The 2014 Georgia Behavioral Risk Factor Surveillance Report 1 Acknowledgements Georgia Department of Public Health Health Protection Epidemiology Program Chronic Disease, Healthy Behaviors and Injury Epidemiology Section Healthy Behavior Team 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 Madhavi.Vajani@dph.ga.gov 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, Benson AB, Annor F, Bayakly RA, 2014 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 Whitfield Murray Fannin Towns Union Rabun Walker Chattooga Gordon U1-1 Floyd Bartow UGilmer 1-2 Pickens UWhiteHabersham Lumpkin 2 Stephens Dawson Cherokee Forsyth Hall Banks Franklin Hart Jackson Madison Elbert Polk U U U Haralson UUU Carroll Cobb Paulding 3-1 Gwinnett 3-4 Barrow Clarke 10 Douglas 3-2 Fulton 3-5 Walton DeKalbRockdale 3-3 Clayton Newton Oconee Morgan Oglethorpe Wilkes Greene Taliaferro Lincoln Columbia Fayette Henry McDuffie Heard Coweta U4 Troup Meriwether Spalding Butts Jasper Putnam Warren Hancock Glascock Richmond U Pike Lamar U Monroe Baldwin Jones 5-2 Washington 6 Jefferson 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 U Muscogee Taylor ChattahoocheeMarion 7 Macon Schley Stewart Webster Sumter Quitman Peach Emanuel Houston Bleckley Laurens Treutlen Candler Bulloch Dooly Pulaski U5-1 Dodge Montgomery Wheeler Toombs Evans Tattnall Crisp Wilcox Telfair Effingham Bryan Chatham Randolph Terrell Lee Turner Ben Hill Jeff Davis Appling ULiberty Long 9-1 Clay Calhoun Dougherty Worth Irwin Tift Coffee U Bacon 9-2 Wayne McIntosh Early U Baker 8-2 Miller Mitchell Seminole Decatur Grady Colquitt UBerrien Cook 8-1 Atkinson Lanier Thomas Brooks 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 Arthritis...................................................................................................................................................... 20 Risk Behaviors 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 HIV Testing ............................................................................................................................................... 33 Shingles Immunization .............................................................................................................................. 34 Tetanus Immunization ............................................................................................................................... 35 HPV Immunization .................................................................................................................................... 36 Bibliography............................................................................................................................................................. 37 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 2014 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 2014 BRFSS data to previous years: Comparison between 2014 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 data can be used in trend analyses. 5 Summary of Results Summary Selected chronic conditions, risk behaviors, and clinical preventive services from the 2014 Georgia BRFSS are shown in the chart below in comparison with median prevalence from 2013 US national BRFSS data, which includes all 50 states, three territories, and Washington, D.C. 2014 US national BRFSS data is currently unavailable. Selected Chronic Conditions and Risk Factors, US and GA BRFSS, 2013 and 2014 Ever Told Stroke Diabetes Heart Attack Current Smoking Obesity (BMI >= 30) 2.8 3.3 9.8 11.6 4.4 4.5 19.0 17.4 28.9 30.5 No Flu Shot in Past Year (65+ Years Old) No Health Care Coverage (18-64 Years Old) 0 20.0 25.0 20 40 Percent (%) 62.6 54.7 60 US Georgia 80 100 Stroke In 2014, 3.3% of Georgia adults had ever been diagnosed with stroke. This estimate was similar to the 2013 US estimate. Diabetes In 2014, 11.6% of Georgia adults had physician diagnosed diabetes. This estimate is higher than the 2013 US median prevalence of 9.8%. Heart Attack In 2014, 4.4% of Georgia adults had ever been told they have had a heart attack. This estimate is similar to the 2013 US median of 4.5%. Tobacco Use In 2014, 17.4% of Georgia adults currently smoked cigarettes. This estimate is slightly lower than the 2013 US median prevalence of 19.0%. (HP 2020 Objective - Reduce tobacco use by adults to 12%) Obesity In 2014, 30.5% of Georgia adults were obese. This estimate is slightly higher than the 2013 US median prevalence of 28.9%. (HP 2020 Objective - Reduce the proportion of adults who are obese to 30.5%) Flu Vaccine in Past Year In 2014, 54.7% of Georgia adults aged 65 years and older received a flu vaccine in the past year. This estimate is lower than the 2013 US median estimate of 62.6%. (HP 2020 Objective - Increase the percentage of noninstitutionalized adults aged 65 years and older who are vaccinated annually against seasonal influenza to 90%) No Health Insurance Coverage In 2014, 25.0% of Georgia adults did not have any form of health coverage, which exceeds the 2013 US median estimate of 20.0%. (HP 2020 Objective- Increase the proportion of persons with health insurance to 100%) 6 Demographic Characteristics Demographics In 2014, there were approximately 7,500,000 adults aged 18 years and older residing in the state of Georgia .2 Approximately 6,350 adults participated in the Georgia BRFSS survey statewide. Georgia BRFSS respondents were 51.8% female and 48.2% male. Georgians completing the survey were white non-Hispanic (56.9%), black non-Hispanic (29.4%) and 8.3% Hispanic. Distribution similar to Georgia population. Approximately 25% of Georgia residents had an annual household income of $75,000 or more. About 84% of the population had at least a high school diploma and 24.7% had at least a college degree. Percent (%) Distribution of Georgia Residents, by Sex, Georgia, 2014 100 80 60 48.2 51.8 40 20 0 Male Female Sex 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 Employment Employed Unemployed Retired State Total (N=6,350) % 95% CI 48.2 (46.5, 50.0) 51.8 (50.1, 53.5) 56.9 (55.2, 58.7) 29.4 (27.8, 31.0) 8.3 (7.2, 9.6) 13.8 (12.4, 15.3) 18.0 (16.5, 19.6) 17.9 (16.5, 19.3) 18.3 (17.1, 19.5) 15.4 (14.4, 16.5) 16.7 (15.9, 17.6) 13.0 (11.7, 14.4) 21.2 (19.7, 22.9) 11.0 (9.9, 12.2) 13.3 (12.1, 14.6) 14.2 (13.0, 15.5) 27.3 (25.7, 28.8) 16.4 (14.9, 18.0) 29.3 (27.8, 30.9) 29.6 (28.1, 31.2) 24.7 (23.5, 26.0) 59.6 (58.0, 61.3) 24.8 (23.2, 26.4) 15.6 (14.8, 16.5) Percent (%) Distribution of Georgia Residents, by Level of Education, Georgia, 2014 100 80 60 40 16.4 20 0 Less than High School 29.3 29.6 24.7 High School Graduate Some College Level of Education College Graduate Percent (%) Distribution of Georgia Residents, by Annual Household Income, Georgia, 2014 100 80 60 40 21.2 27.3 20 13.0 11.0 13.3 14.2 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 Annual Income Percent (%) Distribution of Georgia Residents, by Age Group, Georgia, 2014 100 80 60 40 20 13.8 18 17.9 18.3 15.4 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr Age Group 16.7 65+ yr Percent (%) Distribution of Georgia Residents, by Race/Ethnicity, Georgia, 2014 100 80 56.9 60 40 20 0 White Non-Hispanic 29.4 Black Non-Hispanic Race/Ethnicity 8.3 Hispanic 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 2014, 18.8% of Georgia adults reported that they perceive their health rating as fair or poor. Adults aged 55 to 64 years (28.9%) were most likely to report fair or poor general health when compared to other age groups. Adults with an annual household income less than $15,000 (39.4%) were more likely to report fair or poor general health when compared to adults with an annual household income greater than or equal to $15,000. Adults without health insurance (22.8%) were significantly more likely to report fair or poor general health when compared to adults with health insurance (15.0%) Percent (%) Percent of Adults who reported Fair/Poor General Health, by Annual Household Income, Georgia, 2014 50 39.4 40 30.5 30 21.3 20 13.0 11.6 10 5.2 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 Annual Income Percent (%) Percent of Adults who reported Fair/Poor General Health, by Age Group, Georgia, 2014 50 40 28.9 30 22.2 20 8.8 12 13.1 10 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr Age Group 27.9 65+ yr The HP 2020 target for self-reporting of fair or poor physical health is 20.2%. General Health Fair/Poor a Demographic Characteristics % 95% CI State Totals 18.8 (17.5, 20.1) Sex Male 16.9 (15.1, 19.0) Female 20.5 (18.8, 22.3) Race/Ethnicity White Non-Hispanic 17.6 (16.1, 19.2) Black Non-Hispanic 20.6 (18.2, 23.3) Hispanic 24.5 (18.5, 31.6) Age 18-24 yr 8.8 (6.1, 12.5) 25-34 yr 12.0 (9.1, 15.8) 35-44 yr 13.1 (10.2, 16.7) 45-54 yr 22.2 (19.2, 25.5) 55-64 yr 28.9 (25.8, 32.2) 65+ yr 27.9 (25.5, 30.5) Income Less than $15,000 39.4 (34.1, 44.8) $15,000-$24,999 30.5 (26.8, 34.5) $25,000-$34,999 21.3 (17.3, 26.0) $35,000-$49,999 13.0 (10.1, 16.5) $50,000-$74,999 11.6 (9.0, 14.9) $75,000 or More 5.2 (3.9, 6.7) Education Less than High School 38.8 (33.9, 44.0) High School Graduate 20.6 (18.4, 23.1) Some College 15.8 (13.8, 18.1) College Graduate 7.0 (5.9, 8.4) Health Insurance Coverage Has Health Insurance 15.0 (13.6, 16.6) No Health Insurance 22.8 (19.2, 26.7) Employment Employed 10.9 (9.4, 12.5) Unemployed 34.1 (30.9, 37.5) Retired 24.8 (22.3, 27.4) 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 Health District, Georgia, 2014 Percent (%) Percent of Adults who reported Fair/Poor General Health, by Race/Ethnicity, Georgia, 2014 50 40 30 20.5 20 16.9 10 0 Male Female Race/Ethnicity 8 Health Status Indicators No Health Care Coverage Individuals without health Insurance 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 In 2014, 75.0% of Georgia adults aged 18-64 years reported that they have health care coverage. Hispanics (60.2%) were significantly more likely not to have health Insurance coverage than white non-Hispanics (16.9%) and black