Leading Health Indicators: Data Trends and Disparities

1. Leading Health Indicators: Data Trends and Disparities Richard J. Klein, MPH Suzanne E. Proctor, MSPH National Center for Health Statistics Centers for Disease Control and Prevention

2. Physical Activity Moderate physical activity in adults Vigorous physical activity in adolescentsOverweight and Obesity Obesity in adults Overweight/obesity in children/adolescents Tobacco Use Cigarette smoking by adults Cigarette smoking by adolescents Substance Abuse Alcohol and illicit drug use by adolescents Illicit drug use by adults Binge drinking by adults Mental Health Treatment of adults with recognized depression Suicides* Injury and Violence Deaths from motor vehicle crashes Homicides Environmental Quality Ozone pollution exposure Environmental tobacco smoke exposure Children exposed to tobacco smoke at home* Pediatric asthma hospitalizations* Immunization Fully immunized children aged 19-35 months Influenza vaccination in high-risk adults Pneumococcal vaccination in high-risk adults Access to Care Persons with health insurance Source of ongoing care Early prenatal care Responsible Sexual Behavior Abstinence or condom use by adolescents Condom use by adults Gonorrhea infections* * Supplemental measure Leading Health Indicators and Measures

3. Same national and State source: Number of measures National Vital Statistics System 4 National Household Survey on Drug Abuse 4 Youth Risk Behavior Surveillance System 3 Aerometric Information Retrieval System 1 Healthcare Cost and Utilization Project 1 National Immunization Survey 1 STD Surveillance System 1 Behavioral Risk Factor Surveillance System (State) and different national source: National Health Interview Survey 7 National Health and Nutrition Examination Survey 2 National Survey of Family Growth 1 National data source only: National Health and Nutrition Examination Survey 1 Data sources for the LHI measures

4. Physical Activity

5. Adults and adolescents engaging in physical activity 2010 target Percent Adolescents* 2010 target Adults** * Adolescents: Students in grades 9 to 12 participating in activity that makes them sweat and breathe hard (at least 20 minutes, 3 or more days per week). ** Adults: Persons aged 18 years and over participating in moderate activity (at least 30 minutes, 5 days per week) and/or vigorous activity (at least 20 minutes, 3 days per week). Data for adults are age-adjusted to the 2000 standard population. Data for 2001 are preliminary. Sources: National Health Interview Survey, CDC, NCHS (adults) and Youth Risk Behavior Surveillance System, CDC, NCCDPHP (adolescents).

6. All adults Female Male Less than 9th grade Grades 9-11 High school graduate Some college College graduate I 95% Confidence Interval. Notes: Physical activity is defined as moderate activity (at least 30 minutes, 5 days per week) and/or vigorous activity (at least 20 minutes, 3 days per week). Gender data are for persons 18 years and over. Education data are for persons 25 and over. Data are age adjusted to the 2000 standard population. Source: National Health Interview Survey, CDC, NCHS. Adults engaging in physical activity, by gender and education, 2000 2010 target Age-adjusted percent

7. Physical activity remained steady during the past decade Males are significantly more likely to exercise than females Adults with more education are more likely to exercise Adolescents living in the South are the least likely to exercise Summary

8. Overweight and Obesity

9. I 95% Confidence Interval * Can be of any race. Notes: Obesity is defined as Body Mass Index (BMI) > 30. Data are age-adjusted to the 2000 standard population. Source: National Health and Nutrition Examination Survey, CDC, NCHS. Obesity in adults aged 20 years and over, by race/ethnicity 1988 - 1994 1999 - 2000 Age-adjusted percent 2010 target Mexican American* All adults Black, not Hispanic White, not Hispanic

10. I 95% Confidence Interval * Can be of any race. Note: Overweight is defined as at or above the age- and gender-specific 95th percentile of BMI. Confidence intervals for 1988-1994 are estimated. Source: National Health and Nutrition Examination Survey, CDC, NCHS. Overweight in youth aged 6-19 years, by race/ethnicity 1988 – 1994 1999 - 2000 Percent 2010 target Black, not Hispanic White, not Hispanic Mexican American* All youth

11. * NHANES data are for 1999-2000. I 95% Confidence Interval. Notes: Obesity is defined as Body Mass Index (BMI) > 30. Data are for persons 20 years and over. Data are age adjusted to the 2000 standard population. Sources: Behavioral Risk Factor Surveillance System (BRFSS), CDC, NCCDPHP; National Health Interview Survey (NHIS),CDC, NCHS; National Health and Nutrition Examination Survey (NHANES),CDC, NCHS. Obesity in adults, 1999 Age-adjusted percent Mode of administration affects estimate of obesity obtained from different surveys Self-reported data underestimate the measured prevalence of obesity In-person examination In-person interview Telephone survey NHIS NHANES* BRFSS

