north carolina behavioral risk factor surveillance system: data dissemination and use in planning...
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North Carolina Behavioral Risk Factor North Carolina Behavioral Risk Factor Surveillance System: Data Surveillance System: Data
Dissemination and Use in Planning and Dissemination and Use in Planning and EvaluationEvaluation
Ziya Gizlice, Ph. D.BRFSS Project Director and Coordinator
State Center for Health Statistics Division of Public Health
North Carolina Department of Health and Human Services
Today’s PresentationToday’s Presentation
North Carolina BRFSSNorth Carolina BRFSSEstablishing Partnerships (Funding)Establishing Partnerships (Funding)Data DisseminationData DisseminationData Use Data Use
– State Programs State Programs – Local LevelsLocal Levels
North Carolina BRFSSNorth Carolina BRFSSNC-BRFSS was funded by the Centers for NC-BRFSS was funded by the Centers for
Disease Control and Prevention (CDC) in 1984Disease Control and Prevention (CDC) in 1984– to monitor adult health-risk behaviors and health to monitor adult health-risk behaviors and health
practices;practices;– to collect state and regional estimates for targeting to collect state and regional estimates for targeting
high-risk groups.high-risk groups.
Collects 1,250 interviews/month Collects 1,250 interviews/month NC-BRFSS has its own survey laboratory NC-BRFSS has its own survey laboratory with 20 work stationswith 20 work stations– 30 part time interviewers & 2 part-time supervisors.30 part time interviewers & 2 part-time supervisors.
• 22 largest counties alone
• 13 regions from remaining 78 counties
• 2 Native American Census Tracks
NC BRFSS 2004 and BeyondNC BRFSS 2004 and Beyond
In 2004, the sample size was increased In 2004, the sample size was increased to 15,000 and 22 counties, 13 regions to 15,000 and 22 counties, 13 regions and census tracks with large American and census tracks with large American Indians have been over sampled.Indians have been over sampled.
– 3,000 African Americans3,000 African Americans– 600 + Hispanics (300 Spanish Speaking)600 + Hispanics (300 Spanish Speaking)– 400 American Indians400 American Indians– 200 Asian Americans200 Asian Americans– Produce Race, Sex, and Race X Sex Produce Race, Sex, and Race X Sex
Specific Estimates for whites and African Specific Estimates for whites and African AmericansAmericans
Funding the BRFSSFunding the BRFSS
Funding the BRFSSFunding the BRFSS Federal BRFSS GrantFederal BRFSS Grant
State Public Health ProgramsState Public Health Programs
County Health DepartmentsCounty Health Departments
Special SurveysSpecial Surveys
CDC ProgramsCDC Programs
Health Associations (March of Health Associations (March of
Dimes, ACS etc).Dimes, ACS etc).
Funding the BRFSSFunding the BRFSS UNC School of Public HealthUNC School of Public Health
NC Blue Cross & Blue ShieldNC Blue Cross & Blue Shield
NC MedicaidNC Medicaid
Glaxo Smith Kline?Glaxo Smith Kline?
State Appropriations- State Appropriations- $23,000/year– Public Health Task Force 2004 Recommendation
Interim Report North Carolina Public Health Task Force 2004
Essential Public Health Services:1) Monitor health status to identify and solve community health problems
Planning & Outcomes Committee: Improve the data and epidemiology for state and local decision-making and allocation of resources.– Establish a common set of core health
indicators.– Build capacity to conduct the Behavioral Risk
Factor Surveillance Survey (BRFSS) to provide county-specific or multi-county data ($300,000)
Data DisseminationData Dissemination
Data Dissemination Data Dissemination InternetInternet
– Data posting (close 10,000 data tables)Data posting (close 10,000 data tables)– Annual Statewide and Local Summary PowerPoint Presentations Annual Statewide and Local Summary PowerPoint Presentations
(~5,000 slides)(~5,000 slides)– ReportsReports– Total Requests between July1, 2003-May31, 2004: 152,662 Total Requests between July1, 2003-May31, 2004: 152,662 – 31.4 megabyte/day31.4 megabyte/day
Printed ReportsPrinted Reports
Electronic Distribution of Annual Survey ResultsElectronic Distribution of Annual Survey Results
Data Requests (~300) Data Requests (~300)
Community Level Summary Reports (besides BRFSS Community Level Summary Reports (besides BRFSS
includes other mortality, hospitalization, cancer data, and includes other mortality, hospitalization, cancer data, and
other statistics). other statistics).
Data Users’ Sites July 1, 2003-May 31, 2004July 1, 2003-May 31, 2004
Nu
mb
er
of
Req
uest
s 41000
16827
9584
3370 3676872
NC StateGov.