non-Hispanics (26.7%). Adults aged 55-64 years (14.2%) 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 (56.8%) did not have any form of health Insurance coverage. Adults with less than a high school education (55.4%) were significantly more likely not to have health coverage when compared to high school graduates (27.1%), those with some college (21.0%), and college graduates (8.6%). Percent (%) Percent of Adults aged 18-64 years with No Health Care Coverage, by Race/Ethnicity, Georgia, 2014 100 80 60 40 16.9 20 0 White Non-Hispanic 26.7 Black Non-Hispanic Race/Ethnicity 60.2 Hispanic Percent of Adults aged 18-64 years with No Health Care Coverage, by Annual Household Income, Georgia2014 The HP 2020 target for health care coverage among adults is 100%. No Health Care Coverage a Demographic Characteristics % 95% CI State Totals 25.0 (23.1, 27.0) Sex Male 27.3 (24.4, 30.4) Female 22.8 (20.5, 25.2) Race/Ethnicity White Non-Hispanic 16.9 (14.9, 19.0) Black Non-Hispanic 26.7 (23.3, 30.5) Hispanic 60.2 (52.5, 67.4) Age 18-24 yr 29.8 (24.4, 35.8) 25-34 yr 36.8 (32.0, 41.8) 35-44 yr 24.0 (20.1, 28.3) 45-54 yr 19.9 (16.9, 23.4) 55-64 yr 14.2 (11.8, 17.0) 65+ yr NA NA Income Less than $15,000 56.8 (50.5, 62.9) $15,000-$24,999 45.2 (40.1, 50.4) $25,000-$34,999 23.6 (18.3, 29.9) $35,000-$49,999 21.9 (17.1, 27.7) $50,000-$74,999 9.3 (6.4, 13.1) $75,000 or More 4.7 (3.3, 6.8) Education Less than High School 55.4 (48.9, 61.7) High School Graduate 27.1 (23.9, 30.6) Some College 21.0 (18.1, 24.2) College Graduate 8.6 (6.9, 10.7) Employment Employed 23.5 (21.3, 25.8) Unemployed 31.4 (27.6, 35.5) Retired 8.0 (4.9, 12.7) a The proportion 18-64 years old who have no health care coverage. Percent (%) 100 80 56.8 60 45.2 40 23.6 21.9 20 9.3 4.7 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 aged 18-64 years with No Health Care Insurance, by Health District, Georgia, 2014 Annual Income Percent (%) Percent of Adults aged 18-64 years with No Health Care Insurance, by Educaiton Level, Georgia, 2014 100 80 55.4 60 40 20 0 Less than High School 27.1 High School Graduate 21.0 8.6 Some College College Graduate Educaiton Level 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 in access to primary care have been shown to significantly improve health-related outcomes. In 2014, 28.5% of Georgia adults did not have a personal doctor or a heath care provider. Males (34.7%) were significantly more likely not to have a personal doctor when compared to females (22.8%). Hispanics (58.8%) were significantly more likely not to have a personal doctor when compared to black nonHispanics (30.2%) and white non-Hispanics (22.3%). Adults without health insurance (65.7%) were significantly more likely not to have a personal doctor when compared to adults with health insurance (22.2%). In 2014, 19.0% of Georgia adults could not visit a doctor due to costs within the past 12 months. Hispanics (31.8%) and black non-Hispanics (24.4%) had higher rates of forgoing medical care due to cost when compared to white non-Hispanics (14.4%). Adults with less than a high school education (33.9%) were significantly more likely to forgo medical care due to cost when compared with adults with higher education levels. Adults without health insurance (44.9%) were significantly more likely to forgo medical care due to cost when compared to adults with health insurance (13.8%). Percent (%) Percent of Adults who have Limited Health Care Access, by Race/Ethnicity, Georgia, 2014 100 80 60 40 22.3 20 14.4 30.2 24.4 No Personal Doctor No Doctor's Visits 58.8 31.8 0 White Non-Hispanic Black Non-Hispanic Hispanic Race/Ethnicity The HP 2020 target for those without a usual primary care provider among adults is 16.1%. No Personal Health Care Provider a No Health Care Due to Cost b Demographic Characteristics % 95% CI % 95% CI State Totals 28.5 (26.9, 30.3) 19.0 (17.6, 20.5) Sex Male 34.7 (32.1, 37.5) 15.8 (13.8, 18.1) Female 22.8 (20.8, 24.9) 21.9 (20.0, 23.9) Race/Ethnicity White Non-Hispanic 22.3 (20.4, 24.2) 14.4 (12.9, 16.0) Black Non-Hispanic 30.2 (26.9, 33.7) 24.4 (21.4, 27.6) Hispanic 58.8 (51.2, 66.1) 31.8 (25.1, 39.4) Age 18-24 yr 53.4 (47.5, 59.3) 19.5 (15.4, 24.4) 25-34 yr 48.8 (44.0, 53.6) 25.7 (21.5, 30.3) 35-44 yr 31.2 (27.0, 35.7) 22.4 (18.7, 26.5) 45-54 yr 20.4 (17.4, 23.8) 21.7 (18.7, 25.1) 55-64 yr 14.3 (11.8, 17.1) 17.8 (15.2, 20.7) 65+ yr 6.9 (5.6, 8.6) 6.2 (5.0, 7.7) Income Less than $15,000 44.1 (38.3, 50.0) 42.4 (36.8, 48.3) $15,000-$24,999 37.4 (33.1, 42.0) 32.7 (28.8, 37.0) $25,000-$34,999 30.5 (25.3, 36.2) 20.4 (16.3, 25.4) $35,000-$49,999 26.9 (22.4, 31.9) 16.3 (12.7, 20.6) $50,000-$74,999 22.9 (18.8, 27.7) 5.7 (3.9, 8.3) $75,000 or More 16.0 (13.5, 18.9) 6.4 (4.8, 8.4) Education Less than High School 42.6 (37.1, 48.2) 33.9 (28.8, 39.3) High School Graduate 31.1 (28.1, 34.2) 20.0 (17.6, 22.7) Some College 27.8 (24.8, 31.0) 16.9 (14.7, 19.4) College Graduate 17.5 (15.4, 19.8) 10.4 (8.8, 12.2) Health Insurance Coverage Has Health Insurance 22.2 (20.3, 24.2) 13.8 (12.3, 15.4) No Health Insurance 65.7 (61.4, 69.7) 44.9 (40.3, 49.5) Employment Employed 32.8 (30.5, 35.1) 18.7 (16.8, 20.7) Unemployed 31.8 (28.2, 35.7) 27.7 (24.5, 31.2) Retired 7.1 (5.6, 8.9) 5.7 (4.5, 7.3) 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, 2014 100 80 60 53.4 40 19.5 20 0 18-24 yr 48.8 25.7 25-34 yr 31.2 22.4 35-44 yr 20.421.7 45-54 yr No Personal Doctor No Doctor's Visit 14.317.8 55-64 yr 6.9 6.2 65+ yr Age Group Percent (%) Percent of Adults who have Limited Health Care Access, by Health Insurance Status, Georgia, 2014 100 80 60 40 22.2 20 13.8 No Personal Doctor No Doctor's Visits 65.7 44.9 0 Has Health Coverage No Health Coverage Health Insurance 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 2014, 27.1% of Georgia adults reported that they have not visited a doctor for a routine checkup within the past 12 months. Males (31.2%) were significantly more likely than females (23.4%) not to visit a doctor in the past year. Hispanics (36.6%) were more likely not to visit a doctor in the past year when compared to white non-Hispanics (27.9%) and black non-Hispanics (21.9%). Adults aged 65 years and older (9.1%) were significantly least likely to have not visited a doctor in the past year. Adults with an income of $15,000 - $24,999 (32.5%) were the most likely to have not visited a doctor in the past year. More than half of adults who do not have health insurance (53.9%) did not visit a doctor in the past year. Percent (%) Percent of Adults who had No Doctor's Visit Last Year, by Race/Ethnicity, Georgia, 2014 100 80 60 40 27.9 20 0 White Non-Hispanic 21.9 Black Non-Hispanic 36.6 Hispanic Race/Ethnicity Percent (%) Percent of Adults who had No Doctor's Visit Last Year, by Age Group, Georgia, 2014 100 80 60 36.9 40 41.8 30.7 25.5 20.1 20 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr Age Group 9.1 65+ yr No Doctor's Visit a Demographic Characteristics % 95% CI State Totals 27.1 (25.5, 28.8) Sex Male 31.2 (28.7, 33.9) Female 23.4 (21.5, 25.4) Race/Ethnicity White Non-Hispanic 27.9 (26.0, 29.9) Black Non-Hispanic 21.9 (19.0, 25.1) Hispanic 36.6 (29.3, 44.7) Age 18-24 yr 36.9 (31.3, 42.8) 25-34 yr 41.8 (37.0, 46.8) 35-44 yr 30.7 (26.6, 35.1) 45-54 yr 25.5 (22.3, 28.9) 55-64 yr 20.1 (17.4, 23.1) 65+ yr 9.1 (7.7, 10.8) Income Less than $15,000 30.7 (25.2, 36.8) $15,000-$24,999 32.5 (28.5, 36.8) $25,000-$34,999 29.1 (24.2, 34.5) $35,000-$49,999 25.9 (21.5, 30.8) $50,000-$74,999 22.0 (18.2, 26.5) $75,000 or More 23.5 (20.7, 26.7) Education Less than High School 33.5 (28.2, 39.3) High School Graduate 29.2 (26.3, 32.4) Some College 24.7 (21.9, 27.7) College Graduate 24.1 (21.8, 26.5) Health Insurance Coverage Has Health Insurance 23.6 (21.7, 25.6) No Health Insurance 53.9 (49.2, 58.6) Employment Employed 31.2 (29.0, 33.5) Unemployed 28.9 (25.4, 32.6) Retired 9.0 (7.6, 10.8) 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 Health District, Georgia, 2014 Percent (%) Percent of Adults who had No Doctor's Visit Last Year, by Health Coverage Status, Georgia, 2014 100 80 53.9 60 40 23.6 20 0 Has Health Coverage No Health Coverage 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 2014, 20.4% of Georgia adults reported being disabled in any way. Hispanics (9.9%) were significantly less likely to be disabled when compared to white non-Hispanics (22.3%) and bla1c1k1n1o1n-Hispanics (21.0%). Adults aged 65 years and older (31.1%) were the most likely to be disabled when compared to adults in other age groups. Adults with an annual household income less than $15,000 (39.1%) were the most likely to be disabled when compared to adults in other income levels. Adults with less than a high school education (31.1%) had a significantly higher prevalence of disability when compared to high school graduates (21.0%), adults with some college (20.0%) and college graduates (13.5%). Percent (%) Percent of Adults who reported being Disabled, by Race/Ethnicity, Georgia, 2014 100 80 60 40 22.3 20 0 White Non-Hispanic 21.0 Black Non-Hispanic 9.9 Hispanic Race/Ethnicity Percent (%) Percent of Adults who reported being Disabled, by Annual Household Income, Georgia, 2014 100 80 60 39.1 40 28.6 23.3 20 15.7 13.6 9.8 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 Annual Income Disability a Demographic Characteristics % 95% CI State Totals 20.4 (19.1, 21.8) Sex Male 19.1 (17.1, 21.2) Female 21.7 (20.0, 23.5) Race/Ethnicity White Non-Hispanic 22.3 (20.7, 24.0) Black Non-Hispanic 21.0 (18.4, 24.0) Hispanic 9.9 (6.5, 14.8) Age 18-24 yr 6.4 (4.1, 9.8) 25-34 yr 12.6 (9.5, 16.6) 35-44 yr 15.9 (12.8, 19.5) 45-54 yr 24.7 (21.6, 28.2) 55-64 yr 30.4 (27.2, 33.7) 65+ yr 31.1 (28.7, 33.7) Income Less than $15,000 39.1 (33.7, 44.7) $15,000-$24,999 28.6 (25.1, 32.4) $25,000-$34,999 23.3 (19.2, 28.0) $35,000-$49,999 15.7 (12.6, 19.4) $50,000-$74,999 13.6 (11.0, 16.8) $75,000 or More 9.8 (8.2, 11.7) Education Less than High School 31.1 (26.4, 36.2) High School Graduate 