* UMASS/AMHERST * 31ED-bt DEflS 271fl 5 Health Risks and Preventive Behaviors Results from the Behavioral Risk Factor Surveillance System (1994-1999) THE UPPER VALLEY HEALTH WEB CHNA Franklin County ^ " ers <ty f» " 't0r>Cherts Chronic Disease Surveillance Program + Bureau of Heal th Sta tistics, Researchand Evalua tion + Massachusetts Department of Public Heal th March 2001 MASSACHUSETTS CHNAs CHNA 1 Community Health Network ofBerkshire County CHNA 2 The Upper Valley Health Web. Franklin County CHNA CHNA 3 Partnership for Health in Hampshire County, Greater Northampton CHNA 4 The Community Health Connection, Greater Springfield CHNA CHNA CHNA 21 Four (for) Communities, Greater Holyoke CHNA CHNA 5 ofSouthern Worcester County CHNA 6 Community Partners for Health, Greater Milford CHNA CHNA 7 Community Health Network ofGreater Metro West, Greater Framingham CHNA CHNA 8 Community Wellness Coalition, Greater Worcester CHNA CHNA CHNA 9 Fitchburg/Gardner CHNA CHNA 10 Greater Lowell CHNA CHNA Greater Lawrence 1 1 CHNA CHNA 12 Greater Haverhill CHNA CHNA 13 Greater Beverly/Gloucester CHNA CHNA 14 North Shore CHNA CHNA 15 Greater Wobum/Concord/Littleton CHNA 16 North Suburban Health Alliance, Greater Medford/Malden/Melrose CHNA CHNA CHNA 7 Greater Cambridge/Somerville 1 CHNA CHNA 18 West Suburban Health Network, Greater Newton/Waltham CHNA 19 Alliance for Community Health, Boston/Chelsea/RevereAVinthrop CHNA CHNA 20 Blue Hills Community Health Alliance, Greater Quincy CHNA CHNA CHNA 22 Greater Brockton CHNA 23 South Shore Community Partners in Prevention, Greater Plymouth CHNA CHNA 24 Greater Attleboro-Taunton Health and Education Response (GATHER) CHNA CHNA 25 Partners for a Healthier Community, Greater Fall River CHNA 26 Greater New Bedford Health & Human Services Coalition CHNA CHNA 27 Cape and Islands HEALTH RISKS AND PREVENTIVE BEHAVIORS Results from the Behavioral Risk Factor Surveillance System (1994-1999) The Upper Valley Health Web, Franklin County CHNA Argeo Paul Cellucci. Governor William D. O'Leary, Secretary ofHealth and Human Services Howard K. Koh, MD. MPH. CommissionerofPublic Health Daniel J. Friedman. Assistant Commissioner. Bureau ofHealth Statistics, Research and Evaluation Bruce B. Cohen, Director, Research and Epidemiology Daniel Brooks, Director. Chronic Disease Surveillance Program Massachusetts Department ofPublic Health 617-624-5699 March 2001 Acknowledgements This report was prepared by staffofthe Chronic Disease Surveillance Program: Daniel Brooks. Phyllis Brawarsky. Karen Clements, Lorelei Mucci, Jane West, Michelle Benson, Brian Bradbury, Jason Yeaw, and Diana Ventura. We wish to thank Jennifer Norton for production ofthe maps and Supriya Krishman for her work on this report through a collaborative program with the Department of Biostatistics and Epidemiology. School of Public Health and Health Sciences, University ofMassachusetts, Amherst. We also wish to express our gratitude to the residents ofMassachusetts who participated in this survey. For further information about this report, about the BRFSS. or the Chronic Disease Surveillance Program, please contact: Daniel Brooks. MPH. Chronic Disease Surveillance Program. Bureau ofHealth Statistics, Research, and Evaluation. Massachusetts Department of Public Health. 250 Washington Street, 6th floor. Boston, MA 02108-4619. telephone: (617) 624-5636. email: daniel.brooks©state.ma.us To obtain additional copies ofthis report contact: Massachusetts Department ofPublic Health Bureau ofHealth Statistics, Research and Evaluation 250 Washington Street MA Boston, 02108 (617) 624-5699 TABLE OF CONTENTS INTRODUCTION 1 RISK FACTORS 3 Smoking 3 Alcohol 8 Weight Control 14 Physical Activity 16 Fruits and Vegetables 20 CHRONIC CONDITIONS/PREVENTIVE HEALTH 22 Hypertension Awareness 22 Cholesterol Screening 26 Diabetes 30 Health Status 32 Health Insurance, Access, and Utilization 36 CANCER SCREENING 43 Breast Cancer 43 Cervical Cancer 49 Colorectal Cancer 52 HIV/AIDS 54 SUMMARY OF DATA 58 TECHNICAL NOTES 59 GLOSSARY 61 APPENDIX Digitized by the Internet Archive 2014 in https://archive.org/details/healthriskspreve00mass_9 INTRODUCTION In 1994, the Massachusetts Department of Public Health (MDPH) first published reports detailing the sociodemographics. health status indicators, and distribution of deaths in each Community Health Network Area (CHNA).1 MDPH is now expanding the scope of the data available to CHNAs by providing information on: (1) the prevalence of risk factors for disease and injury; (2) chronic conditions/preventive health; (3) cancer screening; and (4) HIV/AIDS. Many ofthe risk factors and behaviors that contribute to the leading causes of death in Massachusetts, which include heart disease, cancer, stroke, pneumonia and influenza, chronic obstructive pulmonary disease (COPD), diabetes, and injury, are well known. Information on the prevalence of these factors helps in identifying and prioritizing areas ofgreatest need for health intervention and in planning effective health promotion and disease prevention programs. The data in this report come from the Behavioral Risk Factor Surveillance System (BRFSS), an ongoing, random-digit dial statewide telephone survey of adult residents age 18 and older. The BRFSS is currently conducted in all states as a cooperative effort between the national Centers for Disease Control and Prevention