Universities US Gov. Other States NC LocalGov
BCBSNC
Reports by the BRFSS Reports by the BRFSS
Data Use in Planning and Data Use in Planning and Evaluation by State Programs Evaluation by State Programs
Tobacco Prevention and ControlTobacco Prevention and Control Heart Disease and Stroke Heart Disease and Stroke
PreventionPrevention DiabetesDiabetes Physical Activity and NutritionPhysical Activity and Nutrition Cancer Control ProgramCancer Control Program
Tobacco Prevention and ControlTobacco Prevention and ControlBRFSS Tracked Tobacco MeasuresBRFSS Tracked Tobacco Measures
Current Smoking Current Smoking Quit SmokingQuit Smoking Worksite and Home Smoking PolicyWorksite and Home Smoking Policy Visiting Doctor in the Past YearVisiting Doctor in the Past Year Doctor Advice to Quit SmokingDoctor Advice to Quit Smoking Smokeless Tobacco UseSmokeless Tobacco Use Other Tobacco ProductsOther Tobacco Products Tobacco TaxTobacco Tax Total Cigarette ConsumptionTotal Cigarette Consumption Age at Smoking Age at Smoking
Tobacco Prevention and ControlTobacco Prevention and ControlBRFSS Related Program Goals and ObjectivesBRFSS Related Program Goals and Objectives
Ultimate Outcome: Reducing morbidity and mortality related to tobacco Ultimate Outcome: Reducing morbidity and mortality related to tobacco useuse
Goal: Prevent initiation of tobacco among young peopleGoal: Prevent initiation of tobacco among young people Maintain public support greater than 50% for increase of cigarette tax (2006) Maintain public support greater than 50% for increase of cigarette tax (2006) Increase number of people who never smoked (Increase number of people who never smoked (20062006))
Goal: Eliminate exposure to secondhand smoke (SHS)Goal: Eliminate exposure to secondhand smoke (SHS) Increase % of workers covered by work-site smoke-free policies from 74.8% to 80% (Increase % of workers covered by work-site smoke-free policies from 74.8% to 80% (20102010
)) Increase % of adults and youth who do not currently smoke from 74.3% to 77% of adults Increase % of adults and youth who do not currently smoke from 74.3% to 77% of adults
and from 73.2% to 80% of high school students (and from 73.2% to 80% of high school students (20102010))
Goal: Promote smoking cessation among adults and young peopleGoal: Promote smoking cessation among adults and young people Increase the % of adults who have stopped smoking for a day or longer during the last 12 Increase the % of adults who have stopped smoking for a day or longer during the last 12
months from 55.8% to 60% (months from 55.8% to 60% (20102010)) Increase percent of adults “asked and advised” to quit by provider from 73.1 to 77% and Increase percent of adults “asked and advised” to quit by provider from 73.1 to 77% and
“assessed, assisted and arranged follow-up” services from 0 to 25% (“assessed, assisted and arranged follow-up” services from 0 to 25% (20062006))
Goal: Identify and eliminate tobacco-related disparities in specific population Goal: Identify and eliminate tobacco-related disparities in specific population groupsgroups
Decrease tobacco use prevalence rates among priority populations (2010)Decrease tobacco use prevalence rates among priority populations (2010) Increase cessation attempts among priority populations from 51% to 70% (2010)Increase cessation attempts among priority populations from 51% to 70% (2010)
% Current Smoking 1990-% Current Smoking 1990-2003 2003
0
5
10
15
20
25
30
90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03
NCUS
Support for Tobacco Tax (any amount) by Support for Tobacco Tax (any amount) by Sex, Race, Age, Education & Income (2003)Sex, Race, Age, Education & Income (2003)
70.174.2 73.7
67.2
77.7
66.1 65
77.5
68.9
80.5
0
10
20
30
40
50
60
70
80
90
100
Male Female White Otherminority
18-44 45+ H.S. orLess
SomeCollege+
Less than$50,000
$50,000+
%
*Maintain public support greater than 50% for increase of cigarette tax*Maintain public support greater than 50% for increase of cigarette tax
Support for Amount of Tax on Pack Support for Amount of Tax on Pack of Cigarettes by Smoking Statusof Cigarettes by Smoking Status
32.1 32.5
28.4
18.1
11.911.811.7
20.0
12.1
21.5
0
5
10
15
20
25
30
35
<$0.25-$0.49 $0.50-$1.00 >$1.00 No tax DNK/Not sure
Smokers Non-smokers
%
70.9
70.4
70.5
64.5
68.4
84.2
64.3
68.2
67.3
84.9
74.9
71.8
74.1
64.0
79.3
US
NC
Eastern NC
Piedmont NC
Western NC
Wake
Robeson
Randolph
Pitt
Orange
Mecklenburg
Hend./Transyl.
Guilford
Forsyth
Buncombe
0 10 20 30 40 50 60 70 80 90 100
Worksites Prohibit Smoking in Worksites Prohibit Smoking in Both Public and Work Areas Both Public and Work Areas
(2002)(2002)Percent
* Target is 80%, baseline was 74.8%. In 2003 the rate is 77.8%
22.6
26.2
26.9
29.6
30.3
20.8
30.1
27.7
24.4
12.8
19.4
21.0
22.7
25.7
23.6
US
NC
Eastern NC
Piedmont NC
Western NC
Wake
Robeson
Randolph
Pitt
Orange
Mecklenburg
Hend./Transyl.
