Maryland BRFSS State of the State Report

2008 Survey Results on Maryland Healthy Behaviors and Lifestyles

January 2010

Maryland Department of Health & Mental Hygiene

Family Health Administration

Office of Health Policy and Planning

www.marylandbrfss.org

Maryland BRFSS State of the State Report, January 2010 is a publication of the Maryland Department of Health and Mental Hygiene.

Russell W. Moy, MD, MPH Director, Family Health Administration

Produced by the Office of Health Policy and Planning Sara Barra, MS, Lead Author Helio Lopez, MS, BRFSS Coordinator

Jeanette Jenkins, MHS Director, Office of Health Policy and Planning PHONE: (410) 767-5300 FAX: (410) 333-7501 E-MAIL: ohpp@dhmh.state.md.us Visit our website: www.fha.state.md.us/ohpp

Martin O’Malley

Governor

Anthony G. Brown Lt. Governor

John M. Colmers Secretary

Department of Health and Mental Hygiene

Russell W. Moy, M.D., M.P.H. Director

Family Health Administration

Joan H. Salim Deputy Director

Family Health Administration

STATE OF MARYLAND

DHMH

Maryland Department of Health and Mental Hygiene

201 W. Preston Street, Baltimore, Maryland 21201

Martin O’Malley, Governor – Anthony G. Brown, Lt. Governor – John M. Colmers, Secretary

i

Family Health Administration

Russell W. Moy, M.D., M.P.H., Director - Joan H. Salim, Deputy Director

FOREWORD

The Maryland Department of Health and Mental Hygiene’s Family Health Administration proudly presents selected findings from the 2008 Behavioral Risk Factor Surveillance System (BRFSS). The purpose of this report is twofold: Its primary purpose is to present the findings derived from BRFSS. Its secondary purpose is to provide the reader with “how to” information about using the BRFSS website itself. The BRFSS is an ongoing telephone surveillance program designed to collect data on the behaviors and conditions that place Marylanders at risk for chronic diseases, injuries, and preventable infectious diseases. The BRFSS is supported through financial and technical assistance provided by the Centers for Disease Control and Prevention (CDC) and through the Maryland Department of Health and Mental Hygiene (DHMH). These data collected through the BRFSS provide valuable support and services to many statewide and local programs. The BRFSS is an important data component in targeting areas of need, developing programs, and measuring the effectiveness of initiatives. Additional information is available through the Maryland BRFSS website, www.marylandbrfss.org, or by contacting Helio Lopez, BRFSS Coordinator, at 410-767-5159.

We appreciate the efforts of the many individuals both within the Administration and from the general public that made this publication available. This evaluation would not be possible without the willingness of the over 9,400 anonymous Maryland households that participate in surveys each year.

TABLE OF CONTENTS TABLE OF CONTENTS .............................................................................................................................. i

EXECUTIVE SUMMARY .......................................................................................................................... ii

INTRODUCTION ........................................................................................................................................ 3

METHODOLOGY ....................................................................................................................................... 4

HEALTH STATUS....................................................................................................................................... 5

GENERAL HEALTH................................................................................................................................ 6

HEALTHCARE ACCESS......................................................................................................................... 7

DISABILITY.............................................................................................................................................. 8

CHRONIC DISEASES................................................................................................................................. 9

ASTHMA ................................................................................................................................................ 10

DIABETES.............................................................................................................................................. 11

HEART ATTACK................................................................................................................................... 12

STROKE.................................................................................................................................................. 13

OVERWEIGHT/OBESITY..................................................................................................................... 14

HEALTH CARE RISK FACTORS .......................................................................................................... 15

ANXIETY/DEPRESSION ...................................................................................................................... 16

IMMUNIZATIONS................................................................................................................................. 17

CERVICAL CANCER SCREENING..................................................................................................... 18

PROSTATE CANCER SCREENING..................................................................................................... 19

ORAL HEALTH .................................................................................................................................... 20

VISUAL HEALTH ................................................................................................................................. 21

HEALTH BEHAVIOR RISK FACTORS................................................................................................ 22

ALCOHOL CONSUMPTION ................................................................................................................ 23

FRUIT AND VEGETABLE CONSUMPTION...................................................................................... 24

PHYSICAL ACTIVITY.......................................................................................................................... 25

TOBACCO USE...................................................................................................................................... 26

GENERAL PREPAREDNESS.................................................................................................................. 27

DEMOGRAPHIC CHARACTERISTICS: BRFSS SURVEY GENDER DIFFERENCES ................ 28

MARYLAND VERSUS UNITED STATES: BRFSS SURVEY RISK FACTORS .............................. 29

MARYLAND VERSUS UNITED STATES: BRFSS SURVEY DEMOGRAPHIC

CHARACTERISTICS ............................................................................................................................... 30

APPENDIX ................................................................................................................................................. 31

HOW TO USE THE BRFSS ................................................................................................................... 32

FREQUENTLY ASKED QUESTIONS.................................................................................................. 35

LINKS TO FURTHER INFORMATION ............................................................................................... 36

i

EXECUTIVE SUMMARY

The ‘Maryland BRFSS – State of the State’ report provides a snapshot of the health behaviors that place Maryland adults at risk for chronic diseases, injuries, and preventable infectious diseases. The report is based on information collected on residents aged 18 years or older from over 9,400 Maryland households throughout 2008.

HEALTH STATUS:

General Health Status: Over 12% of Maryland adults reported their general health as fair or poor. Health Care Access: Over 12% of Marylanders reported not having any kind of health care coverage. Disability: Over 20% of Marylanders reported having limited activities due to physical, mental, or emotional problems CHRONIC DISEASE: Asthma: 14% of Marylanders reported being told by a health professional that they had asthma. Diabetes: Almost 9% of Marylanders reported being told by a doctor that they had diabetes, excluding gestational diabetes. Heart Attack: Almost 4%, or an estimated 168,564 Marylanders, reported having had a least one heart attack during their lives. Stroke: Almost 3%, or an estimated 111,491 Marylanders, reported having had a least one stroke during their lives. Overweight/Obese: Currently nearly 2.6 million, or 63% of Maryland adults, reported being overweight or obese. HEALTH CARE RISK FACTORS: Anxiety/Depression: 17% of Marylanders reported being diagnosed with depression and 8% of Marylanders reported being diagnosed with both anxiety and depression. Immunizations: 45% of Marylanders aged 50 years and over reported that they did not have a flu shot in the past 12 months. Cervical Cancer Screening: 16% of Maryland women reported that they did not have a PAP Smear test within the past three years. Prostate Cancer Screening: Almost 24% of Maryland men over the age of 50 reported not ever having a PSA test. Oral Health: Almost 30% of Marylanders reported that it has been more than a year since they last had their teeth professionally cleaned. Visual Health: An estimated 31% Marylanders aged 40 years and over reported that it has been more than two years since they last had a dilated eye exam. HEALTH BEHAVIOR RISK FACTORS:

Alcohol Consumption: Almost 14% of Marylanders were at risk for binge drinking. Men were more likely to be at risk for binge drinking than women (18% versus 10%). Fruits and Vegetables Consumption: Over 70% of Marylanders reported eating less than five servings of fruits or vegetables a day. Physical Activity: 24% of Marylanders reported not participating in any physical activity or exercise in the past month. Tobacco Use: 15% of Marylanders reported being current smokers—that is, they are currently smoking everyday or some days and have smoked at least 100 cigarettes in their lifetime.

ii

INTRODUCTION

What is the BRFSS? The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing surveillance program designed to collect data on the behaviors and conditions that place Marylanders at risk for chronic diseases, injuries, and preventable infectious diseases. Researchers, private organizations, health care providers, and public health professionals use BRFSS data to design, implement, and evaluate prevention efforts. Through the BRFSS, organizations characterize health behaviors, ascertain the prevalence of risk factors, and identify demographic groups with increased needs. The BRFSS data can be analyzed by a variety of demographic variables, including age, education, income, marital status, and racial or ethnic background. The ability to assess information within particular populations enables the health care community to maximize the effectiveness of scarce resources. The BRFSS is an important tool in public health. Uses include:

Tracking progress activities – providing baseline data for planning interventions and measuring progress toward goals and objectives (e.g., smoking, seatbelt use).

