment
Status
Education
Level
Binge (Acute) Drinking
(13.5%)
Males/25-34
(33.0%)
Females/18-24
(14.2%)
Hispanic
(18.3%)
Unmarried Couple
(23.3%)
$25 - $34,999
(21.8%)
Student (33.6%) Some College (16.5%)
Chronic Drinking
(2.4%)
Males/18-24
(8.4%)
Females/45-54
(1.3%)
White
(2.8%)
Never Married
(6.1%)
$25 - $34,999
(4.6%)
Employed for
Wages (3.1%)
Some College (3.1%)
Drinking & Driving
(2.7%)
Males/25.34
(7.1%)
Females/35-44
(5.0%)
White
(3.0%)
Never Married
(6.2%)
$25 - $34,999
(6.1%)
Employed for
Wages (4.4%)
High School Grad/GED
(3.8%)
Diabetes
(4.8%)
Males/65+
(13.6%)
Females/55-64
(9.7%)
Hispanic
(7.1%)
Both Married &
Widowed (5.5%)
<$10,000 (11.4%) Retired/Unable to
Work
(11.0%)
Elementary
(11.1%)
Low Fruit & Vegetable
Consumption
(75.7%)
Males/35-44
(89.5%)
Females/18-24
(81.8%)
Hispanic
(81.5%)
Not Available <$10,000
(84.6%)
Not Available Some High School
(83.7%)
No Health Care Plan
(15.2%)
Males/18-24
(21.5%)
Females/18-24
(34.8%)
Hispanic
(30.7%)
Unmarried Couple
(33.2%)
$15 - $19,999
(36.3%)
Out of Work
>1 Year
(37.8%)
Some High School
(34.0%)
Mammography
(14.0%)
Females/40-49
(19.7%)
White
(13.8%)
Divorced (19.3%) < $10,000 (23.8%) Self-Employed
(6.2%)
Some High School
(5.2%)
Overweight (BMI)
(24.5%)
Males/45-54
(41.7%)
Females/55-64
(32.8%)
Black
(42.5%)
Married (28.3%) $15 - $19,999
(32.4%)
Out of Work >1
Year (36.5%)
Never Attended School
(34.8%)
Seatbelt
Non-Use
(25.9%)
Males/18-24
(39.4%)
Females/18-24
(26.7%)
Hispanic
(29.2%)
Unmarried Couple
(42.7%)
<$10,000 (37.0%) Student (36.7%) Some High School
(36.2%)
Sedentary Lifestyle
(59.8%)
Males/45-54
(73.9%)
Females/75+
(67.2%)
Hispanic
(70.5%)
Never Married
(83.0%)
$15 - $19,999
(69.1%)
Out of Work <1
Year (78.0%)
Some High School
(71.4%)
Current Smoking
(22.9%)
Males/18-24
(38.2%)
Females/35-44
(25.9%)
White
(24.3%)
Unmarried Couple
(42.5%)
<$10,000 (29.8%) Out of Work <1
Year (34.4%)
Some High School
(31.1%)
RISK FACTORS DEFINITIONS
4
Acute (Binge) Drinking Respondents reporting they had five or more drinks on one or more occasions, in
the past month.
Chronic Drinking Respondents reporting they had on average 60 or more alcoholic drinks a month.
Drinking and Driving Respondents reporting they have driven after having too much to drink one or
more times in the past month.
Diabetes Respondents reporting that they have been told by a doctor that they have
diabetes.
Fruits & Vegetables Respondents reporting that they consume less than five servings of fruits and
vegetables daily.
Health Care Plan Respondents reporting that they do not have health care coverage.
Mammography Female respondents reporting that they have never had a mammogram.
Mammography and Female respondents reporting that they have never had a mammogram and
Breast Exam clinical breast examination.
Overweight The CDC defines obesity as: females with a BMI (Body Mass Index) $27.3
and males with a BMI $27.8 (BMI is weight in kilograms divided by height in
meters squared (W/H²).
Seat Belt Use Respondents reporting they "sometimes", "seldom" or "never" use seat
belts.
Sedentary Lifestyle Respondents reporting no physical activity or who reported a physical activity or
pair of activities that were done for 20 minutes or less, fewer than three
times/week.
Smoking Respondents reporting smoking 100 cigarettes and who smoke now (regularly
and irregularly).