Guilford
Forsyth
Buncombe
0 10 20 30 40 50
Current Smoker (2002)Current Smoker (2002)Percent
**Increase % of adults who do not currently smoke from 74.3% to 77% of adultsIncrease % of adults who do not currently smoke from 74.3% to 77% of adults2003 Rate: 75.2%2003 Rate: 75.2%
56.6
57.8
59.0
57.9
47.6
71.5
65.6
47.3
64.0
47.8
64.7
50.0
54.4
54.0
50.2
US
NC
Eastern NC
Piedmont NC
Western NC
Wake
Robeson
Randolph
Pitt
Orange
Mecklenburg
Hend./Transyl.
Guilford
Forsyth
Buncombe
0 10 20 30 40 50 60 70 80 90 100
Quit Smoking One Day or Quit Smoking One Day or Longer in Past Year (2002)Longer in Past Year (2002)
Percent
**Increase the % of adults who have stopped smoking for a day or Increase the % of adults who have stopped smoking for a day or longer during the last 12 months from 55.8% to 60%. 2003 Rate is longer during the last 12 months from 55.8% to 60%. 2003 Rate is 52.6%52.6%
69.5
74.5
70.2
77.2
78.1
80.2
64.3
75.2
67.1
72.4
84.2
65.5
64.3
66.3
70.0
US
NC
Eastern NC
Piedmont NC
Western NC
Wake
Robeson
Randolph
Pitt
Orange
Mecklenburg
Hend./Transyl.
Guilford
Forsyth
Buncombe
0 10 20 30 40 50 60 70 80 90 100
Advised by Health Professional Advised by Health Professional to Quit Smoking in Past Year to Quit Smoking in Past Year
(2002)(2002)
Percent
**Increase percent of adults “asked and advised” to quit by provider from 73.1 to 77%Increase percent of adults “asked and advised” to quit by provider from 73.1 to 77%2003---76.1%2003---76.1%
Tobacco Prevention and ControlTobacco Prevention and ControlPolicy Challenges Policy Challenges
NC Preemption Law - NC Preemption Law - NCGS 143-595-601NCGS 143-595-601 : : Regulate Regulate smoking in public places and establishes standards for local smoking in public places and establishes standards for local governments electing to regulate smoking (1993). governments electing to regulate smoking (1993). – Prohibits smoking in some public places such as school Prohibits smoking in some public places such as school
buses and health departments and facilities and requires buses and health departments and facilities and requires designated smoking areas (20%) in state buildingsdesignated smoking areas (20%) in state buildings
– Prohibits local governments to regulate smoking more Prohibits local governments to regulate smoking more stringent than this law.stringent than this law.
– Possible BRFSS Questions to obtain public opinion data on thisPossible BRFSS Questions to obtain public opinion data on this Do you favor or oppose letting local NC communities have the option Do you favor or oppose letting local NC communities have the option
of passing their own laws to restrict smoking in public places, even if of passing their own laws to restrict smoking in public places, even if those laws may be stronger than the state law?those laws may be stronger than the state law?
Do you feel that way strongly or not so strongly?Do you feel that way strongly or not so strongly?
Tobacco Tax (5 Cents) –Increase to 75 Cents/packTobacco Tax (5 Cents) –Increase to 75 Cents/pack– House Bill 1313 to allow local governments to levy taxes on tobacco- Not PassedHouse Bill 1313 to allow local governments to levy taxes on tobacco- Not Passed– House Bill 254 to increase tax on tobacco at a rate of 30% of cost- Not PassedHouse Bill 254 to increase tax on tobacco at a rate of 30% of cost- Not Passed
Success with Tobacco Free SchoolSuccess with Tobacco Free School
Tobacco Prevention and ControlTobacco Prevention and ControlEducation and Other Efforts Education and Other Efforts
A number of annually updated A number of annually updated surveillance briefs featuring surveillance briefs featuring current smoking, worksite smoking current smoking, worksite smoking policies, and quitting smoking. policies, and quitting smoking. – Annual Report for Great American Smokeout Annual Report for Great American Smokeout
day every Novemberday every November– One-pager fact sheets One-pager fact sheets – Numerous presentations and other Numerous presentations and other
educational materialseducational materials
Incorporate Adult Tobacco Survey Incorporate Adult Tobacco Survey into the BRFSSinto the BRFSS
Tobacco Prevention and Tobacco Prevention and ControlControl
Education and Other Efforts Education and Other Efforts
2004 BRFSS includes a question: 2004 BRFSS includes a question: – Are you aware of Quit Now NC smoking
cessation phone lines or Quit Now websites?
Heart Disease & Stroke Heart Disease & Stroke Prevention ProgramPrevention Program
Henderson &Transylvania
Surry
Wake
Lead Health Depts.
Pitt
Priority Population Health Depts.