Supporting initiatives – monitoring legislature (e.g., seatbelt use, cigarette taxes). Targeting services – identifying relationships (e.g., between smoking and education). Documenting geographic variations – (e.g., smoking by county or region). Preparing funding applications – (e.g., diabetes prevention, asthma). Producing reports – (e.g., providing current information to the legislature, academic

institutions and the public about trends, improvement areas, policy implications). Developing surveys – serving as a model to create other surveys (e.g., Maryland Cancer

Survey, Maryland Adult Tobacco Survey).

Why Does Maryland Conduct the BRFSS? Personal health-risk behaviors contribute to premature morbidity and mortality and increased health care costs imposed on the State. Health agencies need to determine the rate at which individuals are participating in risky behaviors in order to prevent these events from occurring. BRFSS provides prevalence estimates to help health agencies plan and enact programs designed to promote healthy behaviors and reduce risky behaviors.

How Does Maryland Conduct the BRFSS? During 2008, over 9,400 randomly selected households participated in the Maryland BRFSS telephone survey. Interviews were conducted and supervised by trained telephone research interviewers at MACRO International Inc., a Maryland-based opinion research corporation company. These data were then weighted by the Centers for Disease Control and Prevention (CDC) to be representative of the demographic distribution of Maryland.

Who Participated in the Maryland BRFSS? The 2008 BRFSS interviewed 9,481 Maryland residents, 18 years of age or older, reporting on their households. 3,457 (47.5%) were male and 6,024 (52.5%) were female; 7,154 (58.9%) were white, 1,551 (26.9%) were African American, 283 (5.8%) were ‘other races’, 124 (1.9%) were multi-race, 259 (6.5%) were Hispanics, and 110 (1.1%) refused to report their background. The initial sample of 9,481 residents was used to “weight” these survey data to obtain representative estimates for the state of Maryland.

iii3

METHODOLOGY

Data have been collected following the procedures established by the Centers for Disease Control and Prevention (CDC). Since January 2000, Maryland BRFSS data have been collected using the CfMC CATI software supported by MACRO International, Inc. (MACRO). The CfMC CATI software is used to: 1) program the CDC core questionnaire and Maryland’s optional modules; 2) administer and manage the sample; 3) collect and backup the data; 4) monitor interviewers; and 5) produce quality control reports.

The Maryland BRFSS is conducted by MACRO, a Maryland-based company that has extensive experience in interviewer recruitment and education. Supervision, training, and technical support are provided to the interviewing staff on a continuous basis. Only interviewers with prior telephone interviewing experience are used for Maryland BRFSS data collection. Each of the 60 BRFSS interviewers completes extensive training, which includes CATI program training, interviewing protocol training, and administrative issues before they join the BRFSS interviewing team.

Experienced MACRO survey supervisors monitor the data collection process from a remote station. Interviewers are evaluated on several performance techniques such as: introducing the survey, asking and repeating questions, probing, and maintaining a smooth pace. Interviewer staff meetings are held weekly to review interviewer performance, discuss problems, and provide feedback.

The response rate for 2008 was 35.8 percent. This is about average for BRFSS surveys. Estimated time per completed interview averaged 21.8 minutes during 2008. This measure only includes the actual time used to conduct the interview. It does not include other interview tasks such as tracking of appointments, validations, follow-up training or consultation, in-person problem solving, and monthly backup of data. It is Maryland’s goal that, on average, actual time per completed interview does not exceed 20 minutes.

For this report, data are presented for the total population, and by demographic

characteristics. These characteristics include gender, race, age, education, and household income. Not all races are represented in this report due to small sample size in some categories; for a complete listing of all demographic, health status, chronic disease, health behavior, and risk factor variables, please visit www.marylandbrfss.org.

4

HEALTH STATUS

5

6

Question: Would you say that your general health is ‘Excellent’, ‘Very good’, ‘Good’, ‘Fair’, or ‘Poor’?

At risk: Adults who answered ‘Fair’ or ‘Poor’ are considered at risk.

Who is at risk in Maryland?

12.5% of Maryland’s residents rated their general health as fair or poor.

There was a statistically significant difference between men (11.0%) and women

(13.8%) in general health.

Black residents reported poor to fair general health (14.6%) more than white

residents (11.5%), however this difference is not statistically significant.

Older persons, persons with lower relative income, or those who did not

complete high school reported poor to fair general health significantly more than

other groups.

Almost 36% of residents whose household income was less than $15,000 per

year reported being in poor to fair general health.

17.7% of those without healthcare coverage reported poor to fair general health,

compared to 11.7% of those with healthcare coverage.

26% of those who were in ‘poor’ general health reported being either

‘dissatisfied’ or ‘very dissatisfied’ with their lives, while only 5% of persons

who were in ‘very good’ or ‘excellent’ general health reported the same.

Percent of Maryland Adults who reported their General Health as Fair or Poor, by Age*, Education*, and Income*, 2008

GENERAL HEALTH

Percent of Maryland Adults who reported their General Health as Fair or

Poor, by Gender* and Race, 2008

13.8

11.0

0

5

10

15

20

Male FemaleGender

Pe

rce

nt

14.6

11.5

0

5

10

15

20

White Black

Race

Pe

rce

nt

6.2

35.7

16.5

9 .1

13.3

8.57 .1

22.8

17.3

4 .9

27.7

17.0

32.0

0

5

10

15

20

25

30

35

40

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colle

ge

College

Gra

d

<$15,

000

$15-

24,9

99

$25-

49,9

99

$50-

74,9

99

>$75,

000

*Denotes a statistically significant difference among the values.

7

Question: Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare?

At risk: Adults who answered ‘No’ are considered at risk.

Who is at risk in Maryland?

Over 12% of Marylanders do not have healthcare coverage.

Men were significantly more likely not to have healthcare coverage as a group

(14.6%) than women (9.9%).

Black residents were significantly more likely not to have healthcare coverage

(14.7%) than white residents (7.7%).

Individuals with no healthcare coverage tended to be younger, have less

education, or be from lower-income households.

26.3% of Marylanders who did not complete high school reported that they did

not have healthcare coverage, and 37.3% of those earning under $15,000 a year

reported that they did not have healthcare coverage.

16.9% of those with no coverage reported not having seen a doctor for a routine

check-up in over 5 years compared to 4.2% that do have coverage.

41% of those with no coverage reported that they needed to see a doctor in the

past year, but could not afford to do so.