5
1. INTRODUCTION & DATA UTILIZATION
Arizona has participated in the Behavioral Risk Factor Survey (BRFS) since 1982. Through a cooperative
agreement with the Centers for Disease Control and Prevention (CDC), the Arizona Department of Health
Services implemented BRFS as a method to collect data on health risk behaviors of adult residents and to
monitor the prevalence of these behaviors over time.
After starting in 1982 with paper and pencil data collection, the state advanced in 1986 to the Computer
Assisted Telephone Interviewing (CATI) system and converted to the Auto-Telephone system, a version of
random digit dialing.
Arizona's sample was drawn from all residents 18 years of age and older with the exception of institutionalized
persons. The prevalence estimates for the total population are accurate to within plus- or minus- 3% at the 95%
confidence level.
Today, chronic diseases and injuries have become the major cause of morbidity and mortality. In Arizona five of
the 10 leading causes of death are due to chronic diseases. The purpose of BRFSS is to provide data that can
be used to plan, implement and monitor health promotion and disease prevention efforts, as well as to study the
distribution among demographic subgroups.
LEADING CAUSES OF DEATH
IN THE STATE OF ARIZONA, 1995
RANK CAUSE OF DEATH
NUMBER OF
DEATHS
PERCENTAGE OF
TOTAL DEATHS
1 Heart Disease 10,104 28.5
2 Cancer 7,993 22.6
3 Cerebrovascular Disease 2,191 6.2
4 Chronic Obstructive Pulmonary Disease 2,037 5.7
5 Influenza and Pneumonia 1,179 3.3
6 Motor Vehicle Related Injuries 1,023 2.9
7 Infectious Parasitic Diseases 996 2.8
8 Other than Motor Vehicle Related Injuries 950 2.7
9 Suicide 858 2.4
10 Diabetes 810 2.3
6
Source: Arizona Health Status and Vital Statistics, 1995
7
2. METHODOLOGY
A. SAMPLING DESIGN
Arizona's BRFS uses the Waksberg cluster-based version of random digit dialing. The survey has the
potential of representing 97% of the households in Arizona that have telephones (U.S. West
Communications data). A cluster size of three was used for maximum efficiency and minimum loss of
precision. A sample size of 1,908 interviews over a 12-month period was selected to achieve an
acceptable 95% confidence interval (+/- 3%) on risk factor prevalence estimates of the adult population.
This means that the percentage found as the estimated prevalence of a risk factor will be accurate to
within plus-or minus-3% in 95 of 100 surveys. Prevalence estimates of individual demographic variables
do not reflect this level of accuracy.
Interviewers, employed by ADHS, contacted the residences during weekdays between 9:00 a.m. and
9:00 p.m. and Saturdays between 8:30 a.m. and 4:30 p.m. Interviews were collected during a two-week
period each month.
After the residence had been contacted, one adult (18 years of age or older) was selected from all adults
residing in the household to be interviewed. The response rate for this year's survey was 73.5%.
B. QUESTIONNAIRE
The questionnaire, designed through cooperative agreements with the CDC, was divided into three
sections. The first section contained questions on health risk behavior; the second section contained
demographic information; and the third section contained optional modules.
C. DATA ANALYSIS
The ADHS Office of Chronic Disease Epidemiology analyzed the data that had been compiled and
returned by the CDC. The percentages of each cell were the results of weighted counts based on the
1995 Arizona population to accurately reflect the population demographics.
The weighting factor considered the number of adults and telephone lines in the household, cluster size,
stratum size, and age/race/sex distribution of the general population. Unknown and/or refused categories
were excluded from the analysis.
D. DEMOGRAPHICS
The demographic information that was collected for Arizona's population included the following: age,
race, sex, marital status, employment status, education, and household income. Weighing adjustments
were made by the CDC to reflect the actual population estimates of males/females and are represented in
the weighted percentages of the data.
8
3. SURVEY RESULTS
This section describes the results of the Behavioral Risk Factor Surveillance statewide telephone survey of
Arizona adult residents.
A. ALCOHOL - CHRONIC
B. ALCOHOL - BINGE
C. ALCOHOL - DRINKING AND DRIVING
D. DIABETES
E. FRUITS AND VEGETABLES
F. HEALTH CARE
G. MAMMOGRAPHY
H. MAMMOGRAPHY AND BREAST EXAM
I. OVERWEIGHT (OBESITY)
J. SEAT BELT USE
K. EXERCISE (SEDENTARY LIFESTYLE)
L. SMOKING
9
A. ALCOHOL - CHRONIC
CHRONIC (HEAVIER) DRINKING - respondents reporting having two or more drinks per day, i.e.,
60 or more per month.