21.0 (18.7, 23.5) Some College 20.0 (17.7, 22.4) College Graduate 13.5 (11.9, 15.2) Health Insurance Coverage Has Health Insurance 17.9 (16.4, 19.6) No Health Insurance 19.2 (15.9, 23.1) Employment Employed 9.7 (8.4, 11.1) Unemployed 39.3 (35.8, 42.9) Retired 30.4 (27.8, 33.2) a The proportion of adults who reported being limited in any activities due to physical, mental, or emotional problems. Percent of Adults who reported being Disabled, by Health District, Georgia, 2014 Percent (%) Percent of Adults who reported being Disabled, by Educaiton Level, Georgia, 2014 100 80 60 40 31.1 20 21.0 20.0 13.5 0 Less than High School High School Graduate Some College College Graduate Educaiton Level 12 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 medicines. Lifetime Asthma a Current Asthma b Demographic In 2014, 13.8% of Georgia adults reported ever having Characteristics % 95% CI % 95% CI asthma and 8.3% currently have asthma. State Totals Sex 13.8 (12.7, 15.1) 8.3 (7.4, 9.3) Male 11.4 (9.7, 13.3) 5.3 (4.2, 6.6) Adult females were significantly more likely than males to Female Race/Ethnicity 16.1 (14.5, 17.8) 11.1 (9.8, 12.5) have ever had asthma (16.1% vs. 11.4%) and to currently have asthma (11.1% vs. 5.3%). White non-Hispanics (8.2%) and black non-Hispanics White Non-Hispanic Black Non-Hispanic Hispanic Age 14.2 (12.7, 15.8) 14.3 (12.1, 16.8) 9.7 (5.9, 15.4) 8.2 (7.1, 9.4) 9.4 (7.7, 11.5) 4.0 (2.2, 7.1) (9.4%) were more likely to currently have asthma when compared to Hispanics (4.0%). 18-24 yr 25-34 yr 35-44 yr 20.4 (16.1, 25.5) 14.1 (11.2, 17.8) 13.4 (10.7, 16.8) 9.9 (6.9, 14.0) 6.6 (4.7, 9.2) 7.7 (5.6, 10.4) Adults with a household income of less than $15,000 were 45-54 yr 11.8 (9.5, 14.5) 7.8 (6.1, 10.1) the most likely to ever had asthma (18.5%) and to currently have asthma (14.8%). 55-64 yr 65+ yr Income 13.0 (10.9, 15.3) 11.7 (10.1, 13.5) 9.5 (7.7, 11.6) 8.8 (7.3, 10.4) Less than $15,000 18.5 (14.8, 22.9) 14.8 (11.5, 18.9) $15,000-$24,999 18.3 (15.2, 21.8) 10.7 (8.6, 13.4) Percent of Adults who have had Asthma, by Gender, Georgia, 2014 $25,000-$34,999 $35,000-$49,999 $50,000-$74,999 12.8 (9.5, 16.9) 11.0 (8.2, 14.6) 11.2 (8.5, 14.6) 7.8 (5.4, 11.1) 5.1 (3.4, 7.5) 6.8 (4.8, 9.6) Percent (%) 50 40 30 20 11.4 Lifetime Asthma Current Asthma 16.1 11.1 $75,000 or More 12.8 (10.5, 15.6) Education Less than High School 15.6 (12.3, 19.7) High School Graduate 12.8 (10.9, 15.1) Some College 16.2 (13.8, 18.8) 6.7 (5.1, 8.8) 10.2 (7.7, 13.3) 8.3 (6.8, 10.1) 8.9 (7.1, 11.0) 10 5.3 College Graduate 11.2 (9.6, 12.9) 6.4 (5.2, 7.8) 0 Male Gender Female Health Insurance Coverage Has Health Insurance 13.9 (12.4, 15.5) 8.2 (7.1, 9.5) No Health Insurance 15.1 (12.3, 18.5) 8.0 (6.0, 10.5) Employment Employed 12.0 (10.5, 13.7) 5.6 (4.6, 6.7) Percent of Adults who have had Asthma, by Race/Ethnicity, Georgia, 2014 Unemployed Retired 19.7 (16.9, 22.8) 11.6 (9.9, 13.6) 14.6 (12.3, 17.4) 8.6 (7.1, 10.3) 50 a The proportion of adults who reported that they were ever told by a Lifetime Asthma doctor, nurse, or other health care professional that they had asthma. 40 Current Asthma b The proportion of adults who reported that they still had asthma. 30 Percent (%) 20 14.2 8.2 10 0 White Non-Hispanic 14.3 9.4 Black Non-Hispanic 9.7 4.0 Hispanic Percent of Adults who currently have Asthma, by Health District, Georgia, 2014 Race/Ethnicity Percent (%) Percent of Adults who have had Asthma, by Annual Household Income, Georgia2014 50 Lifetime Asthma 40 Current Asthma 30 18.5 18.3 20 12.8 11.0 11.2 12.8 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 Annual Income 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 in Georgia, increasing the risk for heart disease, stroke, high blood pressure, blindness, kidney disease, amputations, nerve problems, dental disease, and infections.7 In 2014, 11.6% of Georgia adults reported ever being diagnosed with diabetes by a health care professional. Black non-Hispanics (14.4%) were significantly more likely to have ever been diagnosed with diabetes than Hispanics (6.1%). The prevalence of diabetes was highest among adults aged 65 years and older (25.9%). Adults with a household income of less than $15,000 (19.9%) were the most likely to ever have diabetes compared with adults from other income levels. Adults with less than a high school education (16.2%) were significantly more likely to ever have diabetes when compared to college graduates (7.2%). Percent (%) Percent of Adults Diagnosed with Diabetes, by Race/Ethnicity, Georgia, 2014 30 25 20 15 10.9 10 5 0 White Non-Hispanic 14.4 Black Non-Hispanic Race/Ethnicity 6.1 Hispanic Percent (%) Percent of Adults Diagnosed with Diabetes, by Age Group, Georgia, 2014 30 25 20.3 20 14.8 15 10 5.9 5 0.8 1.3 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr Age Group 25.9 65+ yr Diabetes a Demographic Characteristics % 95% CI State Totals 11.6 (10.7, 12.5) Sex Male Female 11.6 (10.2, 13.2) 11.5 (10.4, 12.7) Race/Ethnicity White Non-Hispanic Black Non-Hispanic Hispanic 10.9 (9.8, 12.0) 14.4 (12.4, 16.5) 6.1 (3.7, 9.8) Age 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 65+ yr 0.8 (0.3, 2.4) 1.3 (0.6, 2.8) 5.9 (3.9, 8.8) 14.8 (12.3, 17.8) 20.3 (17.7, 23.2) 25.9 (23.6, 28.3) 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 19.9 (16.1, 24.3) 13.5 (11.2, 16.0) 11.3 (8.7, 14.7) 10.2 (8.2, 12.6) 9.1 (7.0, 11.8) 7.9 (6.3, 9.8) Education Less than High School High School Graduate Some College College Graduate 16.2 (13.2, 19.8) 12.0 (10.4, 13.8) 12.1 (10.4, 14.0) 7.2 (6.2, 8.4) Health Insurance Coverage Has Health Insurance No Health Insurance 9.3 (8.2, 10.5) 6.8 (5.0, 9.3) Employment Employed 7.0 (5.9, 8.1) Unemployed 14.5 (12.5, 16.9) Retired 24.1 (21.7, 26.7) a The proportion of adults who have physician-diagnosed diabetes. Adults with prediabetes or diabetes only during pregnancy are not considered to have diagnosis of diabetes. Percent of Adults Diagnosed with Diabetes, by Health District, Georgia, 2014 Percent (%) Percent of Adults Diagnosed with Diabetes, by Education Level, Georgia, 2014 30 25 20 16.2 15 10 5 0 Less than High School 12.0 12.1 7.2 High School Graduate Some College Education Level College 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 2014, 4.5% of Georgia adults had ever been told that they have had a heart attack. Adult males (5.5%) were more likely to have had a heart attack when compared to females (3.5%). Adults aged 65 years or older (11.8%) were more likely to have had a heart attack when compared to other age groups. Adults with a household income of less than $15,000 (7.2%) were the most likely to have had a heart attack. Percent (%) Percent of Adults who have had a Heart Attack, by Race/Ethnicity, Georgia, 2014 15 10 4.9 5 0 White Non-Hispanic 4.7 Black Non-Hispanic Race/Ethnicity 0.4 Hispanic Percent (%) Percent of Adults who have had a Heart Attack, by Age Group, Georgia, 2014 15 11.8 10 8.7 5 0.0 0 18-24 yr 0.5 25-34 yr 4.6 1.3 35-44 yr 45-54 yr Age Group 55-64 yr 65+ yr Heart Attack a Demographic Characteristics % 95% CI State Totals 4.5 (3.9, 5.2) Sex Male 5.5 (4.6, 6.7) Female 3.5 (2.8, 4.3) Race/Ethnicity White Non-Hispanic 4.9 (4.2, 5.7) Black Non-Hispanic 4.7 (3.5, 6.3) Hispanic 0.4 (0.1, 1.0) Age 18-24 yr 0.0 NA 25-34 yr 0.5 (0.1, 3.7) 35-44 yr 1.3 (0.6, 2.8) 45-54 yr 4.6 (3.1, 6.6) 55-64 yr 8.7 (6.7, 11.4) 65+ yr 11.8 (10.2, 13.7) Income Less than $15,000 7.2 (5.0, 10.1) $15,000-$24,999 6.1 (4.5, 8.1) $25,000-$34,999 6.0 (3.9, 9.2) $35,000-$49,999 2.7 (1.7, 4.3) $50,000-$74,999 3.1 (1.9, 5.0) $75,000 or More 2.3 (1.6, 3.3) Education Less than High School 9.5 (7.1, 12.6) High School Graduate 4.3 (3.4, 5.4) Some College 3.7 (2.8, 5.0) College Graduate 2.2 (1.7, 2.9) Health Insurance Coverage Has Health Insurance 2.8 (2.2, 3.6) No Health Insurance 3.6 (2.3, 5.6) Employment Employed 1.5 (1.1, 2.1) Unemployed 6.3 (4.8, 8.2) Retired 12.6 (10.5, 15.0) a The proportion of adults who had ever been told by a health professional that they had a heart attack of myocardial infarction. Percent of Adults who have had a Heart Attack, by Health District, Georgia, 2014 Percent (%) Percent of Adults who have had a Heart Attack, by Annual Household Income, Georgia, 2014 15 10 7.2 6.1 6.0 5 2.7 3.1 2.3 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 Annual Income 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 in Georgia, and can cause significant disability, such as paralysis, speech difficulties, and emotional problems.9 In 2014, 3.3% of Georgia adults reported ever being told by a health professional that they had a stroke. Hispanics (0.9%) were significantly least likely to have ever had a stroke when compared to black non-Hispanics (4.2%) and white non-Hispanics (3.3%). Adults of age 65 years or older (8.7%) were significantly 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 (6.5%) were most likely to have ever had a stroke when compared to high school graduates (3.7%), those with some college (2.6%), and college graduates (1.5%). Percent of Adults who have ever had Stroke, by Race/Ethnicity, Georgia, 2014 15 Percent (%) 10 5 3.3 0 White Non-Hispanic 4.2 Black Non-Hispanic Race/Ethnicity 0.9 Hispanic Percent (%) Percent of Adults who ever had Stroke, by Age Group, Georgia, 2014 15 10 4.6 4.5 5 1.5 0.0 0.5 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr Age Group 8.7 65+ yr Stroke a Demographic Characteristics % 95% CI State Totals 3.3 (2.8, 3.9) Sex Male 3.2 (2.5, 4.1) Female 3.4 (2.8, 4.2) Race/Ethnicity White Non-Hispanic 3.3 (2.8, 4.0) Black Non-Hispanic 4.2 (3.2, 5.6) Hispanic 0.9 (0.1, 5.3) Age 18-24 yr 0.0 NA 25-34 yr 0.5 (0.2, 1.7) 35-44 yr 1.5 (0.8, 3.1) 45-54 yr 4.6 (3.2, 6.6) 55-64 yr 4.5 (3.3, 6.1) 65+ yr 8.7 (7.1, 10.5) Income Less than $15,000 6.3 (4.5, 8.8) $15,000-$24,999 5.2 (3.7, 7.1) $25,000-$34,999 4.1 (2.6, 6.5) $35,000-$49,999 1.6 (0.9, 3.0) $50,000-$74,999 1.5 (0.8, 2.7) $75,000 or More 1.2 (0.7, 1.8) Education Less than High