Percent of Maryland Adults with no Health Insurance by Age*, Education*, and Income*, 2008

Percent of Maryland Adults with no Health Insurance

by Gender* and Race*, 2008

14.6

9.9

0

5

10

15

20

Male FemaleGender

Pe

rce

nt

14.7

7.7

0

5

10

15

20

White BlackRace

Pe

rce

nt

HEALTHCARE ACCESS

26.3

4.5

37.3

31.2

7.72.8

19.4

1.5

22.6

11.2

13.7

19.6

7.1

0

5

10

15

20

25

30

35

40

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colle

ge

College

Gra

d

<$15,

000

$15-

24,9

99

$25-

49,9

99

$50-

74,9

99

>$75,

000

Per

cen

t

*Denotes a statistically significant difference among the values.

8

DISABILITY

Question:

At risk:

Are you limited in any way in any activities because of physical, mental, or emotional problems?

Adults who answered ‘Yes’ are considered at risk.

Who is at risk in Maryland?

Over 20% of Marylanders reported having limited activities due to physical,

mental, or emotional problems.

Men are significantly less likely to report limited activities due to physical,

mental, or emotional problems (18.7%) than women (22.1%).

Black residents were significantly less likely to report limited activities due to

physical, mental, or emotional problems (16.9%) than white residents (23.4%).

Individuals who reported limited activities due to physical, mental, or

emotional problems tended to be older, have less education, or be from lower-

income households.

12.7% of Marylanders who reported limited activities due to physical, mental,

or emotional problems reported being dissatisfied or very dissatisfied with their

life and 27.6% reported getting social and emotional support they need only

sometimes, rarely, or never.

Percent of Maryland Adults who reported Limited

Activity due to Physical, Mental, or Emotional

Problems by Gender and Race*, 2008

18.722.1

0

5

10

15

20

25

Male FemaleGender

Pe

rce

nt

16.9

23.4

0

5

10

15

20

25

White BlackRace

Pe

rce

nt

Percent of Maryland Adults who reported Limited Activity due to Physical, Mental, or Emotional Problems by Age*, Education*, and

Income*, 2008

12.5

32.8 32.3

21.0 22.3

42.2

30.2

23.119.8

14.9

26.9

17.316.5

0

10

20

30

40

50

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colleg

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College

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d

<$15,

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$15-

24,99

9

$25-

49,99

9

$50-

74,99

9

>$75,

000

Per

cen

t

*Denotes a statistically significant difference among the values.

CHRONIC DISEASES

9

10

Question: Have you ever been told by a doctor, nurse, or other health professional that you had asthma?

At risk: Adults who answered ‘Yes’ are considered at risk.

Who is at risk in Maryland?

ers, or an estimated 614,939 Maryland adults, were told b

y had asthma.

er percentage of women reported having asthma (16.3%

than men (12.1%).

There was no significant difference between the percentage of white residents

and the percentage of black residents who had asthma.

Younger adults and those with less income were significantly more likely

report having asthma.

14.3% of Maryland

health professional that the

A significantly high

y a

)

to

14.3% of Marylanders, or an estimated 191,255 Maryland children (under the

age of 18), were told by a health professional that they had asthma. This

information was gathered from their parents, who participated in the survey.

Of the residents who report having been told they have asthma, 28.2% reported

that at least one child has been diagnosed with asthma as well.

Percent of Maryland Adults who have Asthma, by Age*, Education, and Income*, 2008

Percent of Maryland Adults who have Asthma, by

Gender* and Race, 2008

16.312.1

0

5

10

15

20

le Female

Gender

Pe

rce

nt

Ma

14.2 14.7

0

5

10

15

20

White BlackRace

Pe

rce

nt

ASTHMA

14.6

20.2

15.814.013.113.0 14.1 13.3

17.7

13.5

10.9

17.5

13.7

0

5

10

15

20

25

18-3

4

35-4

9

50-6

465

+ G

rad

Gra

d

Some

Colle

ge

<HS HS

Colle

Gra

d,0

00

15-24

,999

$25-

49,9

99

$50-

74,9

99

>$75,

000

Pe

rce

nt

eg <$15

$

*Denotes a statistically significant difference among the values.

11

Question: Have you ever been told by a doctor that you have diabetes

(excluding gestational diabetes)?

At risk: Adults who answered ‘Yes’ are considered at risk.

Who is at risk in Maryland?

An estimated 373,346 Maryland adults (8.7%) were told by a doctor that they

had diabetes. This number does not include those with undiagnosed diabetes,

pre-diabetes, or women who were diagnosed while pregnant.

There was no significant difference between the percentage of men and the

percentage of women who had diabetes.

Black residents were significantly more likely to report having diabetes (12.4%)

than white residents (7.6%).

Older adults, those with less than a high school education, and those with less

income were significantly more likely to be diagnosed with diabetes.

Of those who had been diagnosed with diabetes, over 27% reported being told

by a doctor that their diabetes has affected their eyes or that they have

retinopathy.

Nearly half of those diagnosed with diabetes (45.5%) had never taken a class

on how to manage their diabetes.

Percent of Maryland Adults who have Diabetes, by Age*, Education*, and Income*, 2008

Percent of Maryland Adults who have Diabetes, by

Gender and Race*, 2008

9.28.3

0

3

6

9

12

Male FemaleGender

Pe

rce

nt

12.4

7.6

0

3

6

9

12

15

White BlackRace

Pe

rce

nt

DIABETES

1.8

4.6

20.1

11.0

5.5

14.4

11.6

5.2

14.616.2

9.88.4

17.8

0

5

10

15

20

25

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colleg

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College

Gra

d

<$15,

000

$15-

24,99

9

$25-

49,99

9

$50-

74,99

9

>$75,

000

Per

cen

t

*Denotes a statistically significant difference among the values.

12

Question: Has a doctor, nurse, or other health professional ever told you that you have had a heart attack, also called a myocardial infarction?

At risk: Adults who answered ‘Yes’ are considered at risk.

Who is at risk in Maryland?

An estimated 168,564 Marylanders (3.9%) reported being told that they had a

heart attack.

Men were significantly more likely to report a heart attack (5.2%) than women

(2.8%).

No statistically significant racial differences were found for the prevalence of

heart attack.

Reporting having a heart attack was significantly more prevalent among older

residents (those 65+ years in age), those with less than a high school education,

and less affluent residents.

Marylanders who have reported being told by a health professional that they

had a heart attack are more likely to report being overweight and obese (74%)

than those who have not reported having a heart attack (63%).

Percent of Maryland Adults who have had a Heart Attack, by Age*, Education*, and Income*, 2008

Percent of Maryland Adults who have had a Heart

Attack, by Gender* and Race, 2008

5.2

2.8

0

2

4

6

8

Male FemaleGender

Pe

rce

nt

4.63.3

0

2

4

6

8

White BlackRace

Pe

rce

nt

HEART ATTACK

1.5

11.8

4.43.4

2.02.6

12.8

0.4

5.5

10.7 8.9

3.7

4.5

0

2

4

6

8

10

12

14

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colleg

e

College

Gra

d

<$15,

000

$15-

24,99

9

$25-

49,99

9

$50-

74,99

9

>$75,

000

Per

cen

t

* Denotes a statistically significant difference among the values.

13

STROKE

Question:

At risk:

Has a doctor, nurse, or other health professional ever told you that you have had a stroke?

Adults who answered ‘Yes’ are considered at risk.