Alcohol abuse is associated with several forms of illness, injury and death. Alcohol is a factor in 50% to 55% of
fatal motor vehicle accidents, 29% of serious injury accidents, and 7% of property damage accidents.1 While
material damage occurs, alcohol abuse has a serious health cost impact. Families with an alcohol abusing
member incur twice as many health care costs as families without such a member.2
According to the 1995 BRFS, 2.4% of all respondents reported chronic drinking behavior. More males (4.3%)
reported this behavior than females (0.6%). The 18-24 year age group (4.7%) reported the highest risk for
chronic drinking followed by the 25 - 34 year age group (3.3%). Respondents with some college (3.1%)
reported the highest incidence of chronic drinking while respondents in the three other education groups reported
incidence levels of 0.9% to 2.4%. According to income criteria, respondents reporting total household incomes
of less than $10,000 comprised the highest percentage of chronic drinkers (5.3%) followed by the $25 -
$34,999 income group (4.6%).
1995 Arizona BRFSS
Chronic (Heavier) Drinking
GROUPS PERCENTAGE
Sex
Male
Female
4.3
0.6
Age
18-24
25-34
35-44
45-54
55-64
65+
4.7
3.3
1.3
2.4
1.4
1.6
Education
Some High School
High School Grad or GED
Some College or Tech School
College Grad
0.9
2.4
3.1
2.3
Income
<$10,000
$10-$14,999
$15-$19,999
$20-$24,999
$25-$34,999
$35-$49,999
$50-$74,999
>=$75,000
5.3
3.0
2.0
1.2
4.6
3.4
0.6
1.9
10
References
1. National Safety Council. Accident Facts 1989 Edition. Chicago, Illinois, 1989.
2. Department of Health and Human Services. ADAMHA update: Treatment for Alcoholism -
Impact on Use of Health Care, No. 7. Washington, D.C., July 1986.
11
B. ALCOHOL - BINGE
ACUTE (BINGE) DRINKING - Respondents reporting having five or more drinks on one or more
occasions during the previous month.
Major hazards to health and well-being occur when alcohol is misused. Medical consequences arise from
alcohol toxicity and the increased risk of injury or death while under the influence of alcohol.1 Costs related to
increased health care expense are estimated adequately enough, however other costs related to alcohol misuse
are more difficult to measure, i.e. family life disruption, increased crime and violence, lowered self-esteem,
increased employee absenteeism and decreased employee performance.
In the 1995 BRFS, 13.5% of all respondents reported binge drinking behavior. Males were at greater risk for
acute drinking (20.5%) than females (6.8%) by a 3:1 margin. There appeared to be a general negative
correlation between age and risk (as age went up percentage went down) for acute drinking behavior. The 18 -
24 year age group (23.1%) reported the highest incidence followed by the 25 - 34 age group (22.5%).
Respondents with some college or technical school (16.5%) were at greatest risk followed by high school
graduates or GED (13.7%). Respondents in the $25,000 - $34,999 income group (21.8%) reported the highest
incidence of binge drinking followed by those in the $50,000 - $74,999 group (15.9%).
1995 Arizona BRFSS
Acute (Binge) Drinking
GROUPS PERCENTAGE
Sex
Male
Female
20.5
6.8
Age
18-24
25-34
35-44
45-54
55-64
65+
23.1
22.5
13.2
9.4
4.1
4.9
Education
Some High School
High School Grad or GED
Some College or Tech School
College Grad
9.8
13.7
16.5
10.6
Income
<$10,000
$10-$14,999
$15-$19,999
$20-$24,999
$25-$34,999
$35-$49,999
$50-$74,999
>=$75,000
9.6
14.5
14.6
9.7
21.8
14.5
15.9
8.5
12
References
1. U.S. Department of Health and Human Services, Office of Disease Prevention and Health
Promotion, U.S. Public Health Service. Disease Prevention/Health Promotion: The Facts.
1988.
13
C. ALCOHOL - DRINKING AND DRIVING
DRINKING AND DRIVING - Respondents reporting having driven an automobile one or more times
during the past month after having too much to drink.
