The 2012 Georgia Behavioral Risk Factor Surveillance System Report 1 Acknowledgements Georgia Department of Public Health Health Protection Epidemiology Program Chronic Disease, Healthy Behaviors and Injury Epidemiology Section Healthy Behavior Brenda Fitzgerald, MD Commissioner, State Health Officer J. Patrick O'Neal, MD Director Cherie L. Drenzek, DVM, MS State Epidemiologist Rana Bayakly, MPH Director Madhavi Vajani, MPH Team Lead The Georgia Department of Public Health is grateful for the support and contribution of: Abt SRBI Inc. Centers for Disease Control and Prevention Residents of Georgia who agreed to participate in the survey For more information on the Georgia Behavioral Risk Factor Surveillance System, please contact: BRFSS Coordinator Chronic Disease, Healthy Behaviors and Injury Epidemiology Section Epidemiology Program Division of Health Protection Georgia Department of Public Health 2 Peachtree Street, 14th Floor Atlanta, GA 30303-3142 404-657-2588 This report was made possible with funding from the Centers for Disease Control and Prevention. Its contents do not necessarily represent the official view of the CDC. Suggested citation: Vajani M, Annor F, Sigalo N, Benson AB, Bayakly RA, 2012 Georgia Behavioral Risk Factor Surveillance Report. Georgia Department of Public Health Epidemiology Program. Chronic Disease, Healthy Behaviors and Injury Epidemiology Section. July, 2015. 2 Georgia Public Health Districts Dade Catoosa Fannin Whitfield Murray Towns Union Rabun Walker Chattooga Gordon UGilmer 1-2 Pickens UWhite Habersham Lumpkin 2 Stephens U1-1 Floyd Bartow Dawson Cherokee Forsyth Hall Banks Franklin Hart Jackson Madison Elbert Polk Cobb U Paulding U U 3-1 Gwinnett 3-4 Barrow Clarke 10 Oglethorpe Haralson UUU Carroll Douglas 3-2 Fulton 3-5 Walton DeKalbRockdale 3-3 Clayton Newton Oconee Morgan Greene Wilkes Taliaferro Lincoln Columbia Fayette Henry McDuffie Coweta Heard U4 Troup Meriwether Warren Spalding Butts Jasper Putnam Hancock Richmond Pike Lamar Monroe Baldwin U Jones 5-2 Glascock U6 Jefferson Washington Burke Upson Harris Talbot Bibb Wilkinson Crawford Twiggs Johnson Jenkins 1-1 Northwest (Rome) 1-2 North Georgia (Dalton) 2 North (Gainesville) 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton (Jonesboro) 3-4 East Metro (Lawrenceville) 3-5 Dekalb 4 LaGrange 5-1 South Central (Dublin) 5-2 North Central (Macon) 6 East Central (Augusta) 7 West Central (Columbus) 8-1 South (Valdosta) 8-2 Southwest (Albany) 9-1 Coastal (Savannah) 9-2 Southeast (Waycross) 10 Northeast (Athens) Screven Muscogee Taylor U7 Chattahoochee Marion Macon Schley Stewart Webster Sumter Quitman Peach Emanuel Houston Bleckley Laurens Treutlen Candler Bulloch Dooly Pulaski U5-1 Dodge Montgomery Wheeler Toombs Evans Tattnall Wilcox Crisp Telfair Effingham Bryan Chatham Randolph Terrell Lee Turner Ben Hill Jeff Davis Appling Liberty U Long 9-1 Clay Calhoun Dougherty Worth Irwin Tift Coffee Bacon U9-2 Wayne McIntosh Early U Baker 8-2 Miller Mitchell Colquitt UBerrien Atkinson Cook 8-1 Seminole Decatur Grady Thomas Brooks Lanier Lowndes Clinch Pierce Brantley Glynn Ware Charlton Camden Echols 3 Table of Contents Table of Contents Acknowledgements .................................................................................................................................... 2 Georgia Public Health Districts.................................................................................................................. 3 BRFSS Methodology ................................................................................................................................. 5 Summary of Results ................................................................................................................................... 6 Demographic Characteristics, State of Georgia ......................................................................................... 7 Health Status Indicators General Health .............................................................................................................................. 8 No Health Care Coverage ............................................................................................................. 9 Limited Health Care Access........................................................................................................ 10 No Annual Doctor's Visit ........................................................................................................... 11 Disability ..................................................................................................................................... 12 Chronic Conditions Asthma ........................................................................................................................................ 13 Diabetes....................................................................................................................................... 14 Heart Attack ................................................................................................................................ 15 Stroke .......................................................................................................................................... 16 Angina ......................................................................................................................................... 17 Obesity ........................................................................................................................................ 18 Overweight.................................................................................................................................. 19 Risk Behaviors Adequate Physical Activity......................................................................................................... 20 No Leisure-Time Physical Activity............................................................................................. 21 Seatbelt Use................................................................................................................................. 22 Smoking ...................................................................................................................................... 23 Smokeless Tobacco..................................................................................................................... 24 Binge Drinking............................................................................................................................ 25 Heavy Drinking ........................................................................................................................... 26 One Drink Per Month.................................................................................................................. 27 Use of Equipment ....................................................................................................................... 28 Clinical Preventive Practices Adult Immunizations................................................................................................................... 29 Breast Cancer Screening ............................................................................................................. 30 Cervical Cancer Screening .......................................................................................................... 31 Colorectal Cancer Screening....................................................................................................... 32 Bibliography............................................................................................................................................. 33 4 BRFSS Methodology The Georgia Behavioral Risk Factor Surveillance System (BRFSS) is a primary source of information on major chronic conditions, health risk behaviors, and the use of clinical preventive services among adult Georgians. Sampling: Using list-assisted, random digit dialing, Georgia respondents were randomly selected from the non-institutionalized adult population aged 18 years and older from each household. Trained interviewers administered the questionnaire and participation was voluntary and anonymous. The sample excluded institutionalized individuals and households without telephones. Data came from both respondents who had landline telephones as well as those who mostly use cellular phones.1 Weighting: Iterative proportional fitting, or raking, methodology was used for the 2012 Georgia BRFSS. Raking is a repetitive post-stratification weighting technique used to match the marginal distributions of the survey sample to known population margins. An advantage of raked weighting technique is that it allows for adjustment of probability selection, telephone source (landline or cellular phone), race, ethnicity, education level, marital status, age by gender, gender by race/ethnicity, age by race/ethnicity, and renter/owner status. The goal is to improve sample representation by reducing respondent under-coverage and non-response biases.1 Data Analysis: SAS-callable SUDAAN was used for all data analysis to construct estimates and 95% confidence intervals (95% CI). Results were considered not "statistically different" if the 95% CI associated with the weighted percentages overlapped. A result was considered "statistically significant" (indicating a difference) if there was no overlap in the 95% CI of the percentages being compared. Prevalence estimates exclude those who either answered "don't know/not sure" or refused. Comparing 2012 BRFSS data to previous years: Comparison between 2012 BRFSS data and years prior to 2011 is not recommended due to the significant changes in methodology. Beginning in 2011, methodological changes have improved the accuracy, coverage, validity, and representativeness of the BRFSS.1 Data from 2011, 2012, and subsequent BRFSS can be used in trend analyses. 