School 6.5 (4.8, 8.8) High School Graduate 3.7 (2.7, 4.9) Some College 2.6 (2.0, 3.5) College Graduate 1.5 (1.1, 2.2) Health Insurance Coverage Has Health Insurance 2.3 (1.7, 2.9) No Health Insurance 2.3 (1.4, 3.8) Employment Employed 1.1 (0.7, 1.6) Unemployed 6.1 (4.8, 7.8) Retired 7.3 (5.8, 9.1) aThe proportion of adults who have ever been told by a health professional that they had a stroke. Percent of Adults who have ever had a Stroke, by Health District, Georgia, 2014 Percent (%) Percent of Adults who ever had Stroke, by Education Level, Georgia, 2014 15 10 6.5 5 0 Less than High School 3.7 2.6 1.5 High School Graduate Some College Education Level College Graduate 16 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 In 2014, 4.1% of Georgia adults reported ever being told by a health professional that they have angina or coronary heart disease. Adult males (4.6%) were more likely to have had angina when compared to adult females (3.6%). Hispanics (1.7%) were least likely to have had angina when compared to black non-Hispanics (2.8%) and white non-Hispanics (5.3%). Adults aged 65 years and older were most likely to have had angina (12.1%) when compared to other age groups. Percent (%) Percent of Adults who have ever had Angina, by Race/Ethnicity, Georgia, 2014 15 10 5.3 5 0 White Non-Hispanic 2.8 Black Non-Hispanic Race/Ethnicity 1.7 Hispanic Percent of Adults who ever had Angina, by Age Group, Georgia, 2014 15 12.1 10 Angina a Demographic Characteristics % 95% CI State Totals 4.1 (3.6, 4.7) Sex Male 4.6 (3.8, 5.6) Female 3.6 (3.1, 4.4) Race/Ethnicity White Non-Hispanic 5.3 (4.6, 6.1) Black Non-Hispanic 2.8 (2.0, 3.8) Hispanic 1.7 (0.5, 5.3) Age 18-24 yr 0.3 (0.0, 2.1) 25-34 yr 0.4 (0.1, 2.8) 35-44 yr 1.7 (0.8, 3.4) 45-54 yr 4.0 (2.8, 5.7) 55-64 yr 6.0 (4.6, 7.8) 65+ yr 12.1 (10.5, 13.9) Income Less than $15,000 4.1 (2.9, 5.9) $15,000-$24,999 6.5 (5.0, 8.4) $25,000-$34,999 5.7 (4.0, 8.1) $35,000-$49,999 2.6 (1.8, 4.0) $50,000-$74,999 4.4 (2.9, 6.8) $75,000 or More 2.7 (1.9, 3.7) Education Less than High School 6.1 (4.4, 8.4) High School Graduate 4.0 (3.1, 5.0) Some College 4.0 (3.1, 5.1) College Graduate 3.0 (2.4, 3.9) Health Insurance Coverage Has Health Insurance 2.5 (2.0, 3.2) No Health Insurance 2.3 (1.4, 3.9) Employment Employed 1.9 (1.4, 2.5) Unemployed 5.1 (4.0, 6.4) Retired 11.3 (9.6, 13.3) a The proportion of adults who had ever been told by a health professional that they had angina or coronary heart disease. Percent (%) 6.0 5 4.0 1.7 0.3 0.4 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 Health District, Georgia, 2014 Age Group Percent (%) Percent of Adults who have ever had Angina, by Health Insurance Coverage Status, Georgia, 2014 15 10 5 2.5 2.3 0 Has Health Coverage No Health Coverage Health Insurance 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 2014, 30.5% of Georgia adults were obese. Adult females (32.4%) were more likely to be obese than males (28.5%). Black non-Hispanics (37.9%) were significantly more likely to be obese when compared to white non-Hispanics (28.8%). Adults with an age of 18-24 years (17.3%) were least likely to be obese when compared to adults of age 25 or older. Adults who are college graduates (25.5%) were significantly least likely to be obese when compared to any other education category. Percent (%) Percent of Adults who were Obese, by Gender, Georgia, 2014 100 80 60 40 28.5 32.4 20 0 Male Female Gender Percent (%) Percent of Adults who were Obese, by Race/Ethnicity, Georgia, 2014 100 80 60 37.9 40 28.8 23.1 20 0 White Non-Hispanic Black Non-Hispanic Hispanic Race/Ethnicity The HP 2020 target for obesity among adults is 30.5%. Obese a Demographic Characteristics % 95% CI State Totals 30.5 (28.9, 32.1) Sex Male 28.5 (26.2, 31.0) Female 32.4 (30.4, 34.6) Race/Ethnicity White Non-Hispanic 28.8 (27.0, 30.8) Black Non-Hispanic 37.9 (34.6, 41.3) Hispanic 23.1 (16.9, 30.7) Age 18-24 yr 17.3 (13.2, 22.3) 25-34 yr 29.3 (25.0, 34.1) 35-44 yr 33.2 (29.0, 37.7) 45-54 yr 36.3 (32.8, 40.0) 55-64 yr 35.5 (32.2, 39.0) 65+ yr 29.5 (27.0, 32.0) Income Less than $15,000 40.1 (34.5, 45.9) $15,000-$24,999 31.9 (28.0, 36.0) $25,000-$34,999 33.8 (28.8, 39.1) $35,000-$49,999 34.2 (29.6, 39.2) $50,000-$74,999 30.8 (26.6, 35.3) $75,000 or More 24.0 (21.3, 26.8) Education Less than High School 37.9 (32.7, 43.4) High School Graduate 30.7 (27.8, 33.7) Some College 30.8 (27.9, 33.9) College Graduate 25.5 (23.2, 27.9) Health Insurance Coverage Has Health Insurance 30.8 (28.8, 32.9) No Health Insurance 30.8 (26.6, 35.4) Employment Employed 29.4 (27.3, 31.6) Unemployed 33.4 (30.0, 37.0) Retired 30.1 (27.4, 33.1) 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 Health District, Georgia, 2014 Percent (%) Percent of Adults who were Obese, by Education Level, Georgia, 2014 100 80 60 37.9 40 20 0 Less than High School 30.7 30.8 25.5 High School Graduate Some College Education Level 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 In 2014, 35.2% of Georgia adults were overweight. Adult males (42.1%) were significantly more likely to be overweight than females (28.4%). Hispanics (40.8%) were least likely to be overweight when compared to white non-Hispanics (34.9%) and black nonHispanics (33.3%). Adults of 18-24 years (28.1%) were significantly least likely to be overweight compared to adults of age 25 or older. Adults with an annual income of $75,000 or more (39.4%) were most likely to be overweight compared to adults from any other annual household income category. Percent (%) Percent of Adults who were Overweight, by Gender, Georgia, 2014 100 80 60 42.1 40 20 0 Male 28.4 Female Gender Percent (%) Percent of Adults who were Overweight, by Annual Household Income, Georgia, 2014 100 80 60 40 28.6 34.6 36.8 33.0 35.9 39.4 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 Annual Income The HP 2020 target for adults who are at a healthy weight is 33.9%. Overweight a Demographic Characteristics % 95% CI State Totals 35.2 (33.5, 36.9) Sex Male 42.1 (39.5, 44.8) Female 28.4 (26.5, 30.5) Race/Ethnicity White Non-Hispanic 34.9 (32.9, 36.9) Black Non-Hispanic 33.3 (30.1, 36.5) Hispanic 40.8 (32.9, 49.3) Age 18-24 yr 28.1 (22.9, 34.0) 25-34 yr 31.2 (26.7, 36.0) 35-44 yr 37.4 (33.0, 42.0) 45-54 yr 36.4 (32.8, 40.2) 55-64 yr 37.5 (34.2, 41.0) 65+ yr 39.3 (36.6, 41.9) Income Less than $15,000 28.6 (23.8, 33.9) $15,000-$24,999 34.6 (30.4, 39.0) $25,000-$34,999 36.8 (31.5, 42.4) $35,000-$49,999 33.0 (28.4, 38.0) $50,000-$74,999 35.9 (31.5, 40.5) $75,000 or More 39.4 (36.2, 42.6) Education Less than High School 33.4 (28.2, 39.1) High School Graduate 34.8 (31.7, 37.9) Some College 35.3 (32.2, 38.5) College Graduate 36.5 (34.0, 39.2) Health Insurance Coverage Has Health Insurance 35.1 (33.0, 37.3) No Health Insurance 32.4 (28.0, 37.2) Employment Employed 36.9 (34.6, 39.2) Unemployed 28.6 (25.2, 32.3) Retired 39.0 (36.2, 42.0) 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 of Adults who were Overweight, by Health District, Georgia, 2014 Percent (%) Percent of Adults who were Overweight, by Age Group, Georgia, 2014 100 80 60 40 28.1 31.2 37.4 36.4 37.5 20 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr Age Group 39.3 65+ yr 19 Chronic Conditions Arthritis Arthritis refers to rheumatic conditions that cause pain in and around joints and connective tissues. This pain can develop over time or can occur suddenly. Arthritis pain can be relieved by engaging in frequent physical activity.33 In 2014, 25.2% of Georgia adults had arthritis. Adult females (28.6%) were significantly more likely to have arthritis than males (21.6%). Hispanics (8.1%) were significantly least likely to have arthritis when compared to white non-Hispanics (28.9%) and black non-Hispanics (24.3%). Adults aged 65 years and older (54.2%) were significantly more likely to have arthritis when compared to other age groups. Adults with an annual income of less than $15,000 (37.8%) were significantly most likely to have arthritis when compared to adults from any other annual household income category. Percent (%) Percent of Adults who had Arthritis, by Gender, Georgia, 2014 100 80 60 40 28.6 21.6 20 0 Male Female Gender Percent of Adults who had Arthritis, by Age Group, Georgia, 2014 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 Employment Employed Unemployed Retired Arthritis % 95% CI 25.2 (23.9, 26.5) 21.6 (19.7, 23.6) 28.6 (26.9, 30.4) 28.9 (27.3, 30.6) 24.3 (21.8, 27.0) 8.1 (5.0, 12.7) 2.2 (1.0, 4.8) 6.7 (4.7, 9.5) 15.6 (12.8, 19.0) 30.0 (26.8, 33.5) 41.4 (38.1, 44.8) 54.2 (51.6, 56.9) 37.8 (32.7, 43.1) 27.7 (24.5, 31.1) 27.6 (23.4, 32.2) 24.8 (21.2, 28.9) 22.5 (19.3, 26.1) 18.3 (16.1, 20.6) 32.9 (28.5, 37.6) 26.7 (24.3, 29.3) 25.1 (22.8, 27.6) 18.3 (16.6, 20.1) 20.4 (18.9, 22.1) 16.2 (13.3, 19.5) 15.2 (13.8, 16.8) 32.4 (29.3, 35.6) 51.7 (48.8, 54.6) Percent (%) 100 80 60 41.4 40 30.0 20 2.2 15.6 6.7 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr 54.2 65+ yr Percent of Adults who had Arthritis, by Health District, Georgia, 2014 Age Group Percent (%) Percent of Adults who had Arthritis, by Annual Household Income, Georgia, 2014 100 80 60 37.8 40 27.7 27.6 24.8 22.5 18.3 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 Annual Income 20 Risk Behaviors No Leisure-Time Physical Activity Leisure-time physical activity helps improve overall health and fitness, and reduces your 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 2014, 23.6% of Georgia adults were physically inactive during leisure time within the past month. Adult females (25.8%) were significantly more likely than males (21.2%) to be physically inactive. Adults with an income of $75,000 or more (9.9%) were least likely to be physically inactive. Adults with a less than high school education (41.4%) were significantly more likely to be physically inactive when compared to high school graduates (27.7%), adults with some college (20.6%), and college graduates (10.5%). Adults with health insurance (18.5.0%) were significantly less likely to be physically inactive when compared to adults without health insurance (30.4%). Percent (%) Percent of Adults who reported No-Leisure Time Activity, by Gender, Georgia, 2014 100 80 60 40 21.2 25.8 20 0 Male Female Gender Percent (%) Percent of Adults who reported No-Leisure Time Activity, by Income Level, Georgia, 2014 100 80 60 42.6 40 30.4 26.3 23.4 20 13.7 9.9 0 Less Than $15,000 - $25,000 - $35,000 - $50,000 - $75,000 or $15,000 $14,999 $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 21.2 (19.1, 23.5) Female 25.8 (24.0, 27.8) Race/Ethnicity White Non-Hispanic 22.4 (20.7, 24.0) Black Non-Hispanic 26.9 (24.1, 30.0) Hispanic 23.6 (17.6, 30.8) Age 18-24 yr 14.9 (11.2, 19.5) 25-34 yr 18.6 (15.0, 22.7) 35-44 yr 19.7 (16.3, 23.7) 45-54 yr 26.2 (23.0, 29.7) 55-64 yr 27.1 (24.1, 30.2) 65+ yr 34.6 (32.0, 37.2) Income Less than $15,000 42.6 (37.1, 48.2) $15,000-$24,999 30.4 (26.7, 34.4) $25,000-$34,999 26.3 (21.9, 31.2) $35,000-$49,999 23.4 (19.5, 27.8) $50,000-$74,999 13.7 (11.0, 17.0) $75,000 or More 9.9 (8.3, 11.8) Education Less than High School 41.4 (36.3, 46.7) High School Graduate 27.7 (25.1, 30.5) Some College 20.6 (18.3, 23.1) College Graduate 10.5 (9.1, 12.1) Health Insurance Coverage Has Health Insurance 18.5 (16.9, 20.2) No Health Insurance 30.4 (26.4, 34.8) Employment Employed 18.9 (17.2, 20.9) Unemployed 31.4 (28.2, 34.8) Retired 28.6 (26.1, 31.4) 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 Activity, by Health District, Georgia, 2014 Income Level Percent (%) Percent of Adults who reported No-Leisure Time Activity, by Health Insurance Status, Georgia, 2014 100 80 60 40 30.4 18.5 20 0 Has Health Coverage No Health Coverage Health Insurance 21 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 2014, 94.9% of Georgia adults reported always or almost always using a seatbelt when they are driving or riding in a car. Females (96.5%) were significantly more likely to always or almost always use a seatbelt when compared to males (93.1%). Adults aged 18-24 years (89.6%) were significantly least likely to always or almost always use a seatbelt compared to all other age groups. Adults identified as college graduates (98.2%) were significantly more likely to always or almost always use a seatbelt compared to adults with lower levels of education. Adults with health coverage (95.3%) were more likely to always use a seatbelt when compared to those without health insurance coverage (92 4%) The HP 2020 target for seatbelt use is 92.4%. Percent (%) Percent of Adults who Always or Almost Always Use a Seatbelt, by Gender, Georgia, 2014 100 93.1 96.5 80 60 40 20 0 Male Female Gender Percent (%) Percent of Adults who Always or Almost Always Use a Seatbelt, by Age Group, Georgia, 2014 100 89.6 96.1 94.8 94.9 96.8 96.1 80 60 40 20 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr Age Group 65+ yr Always/Almost Always use a Seatbelt a Demographic Characteristics % 95% CI State Totals 94.9 (94.0, 95.7) Sex Male 93.1 (91.5, 94.4) Female 96.5 (95.5, 97.4) Race/Ethnicity White Non-Hispanic 94.8 (93.7, 95.7) Black Non-Hispanic 94.6 (92.4, 96.2) Hispanic 95.8 (90.8, 98.1) Age 18-24 yr 89.6 (85.2, 92.8) 25-34 yr 96.1 (93.8, 97.6) 35-44 yr 94.8 (92.0, 96.6) 45-54 yr 94.9 (92.6, 96.5) 55-64 yr 96.8 (95.3, 97.8) 65+ yr 96.1 (94.8, 97.1) Income Less than $15,000 94.3 (90.6, 96.6) $15,000-$24,999 93.2 (90.5, 95.2) $25,000-$34,999 92.6 (89.0, 95.0) $35,000-$49,999 93.7 (90.6, 95.9) $50,000-$74,999 96.5 (93.9, 98.0) $75,000 or More 97.0 (95.5, 98.1) Education Less than High School 92.6 (89.0, 95.0) High School Graduate 92.5 (90.5, 94.1) Some College 95.6 (93.9, 96.8) College Graduate 98.2 (97.2, 98.8) Health Insurance Coverage Has Health Insurance 95.3 (94.1, 96.2) No Health Insurance 92.4 (89.3, 94.7) Employment Employed 94.7 (93.3, 95.7) Unemployed 94.3 (92.1, 95.8) Retired 96.7 (95.4, 97.6) a The proportion of adults who always or almost always use a seatbelt while driving or riding in a car. Percent of Adults who always or almost always use a Seatbelt, by Health District, Georgia, 2014 Percent (%) Percent of Adults who Always or Almost Always Use a Seatbelt, by Level of Education, Georgia, 2014 100 92.6 92.5 95.6 98.2 80 60 40 20 0 Less than High School High School Graduate Some College College Graduate Level of Education 22 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 2014, 17.4% of Georgia adults were current cigarette smokers and 22.4% were former smokers. Adult males (21.4%) were significantly more likely to currently smoke cigarettes than females (13.6%). Adults with an annual income of less than $15,000 (33.5%) 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 (31.8%) were significantly more likely to currently smoke cigarettes compared to high school graduates (20.4%), those with some college (16.6%), and college graduates (5.6%). Adults with health insurance (15.4%) were significantly less likely to currently smoke compared to adults without health insurance (31.4%). The HP 2020 target for current cigarette smokers is 12%. Percent (%) Percent of Adults who Smoke Cigarettes, by Gender, Georgia, 2014 50 40 30 21.4 20 13.6 10 0 Male Female Gender Percent (%) Percent of Adults who Smoke Cigarettes, by Level of Education Georgia, 2014 50 40 31.8 30 20.4 20 16.6 10 5.6 0 Less than High School High School Graduate Some College College Graduate Current Smoker a Former Smoker b Demographic Characteristics % 95% CI % 95% CI State Totals Sex Male Female 17.4 (16.0, 18.8) 21.4 (19.1, 23.9) 13.6 (12.1, 15.3) 22.4 (21.1, 23.8) 26.5 (24.3, 28.8) 18.6 (17.0, 20.2) Race/Ethnicity White Non-Hispanic Black Non-Hispanic Hispanic 19.3 (17.5, 21.2) 14.6 (12.2, 17.5) 15.6 (10.4, 22.7) 27.4 (25.6, 29.2) 16.3 (14.0, 18.8) 14.4 (10.0, 20.5) 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 16.4 (12.3, 21.6) 23.5 (19.3, 28.3) 18.3 (15.0, 22.2) 18.9 (15.9, 22.3) 18.9 (16.2, 22.0) 8.1 (6.7, 9.8) 33.5 (28.1, 39.4) 19.5 (16.2, 23.3) 20.0 (15.8, 25.0) 17.0 (13.3, 21.5) 17.4 (13.9, 21.7) 8.1 (6.4, 10.4) 7.3 (4.8, 11.0) 13.2 (10.2, 17.0) 16.9 (13.8, 20.5) 22.9 (19.8, 26.2) 31.5 (28.3, 35.0) 40.7 (38.1, 43.4) 20.2 (16.4, 24.7) 23.0 (19.7, 26.6) 23.0 (18.9, 27.7) 25.0 (21.0, 29.5) 22.6 (19.2, 26.5) 22.8 (20.3, 25.4) Education Less than High School 31.8 (26.7, 37.4) 21.3 (17.5, 25.6) High School Graduate 20.4 (17.9, 23.2) 23.4 (20.9, 26.1) Some College 16.6 (14.3, 19.1) 25.3 (22.8, 28.1) College Graduate 5.6 (4.5, 6.9) 18.5 (16.7, 20.4) Health Insurance Coverage Has Health Insurance 15.4 (13.8, 17.1) 19.6 (18.0, 21.4) No Health Insurance 31.4 (27.1, 36.1) 15.5 (12.6, 19.0) Employment Employed 17.1 (15.3, 19.1) 18.8 (17.1, 20.6) Unemployed 22.9 (19.7, 26.3) 19.6 (17.0, 22.5) Retired 9.7 (7.9, 11.7) 40.3 (37.4, 43.2) 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 currently Smoke Cigarettes, by Health District, Georgia, 2014 Level of Education Percent (%) Percent of Adults whoSmoked Cigarettes, by Income Level, Georgia, 2014 50 40 33.5 30 20 19.5 20.0 17.0 17.4 8.1 10 0 Less Than $15,000 - $25,000 - $35,000 - $50,000 - $75,000 or $15,000 $14,999 $34,999 $49,999 $74,999 More Income Level 23 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 2014, 4.7% of Georgia adults reported using smokeless tobacco. Adult males (8.3%) were significantly more likely to use smokeless tobacco compared to females (1.5%). White non-Hispanics (5.8%) were more likely to use smokeless tobacco compared to black non-Hispanics (3.6%) and Hispanics (2.6%). A higher proportion of adults with a household income of less than $15,000 (6.9%) used smokeless tobacco. Adults with less than high school education (8.8%) were significantly more likely to use smokeless tobacco compared to college graduates (2.1%). Percent of Adults who used Smokeless Tobacco, by Gender, Georgia, 2014 15 Percent (%) 10 8.3 5 1.5 0 Male Female Gender Percent (%) Percent of Adults who used Smokeless Tobacco, by Race/Ethnicity, Georgia, 2014 15 10 5.8 5 3.6 0 White Non-Hispanic Black Non-Hispanic Race/Ethnicity 2.6 Hispanic The HP 2020 target for smokeless tobacco use is 0.3%. Smokeless Tobacco Use a Demographic Characteristics % 95% CI State Totals 4.7 (4.0, 5.7) Sex Male 8.3 (6.8, 10.1) Female 1.5 (1.1, 2.0) Race/Ethnicity White Non-Hispanic 5.8 (4.8, 7.1) Black Non-Hispanic 3.6 (2.3, 5.6) Hispanic 2.6 (1.0, 6.6) Age 18-24 yr 5.4 (3.3, 8.8) 25-34 yr 5.6 (3.4, 9.1) 35-44 yr 5.3 (3.5, 7.9) 45-54 yr 5.5 (3.8, 7.7) 55-64 yr 3.3 (2.2, 5.0) 65+ yr 3.4 (2.5, 4.5) Income Less than $15,000 6.9 (4.1, 11.4) $15,000-$24,999 5.9 (4.1, 8.5) $25,000-$34,999 4.3 (2.5, 7.5) $35,000-$49,999 3.8 (2.3, 6.3) $50,000-$74,999 5.3 (3.3, 8.3) $75,000 or More 3.0 (1.9, 4.5) Education Less than High School 8.8 (6.0, 12.7) High School Graduate 6.6 (5.0, 8.6) Some College 3.1 (2.1, 4.5) College Graduate 2.1 (1.4, 3.1) Health Insurance Coverage Has Health Insurance 4.8 (3.9, 6.0) No Health Insurance 5.8 (3.7, 8.9) Employment Employed 4.7 (3.8, 5.8) Unemployed 6.1 (4.2, 8.7) Retired 2.9 (1.9, 4.3) a The proportion of adults who reported that they currently use chewing tobacco, snuff or snus, either every day or some days. Percent of Adults who used Smokeless Tobacco, by Health District, Georgia, 2014 Percent (%) Percent of Adults who used Smokeless Tobacco, by Level of Education, Georgia, 2014 15 10 8.8 5 0 Less than High School 6.6 3.1 2.1 High School Graduate Some College Level of Education College Graduate 24 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 2014, 14.2% of Georgia adults engaged in binge drinking. Adult males (19.6%) were significantly more likely than females (9.2%) to engage in binge drinking. More young adults aged 18-24 (18.0%) and 25-34 (24.8%) reported binge drinking than any other age groups. Adults with an annual household income of $75,000 or more (14.5%), and less than $15,000 (14.5%) 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, 2014 40 30 19.6 20 9.2 10 0 Male Female Gender