In Arizona during 1992, alcohol was involved in an estimated 262 traffic fatalities and 7,217 traffic injuries.1 Over
32% of these traffic fatalities involved a driver, bicyclist, or pedestrian who had been drinking. More than 80% of
such crashes involved a blood alcohol concentration (BAC) of more than 0.10%, the legal limit in Arizona for
alcohol intoxication. A driver with a BAC exceeding 0.10% is six times more likely than a sober one to have an
accident. Young drivers are especially at risk, considering nearly 3,300 teenagers die each year nationally in
alcohol-related crashes, making this the number one killer of youth.2
In the 1995 BRFS, 2.7% of all respondents reported drinking and driving behavior. More males (3.7%) reported
this behavior than females (1.7%) by more than 2:1. The 35 - 44 year old group of respondents (5.5%) reported the
highest incidence of drinking and driving with the 25 - 34 year old group next (4.0%). Respondents who are high
school graduates or GED (3.8%) reported a higher incidence of drinking and driving with college graduates a
relatively close second at 3.4%. The $25,000 - $34,999 income group (6.1%) reported the highest incidence
followed by the $35,000 - $49,999 group (3.4%).
1995 Arizona BRFSS
Drinking and Driving
GROUPS PERCENTAGE
Sex
Male
Female
3.7
1.7
Age
18-24
25-34
35-44
45-54
55-64
65+
3.4
4.0
5.5
1.2
0.0
0.4
Education
Some High School
High School Grad or GED
Some College or Tech School
College Grad
2.2
3.8
1.7
3.4
Income
<$10,000
$10-$14,999
$15-$19,999
$20-$24,999
$25-$34,999
$35-$49,999
$50-$75,000
>$75,000
2.6
1.4
1.7
1.3
6.1
3.4
2.9
0.7
14
References
1. Arizona Department of Transportation. Arizona Traffic Accident Summary for 1992. Phoenix:
Traffic Records Unit
2. National Safety Council. Accident Facts 1989 Edition. Chicago, Illinois 1988.
15
1. Diabetes Overview, 1993, Vol. 92 Issue 3235, p1, 5p.
D. DIABETES
DIABETES - Respondents reporting that they have been told by a doctor that they have diabetes.
Diabetes is associated with long-term complications that affect almost every major part of the body. It can cause
blindness, heart disease, strokes, kidney failure, amputations, nerve damage, and birth defects in babies born to
women with diabetes. In terms of medical care, treatment supplies, hospitalizations, time lost from work, disability
payments, and premature death, diabetes costs this country more than $40 billion annually.1
According to the 1995 BRFS, 4.8% of all respondents reported that they were told they have diabetes. More males
(5.5%) reported being diabetic than females (4.1%). There appears to be a general positive correlation between
age and risk (as age went up the percentage went up) for diabetes. The 55 - 64 year age group (10.4%) reported
the highest incidence followed by the 65+ age group (9.4%). Respondents with an elementary level education
(11.1%) reported the highest incidence followed by those with some college or technical school (5.6%). The less
than $10,000 income group (11.4%) had the highest incidence followed by the $15,000 - $19,999 group (7.7%).
1995 Arizona BRFSS
Ever been told by a doctor you have diabetes
GROUPS PERCENTAGE
Sex
Male
Female
5.5
4.1
Age
18-24
25-34
35-44
45-54
55-64
65+
0.4
0.1
3.0
7.0
10.4
9.4
Education
Never Attended School
Elementary
Some High School
High School Grad or GED
Some College or Tech School
College Grad
4.0
11.1
4.7
4.8
5.6
2.8
Income
<$10,000
$10-$14,999
$15-$19,999
$20-$24,999
$25-$34,999
$35-$49,999
$50-$74,999
>=$75,000
11.4
4.2
7.7
4.9
4.7
2.5
1.9
6.8
16
1. Public Health Reports, Jan/Feb95, Vol. 110 Issue 1, p68, 12p.
E. FRUITS AND VEGETABLES
FRUITS & VEGETABLES - Respondents reporting that they consume less than five servings of fruits
and vegetables daily.