Robeson
Cabarrus
HDSP Program Lead HDSP Program Lead CountiesCounties
Nash
Craven
Heart Disease & Stroke Prevention Heart Disease & Stroke Prevention
ProgramProgram BRFSS Tracked HDSP MeasuresBRFSS Tracked HDSP Measures
Physical activityPhysical activity Fruit and vegetable consumptionFruit and vegetable consumption Overweight and ObesityOverweight and Obesity Tobacco useTobacco use Diabetes Diabetes Hypertension Hypertension High cholesterolHigh cholesterol Heart disease and stroke historyHeart disease and stroke history Knowledge of heart attack and stroke Knowledge of heart attack and stroke
symptomssymptoms Calling 911 for heart attack or stroke Calling 911 for heart attack or stroke
Improve Physical Activity & Healthy EatingImprove Physical Activity & Healthy Eating– support Tobacco Prevention & Control Effortssupport Tobacco Prevention & Control Efforts
Through Policy & Environmental ChangeThrough Policy & Environmental Change In 4 Settings:In 4 Settings:
– CommunityCommunity– WorksiteWorksite– SchoolsSchools– HealthcareHealthcare
Heart Disease & Stroke Prevention Heart Disease & Stroke Prevention
ProgramProgram Original Focus - 1998-2003 Original Focus - 1998-2003
25.3
29.5
31.4
34.7
29.2
18.4
40.9
32.4
21.6
22.5
24.9
23.6
29.7
22.7
25.3
US
NC
Eastern NC
Piedmont NC
Western NC
Wake
Robeson
Randolph
Pitt
Orange
Mecklenburg
Hend./Transyl.
Guilford
Forsyth
Buncombe
0 10 20 30 40 50
No Leisure Time Physical No Leisure Time Physical ActivityActivity
*Henderson/Transylvania, Pitt, Robeson, Wake
Percent
24.4
23.6
23.3
21.1
24.3
25.2
10.7
25.1
22.8
32.0
23.7
25.5
33.8
29.7
31.0
US
NC
Eastern NC
Piedmont NC
Western NC
Wake
Robeson
Randolph
Pitt
Orange
Mecklenburg
Hend./Transyl.
Guilford
Forsyth
Buncombe
0 10 20 30 40 50
Fruits & Vegetables (5/Day-Fruits & Vegetables (5/Day-2002)2002)
Percent
21.9
23.6
25.4
26.4
20.6
19.1
26.9
22.4
24.8
16.7
20.6
20.3
20.8
20.4
23.4
US
NC
Eastern NC
Piedmont NC
Western NC
Wake
Robeson
Randolph
Pitt
Orange
Mecklenburg
Hend./Transyl.
Guilford
Forsyth
Buncombe
0 10 20 30 40
Prevalence of Obesity (2002)Prevalence of Obesity (2002)
Percent
Obesity Prevalence 1990-Obesity Prevalence 1990-2003 2003
0
5
10
15
20
25
30
90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03
NCUS
Improve Hypertension and Dyslipidemia Improve Hypertension and Dyslipidemia Prevention & Control, Emergency Prevention & Control, Emergency Response to Acute CVD Events, Response to Acute CVD Events, Secondary Prevention of CVDSecondary Prevention of CVD– support work of Phys. Act/Nutrition, support work of Phys. Act/Nutrition,
Obesity, Tobacco, Diabetes ProgramsObesity, Tobacco, Diabetes Programs Through Policy & Environmental ChangeThrough Policy & Environmental Change In the same 4 SettingsIn the same 4 Settings Program is in transitionProgram is in transition
Heart Disease & Stroke Prevention Heart Disease & Stroke Prevention
ProgramProgram New Focus Beginning 2003 New Focus Beginning 2003
Goal 1: Collaborate with other programs and agencies within and outside state government
to promote cardiovascular health (CVH) and prevent cardiovascular disease (CVD).
Goal 2: Support the efforts of local health departments to create communities that support
CVH and prevent CVD - and build their capacity to do so.
Goal 3: Promote changes in policies, environments and systems to support CVH and
prevent CVD at the national, state, regional, and local levels.
Goal 4: Reduce disparities in CVH and CVD.
Goal 5: Build capacity for measuring changes in policies, environments and systems that
support CVH and prevent CVD and for monitoring changes in cardiovascular-related risk
factors and health status.
Heart Disease & Stroke Prevention Heart Disease & Stroke Prevention
ProgramProgram Program Goals Program Goals
Heart Disease & Stroke Prevention Heart Disease & Stroke Prevention
ProgramProgram BRFSS Related Program Objectives by 2010 BRFSS Related Program Objectives by 2010
Increase to at least 90% the proportion of adults who have had Increase to at least 90% the proportion of adults who have had their blood cholesterol checked within the preceding 5 years. their blood cholesterol checked within the preceding 5 years.
Maintain at 95% or more the proportion of adults who have had Maintain at 95% or more the proportion of adults who have had their blood pressure checked within the preceding 2 years. their blood pressure checked within the preceding 2 years.
Increase the proportion of adults who are aware of the early Increase the proportion of adults who are aware of the early warning signs and symptoms of a stroke (developmental). warning signs and symptoms of a stroke (developmental).
Increase the proportion of adults who are aware of the early Increase the proportion of adults who are aware of the early warning signs and symptoms of a heart attack (developmental). warning signs and symptoms of a heart attack (developmental).