Percent of Maryland Adults who have had a Stroke, by

Gender and Race, 2008

2.82.4

0

1

2

3

4

Male FemaleGender

Pe

rce

nt

2.72.7

0

1

2

3

4

White BlackRace

Pe

rce

nt

Who is at risk in Maryland?

An estimated 111,491 Marylanders (2.6%) reported being told that they had a

stroke.

Women were more likely to report a stroke (2.8%) than men (2.4%), though

this difference is not statistically significant.

No statistically significant racial differences were found for the prevalence of

stroke.

Reporting having a stroke was significantly more prevalent among older

residents (those 65+ years in age), less educated residents and less affluent

residents.

Of those who reported having a stroke, 28.7% reported being told by a health

professional that they had angina or coronary heart disease; in respondents who

report never having a stroke, only 3.7% reported being told by a health

professional that they had angina or coronary heart disease.

Percent of Maryland Adults who have had a Stroke, by Age*, Education, and Income*, 2008

2.8

7.3

0.9

3.4

9.3

2.7

1.2

7.9

2.3 1.42.0

8.9

0.30

2

4

6

8

10

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colleg

e

College

Gra

d

<$15,

000

$15-

24,99

9

$25-

49,99

9

$50-

74,99

9

>$75,

000

Per

cen

t

* Denotes a statistically significant difference among the values.

14

Question: Body Mass Index (BMI) was calculated based on data collected from: 1) How much do you weigh without shoes? 2) How tall are you without shoes?

At risk: Respondents with BMI scores greater than 24.99 are considered overweight and respondents with BMI scores greater than 29.99 are considered obese.

Who is at risk in Maryland? Over 2.6 million, or about 63% of Marylanders, were classified as overweight

or obese.

Men were more likely to be classified as overweight or obese (69.5%) than

women (57.6%), and black residents were more likely to be overweight or

obese (73.9%) than white residents (60.2%); these differences are statistically

significant.

Adults aged 18-34 years were significantly less likely to be overweight or obese

than groups 35 years and older.

Persons categorized as obese were significantly more likely to report having

fair/poor health (18.9%) than those who are not classified as obese (9.5%)

In 2008, persons categorized as overweight/obese were significantly more

likely to have been diagnosed with diabetes (11.5%) than those classified as not

overweight/obese (3.8%).

Percent of Maryland Adults who are Overweight or Obese, by Age*, Education, and Income, 2008

Percent of Maryland Adults who are Overweight or Obese, by Gender* and

Race*, 2008

57.6

69.5

0

15

30

45

60

75

90

Male Female

Gender

Pe

rce

nt

73.9

60.2

0

15

30

45

60

75

90

White Black

RaceP

erc

en

t

OVERWEIGHT/OBESITY

59.6

68.671.2

65.766.166.468.062.0

65.866.7

52.0

63.766.0

0.0

15.0

30.0

45.0

60.0

75.0

90.0

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colleg

e

College

Gra

d

<$15,

000

$15-

24,99

9

$25-

49,99

9

$50-

74,99

9

>$75,

000

Per

cen

t

*Denotes a statistically significant difference among the values.

15

HEALTH CARE RISK FACTORS

16

Question: Has a doctor or other healthcare provider ever told you that you had an anxiety disorder or depressive disorder?

At risk: Adults who answered ‘Yes’ are considered at risk.

Who is at risk in Maryland?

Almost 13% of Maryland adults reported being diagnosed with anxiety, over 17%

of Maryland adults reported being diagnosed with depression, and almost 8% of

Maryland adults reported being diagnosed with both anxiety and depression.

Men were significantly less likely to report ever being diagnosed with anxiety or

depression (9.7% and 12.8%) than women (15.2% and 21.4%).

Black Marylanders were significantly less likely to report ever being diagnosed

with anxiety or depression (9.1% and 12.0%) than white Marylanders (14.8% and

20.9%).

Maryland adults from households earning less than $15,000/year were

significantly more likely to report ever being diagnosed with anxiety or depression

(23.9% and 34.6%, respectively) than households earning more income.

There was no statistically significant difference in the likelihood of ever being

diagnosed with anxiety or depression among the different levels of age or

educational attainment.

Percent of Maryland Adults who have an

Anxiety or Depressive Disorder, by Gender* and

Race*, 2008

21.4

15.29.7

12.8

0

5

10

15

20

25

Male FemaleGender

Pe

rce

nt

20.9

14.8

9.1

12.0

0

5

10

15

20

25

White BlackRace

Pe

rce

nt

ANXIETY/DEPRESSION

0

5

10

15

20

25

30

35

40

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colleg

e

College

Gra

d

<$15,

000

$15-

24,99

9

$25-

49,99

9

$50-

74,99

9

>$75,

000

Per

cen

t

Anxiety Depression

* Denotes a statistically significant difference among the values.

Percent of Maryland Adults who have an Anxiety or Depressive Disorder, by Age, Education, and Income*, 2008

17

IMMUNIZATIONS

Question:

At risk:

In the past twelve months, have you had a flu shot?

Adults aged 50 years or older who did not receive a flu shot in the past twelve months are considered at risk.

Who is at risk in Maryland?

45% of Marylanders aged 50 years and over reported that they did not have a

flu shot in the past twelve months.

No statistically significant difference was found between the percentages of

men versus women who did not have a flu shot in the past year.

The percentage of black residents who did not have a flu shot in the past year

was significantly greater than that of white residents (55.6% versus 40.0%).

The difference between those 50-64 years old and 65+ years old who did not

receive a flu shot (53.7% versus 30.2%) is statistically significant.

There was no difference in the likelihood of having a flu shot among the

different levels of educational attainment or income level.

40.3% of those 50-64 years old and 49.4% of those 65+ years old reported

getting their flu shots at a doctor’s office or HMO. Other places residents

reported getting a flu shot include health departments, community health

centers, drug/grocery stores, hospitals, and the workplace.

Percent of Maryland Adults (50+yrs) who did not have a

Flu Shot in the Past Year, by Gender and Race*, 2008

46.743.0

0

15

30

45

60

Male FemaleGender

Pe

rce

nt

55.6

40.0

0

15

30

45

60

White BlackRace

Pe

rce

nt

53.7

30.2

42.1

45.0 46.4 45.144.0

41.9

50.845.0 46.2

0

10

20

30

40

50

60

-64

65+

S Gra

dra

dleg

eG

rad

<$15,0

00

$15-

24,9

99

$25-

49,9

99

$50-

74,9

99

>$75,0

00

Pe

rce

nt

50

<H HS G

Some

Col

Colleg

e

* Denotes a statistically significant difference among the values.

Percent of Maryland Adults (50+ years) who did not have a Flu Shot in the Past Year, by Age*, Education, and Income, 2008

18

CERVICAL CANCER SCREENING

Percent of Maryland Adult Females who did not have a PAP Smear Test in the Past Three Years, by Race, 2008

14.716.5

0

5

10

15

20

White Black

Race

Pe

rce

nt

Question: A PAP Smear is a test for cancer of the cervix. How long has it been since you had your last PAP Smear test?

At risk: Women who reported that they did not have a PAP Smear test within the last three years are considered at risk.

Who is at risk in Maryland?

15.9% of Maryland women reported that they did not have a PAP Smear test

within the last three years.

The percentage of white women reported that they did not have a PAP Smear

test within the last three years was greater than that of black women (16.5%

versus 14.7%), but not significantly greater.