One of the national objectives in "Healthy People 2000" is for members of the public to increase their consumption
of fruits and vegetables to five or more servings daily. Studies have indicated that a variety of fruits and vegetables
are associated with a reduced risk of cancer. These included dark green, yellow, and orange fruits and vegetables,
cruciferous vegetables, dried fruits, berries, beans, tomatoes, and carrots.1
According to the 1995 BRFS, 75.7% of all respondents reported eating fewer than five servings of fruits and
vegetables. More males (80.8%) reported this behavior than females (70.8%). The 18 - 24 year age group
(84.8%) were least likely to consume the recommended number of servings followed by the 35 to 44 age group
(82.4%). Respondents with some high school (83.7%) were the least likely to consume five servings next were
those who had an elementary education (80.6%). Respondents in the two lowest income groups, less than $10,000
(84.6%) and the $10,000 - $14,999 income group (81.9%) were less likely to eat the recommended number of
servings.
1995 Arizona BRFSS
Less than 5 servings of fruits and vegetables
GROUPS PERCENTAGE
Sex
Male
Female
80.8
70.8
Age
18-24
25-34
35-44
45-54
55-64
65+
84.8
80.7
82.4
77.0
63.1
62.1
Education
Never Attended School
Elementary
Some High School
High School Grad or GED
Some College or Tech School
College Grad
45.2
80.6
83.7
79.8
72.9
74.5
Income
<$10,000
$10-$14,999
$15-$19,999
$20-$24,999
$25-$34,999
$35-$49,999
$50-$74,999
>=$75,000
84.6
81.9
73.1
68.1
77.2
76.0
76.6
68.6
17
1. Health Risks in America, Gaining Insight From the Behavioral Risk Factor Surveillance System,
1995, p13.
F. HEALTH CARE
HEALTH CARE - Respondents reporting that they do not have health care coverage.
According to the nationwide 1993 BRFS, the percentage of adults aged 18 to 64 years who reported not having any
health care insurance varied nearly fourfold across states - from 6.8% in Hawaii to 25.5% in Louisiana (median =
14.9%). More than one-fifth of adults in seven states (California, Florida, Louisiana, Nevada, New Mexico,
Oklahoma, and Texas) reported being uninsured. Men (15.6%) were only slightly more likely than women (14.0%)
to report not having health insurance.1
According to the 1995 BRFS, 15.2% of all respondents reported not having health care coverage. Males (15.7%)
were more likely than females (14.6%) not to have health care coverage. More respondents in the 18 - 24 year
age group (28.0%) did not have health care coverage than any other age group. Respondents who had some high
school education (34.0%) were at greatest risk followed by high school graduates or GED (26.0%). There appears
to be a general negative correlation regarding income. Respondents in the $15,000 - $19,999 group (36.3%)
followed by the less than $10,000 (36.1%) were more likely not to have health care coverage than the other income
groups.
1995 Arizona BRFSS
Does not have health care coverage
GROUPS PERCENTAGE
Sex
Male
Female
15.7
14.6
Age
18-24
25-34
35-44
45-54
55-64
65+
28.0
19.1
17.6
17.3
10.0
0.7
Education
Never Attended School
Elementary
Some High School
High School Grad or GED
Some College or Tech School
College Grad
3.1
25.7
34.0
26.0
12.1
8.0
Income
<$10,000
$10-$14,999
$15-$19,999
$20-$24,999
$25-$34,999
$35-$49,999
$50-$74,999
>=$75,000
36.1
34.1
36.3
26.9
11.6
5.7
4.7
0.0
18
1. U.S. Department of Health and Human Services, National Institute of Health. "Promoting Mammography
Screening". 1990. NIH Publication No. 90-497.
G. MAMMOGRAPHY
MAMMOGRAPHY - Female respondents reporting that they have never had a mammogram.
The key to reduction in breast cancer mortality depends on successful interventions and early detection. It is
recommended that the screening process begin by age 40 and consist of annual clinical examinations with a
mammogram every 1 to 2 years through age 49. Annual screening mammograms at age 50 or older should be
performed in conjunction with annual clinical breast examinations.1
Based on the 1995 BRFS, 13.7% of the female respondents age 40 and older said they never had a mammogram.
More respondents in the other race group (16.1%) reported not having a mammogram than any other racial/ethnic
group. There appears to be a negative correlation between education and not having a mammogram. More
respondents with some high school (25.2%) and those who were high school graduates/GED (13.9%) said they
never had a mammogram compared to those who attended college. Respondents whose incomes were less than
$10,000 (23.8%) were more likely not to have had a mammogram than those in the higher income groups.