Increase the proportion of adults who are aware of the Increase the proportion of adults who are aware of the importance of accessing rapid emergency care for heart attack importance of accessing rapid emergency care for heart attack and stroke by calling 911 (developmental). and stroke by calling 911 (developmental).
Increase to at least 75% the proportion of adults with coronary Increase to at least 75% the proportion of adults with coronary heart disease or stroke history who have been counseled about heart disease or stroke history who have been counseled about diet and exercise. diet and exercise.
Increase to at least 95% the proportion of adults with a heart Increase to at least 95% the proportion of adults with a heart attack history (and with no contraindications to aspirin) who are attack history (and with no contraindications to aspirin) who are taking aspirin daily or every other day. taking aspirin daily or every other day.
Ever Told by Health Professional Ever Told by Health Professional that You Have High Blood Pressure that You Have High Blood Pressure
(2003)(2003)
31.2
27.2
28.8
25.6
30.5
25.8
28.6
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
US
Percent0 5 10 15 20 25 30 35 40 45 50
Have Had Blood Cholesterol Have Had Blood Cholesterol Checked within 5 YearsChecked within 5 Years
74.2
75.8
71.8
76.3
69.7
73.8
74.7
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
US
Percent0 10 20 30 40 50 60 70 80 90 100
Told by a Doctor that Your Told by a Doctor that Your Blood Cholesterol is HighBlood Cholesterol is High
33.2
33.9
35.9
32.3
35
33.6
34.0
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
US
Percent0 5 10 15 20 25 30 35 40 45 50
Did Not Know All Heart Attack Did Not Know All Heart Attack Symptoms -2003Symptoms -2003
90.9
88.3
90.5
88.1
90.2
88.6
89.4
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
US
Percent0 10 20 30 40 50 60 70 80 90 100
Percent Who Recognized Signs & Percent Who Recognized Signs & Symptoms of a Heart Attack-2003Symptoms of a Heart Attack-2003
69.6
92.6
87.2
86.3
51.9
0 10 20 30 40 50 60 70 80 90 100
feeling weak, lightheaded
chest pain
shortness of breath
arms or shoulder pain
pain in jaw, neck or back
Did Not Know All Stroke Did Not Know All Stroke Symptoms -2003Symptoms -2003
85.4
81.8
83.2
80.1
84.9
81.5
83.1
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
US
Percent0 10 20 30 40 50 60 70 80 90 100
Percent Who Recognized Signs & Percent Who Recognized Signs & Symptoms of a Stroke -2003Symptoms of a Stroke -2003
85.7
71.2
91.0
68.6
87.0
0 10 20 30 40 50 60 70 80 90 100
sudden trouble walking / dizziness
sudden trouble seeing in one orboth eyes
sudden numbness/face, arm, leg
severe headache / no knowncause
sudden trouble speaking
Percent with History of CVD Percent with History of CVD Counseled by Health Professional to:Counseled by Health Professional to:
52.4
32.1
51.7
29.8
0 10 20 30 40 50 60 70 80 90 100
Be more physically active
All North Carolinians- Be MoreActive
Eat more fruits and vegetables
All North Carolinians- Eat moreF&V
Call 911 as First Response, if Someone Call 911 as First Response, if Someone Was Having a Heart Attack or Stroke:Was Having a Heart Attack or Stroke:
88.0
88.8
85.9
90.1
86.9
87.7
88.1
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
US
Percent0 10 20 30 40 50 60 70 80 90 100
Heart Disease & Stroke Prevention Heart Disease & Stroke Prevention ProgramProgram
Policy and Environmental Measures Obtained through Policy and Environmental Measures Obtained through BRFSS BRFSS
Environmental tobacco smoke policiesEnvironmental tobacco smoke policies– worksiteworksite– homehome
Neighborhood environments relevant to Neighborhood environments relevant to physical activity (state-added) physical activity (state-added) – perceived safety from crimeperceived safety from crime– presence of sidewalks, trails, heavy traffic, presence of sidewalks, trails, heavy traffic,
unattended dogs unattended dogs Social marketing efforts includeSocial marketing efforts include
– need to know stroke symptomsneed to know stroke symptoms– take appropriate action (call 911)take appropriate action (call 911)
Heart Disease & Stroke Prevention Heart Disease & Stroke Prevention ProgramProgram
Social MarketingSocial Marketing Current social marketing efforts includeCurrent social marketing efforts include
– need to know and understand blood need to know and understand blood pressure numberspressure numbers
– need to know stroke symptoms and take need to know stroke symptoms and take appropriate action (call 911)appropriate action (call 911)
Social marketing efforts tied to policy & Social marketing efforts tied to policy & environmental change efforts, e.g.environmental change efforts, e.g.– provider policies and systems to improve provider policies and systems to improve
hypertension detection & treatment hypertension detection & treatment (working diabetes program)(working diabetes program)
– EMS and hospital policies and systems to EMS and hospital policies and systems to treat acute stroketreat acute stroke
– AED (Automatic External Defibrillators) AED (Automatic External Defibrillators) placement and training (working with placement and training (working with American Heart Association)American Heart Association)
Physical Activity and Nutrition (PAN) Physical Activity and Nutrition (PAN)
ProgramProgram Environmental Change EffortEnvironmental Change Effort
