Trends in Health Risks and Behaviors

Highlights from the 2003 Massachusetts Behavioral Risk Factor Surveillance System

Health Survey Program Center for Health Information, Statistics, Research, and

EvaluationMassachusetts Department of Public Health

December 2004

What is the BRFSS?o Random digit dial telephone survey

o Adults ages 18 and older

o Collaboration between CDC and States

o Massachusetts BRFSS since 1986

o Data are weighted: provide population-based estimates of health

o Sample Size: 7,000 - 8,000 annually

Source: Massachusetts BRFSS

BRFSS

TOBACCO

CANCER SCREENING

DRUG &ALCOHOL

ASTHMA CHOLESTEROL

NUTRITION& EXERCISE

HEALTH CARE ACCESS

INJURY

DIABETES

50 OTHER TOPICS

WEIGHT

Source: Massachusetts BRFSS

Topics to be covered

o Flu Vaccinationo Overweight or Obesityo Tobacco Useo Binge Drinkingo Mammogramo HIV Testing

Influenza (flu) Vaccine

Trend in the percentage of adults, ages 65+, who have had a flu vaccine in the past year, 1993-

2003

0

20

40

60

80

100

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

% flu

shot

Note: Dotted line signifies year in which question was not asked.

Source: Massachusetts BRFSS

State vaccine purchase and statewide immunization rates

0

10

20

30

40

50

60

70

80

1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Perc

ent >

64 y

.o. R

ecei

ving

In

fluen

za a

nd P

nem

onia

Vac

cine

0

100

200

300

400

500

600

700

800

Num

ber o

f Dos

es o

f Sta

te S

uppl

ied

Vacc

ine

(100

0s)

Influenza BRFSS Pneumonia BRFSS Influenza Purchase Pneumonia Purchase

Percentage of adults who received a flu or pneumonia

vaccine by race/ethnicity, 2001-2003

0

20

40

60

80

100

fl u shot, 65+ pneumonnia shot, 65+

% flu

or pn

eumo

nnia

shot

White, NH

Black, NH

Hispanic

Source: Massachusetts BRFSS

MDPH Program Highlights Immunization Program

o Educational outreach • Mailing to 10,000 providers about flu vaccination recommendations• Presentations and grand rounds to health care providers• MDPH influenza web site• Partnerships and Coalitions• Promotional campaign targeting Latino and African-American

communities

o Standing Orders Project to vaccinate hospital in-patientso Flu vaccination of health care workers

Source: MDPH Immunization Program

Obesity

Overweight Obese Height BMI* 25.0-29.9 BMI* >

30

5’ 128 lbs. 153 lbs. 5’2’’ 136 164 5’4’’ 145 174 5’6’’ 155 186 5’8’’ 164 197 6’ 184 221

Adult Overweight or Obese by Height

*BMI (Body Mass Index): weight in kilograms height in meters squared

Source: Massachusetts BRFSS

Overweight Obese Height BMI* 25.0-29.9 BMI* >

30

5’ 128 lbs. 153 lbs. 5’2’’ 136 164 5’4’’5’4’’ 145145 174174 5’6’’ 155 186 5’8’’ 164 197 6’ 184 221

Adult Overweight or Obese by Height

Source: Massachusetts BRFSS *BMI (Body Mass Index): weight in kilograms height in meters squared

Trend in the percentage of adults who are overweight or

obese, 1990-2003

0

20

40

60

80

100

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

% ov

erwe

ight o

r obe

se

overweight obese

Source: Massachusetts BRFSS

Percentage of adults who are obese, by sex and

race/ethnicity, 2003

0

10

20

30

40

50

Total White, NH Black, NH Hispanic Asian, NH

% ob

ese

male f emale

Rates are age adjusted to the US 2000 standard population.Source: Massachusetts BRFSS

MDPH Program Highlights: Massachusetts Overweight Prevention

and Control Initiative (MOPCI)o Statewide: partnering with public and private organizations

to coordinate overweight prevention and control efforts

o Communities: working with communities to implement walk/bike to school and work initiatives

o Schools: working with schools to increase student awareness and participation in healthy eating and physical activity before, during, and after school

o Worksites: working with employers to support improved nutrition and increased participation in physical activity for their employees

Source: Massachusetts Overweight Prevention and Control Initiative

Breast Cancer Screening

Trend in the percentage of women, ages 40+, who had a mammogram in past 2 years,

2003

0

20

40

60

80

100

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

% ma

mmog

ram

Note: Dotted line signifies year in which question was not asked.