5 Summary of Results Summary Selected chronic conditions, risk behaviors, and clinical preventive services from the 2012 Georgia BRFSS are shown in the chart below in comparison with median prevalence from 2012 US national BRFSS data, which includes all 50 states, three territories, and Washington, D.C. Selected Chronic Conditions and Risk Factors, US and GA BRFSS, 2012 Ever Told Stroke Diabetes 2.9 3.3 9.7 9.9 Heart Attack 4.5 4.2 Current Smoking Obesity (BMI >= 30) 20.4 19.6 29.0 28.1 US Georgia No Flu Shot in Past Year (65+ Years Old) 60.1 60.1 No Health Care Coverage (18-64 Years Old) 27.3 20.4 0 20 40 60 80 100 Percent (%) Stroke In 2012, 3.3% of Georgia adults had ever been diagnosed with stroke. This estimate is slightly higher than the US median prevalence of 2.9%. Diabetes In 2012, 9.9% of Georgia adults had physician diagnosed diabetes. This estimate is similar to the US median prevalence of 9.7%. Heart Attack In 2012, 4.2% of Georgia adults had ever been told they have had a heart attack. This estimate is similar to the US median of 4.5%. Tobacco Use In 2012, 20.4% of Georgia adults were current cigarette smokers. This estimate is slightly higher than the US median prevalence of 19.6%. (HP 2020 Objective - Reduce tobacco use by adults to 12%) Obesity In 2012, 29% of Georgia adults were obese. This estimate is slightly higher than the US median prevalence of 28.1%. (HP 2020 Objective - Reduce the proportion of adults who are obese to 30.5%) Flu Vaccine in Past Year In 2012, 60.1% of Georgia adults aged 65 years and older received a flu vaccine in the past year. This estimate is the similar to the US median estimate of 60.1%. (HP 2020 Objective - Increase the percentage of non-institutionalized adults aged 65 years and older who are vaccinated annually against seasonal influenza to 90%) No Health Care Coverage In 2012, 27.3% of Georgia adults did not have any form of health insurance coverage, which exceeds the US median estimate of 20.4%. (HP 2020 Objective- Increase the proportion of persons with health insurance to 100%) 6 Demographic Characteristics Demographics In 2012, there were approximately 7,400,000 adults aged 18 years and older residing in the state of Georgia .2 Approximately 6,100 adults participated in the Georgia BRFSS survey statewide. Georgia BRFSS respondents were 51.9% female and 48.1% male. Georgians completing the survey were white non-Hispanic (56.6%), black non-Hispanic (29.8%), and 8.4% Hispanic. Distribution similar to Georgia population. Approximately 25% of Georgia residents had an annual household income of $75,000 or more. About 83% of the population had at least a high school diploma and 24.7% had at least a college diploma. Percent (%) Distribution of Georgia Residents, by Sex, Georgia, 2012 100 80 60 48 52 40 20 0 Male Female Percent (%) Distribution of Georgia Residents, by Race/Ethnicity, Georgia, 2012 100 80 57 60 40 30 20 8 0 White Non-Hispanic Black Non-Hispanic Hispanic Demographic Characteristics Sex Male Female Race/Ethnicity White Non-Hispanic Black Non-Hispanic Hispanic Age 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65+ yr Income Less than $15,000 $15,000-$24,999 $25,000-$34,999 $35,000-$49,999 $50,000-$74,999 $75,000 or More Education Less than High School High School Graduate Some College College Graduate State Total (N=6,100) % 95% CI 48.1 (46.3, 49.9) 51.9 (50.1, 53.7) 56.6 (54.8, 58.4) 29.8 (28.1, 31.5) 8.4 (7.1, 9.7) 13.7 (12.2, 15.2) 17.9 (16.4, 19.5) 18.6 (17.1, 20.0) 19.0 (17.7, 20.3) 15.1 (14.1, 16.1) 15.7 (14.8, 16.6) 15.1 (13.6, 16.5) 20.8 (19.2, 22.4) 11.9 (10.6, 13.1) 13.2 (11.9, 14.5) 14.0 (12.7, 15.3) 25.0 (23.4, 26.5) 16.7 (15.1, 18.2) 29.8 (28.1, 31.4) 28.8 (27.2, 30.5) 24.7 (23.3, 26.0) Percent (%) Distribution of Georgia Residents, by Annual Household Income Level, Georgia, 2012 100 80 60 40 21 25 20 15 12 13 14 0 Less than $15,000 - $25,000 - $35,000 - $50,000 - $75,000 or $15,000 $24,999 $34,999 $49,999 $74,999 More Percent (%) Distribution of Georgia Residents, by Age Group, Georgia, 2012 100 80 60 40 20 14 18 19 19 15 16 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65+ yr Percent (%) Distribution of Georgia Residents, by Level of Education, Georgia, 2012 100 80 60 40 30 29 25 17 20 0 Less than High School High School Graduate Some College College Graduate 7 Health Status Indicators General Health Self-assessed health status is a measure of how individuals perceive their health rating (excellent, very good, good, fair, or poor). It is a useful indicator of health for a variety of populations and allows for general comparisons. In 2012, 17.5% of Georgia adults reported that they perceive their health rating as fair or poor. Adults aged 65 years and older (27.9%) were most likely to report fair or poor general health when compared to other age groups. Adults with an annual household income less than $25,000 were significantly more likely to report fair or poor general health when compared to adults with an annual household income greater than or equal to $25,000. Adults without health insurance (23.1%) were significantly more likely to report fair or poor general health when compared to adults with health insurance (12.7%) Percent (%) Percent of Adults who reported Fair/Poor General Health, by Annual Household Income Level, Georgia, 2012 40 35 30 30 19 20 10 9 10 5 0 Less than $15,000 - $25,000 - $35,000 - $50,000 - $75,000 or $15,000 $24,999 $34,999 $49,999 $74,999 More Percent (%) Percent of Adults who reported Fair/Poor General Health, by Age Group, Georgia, 2012 40 35 30 26 25 20 20 15 10 10 12 10 5 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 28 65+ yr The HP 2020 target for self-reporting of fair or poor physical health is 21.2%. General Health Fair/Poor a Demographic Characteristics % 95% CI State Totals 17.5 (16.2, 18.8) Sex Male 16.8 (14.8, 18.9) Female 18.1 (16.5, 19.9) Race/Ethnicity White Non-Hispanic 16.7 (15.2, 18.4) Black Non-Hispanic 18.5 (16.1, 21.1) Hispanic 20.5 (14.8, 27.7) Age 18-24 yr 9.9 (6.5, 14.6) 25-34 yr 10.2 (7.4, 13.7) 35-44 yr 11.7 (9.0, 15.1) 45-54 yr 20.1 (17.1, 23.4) 55-64 yr 26.3 (23.3, 29.6) 65+ yr 27.9 (25.3, 30.6) Income Less than $15,000 34.5 (29.8, 39.5) $15,000-$24,999 29.5 (25.8, 33.6) $25,000-$34,999 19.3 (15.3, 23.9) $35,000-$49,999 9.6 (7.3, 12.5) $50,000-$74,999 8.8 (6.5, 11.8) $75,000 or More 5.4 (4.0, 7.4) Education Less than High School 38.2 (33.4, 43.3) High School Graduate 18.8 (16.6, 21.2) Some College 13.2 (11.2, 15.3) College Graduate 7.0 (5.8, 8.5) Health Insurance Coverage Has Health Insurance 12.7 (11.3, 14.3) No Health Insurance 23.1 (19.6, 27.0) a The proportion of adults who reported that their health, in general, was fair or poor. Percent of Adults who reported Fair/Poor General Health, by Public Health District, Georgia, 2012 <15% 15 to 20% 20 to 25% >=25% Percent (%) Percent of Adults who reported Fair/Poor General Health, by Health Insurance Status, Georgia, 2012 40 30 23 20 13 10 0 8 Has Health Coverage No Health Coverage Health Status Indicators No Health Care Coverage Individuals without health care coverage have decreased access to health care services and usually delay getting needed medical attention.3 Insurance coverage is an important factor in determining whether people will have access to services like screenings, treatment, and health education.4 Access to health care can be limited both by lack of health insurance and by insufficient coverage. In 2012, 72.7% of Georgia adults aged 18-64 years reported that they had health care coverage. Hispanics (52.3%) were significantly more likely not to have health coverage than white non-Hispanics (20.6%) and black non-Hispanics (33%). Adults aged 55-64 years (16.8%) were significantly less likely not to have health insurance coverage when compared to other age groups. More than half of adults aged 18-64 years with an annual household income less than $15,000 (56.1%) did not have any form of health care coverage. Adults with less than a high school education (55.3%) were significantly more likely not to have health care coverage when compared to high school graduates (31.7%), those with some college (24.3%), and college graduates (8.8%). Percent (%) Percent of Adults aged 18-64 years with No Health Care Coverage, by Race/Ethnicity, Georiga, 2012 100 80 60 52 40 33 21 20 0 White Non-Hispanic Black Non-Hispanic Hispanic The HP 2020 target for health care coverage among adults is 100%. No Health Care Coverage a Demographic Characteristics % 95% CI State Totals 27.3 (25.4, 29.3) Sex Male 27.8 (24.9, 30.9) Female 26.9 (24.4, 29.5) Race/Ethnicity White Non-Hispanic 20.6 (18.4, 23.1) Black Non-Hispanic 33.0 (29.5, 36.8) Hispanic 52.3 (43.8, 60.7) Age 18-24 yr 33.2 (27.4, 39.5) 25-34 yr 33.4 (28.7, 38.5) 35-44 yr 28.0 (23.9, 32.5) 45-54 yr 25.2 (21.8, 28.8) 55-64 yr 16.8 (14.3, 19.6) Income Less than $15,000 56.1 (50.1, 61.9) $15,000-$24,999 49.0 (43.9, 54.1) $25,000-$34,999 35.4 (29.0, 42.4) $35,000-$49,999 15.7 (11.3, 21.3) $50,000-$74,999 10.4 (6.8, 15.6) $75,000 or More 4.3 (3.0, 6.2) Education Less than High School 55.3 (48.9, 61.6) High School Graduate 31.7 (28.1, 35.6) Some College 24.3 (21.1, 27.9) College Graduate 8.8 (6.9, 11.1) a The proportion 18-64 years old who have no health care coverage,. Percent (%) Percent of Adults aged 18-64 years with No Health Care Coverage, by Education Level, Georgia, 2012 100 80 60 $55 40 $32 $24 20 $9 0 Less than High School High School Graduate Some College College Graduate Percent of Adults aged 18-64 years with Health Care Coverage, by Public Health District, Georgia, 2012 <65% 65 to 70% 70 to 75% >=75% Percent (%) Percent of Adults aged 18-64 years with No Health Care Coverage, by Annual Household Income, Georgia, 2012 100 80 56 60 49 40 35 20 16 10 4 0 Less Than $15,000 - $25,000 - $35,000 - $50,000 - $75,000 or $15,000 $24,999 $34,999 $49,999 $74,999 More 9 Health Status Indicators Limited Health Care Access Limited health care coverage is indicated as: (1) not having a personal doctor or health care provider; and (2) having a time in the past year when one needed to see a doctor but could