•Winner’s Circle Program Sponsored by •Mecklenburg County Health Department •Charlotte REACH 2010 Program •NC Prevention Partners •Cardiovascular Health Program •NC Department of Health and Human Services
Diabetes Prevention ProgramDiabetes Prevention Program BRFSS Tracked Diabetes MeasuresBRFSS Tracked Diabetes Measures
Diabetes Diabetes Diabetes Best Practice indicatorsDiabetes Best Practice indicators Diabetes ScreeningDiabetes Screening Diabetes CounselingDiabetes Counseling Overweight and Obesity Overweight and Obesity Physical activityPhysical activity Fruit and vegetable consumptionFruit and vegetable consumption Hypertension Hypertension High cholesterolHigh cholesterol
Diabetes PrevalenceDiabetes Prevalence
9.6
7.4
7.9
6.9
8.9
7.5
8.1
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
US
Percent0 2 4 6 8 10
The Prevalence of Diabetes by Sex & RaceThe Prevalence of Diabetes by Sex & Race
8.4 8.1 7.7
12.1
5.9
12.8
0
5
10
15
20
25
Male Female White African American Asian Native American
%
III. Chronic Diseases
Diabetes Prevention ProgramDiabetes Prevention Program BRFSS Related Program Goals and Objectives BRFSS Related Program Goals and Objectives
Goals: Goals: By March 2008, establish surveillance procedures to By March 2008, establish surveillance procedures to
address the burden of diabetes in high risk populations address the burden of diabetes in high risk populations not currently captured in the BRFSS as evidence by not currently captured in the BRFSS as evidence by data collection, analysis and reporting.data collection, analysis and reporting.
By 2005:By 2005: determine the the prevalence of diabetes screening determine the the prevalence of diabetes screening
test in the population at risk for diabetestest in the population at risk for diabetes monitor the trend of self-reported diabetes prevalence monitor the trend of self-reported diabetes prevalence
by race/ethnicity, socioeconomic status, insurance by race/ethnicity, socioeconomic status, insurance status, minorities, age and genderstatus, minorities, age and gender
monitor the trend of diabetes prevalence quality of monitor the trend of diabetes prevalence quality of health care indicators by race, sex and age health care indicators by race, sex and age
BRFSS: 12 Questions of the Diabetes modules linked to the BRFSS: 12 Questions of the Diabetes modules linked to the above objectivesabove objectives
Ever Had a Blood Test for Ever Had a Blood Test for DiabetesDiabetes
63.9
60.9
61.9
59.7
63.3
61.9
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
Percent0 10 20 30 40 50 60 70 80 90 100
Diabetes Management IndicatorsDiabetes Management Indicators
53.8
72.3
60.3
72.8
24.3
0 20 40 60 80
Had last eye exam/past year
Check feet 1+ x day
Check blood/glucose 1+ x day
Taking diabetes pills
Taking insulin%
Diabetes Risk IndicatorsDiabetes Risk Indicators
11.2
44.5
23.3
10.3
8.1
0 10 20 30 40 50
Time w/out medicines & testingsupplies b/c of cost
Never taken self-managementclass
Has retinopathy
Never checked for "A one C"
Diabetes onset less than age 30
%
DiabetesDiabetes Prevention Program Prevention Program Planning and EvaluationPlanning and Evaluation
BRFSS data allowed to plan, monitor BRFSS data allowed to plan, monitor and evaluate the main outcomes of the and evaluate the main outcomes of the NC diabetes PlanNC diabetes Plan
By 2002 increase the percentage of person with By 2002 increase the percentage of person with diabetes in North Carolina who received the diabetes in North Carolina who received the recommended foot and eye exams, influenza and recommended foot and eye exams, influenza and pneumocoala vaccines, nephpathy assessment, pneumocoala vaccines, nephpathy assessment, and test for hemoglobin A1c and and test for hemoglobin A1c and
By 2002 establish at least ten useful community By 2002 establish at least ten useful community based programs for promotion of wellness, based programs for promotion of wellness, physical activity, weight and blood pressure physical activity, weight and blood pressure control, smoking cessation for persons with and control, smoking cessation for persons with and at risk for diabetes.at risk for diabetes.
By 2002 reduce health disparities for high risk By 2002 reduce health disparities for high risk populations with respect to diabetes prevention populations with respect to diabetes prevention and controland control
Prevalence of Selected Health Care Prevalence of Selected Health Care Indicators in People with Diabetes 1998-Indicators in People with Diabetes 1998-
20032003
0%
20%
40%
60%
80%
100% 1998 2000 2003
1998 67% 64% 12% 39% 43%
2000 70% 71% 65% 42% 53%
2003 76% 77% 74% 53% 58%
Eye Exam Foot Exam Two A1c Neum Vac Flu Vac
DiabetesDiabetes Prevention Program Prevention Program Policy Changes Policy Changes
NC Coverage for Diabetes Act in Health and NC Coverage for Diabetes Act in Health and Accident Insurance Policies in Hospitals or Accident Insurance Policies in Hospitals or Medical Services and HMO Plans. Law - Medical Services and HMO Plans. Law - NCGS S.L NCGS S.L 1997-225, House Bill 51997-225, House Bill 5 : :– Regulate insurance coverage for medically and necessary Regulate insurance coverage for medically and necessary
services including diabetes outpatient self-management services including diabetes outpatient self-management training and educational services , equipment, supplies, training and educational services , equipment, supplies, medications and laboratory procedures used to treat medications and laboratory procedures used to treat diabetes.diabetes.