1995 Arizona BRFSS
Never had a mammogram
Women 40+ years
GROUPS PERCENTAGE
Age
40-49
50-59
60-69
70+
19.7
9.3
6.6
16.3
Race
White/Non-hispanic
Hispanic
Other
13.8
12.8
16.1
Education
Some High School
High School Grad or GED
Some College or Tech School
College Grad
25.2
13.9
12.2
10.3
Income
<$10,000
$10-$14,999
$15-$19,999
$20-$24,999
$25-$34,999
$35-$49,999
$50-$74,999
>=$75,000
23.8
20.7
10.7
16.4
14.3
23.2
4.4
5.0
NOTE: Percentages may not always sum to 100% due some respondents reporting that they "don't know/not sure" or "refused" to that particular question.
H. MAMMOGRAPHY AND BREAST EXAM
19
MAMMOGRAPHY AND BREAST EXAM - Female respondents reporting that they have never had a
mammogram and clinical breast examination.
According to the American Cancer Society, women from 40 to 49 years of age should receive a clinical breast
examination every three years and women aged 50 and older should receive an annual examination.
The 1995 BRFS found that 17.8% of the female respondents age 40 and older had never had a mammogram and a
clinical breast exam. Respondents in the 40 - 49 age group (22.0%) followed by the 70+ age group (21.0%) were
more likely to not have had these screening tests. Other race respondents (24.0%) were the most likely to not have
both exams, next were Hispanics (20.7%). There appears to be a negative correlation between education and not
having a mammogram and clinical breast exam. Respondents with some high school (28.6%) were most at risk
followed by those who were high school graduates/GED (18.9%). Respondents in the less than $10,000 income
group (25.9%) and the $10,000 - $14,999 group (25.2%) were most likely to not have had either screening test.
1995 Arizona BRFSS
Never had a mammogram & breast exam
Women 40+ years
GROUPS PERCENTAGE
Age
40-49
50-59
60-69
70+
22.0
11.3
15.5
21.0
Race
White/Non-hispanic
Black/Non-hispanic
Hispanic
Other
17.3
4.7
20.7
24.0
Education
Some High School
High School Grad or GED
Some College or Tech School
College Grad
28.6
18.9
16.9
11.7
Income
<$10,000
$10-$14,999
$15-$19,999
$20-$24,999
$25-$34,999
$35-$49,999
$50-$74,999
>=$75,000
25.9
25.2
15.1
19.1
22.9
23.5
4.4
9.7
NOTE: Percentages may not always sum to 100% due some respondents reporting that they "don't know/not sure" or "refused" to that particular question.
20
I. OVERWEIGHT (OBESITY)
OVERWEIGHT - The CDC defines obesity as: females with a BMI (Body Mass Index) $27.3 and
males with a BMI $27.8 (BMI is weight in kilograms divided by height in meters squared (W/H²).
The following are some factors included in the pathogenesis of obesity: excess caloric intake, decreased physical
activity, and metabolic and endocrine abnormalities. Obesity is more likely to lead to coronary heart disease,
hypertension, hypercholesterolemia and diabetes mellitus. Higher mortality rates from cancer have also been
attributed to obesity.1 Persons suffering from obesity are 2.9 times more likely to suffer from hypertension. Even
moderately obese people (110% to 120% of ideal body weight) under the age of 50 are more likely to suffer from
hypertension than people of normal body weight.2 Diabetes mellitus and high serum cholesterol levels are
respectively 2.1 and 2.9 times more likely to be present in obese people.3
According to the 1995 BRFS, 24.5% of all respondents said they were overweight. More males (26.5%) reported
being overweight than females (22.6%). More respondents in the 45 - 54 year age group (34.0%) and the 35 - 44
age group (31.0%) said they were overweight. Respondents never attending school (34.8%) were at greatest risk
followed by those with an elementary school education (29.9%.) Respondents in the $15,000 - $19,999 income
group (32.4%) had the highest incidence followed by the those in the $20,000 - $24,999 group (29.5%).