Women between the ages of 35-64 were more likely to report having a Pap

Smear test within the past three years than women in the 18-34 or 65+ age

groups.

Maryland adult women with less than a college education or from households

earning less income were significantly more likely to report not having a PAP

Smear test within the last three years.

Maryland females without health insurance coverage are significantly more

likely to report not having a Pap Smear test within the past three years (29.7%)

than those who do have health coverage (14.0%).

Percent of Maryland Adult Females who did not have a Pap SmearTest in the Past Three Years, by Age*, Education, and Income, 2008

20.3

12.0

35.5

16.4

26.9 26.1

9.3 13.2

23.0

26.0

9.4 9.5

17.2

0

10

20

30

40

50

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colleg

e

College

Gra

d

<$15,

000

$15-

24,99

9

$25-

49,99

9

$50-

74,99

9

>$75,

000

Per

cen

t

* Denotes a statistically significant difference among the values.

19

PROSTATE CANCER SCREENING

Question: Have you ever had a Prostate-Specific Antigen test, also called a PSA test, and a digital rectal exam?

At risk: Adult males aged 50 years or older who report not having had a PSA test and a digital rectal exam are considered at risk.

Who is at risk in Maryland?

23.6% of Maryland males aged 50 years and over reported that they have not

had a PSA test and digital rectal exam.

Black Marylanders were more likely to report not having had a PSA test

(24.8%) than white Marylanders (23.1%); this difference is not statistically

significant.

The difference between those 50-64 years old and 65+ years old who did not

receive a PSA test (27.9% versus 16.1%) is statistically significant.

Maryland adults with less than a college education or from households earning

less income were significantly more likely to report not having a PSA test.

Maryland males aged 50 years and over with health insurance coverage are

significantly more likely to have ever had a PSA test and digital rectal exam

(78.0%) than those who do not have health coverage (50.8%).

Percent of Maryland Adult Males (50+ years) who have not had a PSA Test and a Digital Rectal Exam, by Age*, Education*, and Income*, 2008

33.2 33.4

23.4

38.7 40.3

26.8

17.519.8

17.716.1

27.9

0

10

20

30

40

50

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colleg

e

College

Gra

d

<$15,

000

$15-

24,9

99

$25-

49,9

99

$50-

74,999

>$75,

000

Per

cen

t

* Denotes a statistically significant difference among the values.

Percent of Maryland Adult Males (50+yrs) who have not had a PSA Test and a

Digital Rectal Exam in the Past Year, by Race*, 2008

23.1 24.8

0

5

10

15

20

25

30

White Black

Race

Pe

rce

nt

20

Question: How long has it been since you last had your teeth cleaned by a dentist or dental hygienist?

At risk: Adults who answered ‘more than 1 year’ or ‘never’ are considered at risk.

Who is at risk in Maryland?

Almost 30% of Marylanders reported that they either never had their teeth

cleaned or that it has been more than a year since they last had their teeth

cleaned by a dentist or dental hygienist. About 1% reported that they have

never had their teeth cleaned professionally.

Men were more likely than women not to have their teeth cleaned in the past

year (29.9% versus 28.2%), but the difference was not statistically significant.

Black residents were significantly less likely to have had their teeth cleaned in

the past year than white residents (38.1% versus 24.4%).

Adults aged 18 to 34 were significantly less likely to have their teeth cleaned

professionally in the past year than older groups.

Adults who did not complete college or those from low-income households

were significantly less likely to have their teeth cleaned professionally.

Percent of Maryland Adults who did not have their Teeth Professionally Cleaned in the Past Year, by Age*, Education*, and

Income*, 2008

Percent of Maryland Adults who did not have their Teeth Professionally Cleaned in the

Past Year, by Gender and Race*, 2008

29.9 28.2

0

15

30

45

60

Male FemaleGender

Pe

rce

nt

38.1

24.4

0

15

30

45

60

White Black

RaceP

erc

en

t

ORAL HEALTH

19.9

64.2

49.2

18.1

32.9

35.6

53.8

24.9

33.728.0

36.3

25.629.2

0

10

20

30

40

50

60

70

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colleg

e

College

Gra

d

<$15,

000

$15-

24,99

9

$25-

49,99

9

$50-

74,99

9

>$75,

000

Per

cen

t

*Denotes a statistically significant difference among the values.

21

VISUAL HEALTH

Question:

At risk:

When was the last time you had an eye exam in which the pupils were dilated?

Adults age 40 years and older who answered ‘more than 2 years’ or ‘never’ are considered at risk.

Percent of Maryland Adults 40 years and older who have not had a Dilated Eye Exam in

the Last Two Years, by Gender and Race, 2008

27.934.7

0

10

20

30

40

Male Female

Gende r

Pe

rce

nt

31.829.4

0

10

20

30

40

White BlackRace

Pe

rce

nt

Who is at risk in Maryland?

An estimated 31% of Marylanders 40 years and older reported that they either

never had an eye exam in which the pupils were dilated or that it has been more

than two years since they last had an eye exam in which the pupils were dilated.

Men were more likely than women not to have a dilated eye exam in the past

two years (34.7% versus 27.9%), but the difference was not statistically

significant.

There was no racial difference in reporting not having a dilated eye exam in the

past two years.

Adults aged 65 and older were significantly more likely to have a dilated eye

exam in the past two years than younger groups.

There was no difference in the likelihood of having an eye exam in which the

pupils were dilated in the past two years among the different levels of

educational attainment or income level.

Percent of Maryland Adults (40+ years) who have not had a Dilated Eye Exam in the Last Two Years, by Age*, Education, and Income, 2008

40.5

32.0

18.2

34.0 33.5 32.0 31.8 31.829.6 29.6

32.632.5

0

10

20

30

40

50

40-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colleg

e

College

Gra

d

<$15,

000

$15-

24,99

9

$25-

49,99

9

$50-

74,99

9

>$75,

000

Pe

rce

nt

*Denotes a statistically significant difference among the values.

HEALTH BEHAVIOR RISK FACTORS

22

23

Question: Considering all types of alcoholic beverages, how many times during the past month did you have five or more drinks on one occasion?

At risk: Adults reporting drinking at least five alcoholic beverages on one occasion in the past month are considered at risk.

Who is at risk in Maryland?

In 2008, almost 14% of Marylanders were at risk for binge drinking (having at

least 5 alcoholic beverages in one occasion).

Men reported binge drinking significantly more than women (17.9% versus

10.0%).

White residents were significantly more likely to report binge drinking (16.5%)

than black residents (9.0%).

Younger adults were significantly more likely to have had five or more

alcoholic beverages on one occasion in the last month than older adults.

Binge drinking did not significantly vary by education level.

Although the amount of binge drinking appeared to vary by income level, this

difference was largely due to the low percentage of binge drinkers in the lowest

income levels (less than $15,000 and $15,000-$24,999). Binge drinking did not

vary significantly across the other income levels.

Those who currently smoke were significantly more likely to binge drink than

those who do not smoke (29.8% versus 11.0%).

Percent of Maryland Adults who are classified as Binge Drinkers, by Age*, Education, and Income*, 2008

Percent of Maryland Adults who are classified as Binge Drinkers, by Gender* and

Race*, 2008

17.9

10.0

0

5

10

15

20

Male FemaleGender

Pe

rce

nt

16.5

9.0

0

5

10

15

20

White BlackRace

Pe

rce

nt

ALCOHOL CONSUMPTION

23.2

10.1

12.4

7.3

14.316.3

13.713.715.4

9.9

15.5

3.2

9.6

0

5

10

15

20

25

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colleg

e

College

Gra

d

<$15,

000

$15-

24,99

9

$25-

49,99

9

$50-

74,99

9

>$75,

000

Per

cen

t

* Denotes a statistically significant difference among the values.