Percent (%) Percent of Adults who Engaged in Binge Drinking, by Age Group, Georgia, 2014 40 30 24.8 20 18.0 10 17.3 13.5 9.3 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr Age Group 2.6 65+ yr Binge Drinking a Demographic Characteristics % 95% CI State Totals 14.2 (12.9, 15.6) Sex Male 19.6 (17.3, 22.1) Female 9.2 (7.9, 10.6) Race/Ethnicity White Non-Hispanic 15.3 (13.7, 17.1) Black Non-Hispanic 11.3 (9.0, 14.0) Hispanic 19.3 (13.5, 27.0) Age 18-24 yr 18.0 (13.8, 23.1) 25-34 yr 24.8 (20.6, 29.5) 35-44 yr 17.3 (13.8, 21.5) 45-54 yr 13.5 (11.1, 16.3) 55-64 yr 9.3 (7.4, 11.8) 65+ yr 2.6 (2.0, 3.5) Income Less than $15,000 14.5 (10.6, 19.4) $15,000-$24,999 12.9 (10.0, 16.6) $25,000-$34,999 13.5 (9.7, 18.6) $35,000-$49,999 15.8 (11.9, 20.6) $50,000-$74,999 18.0 (14.2, 22.6) $75,000 or More 14.5 (12.3, 17.2) Education Less than High School 16.8 (12.5, 22.1) High School Graduate 15.3 (12.8, 18.0) Some College 12.9 (10.7, 15.5) College Graduate 12.9 (11.2, 15.0) Health Insurance Coverage Has Health Insurance 15.0 (13.4, 16.8) No Health Insurance 21.8 (17.9, 26.4) Employment Employed 18.3 (16.4, 20.4) Unemployed 11.4 (9.0, 14.3) Retired 3.5 (2.5, 4.9) 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 Health District, Georgia, 2014 Percent (%) Percent of Adults who Engaged in Binge Drinking, by Income Level, Georgia, 2014 40 30 20 14.5 12.9 13.5 15.8 18.0 14.5 10 0 Less Than $15,000 - $25,000 - $35,000 - $50,000 - $75,000 or $15,000 $14,999 $34,999 $49,999 $74,999 More Income Level 25 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, andHesauviyciDderi.n21king a In 2014, 5.3% of Georgia adults engaged in heavy Demographic Characteristics State Totals % 95% CI 5.3 (4.5, 6.1) drinking. Sex Male 6.2 (4.9, 7.8) White non-Hispanics (5.7%) were more likely to be engaged in heavy drinking compared to black non- Female Race/Ethnicity White Non-Hispanic 4.4 (3.6, 5.4) 5.7 (4.8, 6.9) Hispanics (4.4%) and Hispanics (5.5%). Black Non-Hispanic 4.4 (3.1, 6.2) Adults aged 25 to 34 years of age (8.0%) were the most likely to engage in heavy drinking compared to any other Hispanic Age 18-24 yr 5.5 (3.0, 9.8) 3.6 (2.0, 6.2) age group. 25-34 yr 8.0 (5.5, 11.3) Heavy drinking is more prevalent among adults with an annual household income $50,000 to $74,999 (7.0%). 35-44 yr 45-54 yr 55-64 yr 5.8 (3.8, 8.7) 5.5 (4.0, 7.6) 5.0 (3.7, 6.7) 65+ yr 3.4 (2.7, 4.4) Income Less than $15,000 6.1 (3.7, 10.0) Percent of Adults who Engaged in Heavy Drinking, by Race/Ethnicity, Georgia, 2014 $15,000-$24,999 $25,000-$34,999 4.0 (2.5, 6.3) 3.5 (2.0, 6.1) 30 $35,000-$49,999 5.0 (3.1, 7.8) $50,000-$74,999 7.0 (4.7, 10.3) Percent (%) $75,000 or More 6.2 (4.9, 8.0) 20 Education Less than High School 6.8 (4.3, 10.7) 10 5.7 4.4 5.5 High School Graduate Some College 5.2 (3.8, 7.1) 4.4 (3.3, 5.9) 0 College Graduate 5.4 (4.4, 6.7) White Non-Hispanic Black Non-Hispanic Hispanic Health Insurance Coverage Race/Ethnicity Has Health Insurance No Health Insurance 4.8 (3.9, 5.9) 8.6 (6.3, 11.7) Employment Percent of Adults who Engaged in Heavy Drinking, by Age Group, Georgia, 2014 Employed Unemployed Retired 6.0 (4.9, 7.3) 4.4 (3.0, 6.4) 3.6 (2.7, 4.7) a The proportion of adults who reported drinking 2 or more drinks for males or 1 or more 30 drinks for women per day. Percent (%) 20 10 3.6 8.0 5.8 5.5 5.0 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr Age Group 3.4 65+ yr Percent of Adults who Engaged in Heavy Drinking, by Health District, Georgia, 2014 Percent (%) Percent of Adults who Engaged in HeavyDrinking, by Income Level, Georgia, 2014 30 20 10 6.1 4.0 3.5 5.0 7.0 6.2 0 Less Than $15,000 - $25,000 - $35,000 - $50,000 - $75,000 or $15,000 $14,999 $34,999 $49,999 $74,999 More Income Level 26 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 2014, 48.1% of Georgia adults consumed at least one alcoholic drink within the past month. Adult males (55.6%) were significantly more likely than females (41.2%) to consume at least one drink within the past 30 days. White non-Hispanics (51.7%) were significantly more likely than black non-Hispanics (43.9%) and Hispanics (42.8%) to consume at least one drink within the past 30 days. Adults with college degrees (62.1%) 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, by Gender, Georgia, 2014 100 80 55.6 60 41.2 40 20 0 Male Female Gender Percent of Adults who Consumed at Least One Drink, by Race/Ethnicity, Georgia, 2014 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 Employment Employed Unemployed Retired At Least One Drink per Month % 95% CI 48.1 (46.4, 49.9) 55.6 (52.9, 58.3) 41.2 (39.0, 43.4) 51.7 (49.6, 53.8) 43.9 (40.4, 47.4) 42.8 (35.1, 50.8) 43.1 (37.3, 49.2) 55.9 (50.9, 60.7) 57.8 (53.3, 62.2) 52.0 (48.2, 55.8) 44.9 (41.4, 48.4) 32.7 (30.2, 35.2) 36.1 (30.6, 42.0) 36.9 (32.6, 41.3) 46.0 (40.5, 51.6) 52.1 (47.0, 57.2) 55.7 (51.0, 60.4) 63.6 (60.3, 66.8) 33.9 (28.5, 39.6) 41.9 (38.6, 45.2) 50.0 (46.8, 53.2) 62.1 (59.4, 64.6) 52.1 (49.9, 54.4) 49.2 (44.3, 54.0) 56.6 (54.2, 59.0) 35.8 (32.3, 39.6) 36.4 (33.6, 39.4) Percent (%) 100 80 60 51.7 43.9 40 20 0 White Non-Hispanic Black Non-Hispanic 42.8 Hispanic Percent of Adults who Consumed at Least One Drink per Month, by Health District, Georgia, 2014 Race/Ethnicity Percent (%) Percent of Adults who Consumed at Least One Drink, by Level of Education, Georgia, 2014 100 80 60 40 33.9 20 0 Less than High School 41.9 High School Graduate 62.1 50.0 Some College College Graduate Level of Education 27 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 2014, 8.7% of Georgia adults reported using equipment due to a health problem or disability. Hispanic adults (1.0%) were significantly less likely than Black non-Hispanics (9.6%) or white non-Hispanics (8.4%) to use equipment. Use of equipment increases with age. Adults of age 65 years or older (18.1%) were more likely to use equipment than any younger age category. Adults with less than a high school education (14.5%) 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/Ethnicity, Georgia, 2014 30 20 9.4 9.6 10 0 White Non-Hispanic Black Non-Hispanic Race/Ethnicity 1.0 Hispanic Percent of Adults who use Equipment, by Age Group, Georgia, 2014 30 20 15.3 10.7 10 4.3 1.4 1.9 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr Age Group 18.1 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 Employment Employed Unemployed Retired Use of Equipment % 95% CI 8.7 (7.9, 9.6) 8.6 (7.4, 10.0) 8.8 (7.8, 9.9) 9.4 (8.3, 10.5) 9.6 (7.9, 11.5) 1.0 (0.3, 3.2) 1.4 (0.6, 3.2) 1.9 (1.0, 3.5) 4.3 (2.7, 6.8) 10.7 (8.5, 13.4) 15.3 (13.0, 18.0) 18.1 (16.2, 20.2) 18.5 (14.9, 22.8) 10.9 (9.0, 13.1) 10.7 (8.1, 13.9) 6.9 (5.2, 9.2) 6.4 (4.5, 9.1) 2.9 (2.1, 3.9) 14.5 (11.6, 18.0) 9.4 (8.0, 11.2) 7.7 (6.5, 9.2) 5.2 (4.2, 6.3) 7.1 (6.1, 8.2) 5.9 (4.2, 8.2) 2.7 (2.1, 3.6) 16.6 (14.4, 19.1) 18.2 (16.0, 20.5) Percent of Adults who reported Using Equipment, by Health District, Georgia, 2014 Percent (%) Percent of Adults who use Equipment, by Level of Education, Georgia, 2014 30 20 14.5 10 9.4 7.7 5.2 0 Less than High School High School Graduate Some College College Graduate Level of Education 28 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 In 2014, 54.7% of Georgia adults aged 65 and older had a seasonal flu vaccine within the past year. White non-Hispanics (57.5%) were significantly more likely to receive the seasonal flu vaccine when compared to black non-Hispanics (46.2%). The HP 2020 Target for influenza immunization in adults aged 65 years and older is 90% In 2014, 65.2% of Georgia adults aged 65 and older have ever had the pneumonia vaccine. Females (68.2%) were more likely to receive the pneumonia vaccine when compared to males (61.3%). White non-Hispanics (68.4%) were significantly more likely to receive the pneumonia vaccine compared to black nonHispanics (55.5%). Adults with an annual household income of less than $15,000 (60.6%) were the least likely to receive the pneumonia vaccine. The HP 2020 Target for pneumonia immunization in adults aged 65 years and older is 90% Influenza Pneumonia Vaccine a Vaccine b Demographic Characteristics % 95% CI % 95% CI State Totals 54.7 (52.0, 57.4) 65.2 (62.5, 67.9) Sex Male 55.9 (51.5, 60.2) 61.3 (56.8, 65.7) Female 53.7 (50.3, 57.1) 68.2 (64.8, 71.3) Race/Ethnicity White Non-Hispanic 57.5 (54.5, 60.4) 68.4 (65.5, 71.3) Black Non-Hispanic 46.2 (39.4, 53.0) 55.5 (48.6, 62.3) Hispanic NA NA NA NA Income Less than $15,000 46.1 (37.7, 54.7) 60.6 (51.5, 69.1) $15,000-$24,999 54.1 (47.6, 60.4) 64.1 (57.5, 70.2) $25,000-$34,999 53.2 (45.4, 60.9) 67.9 (60.0, 74.9) $35,000-$49,999 56.4 (48.7, 63.7) 61.7 (53.8, 69.0) $50,000-$74,999 60.0 (51.9, 67.6) 66.8 (58.2, 74.5) $75,000 or More 57.9 (51.5, 64.1) 70.9 (64.5, 76.5) Education Less than High School 48.0 (40.9, 55.3) 54.6 (47.2, 61.8) High School Graduate 54.1 (49.1, 59.1) 64.6 (59.6, 69.3) Some College 55.7 (50.5, 60.7) 69.5 (64.5, 74.1) College Graduate 59.6 (55.1, 63.9) 70.7 (66.3, 74.8) Employment Employed 45.8 (38.9, 52.9) 52.4 (45.0, 59.8) Unemployed 51.0 (43.5, 58.4) 57.9 (50.1, 65.2) Retired 57.2 (54.0, 60.3) 69.0 (65.8, 71.9) 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 (%) Percent (%) Percent of Adults aged 65+ years who recieve Vaccinations, by Race/Ethnicity, Georgia, 2014 100 80 68.4 57.5 60 40 Flu Vaccine In Past Year Pneumonia Vaccine 55.5 46.2 20 0 White Non-Hispanic Black Non-Hispanic Percent of Adults aged 65+ years who had the Flu Vaccine, by Health District, Georgia, 2014 Percent of Adults aged 65+ years who recieve Vaccinations, by Level of Education, Georgia, 2014 100 80 60 54.6 48.0 40 64.6 54.1 Flu Vaccine In Past Year Pneumonia Vaccine 69.5 70.7 55.7 59.6 20 0 Less than High School High School Graduate Some College College Graduate Percent of Adults aged 65+ years who had the Pneumonia Vaccine, by Health District, Georgia, 2014 29 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 The HP 2020 target for breast cancer screening in adults In 2014, 