12. Overweight/obesity is increasing for all ages The increase is observed for all race/ethnic groups Adult females are more likely to be obese than adult males Overweight/obesity is highest among Black and Mexican-Americans Summary

13. Tobacco Use

14. Cigarette smoking by adults and adolescents Percent Adolescents* Adults** 2010 target 2010 target * Adolescents: Students in grades 9 to 12 who reported smoking cigarettes on 1 or more of the 30 days preceding the survey. ** Adults: Persons aged 18 years and over who have smoked at least 100 cigarettes in lifetime and who now smoke every day or some days. Data are age-adjusted to the 2000 standard population. Data for 2001 are preliminary. Sources: National Health Interview Survey, CDC, NCHS (adults). Youth Risk Behavior Surveillance System, CDC, NCCDPHP (adolescents, all years except 2000) and National Youth Tobacco Survey, CDC, OSH (adolescents, 2000).

15. * Can be of any race I 95% Confidence Interval. Notes: Smoking is defined as having at least 100 cigarettes in lifetime and now smoking every day or some days. Data are age-adjusted to the 2000 standard population. Source: National Health Interview Survey, CDC, NCHS. Cigarette smoking by adults 18 years and over, by race/ethnicity and gender, 2000 Age-adjusted percent 2010 target Male Female All adults Hispanic* Black, not Hispanic White, not Hispanic Asian or Pacific Islander American Indian or Alaska Native

16. Cigarette smoking by adolescents in grades 9 to 12, 2001 N Percent (14) (15) (15) (7) 29.8 – 38.5 25.3 – 29.7 8.3 – 25.2 No data Notes: Smoking is defined as having cigarettes on 1 or more of the 30 days preceding the survey. Data are for all reporting States (weighted and unweighted data included). Source: Youth Risk Behavior Surveillance System, CDC, NCCDPHP.

17. Summary Adult cigarette smoking has changed little during the past decade American Indian and Alaska Native adults are the most likely to smoke Adolescent cigarette smoking is on the decline White adolescents are the most likely to smoke

18. Substance Abuse

19. All adults Female Male American Indian/Alaska Native only Asian only Black only White only More than one race Hispanic* * Can be of any race. Note: Binge drinking is defined as having 5 or more drinks at once in the 30 days prior to the survey. Source: National Household Survey on Drug Abuse, SAMHSA. Binge drinking by adults 18 years and over, by race/ethnicity, 2000 2010 target Percent

20. N Percent (17) (17) (17) 10.8 – 16.5 9.4 – 10.7 7.4 – 9.2 Illicit drug use in the past month by adolescents aged 12-17 years, 1999 Note: Illicit drug use is defined as using at least one of the following substances in the past month: marijuana or hashish, cocaine, inhalants, hallucinogens, heroin, or any nonmedical use of analgesics, tranquilizers, stimulants, or sedatives. Source: National Household Survey on Drug Abuse, SAMHSA.

21. Alcohol abuse is increasing among adults and decreasing among adolescents Drug use among has remained steady for both groups Adult males are more than twice as likely to binge drink than adult females American Indian/Alaska Native adults are the most likely to binge drink Summary

22. Responsible Sexual Behavior

23. Abstain or use condoms Percent Never had intercourse Used condom at last intercourse No intercourse in past 3 months Responsible sexual behavior by adolescents in grades 9 - 12 Source: Youth Risk Behavior Surveillance System, CDC, NCCDPHP.

24. * Can be of any race Source: Sexually Transmitted Diseases Surveillance System, CDC, NCHSTP. Gonorrhea incidence, by age and race/ethnicity, 2000 2010 target = 19 All persons 15-24 years 25-34 years 35-44 years American Indian/Alaska Native New cases per 100,000 population Asian or Pacific Islander Black, not Hispanic White, not Hispanic Hispanic* Supplemental Measure

25. Summary Adolescents abstaining from sexual intercourse or using condoms is increasing Nearly 3 times as many adolescents have never had intercourse as those who have No significant differences in responsible sexual behavior among adolescent race/ethnic groups Responsible sexual behavior decreases with each grade

26. Mental Health

27. * Can be of any race . Note: Data are age adjusted to the 2000 standard population. Source: National Vital Statistics System - Mortality, CDC, NCHS. Suicide rates, by race/ethnicity, 2000 Age-adjusted rate per 100,000 standard population 2010 target White, not Hispanic All persons Hispanic* Black, not Hispanic Asian or Pacific Islander American Indian or Alaska Native Supplemental Measure