24

Question: How many servings of vegetables or fruits do you usually eat per day?

At risk: Adults who answered ‘Less than 5 times’ or ‘Never’ are considered at risk.

Who is at risk in Maryland?

73% of Marylanders eat less than 5 servings of fruits or vegetables per day.

Men are more likely to be at risk for not eating 5 servings of fruits or vegetables

per day (76.2%) than are women (69.6%); the difference is statistically

significant.

Black residents are slightly more likely to be at risk for not eating 5 servings of

fruits or vegetables per day (74.4%) than white residents (72.9%), although the

difference is not statistically significant.

Persons with less than a college education were significantly more likely to be

at risk for not consuming 5 servings of fruits or vegetables per day compared to

those with a college-education.

Individuals whose household income was more than $75,000 per year were less

likely to be at risk of consuming less than 5 servings of fruits or vegetables per

day compared to lower income households.

Persons who did not consume 5 fruits or vegetables a day were significantly

more likely to be overweight/obese than those who did eat 5 servings of fruits

or vegetables per day.

Percent of Maryland Adults who Consume Less than 5 Servings of Fruits or Vegetables a Day, by Age, Education*, and Income*, 2008

Percent of Maryland Adults who Consume Less than 5

Servings of Fruits or Vegetables a Day, by Gender*

and Race, 2008

76.2 69.6

0

20

40

60

80

100

Male FemaleGender

Per

cen

t

72.9 74.4

0

20

40

60

80

100

White BlackRace

Per

cen

t

FRUITS AND VEGETABLES CONSUMPTION

82.474.9

67.269.872.373.7

76.8 76.677.871.071.3

75.172.5

0

20

40

60

80

100

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colle

ge

College

Gra

d

<$15,

000

$15-

24,9

99

$25-

49,9

99

$50-

74,9

99

>$75,

000

Per

cen

t

* Denotes a statistically significant difference among the values.

25

Question: During the past 30 days, other than your regular job, did you participate in any physical activity or exercise such as running, calisthenics, golf, gardening, or walking for exercise?

At risk: Adults who do not participate in any physical activity or exercise during the last 30 days are considered at risk.

Who is at risk in Maryland? 24% of Marylanders reported not participating in any physical activities or

exercise during the past month.

Women were more likely to report being physically inactive (27.6%) than men

(19.9%); this difference is statistically significant.

Black residents were significantly more likely to be physically inactive (30.2%)

than white residents (20.9%).

Respondents 65 and older, individuals with less education or those with lower

income were significantly more likely to be physically inactive.

Compared to those who did not exercise during the past 30 days, those who did

exercise were significantly less likely to be classified as obese, have angina or

coronary disease, or have diabetes.

Percent of Maryland Adults who did not participate in any Physical Activity During the Past 30 Days, by Age*, Education*, and Income*, 2008

Percent of Maryland Adults who did not participate in

any Physical Activity During the Past 30 Days, by

Gender* and Race*, 2008

27.619.9

0

10

20

30

40

Male Female

Gender

Per

cen

t

20.9

30.2

0

10

20

30

40

White Black

RaceP

erce

nt

PHYSICAL ACTIVITY

22.0 21.1

31.7

40.5

48.2

37.3

31.3

22.6

33.4

14.2

25.9

14.5

24.8

0

10

20

30

40

50

60

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colleg

e

College

Gra

d

<$15,

000

$15-

24,99

9

$25-

49,99

9

$50-

74,99

9

>$75,

000

Per

cen

t

*Denotes a statistically significant difference among the values.

26

Question: If you have smoked at least 100 cigarettes in your entire life, are you now smoking everyday, some days, or not at all?

At risk: Adults who smoke ‘everyday’ or ‘some days’ are considered at risk.

Who is at risk in Maryland?

14.9% of Marylanders are current smokers (i.e., smoke everyday or some days).

Male residents were more likely to be current smokers (16.1%) than female

residents (13.8%), although this difference is not statistically significant.

Black residents were more likely to be current smokers (16.4%) than white

residents (15.8%), although this difference is not statistically significant.

Adults under 65 years old, individuals who have less than a college education

or those with less income were significantly more likely to be smokers.

31% of those who have never smoked had not visited a doctor for a routine

check up in the past year, while 40% of everyday smokers reported the same.

20% of everyday smokers were at risk for fair or poor general health compared

to 10% of those who reported never smoking.

5.2% of everyday smokers had been told by a health professional that they have

had a heart attack compared to 2.5% of those who reported never smoking.

Percent of Maryland Adults who are Current Smokers (Smoke Everyday or Some Days), by Age*, Education*, and Income*, 2008

Percent of Maryland Adults who are Current Smokers (Smoke Everyday or Some

Days), by Gender and Race, 2008

16.113.8

0

5

10

15

20

Male FemaleGender

Per

cen

t

15.8 16.4

0

5

10

15

20

White BlackRace

Per

cen

t

TOBACCO USE

14.4

29.0

21.1

9.5

21.7

26.3

7.0

17.8 17.120.4

8.3

16.1

18.0

0

5

10

15

20

25

30

35

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colle

ge

College

Gra

d

<$15,

000

$15-

24,9

99

$25-

49,9

99

$50-

74,9

99

>$75,

000

Per

cen

t

* Denotes a statistically significant difference among the values.

27

Who is at risk in Maryland? Female residents were more likely to report not being well prepared for a large-

scale emergency (82.7%) than male residents (76.1%); this difference is

statistically significant.

Black residents were more likely to report not being well prepared for a large-

scale emergency (83.4%) than white residents (78.2%), although this difference

is not statistically significant.

Differences in education, and income were not statistically significant; residents

over the age of 50 are more likely to report not being well prepared for a large-

scale emergency than residents over the age of 65.

Of those who report that they are well prepared for a large-scale emergency,

33.9% have an evacuation plan, 96.4% have a 3-day supply of food, and 77.1%

have a 3-day supply of water.

75% of people reported that cell phones would be their main method of

communication following a large-scale emergency.

52% of people reported that the radio would be their main method of getting

information following a large-scale emergency.

Percent of Maryland Adults who report not being well prepared for a large-scale emergency, by Age*, Education, and Income, 2008

Percent of Maryland Adults who report not

being well prepared for a large-scale emergency, by Gender* and Race, 2008

82.776.1

0

20

40

60

80

100

Male Female

Gender

Per

cen

t

78.2 83.4

0

20

40

60

80

100

White BlackRace

Per

cen

t

82.5 80.476.982.278.5 81.179.782.6

81.8 72.478.6

71.5

83.4

0

20

40

60

80

100

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colleg

e

College

Gra

d

<$15,

000

$15-

24,99

9

$25-

49,99

9

$50-

74,99

9

>$75,

000

Per

cen

t

* Denotes a statistically significant difference among the values.

Question:

At risk:

How prepared do you feel your household is to handle a large-scale disaster or emergency?

Adults who answer ‘Somewhat prepared’ or ‘Not prepared at all’ are considered at risk.