79.9% of Georgian women aged 50-74 years aged 50 to 74 years old is 81.1% in the past two years. and older have had a mammogram in the past two years. Among women 50 to 74 years of age: Black non-Hispanic women (86.8%) were more significantly more likely than white non-Hispanic women (78.1%) to have had a mammogram in the past two years. Women with an annual household income of $15,000 to $24,999 (75.4%) were least likely to have had a mammogram in the past two years. Women with some college education (76.4%) were the least likely to have had a mammogram in the past two years when compared to women of other education levels. Women with health care coverage (81.1%) were significantly more likely to have had a mammogram in the past two years when compared to women without health care coverage (57.9%). Women who were retired (85.8%) were significantly more likely to have had a mammogram in the past two years compared to women who were employed or unemployed. Percent of Females who have had a Mammogram in the Past 2 Years, by Health Care Coverage, Georgia, 2014 100 85.9 84.8 80 60 40-64 Years Old 50-74 Years Old 59.3 56.5 Mammogram 50-74 in Past 2 Years a Demographic Characteristics % 95% CI State Totals 79.9 Race/Ethnicity White Non-Hispanic 78.1 (77.4, 82.2) (75.1, 80.8) Black Non-Hispanic 86.8 Hispanic NA (82.2, 90.3) NA Age 50-54 yr 76.2 (60.3, 83.1) 55-64 yr 65-74 yr 79.9 (74.0, 84.7) 77.6 (73.8, 81.1) Annual Income Less than $15,000 75.6 (68.0, 81.9) $15,000-$24,999 $25,000-$34,999 75.4 (68.4, 81.2) 79.8 (71.4, 86.2) $35,000-$49,999 $50,000-$74,999 83.0 (75.7, 88.4) 85.1 (78.9, 89.7) $75,000 or More 81.3 (75.4, 86.0) Education Less than High School 77.2 High School Graduate 82.8 (69.4, 83.4) (78.5, 86.4) Some College College Graduate 76.4 (71.3, 80.8) 82.9 (79.0, 86.3) Health Insurance Coverage Has Health Insurance 81.1 No Health Insurance 57.9 (77.7, 84.0) (47.4, 67.7) Employment Employed Unemployed 78.2 (74.0, 81.9) 76.0 (70.7, 80.5) Retired 85.8 (82.3, 88.8) a The proportion of women aged 50-74 years who had a mammogram within the past 2 years. Percent (%) 40 Percent of Females aged 50-74 years who have had a Mammogram 20 in the Past 2 years, by Health District, Georgia, 2014 0 Has Health Coverage No Health Coverage Health Care Coverage Percent (%) Percent of Females who have had a Mammogram in the Past 2 Years, by Level of Education, Georgia, 2014 100 80 73.6 76.6 60 40 20 0 Less than High School 80.8 78.1 82.3 82.9 40-64 Years Old 50-74 Years Old 86.5 84.6 High School Some College Graduate Level of Education College Graduate 30 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 2014, 84.2% of Georgia women aged 21-65 years reported having a Pap test within the past 3 years. White non-Hispanic women (83.6%) were less likely to have had a Pap test in the past 3 years than other race/ethnicity groups. Women with an annual household income of less than $15,000 (75.9%) were the least likely to have had a Pap test in the past 3 years. Women without high school diplomas (80.2%) were the least likely to have had a Pap test in the past 3 years compared to college graduates (89.9%). Woman with health care coverage (87.2%) were significantly more likely to have had a Pap test in the past 3 years than women without health care coverage (74.3%). Percent of Females aged 21-65 years who have had a Pap Test in the Past 3 Years, by Race/Ethnicity, Georgia, 2014 100 87.1 83.6 84.2 80 Percent (%) 60 White Non-Hispanic Black Non-Hispanic Race/Ethnicity Hispanic Percent of Females aged 21-65 years who have had a Pap Test in the Past 3 Years, by Level of Education, Georgia, 2014 The HP 2020 target for cervical cancer screening in adults aged 21 to 65 years old is 93% in the past 3 years. Pap Test in Past 3 Years a Demographic Characteristics % 95% CI State Totals Race/Ethnicity White Non-Hispanic Black Non-Hispanic Hispanic 84.2 (81.8, 86.4) 83.6 (80.4, 86.4) 87.1 (82.5, 90.6) 84.2 (73.3, 91.2) Age 21-24 yr 25-34 yr 35-44 yr 45-54 yr 55-65 yr NA NA 82.2 (71.7, 89.3) 86.8 (81.0, 91.0) 88.7 (84.0, 92.1) 84.1 (79.0, 88.2) Annual 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 75.9 (67.0, 83.0) 79.8 (72.9, 85.3) 84.3 (75.4, 90.4) 87.2 (79.6, 92.3) 87.6 (81.6, 91.8) 91.8 (88.0, 94.5) 80.2 (70.4, 87.5) 83.5 (78.2, 87.8) 80.6 (75.7, 84.7) 89.9 (86.8, 92.4) Health Insurance Coverage Has Health Insurance No Health Insurance 87.2 (84.6, 89.4) 74.3 (67.6, 80.0) Employment Employed 86.0 (83.1, 88.4) Unemployed 79.8 (74.7, 84.2) Retired 88.9 (81.2, 93.6) a The proportion of adult females aged 21-65 years who have had a Pap test within the past three years. Percent (%) 100 80.2 80 60 40 20 0 Less than High School 83.5 High School Graduate 89.9 80.6 Some College College Graduate Percent of Females aged 21-65 years who have had a Pap Test in the Past 3 years, by Health District, Georgia, 2014 Level of Education Percent (%) Percent of Females aged 21-65 years who have had a Pap Test in the Past 3 Years, by Health Insurance Coverage, Georgia, 2014 100 87.2 80 60 40 20 0 Has Health Coverage 74.3 No Health Coverage Insurance Coverage 31 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 2014, 68.5% of Georgia adults aged 50 to 75 years met the recommendations for colorectal cancer screening. Blacks aged 50 to 75 years (68.8%) were slightly less likely to meet recommendations for colorectal cancer screening. Adults aged 65 to 75 years (70.8%) were most likely to meet the recommendations for colorectal cancer screening. Adults aged 50 to 75 years with an annual household income of $75,000 or more (76.5%) were most likely to meet recommendations for colorectal cancer screening. Adults aged 50 to 75 years with less than a high school education (49.0%) were significantly less likely to meet colorectal cancer screening recommendations when Demographic Characteristics State Totals Sex Males Females Race/Ethnicity White Non-Hispanic Black Non-Hispanic Hispanic Age 50-54 yr 55-64 yr 65-75 yr Annual 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 Colorectal Cancer Screening a % 95% CI 68.5 (66.3, 70.7) 66.5 (62.8, 69.9) 70.4 (67.6, 73.1) 71.2 (68.7, 73.7) 68.8 (64.2, 73.0) NA NA 40.7 (30.4, 81.8) 58.2 (52.9, 63.4) 70.8 (67.4, 73.9) 53.3 (46.0, 60.5) 59.9 (53.8, 65.6) 72.2 (65.3, 78.3) 74.7 (67.8, 80.5) 72.9 (66.8, 78.2) 76.5 (72.5, 80.0) compared to those who are high school graduates (67.2%), some college (73.3%) and college graduates (77.6%). Adults aged 50 to 75 years without health insurance coverage (31.2%) were significantly less likely to meet colorectal cancer screening recommendations when compared to those with health insurance coverage (68.6%). Education Less than High School High School Graduate Some College College Graduate Health Insurance Coverage Has Health Insurance No Health Insurance 49.0 (42.1, 56.0) 67.2 (63.0, 71.1) 73.3 (69.2, 76.9) 77.6 (74.4, 80.4) 68.6 (65.5, 71.4) 31.2 (23.8, 39.6) The HP 2020 target for colorectal cancer screening in adults aged 50 to 75 years old is 70.5%. Employment Employed 63.2 (59.7, 66.6) Unemployed 61.0 (55.8, 65.9) Retired 82.6 (79.6, 85.2) 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. Percent (%) Percent of Adults aged 50 to 75 years who met Colorectal Cancer Screening Recommendations, by Race/Ethnicity, Georgia, 2014 100 71.2 68.8 50 0 White Non-Hispanic Black Non-Hispanic Race/Ethnicity Percent (%) Percent of Adults aged 50 to 75 years who met Colorectal Cancer Screening Recommendations, by Level of Education, Georgia, 2014 100 80 67.2 73.3 77.6 60 49.0 40 20 0 Less than High School High School Graduate Some College College Graduate Education Level Percent (%) Percent of Adults aged 50 to 75 years who met Colorectal Cancer Screening Recommendations, by Health Insurance Coverage, Georgia, 2014 100 68.6 50 31.2 0 Has Health Coverage No Health Coverage Health Insurance Percent (%) Percent of Adults aged 50 to 75 years who met Colorectal Cancer Screening Recommendations, by Annual Household Income, Georgia, 2014 100 72.2 74.7 72.9 76.5 80 53.3 59.9 60 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 Annual Income 32 Clinical Preventive Practices HIV Testing Human Immunodeficiency Virus (HIV) is a preventable disease that affects both men and women alike. While there is no known cure for HIV, getting tested for HIV can reduce the risk of transmitting the virus to others and improve the health of infected persons with early detection.32 In 2014, 43.7% of Georgia adults reported that they had ever been tested for HIV. White non-Hispanics (34.3%) were least likely to have ever been tested for HIV compared to black non-Hispanics (63.4%) and Hispanics (38.1%). Adults 25 to 34 years old (60.9%) were most likely to have ever been tested for HIV. Adults with less than a high school education (34.6%) were least likely to have ever been tested for HIV. Adults without health insurance coverage (50.2%) were slightly more likely to have ever been tested for HIV when compared to those with health insurance coverage (49.2%). Percent (%) Percent of Adults who Ever Tested for HIV, by Race/Ethnicity, Georgia, 2014 80 70 60 50 40 34.3 30 20 10 0 White Non-Hispanic 63.4 Black Non-Hispanic 38.1 Hispanic Race/Ethnicity 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 Employment Employed Unemployed Retired Ever Tested for HIV % 95% CI 43.7 (41.9, 45.5) 41.9 (39.2, 44.7) 45.4 (43.1, 47.7) 34.3 (32.2, 36.5) 63.4 (59.9, 66.8) 38.1 (30.8, 46.0) 40.4 (34.5, 46.6) 60.9 (55.8, 65.8) 60.0 (55.4, 64.5) 46.8 (42.9, 50.7) 34.3 (30.9, 37.8) 15.8 (13.9, 18.0) 47.3 (41.4, 53.2) 42.6 (38.2, 47.1) 46.3 (40.7, 52.0) 47.2 (42.0, 52.5) 43.4 (38.5, 48.4) 43.8 (40.5, 47.2) 34.6 (29.4, 40.1) 40.1 (36.8, 43.6) 50.3 (47.0, 53.6) 46.0 (43.2, 48.8) 49.2 (46.9, 51.5) 50.0 (45.1, 55.0) 47.5 (45.0, 49.9) 49.3 (45.3, 53.2) 20.4 (18.0, 23.2) Percent (%) Percent of Adults who Ever Tested for HIV, by Age Group, Georgia, 2014 80 70 60 50 40.4 40 30 20 10 0 18-24 yr 60.9 25-34 yr 60.0 