not due to cost. These indicators are very important to health care due to the fact that increases access to primary care provider have been shown to significantly improve health-related outcomes. In 2012, 25.3% of Georgia adults did not have a personal doctor or a heath care provider. Males (32.1%) were significantly more likely not to have a personal doctor when compared to females (18.9%). Hispanics (52.9%) were significantly more likely not to have a personal doctor when compared to black nonHispanics (27.6%) and white non-Hispanics (19.7%). Adults without health insurance (59.9%) were significantly more likely not to have a personal doctor when compared to adults with health insurance (17.4%). In 2012, 19.9% of Georgia adults could not visit a doctor due to costs within the past 12 months. Hispanics (27.1%) and black non-Hispanics (25.2%) had higher rates of forgoing medical care due to cost when compared to white non-Hispanics (16.1%). Adults with less than a high school education (33.1%) were about four times more likely to forgo medical care due to cost than college graduates (8.8%). Adults without health insurance (48.7%) were significantly more likely to forgo medical care due to cost when compared to adults with health insurance (12.7%). Percent (%) Percent of Adults who have Limited Health Care Access, by Race/Ethnicity, Georgia, 2012 100 No Doctor's Visit 80 No Personal Doctor 60 $53 40 25.2 $28 27.1 20 16.1 $20 0 White Non-Hispanic Black Non-Hispanic Hispanic The HP 2020 target for those without a usual primary care provider among adults is 16.1%. No Personal Health No Health Care Care Provider a Due to Cost b Demographic Characteristics % 95% CI % 95% CI State Totals 25.3 (23.6, 27.0) 19.9 (18.5, 21.5) Sex Male 32.1 (29.4, 35.0) 16.5 (14.4, 18.9) Female 18.9 (17.1, 20.9) 23.1 (21.2, 25.2) Race/Ethnicity White Non-Hispanic 19.7 (17.9, 21.8) 16.1 (14.4, 17.9) Black Non-Hispanic 27.6 (24.4, 30.9) 25.2 (22.3, 28.4) Hispanic 52.9 (44.8, 60.9) 27.1 (20.4, 35.0) Age 18-24 yr 44.0 (37.8, 50.3) 21.4 (16.8, 26.9) 25-34 yr 44.1 (39.1, 49.2) 24.0 (20.1, 28.5) 35-44 yr 26.6 (22.7, 31.0) 22.8 (19.0, 26.9) 45-54 yr 19.5 (16.5, 22.9) 24.4 (21.2, 28.0) 55-64 yr 13.0 (10.8, 15.5) 19.0 (16.3, 22.0) 65+ yr 5.0 (3.8, 6.5) 5.9 (4.6, 7.6) Income Less than $15,000 41.3 (36.1, 46.8) 44.0 (38.8, 49.3) $15,000-$24,999 33.4 (29.2, 37.8) 29.1 (25.3, 33.2) $25,000-$34,999 26.7 (21.6, 32.5) 25.0 (20.1, 30.7) $35,000-$49,999 23.3 (18.7, 28.5) 14.5 (11.2, 18.6) $50,000-$74,999 17.2 (13.3, 21.9) 11.8 (8.6, 15.9) $75,000 or More 13.6 (11.2, 16.4) 5.0 (3.6, 6.8) Education Less than High School 38.5 (33.3, 43.9) 33.1 (28.4, 38.3) High School Graduate 26.5 (23.5, 29.8) 21.9 (19.1, 24.9) Some College 24.6 (21.6, 27.8) 19.9 (17.4, 22.7) College Graduate 15.5 (13.3, 18.0) 8.8 (7.3, 10.6) Health Insurance Coverage Has Health Insurance 17.4 (15.6, 19.4) 12.7 (11.3, 14.3) No Health Insurance 59.9 (55.6, 64.1) 48.7 (44.3, 53.1) a The proportion of adults who reported that they did not have anyone that they thought of as their personal doctor or health care provider b The proportion of adults who reported that they could not see a doctor when needed due to cost within the past 12 months. Percent (%) Percent of Adults who have Limited Health Care Access, by Age Group, Georgia, 2012 100 No Doctor's Visits No Personal Doctor 80 60 44 40 21 20 44 24 23 27 24 20 19 13 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65 65+ yr Percent (%) Percent of Adults who have Limited Health Care Access, by Health Insurance Status, Georgia, 2012 100 No Doctor's Visits No Personal Doctor 80 60 60 49 40 20 13 17 0 Has Health Coverage No Health Coverage 10 Health Status Indicators No Annual Doctor's Visit Annual doctor's visit serves as a preventive measure that can reduce risk factors for common chronic diseases. By having a visit every year, certain problems can be detected earlier when treatment might be more effective. In 2012, 28.7% of Georgia adults reported that they have not visited a doctor for a routine checkup within the past 12 months. Males (32.4%) were significantly more likely than females (25.4%) not to visit a doctor in the past year. Hispanics (42.4%) were significantly more likely not to visit a doctor in the past year when compared to white nonHispanics (30.4%) and black non-Hispanics (22.5%). Adults aged 65 years and older (11.3%) were significantly least likely to have not visited a doctor in the past year. Adults with an income of $15,000 - $24,999 (35.6%) were the most likely to have not visited a doctor in the past year. More than half of adults who do not have health coverage (53.8%) did not visit a doctor in the past year. Percent (%) Percent of Adults who had No Doctor's Visit Last Year, by Race/Ethnicity, Georiga, 2012 100 80 60 42 40 30 23 20 0 White Non-Hispanic Black Non-Hispanic Hispanic Percent (%) Percent of Adults who had No Doctor's Visit Last Year, by Age, Georgia, 2012 100 80 60 38 41 40 32 27 22 20 11 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65+ yr No Doctor's Visit a Demographic Characteristics % 95% CI State Totals 28.7 (27.0, 30.5) Sex Male 32.4 (29.7, 35.2) Female 25.4 (23.3, 27.5) Race/Ethnicity White Non-Hispanic 30.4 (28.3, 32.6) Black Non-Hispanic 22.5 (19.6, 25.6) Hispanic 42.4 (34.3, 51.0) Age 18-24 yr 37.8 (31.9, 44.1) 25-34 yr 41.1 (36.2, 46.3) 35-44 yr 32.2 (28.1, 36.6) 45-54 yr 27.3 (24.0, 30.8) 55-64 yr 22.2 (19.5, 25.2) 65+ yr 11.3 (9.5, 13.4) Income Less than $15,000 34.8 (29.8, 40.2) $15,000-$24,999 35.6 (31.3, 40.2) $25,000-$34,999 32.0 (26.6, 37.9) $35,000-$49,999 28.6 (23.9, 33.9) $50,000-$74,999 22.8 (18.9, 27.3) $75,000 or More 22.8 (19.8, 26.1) Education Less than High School 34.9 (29.8, 40.3) High School Graduate 28.8 (25.7, 32.1) Some College 30.1 (27.1, 33.4) College Graduate 23.0 (20.6, 25.7) Health Insurance Coverage Has Health Insurance 23.8 (21.9, 25.9) No Health Insurance 53.8 (49.3, 58.3) a The proportion of adults who reported that they did not have a personal doctor. Percent of Adults who reported having No Annual Doctor's Visit, by Public Health District, Georgia, 2012 Percent No Annual Doctor's Visit <24% 24-<27% 27-<30% >=30% Percent (%) Percent of Adults who had No Doctor's Visit Last Year, by Health Coverage Status, Georgia, 2012 100 80 60 54 40 24 20 0 Has Health Coverage No Health Coverage 11 Health Status Indicators Disability Disability refers to limitations in activities due to physical, mental, or emotional problems or having health problems that require the use of special equipment. People with disabilities may lack access to health services and medical care.5 In 2012, 20.1% of Georgia adults reported being disabled in any way. Hispanics (12.7%) were significantly less likely to be disabled when compared to white non-Hispanics (21.8%). Adults 1ag1e1d1155-64 (31.1%) were most likely to be disabled when compared to adults in other age groups. Adults with an annual household income less than $15,000 (33.8%) were the most likely to be disabled when compared to adults in other income levels. Adults with less than a high school education (30.4%) had a significantly higher prevalence of disability when compared to high school graduates (20.4%), adults with some college (19.8%), and college graduates (13.4%). Percent (%) Percent of Adults who reported being Disabled, by Race/Ethnicity, Georiga, 2012 100 80 60 40 22 20 19 15 0 White Non-Hispanic Black Non-Hispanic Hispanic Percent of Adults who reported being Disabled, by Annual Household Income, Georiga, 2012 100 80 60 40 34 26 20 20 16 16 12 0 Less Than $15,000 $15,000 $24,999 $25,000 $34,999 $35,000 $49,999 $50,000 $74,999 $75,000 or More Percent (%) Disability a Demographic Characteristics % 95% CI State Totals 20.1 (18.7, 21.5) Sex Male 18.6 (16.7, 20.8) Female 21.4 (19.6, 23.2) Race/Ethnicity White Non-Hispanic 21.8 (20.1, 23.6) Black Non-Hispanic 18.7 (16.2, 21.5) Hispanic 12.7 (8.4, 18.7) Age 18-24 yr 8.8 (5.8, 13.2) 25-34 yr 12.7 (9.7, 16.5) 35-44 yr 13.8 (11.0, 17.2) 45-54 yr 25.8 (22.5, 29.5) 55-64 yr 31.1 (28.0, 34.5) 65+ yr 28.2 (25.8, 30.9) Income Less than $15,000 33.8 (29.1, 38.8) $15,000-$24,999 26.0 (22.7, 29.7) $25,000-$34,999 19.9 (16.1, 24.3) $35,000-$49,999 15.6 (12.5, 19.3) $50,000-$74,999 15.5 (12.0, 19.8) $75,000 or More 12.1 (9.9, 14.6) Education Less than High School 30.4 (25.9, 35.3) High School Graduate 20.4 (18.0, 22.9) Some College 19.8 (17.4, 22.3) College Graduate 13.4 (11.5, 15.4) Health Insurance Coverage Has Health Insurance 18.2 (16.5, 20.0) No Health Insurance 19.9 (16.8, 23.5) a The proportion of adults who reported being limited in any activities due to physical, mental, or emotional problems. Percent of Adults who reported Disabled, by Public Health District, Georgia, 2012 Percent Disabled <22% 22-<24% 24-<26% >=26% Percent (%) Percent of Adults who reported being Disabled, 100 by Education Level, Georgia, 2012 80 60 40 30 20 20 20 13 0 12 Less than High High School Some College College Graduate School Graduate Chronic Conditions Asthma Asthma is a lifelong disease that causes wheezing, breathlessness, chest tightness, and coughing.6 Most people with asthma can control their symptoms and prevent asthma attacks by avoiding asthma triggers and correctly using prescribed medication. In 2012, 13% of Georgia adults reported ever having asthma and 8.2% currently have asthma. Adult females were significantly more likely than males to have ever had asthma (15.4% vs. 10.5%) and to currently have asthma (11% vs. 5.1%). White non-Hispanics (7.7%) and black non-Hispanics (10.7%) were more likely to currently have asthma when compared to Hispanics (3.4%). Adults with a household income of less than $15,000 were the most likely to ever had asthma (20.2%) and to currently have asthma (14.4%). Percent (%) Percent of Adults who have had Asthma, by Gender, Georgia, 2012 50 Lifetime Asthma 40 Current Asthma 30 20 11 10 5 15 11 0 Male Female Percent (%) Percent of Adults who have had Asthma, by Race/Ethnicity, Georgia, 2012 