GENERAL PREPAREDNESS

28

Percent of Maryland Adult Men and Women who

Participated in the BRFSS Survey by Demographic

Characteristic, by Gender and Race, 2008

BRFSS Survey Demographic Characteristics by Gender

In 2007, 52.5% of adult residents who participated in the BRFSS survey were

women and 47.5% were men.

52.547.5

0

10

20

30

40

50

60

Male Female

Gender

Per

cen

t

For both races (black and white) the percentage of women who participated was

greater than that of men. However, the ratio of black women to black men was

greater than the ratio of white women to white men.

There was a statistically significant difference in the percentage of men who

participated in the BRFSS survey versus women in the 65+ years age group.

Only 13.9% of participating men were over the age of 65 years of age, whereas

17.6% of participating women were over the age of 65.

52.5 55.4

44.647.5

0

10

20

30

40

50

60

White BlackRace

Per

cen

t

The percentage of participating men who are college graduates (44.2%) was

greater than the percentage of participating women who are college graduates

(42.5%); this difference is not statistically significant.

Similarly, the percentage of participating men earning over $75,000 per year

was significantly higher than the percentage of participating women earning the

same amount.

Percent of Maryland Adult Men and Women who Participated in

the BRFSS Survey by Demographic Characteristic, by Age*, Education, and Income*, 2008

0

10

20

30

40

50

60

18-3

4

35-4

9

50-6

465

+

<HS Gra

d

HS Gra

d

Some

Colleg

e

College

Gra

d

<$15,

000

$15-

24,99

9

$25-

49,99

9

$50-

74,99

9

>$75,

000

Male Female

BRFSS SURVEY DEMOGRAPHIC CHARACTERISTICS: GENDER DIFFERENCES

29

63.4

12.112.5

63.4

14.514.4

0

15

30

45

60

75

Fair/Poor GeneralHealth

No Health CareCoverage

Overw eight or Obese

Per

cen

t

Maryland United States

Health Behavioral Risk Factors in the BRFSS Survey Population, 2008

Relative to the nation overall, Maryland residents participating in the BRFSS survey were less likely to report binge drinking, i.e., drinking 5 or more drinks in a sitting (13.8% versus 15.6%). Participating Marylanders were also less likely to report being current smokers (14.9% versus 18.4%). The percentage of participating Maryland residents reporting no physical activity in the past month was slightly lower than the national BRFSS median (24.0% versus 24.6%).

MARYLAND VERSUS UNITED STATES: BRFSS SURVEY RISK FACTORS

Self-Reported Health and Other Risks in the BRFSS Survey

Population, 2008

13.8 14.9

24.0 24.6

18.4

15.6

0

5

10

15

20

25

30

Binge Drinking Current Smoking No Physical Activity

Per

cent

Maryland United States

Marylanders participating in the BRFSS survey reported themselves in better health than the nation overall. The percentage of participating Marylanders reporting that their health was fair or poor was lower than the national level (12.5% versus 14.4%). Participating Marylanders are more likely to report having healthcare coverage than the nation overall. The percentage of participating Marylanders who report lacking health care coverage was lower than that for the nation as a whole (12.1% versus 14.5%). The percentage of the Maryland BRFSS population classified as overweight or obese according to BMI scores was the as the national BRFSS population (63.4% versus 63.4%). Source: National Center for Chronic Disease Prevention & Health Promotion (CDC) ‘Behavioral Risk Factor Surveillance System – Prevalence and Trend Data’, available from http://apps.nccd.cdc.gov/brfss/ Accessed December 8, 2009.

30

MARYLAND VERSUS UNITED STATES: BRFSS SURVEY DEMOGRAPHIC CHARACTERISTICS

Educational Characteristics of Adult BRFSS Survey Population, 2008

Age Distribution of Adult BRFSS Survey Population, 2008 Compared to the national

BRFSS adult population age distribution, Maryland’s participating residents showed a higher relative percentage of adults (35-54 years), a lower relative percentage of adults aged 65+ years, and a similar percentage of adults aged 18-34 years and 55-64 years.

19.6

15.715.0

20.317.3

12.1

17.3

14.9

19.218.217.7

12.5

0

10

20

30

18-2

4 yr

s

25-3

4 yrs

35-4

4 yr

s

45-5

4 yrs

55-6

4 yrs

65+

yrs

Per

cent

Maryland United States

Relative to the country as a whole, the population of Maryland participating in the BRFSS survey is well-educated. The percentage of those not completing high school was about the same as the national BRFSS level and the percentage of participating Marylanders having a college degree was almost 12% higher than the national BRFSS level (43.3% versus 31.7%).

6.7 8.7

29.6 26.8

43.3

23.6

26.4 31.7

0

10

20

30

40

50

Less Than HSGraduate

HS Graduate Some College orVocational

College Graduate

Per

cen

t

Maryland United States

Income Characteristics of Adult BRFSS Survey Population, 2008

9.9 13.5

63.1

11.515.5

8.55.1

49.6

8.015.0

0

15

30

45

60

75

< $15,000 $15 - 24,999 $25- 34,999 $35-49,999 > $50,000

Per

cent

Maryland United States

Overall, Marylanders participating in the BRFSS survey were wealthier than the BRFSS national average. In 2008, over 63% of participating Maryland households had incomes above $50,000 per year, compared to only 50% of the population attaining that level across the nation. Given the large percentage of the Maryland participating population earning over $50,000 per year, for all other income levels, the relative percentage of participating Marylanders was below the national levels. Source: National Center for Chronic Disease Prevention & Health Promotion (CDC) ‘Behavioral Risk Factor Surveillance System – Prevalence and Trend Data’, available from http://apps.nccd.cdc.gov/brfss/ Accessed December 8, 2009.

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APPENDICES

HOW TO USE THE MARYLAND BRFSS

The Maryland BRFSS is accessible on the web at www.marylandbrfss.org (for national data, please go to www.cdc.gov/brfss/). Users will be brought to a homepage of survey reports; choose the BRFSS by clicking on the icon. The next page is a resource page for the BRFSS; it is here that users will find resources such as detailed instructions on how to use the site, tools, and the questionnaires. To enter the query window, choose the year of interest in the right hand side column. The search window will look like the image below.

Example of a Query: Search Window: Question = “How many Marylanders currently smoke everyday?”

To begin searching, choose the year of interest, the topic of interest, then any crossing variables (e.g., gender, race, age, income, county etc.). Finally, click the “Run Tabulate” button on the bottom of the page.

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Output Window: Answer = An estimated 236,484 Men (11.6%) and 219,357 Women (9.7%) smoke everyday.

Choose topic: “How many people smoke everyday?

Choose year of report

Choose “crossing” variable, or subtopic “How many men versus women smoke everyday?

Choose counties

Click “Run Tabulate”

An estimated 236,484, or (11.6%) of Maryland adult men smoke everyday. An estimated 219,357, or (9.7%) of Maryland adult women smoke everyday. Click to generate an excel file or a graph of the results.

The results provide two different frequencies: n= the number of respondents interviewed (i.e., the number of people who actually responded) and N = the weighted sample frequency (i.e., the number estimated if all the persons in the state would have responded). The percent value that is given is based on the estimate of the Maryland population, and is therefore, an estimation of the percentage of Maryland residents, not the actual percentage of Marylanders.