35-44 yr 46.8 45-54 yr 34.3 55-64 yr Age Group 15.8 65+ yr Percent (%) Percent of Adults who Ever Tested for HIV, by Health Care Coverage, Georgia, 2014 80 70 60 49.2 50.0 50 40 30 20 10 0 Has Health Coverage No Health Coverage Health Care 33 Clinical Preventive Practices Shingles Immunization Shingles vaccination is an important preventative measure to reduce the risk of older adults developing shingles and the long-term pain [postherpetic neuralgia (PHN)] associated with 1 in 5 shingles cases. The risk of getting shingles increases as adults age, particularly for those greater than 50 years old. Current recommendations for shingles vaccination is one dose of the shingles vaccines for those aged 60 years and older, even for those who have already developed shingles previously.34 In 2014, 27.2% of Georgians aged 60 years and older reported ever having the Shingles (Zoster) vaccine. Black non-Hispanic adults aged 60 years or older (12.6%) were significantly less likely to have had a Shingles vaccine compared to White Non-Hispanic adults aged 60 years or older (32.8%). Adults aged 60 years or older with an annual household income of less than $15,000 (13.4%) were the least likely to have had a Shingles vaccine compared to other income groups. Adults aged 60 years or older who had less than a high school education (66.7%) were the least likely to have had a Shingles vaccine compared to adults with other education levels. Percent (%) Percent of Adults aged 60 years or older who have ever had a Shingles vaccine, by Race/Ethnicity, Georgia, 2014 50 40 32.8 30 20 12.6 10 0 White Non-Hispanic Black Non-Hispanic Race/Ethnicity The HP 2020 target for Shingles (Zoster) vaccine in adults 60 years and old is 30%. Ever had a Singles Vaccinea Demographic Characteristics % 95% CI State Totals 27.2 (25.2, 29.3) Sex Male 25.9 (22.8, 29.2) Female 28.3 (25.8, 30.9) Race/Ethnicity White Non-Hispanic 32.8 (30.4, 35.3) Black Non-Hispanic 12.6 (9.5, 16.6) Hispanic NA NA Annual Income Less than $15,000 13.4 (9.7, 18.4) $15,000-$24,999 20.0 (15.9, 24.8) $25,000-$34,999 26.0 (20.3, 32.7) $35,000-$49,999 26.8 (21.3, 33.1) $50,000-$74,999 25.2 (20.2, 31.0) $75,000 or More 44.2 (39.1, 49.5) Education Less than High School 19.1 (14.7, 24.5) High School Graduate 22.6 (19.3, 26.3) Some College 27.4 (23.8, 31.5) College Graduate 39.9 (36.2, 43.8) Health Insurance Coverage Has Health Insurance 18.9 (15.4, 22.9) No Health Insurance NA NA Employment Employed 20.0 (16.5, 24.0) Unemployed 23.0 (18.4, 28.4) Retired 31.5 (28.9, 34.3) a The proportion of adult aged 60 years or older who have ever had a Shingles (Zoster) vaccine. Percent (%) Percent of Adults aged 60 years or older who have ever had a Shingles vaccine, by Level of Education, Georgia, 2014 50 40 30 19.1 20 10 0 Less than High School 22.6 High School Graduate 39.9 27.4 Some College College Graduate Percent of Adults aged 60 years or older who have ever had a Shingles Vaccine, by Health District, Georgia, 2014 Level of Education Percent (%) Percent of Adults aged 60 years or older who have ever had a Shingles vaccine, by Annual Household Income, Georgia, 2014 50 44.2 40 30 26.0 26.8 25.2 20.0 20 13.4 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 Annual Income 34 Clinical Preventive Practices Tetanus (Tdap) Immunization The Tdap (Tetanus, diphtheria, and acellular pertussis) vaccination is given to older children and adults and is an important tool in preventing tetanus, a bacterial infection that induces muscle spasms from excreted toxins.35 Current recommendations state that adults aged 19 and older should receive a single dose of Tdap as well as expectant mothers in their third trimester. All adults should receiver a Td booster vaccine once every 10 years.35 In 2014, 53.1% of Georgia adults reported having a Tdap vaccine since 2005. Hispanic adults (45.9%) were less likely to have had a Tdap vaccine since 2005 compared to other race/ethnicity groups. Adults with an annual household income of less than $15,000 (45.7%) were the least likely to have had a Tdap vaccine since 2005, compared other income groups. Adults who had less than a high school education (45.8%) were less likely to have had a Tdap vaccine since 2005 compared to college graduates (58.7%). Adults with health insurance coverage (57.2%) were significantly more likely to have had a Tdap vaccine since 2005 than adults without health insurance coverage Percent (%) Percent of Adults who have had a Tdap vaccine since 2005, by Age Group, Georgia, 2014 100 80 56.9 60 56.6 54.5 53.2 53.6 40 20 0 18-24 yr 25-34 yr 35-44 yr 45-54 yr 55-64 yr Age Group 45.7 65+ yr Percent (%) Percent of Adults who have had a Tdap vaccine since 2005, by Level of Education, Georgia, 2014 100 80 60 45.8 40 20 0 Less than High School 51.5 54.3 58.7 High School Graduate Some College Level of Education College Graduate Tdap vaccine since 2005a Demographic Characteristics % 95% CI State Totals 53.1 (51.1, 55.1) Sex Male 57.6 (54.5, 60.6) Female 48.9 (46.4, 51.4) Race/Ethnicity White Non-Hispanic 56.1 (53.8, 58.3) Black Non-Hispanic 48.1 (44.2, 52.0) Hispanic 45.9 (37.4, 54.6) Age 18-24 yr 56.9 (49.4, 64.0) 25-34 yr 56.6 (50.6, 62.3) 35-44 yr 54.5 (49.4, 59.6) 45-54 yr 53.2 (49.0, 57.4) 55-64 yr 53.6 (49.8, 57.4) 65+ yr 45.7 (42.8, 48.7) Annual Income Less than $15,000 45.7 (39.4, 52.1) $15,000-$24,999 49.2 (44.3, 54.2) $25,000-$34,999 51.4 (45.3, 57.4) $35,000-$49,999 49.8 (44.1, 55.6) $50,000-$74,999 59.0 (53.7, 64.2) $75,000 or More 61.0 (57.4, 64.5) Education Less than High School 45.8 (39.9, 51.9) High School Graduate 51.5 (47.8, 55.2) Some College 54.3 (50.7, 57.9) College Graduate 58.7 (55.6, 61.6) Health Insurance Coverage Has Health Insurance 57.2 (54.7, 59.6) No Health Insurance 47.5 (42.1, 52.9) Employment Employed 55.8 (53.1, 58.4) Unemployed 51.2 (46.9, 55.5) Retired 46.6 (43.4, 49.9) a The proportion of adults aged18-65 years who have had a TDAP vaccine (Tetanus, diphtheria, and acellular pertussis) since 2005. Percent of Adults aged 18 years or older who have had a Tdap vaccine since 2005, by Health District, Georgia, 2014 Percent (%) Percent of Adults who have had a Tdap vaccine since 2005, by Health Insurance Coverage, Georgia, 2014 100 80 57.2 60 47.5 40 20 0 Has Health Coverage No Health Coverage Health Insurance 35 Clinical Preventive Practices HPV Immunization The Human Papillomavirus (HPV) is a common family of viruses that are spread through sexual contact. Some types of HPV can lead to cervical, vulvar, vaginal, and anal cancer in women, anal cancer in men, as well as genital warts in both men and women. Current recommendations state that all children 11 or 12 years old should get the three-dose series of HPV vaccine. Young women can get the vaccine up to 26 years old, and young men can get the vaccine up until 21, or 26 if they are at high risk for HPV.36 In 2014, 12.5% of Georgia adults reported having ever had a HPV vaccine. Female adults (16.4%) were significantly more likely to have had a HPV vaccine than male adults (8.3%). Hispanic adults (7.7%) were the least likely to have had a HPV vaccine compared to other race/ethnicity groups. Adults aged both 18 to 24 years (30.3%) and 25 to 34 years (14.7%) were significantly more likely to have ever had a HPV vaccine compared to older adults. Adults whose annual household income was $50,000 to $74,999 were the least likely to have ever had a HPV vaccine compared to other income groups. Adults who have had some college education were the most likely to have ever had a HPV vaccine (17.6%) compared to adults with other educational backgrounds. Percent (%) Percent of Adults who have ever had a HPV vaccine, by Age Group, Georgia, 2014 50 40 30.3 30 20 14.7 10 0 18-24 yr 25-34 yr Age Group Percent (%) Percent of Adults who have ever had a HPV vaccine, by Level of Education, Georgia, 2014 50 40 30 20 10.7 10 0 Less than High School 17.6 13.0 7.1 High School Graduate Some College Level of Education College Graduate HPV vaccinea Demographic Characteristics % 95% CI State Totals 12.5 (10.5, 14.8) Sex Male 8.3 (5.8, 11.8) Female 16.4 (13.5, 19.6) Race/Ethnicity White Non-Hispanic 12.9 (10.3, 16.0) Black Non-Hispanic 14.8 (10.8, 19.9) Hispanic 7.7 (3.8, 15.1) Age 18-24 yr 30.3 (24.2, 37.3) 25-34 yr 14.7 (10.8, 19.7) 35-44 yr NA NA 45-54 yr NA NA 55-64 yr NA NA 65+ yr NA NA Annual Income Less than $15,000 14.7 (8.4, 24.4) $15,000-$24,999 14.9 (10.3, 21.2) $25,000-$34,999 10.3 (5.9, 17.5) $35,000-$49,999 9.8 (5.8, 16.0) $50,000-$74,999 8.9 (4.9, 15.3) $75,000 or More 11.0 (7.7, 15.5) Education Less than High School 10.7 (5.5, 19.7) High School Graduate 13.0 (9.6, 17.4) Some College 17.6 (13.6, 22.4) College Graduate 7.1 (5.1, 9.9) Health Insurance Coverage Has Health Insurance 12.6 (10.4, 15.2) No Health Insurance 12.1 (8.2, 17.3) Employment Employed 10.8 (8.7, 13.3) Unemployed 17.5 (13.0, 23.0) Retired NA NA a The proportion of adults aged18 years and older who ever had a vaccine to prevent the human papilloma virus (HPV), including either Gardasil and Cervarix for women, and Gardasil for men. Percent of Adults aged 18 years or older who have ever had a HPV vaccine, by Health District, Georgia, 2014a Percent (%) Percent of Adults who have ever had a HPV vaccine, by Health Care Coverage, Georgia, 2014 50 40 30 20 12.6 12.1 10 0 Has Health Coverage No Health Coverage Health Care a Insufficient data for district level estimates is indicated by sample sizes (n) less than 100 for a particular Public Health District. 36 Bibliography 1. CDC - Surveillance Resource Center - Methodologic Changes in the Behavioral Risk Factor Surveillance System in 2011 and Potential Effects on Prevalence Estimates. (2012, June 18). Centers for Disease Control and Prevention. Retrieved November 29, 2012, from http://www.cdc.gov/surveillancepractice/reports/brfss/brfss.html 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). 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