and state health departments. The BRFSS includes questions about a wide variety ofhealth issues, from personal behaviors and access to medical care to opinions on health-related policy issues. (See Technical Notes for a more detailed description ofthe survey and for important information on limitations ofthe data.) This report summarizes results ofthe BRFSS for the Upper Valley Health Web, Franklin County CHNA for the years 1994 through 1999. A total of224 residents in the Upper Valley Health Web, Franklin County CHNA were interviewed during 1994 through 1999. Text and graphs in this report provide prevalence estimates for this CHNA, comparison data for Massachusetts and, where available, comparable data for the U.S. as a whole. In addition, where it exists, we provide the relevant national Healthy People 2000 objective. (Refer to the Glossary for an explanation ofprevalence and the Healthy People 2000 objectives.) Analyses were based on six years ofdata whenever possible to produce more stable estimates ofprevalence, as the stability of an estimate increases with an increasing number ofrespondents. However, not all questions were asked every year, and some analyses are based on less than six years ofdata. For each question, we provide the prevalence estimate and a 95% confidence interval around the estimate that shows the range ofvalues that would be compatible with the data. '(Refer to the Glossary for an explanation ofconfidence intervals.) Updated data is now available through MassCHIP, an internet accessible database information system, developed and administered by the MDPH. Information on how to register as a MassCHIP useris available through the MDPH homepage located at http://www.magnet.state.ma.us/dph/dphhome.htm. In addition, this report summarizes how the Upper Valley Health Web. Franklin County CHNA. compares to other CHNAs on each health measure. For each health topic, we provide a map of Massachusetts, which shows the CHNAs where the prevalence A estimate is significantly higher, or significantly lower, than the state average. test of significance was based on a p-value of less than or equal to 0.10. (Refer to the Glossary We for an explanation ofp-value.) also provide the prevalence estimates for all variables CHNA for each in the Appendix. Due to the limited number ofrespondents in some CHNAs. we have prepared two versions of this report. The abridged version, prepared for CHNAs with fewer respondents, includes data on questions that are asked of all respondents and questions asked of large groups ofrespondents, such as questions that focus on all women. The full version, prepared for the larger CHNAs. also includes questions asked of groups with fewer respondents (e.g. individuals over the age of50). This report for the Upper Valley Health Web. Franklin County CHNA. is the abridged version. Even though this report includes questions asked only of large groups ofrespondents, readers should nevertheless exercise caution in their interpretation ofthe data due to the limited overall number of respondents in the Upper Valley Health Web. Franklin County CHNA during the six-year period. The BRFSS provides a rich source of information on the health ofadults residing in Massachusetts and each CHNA. We hope that the data presented in this report will contribute to the development and targeting of medical, educational, and policy initiatives to improve the health status ofthe Upper Valley Health Web. Franklin County CHNA. 2 RISK FACTORS SMOKING Tobacco use causes more deaths in the U.S. than any other preventable risk factor. Smoking causes lung cancer as well as laryngeal, oral, esophageal, bladder, pancreatic, kidney, and cervical cancers. Lung cancer mortality rates are about 22 times higher for current male smokers and about 10-12 times higher for current female smokers compared to lifelong never smokers. Each year in Massachusetts, approximately 4,300 residents are diagnosed with lung cancer and 3.700 people die ofthe disease. Smoking also is a major cause ofcoronary heart disease and stroke among both men and women. Smokers have twice the risk ofhaving a heart attack and 2 to 4 times . the risk of sudden death from heart attack compared to nonsmokers. Smoking is a cause ofCOPD, a leading cause ofdeath in Massachusetts. Gastric ulcers, intrauterine growth retardation, and low birthweight, among other conditions, are also related to smoking. In September 1990, the Surgeon General reported that regardless of age, people who quit smoking live longer than those who do not quit. Also, smokers who quit before age 50 have halfthe risk ofdying in the next 15 years compared to those who continue to smoke. 3 In the Upper Valley Health Web. Franklin County CHNA. 19% of adults were current smokers (Figure 1)." The percentage of current smokers was not statistically different from the state average (see map). Figure 1 Percentage of adults who were current smokers; BRFSS data forthe Franklin County CHNA, Massachusetts. U.S.. 1994-1999. Healthy People 2000 Objective 50 -I 2 40 - CD o Z CHNA - MA bU.S. SHP2000 CHNA MA US HP2000- Current smokers 18S% 21.2% 22.9^ 15.0<7c 95^ CI4 12.8-24.2 20.4-21.9 " The bars within the CHNA and MA bar graphs are "error bars" and show the endpoints and uidth ofthe confidence interval. ' Healthy People 2000Objecthes (see Glossary) * Confidence Interval (see Glossary) 4