1995 Arizona BRFSS
Overweight (Based on BMI)
GROUPS PERCENTAGE
Sex
Male
Female
26.5
22.6
Age
18-24
25-34
35-44
45-54
55-64
65-74
75+
8.1
18.1
31.0
34.0
30.4
29.7
17.4
Education
Never Attended School
Elementary
Some High School
High School Grad or GED
Some College or Tech School
College Grad
34.8
29.9
25.4
25.0
26.4
19.3
Income
<$10,000
$10-$14,999
$15-$19,999
$20-$24,999
$25-$34,999
$35-$49,999
$50-$74,999
>=$75,000
21.6
18.1
32.4
29.5
27.8
27.9
18.1
21.9
21
References
1. Burton, Benyamit, and Foster, Willis R.: Health Implications of Obesity: NIH Consensus
Development Conference. Journal of the American Dietetic Association. Vol 85: No. 9, Sept.
1985. pp 1117-1121.
2. Simopoulos, Artemis P., M.D.: The Health Implications of Overweight and Obesity - Nutrition
Review. Vol. 43: February 85. pp 33-40.
3. Seidell, Jacob C. et al: Associations of Moderate and Severe Overweight with Self Reported
Illness and Medical Care in Dutch Adults. American Journal of Public Health. Vol. 76:
February 85. pp 264-269.
22
J. SEAT BELT USE
SEAT BELT USE - Respondents reporting they "sometimes", "seldom" or "never" use seat belts.
The Arizona Department of Transportation's report "Arizona Traffic Accident Summary for 1992" indicated 81% of
all drivers involved in an accident were using seat belts and 80% of all passengers age 5 and older were secured.1
In 1992, every 10.9 hours a traffic-related death occurred and 73 persons were injured in Arizona.2 Risks of injury,
death and related economic costs are reduced by 50% or more when driving with secured seat belts.3
According to the 1995 BRFS, 12.7% of all respondents said they did not always use seat belts. More males
(16.6%) reported this behavior than females (8.9%). The 18 - 24 year age group (19.2%) were more likely to not
use seat belts, followed by the 25 - 34 age group (17.4%). Respondents with some high school (24.5%) were at
greatest risk, next were the high school graduate/GED group (14.1%). The below $10,000 income group (22.1%)
had the highest risk followed by the $15,000 - $19,999 group (16.4%).
1995 Arizona BRFSS
Do Not Always Use Seat Belts
GROUPS PERCENTAGE
Sex
Male
Female
16.6
8.9
Age
18-24
25-34
35-44
45-54
55-64
65+
19.2
17.4
10.3
14.0
7.4
7.5
Education
Elementary
Some High School
High School Grad or GED
Some College or Tech School
College Grad
11.5
24.5
14.1
13.1
8.0
Income
<$10,000
$10-$14,999
$15-$19,999
$20-$24,999
$25-$34,999
$35-$49,999
$50-$74,999
>=$75,000
22.1
15.8
16.4
11.7
8.5
14.6
10.1
9.9
23
References
1. Arizona Department of Transportation. Arizona Traffic Accident Summary, 1992. Phoenix:
Traffic Records Unit.
2. Arizona Department of Transportation. Arizona Traffic Accident Summary, 1992. Phoenix:
Traffic Records Unit.
3. Campbell, B.J. Safety Belt Injury Reduction Related to Crash Severity and Front Seated
Position, publication PR129, Chapel Hill, NC: University of North Carolina Highway Safety
Research Center, 1984.
24
References
K. EXERCISE (SEDENTARY LIFESTYLE)
EXERCISE (SEDENTARY LIFESTYLE) - Respondents reporting no physical activity or who
reported a physical activity or pair of activities that were done for 20 minutes or less, fewer than three
times/week.
Physical activity and exercise are critical elements in the promotion of health in adults. Increased levels of
physical activity reduce the risk of hypertension, diabetes mellitus, colon cancer and osteoporosis.1 Exercise and
physical activity may also retard or prevent age related cerebral atherogenesis and sustain cognitive abilities.2 It
can help to maintain weight and increase longevity.3 High energy exercise (more than 8,500 kilo calories per
week) significantly reduces the risk of coronary heart disease. It has been estimated that exercise can reduce
death rates from coronary heart disease by 30% to 50%.4
According to the 1995 BRFS, 59.8% of all respondents are at risk for a sedentary lifestyle. Females had a
slightly greater risk (60.3%) than males (59.3%). The 45 - 54 year age group (67.4%) had the greatest risk
followed by the 35 - 44 age group (65.6%). Risk for sedentary lifestyle was highest for respondents with some
high school (71.4%) followed by with an elementary level education (69.3%). Respondents in the $15,000 -
$19,999 income group (69.1%) had the highest risk followed by those in the less than $10,000 group (66.5%).