– Diabetes outpatient self-management training and Diabetes outpatient self-management training and educational services shall be provided by a physician or educational services shall be provided by a physician or health care professional designated by the physician. health care professional designated by the physician.
BRFSS Questions to obtain prevalence estimates BRFSS Questions to obtain prevalence estimates in people with diabetesin people with diabetes– Have you ever taken a course or class in how to manage Have you ever taken a course or class in how to manage
your diabetes yourself?your diabetes yourself?– During the past 12 months, was there any time that you did During the past 12 months, was there any time that you did
not have testing supplies (strips lancet, meter) or diabetes not have testing supplies (strips lancet, meter) or diabetes medicine due to lack of money?medicine due to lack of money?
Cancer Control Cancer Control ProgramProgram BRFSS Related Program Goals and Objectives BRFSS Related Program Goals and Objectives
Prevention Related:Prevention Related: Goal 1: Goal 1: To promote and increase dietary
consumption of foods and nutrients that are known to decrease cancer.
Objectives– Increase to 35% the proportion of North Carolina
adults 18 and older who consume at least five servings
– of fruits and vegetables each day.– Increase to 50% the proportion of North Carolina
adults 18 and older with BMI below 25.0. Goal 2: Goal 2: Tobacco related and aligns with HP
2010 Objectives Goal 3: To decrease ultraviolet radiation
exposure by 2006. Goal 4: To promote and increase PA levels
http://www.nccancer.org/ccplan2006/prevention.pdf
Cancer Control Cancer Control ProgramProgram BRFSS Related Program Goals and Objectives BRFSS Related Program Goals and Objectives
Early Detection:Early Detection: To promote and increase the appropriate
utilization of high-quality breast cancer screening and follow-up services.– Breast Cancer –Mammogram and CBE– Cervical Cancer –Pap smear– Colorectal Cancer –FOBT,
Sigmoidoscopy/Colonoscopy– Prostate Cancer
educate men and their families about prostate cancer and issues related to screening and treatment.
PSA and DRE but no target set.http://www.nccancer.org/ccplan2006/prevention.pdf
Cancer Control ProgramCancer Control Program BRFSS Tracked Cancer Control MeasuresBRFSS Tracked Cancer Control Measures
Prostate Specific Antigen Test Prostate Specific Antigen Test Digital Rectal ExamDigital Rectal Exam Blood Stool TestBlood Stool Test Colonoscopy/SigmoidoscopyColonoscopy/Sigmoidoscopy Mammogram & CBEMammogram & CBE Pap SmearPap Smear Skin Cancer Prevention Skin Cancer Prevention Cancer PrevalenceCancer Prevalence
49.0
47.8
50.8
41.9
44.7
58.2
42.5
40.5
36.4
53.1
51.8
55.3
55.7
58.8
46.0
US
NC
Eastern NC
Piedmont NC
Western NC
Wake
Robeson
Randolph
Pitt
Orange
Mecklenburg
Hend./Transyl.
Guilford
Forsyth
Buncombe
0 10 20 30 40 50 60 70 80 90 100
Ever Had a Colonoscopy Exam Ever Had a Colonoscopy Exam (2002)(2002)
Percent
% Not Had Mammogram and Breast % Not Had Mammogram and Breast
Exam in the Last Year (Age 50+)Exam in the Last Year (Age 50+)
05
101520253035404550
90 91 92 93 94 95 96 97 98 99
NC
US
23.0
29.3
23.1
17.3
35.9
21.1
26.1
19.1
20.1
30.5
28.5
NC
Onslow
Gaston
Durham
New Hanover
Cumberland
Buncombe
Forsyth
Guilford
Mecklenburg
Wake
Percent0 5 10 15 20 25 30 35 40 45 50
Tried to Get a Tan from the Sun (2001)Tried to Get a Tan from the Sun (2001)
21.7
26.6
19.2
17.0
38.4
15.3
26.9
18.5
13.9
28.2
25.2
NC
Onslow
Gaston
Durham
New Hanover
Cumberland
Buncombe
Forsyth
Guilford
Mecklenburg
Wake
Percent0 5 10 15 20 25 30 35 40 45 50
Sunburn in the Past Year (2001)Sunburn in the Past Year (2001)
Physical Activity and Nutrition (PAN) Physical Activity and Nutrition (PAN)
ProgramProgram BRFSS Tracked PAN MeasuresBRFSS Tracked PAN Measures
Reduce the proportion of adults who are Reduce the proportion of adults who are obese. obese. – TargetTarget: 16.8 percent. : 16.8 percent.