28. Age-adjusted rate per 100,000 N (17) (17) (17) 13.0 – 21.7 10.7 – 12.9 4.4 – 10.6 Note: Rates are age adjusted to the 2000 standard population. Source: National Vital Statistics System - Mortality, CDC, NCHS Suicide rates, 2000

29. Summary Whites and American Indians/Alaska Natives are twice as likely to commit suicide as other groups Males are almost 5 times as likely to commit suicide than females Suicide rates are highest in Western States

30. Injury and Violence

31. Motor vehicle crash deaths and homicides Motor vehicle crash deaths Age-adjusted rate per 100,000 standard population Homicides 2010 target 2010 target Note: Data are age adjusted to the 2000 standard population. Source: National Vital Statistics System - Mortality, CDC, NCHS.

32. Homicide rates, 2000* Age-adjusted rate per 100,000 N (16) (16) (16) (3) 7.2 – 36.2 4.0 – 6.4 2.0 – 3.8 DSU** * Data for ME, NH, and SD are for 1999. ** Data are suppressed. Too few homicides occurred in ND, VT, and WY to report reliable rates. Note: Rates are age adjusted to the 2000 standard population. Source: National Vital Statistics System - Mortality, CDC, NCHS

33. Motor vehicle crash deaths and homicides decreased during the past decade Males and those with less education are more likely to die from both causes American Indians/Alaska Natives are 2 times as likely to die in a motor vehicle crash as other groups Blacks are much more likely to die from homicide than other groups Homicide rates are highest in the South and Southwest Summary

34. Environmental Quality

35. * Can be of any race I 95% Confidence Interval. Notes: Data are for children aged 6 years and under. Exposure to tobacco smoke at home is defined as living in a household where a resident smokes inside the home at least 4 days per week. Data for American Indian or Alaska Natives and Asian or Pacific Islanders are statistically unreliable and are not shown. Data are age-adjusted to the 2000 standard population. Source: National Health Interview Survey, CDC, NCHS. Young children exposed to tobacco smoke at home, by race/ethnicity and family income level, 1998 Percent 2010 target Near poor Middle/ high Hispanic* All children White, not Hispanic Poor Black, not Hispanic Supplemental Measure

36. Percent of persons exposed to ozone pollution has not changed significantly during the past 4 years Asians are the most likely to be exposed to ozone pollution 25 States have already met the Healthy People 2010 target for ozone exposure Black children and children with low income are the most likely to be exposed to tobacco smoke at home Summary

37. Immunization

38. * Received within the past 12 months. ** Ever received. Notes: Data are age adjusted to the 2000 standard population. Data for 2001 are preliminary. Source: National Health Interview Survey (NHIS), CDC, NCHS. Influenza and pneumococcal vaccination among adults aged 65 and over 2010 target Age-adjusted percent Influenza* Pneumococcal**

39. Notes: Fully immunized children are those receiving at least 4 doses of DTaP, 3 doses of Polio, 1 dose of MMR, 3 doses of Hib, and 3 doses of Hepatitis B antigens. Source: National Immunization Survey, CDC, NIP and NCHS. Fully immunized children aged 19 to 35 months, 2001 Age-adjusted percent N (17) (17) (17) 63 – 71 72 – 77 78 – 82

40. Summary Percent of older adults receiving influenza and pneumococcal vaccinations increased during the 1990s but has plateaued in recent years Blacks are the least likely of any race/ethnic group to receive either vaccination Vaccination rates for children are lowest in the Southwest and Pacific Northwest

41. Access to Care

42. * Can be of any race. Source: National Health Interview Survey, CDC, NCHS. Persons under age 65 with health insurance, by race/ethnicity, 2000 2010 target White, not Hispanic Age-adjusted percent All persons Asian Black, not Hispanic Native Hawaiian/ Other Pacific Islander Hispanic * American Indian or Alaska Native 0

43. Health insurance coverage has not increased substantially during the past 4 years Hispanics are among the least likely to have access to care for all measures American Indians/Alaska Natives are least likely to have health insurance but most likely to have a usual source of care Prenatal care in the first trimester is lowest in the Southwest Summary

44. Resources

48. Healthy People 2010 Statistical Workshop for Regional, State, and Local Health Staff Variability Small area estimation Basic epidemiologic methods Target-setting methods Software for statistical analysis Data availability via websites Mortality data Age adjustment Life tables Hospital discharge statistics State data Race and ethnicity classification Measuring health disparities For more information, contact: Richard J. Klein, MPH Rklein@cdc.gov

49. Websites DHHS Healthy People:www.health.gov/healthypeople NCHS Healthy People:www.cdc.gov/nchs/healthypeople DATA2010:www.wonder.cdc.gov/data2010