50 40 Lifetime Asthma Current Asthma 30 20 12 10 8 0 White Non-Hispanic 16 11 Black Non-Hispanic 7 3 Hispanic Percent of Adults who have had Asthma, by Annual Household Income, Georgia, 2012 50 40 30 20 20 14 10 15 11 12 8 Lifetime Asthma Current Asthma 11 5 10 6 11 6 0 Less than $15,000 $15,000$24,999 $25,000$34,999 $35,000$49,999 $50,000$74,999 $75,000 or More Percent (%) Demographic Characteristics State Totals Sex Male Female Race/Ethnicity White Non-Hispanic Black Non-Hispanic Hispanic Age 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65+ yr Income Less than $15,000 $15,000-$24,999 $25,000-$34,999 $35,000-$49,999 $50,000-$74,999 $75,000 or More Education Less than High School High School Graduate Some College College Graduate Health Insurance Coverage Has Health Insurance No Health Insurance Lifetime Asthma a % 95% CI 13.0 (11.8, 14.3) Current Asthma b % 95% CI 8.2 (7.3, 9.2) 10.5 (8.8, 12.4) 5.1 15.4 (13.7, 17.2) 11 (4.1, 6.5) (9.7, 12.6) 12.4 (10.9, 14.0) 7.7 (6.6, 9.0) 15.9 (13.4, 18.8) 10.7 (8.8, 13.1) 6.7 (3.8, 11.6) 3.4 (1.7, 6.6) 20.2 (15.3, 26.0) 9.3 12.8 (9.8, 16.6) 7.8 9.7 (7.5, 12.6) 6.6 13.4 (11.2, 16.1) 9.0 12.8 (10.6, 15.3) 9.0 10.6 (9.1, 12.5) 8.0 (6.3, 13.6) (5.5, 10.9) (4.8, 9.0) (7.2, 11.3) (7.2, 11.2) (6.6, 9.6) 20.2 (16.1, 25.0) 14.4 (11.3, 18.3) 14.8 (12.0, 18.1) 10.9 (8.6, 13.8) 12.1 (9.0, 16.2) 7.6 (5.2, 10.9) 10.5 (7.5, 14.4) 4.6 (3.2, 6.6) 9.7 (6.9, 13.3) 5.9 (3.7, 9.4) 10.5 (8.5, 12.9) 5.6 (4.2, 7.5) 17.9 (14.2, 22.3) 12.2 (9.4, 15.7) 11.1 (9.3, 13.2) 7.4 (5.9, 9.1) 13.9 (11.6, 16.7) 8.9 (7.1, 11.0) 11.2 (9.3, 13.3) 5.8 (4.6, 7.3) 12.5 (11.1, 14.1) 7.5 (6.5, 8.7) 16.3 (13.1, 20.0) 10.4 (8.0, 13.5) Percent of Adults who currently have Asthma, by Public Health District, Georgia, 2012 <7% 7 to 9% 9 to 11% >=11% 13 Chronic Conditions Diabetes Diabetes is a chronic disease where the body is unable to process glucose, causing blood glucose levels to be higher than normal. Diabetes is the seventh leading cause of death in the United States and the sixth leading cause of death in Georgia, and increases the risk for heart disease, stroke, high blood pressure, blindness, kidney disease, amputations, nerve problems, dental disease, and infections.7 In 2012, 9.9% of Georgia adults reported ever being diagnosed with diabetes by a health care professional. Black non-Hispanics (11.5%) were more likely to have ever been diagnosed with diabetes than Hispanics (6.6%). The prevalence of diabetes was significantly higher among adults aged 65 years and older (24.8%). Adults with a household income of $15,000-$24,999 (12.5%) were more likely to ever have diabetes than adults with an income of $75,000 or more (6%). Adults with less than a high school education (14.4%) were significantly more likely to ever have diabetes when compared to individuals with some college education (9%) and college graduates (7.2%). Percent (%) Percent of Adults Diagnosed with Diabetes, by Race/Ethnicity, Georiga, 2012 30 25 20 15 10 10 5 0 White Non-Hispanic 12 Black Non-Hispanic 7 Hispanic Percent (%) Percent of Adults Diagnosed with Diabetes, by Age Group, Georgia, 2012 30 25 25 19 20 15 10 10 4 5 2 2 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65+ yr Diabetes a Demographic Characteristics % 95% CI State Totals 9.9 (9.1, 10.8) Sex Male 9.8 (8.5, 11.2) Female 10.0 (8.9, 11.2) Race/Ethnicity White Non-Hispanic 9.8 (8.8, 10.9) Black Non-Hispanic 11.5 (9.7, 13.5) Hispanic 6.6 (4.0, 10.7) Age 18-24 yr 1.5 (0.5, 4.1) 25-34 yr 1.8 (0.9, 3.5) 35-44 yr 4.4 (2.8, 6.7) 45-54 yr 9.6 (7.8, 11.9) 55-64 yr 18.7 (16.1, 21.7) 65+ yr 24.8 (22.3, 27.5) Income Less than $15,000 11.3 (8.9, 14.2) $15,000-$24,999 12.5 (10.4, 15.1) $25,000-$34,999 14.0 (10.8, 17.8) $35,000-$49,999 9.8 (7.5, 12.8) $50,000-$74,999 7.6 (5.8, 9.9) $75,000 or More 6.0 (4.6, 7.6) Education Less than High School 14.4 (11.7, 17.6) High School Graduate 10.6 (9.0, 12.4) Some College 9.0 (7.5, 10.7) College Graduate 7.2 (6.0, 8.5) Health Insurance Coverage Has Health Insurance 7.6 (6.6, 8.7) No Health Insurance 5.9 (4.4, 7.8) a The proportion of adults who have physician-diagnosed diabetes. Adults with pre-diabetes or diabetes only during pregnancy are not considered to have diagnosis of diabetes. Percent of Adults Diagnosed with Diabetes, by Public Health District, Georgia, 2012 <8% 8 to 10% 10 to 12% >=12% Percent (%) Percent of Adults Diagnosed with Diabetes, by Education Level, Georgia, 2012 30 25 20 14 15 11 9 10 7 5 0 Less than High High School Some College College Graduate School Graduate 14 Chronic Conditions Heart Attack Heart attack, also called myocardial infarction, occurs when blood flow to a section of the heart muscle becomes blocked. Risk factors for heart attack include high blood cholesterol levels, high blood pressure, smoking, lack of physical activity and obesity.8 In 2012, 4.2% of Georgia adults had ever been told that they have had a heart attack. Adult males (5.5%) were significantly more likely to have had a heart attack when compared to females (3%). Adults aged 65 years or older (12%) were significantly more likely to have had a heart attack when compared to other age groups. Adults with a household income of $15,000-$24,999 (5.7%) were most likely to have had a heart attack. Percent (%) Percent of Adults who have had a Heart Attack, by Race/Ethnicity, Georiga, 2012 15 10 5 5 4 0 White Non-Hispanic Black Non-Hispanic 3 Hispanic Percent of Adults who have had a Heart Attack, by Age Group, Georgia, 2012 15 12 10 8 5 0 0 18-24 yr 0 25-34 yr 2 35-44 yr 4 45-54 yr 55-64 yr 65+ yr Percent (%) Demographic Characteristics State Totals Sex Male Female Race/Ethnicity White Non-Hispanic Black Non-Hispanic Hispanic Age 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65+ yr Income Less than $15,000 $15,000-$24,999 $25,000-$34,999 $35,000-$49,999 $50,000-$74,999 $75,000 or More Education Less than High School High School Graduate Some College College Graduate Health Insurance Coverage Has Health Insurance No Health Insurance Heart Attack a % 95% CI 4.2 (3.6, 4.8) 5.5 (4.6, 6.6) 3.0 (2.4, 3.6) 4.7 (4.1, 5.5) 3.5 (2.6, 4.7) 3.1 (1.3, 7.0) 0.0 (0.0, 0.3) 1.7 (0.8, 3.6) 4.3 (2.9, 6.2) 7.8 (6.2, 9.8) 12.0 (10.3, 13.9) 5.2 (3.8, 7.2) 5.7 (4.4, 7.5) 5.4 (3.5, 8.5) 2.9 (1.8, 4.4) 2.6 (1.5, 4.2) 2.6 (1.8, 3.6) 6.4 (4.8, 8.7) 4.9 (3.9, 6.1) 3.8 (2.9, 5.0) 2.3 (1.7, 3.0) 2.9 (2.3, 3.7) 2.3 (1.4, 3.8) Percent of Adults who have had a Heart Attack, by Public Health District, Georgia, 2012 <3% 3 to 5% 5 to 7% >=7% Percent (%) Percent of Adults who have had Heart a Attack, by Annual Household Income, Georgia, 2012 15 10 5 6 5 5 3 3 3 0 Less Than $15,000 - $25,000 - $35,000 - $50,000 - $75,000 or $15,000 $24,999 $34,999 $49,999 $74,999 More 15 Chronic Conditions Stroke Stroke is the result of a blocked artery or a ruptured artery that prevents blood flow to the brain. Stroke is the fourth leading cause of death in the United States and the fifth leading cause of death in Georgia and can cause significant disability, such as paralysis, speech difficulties, and emotional problems.9 In 2012, 3.3% of Georgia adults reported ever being told by a health professional that they had a stroke. Black non-Hispanics (4.3%) were more likely to have ever had a stroke when compared to white non-Hispanics (3%) and Hispanics (2.1%). Adults of age 65 years or older (9.5%) were most likely to have ever had a stroke. Adults with household income less than $15,000 (6.3%) were most likely to have ever had a stroke. Adults with less than a high school education (6.3%) were most likely to have ever had a stroke when compared to high school graduates (4.1%), those with some college (2.3%), and college graduates (1.4%). Percent of Adults who have ever had a Stroke, by Race/Ethnicity, Georiga, 2012 15 Percent (%) 10 5 3 4 0 White Non-Hispanic Black Non-Hispanic 2 Hispanic Demographic Characteristics State Totals Sex Male Female Race/Ethnicity White Non-Hispanic Black Non-Hispanic Hispanic Age 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65+ yr Income Less than $15,000 $15,000-$24,999 $25,000-$34,999 $35,000-$49,999 $50,000-$74,999 $75,000 or More Education Less than High School High School Graduate Some College College Graduate Health Insurance Coverage Has Health Insurance No Health Insurance Stroke a % 95% CI 3.3 (2.8, 3.8) 3.2 (2.5, 4.2) 3.3 (2.7, 4.0) 3.0 (2.4, 3.6) 4.3 (3.2, 5.9) 2.1 (0.9, 5.2) 0.6 (0.1, 2.3) 1.0 (0.4, 3.0) 0.4 (0.1, 1.8) 2.6 (1.6, 4.2) 6.2 (4.6, 8.2) 9.5 (7.7, 11.5) 6.3 (4.3, 9.2) 5.4 (4.0, 7.2) 2.8 (1.7, 4.4) 2.5 (1.3, 4.5) 0.7 (0.3, 1.3) 1.4 (0.8, 2.3) 6.3 (4.5, 8.8) 4.1 (3.1, 5.3) 2.3 (1.7, 3.0) 1.4 (0.9, 2.2) 1.9 (1.4, 2.5) 2.8 (1.7, 4.4) Percent (%) Percent of Adults who have ever had Stroke, by Age Group, Georgia, 2012 15 10 6 5 3 1 1 0 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 10 65+ yr Percent of Adults who have ever had a Stroke, by Public Health District, Georgia, 2012 <3% 3 to 4% 4 to 5% >=5% Percent (%) Percent of Adults who have ever had Stroke, by Level of Education, Georgia, 2012 15 10 6 5 4 2 1 0 Less than High High School Some College College Graduate 16 School Graduate Chronic Conditions Angina Angina is chest pain or discomfort that occurs when the heart muscle is not getting enough blood. Angina may feel like pressure or a squeezing pain in the chest. The pain may also occur in the shoulders, arms, neck, jaw, or back, and it may feel like indigestion.10 Angina a In 2012, 4.5% of Georgia adults reported ever being told by a health professional that they have angina or coronary heart disease. Demographic Characteristics % State Totals 4.5 Sex Male 5.6 95% CI (4.0, 5.2) (4.7, 6.7) Female 3.5 (2.9, 4.3) Adult males (5.6%) were significantly more likely to have had angina when compared to adult females (3.5%). Race/Ethnicity White Non-Hispanic Black Non-Hispanic 5.5 (4.7, 6.4) 4.0 (2.9, 5.4) Hispanics (1.0%) were significantly least likely to have had angina when compared to black non-Hispanics (4.0%) and white non-Hispanics (5.5%). Hispanic Age 18-24 yr 25-34 yr 1.0 (0.4, 2.6) 0.3 (0.0, 2.0) 0.4 (0.1, 1.3) Adults aged 65 years and older were significantly most likely to have had angina (14%) when compared to other age groups. 