1995 Arizona BRFSS
Sedentary Lifestyle
GROUPS PERCENTAGE
Sex
Male
Female
59.3
60.3
Age
18-24
25-34
35-44
45-54
55-64
65+
56.2
56.8
65.6
67.4
53.8
57.3
Education
Never Attended School
Elementary
Some High School
High School Grad or GED
Some College or Tech School
College Grad
62.8
69.3
71.4
64.8
61.1
47.3
Income
<$10,000
$10-$14,999
$15-$19,999
$20-$24,999
$25-$34,999
$35-$49,999
$50-$74,999
>=$75,000
66.5
62.5
69.1
64.8
63.0
53.9
49.2
53.5
25
1. Siscovick, David S., et.al: Disease Specific Benefits and Risks of Physical Activities and
Exercise. Public Health Reports, Vol 100: No. 2, March-April 1985. pp 180-188.
2. Rogers, Robert L., Meyers, John S., and Mortel, Karl F., "After Reaching Retirement Age,
Physical Activity Sustains Cerebral Perfusion and Cognition". Journal of the American
Geriatrics Society. Vol. 38, February 1990. pp 123-128.
3. Paffenbarger, Ralph S., et al: Physical Activity, All-Cause Mortality, and Longevity of College
Alumni. New England Journal of Medicine, Vol. 314: 1986. pp 605-613.
4. Dishmas, Rodo K., ed. Exercise Adherence: It's Impact on Public Health. "Exercise
Adherence, Coronary Heart Disease, and Longevity" Paffenbarger, Ralph S., and Hyde,
Robert T.: pp 41-73. Champaign, Illinois: Human Kinetics Books.
26
L. SMOKING
SMOKING - Respondents reporting smoking 100 cigarettes and who smoke now (regularly and
irregularly).
C. Everett Koop, M.D., former Surgeon General of the United States, described smoking as the "chief, single
AVOIDABLE cause of death in our society"1. For many years the health effects of smoking have been well
documented and it has been determined that cigarette smoking is a major contributor to deaths from heart disease,
lung disease and cancer.2
The major voluntary health agencies (American Cancer Society, American Heart Association and American Lung
Association) have joined forces to achieve "Smoke Free Class of 2000" aimed at schools nationwide.3 Also, the
Surgeon General has proclaimed a goal of a "Smoke-Free Society by the Year 2000".4 Joint efforts among schools,
employers, community organizations, government agencies and public health organizations need to be employed to
achieve these goals.
According to the 1995 BRFS, 22.9% of all respondents identified themselves as smokers. More males (26.8%)
said they were smokers than females (19.1%). The 18 - 24 year age group (31.5%) had the greatest incidence of
smoking followed by the 45 - 54 age group (27.3%). Respondents with some high school (31.1%) were at greatest
risk with those in the high school graduate/GED group (28.4%). Respondents in the below $10,000 income group
(29.8%) had the highest incidence of smoking followed by the $10,000 - $14,999 group (28.3%).
1995 Arizona BRFSS
Current Smoking
GROUPS PERCENTAGE
Sex
Male
Female
26.8
19.1
Age
18-24
25-34
35-44
45-54
55-64
65+
31.5
22.3
26.4
27.3
18.6
12.1
Education
Elementary
Some High School
High School Grad or GED
Some College or Tech School
College Grad
13.6
31.1
28.4
24.9
13.4
Income
<$10,000
$10-$14,999
$15-$19,999
$20-$24,999
$25-$34,999
$35-$49,999
$50-$74,999
>=$75,000
29.8
28.3
27.3
24.9
27.4
22.1
16.4
12.1
27
References
1. Department of Health and Human Services, Public Health Service. The Health Consequences
of Smoking: Cancer. A Report of the Surgeon General. U.S. Government Printing Office,
Washington, D.C., February 1982.
2. Department of Health Services, Division of Disease Prevention. Arizona Cancer Registry.
Annual Economic Costs and Deaths Attributable to Cigarette Smoking in Arizona. March
1988.
3. Arizona Tobacco-Free Advisory Committee Report and Recommendations, June, 1990.
4. Department of Health Services, Tobacco-Free Arizona, Planning White Paper on Tobacco
Use. Revised November, 1988.
Office of Chronic Disease Epidemiology
Arizona Department of Health Services
1400 West Washington
Phoenix, Arizona 85007
(602) 542-7335