Increase the proportion of adults eating Increase the proportion of adults eating five or more servings of fruits and five or more servings of fruits and vegetables each day.vegetables each day.– TargetTarget: 25.1 percent. : 25.1 percent.
Increase the proportion of adults (18 Increase the proportion of adults (18 years and older) who engage in physical years and older) who engage in physical activity for at least 30 minutes on 5 or activity for at least 30 minutes on 5 or more days of the week.more days of the week.
Reduce the proportion of adults (18 Reduce the proportion of adults (18 years and older) who engage in no years and older) who engage in no leisure-time physical activity.leisure-time physical activity. – TargetTarget: 29 percent : 29 percent
Obesity Prevalence -2003Obesity Prevalence -2003
26.7
22.6
23.9
20.7
26.0
22.8
24.0
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
US
Percent0 5 10 15 20 25 30 35 40 45 50
Recommended Level Of Recommended Level Of Physical Activity per Week-2003Physical Activity per Week-2003
36.6
37.6
40.4
39.7
36.5
45.9
37.7
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
US
Percent0 5 10 15 20 25 30 35 40 45 50
No Leisure Time ActivityNo Leisure Time Activity
24.1
21.5
22.3
18.9
24.5
24.6
22.4
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
US
Percent0 5 10 15 20 25 30 35 40 45 50
Fruits and Vegetable Fruits and Vegetable Consumption (5/day) -2003Consumption (5/day) -2003
21.4
23.2
27.0
25.1
21.3
22.9
23.2
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
US
Percent0 5 10 15 20 25 30 35 40 45 50
Received Advise about Weight by Received Advise about Weight by Health Professional in Past YearHealth Professional in Past Year
13.4
14.9
13.6
14.8
14.0
13.2
14.3
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
US
Percent0 5 10 15 20 25
In Past Two Years, Taken Over-the-In Past Two Years, Taken Over-the-counter Weight Loss Pillscounter Weight Loss Pills
9.8
8.4
9.0
8.5
9.1
8.9
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
Percent0 2 4 6 8 10 12 14
In Past Two Years, Taken Weight In Past Two Years, Taken Weight Loss Pills Prescribed by a DoctorLoss Pills Prescribed by a Doctor
2.2
2.1
3.0
2.3
2.2
2.3
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
Percent0 2 4 6 8
Taking Over-the-counter Weight Taking Over-the-counter Weight Loss Pills that Contain EphedraLoss Pills that Contain Ephedra
52.5
51.1
51.1
53.8
50.3
51.5
Eastern NC
Piedmont
Western NC
Urban
Rural
NC
Percent0 10 20 30 40 50 60 70 80 90 100
North Carolina Folic Acid Use CampaignNorth Carolina Folic Acid Use Campaign The BRFSS data showed that The BRFSS data showed that
Buncombe County had the highest Buncombe County had the highest percentage of folic acid knowledge percentage of folic acid knowledge among all individual counties among all individual counties surveyed.surveyed.
This result was corroborated by a This result was corroborated by a separate independent telephone separate independent telephone survey conducted by the Fullerton survey conducted by the Fullerton Genetics Center in Asheville.Genetics Center in Asheville.
March of Dimes expanded that March of Dimes expanded that program to other areas of the state. program to other areas of the state.
41.4
47.4
45.9
49.4
38.6
27.9
32.1
47.1
52.2
60.5
44.5
NC
Onslow
Gaston
Durham
New Hanover
Cumberland
Buncombe
Forsyth
Guilford
Mecklenburg
Wake
Percent0 10 20 30 40 50 60 70 80 90 100
Believe Folic Acid Helps Prevent Birth Defects (2001)Believe Folic Acid Helps Prevent Birth Defects (2001)
*Ages 18-44 included here
Local Level BRFSS Data Local Level BRFSS Data UseUse
Community Health Assessment (CHA Community Health Assessment (CHA by Local Healthy Carolinian by Local Healthy Carolinian Coalitions)Coalitions)– Orange CountyOrange County : www.co.orange.nc.us/health/Chareport.pdf : www.co.orange.nc.us/health/Chareport.pdf– Guilford CountyGuilford County: :
www.co.guilford.nc.us/goverment/publichealth/HealthStatus2002.pdfwww.co.guilford.nc.us/goverment/publichealth/HealthStatus2002.pdf
Monitoring County Health Monitoring County Health Department Objectives mainly Department Objectives mainly identified through CHA. identified through CHA.
Local Level BRFSS Data Local Level BRFSS Data UseUse
State Programs Set Objectives for State Programs Set Objectives for Local Health Programs that are Local Health Programs that are funded by the state.funded by the state.– Heart Attack and Stroke Prevention GrantsHeart Attack and Stroke Prevention Grants– Health and Wellness Trust Fund GrantsHealth and Wellness Trust Fund Grants
– ASSIST (Tobacco Prevention & Control)ASSIST (Tobacco Prevention & Control) County Health Projects funded by County Health Projects funded by
sources other than statesources other than state– Stroke Elimination GrantStroke Elimination Grant– STEPS to Healthier US GrantsSTEPS to Healthier US Grants