35-44 yr 45-54 yr 55-64 yr 65+ yr 1.5 (0.6, 3.5) 4.2 (2.8, 6.3) 7.8 (6.2, 9.9) 14 (12.0, 16.2) Income Less than $15,000 7.6 (5.4, 10.5) Percent of Adults who have ever had Angina, by Race/Ethnicity, Georiga, 2012 $15,000-$24,999 $25,000-$34,999 $35,000-$49,999 5.2 (4.0, 6.8) 5.1 (3.4, 7.5) 4.0 (2.8, 5.9) $50,000-$74,999 4.3 (2.7, 6.8) 15 $75,000 or More 2.4 (1.6, 3.4) Percent (%) 10 6 5 4 Education Less than High School High School Graduate Some College College Graduate 7.3 (5.4, 9.9) 4.2 (3.4, 5.3) 4.9 (3.8, 6.3) 2.6 (2.0, 3.3) 0 White Non-Hispanic Black Non-Hispanic 1 Hispanic Health Insurance Coverage Has Health Insurance No Health Insurance 3.0 (2.3, 3.8) 2.4 (1.5, 3.9) Percent (%) Percent of Adults who have ever had Angina, by Age Group, Georgia, 2012 15 14 10 8 5 4 2 0 0 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65+ yr Percent of Adults who have ever had Angina, by Public Health District, Georgia, 2012 <4% 4 to 6% 6 to 8% >=8% Percent (%) Percent of Adults who have ever had Angina, by Health Insurance Status, Georgia, 2012 15 10 5 3 2 0 Has Health Coverage No Health Coverage 17 Chronic Conditions Obesity Obesity is defined as having a body mass index (BMI) greater than or equal to 30.0 kg/m2. Obesity increases the risk of developing high blood pressure, diabetes, coronary heart disease, stroke, high cholesterol, gallbladder disease and some types of cancers.11 In 2012, 29% of Georgia adults were obese. Adult females (30.4%) were more likely to be obese than males (27.6%). Black non-Hispanics (36.4%) were significantly more likely to be obese when compared to white non-Hispanics (26.2%). Adults with an age of 18-24 years (14.2%) were least likely to be obese when compared to adults of age 25 or older. Adults who are college graduates (23.1%) were least likely to be obese when compared to any other education category. Percent (%) Percent of Adults who were Obese, by Gender, Georgia, 2012 100 80 60 40 28 30 20 0 Male Female Percent of Adults who were Obese, by Race/Ethnicity, Georiga, 2012 100 80 The HP 2020 target for obesity among adults is 30.5%. The current prevalence among Georgia adults meets this goal. Obese a Demographic Characteristics % 95% CI State Totals 29.0 (27.4, 30.7) Sex Male 27.6 (25.1, 30.2) Female 30.4 (28.3, 32.6) Race/Ethnicity White Non-Hispanic 26.2 (24.3, 28.2) Black Non-Hispanic 36.4 (33.1, 39.9) Hispanic 29.1 (21.9, 37.4) Age 18-24 yr 14.2 (10.3, 19.2) 25-34 yr 30.4 (25.7, 35.4) 35-44 yr 31.9 (27.8, 36.4) 45-54 yr 33.5 (29.9, 37.3) 55-64 yr 36.0 (32.6, 39.5) 65+ yr 25.4 (23.0, 28.0) Income Less than $15,000 32.5 (27.8, 37.5) $15,000-$24,999 33.0 (28.9, 37.3) $25,000-$34,999 32.8 (27.8, 38.2) $35,000-$49,999 27.6 (23.2, 32.6) $50,000-$74,999 27.6 (23.5, 32.2) $75,000 or More 25.3 (22.3, 28.6) Education Less than High School 28.4 (24.0, 33.4) High School Graduate 32.6 (29.5, 35.9) Some College 30.8 (27.7, 34.1) College Graduate 23.1 (20.7, 25.7) Health Insurance Coverage Has Health Insurance 29.7 (27.6, 31.8) No Health Insurance 30.4 (26.4, 34.7) a The proportion of adults whose BMI was greater than or equal to 30.0 kg/m2. Note: Body mass index, BMI, is defined as weight (kg) divided by height (m) squared. Percent of Adults who were Obese, by Public Health District, Georgia, 2012 Percent (%) 60 40 26 20 0 White Non-Hispanic 36 Black Non-Hispanic 29 Hispanic <65% 65 to 70% 70 to 75% >=75% Percent (%) Percent of Adults who were Obese, by Education Level, Georgia, 2012 100 80 60 40 28 33 31 23 20 0 Less than High School High School Graduate Some College College Graduate 18 Chronic Conditions Overweight Overweight is defined as having a body mass index (BMI) between 25.0 and 29.9 kg/m2. Being overweight increases poor health outcomes such as coronary heart disease, type 2 diabetes, high blood pressure, stroke, liver and gallbladder disease, and cancer.12 Overweight a In 2012, 35.3% of Georgia adults were overweight. Adult males (41.1%) were significantly more likely to be overweight than females (29.7%). Hispanics (39.1%) were more likely to be overweight when compared to white non-Hispanics (36.3%) and black nonHispanics (32.4%). Adults with an annual income of $35,000-$49,999 (39.6%) were most likely to be overweight when compared to adults from any other annual household income category. Adults with an age of 18-24 years (26.3%) were least likely to be overweight when compared to adults of age 25 or older. Percent (%) Percent of Adults who were Overweight, by Gender, Georgia, 2012 100 80 60 41 40 30 20 0 Male Female Demographic Characteristics % 95% CI State Totals 35.3 (33.6, 37.1) Sex Male 41.1 (38.3, 43.9) Female 29.7 (27.6, 31.8) Race/Ethnicity White Non-Hispanic 36.3 (34.2, 38.4) Black Non-Hispanic 32.4 (29.2, 35.9) Hispanic 39.1 (30.9, 48.0) Age 18-24 yr 26.3 (21.1, 32.3) 25-34 yr 33.1 (28.4, 38.1) 35-44 yr 36.5 (32.1, 41.1) 45-54 yr 36.4 (32.8, 40.2) 55-64 yr 39.1 (35.8, 42.6) 65+ yr 39.5 (36.6, 42.5) Income Less than $15,000 30.6 (25.9, 35.8) $15,000-$24,999 33.9 (29.8, 38.1) $25,000-$34,999 35.8 (30.5, 41.4) $35,000-$49,999 39.6 (34.7, 44.8) $50,000-$74,999 39.1 (34.5, 44.0) $75,000 or More 37.2 (33.7, 40.8) Education Less than High School 35.0 (30.0, 40.3) High School Graduate 37.5 (34.3, 40.9) Some College 33.1 (30.0, 36.2) College Graduate 35.4 (32.6, 38.4) Health Insurance Coverage Has Health Insurance 34.4 (32.2, 36.7) No Health Insurance 34.9 (30.7, 39.3) a The proportion of adults whose BMI was between 25.0 and 29.9 kg/m2 . Note: Body mass index, BMI, is defined as weight (kg) divided by height (m) squared. Percent (%) Percent of Adults who were Overweight, by Annual Household Income, Georgia, 2012 100 80 60 40 31 34 36 40 39 37 20 0 Less than $15,000 - $25,000 - $35,000 - $50,000 - $75,000 or $15,000 $24,999 $34,999 $49,999 $74,999 More Percent of Adults who were Overweight, by Public Health District, Georgia, 2012 <32% 32 to 36% 36 to 40% >=40% Percent (%) Percent of Adults who were Overweight, by Age Group, Georgia, 2012 100 80 60 40 33 37 36 39 40 26 20 0 19 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65+ yr Risk Behaviors No Leisure-Time Physical Activity Leisure-time physical activity helps improve overall health and fitness, and reduces the risk for many chronic diseases such as cardiovascular disease, diabetes, colon and breast cancers, and osteoporosis. Regular physical activity also helps to maintain body weight, healthy bones, muscles, and joints, reduce symptoms of anxiety and depression, and enhances quality of life.14 In 2012, 23.6% of Georgia adults were physically inactive during leisure time within the past month. Adult females (25.7%) were significantly more likely than males (21.3%) to be physically inactive. Adults with an income of $75,000 or more (10.5%) were significantly least likely to be physically inactive. Adults with a less than high school education (39.9%) were significantly more likely to be physically inactive when compared to high school graduates (27.4%), adults with some college (20.4%), and college graduates (11.5%). Adults with health insurance (19.9%) were significantly less likely to be physically inactive when compared to adults without health insurance (26.1%). Percent (%) Percent of Adults who reported No-Leisure Time Activity, by Gender, Georgia, 2012 100 80 60 40 21 26 20 0 Male Female Percent (%) Percent of Adults who reported No Leisure-Time Activity, by Income Level, Georgia, 2012 100 80 60 40 34 30 32 18 17 20 11 0 less Than $15,000 - $25,000 - $35,000 - $50,000 - $75,000 or $15,000 $24,999 $34,999 $49,999 $74,999 More The HP 2020 target for adults who engage in no leisure-time physical activity is 32.6%. The current prevalence among Georgia adults meets this goal. No Leisure-Time Physical Activity a Demographic Characteristics % 95% CI State Totals 23.6 (22.2, 25.1) Sex Male 21.3 (19.1, 23.6) Female 25.7 (23.9, 27.6) Race/Ethnicity White Non-Hispanic 22.7 (21.0, 24.5) Black Non-Hispanic 24.4 (21.6, 27.3) Hispanic 26.2 (19.8, 33.8) Age 18-24 yr 17.3 (13.2, 22.2) 25-34 yr 35-44 yr 17.6 (13.9, 21.9) 17.3 (14.2, 20.8) 45-54 yr 25.6 (22.4, 29.0) 55-64 yr 31.0 (27.8, 34.3) 65+ yr 34.4 (31.8, 37.2) Income Less than $15,000 33.8 (29.1, 38.8) $15,000-$24,999 30.1 (26.5, 33.9) $25,000-$34,999 $35,000-$49,999 31.6 (26.8, 36.8) 18.1 (14.8, 21.9) $50,000-$74,999 17.3 (14.0, 21.1) $75,000 or More 10.5 (8.6, 12.8) Education Less than High School 39.9 (35.1, 44.9) High School Graduate 27.4 (24.7, 30.3) Some College 20.4 (18.1, 23.1) College Graduate 11.5 (9.8, 13.3) Health Insurance Coverage Has Health Insurance 19.9 (18.2, 21.8) No Health Insurance 26.1 (22.6, 30.0) a The proportion of adults who reported not participating in any leisure-time physical activities or exercises during the past month. Percent of Adults who reported No Leisure-Time Physical Activity, by Public Health District, Georgia, 2012 <17.7% 17.7 to 22.1% 22.2 to 28% >=28% Percent (%) Percent of Adults who reported No Leisure-Time Activity, by Health Insurance Status, Georgia, 2012 100 80 60 40 26 20 20 0 Has Health Coverage No Health Coverage 20 Risk Behaviors Seatbelt Use Seatbelt use reduces serious injuries and deaths in motor vehicle crashes by 50%.15 In 2009, about 12,000 more injuries would have been prevented and about 450 more lives saved if all states had primary enforcement seat belt laws.15 Georgia's seat belt law states that while the passenger vehicle is being operated on a public road, street or highway, each occupant in the front seat of a passenger vehicle should be restrained by a seat safety belt approved under federal motor vehicle safety standard 208.16 In 2012, 87.5% of Georgia adults reported always using a seatbelt when they are driving or riding in a car. Females (90.9%) were significantly more likely to always use a seatbelt when compared to males (83.7%). Adults aged 18-24 