Source: Massachusetts BRFSS

Trend in the percentage of women, ages 40+, who had a mammogram in past 2 years by insurance status, 2003

0

20

40

60

80

100

1992-1

993

1994-1

995

1996-1

997

1998-1

999

2000-2

001*

2002-2

003

% ma

mmog

ram

insured uninsured

* 2000 data onlySource: Massachusetts BRFSS

Percentage of women, ages 40+, who had a mammogram

in the past 2 years, by disability status, 2003

60

70

80

90

100

not disabled disabled

% m

amm

ogra

m

Rates are age adjusted to the US 2000 standard population.Source: Massachusetts BRFSS

MDPH Program Highlights: Breast Cancer Screening

o Increase in mammograms among women ages 40+ after

program

inception.

o Better access to care needed for people with disabilities.

o More outreach needed to Hispanic women.

Source: Massachusetts Women’s Health Network

Binge Drinking(5 or more drinks on one occasion)

Trend in the percentage of binge drinkers among

adults, 1990-2003

0

5

10

15

20

25

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000 20

0120

0220

03

% bin

ge d

rinke

r

US MA

Note: Dotted line signifies year in which question was not asked.

Source: Massachusetts BRFSS

Percentage of binge drinkers among adults, by household

income, 2003

0

5

10

15

20

25

<$25,000 $25-34,999 $35-49,999 $50-74,999 $75,000+

% bin

ge d

rink

Source: Massachusetts BRFSS

MDPH Program Highlights:Binge Drinking

o MA monitors binge drinking because of the associated high risk behaviors

o Percentage of MA adults reporting binge drinking is consistently higher than US average on both the BRFSS and SAHMSA. (Substance Abuse Mental Health Services Administration’s National Survey on Drug Use and Health (NSDUH)).

o Both BRFSS and NSDUH show similar patterns by demographic group.

o Bureau of Substance Abuse Services funds a broad spectrum of regional and community-based prevention programs and a continuum of substance use treatment services.

Source: MDPH Bureau of Substance Abuse and Services

Cigarette Smoking

Percentage of current smokers among adults, 1986-2003

0

10

20

30

40

50

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000 20

0120

0220

03

% cu

rren

t smo

ker

Source: Massachusetts BRFSS

Percentage of current smokers among adults and young

adults, 1986-2003

0

10

20

30

40

50

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000 20

0120

0220

03

% cu

rren

t smo

ker

overall ages 18-24

Source: Massachusetts BRFSS

Percentage of current smokers among adults, by household

income, 1986-2003

0

10

20

30

40

50

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

% cu

rren

t smo

ker

<$50,000 $50,000+

Source: Massachusetts BRFSS

MDPH Program Highlights:Tobacco Control Program

o Implementation of smokefree workplace lawso Monitoring illegal cigarette sales to minors via

statewide compliance check programo Working with health care systems to determine

smoking status of patients and refer smokers to quit line

o Promoting smokefree homes and smoking cessation services to programs serving young women with children such as Healthy Start, Early Intervention, Head Start and WIC

Source: MDPH Tobacco Control Program

HIV Testing

Percentage of adults, ages 18-64, who report ever being

tested for HIV, by risk status, 1993-2003

0

20

40

60

80

100

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

% e

ver

test

ed

ever tested ever tested and high risk behavior

Source: Massachusetts BRFSS

MDPH Program HighlightsHIV/AIDS Bureau

Counseling and Testing Programo The general population have multiple opportunities for HIV testing,

including private health care and life insurance application processes.o Publicly funded HIV testing and counseling programs are required to

identify and target high risk populations for testing.o Public and clinical education programs emphasize the importance of

knowing one’s risk and HIV testing as the point of access to HIV care.o Higher relative testing rates among high risk individuals may reflect the

impact of educational programming about HIV risk and the benefits of testing, as well as the effectiveness of targeted public test access.

o As the efficiency of the publicly funded HIV counseling and testing system increases, it remains important to maintain access to health care and anti-HIV medications for the 1,000 Massachusetts resident who yearly are newly identified with HIV.

Source: MDPH HIV/AIDS Bureau

Summaryo Important to examine trends to inform

program developmento Trends that bear watching:

• Smoking: rates stable among adults; concerns among young adults

• Mammogram: concerns among women with disabilities• Overweight/Obesity: continued rise for all; race and

gender disparities exist• Binge Drinking: Massachusetts higher than the US• HIV testing: high testing rate among high risk adults

Monitoring the Health of Massachusetts: 2003 BRFSS

Reporto Overall health measures: health status, quality of lifeo Access and Utilization: insurance coverage, access to

careo Risk factors and preventive behaviors: physical

activity, nutrition, hypertension, cholesterol awarenesso Chronic conditions: diabetes, CVD, asthma, disabilityo Cancer screeningo Childhood health: dental sealant, access to care, asthmao Others: HIV testing, illicit drug use, unwanted sexual contact

How to obtain this report? For access to reports and data:

Visit the BRFSS website: http://www.state.ma.us/dph/bhsre/cdsp/brfss/brfss.htm MassCHIP: 2003 BRFSS data will be available late in 2005

For more information about BRFSS, please contact: Zi Zhang, Director of Health Survey Program Tel: (617) 624-5623 E-mail: zi.zhang@state.ma.us