If the BRFSS was to be administered to all Marylanders, then no estimation would be needed, and one could make conclusions based on the population values. For example, if we were to ask all Marylanders if they had their teeth cleaned and 95% of women responded ‘yes’ versus 90% of the men, then one could draw the conclusion that the proportion of women who have their teeth cleaned is greater than that of men. However, the BRFSS does not reach every citizen; therefore, the percentage values given are only estimates of the true population values. Consequently, one cannot draw conclusions based solely on these values without further information as described below.

The additional information needed is the confidence interval (CI) for the respective values. By comparing the confidence intervals, one can determine if the given estimates represent a probable difference in the actual population. These values are given in the BRFSS output. To compare values and their respective confidence intervals, compare them to see if there is an overlap in the range of each confidence interval. If the confidence intervals overlap, then the values are not considered statistically significant. If the confidence intervals do not overlap, then the difference between the values is large enough to conclude that the estimated values are different. For example, in 2008, 11.6% of males reported smoking everyday (CI = 10.3, 12.9) and 9.7% of women reported smoking everyday (CI = 8.8, 10.6); since the range of the two sets of confidence intervals overlaps, one would conclude that the values of 11.6% for men and 9.7% for women are not significantly different. Therefore, one could not make the conclusion that the percentage of men that smoke everyday is larger than the percentage of women. By contrast, when one compares the values for those who currently have asthma (including never had asthma), 7.2% of men reported still having asthma (CI = 6.1, 8.3), while 11.4% of women reported still having asthma (CI = 10.4, 12.4); a statistically significant difference is found because the confidence intervals do not overlap (the lowest boundary for women, 10.4, is higher than the highest boundary for men, 8.3). Consequently, one could conclude that the percentage of men that currently have asthma is significantly less than that of women—that is, men are less likely to currently have asthma than women.

Lastly, one can generate graphs and maps of the output by clicking on the appropriate icon immediately below the results. The graph below presents the percent of men and women who smoke everyday. Graph Window: An Estimated 11.6% of Men and 9.7% of Women Smoke Everyday

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Maps can be generated by clicking on the appropriate icon immediately below the results table, but

only if “County” or “Region” is selected as a row variable. Otherwise, the “View Map” icon will not appear. The map below presents the percent of the population who smoke everyday by county. Mapping Window: Percent of Population who Smoke Everyday by County

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FREQUENTLY ASKED QUESTIONS (FAQs)

When I run my query, no numbers appear in the cells. What went wrong? Most likely, nothing went wrong. When the values in the cells are too small (n<50), BRFSS will not generate an output for those cells because the estimates are considered too unreliable. This often happens when the user crosses one or more variables with conditions that have a low prevalence (e.g., asthma by county). This situation might be corrected by aggregating a number of years together when running your analysis. (This can be done by holding down the control key while choosing multiple years in the search window). How can I tell if the estimated values presented in this report are statistically significant? Although the BRFSS results present confidence intervals in the output, for the sake of clarity, this report does not. However, when there is no overlap in the confidence intervals, an asterisk is placed near the value or title (e.g., “Gender*) to indicate to the reader that the estimated values are statistically significant For any other questions, please contact Helio Lopez, BRFSS Coordinator, at lopezh@dhmh.state.md.us

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Below are resources providing definitions and descriptions of conditions found in the BRFSS report. These links direct you to government sources or non-profit institutions that have assembled reliable, non-commercial information. Most sites provide information about disease symptoms, causes, risk factors, and tips about prevention. Other sites provide important information about finding good quality health care and making informed choices about your options.

Health care access and quality: http://mhcc.maryland.gov/ http://www.hrsa.gov/help/default.htm http://www.ahrq.gov/consumer/

Chronic disease and conditions: http://fha.maryland.gov/cdp/ http://www.nichd.nih.gov/health/topics/ Asthma http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs.html http://www.noattacks.org/?gclid=CKOktZL5zosCFRQkUAodpFklGw Diabetes http://www.nlm.nih.gov/medlineplus/diabetes.html http://www2.niddk.nih.gov/ http://www.diabetes.org/ Heart Attack http://www.nlm.nih.gov/medlineplus/heartdiseases.html http://www.americanheart.org/presenter.jhtml?identifier=1200000 http://www.nhlbi.nih.gov/health/public/heart/index.htm Overweight/Obesity http://www.nlm.nih.gov/medlineplus/obesity.html http://diabetes.org/weightloss-and-exercise/are-you-at-risk.jsp http://www.niehs.nih.gov/health/scied/documents/Fact%20Sht%20Obesity%202005%20final.pdf Stroke http://www.nlm.nih.gov/medlineplus/stroke.html http://www.strokeassociation.org/presenter.jhtml?identifier=1200037 http://www.ninds.nih.gov/disorders/stroke/stroke.htm

Risk factors and prevention: Anxiety/Depression http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml http://www.nimh.nih.gov/health/topics/depression/index.shtml http://www.nami.org/Template.cfm?Section=By_Illness&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=54&ContentID=23039&lstid=326

LINKS FOR FURTHER INFORMATION

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Flu Shot http://www.nlm.nih.gov/medlineplus/flu.html http://www.cdc.gov/flu/protect/children.htm http://www.mayoclinic.com/health/influenza/AN00651 Oral Health http://www.nlm.nih.gov/medlineplus/toothdisorders.html http://www.ada.org/public/topics/decay_faq.asp http://www.nlm.nih.gov/medlineplus/oralcancer.html http://www.nidcr.nih.gov/OralHealth/Topics/OralCancer/OralCancer.htm Alcohol Consumption http://getfit.samhsa.gov/Alcohol/Tests/default.aspx?position=2 http://www.niaaa.nih.gov/FAQs/General-English/default.htm http://www.nida.nih.gov/students.html http://www.nlm.nih.gov/medlineplus/pregnancyandsubstanceabuse.html Fruit and Vegetable Consumption http://www.nlm.nih.gov/medlineplus/nutrition.html http://www.cnpp.usda.gov/ http://www.cfsan.fda.gov/~lrd/advice.html Physical Activity http://www.cdc.gov/nccdphp/dnpa/physical/ http://www.nlm.nih.gov/medlineplus/exerciseandphysicalfitness.html http://www.fitness.gov/ http://apps.nccd.cdc.gov/DNPAProg/StateV.asp Tobacco Use http://www.nlm.nih.gov/medlineplus/smoking.html http://smoking.drugabuse.gov/ http://www.lungusa.org/ http://www.lungcancer.org/ http://www.cancer.org/docroot/home/index.asp

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Choose year of report

Choose counties

Choose topic: “How many people smoke everyday?

Choose “crossing” variable, or subtopic “How many men versus women smoke everyday?

HHaavvee qquueessttiioonnss aabboouutt tthhee ssttaattee ooff MMaarryyllaanndd’’ss hheeaalltthh?? VViissiitt uuss aatt www.marylandbrfss.orgwww.marylandbrfss.org

YYoouurr aannsswweerrss aarree jjuusstt aa ffeeww cclliicckkss aawwaayy.. HHeerree’’ss hhooww…… Search Window:

Question = “How many Marylanders currently smoke everyday?”

Output Window: Answer = An estimated 236,484 Men (11.6%) and 219,357 Women (9.7%) smoke everyday

Graph Window Map Window

Click “Run Tabulate”

An estimated 236,484, or (11.6%), of men smoke everyday. An estimated 219,357, or (9.7%), of women smoke everyday. Click to generate an excel file of results, a graph or a map for a report of the results.