years (79.7%) were least likely to always use a seatbelt when compared to all other age groups. Adults identified as college graduates (91%) were more likely to always use a seatbelt when compared to adults with lower levels of education. Adults with health coverage (88.3%) were significantly more likely to always use a seatbelt when compared to those without health coverage (83.2%). The HP 2020 target for seatbelt use is 92.4%. Percent (%) Percent of Adults who Always Use a Seatbelt, by Gender, Georgia, 2012 100 84 80 60 40 20 0 Male 91 Female Percent (%) Percent of Adults who Always Use a Seatbelt, by Age Group Georgia, 2012 100 80 85 87 90 91 90 80 60 40 20 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65+ yr Always use a Seatbelt a Demographic Characteristics % 95% CI State Totals 87.5 (86.1, 88.7) Sex Male 83.7 (81.4, 85.8) Female 90.9 (89.3, 92.3) Race/Ethnicity White Non-Hispanic 87.3 (85.6, 88.9) Black Non-Hispanic 87.4 (84.6, 89.8) Hispanic 87.4 (81.2, 91.7) Age 18-24 yr 79.7 (74.1, 84.4) 25-34 yr 85.0 (80.7, 88.4) 35-44 yr 87.4 (83.9, 90.2) 45-54 yr 89.8 (86.9, 92.1) 55-64 yr 91.3 (89.1, 93.1) 65+ yr 90.3 (88.2, 92.1) Income Less than $15,000 87.5 (83.4, 90.6) $15,000-$24,999 83.9 (79.9, 87.3) $25,000-$34,999 87.3 (82.4, 91.1) $35,000-$49,999 84.5 (80.0, 88.2) $50,000-$74,999 88.7 (84.8, 91.7) $75,000 or More 90.9 (88.4, 92.9) Education Less than High School 84.3 (79.7, 88.0) High School Graduate 85.3 (82.5, 87.7) Some College 88.4 (85.9, 90.5) College Graduate 91.0 (89.1, 92.6) Health Insurance Coverage Has Health Insurance 88.3 (86.6, 89.8) No Health Insurance 83.2 (79.3, 86.5) a The proportion of adults who always or nearly always use a seatbelt while driving or riding in a car. Percent of Adults who always use Seatbelt, by Public Health District, Georgia, 2012 Percent (%) Percent of Adults who Always Use a Seatbelt, by Level of Education Georgia, 2012 100 84 80 60 40 20 0 Less than High School 85 High School Graduate 88 91 Some College College Graduate 21 Risk Behaviors Smoking Cigarette smoking is one of the leading causes of preventable deaths in the United States.17 Smoking is associated with deaths related to cancer, respiratory diseases, and cardiovascular diseases.18 About 10.1% of deaths among Georgia adults are linked to smoking.18 In 2012, 20.4% of Georgia adults were current cigarette smokers and 21.1% were former smokers. Adult males (23.5%) were significantly more likely to currently smoke cigarettes than females (17.4%). Adults with an annual income of less than $15,000 (33.3%) were more likely to currently smoke cigarettes than those with an annual income of $15,000 or greater. Adults with less than a high school education (36.1%) were significantly more likely to currently smoke cigarettes when compared to high school graduates (22.2%), those with some college (19.8%), and college graduates (8.7%). Adults with health insurance (17.5%) were significantly less likely to currently smoke when compared to adults without health insurance (35.9%). The HP 2020 target for prevalence of current cigarette smokers is 12%. Percent (%) Percent of Adults who Smoke Cigarettes, by Gender, Georgia, 2012 50 40 30 24 20 17 10 0 Male Female Current Smoker a Former Smoker b Demographic Characteristics % 95% CI % 95% CI State Totals 20.4 (18.9, 22.0) 21.1 (19.8, 22.5) Sex Male 23.5 (21.1, 26.2) 25.8 (23.6, 28.1) Female 17.4 (15.7, 19.3) 16.8 (15.4, 18.3) Race/Ethnicity White Non-Hispanic 21.4 (19.5, 23.4) 25.7 (24.0, 27.6) Black Non-Hispanic 19.3 (16.6, 22.5) 13.9 (11.7, 16.3) Hispanic 19.4 (13.3, 27.4) 17.8 (12.7, 24.4) Age 18-24 yr 22.3 (17.5, 27.9) 5.8 (3.4, 9.7) 25-34 yr 24.9 (20.7, 29.7) 12.5 (9.4, 16.5) 35-44 yr 21.5 (17.8, 25.7) 15.3 (12.5, 18.7) 45-54 yr 23.2 (20.0, 26.7) 21.8 (18.9, 25.0) 55-64 yr 19.4 (16.6, 22.5) 30.3 (27.2, 33.7) 65+ yr 9.9 (8.0, 12.3) 41.6 (38.7, 44.5) Income Less than $15,000 33.3 (28.4, 38.7) 21.2 (17.3, 25.6) $15,000-$24,999 27.1 (23.3, 31.3) 16.5 (14.0, 19.3) $25,000-$34,999 22.8 (18.2, 28.2) 20.3 (16.7, 24.4) $35,000-$49,999 20.7 (16.4, 25.7) 25.2 (21.1, 29.8) $50,000-$74,999 14.9 (11.4, 19.4) 23.7 (20.2, 27.5) $75,000 or More 10.9 (8.7, 13.4) 24.0 (21.0, 27.1) Education Less than High School 36.1 (31.1, 41.5) 21.9 (18.2, 26.0) High School Graduate 22.2 (19.5, 25.1) 21.3 (18.9, 23.9) Some College 19.8 (17.1, 22.8) 21.1 (18.8, 23.7) College Graduate 8.7 (7.2, 10.5) 20.5 (18.3, 22.9) Health Insurance Coverage Has Health Insurance 17.5 (15.7, 19.3) 18.9 (17.2, 20.6) No Health Insurance 35.9 (31.7, 40.4) 13.5 (10.9, 16.6) a The proportion of adults who reported that they had smoked at least 100 cigarettes (5 packs) in their life and they currently smoke cigarettes, either every day or on some days. b The proportion of adults who reported that they had smoked at least 100 cigarettes (5 packs) in their life but do not currently smoke. Percent of Adults who Smoke Cigarettes, by Level of Education, Georgia, 2012 50 40 36 30 22 20 20 9 10 Percent of Adults who currently Smoke Cigarettes, by Public Health District, Georgia, 2012 <17% 17 to 20% 20 to 23% 23 to 26% >=26% Percent (%) 0 Less than High School High School Graduate Some College College Graduate Percent (%) Percent of Adults who Smoke Cigarettes, by Household Income, Georgia, 2012 50 40 33 30 27 23 21 20 15 11 10 0 22 Less than $15,000- $25,000- $35,000- $50,000- $75,000 or $15,000 $24,999 $34,999 $49,999 $74,999 More Risk Behaviors Smokeless Tobacco Smokeless tobacco is known to cause cancer of the oral cavity and pancreas, and should not be considered a safe substitute for smoking cigarettes.19 The two main types of smokeless tobacco sold in the United States are chewing tobacco and snuff. In 2012, 4.1% of Georgia adults reported using smokeless tobacco. Adult males (6.9%) were significantly more likely to use smokeless tobacco compared to females (1.5%). White non-Hispanics (5.2%) were significantly more likely to use smokeless tobacco when compared to black non-Hispanics (2.3%). A higher proportion of adults with a household income of less than $15,000 (5.3%) used smokeless tobacco. Adults with less than high school education (6.1%) were significantly more likely to use smokeless tobacco when compared to college graduates (1.7%). Percent of Adults who used Smokeless Tobacco, by Gender, Georgia, 2012 15 Percent (%) 10 7 5 0 Male 2 Female The HP 2020 target for smokeless tobacco use is 0.3%. Demographic Characteristics State Totals Sex Male Female Race/Ethnicity White Non-Hispanic Black Non-Hispanic Hispanic Age 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65+ yr Income Less than $15,000 $15,000-$24,999 $25,000-$34,999 $35,000-$49,999 $50,000-$74,999 $75,000 or More Education Less than High School High School Graduate Some College College Graduate Health Insurance Coverage Has Health Insurance No Health Insurance Smokeless Tobacco Use a % 95% CI 4.1 (3.4, 4.9) 6.9 (5.6, 8.5) 1.5 (1.0, 2.1) 5.2 (4.2, 6.5) 2.3 (1.6, 3.5) 3.7 (1.7, 8.0) 5.0 (2.9, 8.7) 4.4 (2.6, 7.2) 4.4 (2.8, 6.8) 3.9 (2.7, 5.7) 3.2 (2.2, 4.6) 3.6 (2.6, 4.9) 5.3 (3.2, 8.7) 3.9 (2.5, 5.9) 4.4 (2.7, 7.0) 4.8 (2.6, 8.5) 4.9 (3.0, 7.8) 2.9 (1.9, 4.3) 6.1 (4.0, 9.3) 4.8 (3.5, 6.6) 4.0 (2.9, 5.6) 1.7 (1.1, 2.7) 4.0 (3.1, 5.0) 4.8 (3.2, 7.1) Percent (%) Percent of Adults who use Smokeless Tobacco, by Race/Ethnicitiy, Georiga, 2012 15 10 5 5 0 White Non-Hispanic 2 Black Non-Hispanic 4 Hispanic Percent of Adults who used Smokeless Tobacco, by Public Health District, Georgia, 2012 <2% 2 to 4% 4 to 6% >=6% Percent (%) Percent of Adults who used Smokeless Tobacco, by Education Level, Georgia, 2012 15 10 6 5 5 4 2 0 Less than High High School Some College College Graduate School Graduate 23 Risk Behaviors Binge Drinking Binge drinking is linked to unintentional injuries (falls, car crashes), intentional injuries (sexual assault, domestic violence), alcohol poisoning, liver disease, and neurological damage.20 Binge drinking is defined as consuming five or more drinks per occasion for men or four or more drinks per occasion for women at least once in the previous month. In 2012, 14.4% of Georgia adults engaged in binge drinking. Adult males (19.4%) were significantly more likely than females (9.8%) to engage in binge drinking. More young adults aged 18-24 (21.5%) and 25-34 (24.3%) reported binge drinking than any other age groups. Adults with an annual household income of $35,000$49,999 (18.2%) were the most likely to engage in binge drinking. The HP 2020 target for binge drinking is 24.4%. The current prevalence among Georgia adults meets this goal. Percent (%) Percent of Adults who Engaged in Binge Drinking, by Gender, Georgia, 2012 40 30 19 20 10 10 0 Male Female Percent (%) Percent of Adults who Engaged in Binge Drinking, by Age Group, Georgia, 2012 40 30 24 22 20 15 13 8 10 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 4 65+ yr Binge Drinking a Demographic Characteristics % 95% CI State Totals 14.4 (13.1, 15.8) Sex Male 19.4 (17.1, 21.9) Female 9.8 (8.4, 11.4) Race/Ethnicity White Non-Hispanic 16.3 (14.5, 18.2) Black Non-Hispanic 12.1 (9.7, 14.8) Hispanic 11.3 (6.9, 18.0) Age 18-24 yr 21.5 (16.7, 27.1) 25-34 yr 24.3 (20.1, 28.9) 35-44 yr 14.8 (11.9, 18.3) 45-54 yr 13.1 (10.6, 16.2) 55-64 yr 8.4 (6.4, 10.9) 65+ yr 4.0 (3.0, 5.4) Income Less than $15,000 13.8 (10.4, 18.0) $15,000-$24,999 14.3 (11.1, 18.1) $25,000-$34,999 11.4 (7.9, 16.0) $35,000-$49,999 18.2 (14.2, 23.2) $50,000-$74,999 14.3 (10.8, 18.7) $75,000 or More 16.2 (13.5, 19.2) Education Less than High School 13.9 (10.1, 18.8) High School Graduate 13.9 (11.5, 16.7) Some College 14.4 (12.0, 17.1) College Graduate 15.4 (13.2, 17.9) Health Insurance Coverage Has Health Insurance 16.3 (14.5, 18.1) No Health Insurance 16.7 (13.3, 20.6) a The proportion of adults who reported drinking 5 or more drinks for men or 4 or more drinks for women per occasion at least once in the previous month. Percent of Adults who Engaged in Binge Drinking, by Public Health District, Georgia, 2012 <12% 12 to 15% 15 to 18% >=18% Percent (%) Percent of Adults who Engaged in Binge Drinking, by Household Income, Georgia, 2012 40 30 20 14 14 18 14 16 11 10 0 Less than $15,000 - $25,000 - $35,000 - $50,000 - $75,000 or $15,000 $24,999 $34,999 $49,999 $74,999 More 24 Risk Behaviors Heavy Drinking Heavy drin1king is defined as consuming more than two drinks per day for males and more than one drink per day for females. Excessive alcohol use is the third leading lifestyle-related cause of death in the United States and has been associated with cirrhosis of the liver, high blood pressure, stroke, and can increase the risk for motor vehicle accidents, injuries, violence, and suicide.21 In 2012, 5.1% of Georgia adults engaged in heavy drinking. White non-Hispanics (6.4%) were significantly more likely to be engaged in heavy drinking when compared to Hispanics (1.1%). Adults aged 18 to 24 years of age (6.8%) were the most likely to engage in heavy drinking when compared to any other age groups. Heavy drinking is more prevalent among adults with an annual household income of $50,000-$74,000 (7.7%). Percent (%) Percent of Adults who Engaged in Heavy Drinking, by Race/Ethnicitiy, Georiga, 2012 30 20 10 6 0 White Non-Hispanic 4 Black Non-Hispanic 1 Hispanic Percent of Adults who Engaged in Heavy Drinking, by Age Group, Georgia 2012 30 20 Heavy Drinking a Demographic Characteristics % 95% CI State Totals 5.1 (4.3, 5.9) Sex Male 5.7 (4.5, 7.2) Female 4.4 (3.5, 5.6) Race/Ethnicity White Non-Hispanic 6.4 (5.3, 7.7) Black Non-Hispanic 3.8 (2.7, 5.5) Hispanic 1.1 (0.3, 4.0) Age 18-24 yr 6.8 (4.4, 10.4) 25-34 yr 5.7 (3.7, 8.8) 35-44 yr 4.1 (2.8, 6.1) 45-54 yr 6.0 (4.2, 8.5) 55-64 yr 4.2 (3.0, 5.7) 65+ yr 3.8 (2.8, 5.2) Income Less than $15,000 5.7 (3.7, 8.6) $15,000-$24,999 5.3 (3.4, 8.2) $25,000-$34,999 3.8 (2.1, 6.7) $35,000-$49,999 5.5 (3.6, 8.3) $50,000-$74,999 7.7 (5.2, 11.4) $75,000 or More 4.9 (3.7, 6.4) Education Less than High School 5.8 (3.5, 9.5) High School Graduate 5.3 (4.0, 7.1) Some College 4.6 (3.4, 6.2) College Graduate 4.9 (3.8, 6.2) Health Insurance Coverage Has Health Insurance 4.9 (4.0, 5.9) No Health Insurance 6.7 (4.6, 9.7) a The proportion of adults who reported drinking 2 or more drinks for males or 1 or more drinks for women per day. Percent of Adults who Engaged in Heavy Drinking, by Public Health District, Georgia, 2012 Percent (%) 10 7 6 4 6 4 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 4 65+ yr <4% 4 to 6% 6 to 8% >=8% Percent (%) Percent of Adults who Engaged in Heavy Drinking, by Income, Georgia 2012 30 20 10 6 5 4 6 8 5 0 Less Than $15,000- $25,000 - $35,000 - $50,000 - $75,000 or $15,000 $24,999 $34,999 $49,999 $74,999 More 25 Risk Behaviors At Least One Drink per Month Those categorized as having at least one drink per month have consumed either a 12-ounce beer, a 5-ounce glass of wine, or a drink with one shot of liquor within the past 30 days. In 2012, 47.8% of Georgia adults consumed at least one alcoholic drink within the past month. Adult males (55.3%) were significantly more likely than females (40.9%) to consume at least one drink within 30 days. White non-Hispanics (50.9%) were significantly more likely than black non-Hispanics (44.2%) and Hispanics (39.6%) to consume at least one drink within 30 days. Adults with college degrees (63.5%) were significantly more likely to consume at least one drink per month when compared to adults of lower education levels. Percent (%) Percent of Adults who Consumed at Least One Drink per Month, by Gender, Georgia, 2012 100 80 60 55 41 40 20 0 Male Female Percent of Adults who Consumed at Least One Drink per Month, by Race/Ethnicitiy, Georiga, 2012 100 80 60 51 44 40 40 20 0 White Non-Hispanic Black Non-Hispanic Hispanic Percent (%) Demographic Characteristics State Totals Sex Male Female Race/Ethnicity White Non-Hispanic Black Non-Hispanic Hispanic Age 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65+ yr Income Less than $15,000 $15,000-$24,999 $25,000-$34,999 $35,000-$49,999 $50,000-$74,999 $75,000 or More Education Less than High School High School Graduate Some College College Graduate Health Insurance Coverage Has Health Insurance No Health Insurance At Least One Drink per Month % 95% CI 47.8 (46.0, 49.6) 55.3 (52.4, 58.1) 40.9 (38.7, 43.2) 50.9 (48.7, 53.1) 44.2 (40.7, 47.8) 39.6 (31.8, 47.9) 48.8 (42.5, 55.2) 56.1 (51.0, 61.1) 51.5 (47.0, 56.0) 52.1 (48.3, 55.9) 44.3 (40.9, 47.8) 31.7 (29.1, 34.5) 37.7 (32.6, 43.1) 39.5 (35.3, 44.0) 41.2 (35.7, 46.8) 52.3 (47.1, 57.4) 51.4 (46.5, 56.3) 65.5 (61.9, 68.9) 33.4 (28.4, 38.8) 41.6 (38.3, 45.0) 48.7 (45.3, 52.1) 63.5 (60.7, 66.3) 53.4 (51.1, 55.7) 44.0 (39.6, 48.6) Percent of Adults who Consumed at Least One Drink per Month, by Public Health District, Georgia, 2012 <30% 30 to 40% 40 to 50% >=50% Percent (%) Percent of Adults who Consumed at Least One Drink per Month, by Level of Education, Georgia, 2012 100 80 64 60 49 42 40 33 20 0 Less than High School High School Graduate Some College College Graduate 26 Risk Behaviors Use of Equipment Use of equipment such as a cane, a wheelchair, a special bed, or a special telephone can make everyday tasks easier and improve the overall quality of life for those with health problems or disabilities. In 2012, 7.9% of Georgia adults reported using equipment due to a health problem or disability. Hispanic adults (2.3%) were significantly less likely than Black non-Hispanics (9.5%) or white non-Hispanics (8.1%) to use equipment. Use of equipment increases with age. Adults of age 65 or older (19.4%) are significantly more likely to use equipment than any younger age category. Adults with less than a high school education (15.4%) were significantly more likely to use equipment when compared to adults with higher levels of education. Percent (%) Percent of Adults who use Equipment, by Race/Ethnicitiy, Georiga, 2012 30 25 20 15 10 10 8 5 0 White Non-Hispanic Black Non-Hispanic 2 Hispanic Percent of Adults who use Equipment, by Age Group, Georgia, 2012 30 25 20 14 15 10 10 5 0 1 3 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 19 65+ yr Percent (%) Demographic Characteristics State Totals Sex Male Female Race/Ethnicity White Non-Hispanic Black Non-Hispanic Hispanic Age 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65+ yr Income Less than $15,000 $15,000-$24,999 $25,000-$34,999 $35,000-$49,999 $50,000-$74,999 $75,000 or More Education Less than High School High School Graduate Some College College Graduate Health Insurance Coverage Has Health Insurance No Health Insurance Use of Equipment % 95% CI 7.9 (7.1, 8.7) 7.9 (6.7, 9.2) 7.9 (6.9, 8.9) 8.1 (7.1, 9.1) 9.5 (7.8, 11.4) 2.3 (1.0, 5.2) 0.4 (0.1, 2.8) 1.3 (0.5, 3.1) 2.8 (1.7, 4.6) 9.8 (7.7, 12.3) 14.2 (11.9, 16.9) 19.4 (17.2, 21.8) 14.5 (11.6, 17.9) 10.8 (8.9, 13.1) 8.5 (6.3, 11.5) 4.5 (3.1, 6.4) 4.7 (3.1, 7.3) 3.5 (2.6, 4.8) 15.4 (12.5, 18.7) 7.8 (6.5, 9.2) 6.5 (5.3, 7.9) 4.7 (3.7, 6.0) 6.3 (5.4, 7.4) 4.3 (3.1, 6.0) Percent of Adults who reported Using Equipment, by Public Health District, Georgia, 2012 Percent Use of Equipment <7% 7 to 10% 10 to 13% >=13% Percent (%) Percent of Adults who use Equipment, by Level of Education, Georgia, 2012 30 25 20 15 15 10 5 0 Less than High School 8 High School Graduate 7 5 Some College College Graduate 27 Clinical Preventive Practices Adult Immunizations Adult immunizations against influenza and pneumococcal disease are important preventative measures against morbidity and mortality for adults aged 65 years and older since they are at high risk of developing complications from the diseases.30 From 1976 to 2007, there was an estimated annual average of 5,546 (87.9%) influenza-associated deaths among adults 65 years and older.31 Percent (%) Percent (%) In 2012, 60.1% of Georgia adults aged 65 and older had a seasonal flu vaccine within the past year. White non-Hispanics (64.1%) were significantly more likely to receive the seasonal flu vaccine when compared to black non-Hispanics (43.6%). The HP 2020 target for influenza immunization in adults aged 65 years and older is 90% In 2012, 66.2% of Georgia adults aged 65 and older have ever had the pneumonia vaccine. Females (71.5%) were significantly more likely to receive the pneumonia vaccine when compared to males (58.9%). White non-Hispanics (70.6%) were significantly more likely to receive the pneumonia vaccine when compared to black nonHispanics (52.8%). Adults with an annual household income of $75,000 or more (58.8%) were the least likely to receive the pneumonia vaccine The HP 2020 target for pneumonia immunization in advualtcscaingee.d 65 years and older is 90% Percent of Adults aged 65+ years who recieve Vaccinations, by Race/Ethnicity, Georiga, 2012 100 80 71 64 60 40 Flu Vaccine In Past Year Pneumonia Vaccine 53 44 20 0 White Non-Hispanic Black Non-Hispanic Influenza Pneumonia Vaccinea Vaccine b Demographic Characteristics % 95% CI % 95% CI State Totals 60.1 (57.2, 62.9) 66.2 (63.2, 69.0) Sex Male 57.8 (52.9, 62.6) 58.9 (53.7, 63.9) Female 61.8 (58.3, 65.2) 71.5 (68.2, 74.6) Race/Ethnicity White Non-Hispanic 64.1 (61.0, 67.1) 70.6 (67.5, 73.5) Black Non-Hispanic 43.6 (36.0, 51.6) 52.8 (44.7, 60.7) Hispanic NA NA NA NA Income Less than $15,000 59.7 (50.7, 68.1) 65.5 (56.3, 73.7) $15,000-$24,999 54.7 (48.0, 61.3) 67.2 (60.7, 73.2) $25,000-$34,999 55.5 (47.6, 63.1) 62.4 (54.4, 69.9) $35,000-$49,999 64.4 (55.7, 72.2) 69.3 (59.1, 77.8) $50,000-$74,999 65.3 (57.1, 72.7) 72.8 (64.5, 79.7) $75,000 or More 62.0 (53.9, 69.5) 58.8 (50.5, 66.7) Education Less than High School 56.6 (49.6, 63.4) 64.6 (57.6, 71.1) High School Graduate 62.8 (57.9, 67.6) 66.2 (60.8, 71.3) Some College 56.5 (50.7, 62.0) 67.1 (61.3, 72.4) College Graduate 65.4 (60.1, 70.4) 66.9 (61.6, 71.7) a The proportion of adults 65+ years that had a seasonal flu vaccine within the past year. b The proportion of adults 65+ years that have ever had a pneumonia vaccine Percent of Adults aged 65+ years who recieve Vaccinations, by Level of Education, Georgia, 2012 100 80 65 60 57 63 66 67 57 Flu Shot in Past Year Pneumonia Shot 65 67 40 20 0 Less than High School High School Graduate Some College College Graduate Percent of Adults aged 65+ years who had the Flu Vaccine, by Public Health District, Georgia, 2012 Percent of Adults aged 65+ years who had the Pneumonia Vaccine, by Public Health District, Georgia, 2012 <50% 50 to 55% 55 to 60% >=60% <60% 60 to 65% 65 to 70% >=70% 28 Clinical Preventive Practices Breast Cancer Screening Breast cancer screening means checking a woman's breast for cancer before there are signs or symptoms of the diseases. Mammograms help screen for breast cancer by detecting for tumors or lumps using X-rays imaging. Women between 50-74 years old should get mammograms once every 2 years.22 Breast cancer screening for women 40 to 49 years old should be determined by a doctor.22 In 2012, 81.8% of Georgian women aged 50-74 years have had a mammogram in the past two years. Among women 50 to 74 years of age: Black non-Hispanic women (88.6%) were significantly The HP 2020 target for breast cancer screening in adults aged 50 to 74 years old is 81.1%. in past two years. Demographic Characteristics State Totals Mammogram 50-74 in Past 2 Years a % 95% CI 81.8 (79.4, 84.0) more likely than white non-Hispanic women (79.3%) to have had a mammogram in the past two years. Women with an annual household income of less than $15,000 (71.7%) were least likely to have had a mammogram in the past two years. Women with less than high school education (73.1%) were the least likely to have had a mammogram in the past two years when compared to women with higher education levels. Women with health care coverage (84.5%) were significantly more likely to have had a mammogram in the past two years when compared to women without health care coverage (58.3%). Percent of Females who have had a Mammogram in the Past 2 Years, by Health Care Coverage, Georiga, 2012 100 81 85 80 40-64 Years Old 50-74 Years Old Race/Ethnicity White Non-Hispanic 79.3 (76.3, 82.0) Black Non-Hispanic 88.6 (84.4, 91.8) Hispanic NA NA Age 35-44 years NA NA 45-54 years 79.7 (73.9, 84.4) 55-64 years 79.3 (75.5, 82.6) 65-74 years 87.9 (84.7, 90.5) Annual Income Less than $15,000 71.7 (62.6, 79.3) $15,000-$24,999 76.5 (70.3, 81.8) $25,000-$34,999 86.2 (79.1, 91.2) $35,000-$49,999 87.5 (81.6, 91.6) $50,000-$74,999 80.4 (72.7, 86.3) $75,000 or More 85.9 (80.6, 90.0) Education Less than High School 73.1 (64.6, 80.2) High School Graduate 81.8 (77.5, 85.4) Some College 84.2 (79.7, 87.9) College Graduate 84.3 (80.0, 87.7) Health Insurance Coverage Has Health Insurance 84.5 (81.4, 87.2) No Health Insurance 58.3 (49.3, 66.8) a The proportion of women aged 50+ years who had a mammogram within the past 2 years. Percent (%) 60 58 Percent of Females aged 50-74 years who have had a Mammogram 45 in the Past 2 years, by Public Health District, Georgia, 2012 40 Percent Mammogram 20 0 Has Health Coverage No Health Coverage Percent (%) Percent of Females who have had a Mammogram in the Past 2 Years, by Level of Education, Georiga, 2012 100 80 66 60 53 40 20 0 Less than High School 78 70 High School Graduate 77 82 40-64 Years Old 50-74 Years Old 80 84 Some College College Graduate 29 Clinical Preventive Practices Cervical Cancer Screening Cervical cancer screening is one of the most effective ways to prevent cervical cancer. Current recommendations for cervical cancer screening states that Pap testing should begin at 21 years of age. Women aged 21-29 years should have a Pap test every 3 years and women aged 30-65 years can have Pap and HPV co-testing every 5 years or just a pap test alone every 3 years. Women aged 65 years or older with adequate screening history or women who had a total hysterectomy should not be screened.24 In 2012, 79.1% of Georgia women aged 21-65 years reported having a Pap test within the past 3 years. White non-Hispanic women (77.0%) were less likely to have had a Pap test in the past 3 years than other race/ethnicity groups. Woman with an annual household income of less than $15,000 (60.7%) were the least likely to have had a Pap test in the past 3 years. Women with less than high school education (56.6%) were less likely to have had a Pap test in the past 3 years compared to college graduates (88.6%). Woman with health care coverage (85.5%) were significantly more likely to have had a Pap test in the past 3 years than women without health care coverage (63.2%). Percent (%) Percent of Females aged 21-65 years who had a Pap Test in the Past 3 Years, by Race/Ethnicitiy, Georiga, 2012 100 84 77 79 80 60 40 20 0 White Non-Hispanic Black Non-Hispanic Hispanic The HP 2020 target for cervical cancer screening in adults aged 18 to 65 years old is 93% in the past 3 years. Pap Test in Past 3 Years a Demographic Characteristics % 95% CI State Totals 79.1 (76.4, 81.7) Race/Ethnicity White Non-Hispanic 77.0 (73.2, 80.4) Black Non-Hispanic 83.8 (79.0, 87.7) Hispanic 78.9 (67.2, 87.2) Age 21-24 years 83.4 (77.4, 88.1) 25-34 years 82.0 (76.5, 86.4) 35-44 years 78.0 (71.9, 83.1) 45-54 years 75.3 (70.1, 79.8) 55-65 years 64.8 (48.4, 78.3) Annual Income Less than $15,000 60.7 (52.3, 68.5) $15,000-$24,999 72.5 (65.0, 78.9) $25,000-$34,999 78.1 (68.3, 85.5) $35,000-$49,999 87.7 (81.7, 91.9) $50,000-$74,999 82.6 (72.6, 89.5) $75,000 or More 90.9 (87.0, 93.7) Education Less than High School 56.6 (45.5, 67.1) High School Graduate 78.7 (73.8, 83.0) Some College 78.8 (73.2, 83.5) College Graduate 88.6 (85.6, 91.1) Health Insurance Coverage Has Health Insurance 85.5 (82.8, 87.9) No Health Insurance 63.2 (56.5, 69.5) a The proportion of adult females aged181-65 years who have had a Pap test within the past three years. Percent (%) Percent of Females aged 21-65 years who had a Pap Test in the Past 3 Years, by Level of Education, Georiga, 2012 100 80 57 60 40 20 0 Less than High School 79 High School Graduate 89 79 Some College College Graduate Percent of Females aged 21-65 years who have had a Pap Test in the Past 3 years, by Public Health District, Georgia, 2012 Percent Pap Test Percent (%) Percent of Females aged 21-65 years who had a Pap Test in the Past 3 Years, by Health Care Coverage, Georiga, 2012 100 86 80 63 60 40 20 0 30 Has Health Coverage No Health Coverage Clinical Preventive Practices Colorectal Cancer Screening Colorectal cancer affects both men and women, particularly those aged 50 years and older.28 Screening can find precancerous polyps (abnormal growths in the colon or rectum) so they can be removed before turning cancerous. The U.S. Preventive Services Task Force recommends colorectal cancer screening for men and women aged 5075 years using high-sensitivity fecal occult blood testing (FOBT) every year, sigmoidoscopy every five years, or colonoscopy every ten years.29 In 2012, 68.6% of Georgia adults aged 50-75 years met the recommendations for colorectal cancer screening. Hispanics aged 50-75 years old (60.5%) were least likely to meet recommendations for colorectal cancer screening. Adults aged 65 years or older (81.3%) were significantly most likely to meet the recommendations for colorectal cancer screening. Adults aged 50-75 years old with an annual household income of $50,000 to $74,999 (77.8%) were more likely to meet recommendations for colorectal cancer screening. Adults aged 50-75 years old with less than a high school education (56.4%) were significantly less likely to meet colorectal cancer screening recommendations when compared to those who are high school graduates (65.3%), some college (72.8%) and college graduates (75.9%). Adults aged 50-75 years old without health care coverage (36.9%) were significantly less likely to meet colorectal cancer screening recommendations when compared to those with health care coverage (69.8%). Percent (%) Percent of Adults aged 50-75 years who met Colorectal Cancer Screening Recommendations, by Race/Ethnicitiy, Georiga, 2012 100 80 70 60 40 20 0 White Non-Hispanic 65 Black Non-Hispanic 61 Hispanic The HP 2020 target for colorectal cancer screening in adults aged 50 to 75 years old is 70.5%. Colorectal Cancer Screening a Demographic Characteristics % 95% CI State Totals 68.6 (66.3, 70.8) Sex Males 69.0 (65.4, 72.4) Females 68.3 (65.3, 71.1) Race/Ethnicity White Non-Hispanic 70.2 (67.6, 72.6) Black Non-Hispanic 65.2 (60.1, 70.0) Hispanic 60.5 (43.3, 75.5) Age 50-54 years 51.8 (46.6, 57.1) 55-64 years 70.9 (67.6, 74.0) 65-75 years 81.3 (78.2, 84.0) Annual Income Less than $15,000 53.2 (45.8, 60.5) $15,000-$24,999 58.1 (52.0, 64.0) $25,000-$34,999 68.2 (60.8, 74.9) $35,000-$49,999 68.2 (60.8, 74.7) $50,000-$74,999 77.8 (72.3, 82.4) $75,000 or More 77.3 (72.9, 81.1) Education Less than High School 56.4 (49.6, 63.0) High School Graduate 65.3 (61.0, 69.4) Some College 72.8 (68.5, 76.7) College Graduate 75.9 (72.2, 79.3) Health Insurance Coverage Has Health Insurance 69.8 (66.6, 72.7) No Health Insurance 36.9 (30.0, 44.4) a The proportion of adults aged 50 to 75 years who have had a blood stool test ever year, sigmoidoscopy every five years, or colonoscopy every ten years. Adults aged 50-75 years who met the colorectal screening recommendations, by Public Health District, Georgia, 2012 Percent Colorectal Screening Percent (%) Percent of Adults aged 50 to 75 years who met Colorectal Cancer Screening Recommendations, by Annual Household Income, Georiga, 2012 100 78 77 80 68 68 60 53 58 40 20 0 Less Than $15,000 - $25,000 - $35,000 - $50,000 - $75,000 or $15,000 $24,999 $34,999 $49,999 $74,999 More 31 Bibliography 1. CDC - Behavioral Risk Factor Surveillance System Overview: BRFSS 2012 (2013, July 15). Centers for Disease Control and Prevention. Retrieved July, 16, 2014, from http://www.cdc.gov/brfss/annual_data/2012/pdf/Overview_2012.pdf 2. US Census Bureau (n.d.). Georgia QuickFacts. State and County QuickFacts. Retrieved November 29, 2012, from http://quickfacts.census.gov/qfd/states/13000.html 3. Access to Health Services - Healthy People. (2012). Healthy People 2020 - Improving the Health of Americans. 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